Can guidelines rein in oxygen use? A retrospective cross-sectional study using routinely collected data.

Oxygen is one of the most commonly used emergency therapies. Like other therapies, oxygen can cause harm if used inappropriately. During the COVID-19 pandemic, guidelines were released to optimize oxygen and medication use. In the current study, we examine whether oxygen and medication use during the first wave of the COVID-19 pandemic was in concordance with new guidelines. A retrospective cross-sectional study was conducted using routinely collected data from University of Birmingham NHS Foundation Trust in England. Patients were admitted between April 2020 and September 2020, were over the age of 18 years, and had a confirmed diagnosis of COVID-19. To assess adherence to the oxygen guidelines (i.e. SpO2 adherence), the percentage of times oxygen therapy was administered within, over, and under guideline specifications were calculated for patients overall, and then for patients with and without chronic obstructive pulmonary disease (COPD)/pulmonary disease separately. Next, two multinomial regression analyses were conducted to assess whether clinical processes, pre-admission diagnoses, and other demographic factors were related to oxygen use. Analysis 1 included patients not diagnosed with COPD/pulmonary disease. Analysis 2 included patients diagnosed with COPD/pulmonary disease. Results are reported as tallies, percentages, and odds ratios with 95% confidence intervals. To assess adherence to a new medication guideline, the percentage of patients administered oxygen and dexamethasone was calculated for those admitted after 25 June 2020. The overall number of patients included in our SpO2 adherence analyses was 8751 (female = 4168). Oxygen was used within guideline specifications less than half the time, i.e. 41.6% (n = 3638/8751); non-adherence involving under-administering (3.5%, n = 304/8751) was markedly lower than over-administering (55.0%, n = 4809/8751). Adherence was higher for patients without COPD (43.7%, n = 3383/7741) than with COPD (25.2%, n = 255/1010). Under-administering was low across groups (non-COPD 3.5%, n = 274/7741 and COPD 2.9%, n = 30/1010). Over-administering was markedly lower for non-COPD (52.3%, n = 4084/7741) than COPD (71.8%, n = 725/1010) patients. Diagnoses associated with over-administering varied across the groups. Regarding the dexamethasone guidelines, of the 6397 patients admitted after the 24th of June, only 12.6% (n = 805) received dexamethasone. Suboptimal use of oxygen and medication were common during the first wave of the COVID-19 pandemic. As found in previous studies, over-administering was more common than under-administering. The new guidelines issued during the COVID-19 pandemic were not by themselves sufficient to optimize oxygen use. Behavioural strategies are explored which may help policymakers optimize oxygen use.

A workshop to co-design messages that may increase uptake of vaccines: A case study.

The present case study describes a co-produced and theoretically informed workshop wherein messages were co-designed to increase the uptake of future COVID-19 vaccines in the United Kingdom. Co-design can enhance the legitimacy and effectiveness of public interventions, but many researchers, service providers, and policymakers may be uncertain where to start. This demonstrative example applies behavioural science and design thinking theory, illustrating how others can integrate theoretically informed co-design into similar and more complex projects efficiently. The workshop brought together members of the public, immunisers, and public health specialists. A narrative analysis was conducted to identify themes related to vaccine hesitancy. The workshop's supporting materials are made available as supplemental materials, which can be modified for future workshops. The discussion encourages additional workshops to be conducted, including diverse members of the public, to co-design novel solutions to improve public health more generally.

A systematic review of hand-hygiene and environmental-disinfection interventions in settings with children.

BACKGROUND: Helping adults and children develop better hygiene habits is an important public health focus. As infection causing bacteria can live on one's body and in the surrounding environment, more effective interventions should simultaneously encourage personal-hygiene (e.g. hand-hygiene) and environmental-disinfecting (e.g. cleaning surfaces). To inform the development of a future multi-faceted intervention to improve public health, a systematic literature review was conducted on behavior change interventions designed to increase hand-hygiene and environmental-disinfecting in settings likely to include children. METHODS: The search was conducted over two comprehensive data-bases, Ebsco Medline and Web of Science, to locate intervention studies that aimed to increase hand-hygiene or environmental-disinfecting behavior in settings likely to include children. Located article titles and abstracts were independently assessed, and the full-texts of agreed articles were collaboratively assessed for inclusion. Of the 2893 titles assessed, 29 met the eligibility criteria. The extracted data describe the Behavior Change Techniques (version 1) that the interventions employed and the interventions' effectiveness. The techniques were then linked to their associated theoretical domains and to their capability-opportunity-motivation (i.e., COM-B model) components, as described in the Behavior Change Wheel. Due to the heterogeneity of the studies' methods and measures, a meta-analysis was not conducted. RESULTS: A total of 29 studies met the inclusion criteria. The majority of interventions were designed to increase hand-hygiene alone (N = 27), and the remaining two interventions were designed to increase both hand-hygiene and environmental-disinfecting. The most used techniques involved shaping knowledge (N = 22) and antecedents (N = 21). Interventions that included techniques targeting four or more theoretical domains and all the capability-opportunity-motivation components were descriptively more effective. CONCLUSIONS: In alignment with previous findings, the current review encourages future interventions to target multiple theoretical domains, across all capability-opportunity-motivation components. The discussion urges interventionists to consider the appropriateness of interventions in their development, feasibility/pilot, evaluation, and implementation stages. REGISTRATION: Prospero ID - CRD42019133735.

Differential outcomes facilitate same/different concept learning.

Commonly recognized, the training procedure one employs often affects the results they obtain. Here, we demonstrate for the first time that abstract-concept learning is affected by employing a differential-outcomes procedure. The differential-outcome effect has been shown to occur for item-specific strategies but has not been established for relational strategies. To test whether different-outcome expectancies can facilitate a relational strategy, eight pigeons were trained and tested in a two-item same/different task with pictures. After pecking an upper picture, they pecked a lower picture if the pictures were the same or a white rectangle if the pictures were different. Two groups of pigeons were rewarded with either different outcomes (sounds and food amounts) or same outcomes. Both groups were trained to criterion with successively larger picture sets (8-1,024 items) and were transfer tested with novel pictures following each acquisition. With the smallest training sets, neither group showed any novel-stimulus transfer. But after acquiring the task with 32 pictures, the different-outcomes group responded more accurately to novel pictures than the same-outcome group. As the training set-size increased, both groups' transfer performance converged and became equivalent to training performance. These results show for the first time that training with different outcomes facilitates abstract-concept learning.