The Clinical Effectiveness of Dynamic Electronic Tracking and Escalation to Reduce Critical Care Transfers (the Detect Study)

BACKGROUND AND AIM: Physiological surveillance systems significantly reduced adult mortality in two large UK hospitals. In hospitalised children mortality is low, but there may be potential to reduce the morbidity associated with critical deterioration (CD). However, the risk models for adults are unsuitable for use in children because the signs associated with deterioration [heart rate, breathing rate, blood pressure], alter significantly across the age range. The aim is to evaluate whether this technology improves clinical outcomes for in-hospital deterioration, including sepsis in children. METHOD(S): ISRCTN61279068. https://bit.ly/36HtEGF Participants: Paediatric in-patients, aged less than 18 years at a tertiary hospital (240 beds). Intervention(s): Careflow Vitals and Connect app platform configured to incorporate the Alder Hey age-specific Paediatric Early Warning score (PEWS) and modified National Institute of Health and Clinical Excellence (NICE) Sepsis screening. The documentation of vital signs and clinical observations occur at the patient's bedside at intervals determined by the PEWS risk model. PEWS categorised CD risk as low, moderate, high and critical and provided targeted escalation advice and automated alerts to the Nurse in Charge of the shift and the responsible Clinical Teams. Primary Outcome:Emergency transfers to Critical Care (PICU/ HDU). RESULT(S): Prospective data collection baseline year March 2018 - February 2019 compared with 2 years postintervention March 2020-February 2022 (Extended due to COVID). Summary of results in Figure 1. CONCLUSION(S): The absolute number of CD and patients affected reduced by 29%. Associated review of the cases using the Predictability/Preventability framework showed reduction in the late recognition and CD with modifiable factors. (Figure Presented).

Testing and tracking in the UK: A dynamic causal modelling study [version 1;peer review: 1 approved with reservations, 1 not approved]

By equipping a previously reported dynamic causal modelling of COVID-19 with an isolation state, we were able to model the effects of self-isolation consequent on testing and tracking. Specifically, we included a quarantine or isolation state occupied by people who believe they might be infected but are asymptomatic—and could only leave if they test negative. We recovered maximum posteriori estimates of the model parameters using time series of new cases, daily deaths, and tests for the UK. These parameters were used to simulate the trajectory of the outbreak in the UK over an 18-month period. Several clear-cut conclusions emerged from these simulations. For example, under plausible (graded) relaxations of social distancing, a rebound of infections is highly unlikely. The emergence of a second wave depends almost exclusively on the rate at which we lose immunity, inherited from the first wave. There exists no testing strategy that can attenuate mortality rates, other than by deferring or delaying a second wave. A testing and tracking policy—implemented at the present time—will defer any second wave beyond a time horizon of 18 months. Crucially, this deferment is within current testing capabilities (requiring an efficacy of tracing and tracking of about 20% of asymptomatic infected cases, with 50,000 tests per day). These conclusions are based upon a dynamic causal model for which we provide some construct and face validation—using a comparative analysis of the United Kingdom and Germany, supplemented with recent serological studies. © 2020. Friston KJ et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Mask decontamination - a review of the literature

The COVID-19 pandemic caused by the SARS-CoV-2 virus has been responsible for 401,000 deaths worldwide (06/09/2020). Contact and droplet precautions must be taken to stop the spread of this virus, which is essentially transmitted by respiratory routes. Reprocessing units for medical devices (RUMEDs) have had to quickly adapt to the decontamination (reprocessing) of medical devices that had come into contact with COVID-19 patients. Moreover, to deal with shortages in their establishments, they have had to respond to demands for decontamination of single-use face masks and filtering facepiece respirators (FFRs). A comprehensive review of the literature was carried out to describe, analyse and discuss effective methods for decontamination of single-use masks. We can conclude that few studies have tested the overall decontamination process ranging from collection and sorting through cleaning and packaging to sterilization. While the range of mask models tested was limited, and further compounded by a low level of evidence, steam or hydrogen peroxide sterilization would appear to be the most appropriate processes in healthcare settings.

Involvement of a CETD in the COVID epidemic

The first COVID crisis had a considerable impact on the functioning of health establishments and Pain Structures (SD). The huge reorganization of the establishment, the confinement, the cessation of surgical activity and outpatient consultations led the team of the Center for the Assessment and Treatment of Pain (CETD) to adjust its activity. After analyzing the origins of the suffering of caregivers (double confinement, mental, emotional, sensory and physical overload) and in order to avoid or limit burnout, the CETD proposed “relaxation breaks” of 30 minutes accessible to all hospital staff and made available to staff all their material and human resources from 03/20/20 to 06/29/20. The sessions offered: deep dynamic waves, aromatherapy, relaxation, music therapy, virtual reality, auriculotherapy, chiropractic, massages, sophrology, hypnotic communication, informal debriefing. Results: 1233 visits were recorded representing all professions, mainly nurses (262), nursing assistants (174) and doctors (109). The reasons for the consultations were the search for relaxation, muscle “tension”, back pain or diffuse pain. This experience made it possible to highlight the importance of the consequences of the intense work of caregivers during the epidemic, the lack of management of their health problems and the interest of a psycho-bodily approach in these periods of crisis and compassion fatigue. © 2021 Elsevier Masson SAS

Second waves, social distancing, and the spread of COVID-19 across America

We recently described a dynamic causal model of a COVID-19 outbreak within a single region. Here, we combine several of these (epidemic) models to create a (pandemic) model of viral spread among regions. Our focus is on a second wave of new cases that may result from loss of immunity-and the exchange of people between regions-and how mortality rates can be ameliorated under different strategic responses. In particular, we consider hard or soft social distancing strategies predicated on national (Federal) or regional (State) estimates of the prevalence of infection in the population. The modelling is demonstrated using timeseries of new cases and deaths from the United States to estimate the parameters of a factorial (compartmental) epidemiological model of each State and, crucially, coupling between States. Using Bayesian model reduction, we identify the effective connectivity between States that best explains the initial phases of the outbreak in the United States. Using the ensuing posterior parameter estimates, we then evaluate the likely outcomes of different policies in terms of mortality, working days lost due to lockdown and demands upon critical care. The provisional results of this modelling suggest that social distancing and loss of immunity are the two key factors that underwrite a return to endemic equilibrium.

Physical Activity and Sedentary Behavior of Elderly Populations during Confinement: Results from the FRENCH COVID-19 ONAPS Survey.

Introduction: A national confinement was imposed in France in March 2020 during 55 days to prevent the spread of the virus and protect vulnerable people such as older individuals. This study aimed to describe the movement behaviors, and their determinants, of elderly people (≥ 65 years) during the confinement.Methods: An online survey was conducted from April 1st, 2020 to May 6th, 2020 by the National Observatory for Physical Activity and Sedentary behaviors. This study compared the level of physical activity (PA), sitting and screen time before and during the confinement and identified the impact of initial PA, sedentary profiles of the participants and housing conditions.Results: 1,178 people were included in this study. Reaching PA recommendations before lock-down was associated with the change in PA level during lock-down (p < .001). Besides, geographic location was associated with the change in PA, sitting time and screen time during lock-down (respectively p = .03, p = .02, p = .02).Conclusion: This study confirm the negative impact of confinement on senior movement behaviors, whether or not they met with public health recommendations prior to the pandemic. The housing conditions of older people must be also taken into future public health policies.

Rehabilitation Response to COVID-19: Optimizing Recovery and Social Reintegration for Military Beneficiaries

COVID-19 is a novel disease with complex primary and secondary health effects that may significantly impact the functional independence and quality of life of patients and their families. While the term "rehabilitation" is often associated with exercise, the interventions employed by rehabilitation professionals in both the inpatient and outpatient setting are much more complex and very relevant in caring for individuals hospitalized with respiratory infections. Since the start of the pandemic, the Department of Rehabilitation at Walter Reed National Military Medical Center has cared for over 85% of the military beneficiaries admitted to the hospital for COVID-19. In addition to providing acute inpatient occupational, physical, and recreational therapy to help maximize each patient's functional independence, the rehabilitation team has also developed a novel program to help facilitate the safe discharge and successful recovery and social reintegration for all patients with COVID-19. Using a holistic approach, a team led by Occupational Therapy has applied a needs-based assessment of each patient and developed an individualized treatment plan, which employs home monitoring, virtual health interventions, peer support, and augmentation to case management and behavioral health care. The overall acceptance and satisfaction of this program by the patients and staff has been excellent, with early evidence to suggest improved quality of life and possible mitigation of long-term complications. This article describes the development and essential elements of this unique rehabilitation program so that other military treatment facilities may consider implementing.

Effect of the COVID-19 lockdown on physical activity and sedentary behaviors in French children and adolescents: New results from the ONAPS national survey.

INTRODUCTION: In France March 14, 2020 a national lockdown was imposed in France for 55 days to prevent the spread of COVID-19 and all schools were closed. This study aimed to investigate the effects of home confinement as a result of  lockdown on the activity (physical activity and sedentary behaviors), and their determinants, on French children (6-10 years) and adolescents (11-17 years). METHODS: The National Observatory for Physical Activity and Sedentary behaviors launched an online survey from April 1st, to May 6th, 2020 using popular social networks and websites. It compared the level of physical activity (PA), sitting and screen time before and during the lockdown and identified the impact of the initial PA (active vs. inactive), sedentary (high vs. low) profiles of the participants and their housing conditions. RESULTS: 6,491 children were included in this study. Initially active children and adolescents decreased their PA more than those initially inactive (p>0.001), while those who met the sitting time recommendations increased more their sitting time during lockdown (p<0.001). The same applied to screen time (p<0.001). Living in an urban environment was associated with a decrease in PA (p<0.001), an increase in sitting time (p<0.001) and children's screen time (p=0.002) during lockdown. CONCLUSION: This study showed the deleterious effects of confinement caused by lockdown on physical activity and sedentary behaviors. Housing conditions were associated with lifestyle behaviors over this period of lockdown. Future public health policies should consider these results.

Involvement of hospital sterilization units in the Covid crisis-19

When the COVID-19 pandemic began, when no one had foreseen that it would spread so rapidly, unprecedented sterilisation problems were encountered in the operating room. The units had to adapt very quickly, while respecting the additional “droplet” precautions required to deal with the severe acute respiratory syndrome coronavirus 2. But also to implement alternative solutions to compensate for the shortage of equipment, medical devices and medicines, in accordance with the rules of proper use of pharmacies for indoor use. © 2020 z Au début de la pandémie de Covid-19, alors que personne n'avait envisagé qu'elle se répandrait aussi vite, des problématiques inédites de stérilisation ont été rencontrées au bloc opératoire z Il s'agissait pour les unités de s'adapter très rapidement, en respectant les précautions complémentaires “gouttelettes” exigées face au severe acute respiratory syndrome coronavirus 2 z Mais aussi de mettre en place des solutions alternatives pour pallier la pénurie d’équipements, de dispositifs médicaux et de médicaments, conformes aux règles de bonne utilisation des pharmacies à usage intérieur. © 2020

Online delivery of teaching and laboratory practices: Continuity of university programmes during COVID-19 pandemic

A great number of universities worldwide are having their education interrupted, partially or fully, by the spread of the novel coronavirus (COVID-19). Consequently, an increasing number of universities have taken the steps necessary to transform their teaching, including laboratory workshops into an online or blended mode of delivery. Irrespective of the measures taken, universities must continue to maintain their high academic standards and provide a high-quality student experience as required for delivery of learning outcomes associated with each degree programme. This has created a challenge across the higher education landscape, where academics had to switch to remote teaching and different approaches to achieving laboratory delivery. As a result, students have not been receiving face-to-face teaching, and access to laboratory facilities has been limited or nearly impossible. This paper reviews numerous approaches taken by universities to deliver teaching and laboratory practices remotely, in consideration of the COVID-19 pandemic, whilst also considering the potential impacts on the student learning experience. This review is primarily focused on the fields of engineering, science and technology, based on published literature including books, reviewing web-based provision of selected universities, institutional and national policy documents. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.