A feasibility and acceptability study of screening the parents/guardians of pediatric dental patients for the social determinants of health.

BACKGROUND: The social determinants of health (SDOH) are the conditions in which people are born, grow, work, live, and age. Lack of SDOH training of dental providers on SDOH may result in suboptimal care provided to pediatric dental patients and their families. The purpose of this pilot study is to report the feasibility and acceptability of SDOH screening and referral by pediatric dentistry residents and faculty in the dental clinics of Family Health Centers at NYU Langone (FHC), a Federally Qualified Health Center (FQHC) network in Brooklyn, NY, USA. METHODS: Guided by the Implementation Outcomes Framework, 15 pediatric dentists and 40 pediatric dental patient-parent/guardian dyads who visited FHC in 2020-2021 for recall or treatment appointments participated in this study. The a priori feasibility and acceptability criteria for these outcomes were that after completing the Parent Adversity Scale (a validated SDOH screening tool), ≥ 80% of the participating parents/guardians would feel comfortable completing SDOH screening and referral at the dental clinic (acceptable), and ≥ 80% of the participating parents/guardians who endorsed SDOH needs would be successfully referred to an assigned counselor at the Family Support Center (feasible). RESULTS: The most prevalent SDOH needs endorsed were worried within the past year that food would run out before had money to buy more (45.0%) and would like classes to learn English, read better, or obtain a high school degree (45.0%). Post-intervention, 83.9% of the participating parents/guardians who expressed an SDOH need were successfully referred to an assigned counselor at the Family Support Center for follow-up, and 95.0% of the participating parents/guardians felt comfortable completing the questionnaire at the dental clinic, surpassing the a priori feasibility and acceptability criteria, respectively. Furthermore, while most (80.0%) of the participating dental providers reported being trained in SDOH, only one-third (33.3%) usually or always assess SDOH for their pediatric dental patients, and most (53.8%) felt minimally comfortable discussing challenges faced by pediatric dental patient families and referring patients to resources in the community. CONCLUSIONS: This study provides novel evidence of the feasibility and acceptability of SDOH screening and referral by dentists in the pediatric dental clinics of an FQHC network.

Clostridioides difficile dynamic electronic order panel, an effective automated intervention to reduce inappropriate inpatient ordering.

BACKGROUND: Ordering Clostridioides difficile diagnostics without appropriate clinical indications can result in inappropriate antibiotic prescribing and misdiagnosis of hospital onset C. difficile infection. Manual processes such as provider review of order appropriateness may detract from other infection control or antibiotic stewardship activities. METHODS: We developed an evidence-based clinical algorithm that defined appropriateness criteria for testing for C. difficile infection. We then implemented an electronic medical record-based order-entry tool that utilized discrete branches within the clinical algorithm including history of prior C. difficile test results, laxative or stool-softener administration, and documentation of unformed bowel movements. Testing guidance was then dynamically displayed with supporting patient data. We compared the rate of completed C. difficile tests after implementation of this intervention at 5 hospitals to a historic baseline in which a best-practice advisory was used. RESULTS: Using mixed-effects Poisson regression, we found that the intervention was associated with a reduction in the incidence rate of both C. difficile ordering (incidence rate ratio [IRR], 0.74; 95% confidence interval [CI], 0.63-0.88; P = .001) and C. difficile-positive tests (IRR, 0.83; 95% CI, 0.76-0.91; P < .001). On segmented regression analysis, we identified a sustained reduction in orders over time among academic hospitals and a new reduction in orders over time among community hospitals. CONCLUSIONS: An evidence-based dynamic order panel, integrated within the electronic medical record, was associated with a reduction in both C. difficile ordering and positive tests in comparison to a best practice advisory, although the impact varied between academic and community facilities.

From Screening to the Receipt of Services: A Qualitative Examination.

INTRODUCTION: Research has focused on developing methods to facilitate screening and tracking data on social risk factors in healthcare settings. Less is known about the multiple factors that shape patients' acceptance of healthcare-based social risk programs. This qualitative study sought to elucidate the multilevel (individual, interpersonal, family/community, system, policy) factors that influence patients' acceptance of a healthcare-based social risk program within a Federally Qualified Health Center in New York City. METHODS: Participants included 5 patients receiving care at the Federally Qualified Health Center who screened positive for social risks, 4 nurses who are responsible for conducting social risk screenings, and 5 Family Support Services counselors who conduct outreach to patients who screened positive. Interviews were conducted from March to June 2021 and analyzed from July to September 2021 using the constant comparative method. RESULTS: Analyses of the transcripts identified the following 3 themes: (1) Patients appreciated being asked about social risk factors, but there was a mismatch between their understanding of the screening process, their desire for assistance, and the support received. Although nurses and counselors described relationship-centered approaches to involve patients in the process, patients reported feeling initial discomfort and confusion; (2) Multilevel barriers inhibit patients' acceptance of assistance; and (3) Patient trust in the physician and healthcare organization serves as facilitators to acceptance. CONCLUSIONS: Patients' views about the purpose of a healthcare-based social risk program differed from nurses' and counselors' perspectives of the process. Although patients face multilevel challenges, strong trust in the physician and Family Health Centers served as facilitators to accepting healthcare-based assistance.

Prospective study of quality of life after lung cancer resection.

BACKGROUND: Surgical resection with curative-intent remains the gold standard for clinically operable early-stage non-small cell lung cancer (NSCLC). This goal can be accomplished using a minimally invasive option, e.g., video assisted thoracic surgery (VATS) or standard thoracotomy. Surgical techniques continue to evolve and few studies have compared the QOL of patients managed with these procedures using current approaches. The primary goal of this study was to investigate differences between patients managed surgically via VATS compared to thoracotomy with respect to ratings of chronic pain, anxiety/depression and quality of life (QOL). The secondary goal was to investigate differences between patients converted from VATS to thoracotomy versus those managed with the originally with thoracotomy. METHODS: We conducted a prospective cross sectional design study comparing the QOL after surgical resection of NSCLC. Data were obtained between 3-12 months postoperatively, from patients with potentially resectable stage I-IIIa NSCLC, who underwent a thoracotomy or VATS resection. All patients were consented. Pain was evaluated with a 0 to 10 numeric pain assessment scale (NAS), mood with the Hospital Anxiety and Depression Scale (HADS) (mood disorders) and QOL with FACT-L (Functional Assessment of Cancer Therapy-Lung). RESULTS: A total of 97 patients with stage I-IIIa lung cancer were enrolled; of these 66 (68%) underwent a standard thoracotomy and 31 (32%) underwent VATS resection. The preferred surgical approach was a thoracotomy for patients with stage IIIa lung cancer, or patients requiring a pneumonectomy or a bi-lobectomy. There were no significant differences between VATS and thoracotomy patients in ratings of chronic pain, mood disorders, or QOL. Conversion from VATS to thoracotomy occurred in 22 (23%) of patients. There were no significant differences between VATS conversion to thoracotomy and those with initial thoracotomy procedures in ratings of chronic pain, mood disorders, or QOL. Conversion from VATS to standard thoracotomy occurred more commonly early in the series. CONCLUSIONS: While previous studies have shown that VATS offers an early advantage with regards to perioperative outcomes, our study demonstrated that VATS and thoracotomy patients had similar late QOL outcomes.

Postthoracotomy Pain Syndrome Following Surgery for Lung Cancer: Symptoms and Impact on Quality of Life.

Postthoracotomy pain syndrome (PTPS) is a common complication following thoracic surgery. Most studies examining the influence of PTPS on patient-reported symptoms include few patients managed using a minimally invasive approach. Associated sensory changes, potentially neuropathic in origin, are not well described. We therefore examined the symptoms and quality of life (QOL) of patients with and without PTPS who underwent a standard thoracotomy (n = 43) or minimally invasive surgery (n = 54). Patients in this prospective, cross-sectional study completed questionnaires to assess pain (McGill Pain Questionnaire), neuropathic symptoms (Neuropathic Symptom Questionnaire), symptom distress (Symptom Distress Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and QOL (Functional Assessment Cancer Therapy-Lung). Excepting younger age (p = .009), no demographic or surgical characteristic differentiated patients with and without PTPS. Patients with PTPS described discomfort as pain only (15.1%), neuropathic symptoms only (30.2%) or pain and neuropathic symptoms (54.7%). Scores differed between patients with and without PTPS for symptom distress (p < .001), anxiety and depression (p < .001), and QOL (p = .009), with higher distress associated with PTPS. Despite new surgical techniques, PTPS remains common and results in considerable distress. A focused assessment is needed to identify all experiencing this condition, with referral to pain management specialists if symptoms persist.

Prevalence of Francisella noatunensis subsp. orientalis in cultured tilapia on the island of Oahu, Hawaii.

Francisellosis is an emergent disease in cultured and wild aquatic animals. The causative agent, Francisella noatunensis subsp. orientalis (Fno), is a gram-negative bacterium recognized as one of the most virulent pathogens of warmwater fish. The main objective of this project was to investigate the prevalence of Fno in cultured tilapia (specifically, Mozambique Tilapia Oreochromis mossambicus, Koilapia [also known as Wami Tilapia] O. hornorum, Blue Tilapia O. aureus, and Nile Tilapia O. niloticus hybrids) on the island of Oahu, Hawaii, using conventional and real-time PCR assays followed by statistical modeling to compare the different diagnostic methods and identify potential risk factors. During 2010 and 2012, 827 fish were collected from different geographical locations throughout the island of Oahu. Upon collection of fish, the water temperature in the rearing system and the length of individual fish were measured. Extraction of DNA from different tissues collected aseptically during necropsy served as a template for molecular diagnosis. High correlation between both molecular methods was observed. Moreover, the bacterium was isolated from infected tilapia on selective media and confirmed to be Fno utilizing a species-specific Taqman-based real-time PCR assay. Although a direct comparison of the prevalence of Fno between the different geographical areas was not possible, the results indicate a high prevalence of Fno DNA in cultured tilapia throughout the farm sites located on Oahu. Of the different tilapia species and hybrids currently cultured in Hawaii, Mozambique Tilapia were more susceptible to infection than Koilapia. Water temperature in the rearing systems and fish size also had a strong effect on the predicted level of infection, with fish held at lower temperatures and smaller fish being more susceptible to piscine francisellosis.

Post-thoracotomy pain syndrome: assessment and intervention.

Surgery is a cornerstone of treatment in early-stage non-small cell lung cancer. Chronic postoperative thoracotomy pain, post-thoracotomy pain syndrome (PTPS), is a condition occurring in 50% of postsurgical patients with lung cancer and is largely unrecognized. This article examines the diagnosis and treatment of PTPS to assist oncology nurses in providing better care to this patient population. Post-thoracotomy pain in patients with lung cancer may be under-reported and undertreated. Causes from the thoracotomy can be trauma and compression to the intercoastal nerves, fractured and compressed ribs, inflammation of the chest muscles, atrophy of chest muscles, or scar tissue rubbing. This article examines the diagnosis and treatment of PTPS to assist oncology nurses in providing better care to this patient population. If left untreated, chronic pain can have a deleterious effect on patients' recovery and overall well-being. Oncology nurses should be aware of the signs and symptoms of PTPS so that more patients are diagnosed and choose to seek treatment.