To achieve progression criteria for a definitive phase three randomised controlled trial (RCT). Prospective phase two multicentre parallel-group RCT. Participants recruited from secondary care respiratory clinics in two health boards in Scotland, United Kingdom. 110 adults with moderate-severe COPD and co-morbidities. Tailored Intervention for COPD and Co-morbidities by Pharmacists and Consultant Physicians (TICC-PCP): home visits (for a year) by generalist prescribing pharmacists collaborating with consultant respiratory physicians. Pharmacists assessed, prescribed, de-prescribed, and referred participants to health and social care services as appropriate, in addition to Usual Care (UC). Recruit ≥100 participants; deliver TICC-PCP to ≥70% intervention-arm participants; collect ≥90% in-person data; retain ≥80% participants until 21-months. Secondary outcomes include clinical and health service utilisation. Recruitment, data collection, retention and participant retention targets were achieved over 21 months. TICC-PCP delivery: the median number of contacts, nine per participant in one year, matched the a-priori target although fewer than expected (13 (27%)) received the planned schedule of contacts (monthly for six months then every other month for six months). Secondary outcomes included increased prescribing of bone strengthening medicines, de-prescribing of medicines associated with increasing falls risk; delayed time to emergency health care contacts, fewer exacerbations; improved health related quality of life and longer duration of hospitalisation. A definitive phase three RCT of TICC-PCP may improve outcomes for people with moderate-severe COPD and co-morbidities. Trial registration: The trial is registered with the UK Clinical Trials Registry ( https://doi.org/10.1186/ISRCTN43508703 ). Registration date: 3/1/2020.

ReOpening Schools Safely and Educating Youth (ROSSEY) was a cluster randomized controlled trial of a risk communication intervention for COVID-19 prevention to promote safe return to school among students in a rural, agricultural community.

This qualitative study evaluated the implementation of a risk communication intervention and a school district's COVID-19 testing program through parent focus groups and interviews with school staff and students.

Parents (n = 37), students (n = 19), and school staff (n = 14) from seven schools that received the intervention shared their experience via focus groups and interviews informed by the RE-AIM framework. Deductive and inductive coding was conducted by four data analysts. Themes were validated with community members.

Parent focus groups, student and staff interviews provided insight into the ROSSEY study implementation. We identified five main themes: (i) social and financial drivers of participation; (ii) personal beliefs and unique challenges to research participation; (iii) intervention reinforced knowledge and shifted behavior; (iv) the appeal of comic books and videos supported adoption; and (v) multimodal communication and partnerships enhanced implementation.

The risk communication intervention was deemed culturally appropriate, reinforced previous knowledge, and encouraged adoption of preventive behaviors. The partnership with the school district and collaboration with the district's COVID-19 testing program ensured success of recruitment, study implementation, and adoption of preventive behaviors.

The COVID-19 pandemic flooded intensive care units with patients needing supportive care. In Scandinavia, the greater Stockholm area was among the most affected. This study aimed to capture healthcare workers' conditions and challenges during this prolonged crisis, including perspectives from the intensive care team.

The data consist of 22 semistructured individual interviews with regular and temporary healthcare workers involved in the intensive care of COVID-19 patients, including nurse assistants, registered nurses, critical care nurses and consultant and junior physicians. Thematic analysis was used to analyse the data.

The overarching theme that emerged was trying to create order in chaos.The theme encompassed four categories: adaptation with consequences, learning and growing while sacrificing my health, supporting and balancing staff resources without having enough, and challenging ICU values and standards. Each category comprised multiple subcategories.

Our study demonstrates challenges and identifies workarounds, support strategies and personnel learning experienced by COVID-19 intensive care teams in delivering patient care, ensuring patient safety and managing staff resilience. The findings can be used to better prepare for future crises.

Home mechanical ventilators (HMV) are positive pressure devices that allow patients with chronic respiratory failure to live in the comfort of their own homes. HMV are more advanced than standard respiratory assist devices, providing features including internal and external batteries for daytime use outside the house, unique modes such as volume-assured pressure support with auto expiratory positive airway pressure and mouthpiece ventilation, and more alarms to provide safety for patients with severe disease. The process of prescribing HMV in the United States can be complex.

Long COVID, characterized by persistent or recurring symptoms post-COVID-19 infection, poses challenges for pediatric care and research due to the lack of a standardized clinical definition. Adult-focused phenotypes do not translate well to children, given developmental and physiological differences, and pediatric-specific phenotypes have not been compared with chart review.This study introduces and evaluates a pediatric-specific rule-based computable phenotype (CP) to identify long COVID using electronic health record data. We compare its performance to manual chart review.We applied the CP, composed of diagnostic codes empirically associated with long COVID, to 339,467 pediatric patients with SARS-CoV-2 infection in the RECOVER PCORnet EHR database. The CP identified 31,781 patients with long COVID. Clinicians conducted chart reviews on a subset of patients across 16 hospital systems to assess performance. We qualitatively reviewed discordant cases to understand differences between CP and clinician identification.Among the 651 reviewed patients (339 females, M _age = 10.10 years), the CP showed moderate agreement with clinician identification (accuracy = 0.62, positive predictive value [PPV] = 0.49, negative predictive value [NPV] = 0.75, sensitivity = 0.52, specificity = 0.84). Performance was largely consistent across age and dominant variant but varied by symptom cluster count. Most discrepancies between the CP and chart review occurred when the CP identified a case, but the clinician did not, often because clinicians attributed symptoms to preexisting conditions (73%). When clinicians identified cases missed by the CP, they often used broader symptom or timing criteria (69%). Model performance improved when the CP accounted for preexisting conditions (accuracy = 0.71, PPV = 0.65, NPV = 0.74, sensitivity = 0.59, specificity = 0.79).This study presents a CP for pediatric long COVID. While agreement with manual review was moderate, most discrepancies were explained by differences in interpreting symptoms when patients had preexisting conditions. Accounting for these conditions improved accuracy and highlights the need for a consensus definition. These findings support the development of reliable, scalable tools for pediatric long COVID research.

The quality of health information on social media is a major concern, especially during the early stages of public health crises. While the quality of the results of the popular search engines related to particular diseases has been analyzed in the literature, the quality of health-related information on social media, such as X (formerly Twitter), during the early stages of a public health crisis has not been addressed.

This study aims to evaluate the quality of health-related information on social media during the early stages of a public health crisis.

A cross-sectional analysis was conducted on health-related tweets in the early stages of the most recent public health crisis (the COVID-19 pandemic). The study analyzed the top 100 websites that were most frequently retweeted in the early stages of the crisis, categorizing them by content type, website affiliation, and exclusivity. Quality and reliability were assessed using the DISCERN and JAMA (Journal of the American Medical Association) benchmarks.

Our analyses showed that 95% (95/100) of the websites met only 2 of the 4 JAMA quality criteria. DISCERN scores revealed that 81% (81/100) of the websites were evaluated as low scores, and only 11% (11/100) of the websites were evaluated as high scores. The analysis revealed significant disparities in the quality and reliability of health information across different website affiliations, content types, and exclusivity.

This study highlights a significant issue with the quality, reliability, and transparency of online health-related information during a public health challenge. The extensive shortcomings observed across frequently shared websites on Twitter highlight the critical need for continuous evaluation and improvement of online health content during the early stages of future health crises. Without consistent oversight and improvement, we risk repeating the same shortcomings in future, potentially more challenging situations.

ObjectiveAcute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with high rates of intensive care unit admission and elevated mortality. While urine output (UO) has been demonstrated to predict short-term adverse outcomes in critically ill patients, there is a paucity of research on its prognostic value for in-hospital mortality in AECOPD patients. This study aims to examine the association between UO and in-hospital mortality in AECOPD patients, and to assess its potential as a non-invasive prognostic indicator.MethodsA retrospective cohort study included 938 AECOPD patients from the Medical Information Mart for Intensive Care IV database. Patients were grouped by initial 24-h UO: low UO (≤800 mL), moderate UO (800-2500 mL, reference), and high UO (≥2500 mL). Restricted cubic spline regression, receiver operating characteristic curves, Kaplan-Meier (K-M) survival analysis, Cox proportional hazards regression models, subgroup analysis, and mediation analysis evaluated UO's association with mortality.ResultsIn-hospital mortality was 16.2%. UO showed a U-shaped non-linear association with mortality (P for nonlinearity < 0.05), with the lowest risk at 1375-4988 mL/24 h (hazard ratio [H.R.] < 1). UO showed limited predictive ability as a standalone marker (area under the curve = 0.62), suggesting it should be interpreted alongside other clinical parameters. K-M analysis indicated higher survival in the polyuria group versus oliguria (P < 0.05). In unadjusted Cox regression, polyuria was associated with a lower risk of mortality (H.R. = 0.51, 95% CI: 0.30-0.85, P = 0.011), whereas oliguria was associated with a higher risk of 28-day mortality (H.R. = 1.67, 95% CI: 1.22-2.27, P = 0.001). Subgroup analyses were consistent. Glasgow Coma Scale partially mediated 8.68% of the UO-mortality relationship (P = 0.026).ConclusionA U-shaped association exists between initial 24-h UO and short-term mortality in AECOPD. UO is an important but non-independent prognostic marker, functioning as a surrogate for overall disease severity. Its clinical application requires corroboration with other clinical markers.

Patients with biochemical evidence of chronic kidney disease (CKD) without a diagnostic code (uncoded CKD) in primary care are at increased risk of death, acute kidney injury (AKI), and unplanned hospital care. Uncoded CKD is highly prevalent and there is no data to evaluate whether patients with uncoded CKD were at an increased risk of COVID-19 death. Aim: to assess whether patients with uncoded CKD stages 3-5 were at increased risk of death and COVID-19 deaths.

Descriptive and inferential analyses to measure adjusted hazard of death, and COVID-19 death in patients with CKD stages 3-5 from 2.85 million primary care patients in Greater Manchester, England. Sensitivity analyses using propensity score matching and competing risk regression.

Coded CKD stages 3 and 4 (versus uncoded) were associated with significantly lower adjusted hazards of death (HR 0.81, CIs 0.77-0.86, p=<0.0001; HR 0.45, CIs 0.34-0.60, p=<0.0001, respectively), and COVID-19 death (HR 0.74, CIs 0.55-0.99, p = 0.03; HR 0.55, CIs 0.30-0.99, p = 0.045, respectively). Descriptive analyses were conducted for patients with CKD stage 5 due to low numbers of patients with uncoded CKD stage 5, precluding survival analyses.

Our retrospective cohort study suggests that clinical coding is a digital intervention associated with a lower adjusted hazard of death and COVID-19 death in patients with CKD stages 3 and 4, and should be considered a key element in the organisation and delivery of care for people with CKD.

The study of epistemically unwarranted beliefs (EUB) (i.e., paranormal, pseudoscientific and conspiracy beliefs) has become relevant due to the negative effects they have produced on people's health, as evidenced in the covid-19 pandemic. However, there is no instrument with appropriate and updated validity evidence for its evaluation in Latin American people. Because of this, the present study aims to develop a brief scale to analyze general epistemically unwarranted beliefs that do not depend on local factors. A total of 634 adults from five Chilean cities participated in the study of whom 93.8% (n = 575) were university students. Exploratory and confirmatory factor analyses revealed that the final structure of the Epistemically Unwarranted Beliefs Scale (EUBS) considers 9 items with three related factors. In addition, results showed good internal consistency (CFI > .95; TLI > .95; RMSEA < .07), gender invariance, and evidence of validity based on the inverse relation with the cognitive reflection test and the relationship with sociodemographic variables (i.e., gender, political orientation, and religious orientation). Finally, implications for the theoretical construct and possible limitations of the scale are discussed.

The use of antenatal corticosteroids (ACS) in mothers less than 34 weeks' period of gestation has shown promising results with significant reduction in neonatal mortality and morbidities in high income settings. This study was carried out to assess the effectiveness of ACS in terms of neonatal outcome in less than 34 weeks in resource limited settings.

A prospective study was conducted from 15 March 2022 to 14 March 2023 among the babies born before 34 weeks' period of gestation (POG), in Paropakar maternity hospital, Nepal. Descriptive statistics using frequency and percentages was used to describe the socio-demographic, obstetric and neonatal characteristics. Multi-variable logistic regression analysis was done to assess the significance of ACS against various neonatal conditions.

Out of 358 preterm neonates (<34 weeks), 206 were born to mothers who received ACS and 152 to mothers who did not. Mothers having any complications during delivery were more likely to receive ACS, (69.7% vs 50.0%, p = 0.002). Newborns of mothers who received ACS had significantly lower rates of respiratory distress syndrome (21.8% vs 61.8%, p < 0.001), necrotizing enterocolitis (5.8% vs 19.7%, p < 0.001), perinatal asphyxia (18.4% vs 35.5%, p < 0.001), neonatal sepsis (32.0% vs 43.4%, p < 0.027), and need for mechanical ventilation (15.5% vs 41.4%, p < 0.001). Newborn of mothers who did not receive ACS had higher odds of respiratory distress syndrome (adjusted odds ratio (a0R): 4.181, 95% CI: 2.462-7.100) and the need for mechanical ventilation (a0R: 2.266, 95% CI: 1.300-3.950). Lack of exposure to ACS was associated with higher odds of prolonged hospital stay (aOR: 3.321, 95% CI: 1.957-5.638) and mortality (aOR: 5.731, 95% CI: 3.199-10.266).

ACS was more frequently used in mothers of less than 34 weeks POG having some complications during pregnancy. Use of ACS in deliveries of less than 34 weeks POG was associated with reduced risk of RDS, NEC and need for Mechanical Ventilation along with decrease hospital stay and neonatal mortality. Strengthening national guidelines with recommendation for the use of ACS in mothers less than 34 weeks POG can avert deaths due to complications of prematurity and help save more newborns.