The Impact of Technology and Quality Improvement on Hba1c at a National Level

Background and Aims: Denmark started a national improvement project focusing on childhood diabetes in spring 2020 at the very beginning of the Covid-19 pandemic. This study reports the development in glycemic control and BMI for the years 2020 +/- 2022 a period where also new automated insulin delivery systems were introduced in Denmark. Method(s): Data are retrieved from the quality improvement data from each visit 2019-2022. Children age 0-17.9 years were included. Serial diagrams were used to follow quality indicators month by month. Definition of overweight was BMI above 2 standard deviation (SD) according to age and sex. Result(s): All 16 clinics in Denmark participated and during the period 3 seminars were held and 8 webinars of 1-2 hours. During the webinars different clinics presented their projects and material and ideas were shared. During the study period between 377 +/- 938 single HbA1c values per month were reported and contributed to the serial diagrams. There was a significant decline in mean HbA1c from 2019 (mean of 58.3 mmol/mol) to september 2021 (54 mmol/mol) and an increase in all age groups obtaining treatment goal below 53 mmol/l. There was an increase in the percentage of children with BMI above 2SD. Conclusion(s): There was signs of decrease in HbA1c from the beginning of 2021 after 9 months with quality improvement and just as automatic insulin delivery was introduced with a simultaneous increase in BMI.

Minding the pandemic A CSR perspective on patterns in Muslim religious responses to COVID-19

This article analyses clusters of Muslim responses to the COVID-19 pandemic in a theoretical framework provided by the cognitive science of religion. The responses include theological reflections on the origin, nature, and religious significance of the dis-ease, religious justifications for restrictions on communal worship, apologetics in the light of COVID-19, and how aspects of the COVID-19 pandemic relate to issues of purity, impurity, and contagion. This article places the responses in a wider theoretic al context that contributes to explaining their emergence as cultural repre-sentations, and, as a consequence, may promote further comparative research into responses to the COVID-19 pandemic in other religious traditions.

Hypercoagulation by rotational thromboelastometry (ROTEM) predicts mortality in COVID-19: A prospectiveobservational study

Background : Severe disease due to COVID-19 has been shown to be associated with coagulopathy with a high rate of micro-and macrothrombosis, and early identification of prothrombotic patients may guide treatment. Rotational Thromboelastometry (ROTEM) is an established point-of-care (POC) blood test, used for detecting and monitoring hypo-and hypercoagulation. Aims : The primary aim of this study was to assess whether analysis by ROTEM alone or in combination with other risk markers can be a predictor of mortality in COVID-19. Methods : This was a single center, prospective, observational study where COVID-19 positive patients over 18 years in need of hospitalization were eligible for inclusion. Conventional coagulation tests and ROTEM were taken day 1-3 after hospital admission and patients were followed for 30 days. A logistic regression approach was applied to the ROTEM data and possible important covariates. Results : 141 patients were included, 62 % men, median age 63 years. 18 patients (13%) died within 30 days. Comorbidities were common, and most patients had laboratory markers indicating hypercoagulation (e.g. d-dimer, P-fibrinogen and ROTEM). The logistic model presented that the risk of death within 30 days for a patient hospitalized due to COVID-19 was increased with increased age, respiratory frequency and the ROTEM variable EXTEM-MCF (all predictors P < 0.05). When the model is applied to the data, the ROC curve AUC is 0.91. FIGURE 1 Predicted probability of death vs risk score Figure 1. Prediction model using logistic regression. Distribution of patients across range of risk scores, with the three predictor variables at inclusion (EXTEM-MCF, age and respiratory frequency). In lower part of figure, a histogram showing the distribution of risk scores for the present data. Conclusions : The results support that hypercoagulation in COVID-19, as measured using ROTEM, is associated with an increased risk of death. In our prediction model, increased EXTEM-MCF, age and respiratory frequency on admission were associated with increased mortality within 30 days.