Nutritional, environmental and economic implications of children plate waste at school: a comparison between two Italian case studies

OBJECTIVE

This study aims at comparing two Italian case studies in relation to school children's plate waste and its implications, in terms of nutritional loss, economic cost, and carbon footprint.

DESIGN

Plate waste was collected through an aggregate selective weighting method for 39 days.

SETTING

Children from the first to the fifth grade from four primary schools, two in each case study (Parma and Lucca), were involved.

RESULTS

With respect to the served food, in Parma the plate waste percentage was lower than in Lucca (p<0.001). Fruit and side-dishes were highly wasted, mostly in Lucca (>50%). The energy loss of the lunch meals accounted for 26% (Parma) and 36% (Lucca). Among nutrients, dietary fibre, folate and vitamin C, calcium and potassium were lost at most (26-45%). Overall, after adjusting for plate waste data, most of the lunch menus fell below the national recommendations for energy (50%, Parma; 79%, Lucca) and nutrients, particularly for fat (85%, Parma; 89%, Lucca). Plate waste was responsible for 19% (Parma) and 28% (Lucca) of the carbon footprint associated to the food supplied by the catering service, with starchy food being the most important contributor (52%, Parma; 47%, Lucca). Overall, the average cost of plate waste was 1.8 €/kg (Parma) and 2.7 €/kg (Lucca), accounting respectively for 4% and 10% of the meal full price.

CONCLUSION

A re-planning of the school meals service organisation and priorities is needed to decrease the inefficiency of the current system and reduce food waste and its negative consequences.

Antagonists of the stress and opioid systems restore the functional connectivity of the prefrontal cortex during alcohol withdrawal through divergent mechanisms

Chronic alcohol consumption leads to dependence and withdrawal symptoms upon cessation, contributing to persistent use. However, the brain network mechanisms by which the brain orchestrates alcohol withdrawal and how these networks are affected by pharmacological treatments remain elusive. Recent work revealed that alcohol withdrawal produces a widespread increase in coordinated brain activity and a decrease in modularity of the whole-brain functional network using single-cell whole-brain imaging of immediate early genes. This decreased modularity and functional hyperconnectivity are hypothesized to be novel biomarkers of alcohol withdrawal in alcohol dependence, which could potentially be used to evaluate the efficacy of new medications for alcohol use disorder. However, there is no evidence that current FDA-approved medications or experimental treatments known to reduce alcohol drinking in animal models can normalize the changes in whole-brain functional connectivity. In this report, we tested the effect of R121919, a CRF1 antagonist, and naltrexone, an FDA-approved treatment for alcohol use disorder, on whole-brain functional connectivity using the cellular marker FOS combined with graph theory and advanced network analyses. Results show that both R121919 and naltrexone restored the functional connectivity of the prefrontal cortex during alcohol withdrawal, but through divergent mechanisms. Specifically, R121919 increased FOS activation in the prefrontal cortex, partially restored modularity, and normalized connectivity, particularly in CRF1-rich regions, including the prefrontal, pallidum, and extended amygdala circuits. On the other hand, naltrexone decreased FOS activation throughout the brain, decreased modularity, and increased connectivity overall except for the Mu opioid receptor-rich regions, including the thalamus. These results identify the brain networks underlying the pharmacological effects of R121919 and naltrexone and demonstrate that these drugs restored different aspects of functional connectivity of the prefrontal cortex, pallidum, amygdala, and thalamus during alcohol withdrawal. Notably, these effects were particularly prominent in CRF1- and Mu opioid receptors-rich regions highlighting the potential of whole-brain functional connectivity using FOS as a tool for identifying neuronal network mechanisms underlying the pharmacological effects of existing and new medications for alcohol use disorder.

Procedural Unit Nurses' Perception of Confidence in Performing Critical Care Skills During COVID-19 Crisis

Nursing professional development practitioners at an academic medical center conducted a quality improvement project to address the educational needs of procedural unit nurses during the COVID-19 pandemic. Procedural nurses completed a 1-day critical care nursing skills education and pre- and postsurveys. Survey results indicated an improved nurses' skills confidence in caring for COVID-19 patients, which was statistically significant, t (34.9) = 4.8, p < .001.

Reducing lower extremity hospital-acquired pressure injuries: a multidisciplinary clinical team approach

OBJECTIVE

Optimal methods of reducing incidence of hospital-acquired pressure injuries (HAPIs) remain to be determined. We assessed changes in yearly incidence of lower extremity HAPIs before and after an intervention aimed at reducing these wounds.

METHOD

In 2012, we implemented a three-pronged intervention to reduce the incidence of HAPIs. The intervention included: a multidisciplinary surgical team; enhanced nursing education; and improved quality data reporting. Yearly incidence of lower extremity HAPIs was tracked.

RESULTS

Pre-intervention, incidence of HAPIs was 0.746%, 0.751% and 0.742% in 2009, 2010 and 2011, respectively. Post-intervention, incidence of HAPIs was 0.002%, 0.051%, 0.038%, 0.000% and 0.006% in 2013, 2014, 2015, 2016 and 2017, respectively. Mean incidence of HAPIs was reduced from 0.746% before the intervention to 0.022% after the intervention (p<0.001).

CONCLUSION

An intervention by a multidisciplinary surgical team enhanced nursing education, and improved quality data reporting reduced the incidence of lower extremity HAPIs.

Curricular Quality Improvement in Midwifery: Simulating Unexpected Perinatal Loss

INTRODUCTION

Caring for families experiencing perinatal loss is a fundamental component of midwifery practice, but little attention is paid to perinatal palliative care in midwifery curricula. Lack of educational preparation and self-care resources negatively impacts midwifery students and health care teams caring for families experiencing stillbirth.

PROCESS

A private, urban university conducted a curricular quality improvement project to integrate perinatal palliative care into the midwifery curriculum using a high-fidelity, branching simulation pedagogy. Simulation objectives were developed from curricular gap analyses and the Core Competencies for Basic Midwifery Practice. Development of the Unexpected Perinatal Loss Simulation was guided by the International Nursing Association for Clinical Simulation and Learning Outcomes and Objectives and Design Standards. The Unexpected Perinatal Loss Simulation was revised based on qualitative data from student focus groups and expert content validation.

OUTCOMES

Qualitative data yielded 4 key domains: presimulation, simulation skills, prior experience/personal reflections, and recommendations. Simulation procedures and scenario content were revised, after which 8 expert clinicians in the fields of midwifery, palliative care, and psychiatry validated the scenario content using the Lynn method. Two items did not meet the content validity index (CVI) threshold of 0.78, necessitating review by stakeholders; however, the overall scenario CVI threshold was met (0.82).

DISCUSSION

Through this project, faculty integrated perinatal palliative care into the midwifery program using a novel approach of high-fidelity, branching simulation, structured debriefing, and an introductory self-care skills workshop. Potential clinical impact includes skillful perinatal palliative care with effective communication skills to mitigate how families experience and remember a traumatic loss and facilitate the grieving process. Students voiced insights into how they would process loss and seek support to mitigate their own grief as future midwives.

Juno's Close Encounter With Ganymede-An Overview

The Juno spacecraft has been in orbit around Jupiter since 2016. Two flybys of Ganymede were executed in 2021, opportunities realized by evolution of Juno's polar orbit over the intervening 5 years. The geometry of the close flyby just prior to the 34th perijove pass by Jupiter brought the spacecraft inside Ganymede's unique magnetosphere. Juno's payload, designed to study Jupiter's magnetosphere, had ample dynamic range to study Ganymede's magnetosphere. The Juno radio system was used both for gravity measurements and for study of Ganymede's ionosphere. Remote sensing of Ganymede returned new results on geology, surface composition, and thermal properties of the surface and subsurface.

90 A RETROSPECTIVE COHORT STUDY COMPARING THE CLINICAL CHARACTERISTICS, TREATMENT AND OUTCOMES OF BIOPSY-CONFIRMED SARCOIDOSIS IN LATE-ONSET AND YOUNGER-ONSET PATIENTS

Background

Late-Onset Sarcoidosis (LOS) accounts for up to one-third of cases and is diagnostically challenging due to the difficulty in satisfactorily excluding malignancy and infection, often necessitating repeated investigations. Endobronchial Ultrasound (EBUS) is the gold standard for diagnosing pulmonary sarcoidosis. This study aims to compare the clinical presentation, treatment and outcomes in patients with biopsy confirmed sarcoidosis in older and younger patients

Methods

A retrospective cohort analysis was performed on all patients with EBUS-confirmed sarcoidosis at a tertiary referral centre between 2012 and 2019. Electronic healthcare records were reviewed to obtain information on clinical presentation, confirmatory investigations, treatment and outcomes. LOS was defined as patients aged &gt;65 years

Results

In total, 247 patients were included, 68.8% were male. LOS accounted for 9.3% (n=23).Extra-pulmonary and systemic features were less common in LOS (26.1% vs 58%, p&lt;0.002). There was no difference in systemic treatment between cohorts (84.6% vs 67.9%, p=0.21) and LOS patients experienced comparably high rates of satisfactory outcomes. At follow up, the majority of patients either improved or achieved clinical stability in both groups (92.3% vs 76.1%, p=0.18). Clinical and/or radiological progression occurred in 7% in both groups with no reported deaths. Confirmatory investigations were infrequent and EBUS was safe and well-tolerated in older patients.

Conclusion

LOS was lower than expected and extra-pulmonary involvement was uncommon suggesting a pre-selected population. Referral for EBUS should be considered as first line for older patients with unexplained thoracic adenopathy provided further diagnostic investigations are in line with their goals of care. Clinical outcomes were excellent with low rates of progression, extra-pulmonary organ involvement and systemic therapy initiation, differing from prior studies and may represent less severe disease at diagnosis, enhanced diagnostic certainty or referral bias.

89 DIAGNOSIS AND TREATMENT OF SUSPECTED OBSTRUCTIVE SLEEP APNOEA (OSA) IN OLDER PEOPLE: A RETROSPECTIVE COMPARATIVE ANALYSIS

Background

Obstructive Sleep Apnoea (OSA) is common yet often undiagnosed in older people as symptoms of fatigue and poor sleep are common and non-specific. OSA screening tools also lack validity in older patients. This study aims to review the clinical presentation, use of screening tools and treatment adherence in older people.

Methods

A retrospective cohort study of patients &gt;65 years attending a tertiary sleep clinic who underwent polysomnography for suspected OSA was performed. Electronic patient records were reviewed to obtain information on clinical presentation, screening scores, polysomnography reports and treatment initiated. Correlation between variables was performed using Pearson’s correlation co-efficient and represented using R-score. To compare CPAP usage with younger people, a cohort of controls &lt;65 years were matched in 2:1 ratio for OSA severity (mild, moderate or severe) at diagnosis. Comparison of adherence rates was performed using Mann-Whitney U-test and represented using Z-scores.

Results

A convenience sample of 100 consecutive older patients were included. Fatigue was present in 53% and witness reported snoring in 86% and apnoeas in 56%. Moderate or severe OSA was confirmed by polysomnography in 91% cases. BMI and the STOP-BANG questionnaire were positively correlated with OSA severity as measured by Apnoea Hypopnea Index, while ESS and Berlin Questionnaire were not. Positive pressure ventilation was initiated in 90% patients. CPAP was extremely effective with the median AHI falling to within normal range on follow up. CPAP usage was significantly higher in older patients compared with younger matched control (85% vs 66% p=013).

Conclusion

Older people with OSA present with classical symptoms. STOP -BANG questionnaire and BMI were positively correlated with AHI values while other screening tools lacked validity. Treatment with CPAP was highly efficacious in older people with high usage rates and should be considered as first-line treatment for moderate and severe OSA in older patients.

87 VERTEBRAL FRACTURES IN OLDER PATIENTS WITH COPD: AN UNDER-DIAGNOSED AND UNDER-TREATED ENTITY

Background

Patients with Chronic Obstructive Pulmonary Disease (COPD) are at increased risk of osteoporosis. Vertebral Fractures (VF) are the most common manifestation of osteoporosis. Only one fourth to one third of incident radiographically identified VF are clinically diagnosed. The aim of this study is to evaluate patients the prevalence of VF in a cohort of patients admitted with Acute Exacerbation of COPD (AECOPD).

Methods

A retrospective review of AECOPD admissions over a four-month period was performed. Information on baseline characteristics, prescribed medications and reports of radiological imaging were obtained from Electronic Healthcare Records, discharge summaries and clinic letters.

Results

In total 116 patients were included over the study period. In 24% (n=28), VF was present on imaging. In those with VF, females accounted for 64.3% (n=18). Median age was 80 (76-85) and median CFS was 6. In 12 cases a single VF was present, in 9 two VFs and in 7 patients 3+ VF were present. There was no documented diagnosis of osteoporosis in 67.8% (n=19). VF were initially detected on CT thorax imaging performed to assess for pulmonary pathology in 35.7% (n=10) cases. Vitamin D3 was prescribed in 60.7% (n=17), concurrently with calcium in 28.6% (n=8). Antiresorptive therapy was prescribed in 39.3% (n=11), oral bisphosphonates in 4 patients and denosumab in 7. Vitamin D (OH) level was measured in 78.6% (n= 22) patients and was insufficient (&lt;50mmol) in 25% (n=7).

Conclusion

Almost one-quarter of patients who were admitted with an AECOPD had vertebral insufficiency fracture on imaging. Identification and treatment of VF was suboptimal. Most were not identified as having osteoporosis nor prescribed antiresorptive therapy. CT imaging should be routinely reviewed for the presence of insufficiency fractures as part of case finding initiatives. Bone health assessment should be routinely performed in patients with COPD, particularly those with frequent corticosteroid usage.

Real world treatment of juvenile-onset systemic lupus erythematosus: Data from the UK JSLE cohort study

BACKGROUND

In the absence of clinical trials evidence, Juvenile-onset Systemic Lupus Erythematosus (JSLE) treatment plans vary.

AIM

To explore 'real world' treatment utilising longitudinal UK JSLE Cohort Study data.

METHODS

Data collected between 07/2009-05/2020 was used to explore the choice/sequence of immunomodulating drugs from diagnosis. Multivariate logistic regression determined how organ-domain involvement (pBILAG-2004) impacted treatment choice.

RESULT

349 patients met inclusion criteria, median follow-up 4-years (IQR:2,6). Mycophenolate mofetil (MMF) was most commonly used for the majority of organ-domains, and significantly associated with renal involvement (OR:1.99, 95% CI:1.65-2.41, pc < 0.01). Analyses assessing the sequence of immunomodulators focused on 197/349 patients (meeting relevant inclusion/exclusion criteria). 10/197 (5%) solely recieved hydroxychloroquine/prednisolone, 62/197 (31%) received a single-immunomodulator, 69/197 (36%) received two, and 36/197 patients (28%) received ≥three immunomodulators. The most common first and second line immunomodulator was MMF. Rituximab was the most common third-line immunomodulator.

CONCLUSIONS

Most UK JSLE patients required ≥two immunomodulators, with MMF used most commonly.

Real world outcomes of minimally invasive epicardial surgical left atrial appendage exclusion in atrial fibrillation patients with high risk of stroke and bleeding

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): AtriCure, Inc

Introduction

The left atrial appendage (LAA) is the site of thrombus formation in patients with atrial fibrillation (AF) and first line therapy for reducing the risk of stroke is oral anticoagulation (OACs). A subset of patients with AF carry a very high risk of stroke and bleeding and are ineligible for OAC and percutaneous LAA occlusion; these patients may be suitable for minimally invasive thoracoscopic epicardial surgical LAA exclusion (LAAE) which can be used with a wide variety of LAA morphologies with a ~98% rate of complete exclusion. While use of LAAE is well studied as a concomitant procedure, there are relatively few data on its use as a stand-alone procedure.

Purpose

To compare real-world outcomes of LAAE versus no-LAAE in AF patients at high risk of stroke and bleeding who are not on OACs.

Methods

We performed an analysis of Medicare beneficiaries with AF who were not on OACs and received LAAE (ICD10-PCS code 02L74CK, Oct 2015 – Dec 31, 2017) in the absence of a concomitant surgical or catheter AF ablation procedure. Patients were propensity-matched (1:4) to otherwise similar patients who did not receive LAAE (control), using age, gender, race, region, AF type, CHA2DS2-VASc, HAS-BLED, and co-morbidities. The primary endpoint was hospital readmission for a thromboembolic event (ischemic stroke, systemic embolism, or transient ischemic attack). Kaplan Meier event rates were calculated and 95% CI were generated via bootstrapping.

Results

A total of 243 patients who underwent LAAE and 1.7M control patients met study criteria. In the matched cohort, the mean age was 75 years, 61% were men, 77% had non-paroxysmal AF, and the mean CHADS2-VASC and HAS-BLED scores were 5.5 and 4.2, respectively. The 1-year rate of thromboembolism in the LAAE and control arms were 7.3% (95% CI 4.3% -10.9%) and 13.6 (95% CI 11.0% -16.4%) (Figure), respectively, with an absolute and relative risk reduction of 6.2% (95% CI 2.0-10.3, p-value=0.001, NNT 17) and 0.54 (95% CI 0.29-0.68, p=0.001).

Conclusion

Among high-risk AF patients who were not on OAC, LAAE was associated with a clinically meaningful and significantly lower risk of TE. Additional studies are needed to confirm these finding.

ORIGINAL RESEARCH Virtual Events in the Era of COVID-19: Perspectives From a Virtual Interdisciplinary Wound Care Symposium

BACKGROUND: The coronavirus disease-19 pandemic has created changes in the way medicine is practiced. The move to virtual conferencing to avoid mass gatherings is a significant change to how health care professionals meet, discuss current trends, and share research. METHODS: Data from exit polls conducted after annual wound care symposiums were reviewed. Physicians, nurses, podiatrists, and other health care professionals attended. Respondents were asked to comment and reflect on their experiences of attending a virtual conference. RESULTS: Over 60% of all (N = 283) respondents stated the virtual conference was better than or on par with a live event. Many respondents had attended this live event in person in previous years. Of all respondents, 83% stated that they planned to access conference materials for the 30 days they remained posted after the event. More than 50% of respondents stated they favored the ability to communicate effectively with colleagues via the instant messaging feature offered by the conference. Approximately 80% of respondents stated that they would like to attend this and other conferences virtually in the future. CONCLUSIONS: The shift from in-person to virtual conferences has the potential to remain a significant method of attending health care conferences. Conference organizers are encouraged to consider how they can implement virtual components, including postconference access to materials, to enhance the conference experience. Additional work needs to be done to understand the impact of the virtual format on knowledge retention.

OA43 Development of a national across specialty multi-disciplinary team for management of hyper-inflammatory conditions during the SARS-CoV-2 pandemic

Background/Aims

Effective multi-specialty team working is extremely beneficial in management of children with hyper-inflammatory conditions. With the recognition of paediatric inflammatory multisystem syndrome (PIMS) it became apparent a standardised process for discussion of patients would be beneficial. This includes urgent discussion, with access to multiple specialties, and sharing knowledge and experience in a novel condition. Delivering equitable healthcare including access to expertise, specific treatments and research is challenging in Scotland due to its geography. This is facilitated by successful clinical networks (Scottish Paediatric & Adolescent Rheumatology Network [SPARN] and Scottish Paediatric& Adolescent Infection & Immunology National Managed Clinical Network [SPAIIN]) and a well-established paediatric transport service (ScotSTAR). Our aim was to develop a multi-specialty multi-disciplinary team (MDT) for management of patients with hyper-inflammatory conditions.

Methods

Narrative account of MDT and service development

Results

We identified a core group of individuals with an interest in inflammatory disorders from different centres and specialties across Scotland including Rheumatology, Infectious Diseases, Cardiology, Intensive Care, Academic Paediatrics, Pharmacists and Clinical Nurse Specialists. Three priorities emerged from initial planning stages: urgent discussions around patient management, peer-to-peer learning and information sharing, and effective prioritisation of research. We designed a written framework and referral pathway, including criteria for acute cardiology involvement, ScotSTAR transfer and intensive care. An electronic proforma was designed to guide MDT discussion, medico-legal documentation and audit purposes. Table 1 describes characteristics of the first nine patients discussed. A particular strength was in diagnostics and consideration of differentials; among patients referred we identified those with haematological malignancy, systemic lupus erythematosus and non-accidental injury. Regular peer-review sessions were held, for reflection on cases and their management in both secondary and tertiary care settings. Clinicians throughout Scotland were encouraged to join via SPARN and SPAIIN networks.

Conclusion

This multi-specialty MDT has been and continues to be beneficial for management of hyper-inflammatory patients. We will review the process but hope the MDT will prove to continue to be beneficial for future patients. The authors would like to acknowledge all members of the MDT.

Disclosure

K. McLellan: None. L. Reilly: None. L. Pollock: None. O. Swann: None. C. Anderson: None. N. Martin: None. M. Brennan: None. R. Hague: None. J. Walsh: None.

Review of the prevalence, pathogenesis and management of OSA-COPD overlap

PURPOSE

OSA-COPD overlap is an important and prevalent condition yet remains under-recognised among the vast majority of respiratory health professionals. Patients with OSA-COPD overlap experience more severe respiratory symptoms and worse quality of life, and the relative risk of exacerbations, hospitalisations, and mortality is higher than in either disease state alone.

METHODS

Electronic databases PUBMED and Google Scholar were searched for studies and academic papers that discussed OSA-COPD overlap. Relevant papers that discussed prevalence, pathophysiology, microbiome studies, treatment regimens and outcomes were included in this paper.

RESULTS

High-risk patients with either COPD or OSA should be screened for overlap syndrome as part of routine clinical practice. Screening questionnaires can identify high-risk patients with COPD who may benefit from formal polysomnography. Patients with OSA who are aged over 40 with a significant smoking history or environmental exposures have an increased pre-test probability of obstructive airway disease. The potential roles of gastro-oesophageal reflux disease and lung-gut microbiome are evolving and merit further investigation. A tailored approach to reach a timely diagnosis and thus optimisation of both conditions are key to management. CPAP is the primary therapy for OSA; however, patients with more advanced COPD, with daytime hypercapnia or severe nocturnal desaturations, may benefit from bilevel positive airway pressure.

CONCLUSION

Increased awareness, access to timely investigations and initiation of therapy will improve overall outcomes in OSA-COPD overlap by reducing hospitalisations for exacerbations of COPD and improve mortality rates.

Attainment of Low Disease Activity and Remission Targets reduces the risk of severe flare and new damage in Childhood Lupus

Objectives

To assess the achievability and effect of attaining low disease activity (LDA) or remission in childhood-onset SLE (cSLE).

Methods

Attainment of three adult-SLE derived definitions of LDA (LLDAS, LA, Toronto-LDA), and four definitions of remission (clinical-SLEDAI-defined remission on/off treatment, pBILAG-defined remission on/off treatment) was assessed in UK JSLE Cohort Study patients longitudinally. Prentice–Williams–Petersen gap recurrent event models assessed the impact of LDA/remission attainment on severe flare/new damage.

Results

LLDAS, LA and Toronto-LDA targets were reached in 67%, 73% and 32% of patients, after a median of 18, 15 or 17 months, respectively. Cumulatively, LLDAS, LA and Toronto-LDA was attained for a median of 23%, 31% and 19% of total follow-up-time, respectively. Remission on-treatment was more common (61% cSLEDAI-defined, 42% pBILAG-defined) than remission off-treatment (31% cSLEDAI-defined, 21% pBILAG-defined). Attainment of all target states, and disease duration (>1 year), significantly reduced the hazard of severe flare (P < 0.001). As cumulative time in each target increased, hazard of severe flare progressively reduced. LLDAS attainment reduced the hazard of severe flare more than LA or Toronto-LDA (P < 0.001). Attainment of LLDAS and all remission definitions led to a statistically comparable reduction in the hazards of severe flare (P > 0.05). Attainment of all targets reduced the hazards of new damage (P < 0.05).

Conclusions

This is the first study demonstrating that adult-SLE-derived definitions of LDA/remission are achievable in cSLE, significantly reducing risk of severe flare/new damage. Of the LDA definitions, LLDAS performed best, leading to a statistically comparable reduction in the hazards of severe flare to attainment of clinical remission.

Limited sensitivity and specificity of the ACR/EULAR-2019 classification criteria for SLE in JSLE?-observations from the UK JSLE Cohort Study

OBJECTIVES

This study aimed to test the performance of the new ACR and EULAR criteria, that include ANA positivity as entry criterion, in JSLE.

METHODS

Performance of the ACR/EULAR-2019 criteria were compared with Systemic Lupus International Collaborating Clinics (SLICC-2012), using data from children and young people (CYP) in the UK JSLE Cohort Study (n = 482), with the ACR-1997 criteria used as reference standard. An unselected cohort of CYP positive for ANA (n = 129) was used to calculate positive/negative predictive values of the criteria.

RESULTS

At both first and last visits, the number of patients fulfilling the different classification criteria varied significantly (P < 0.001). The sensitivity of the SLICC-2012 criteria was higher when compared with that of the ACR/EULAR-2019 criteria at first and last visits (98% vs 94% for first visit, and 98% vs 96% for last visit; P < 0.001), when all available CYP were considered. The ACR/EULAR-2019 criteria were more specific when compared with the SLICC-2012 criteria (77% vs 67% for first visit, and 81% vs 71% for last visit; P < 0.001). Significant differences between the classification criteria were mainly caused by the variation in ANA positivity across ages. In the unselected cohort of ANA-positive CYP, the ACR/EULAR-2019 criteria produced the highest false-positive classification (6/129, 5%).

CONCLUSION

In CYP, the ACR/EULAR-2019 criteria are not superior to those of the SLICC-2012 or ACR-1997 criteria. If classification criteria are designed to include CYP and adult populations, paediatric rheumatologists should be included in the consensus and evaluation process, as seemingly minor changes can significantly affect outcomes.

Weather, Workload and Money: Determining and Evaluating Sources of Stress for Farmers in Ireland

The demands of modern farming can place substantial stress upon the farmer, adversely impacting their wellbeing. This study identifies both the prevalence of stress and assesses the demographic, farm, and social characteristics that impact the incidence of stress. We report the results of a survey of a nationally representative sample of farm enterprises in Ireland undertaken in association with the Teagasc National Farm Survey (NFS) in 2018, which saw 736 questionnaires completed by farm operators. Frequency analysis is used to report the primary sources and prevalence of stress. A probit model is developed identifying and quantifying the factors that impact the incidence of stress. There were 57% of farmers who reported experiencing stress resulting from their farm work. Key sources of stress included "poor weather", (47%), "workload" (32%) and "financial" concerns (28%). The results of the probit model establish that the effect of age on the incidence of stress is significant, positive, and non-linear, indicating as farmers get older they are more likely to experience stress but at a declining rate. Operating a sheep farm system, as opposed to any other type of farm system, reduces the probability of stress. Working off-farm also reduces the probability of stress by 0.097, other things being equal. The findings highlight variance in the levels of stress reported by farmers by age and farm system, and consequently, the need to develop targeted supports that take consideration of differences within the population of farmers and farm enterprises.

A Comparison of Community-Acquired and Hospital-Acquired Hypernatraemia in Patients who are Acutely Admitted to Hospital

Background Hypernatraemia is associated with a short-term mortality of 20-60%. Age-related physiological changes predispose patients to hypernatraemia. This study reviewed acutely admitted patients comparing those with community-acquired (CAH) and hospital-acquired hypernatraemia (HAH). Methods A retrospective study of 102 consecutive acute medical in-patients with serum [Na]>145 mmol/L was conducted. Baseline characteristics, clinical presentation, laboratory values, monitoring, management and outcomes were compared between CAH and HAH groups. Results Patients were exclusively older (>69 years). Forty patients (39.2%) had CAH and sixty-two (61.8%) had HAH. Those with CAH were more likely to be NH residents, have dementia and reduced mobility. Most HAH patients had mild hypernatraemia initially (75.8%, n=47), and higher rates of acute kidney injury (27% (n=11) vs 8% (n=3)/p=0.02) were observed. Monitoring was inadequate and no patient had a free water deficit documented. Medication review and intravenous fluid prescribing was similar between groups. The median length of stay of discharged HAH patients was longer (22.5 vs 8 days/p=0.005). Mortality rates were similar (47% (n=29) vs 37% (n=15)/p=0.416). Time from admission to death was higher in HAH patients (16 vs 8 days/p=0.008). Conclusions Both CAH and HAH present similarly, however, older patients with cognitive/physical impairments are at an increased risk. Early identification of high-risk patients and adherence to best practice guidelines is required.

An Interdisciplinary Team Approach to Decrease Sacral Hospital-acquired Pressure Injuries: A Retrospective Cohort Study

BACKGROUND: Hospital-acquired pressure injuries (HAPIs) of the sacrum are among the most common iatrogenic events in health care. Multi-intervention programs have been shown to decrease the prevalence of pressure injuries. PURPOSE: To assess changes in the yearly incidence of sacral HAPIs before and after implementation of a 3-pronged interdisciplinary intervention to reduce HAPI incidence. METHODS: A retrospective study of all patients admitted between 2010 and 2017 was conducted to evaluate the effect of a 2012 initiative on the incidence of sacral HAPIs. In 2012, an interdisciplinary team was created, and enhanced education programs for nursing staff and quality data reporting measures were implemented for all patients admitted to North Shore University Hospital, Manhasset, NY. Pre- and post-intervention patient variables and sacral HAPI outcomes were compared. RESULTS: Pre- intervention, the sacral HAPI incidence was 0.353% and 0.267% (mean 0.31%) in the years 2010 and 2011, respectively. Post-intervention the HAPI incidence was 0.033%, 0.043%, 0.008%, 0.007%, and 0.004% in the years 2013, 2014, 2015, 2016, and 2017, respectively (mean 0.019%) (2-sample unpaired t-statistic: 11.5937; P < .001). Significant variables and outcomes differences between pre-intervention (n = 245) and post-intervention (n = 49) patients with a sacral HAPI were seen for race (P < .0001), length of stay (P = .0096), and HAPI stage (P < .0001). CONCLUSION: A hospital-wide, multi-part, interdisciplinary intervention resulted in a significant and sustained reduction in the incidence of sacral HAPIs.

An Interdisciplinary Team Approach to Decrease Sacral Hospital-acquired Pressure Injuries: A Retrospective Cohort Study

BACKGROUND

Hospital-acquired pressure injuries (HAPIs) of the sacrum are among the most common iatrogenic events in health care. Multi-intervention programs have been shown to decrease the prevalence of pressure injuries.

PURPOSE

To assess changes in the yearly incidence of sacral HAPIs before and after implementation of a 3-pronged interdisciplinary intervention to reduce HAPI incidence.

METHODS

A retrospective study of all patients admitted between 2010 and 2017 was conducted to evaluate the effect of a 2012 initiative on the incidence of sacral HAPIs. In 2012, an interdisciplinary team was created, and enhanced education programs for nursing staff and quality data reporting measures were implemented for all patients admitted to North Shore University Hospital, Manhasset, NY. Pre- and post-intervention patient variables and sacral HAPI outcomes were compared.

RESULTS

Pre- intervention, the sacral HAPI incidence was 0.353% and 0.267% (mean 0.31%) in the years 2010 and 2011, respectively. Post-intervention the HAPI incidence was 0.033%, 0.043%, 0.008%, 0.007%, and 0.004% in the years 2013, 2014, 2015, 2016, and 2017, respectively (mean 0.019%) (2-sample unpaired t-statistic: 11.5937; P < .001). Significant variables and outcomes differences between pre-intervention (n = 245) and post-intervention (n = 49) patients with a sacral HAPI were seen for race (P < .0001), length of stay (P = .0096), and HAPI stage (P < .0001).

CONCLUSION

A hospital-wide, multi-part, interdisciplinary intervention resulted in a significant and sustained reduction in the incidence of sacral HAPIs.