High mortality among patients with severe COVID-19 and Do Not Intubate orders

INTRODUCTION. Moderate to severe respiratory distress among patients with COVID-19 is associated with a high mortality. This study evaluated ventilator support and mortality by Do Intubate (DI) or Do Not Intubate (DNI) orders. METHODS. This was a retrospective study of patients with COVID-19 and a supplemental oxygen requirement of 15 l/min. The patients were divided into two groups corresponding to the first and second wave of COVID-19 and were subsequently further divided according to DI and DNI orders and analysed regarding need of ventilator support and mortality. RESULTS. The study included 178 patients. The mortality was 24% for patients with DI orders (n = 115) and 81% for patients with DNI orders (n = 63) increasing to 98% (n = 46) for patients with DNI orders and very high flow oxygen requirements ( 30 l/min.). From the first to the second wave of COVID-19, the use of constant continuous positive airway pressure (cCPAP) increased from 71% to 91% (p < 0.001), whereas the use of mechanical ventilation decreased from 54% to 28% (odds ratio = 0.38 (95% confidence interval: 0.17-0.85)). CONCLUSION. The mortality was high for patients with DNI orders and respiratory distress with very high levels in supplemental oxygen in both the first and second wave of COVID-19 despite an increase in use of cCPAP and treatment with dexamethasone and remdesivir during the second wave. Hence, careful evaluation on transition to palliative care must be considered for these patients.

Stillbirth during a pandemic: a retrospective cohort study in a high-risk population

Objective: To examine the rate of stillbirth in a high-risk population at a single institution during the initial twelve months of the COVID-19 pandemic. Study Design: Stillbirths, defined as fetal demise at 20 weeks gestation or greater, were identified during the study period and compared to total deliveries at the institution. Seventy-six stillbirths were identified, 26 in the prepandemic cohort and 50 in the pandemic cohort. Demographic and pregnancy information for each stillbirth dyad was extracted by chart review. Patient outcomes were compared between the prepandemic cohort and the pandemic cohort. Result(s): The rate of stillbirth in the pandemic cohort was 19.3 per 1000 versus the prepandemic cohort rate of 8.9 per 1000 (p < 0.001). The pandemic cohort established prenatal care at a later gestational age (p = 0.049), was less likely to have adequate prenatal care (p=0.013) and was less likely to have established care with a maternal-fetal medicine specialist (p = 0.025). Conclusion(s): Stillbirths increased significantly at a tertiary care center in a high-risk population during the initial twelve months of the COVID-19 pandemic. Our findings suggest a relationship between inadequate prenatal care and perinatal outcomes during the COVID-19 pandemic. Disclosure: No Copyright © 2022

Insights from Design Processes Used in Developing Exergames

Participation rates in physical activity are low, and with gyms closing and lockdowns becoming a necessary tool to fight the global pandemic, evidence suggests COVID-19 is only exacerbating the issue. People are becoming more sedentary as they stay at home longer and do more home office work. Exergames-games that require physical exertion to play-hold promise to combat sedentary behaviours, since they are typically inexpensive and can be played at home. Despite their potential to motivate people to move, it is challenging to design exergames because they must strike a balance between exercise and play. Current research in exergames provides some advice and guidelines on best practices for developing movement-based games. But, to date little attention has been given to the design processes that lead to the development of these guidelines. This paper aims to fill this gap by contributing 1) an in-depth discussion of and insights gained from the design process used when developing an exergame and 2) a novel movement-based method used in the development of a virtual reality (VR) exergame-VR bodystorming. We illustrate these methods through the development of Diverging Squash (DS), a novel VR squash game. We reveal insights throughout the entire design process from the beginning stages using brainstorming to focus on players' needs and motivation for physical activity, to using exertion cards for framing the game's primary elements. Exertion cards, for example, aided in our decision to gradually increase the difficulty of the game during play. We further demonstrate how our novel VR bodystorming method, or bodystorming in a virtual environment while wearing a VR headset, can be a useful tool for designers. For instance, during a VR bodystorming session, we practiced holding a virtual paddle in the VR environment in different ways. Insights from the way it was being held in VR led to adjustments to the way the paddle should be gripped, and the force needed to hit the ball. We conclude with key takeaways that give designers a view into how design methods for exergames are applied in practice and, thus, how they can be used in their own work.