ABSTRACT
Introduction: Many COPD patients do not follow pulmonary rehabilitation (PR) or exercise training in the long-term. Objective(s): To assess the effectiveness of a 12-months home-based, minimal equipment strength exercise programme in patients with COPD who did not conduct PR<1 year. Method(s): COPD patients recruited from primary care and general population were randomized into intervention (IG) or control group (usual care, CG). Primary outcome was change in dyspnoea (Chronic Respiratory Questionnaire;CRQ) from baseline to 12 months, secondary outcomes change in exercise capacity, health status, exacerbations, and symptoms. Adjusted linear regression models were used. Result(s): 50 patients (48% of target sample size) were randomized (25 per group);23 females, mean (SD) age 69.5 (7.4) years, FEV1% 45.9 (16.3) % pred. 48 completed 12-months follow-up (IG: 25, CG: 23). On average, the IG participant trained for 10.5 months and 18 persons (72%) until study end. We found no evidence for a difference in change in CRQ dyspnoea over 12 months (adjusted mean difference 0.45, 95% CI -0.21-1.10, p=0.18, favouring IG). We found no evidence for an effect in other outcomes. Most of the IG participants liked to participate in the programme much (56%) or very much (24%). Due to the Coronavirus pandemic, 60% of follow-up visits were conducted by phone/by questionnaires without exercise tests. Conclusion(s): This trial was underpowered. There was a trend that the training provided benefit in dyspnoea. The fact that it was difficult to motivate COPD patients for participation who did not follow PR<1 year highlights the challenge to reach this patient group. However, most of the participants succeeded to train long-term.
ABSTRACT
Background. Clostridioides difficile infection (CDI) continues to be a major global public health concern, particularly during the ongoing SARS-CoV-2 coronavirus disease 2019 (COVID-19) pandemic. Despite new social distancing guidelines and enhanced infection control procedures (e.g., masking, hand hygiene) being implemented since the beginning of COVID-19, little evidence indicates whether these changes have influenced the prevalence of CDI hospitalizations. This study aims to measure CDI prevalence before and during the COVID-19 pandemic in a local cohort of U.S. Veterans. Methods. This was a cross-sectional study of all Veterans presenting to the South Texas Veterans Health Care System in San Antonio, Texas from Jan 1, 2019 to Apr 30, 2021. Monthly laboratory confirmed CDI events were collected overall and categorized as the following: hospital-onset, healthcare facility-associated (HO-HCFACDI), community-onset, healthcare facility-associated CDI (CO-HCFA-CDI), and community-associated CDI (CA-CDI). Monthly confirmed COVID-19 cases were also collected. CDI prevalence was calculated as CDI events per 10,000 bed days of care (BDOC) and was compared between pre-pandemic (Jan 2019-Feb 2020) and pandemic (Mar 2020-Apr 2021) periods. Results. A total of 285 CDI events, 920 COVID-19 cases, and 104,220 BDOC were included in this study. The overall CDI rate increased from 20.33 per 10,000 BDOC pre-pandemic to 34.51 per 10,000 during the pandemic (p< 0.0001). This was driven primarily by a rise in CO-HCFA-CDI rates (0.95 vs 2.52 per 10,000 BDOC;p< 0.0001) during the pandemic, followed by increases in CA-CDI (15.58 vs. 18.61 per 10,000 BDOC;p< 0.0001) and HO-HCFA-CDI (2.66 vs. 5.43 per 10,000 BDOC;p< 0.0001). Lastly, CDI rates have tripled since the start of the pandemic (March-Apr 2020) compared to the current year (March-Apr 2021) (14.69 vs. 43.76 per 10,000 BDOC). Conclusion. Overall, CDI prevalence increased during the COVID-19 pandemic, driven mostly by an increase in CO-HCFA-CDI. As COVID-19 rates increased, CDI rates also increased, likely due to greater healthcare exposures and antibiotic use. Continued surveillance of COVID-19 and CDI is warranted to further decrease infection rates.