ABSTRACT
COVID-19 had an unprecedented effect on acute stroke services, both directly and indirectly. Intracerebral haemorrhage (ICH) appears to be increasing as a percentage of stroke patients post COVID-19 and is reported to have risen in Grampian from 13.6% of total strokes in 2019, to 17.7% in 2021. In this descriptive analysis we use the NHS Grampian Stroke audit data to explore the factors which could have contributed to this rise. The number of ICH patients on anticoagulation increased from 16.7% in 2019 to 18.4% in 2021. Of these, the proportion on a direct oral anticoagulant (DOAC) has increased from 66.7% in 2018 to 78.3% in 2021. Of the patients that were on anticoagulation, the proportion with a diagnosis of hypertension was similar between 2019 (52.9%) and 2021 (52.0%) but rose to 60% in 2022. In 2019, all ICH patients diagnosed with hypertension were on an antihypertensive. Whereas, in 2021 23.1% of ICH patients had a diagnosis of hypertension but were not on any antihypertensive treatment. The rise in the number of intracerebral haemorrhages post COVID-19 will likely be multifactorial. In this descriptive analysis there appears to be an increase in the number of ICH patients on anticoagulation, and also an increase in patients with untreated hypertension. Potential confounders include excess alcohol use or stress both of which increase the risk of ICH and are known to have risen during COVID-19.
ABSTRACT
Healthcare workers are at high risk of contracting infections including COVID-19 due to close and frequent contact with patients. To promote appropriate use of personal protective equipment (PPE) and to enhance protection of healthcare workers during the COVID-19 pandemic, we trained a team of registered nurses to serve as "PPE Spotters”. This team offered in-person observation, support, feedback, and on-the-spot teaching about proper PPE use and hand hygiene practices. Evaluation showed staff and leaders felt the Spotters effectively promoted best practices for PPE and hand hygiene, and 86% recommended the program continue. PPE Spotters now serve a formal role in the organization, supporting both acute and long-term care.
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P18 Figure 1The percentage of exacerbations with bacteria detected in sputum by qPCR, according to respiratory virus identified at exacerbation, at a) exacerbation onset (n=30) and at b) two weeks (n=11). HI = H. influenzae, SP = S. pneumoniae, MC = M. catarrhalis. RV = rhinovirus, HCV = human coronaviruses, FluA = influenza A, Other = a combination of the other viral exacerbations[Figure omitted. See PDF]ConclusionsSecondary bacterial outgrowth occurs in COPD exacerbations caused by a range of respiratory viruses suggesting that viral infection results in microbiome dysbiosis. Bacterial qPCR detected several bacteria that were not identified using standard microbiological culture with a high bacterial load and Moraxella detection at two weeks Bacterial overgrowth may explain why some exacerbations show prolonged recovery.
ABSTRACT
The aim of this study was to describe the patient's characteristics and clinical course of CAPA and to investigate possible association of Dexamethasone with CAPA incidence. This is a retrospective descriptive study. All adult patients in GGC NHS with laboratory proven SARS-CoV-2 infection who subsequently had Aspergillus species isolated from their respiratory samples between 01/02/20 and 31/01/21were included. A total of 24 patients fulfilled the inclusion criteria.79% of the cases were between October/2020-January/2021 coinciding with the second wave of COVID-19 and the increased use of steroids after the RECOVERY trial results. Based on the proposed screening and diagnostic algorithm for CAPA and Modified AspITU classification, 6 patients had likely/putative, and 2 patients had highly likely/probable CAPA, respectively. Based on the CAPA algorithm, for 11 patients CAPA was not excluded and 5 considered colonization. Based on Modified AspITU, 10 considered query Putative CAPA and 6 colonization. 13 patients were males. The median age was 62. 46% of patients had underlying lung disease, 20% had previous exposure to inhaled steroids, 8% to Methotrexate, 4% to each of systemic steroids and Rituximab. 79% of patients received Dexamethasone and 12.5% received Tocilizumab for COVID-19. 75% of patients were in ITU at time of first Aspergillus isolation. 67% of patients received antifungal for CAPA. CAPA remains an area of research. From our limited data, we observed an association between Dexamethasone use and incidence of CAPA. We also noticed a correlation between the number of samples with positive Aspergillus species culture from the same patient and the likelihood of CAPA diagnosis.
ABSTRACT
The ongoing coronavirus disease 2019 (COVID-19) pandemic affects the Canadian Armed Forces (CAF) and its members in multiple ways. As the CAF manages its own healthcare system for its members, it must consider the impact of COVID-19 not only on the operational effectiveness of its workforce but also on its healthcare operations. Furthermore, given that the CAF has deployed task forces in support of other government departments, including into long-term care facilities that are experiencing outbreaks, it is important for the CAF to maintain situational awareness of the outbreak in the Canadian population generally. In providing analytical support to the CAF on these questions, we focused on establishing the applicability of estimates of COVID-19 infection fatality rates (IFRs) from the literature to the CAF and to the Canadian public. This paper explores how the age-dependent effects of COVID-19 must be taken into account when comparing estimates based on countries with very different age profiles, such as China and Italy. Furthermore, it explores how varying age structures within a country (e.g., within a subnational jurisdiction, or within a given working population) should affect how analysts apply estimates of IFR to scenarios involving those specific populations. Copyright: © 2021 Her Majesty the Queen in Right of Canada, Department of National Defence
ABSTRACT
Background: Never before have clinical trials drawn as much public attention as those testing interventions for COVID-19. We aimed to describe the worldwide COVID-19 clinical research response and its evolution over the first 100 days of the pandemic. Methods: Descriptive analysis of planned, ongoing or completed trials by April 9, 2020 testing any intervention to treat or prevent COVID-19, systematically identified in trial registries, preprint servers, and literature databases. A survey was conducted of all trials to assess their recruitment status up to July 6, 2020. Results: Most of the 689 trials (overall target sample size 396,366) were small (median sample size 120;interquartile range [IQR] 60-300) but randomized (75.8%;n=522) and were often conducted in China (51.1%;n=352) or the USA (11%;n=76). 525 trials (76.2%) planned to include 155,571 hospitalized patients, and 25 (3.6%) planned to include 96,821 health-care workers. Treatments were evaluated in 607 trials (88.1%), frequently antivirals (n=144) or antimalarials (n=112);78 trials (11.3%) focused on prevention, including 14 vaccine trials. No trial investigated social distancing. Interventions tested in 11 trials with >5,000 participants were also tested in 169 smaller trials (median sample size 273;IQR 90-700). Hydroxychloroquine alone was investigated in 110 trials. While 414 trials (60.0%) expected completion in 2020, only 35 trials (4.1%;3,071 participants) were completed by July 6. Of 112 trials with detailed recruitment information, 55 had recruited <20% of the targeted sample;27 between 20-50%;and 30 over 50% (median 14.8% [IQR 2.0-62.0%]). Conclusions: The size and speed of the COVID-19 clinical trials agenda is unprecedented. However, most trials were small investigating a small fraction of treatment options. The feasibility of this research agenda is questionable, and many trials may end in futility, wasting research resources. Much better coordination is needed to respond to global health threats.