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Stigmatisation and workplace violence against healthcare workers: the need for evidence-based preventive strategies

Por: Chowdhury · S. R.

Commentary on: Saragih ID, Tarihoran DETAU, Rasool A, Saragih IS, Tzeng HM, Lin CJ. Global prevalence of stigmatization and violence against healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. J Nurs Scholarsh. 2022;54(6):762–71. doi: 10.1111/jnu.12794. Epub 12 Jul 2022.

Implications for practice and research

  • Health administrators and policymakers should appropriately address issues of stigmatisation and violence against healthcare workers through strategic planning that considers the unique nature of the workplace as well as local culture to ensure better healthcare for the patients.

  • Future research should focus on synthesising evidence-based preventive strategies and management protocols to avert the escalation of stigmatisation and violence towards healthcare workers during catastrophic public health crises.

  • Context

    Violence in the workplace is a common issue in healthcare settings. However, since the beginning of the COVID-19 pandemic, there has been an increase in the number of reports in...

    Oxygen supplementation above a low-flow nasal cannula in patients with COVID-19 may improve arterial oxygen levels but not breathlessness

    Por: Prakash · J. · Sahay · N.

    Commentary on: Poncin W, Baudet L, Braem F, Reychler G, Duprez F, Liistro G, Belkhir L, Yombi JC, De Greef J. Systems on top of nasal cannula improve oxygen delivery in patients with COVID-19: a randomized controlled trial. J Gen Intern Med 2022;37(5):1226–32. doi: 10.1007/s11606-022-07419-2. Epub 8 Feb 2022.

    Implications for practice and research

  • The adverse consequences of continuous exposure to high concentrations of oxygen must be considered before instituting prolonged oxygen therapy in patients with COVID-19.

  • Hypoxaemia is significant in patients with COVID-19, and isolated arterial oxygen pressure (PaO2) improvement may not necessarily translate into any significant survival benefit nor relieve the distress of breathlessness.

  • Context

    Oxygen therapy is important in COVID-19 management. The low-flow nasal cannula (NC) has some drawbacks. The patient’s peak inspiratory flow rate requirements are not met due to significant leakage around the source. A need to improve oxygen...

    People affected by dementia had mixed experiences of using technology during COVID-19

    Por: Pessoa Lima · D. · Rosa · I. D.

    Commentary on: Chirico I, Giebel C, Lion K, Mackowiak M, Chattat R, Cations M, Gabbay M, Moyle W, Pappadà A, Rymaszewska J, Senczyszyn A, Szczesniak D, Tetlow H, Trypka E, Valente M, Ottoboni G. Use of technology by people with dementia and informal carers during COVID-19: A cross-country comparison. Int J Geriatr Psychiatry. 2022 Sep;37(9). doi: 10.1002/gps.5801.

    Implications for practice and research

  • Consider patient and caregiver preferences for using technology.

  • Offer training on the use of technology.

  • Provide the most suitable schedule for caregivers.

  • More multicentre randomised controlled trials are needed to assess the feasibility of telehealth in different stages of dementia.

  • Context

    The COVID-19 pandemic brought to light the need to adopt technology in healthcare systems worldwide due to the need for physical distancing and isolation measures, especially in the older adult group.1 2 Several studies have...

    Sources of vaccine information may have role in decreasing hesitancy among healthcare workers in UK toward receiving COVID-19 regularly

    Por: Pal · S.

    Commentary on: Veli N, Martin CA, Woolf K, Nazareth J, Pan D, Al-Oraibi A, Baggaley RF, Bryant L, Nellums LB, Gray LJ, Khunti K, Pareek M; UK-REACH Study Collaborative Group. Hesitancy for receiving regular SARS-CoV-2 vaccination in UK healthcare workers: a cross-sectional analysis from the UK-REACH study. BMC Med. 2022 Oct 10;20(1):386. doi: 10.1186/s12916-022-02588-7.

    Implications for practice and research

  • Understanding the sources of information as drivers of acceptance toward a regular COVID-19 vaccine could allow for targeted messaging to improve uptake.

  • Further research is needed to assess if the trends in intended hesitancy toward potential regular vaccines translates to vaccination behaviour.

  • Context

    Mass vaccination against COVID-19 has been one of the key measures to combat the spread of COVID-19. Initial vaccines have been highly efficacious in reducing infection prevalence and mortality. However, the emergence of variant strains and waning of immunity from initial vaccination...

    One-third of nurses intend to leave their job because of the COVID-19 pandemic

    Por: de Cordova · P. B. · Reilly · L.

    Commentary on: Ulupınar F, Erden Y. Intention to leave among nurses during the COVID-19 outbreak: A rapid systematic review and Meta-Analysis. J Clin Nurs. 2022 Nov 27. doi: 10.1111/jocn.16588. Epub ahead of print.

    Implications for practice and research

  • During COVID-19, nurses experienced stress, anxiety and fear. Psychological support will help retain staff.

  • Further longitudinal studies on the long-term psychological impacts of the pandemic are needed.

  • Context

    The impact of the COVID-19 pandemic on nurses was unprecedented with high volumes of critically ill patients. This strain on direct care nurses included an increased workload, long hours, separation from family, potential exposure and patient death.1 These factors impacted nurses’ psychological well-being and led to increased reports of nurses intending to leave their jobs. This rapid systematic review and meta-analysis aimed to synthesise the literature of rate of nurses’ intent to leave their job from...

    What we can learn from paediatric ED visit changes during pandemics and epidemics

    Por: Rahman · N. · Pines · J. M.

    Commentary on: Roland D, Gardiner A, Razzaq D, Rose K, Bressan S, Honeyford K, Buonsenso D, Da Dalt L, De T, Farrugia R, Parri N, Oostenbrink R, Maconochie IK, Bognar Z, Moll HA, Titomanlio L, Nijman RGG; in association with the REPEM network (Research in European Paediatric Emergency Medicine) as part of the EPISODES Study. Influence of epidemics and pandemics on paediatric ED use: a systematic review. Arch Dis Child. 2023 Feb;108(2):115–122. doi: 10.1136/archdischild-2022-324108. Epub 2022 Sep 26.

    Implications for practice and research

  • Healthsystems must be prepared for paediatric emergency department (ED) volume shifts during epidemics and pandemics.

  • Two interventions to increase efficient paediatric ED use include: (1) parental education about home care and (2) real-time remote advice.

  • Context

    Epidemics and pandemics have major impacts on ED care. Studies examining the COVID-19 pandemic noted large early US ED visit declines.1 In some...

    Need to reduce anxiety and obtain individualised information are considered the main supportive components of parents/caregivers of children with cancer through the COVID-19 pandemic in the UK

    Por: Ebrahimpour · F.

    Commentary on: Collaco N, Gamble A, Morgan JE, Phillips B, Culliford D, Darlington AS. Experiences and support needs of parents/caregivers of children with cancer through the COVID-19 pandemic in the UK: a longitudinal study. Arch Dis Child. 2023 Mar;108(3):198–203. doi: 10.1136/archdischild-2022-324905. Epub 2022 Nov 30.

    Implications for practice and research

  • To teach paediatric oncology nurses how to provide child-family-centred care based on specific needs.

  • To spark research ideas on nursing interventions for anxiety in children with cancer and their families.

  • Context

    The study based on literature mentions that parents/caregivers of children with cancer have additional worries about the potential impact of COVID-19 on their children’s health. It was conducted to identify the experiences, information and support needs of parents/caregivers of children with cancer throughout the different stages of the COVID-19 pandemic in the UK.

    Methods

    The study used an online survey including...

    Examining the health and functioning status of medical laboratory professionals in Ontario, Canada: an exploratory study during the COVID-19 pandemic

    Por: Joncic · G. · Jain · M. · Chattu · V. K. · Gohar · B. · Nowrouzi-Kia · B.
    Objectives

    This study aims to explore the overall and specific aspects of the functioning of medical laboratory professionals (MLPs) in Ontario, Canada during the COVID-19 pandemic.

    Design

    A cross-sectional analysis where a questionnaire was used to assess the mental status of MLPs.

    Setting

    An online questionnaire administered in Ontario, Canada.

    Participants

    632 MLPs (medical laboratory technologists, technicians and assistants) were included.

    Main outcome measures

    We employed the WHO Disability Assessment Schedule V.2.0 (WHODAS V.2.0) Questionnaire to assess functioning/disability and Copenhagen Psychosocial Questionnaire, third edition for psychosocial workplace factors. Multiple regression analysis examined the relationship between overall and specific domain functioning scores and psychosocial workplace factors.

    Results

    Of the total 632 participants, the majority were female gender and Caucasian. It was found that health (β=2.25, p

    Conclusion

    This study provides preliminary evidence of the overall and specific aspects of functioning among the MLPs during the COVID-19 pandemic. Besides, these findings can support and guide the improvement of workplace practices and policies among MLPs in the future.

    Association between social isolation and loneliness with COVID-19 vaccine uptake in Japan: a nationwide cross-sectional internet survey

    Por: Ukai · T. · Tabuchi · T.
    Objectives

    We examined the association between social isolation and loneliness, increasingly recognised but neglected social determinants of health, with being unvaccinated against COVID-19.

    Design

    This was a cross-sectional study.

    Setting and participants

    A representative cohort of 22 756 individuals (aged 15–81 years) from the general Japanese population who responded to both the Japan COVID-19 and Society Internet Survey 2021 and Japan Society and New Tobacco Internet Survey 2022.

    Primary and secondary outcome measures

    We calculated the ORs of remaining unvaccinated against COVID-19 in 2022, attributable to social isolation as assessed by the Lubben Social Network Scale, or loneliness as evaluated by the University of California, Los Angeles Loneliness Scale version 3. Reasons for abstaining from vaccination were solicited from the unvaccinated respondents. A multivariable logistic regression model was conducted with adjustments for demographic variables. Propensity score-matched comparisons were conducted as part of the sensitivity analysis.

    Results

    Individuals with social isolation were more likely to be unvaccinated (OR 1.48, 95% CI 1.37 to 1.60), while individuals with loneliness were not (OR 0.96, 95% CI 0.88 to 1.05). Socially isolated individuals were significantly less likely to receive information from people who had been vaccinated (11% vs 15%) and less likely not to trust the vaccine approval process (19% vs 27%) compared with those who were not socially isolated.

    Conclusions

    Despite not harbouring negative perceptions of the vaccine, socially isolated individuals exhibited lower rates of COVID-19 vaccination. Socially isolated individuals are important targets to reach to increase the number of vaccinated individuals.

    Interventions to reduce interpersonal stigma towards patients with a mental dysregulation for ambulance and emergency department healthcare professionals: review protocol for an integrative review

    Por: Van de Glind · G. · Galenkamp · N. · Bleijenberg · N. · Schoonhoven · L. · Scheepers · F. E. · Crilly · J. · van Veen · M. · Ham · W. H. W.
    Introduction

    Worldwide, there is an increase in the extent and severity of mental illness. Exacerbation of somatic complaints in this group of people can result in recurring ambulance and emergency department care. The care of patients with a mental dysregulation (ie, experiencing a mental health problem and disproportionate feelings like fear, anger, sadness or confusion, possibly with associated behaviours) can be complex and challenging in the emergency care context, possibly evoking a wide variety of feelings, ranging from worry or pity to annoyance and frustration in emergency care staff members. This in return may lead to stigma towards patients with a mental dysregulation seeking emergency care. Interventions have been developed impacting attitude and behaviour and minimising stigma held by healthcare professionals. However, these interventions are not explicitly aimed at the emergency care context nor do these represent perspectives of healthcare professionals working within this context. Therefore, the aim of the proposed review is to gain insight into interventions targeting healthcare professionals, which minimise stigma including beliefs, attitudes and behaviour towards patients with a mental dysregulation within the emergency care context.

    Methods and analysis

    The protocol for a systematic integrative review is presented, using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols recommendations. A systematic search was performed on 13 July 2023. Study selection and data extraction will be performed by two independent reviewers. In each step, an expert with lived experience will comment on process and results. Software applications RefWorks-ProQuest, Rayyan and ATLAS.ti will be used to enhance the quality of the review and transparency of process and results.

    Ethics and dissemination

    No ethical approval or safety considerations are required for this review. The proposed review will be submitted to a relevant international journal. Results will be presented at relevant medical scientific conferences.

    PROSPERO registration number

    CRD42023390664 (https://www.crd.york.ac.uk/prospero/).

    Impact of the COVID-19 pandemic on the cost of chronic diseases treatment and care at public hospitals in Wallaga zones, Oromia Regional State, Ethiopia: a hospital-based, cross-sectional study

    Por: Terefa · D. R. · Tesfaye · E. · Tolessa · B. E. · Desisa · A. E. · Olani · W. · Fetensa · G. · Chego · M. · Abdisa · E. · Turi · E. · Bekuma · T. T. · Getachew · M. · Tesfaye · L. · Tilahun · T.
    Objective

    Globally, around one-third of the population has at least one long-term health condition that could be affected by the COVID-19 pandemic. Despite the fact that studies have revealed the direct impact of COVID-19 on healthcare provision and utilisation, the impact of the pandemic on the cost of chronic disease treatment and care from a patient perspective was scanty. So, the study aimed to determine the impact of the COVID-19 pandemic on cost of chronic diseases treatment and care at public hospitals in Wallaga zones, Oromia Regional State, Ethiopia, from 1 August to 31 August 2020.

    Methods

    An institutional-based cross-sectional study design was used, and the sample size for the study (n=642) was determined using a single population mean formula. Data were collected using interviews and analysed using SPSS V.25. Descriptive statistics were performed, and the cost of follow-up care before and after the pandemic was compared using a related-samples Wilcoxon signed-rank test, declaring the level of significance of the median cost difference at p

    Results

    A total of 642 patients were included in the study, of whom 605 (94.2%) responded to the interviews. There was a significant median cost difference (n=593, Z=5.05, p=0.001) between the cost of chronic diseases among follow-up patients during the pandemic and the costs incurred by these patients before the pandemic.

    Conclusion

    The cost of follow-up care among chronic disease patients during the COVID-19 pandemic was significantly higher compared with before the pandemic era. Therefore, healthcare providers should arrange special fee waiver mechanisms for chronic disease healthcare costs during such types of pandemics and provide the services at proximal health facilities.

    Systematic review of seroprevalence of SARS-CoV-2 antibodies and appraisal of evidence, prior to the widespread introduction of vaccine programmes in the WHO European Region, January-December 2020

    Por: Vaughan · A. · Duffell · E. · Freidl · G. S. · Lemos · D. S. · Nardone · A. · Valenciano · M. · Subissi · L. · Bergeri · I. · K Broberg · E. · Penttinen · P. · Pebody · R. · Keramarou · M.
    Objectives

    Systematic review of SARS-CoV-2 seroprevalence studies undertaken in the WHO European Region to measure pre-existing and cumulative seropositivity prior to the roll out of vaccination programmes.

    Design

    A systematic review of the literature.

    Data sources

    We searched MEDLINE, EMBASE and the preprint servers MedRxiv and BioRxiv in the WHO ‘COVID-19 Global literature on coronavirus disease’ database using a predefined search strategy. Articles were supplemented with unpublished WHO-supported Unity-aligned seroprevalence studies and other studies reported directly to WHO Regional Office for Europe and European Centre for Disease Prevention and Control.

    Eligibility criteria

    Studies published before the widespread implementation of COVID-19 vaccination programmes in January 2021 among the general population and blood donors, at national and regional levels.

    Data extraction and synthesis

    At least two independent researchers extracted the eligible studies; a third researcher resolved any disagreements. Study risk of bias was assessed using a quality scoring system based on sample size, sampling and testing methodologies.

    Results

    In total, 111 studies from 26 countries published or conducted between 1 January 2020 and 31 December 2020 across the WHO European Region were included. A significant heterogeneity in implementation was noted across the studies, with a paucity of studies from the east of the Region. Sixty-four (58%) studies were assessed to be of medium to high risk of bias. Overall, SARS-CoV-2 seropositivity prior to widespread community circulation was very low. National seroprevalence estimates after circulation started ranged from 0% to 51.3% (median 2.2% (IQR 0.7–5.2%); n=124), while subnational estimates ranged from 0% to 52% (median 5.8% (IQR 2.3%–12%); n=101), with the highest estimates in areas following widespread local transmission.

    Conclusions

    The low levels of SARS-CoV-2 antibody in most populations prior to the start of vaccine programmes underlines the critical importance of targeted vaccination of priority groups at risk of severe disease, while maintaining reduced levels of transmission to minimise population morbidity and mortality.

    How prevalent is COVID-19 vaccine hesitancy in low-income and middle-income countries and what are the key drivers of hesitancy? Results from 53 countries

    Por: Dayton Eberwein · J. · Edochie · I. N. · Newhouse · D. · Cojocaru · A. · Bopahbe · G. D. · Kakietek · J. J. · Kim · Y. S. · Montes · J.
    Objectives

    This study aims to estimate the levels of COVID-19 vaccine hesitancy in 53 low-income and middle-income countries, differences across population groups in hesitancy, and self-reported reasons for being hesitant to take the COVID-19 vaccine.

    Methods

    This paper presents new evidence on levels and trends of vaccine hesitancy in low-income and middle-income countries based on harmonised high-frequency phone surveys from more than 120 000 respondents in 53 low-income and middle-income countries collected between October 2020 and August 2021. These countries represent a combined 53% of the population of low-income and middle-income countries excluding India and China.

    Results

    On average across countries, one in five adults reported being hesitant to take the COVID-19 vaccine, with the most cited reasons for hesitancy being concerns about the safety of the vaccine, followed by concerns about its efficacy. Between late 2020 and the first half of 2021, there tended to be little change in hesitancy rates in 11 of the 14 countries with available data, while hesitancy increased in Iraq, Malawi and Uzbekistan. COVID-19 vaccine hesitancy was higher among female, younger adults and less educated respondents, after controlling for selected observable characteristics.

    Conclusions

    Country estimates of vaccine hesitancy from the high-frequency phone surveys are correlated with but lower than those from earlier studies, which often relied on less representative survey samples. The results suggest that vaccine hesitancy in low-income and middle-income countries, while less prevalent than previously thought, will be an important and enduring obstacle to recovery from the pandemic.

    Chain mediation model of consultation empathy, resilience and resignation coping on depression: a cross-sectional study among patients with COVID-19 in China

    Por: Wang · L. · Huang · S. · Feng · Z. · Lin · Y. · Zhang · Y.
    Objectives

    This study aimed to explore the mediating role of resilience and resignation coping in the relationship between consultation empathy and depression in patients with COVID-19.

    Design

    Cross-sectional study.

    Setting

    Participants were recruited from a tertiary hospital in Guangzhou, Guangdong province.

    Participants

    A total of 215 patients were recruited for this study.

    Outcome measures

    A total of 215 patients completed the Consultation and Relational Empathy Measure, Connor-Davidson Resilience Scale, Medical Coping Modes Questionnaire and Hospital Anxiety and Depression Scale. PROCESS 4.1 model 6 was used to analyse the moderated mediating effects.

    Results

    Consultation empathy had a positive correlation with resilience (r=0.34, p

    Conclusions

    Consultation empathy not only predicted depression directly, but also indirectly predicted depression through the chain mediating effects of resilience and resignation coping.

    What are effective vaccine distribution approaches for equity-deserving and high-risk populations during COVID-19? Exploring best practices and recommendations in Canada: protocol for a mixed-methods multiple case codesign study

    Por: Aggarwal · M. · Katz · A. · Kokorelias · K. M. · Wong · S. T. · Aghajafari · F. · Ivers · N. M. · Martin-Misener · R. · Aubrey-Bassler · K. · Breton · M. · Upshur · R. E. G. · Kwong · J. C.
    Introduction

    The WHO has stated that vaccine hesitancy is a serious threat to overcoming COVID-19. Vaccine hesitancy among underserved and at-risk communities is an ongoing challenge in Canada. Public confidence in vaccine safety and effectiveness and the principles of equity need to be considered in vaccine distribution. In Canada, governments of each province or territory manage their own healthcare system, providing an opportunity to compare and contrast distribution strategies. The overarching objective of this study is to identify effective vaccine distribution approaches and advance knowledge on how to design and implement various strategies to meet the different needs of underserved communities.

    Methods and analysis

    Multiple case studies in seven Canadian provinces will be conducted using a mixed-methods design. The study will be informed by Experience-Based CoDesign techniques and theoretically guided by the Socio-Ecological Model and the Vaccine Hesitancy Matrix frameworks. Phase 1 will involve a policy document review to systematically explore the vaccine distribution strategy over time in each jurisdiction. This will inform the second phase, which will involve (2a) semistructured, in-depth interviews with policymakers, public health officials, researchers, providers, groups representing patients, researchers and stakeholders and (2b) an analysis of population-based administrative health data of vaccine administration. Integration of qualitative and quantitative data will inform the identification of effective vaccine distribution approaches for various populations. Informed by this evidence, phase 3 of the study will involve conducting focus groups with multiple stakeholders to codesign recommendations for the design and implementation of effective vaccine delivery strategies for equity-deserving and at-risk populations.

    Ethics and dissemination

    This study is approved by the University of Toronto’s Health Sciences Research Ethics Board (#42643), University of British Columbia Behavioural Research Ethics Board (#H22-01750-A002), Research Ethics Board of the Nova Scotia Health Authority (#48272), Newfoundland and Labrador Health Research Ethics Board (#2022.126), Conjoint Health Research Ethics Board, University of Calgary (REB22-0207), and University of Manitoba Health Research Board (H2022-239). The outcome of this study will be to produce a series of recommendations for implementing future vaccine distribution approaches from the perspective of various stakeholders, including equity-deserving and at-risk populations.

    'The burden of wanting to make it right: thematic analysis of semistructured interviews to explore experiences of planning for crisis standards of care and ventilator allocation during the COVID-19 pandemic in the USA

    Por: MacMartin · M. · Zeng · A. · Chelen · J. · Barnato · A. · Chuang · E.
    Objectives

    The COVID-19 pandemic prompted planning for clinical surges and associated resource shortages, particularly of equipment such as ventilators. We sought to examine the experience of the healthcare professionals who created policies for crisis standards of care, and allocation of ventilators in the event of shortage.

    Design

    To that end, we conducted semistructured interviews with healthcare professionals in the USA involved in institutional planning for resource shortages in the setting of the COVID-19 pandemic.

    Setting

    USA.

    Participants

    We conducted 25 interviews between May and July 2021. Half of the respondents were female (48%), many from Northeastern institutions (52%), and most practised in academic institutions (92%).

    Results

    Many (64%) respondents reported that their institution had an approved policy to guide ventilator allocation in the event of a shortage. We identified one overarching theme: the work of planning for resource shortages imposed a psychological burden on many planners. We identified four subthemes that influenced that burden: impact of leadership, institutional variation in process and policies, faith in the policies and future directions.

    Conclusions

    Improved leadership strategies and cross-institutional collaboration can reduce the psychological burden of planning and facilitate updating plans in anticipation of future shortages.

    Systematic review of the effect of metabolic syndrome on outcomes due to acute respiratory distress syndrome: a protocol

    Por: Stone · G. · Sisk · A. · Brown · M. · Corder · A. · Tea · K. · Zu · Y. · Shaffer · J. · Kashyap · R. · Qadir · N. · Denson · J. L.
    Introduction

    Acute respiratory distress syndrome (ARDS) is a life-threatening condition commonly seen in the intensive care unit. COVID-19 has dramatically increased the incidence of ARDS—with this rise in cases comes the ability to detect predisposing factors perhaps not recognised before, such as metabolic syndrome (MetS) and its associated conditions (hypertension, obesity, dyslipidaemia and type 2 diabetes mellitus). In this systematic review, we seek to describe the complex relationship between MetS, its associated conditions and ARDS (including COVID-19 ARDS).

    Methods and analysis

    A systematic search of PubMed, Embase, Cochrane Central Register of Controlled Trials, CINAHL and Web of Science will be conducted. The population of interest is adults with ARDS and MetS (as defined according to the study author recognising that MetS definitions vary) or any MetS-associated condition. The control group will be adult patients with ARDS without MetS or any individual MetS-associated condition. We will search studies published in English, with a date restriction from the year 2000 to June 2023 and employ the search phrases ‘metabolic syndrome’, ‘acute respiratory distress syndrome’ and related terms. Search terms including ‘dyslipidaemia’, ‘hypertension’, ‘diabetes mellitus’ and ‘obesity’ will also be utilised. Outcomes of interest will include mortality (in-hospital, ICU, 28-day, 60-day and 90-day), days requiring mechanical ventilation and hospital and/or ICU length of stay. Study bias will be assessed using the NIH Bias Scale.

    Ethics and dissemination

    Ethical approval is not required because this study includes previously published and publicly accessible data. Findings from this review will be disseminated via publication in a peer-reviewed journal.

    PROSPERO registration number

    CRD42023405816.

    Gender disparities, causes and predictors of immediate and short-term cardiovascular readmissions following COVID-19-related hospitalisations in the USA

    Por: Vardar · U. · Shaka · H. · Kumi · D. · Gajjar · R. · Bess · O. · Kanemo · P. · Shaka · A. · Baskaran · N.
    Objectives

    In this study, we aimed to identify the causes, predictors and gender disparities of 30-day and 90-day cardiovascular readmissions after COVID-19-related hospitalisations using National Readmission Database (NRD) 2020.

    Setting

    We used the NRD from 2020 to identify hospitalised adults with a principal diagnosis of COVID-19 infection.

    Participants

    We included subjects who were readmitted within 30 days and 90 days after index admission. We excluded subjects with elective and traumatic admissions. We used a multivariate Cox regression model to identify independent predictors of readmission.

    Primary and secondary outcomes measures

    Our outcomes were inpatient mortality, 30-day and 90-day cardiovascular readmission rates following COVID-19 infection.

    Results

    During the study period, there were 1 024 492 index hospitalisations with a primary diagnosis of COVID-19 infection in the 2020 NRD database, 644 903 (62.9%) were included for 30-day readmission analysis, and 418 122 (40.8%) were included for 90-day readmission analysis. Of patients involved in the 30-day analysis, 7140 (1.1%) patients had a readmission within 30 days; of patients involved in the 90-day analysis, 8379 (2.0%) had a readmission within 90 days due to primarily cardiovascular causes. Cox regression analysis revealed that the female sex (aHR 0.89; 95% CI 0.82 to 0.95; p=0.001) was associated with a lower hazard of 30-day cardiovascular readmissions; however, congestive heart failure (aHR 2.45; 95% CI 2.2 to 2.72; p

    Conclusion

    Our study demonstrates that male gender, heart failure, arrhythmias and valvular disease carry higher hazards of 30-day and 90-day cardiovascular readmissions. Identifying risk factors and common causes of readmission may assist with lowering the burden of cardiovascular disease in patients with COVID-19 infection.

    Shaping care home COVID-19 testing policy: a protocol for a pragmatic cluster randomised controlled trial of asymptomatic testing compared with standard care in care home staff (VIVALDI-CT)

    Por: Adams · N. · Stirrup · O. · Blackstone · J. · Krutikov · M. · Cassell · J. A. · Cadar · D. · Henderson · C. · Knapp · M. · Gosce · L. · Leiser · R. · Regan · M. · Cullen-Stephenson · I. · Fenner · R. · Verma · A. · Gordon · A. · Hopkins · S. · Copas · A. · Freemantle · N. · Flowers · P. · Sh
    Introduction

    Care home residents have experienced significant morbidity, mortality and disruption following outbreaks of SARS-CoV-2. Regular SARS-CoV-2 testing of care home staff was introduced to reduce transmission of infection, but it is unclear whether this remains beneficial. This trial aims to investigate whether use of regular asymptomatic staff testing, alongside funding to reimburse sick pay for those who test positive and meet costs of employing agency staff, is a feasible and effective strategy to reduce COVID-19 impact in care homes.

    Methods and analysis

    The VIVALDI-Clinical Trial is a multicentre, open-label, cluster randomised controlled, phase III/IV superiority trial in up to 280 residential and/or nursing homes in England providing care to adults aged >65 years. All regular and agency staff will be enrolled, excepting those who opt out. Homes will be randomised to the intervention arm (twice weekly asymptomatic staff testing for SARS-CoV-2) or the control arm (current national testing guidance). Staff who test positive for SARS-CoV-2 will self-isolate and receive sick pay. Care providers will be reimbursed for costs associated with employing temporary staff to backfill for absence arising directly from the trial.

    The trial will be delivered by a multidisciplinary research team through a series of five work packages.

    The primary outcome is the incidence of COVID-19-related hospital admissions in residents. Secondary outcomes include the number and duration of outbreaks and home closures. Health economic and modelling analyses will investigate the cost-effectiveness and cost consequences of the testing intervention. A process evaluation using qualitative interviews will be conducted to understand intervention roll out and identify areas for optimisation to inform future intervention scale-up, should the testing approach prove effective and cost-effective. Stakeholder engagement will be undertaken to enable the sector to plan for results and their implications and to coproduce recommendations on the use of testing for policy-makers.

    Ethics and dissemination

    The study has been approved by the London—Bromley Research Ethics Committee (reference number 22/LO/0846) and the Health Research Authority (22/CAG/0165). The results of the trial will be disseminated regardless of the direction of effect. The publication of the results will comply with a trial-specific publication policy and will include submission to open access journals. A lay summary of the results will also be produced to disseminate the results to participants.

    Trial registration number

    ISRCTN13296529.

    What is the aetiology of dysnatraemia in COVID-19 and how is this related to outcomes in patients admitted during earlier and later COVID-19 waves? A multicentre, retrospective observational study in 11 Dutch hospitals

    Por: de Haan · L. · ten Wolde · M. · Beudel · M. · Olde Engberink · R. H. G. · Appelman · B. · Haspels-Hogervorst · E. K. · Rusch · D. · Gritters van den Oever · N. C. · Simsek · S. · Paternotte · N. · van den Bergh · J. P. · Wyers · C. E. · de Kruif · M. D. · Dormans · T. · Moeniralam
    Objectives

    To evaluate the relationship among dysnatraemia at hospital presentation and duration of admission, risk of intensive care unit (ICU) admission and all-cause mortality and to assess the underlying pathophysiological mechanism of hyponatraemia in patients with COVID-19. Our hypothesis is that both hyponatraemia and hypernatraemia at presentation are associated with adverse outcomes.

    Design

    Observational study.

    Setting

    Secondary care; 11 Dutch hospitals (2 university and 9 general hospitals).

    Participants

    An analysis was performed within the retrospective multicentre cohort study COVIDPredict. 7811 patients were included (60% men, 40% women) between 24 February 2020 and 9 August 2022. Patients who were ≥18 years with PCR-confirmed COVID-19 or CT with COVID-19 reporting and data system score≥4 and alternative diagnosis were included. Patients were excluded when serum sodium levels at presentation were not registered in the database or when they had been transferred from another participating hospital.

    Outcome measures

    We studied demographics, medical history, symptoms and outcomes. Patients were stratified according to serum sodium concentration and urinary sodium excretion.

    Results

    Hyponatraemia was present in 2677 (34.2%) patients and hypernatraemia in 126 (1.6%) patients. Patients with hyponatraemia presented more frequently with diarrhoea, lower blood pressure and tachycardia. Hyponatraemia was, despite a higher risk for ICU admission (OR 1.27 (1.11–1.46; p

    Conclusions

    Hypernatraemia at presentation was associated with adverse outcomes in patients with COVID-19. Hypovolaemic hyponatraemia was found to be the most common aetiology of hyponatraemia. Hyponatraemia of unknown aetiology was associated with a higher risk for ICU admission and intubation and longer duration of admission.

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