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Knowledge of infectious diseases and self-action are vital to disease control and prevention. Yet, little is known about the factors associated with knowledge of and self-action to prevent the coronavirus disease (COVID-19). This study accomplishes two objectives. Firstly, we examine the determinants of COVID-19 knowledge and preventive knowledge among women in four sub-Saharan African countries (Kenya, Nigeria, the Democratic Republic of Congo, and Burkina Faso). Secondly, we explore the factors associated with self-action to prevent COVID-19 infections among these women. Data for the study are from the Performance for Monitoring Action COVID-19 Survey, conducted in June and July 2020 among women aged 15-49. Data were analysed using linear regression technique. The study found high COVID-19 knowledge, preventive knowledge, and self-action among women in these four countries. Additionally, we found that age, marital status, education, location, level of COVID-19 information, knowledge of COVID-19 call centre, receipt of COVID-19 information from authorities, trust in authorities, and trust in social media influence COVID-19 knowledge, preventive knowledge, and self-action. We discuss the policy implications of our findings.
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BACKGROUND: Since the onset of the COVID-19 pandemic, direct-to-patient, self-applied ECG patch use has substantially increased. There are limited data comparing clinic versus self-applied ECG patches. OBJECTIVES: To compare rates of ECG patch return, percentages of time patches yielded analyzable data (analyzable time), and percentages of prescribed time ECG patches were worn between clinic and self-applied ECG patches prior to and during COVID-19. METHODS: A retrospective analysis of patients prescribed an ECG patch during "pre-COVID" (3/1/2019-3/1/2020) and "COVID" (4/1/2020-4/1/2021) years was conducted. ECG patch return rates, mean percentages of analyzable time, and mean percentages of prescribed wear time were compared between clinic and self-applied groups. RESULTS: Of 29,093 ECG patch prescriptions (19% COVID self-applied), the COVID self-applied group had a lower return rate (90.8%) than both clinic-applied groups (COVID; 97.1%; pre-COVID; 98.1%; p<0.001). Among the 28,048 ECG patches (17.5% self-applied) returned for analysis, the COVID self-applied group demonstrated a lower mean percentage of analyzable time (95.9 + 8.2%) than both clinic-applied groups (COVID: 96.6 + 6.6%; pre-COVID 96.6 + 7.4%; p<0.001). There were no differences in mean percentage of prescribed wear time between groups (pre-COVID clinic-applied: 96.7 + 34.3%; COVID clinic-applied 97.4 + 39.8%; COVID self-applied 98.1 + 52.1%, p=0.09). CONCLUSIONS: Self-applied ECG patches were returned at a lower rate and had a statistically lower percentage of analyzable time than clinic-applied patches. However, there were no differences between groups in mean percentages of prescribed wear time, and mean percentages of analyzable time were >95% in all groups.
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There have been over 507 million cases of COVID-19, the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulting in 6 million deaths globally. Wastewater surveillance has emerged as a valuable tool in understanding SARS-CoV-2 burden in communities. The National Wastewater Surveillance System (NWSS) partnered with the United States Geological Survey (USGS) to implement a high-frequency sampling program. This report describes basic surveillance and sampling statistics as well as a comparison of SARS-CoV-2 trends between high-frequency sampling 3-5 times per week, referred to as USGS samples, and routine sampling 1-2 times per week, referred to as NWSS samples. USGS samples provided a more nuanced impression of the changes in wastewater trends, which could be important in emergency response situations. Despite the rapid implementation time frame, USGS samples had similar data quality and testing turnaround times as NWSS samples. Ensuring there is a reliable sample collection and testing plan before an emergency arises will aid in the rapid implementation of a high-frequency sampling approach. High-frequency sampling requires a constant flow of information and supplies throughout sample collection, testing, analysis, and data sharing. High-frequency sampling may be a useful approach for increased resolution of disease trends in emergency response. © 2022 American Chemical Society. All rights reserved.
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Organizations such as BCSP, AIHA, American Board of Industrial Hygiene and National Society of Professional Engineers also have formal codes of ethics that guide professionals in safety and related fields to act according to the highest standards of honesty and integrity. Beyond these guidelines, each of us must have a personal code of ethics. In applying your personal code of ethics, it is important to remember that ethics involve more than simply delineating right from wrong.
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P174 Table 1List of studies that NWCORR have undertaken since its inceptionStudy name Description Project start Project end No. of trainees involved No. of hospitals No. of patients Presentations Publications CURB-COVID-NOW Project Investigating the use of CURB65 as a prognostic score for COVID-19 patients. March 2020 December 2020 19 Trainees 9 sites 830 Patients BTS Winter Meeting Feb 2021 BMJ Open Research DOI: 10.1136/bmjresp-2020-000729 PMID: 33293361 * CPAP COVID Project Investigating ward-based oxygen therapy and CPAP in patients with COVID-19 pneumonitis August 2020 May 2021 18 trainees 7 Sites 479 Patients North West Thoracic Society March 2021 Manuscript in preparation Post inflation pneumothorax chest drain management project Investigating clamping of chest drain post pneumothorax resolution August 2020 Ongoing 7 trainees 4 sites Ongoing * Bradley P, Frost F, Tharmaratnam K, Wootton DG;NW Collaborative Organisation for Respiratory Research. Utility of established prognostic scores in COVID-19 hospital admissions: multicentre prospective evaluation of CURB-65, NEWS2 and qSOFA. BMJ Open Respir Res. 2020 Dec;7(1):e000729. doi: 10.1136/bmjresp-2020-000729. PMID: 33293361;PMCID: PMC7722817.ConclusionsThe experience of NWCORR reflects a high rate of trainee enthusiasm to participate in research alongside clinical training and highlights the potential of collaborative networks. It has enabled trainees who may not wish, or have the opportunity, for an ‘out of programme’ research post to develop research skills and interests. We believe NWCORR and other trainee research collaboratives can, and should, play a pivotal role in embedding a research culture into everyday practice, improve patient care and build early career researchers within the NHS.
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S52 Figure 1Kaplan-Meier curve comparing overall survival in the two treatment groups (conventional oxygen therapy vs continuous positive airway pressure therapy). The null hypothesis of no survival difference is evaluated with a log-rank test (p = 0.92)[Figure omitted. See PDF]DiscussionThis is, as far as we are aware, the first study comparing conventional oxygen therapy with CPAP in cohorts unaffected by physician selection. No survival difference was found between using oxygen alone or CPAP to treat patients with severe COVID-19 who were nIMV. A high patient-initiated discontinuation rate for CPAP suggests a significant treatment burden. Further reflection is warranted on the continued widespread use of CPAP in this patient group.Please refer to page A189 for declarations of interest related to this abstract.
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BACKGROUND: Continuous positive airway pressure (CPAP) therapy is commonly used for respiratory failure due to severe COVID-19 pneumonitis, including in patients deemed not likely to benefit from invasive mechanical ventilation (nIMV). Little evidence exists demonstrating superiority over conventional oxygen therapy, whilst ward-level delivery of CPAP presents practical challenges. We sought to compare clinical outcomes of oxygen therapy versus CPAP therapy in patients with COVID-19 who were nIMV. METHODS: This retrospective multi-centre cohort evaluation included patients diagnosed with COVID-19 who were nIMV, had a treatment escalation plan of ward-level care and clinical frailty scale ≤ 6. Recruitment occurred during the first two waves of the UK COVID-19 pandemic in 2020; from 1st March to May 31st, and from 1st September to 31st December. Patients given CPAP were compared to patients receiving oxygen therapy that required FiO2 ≥0.4 for more than 12 hours at hospitals not providing ward-level CPAP. Logistic regression modelling was performed to compare 30-day mortality between treatment groups, accounting for important confounders and within-hospital clustering. FINDINGS: Seven hospitals provided data for 479 patients during the UK COVID-19 pandemic in 2020. Overall 30-day mortality was 75.6% in the oxygen group (186/246 patients) and 77.7% in the CPAP group (181/233 patients). A lack of evidence for a treatment effect persisted in the adjusted model (adjusted odds ratio 0.84 95% CI 0.57-1.23, p=0.37). 49.8% of patients receiving CPAP-therapy (118/237) chose to discontinue it. INTERPRETATION: No survival difference was found between using oxygen alone or CPAP to treat patients with severe COVID-19 who were nIMV. A high patient-initiated discontinuation rate for CPAP suggests a significant treatment burden. Further reflection is warranted on the current treatment guidance and widespread application of CPAP in this setting. FUNDING: L Pearmain is supported by the MRC (MR/R00191X/1). TW Felton is supported by the NIHR Manchester Biomedical Research Centre.
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Introduction and Objectives The COVID-19 pandemic is ongoing yet, due to the lack of a COVID-19 specific tool, clinicians must use pre-existing illness severity scores for initial prognostication. However, the validity of such scores in COVID-19 is unknown. The aim of this study was to determine the performance characteristics of these scores in the context of COVID-19 and to investigate potential components of a COVID-19 specific prognostication tool for future validation. Methods The North West Collaborative Organization for Respiratory Research (NW-CORR), a group of research-interested higher specialty trainees, performed a multi-centre prospective evaluation of adult patients admitted to hospital with confirmed COVID-19 during a two-week period in April 2020. Clinical variables measured as part of usual care at presentation to hospital were recorded, including the CURB-65, NEWS2, and qSOFA scores. Outcomes of interest were 30-day and 72-hour mortality. Scores were compared in terms of calibration and discrimination with multivariable logistic regression performed to assess individual components of each score. Results Data were collected for 830 people with COVID-19 admitted across 7 hospitals. By 30 days, a total of 300 (36.1%) had died and 142 (17.1%) had been in ICU. Calibration plots suggested all scores underestimated mortality compared to their original validation in non-COVID-19 populations, and overall discriminatory ability was generally sub-optimal (AUCs 0.62-0.77). Among the 'low risk' categories (CURB-65<2, NEWS2<5, qSOFA<2) 30-day mortality was 16.7% (vs 1.5% in CAP), 32.9% (vs 5.5% in sepsis) and 21.4% (vs 4.3% in infection) respectively. The diagnostic performances of each score are presented in table 1. Multivariable logistic regression identified features associated with respiratory compromise rather than circulatory collapse as most relevant prognostic variables. Conclusion ll existing prognostic scores evaluated here underestimated adverse outcomes and performed sub-optimally in the COVID-19 setting. New prognostic tools including a focus on features of respiratory compromise rather than circulatory collapse are needed. We provide a baseline set of variables which are relevant to COVID-19 outcomes and may be used as a basis for developing a bespoke COVID-19 prognostication tool. This collaborative project demonstrates the ability of regional trainee networks to collate large datasets to address important clinical questions.
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S95 Table 1Diagnostic performance of individual scores for 30-day and 72-hour mortality Score (n)Death (%)SensitivitySpecificityPPVNPVDeath by 30 days CURB-65 (n=730)<2 (324) ≥2 (406)54 (16.7%) 216 (53.2%)0.800.590.530.83<3 (514) ≥3 (216)141 (27.4%) 129 (59.7%)0.480.810.600.73 NEWS2 (n=730)<5 (215) ≥5 (515)46 (21.4%) 224 (43.5%)0.830.370.430.79 qSOFA (n=730)<2 (596) ≥2 (134)196 (32.9%) 74 (55.2%)0.270.870.550.67 Death within 72 hours Score(n)Death (%)SensitivitySpecificityPPVNPVCURB-65 (n=730)<2 (324) ≥2 (406)9 (2.8%) 50 (12.3%)0.850.470.120.97<3 (514) ≥3 (216)23 (4.5%) 36 (16.7%)0.610.730.170.96 NEWS2 (n=730)<5 (215) ≥5 (515)5 (2.3%) 54 (10.5%)0.920.310.100.98 qSOFA (n=730)<2 (596) ≥2 (134)34 (5.7%) 25 (18.7%)0.420.840.190.94 Abbreviations: PPV=Positive predictive value;NPV=Negative predictive valueConclusionll existing prognostic scores evaluated here underestimated adverse outcomes and performed sub-optimally in the COVID-19 setting. New prognostic tools including a focus on features of respiratory compromise rather than circulatory collapse are needed. We provide a baseline set of variables which are relevant to COVID-19 outcomes and may be used as a basis for developing a bespoke COVID-19 prognostication tool. This collaborative project demonstrates the ability of regional trainee networks to collate large datasets to address important clinical questions.
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BACKGROUND: Novel coronavirus-19 disease (COVID-19) is associated with significant cardiovascular morbidity and mortality. To date, there have not been reports of sinus node dysfunction (SND) associated with COVID-19. This case series describes clinical characteristics, potential mechanisms, and short-term outcomes of COVID-19 patients who experience de novo SND. CASE SUMMARY: We present two cases of new-onset SND in patients recently diagnosed with COVID-19. Patient 1 is a 70-year-old female with no major past medical history who was intubated for acute hypoxic respiratory failure secondary to COVID-19 pneumonia and developed new-onset sinus bradycardia without a compensatory increase in heart rate in response to relative hypotension. Patient 2 is an 81-year-old male with a past medical history of an ascending aortic aneurysm, hypertension, and obstructive sleep apnoea who required intubation for COVID-19-induced acute hypoxic respiratory failure and exhibited new-onset sinus bradycardia followed by numerous episodes of haemodynamically significant accelerated idioventricular rhythm. Two weeks following the onset of SND, both patients remain in sinus bradycardia. DISCUSSION: COVID-19-associated SND has not previously been described. The potential mechanisms for SND in patients with COVID-19 include myocardial inflammation or direct viral infiltration. Patients diagnosed with COVID-19 should be monitored closely for the development of bradyarrhythmia and haemodynamic instability.