Hypoxaemic acute respiratory failure (ARF) in intensive care unit (ICU) patients is associated with high mortality. Three main devices are used to provide oxygen to hypoxaemic ARF patients: non-invasive ventilation (NIV), high-flow nasal cannula oxygen (HFNO) and standard oxygen (first-attempt device in usual care). To date, no multicentre randomised controlled study has compared NIV and HFNO to standard oxygen with day 28 mortality rate as primary outcome in hypoxaemic ARF in non-selected patients. Our hypothesis is that NIV and/or HFNO is superior to standard oxygen to reduce day 28 mortality rate in hypoxaemic ARF.

The Key oxygenation Interventions in Surgical and non-Surgical patients (KISS) trial is an adaptive investigator-initiated, multicentre, stratified, parallel-group unblinded trial with an electronic system-based randomisation. Patients with hypoxaemic ARF were randomly assigned to one of three groups: the 'NIV-group' to receive curative NIV combined with HFNO delivered between NIV trials, or the 'HFNO' group to receive HFNO alone, or the 'standard oxygen-group' to receive oxygen therapy alone.The primary endpoint is day 28 all-cause mortality. The main secondary endpoint is intubation rate at day 28. The exploratory endpoints are intubation rates at day 3 and day 7; oxygenation up to day 7; need for other rescue oxygen therapy up to day 7; ICU and hospital length of stay; and mortality rates in ICU, hospital and at day 90.The main objective is to assess if NIV and/or HFNO is superior to standard oxygen to reduce day 28 mortality rate in hypoxaemic ARF. Additional comparisons between predefined stratum following randomisation will be performed: (1) medical versus postoperative admissions, (2) among medical (immunocompromised vs non-immunocompromised) and (3) among postoperative (abdominal vs cardio-thoracic).An adaptive design will be used. Two interim analyses will be performed after 700 and 1400 included patients among the 2100 planned.

The study project has been approved by the appropriate ethics committee 'Comité-de-Protection-des-Personnes Sud-Est V-23-CHUM-01 Cat2 2022-A02761-42/1'. Informed consent is required. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences. If NIV and/or HFNO reduce the mortality at day 28, NIV and/or HFNO could be proposed to become one of the first-line therapies in hypoxaemic ARF patients.

NCT05812911.

The Omicron variant of SARS-CoV-2 has emerged as the predominant strain of COVID-19 since 2022. Its association with prior vaccines remained under investigation.

Retrospective cohort study.

Clinical data for patients, from 1 May 2022 to 31 January 2023, were extracted from the Chi-Mei Medical Center, Chiali electronic medical record databases.

Hospitalised COVID-19 patients in dedicated wards were enrolled in the study. Cases of COVID-19 reinfection and relapse were also included. Patients who did not have COVID-19, those with PCR repositivity, or those with incomplete laboratory data were excluded.

Various doses of vaccines included primary series, additional dose and booster. The types of vaccines included ChAdOx1-S, mRNA-based vaccines and recombinant protein vaccine. The interval between the last vaccination date and the diagnosis date of COVID-19 was assessed.

The primary outcome was all-cause mortality by day 30. The secondary outcomes were severe disease of COVID-19 and 90-day survival.

Among 469 cases, the adjusted HR for 30-day mortality in vaccinated compared with unvaccinated patients was 0.831 (95% CI 0.541 to 1.277; p=0.398), indicating no statistically significant association. Age, Charlson Comorbidity Index (CCI), quick Sequential Organ Failure Assessment score and administration of dexamethasone were recognised as powerful predictors for survival in multivariable analysis. In subgroup analysis, a statistically significant association with better 30-day survival was observed among patients aged <75 years and those with CCI <3.

Vaccination was associated with lower mortality in younger or low-CCI patients, but not in older or highly comorbid patients.

In Korea, the 10-valent and 13-valent pneumococcal conjugate vaccines (PCVs) were introduced into the national immunization program (NIP) in 2014 for the protection in children. A decade later, in 2024, PCV15 replaced PCV10 and was included in the NIP in April, while PCV20 was licensed for use in October. To inform optimal vaccination policy, this study aimed to analyze the current distribution of serotypes responsible for invasive pneumococcal diseases (IPDs) in children.

IPD cases from children under 19 years of age were collected from a prospective hospital-based surveillance study conducted at 20 hospitals between 2016 and 2023. Data on the changes in IPD case number and serotype distribution were compared between the pre- coronavirus disease 2019 (COVID-19) period (2016-2019) and the during/post-COVID-19 period (2020-2023).

Of the 187 cases with a determined serotype, the most frequent serotypes identified were 10A (21.9%), 15C (11.8%), 15A (9.1%), 15B (8.0%), and 19A (7.5%), and 23B (5.9%). Compared to the pre-COVID-19 period, the proportion of serotype 10A decreased (27.4% vs. 12.9%), while serotypes 23B (0.9% vs. 14.3%) and 6C (0.9% vs. 7.1%) increased. In regard to the vaccine serotype, PCV13 serotypes accounted for 12.3%, PCV15/PCV20 common serotypes for 3.2%, and PCV20 unique serotypes for 35.3% of IPD cases. Serotype 15C, cross protected by the 15B conjugate vaccines, accounted for 11.8%, and non-PCV20 serotypes for 36.4%.

Given the approval of two new PCVs, the study results identified the substantial contribution of non-PCV13 serotypes to pediatric IPD and provide critical insights for optimal vaccination strategies to protect children against pneumococcal diseases.

A particular challenge during the COVID-19 pandemic was to provide testing and treatment for already disadvantaged and vulnerable populations. Many states implemented testing in a sporadic and disorganized way, and it is unclear to what extent this disproportionally affected population experienced barriers to accessing care. It is also unclear whether potential barriers to testing were caused by systemic challenges, such as rurality, or by individuals' motivations for not getting tested.

The objective of this study was to understand the trade-offs individuals in rural and vulnerable populations make between attributes of COVID-19 testing and how these vary across individuals. The study was part of RADx-UP, a consortium of more than 125 projects studying COVID-19 testing patterns in communities across the United States.

First, we conducted 7 focus groups to identify barriers to COVID-19 testing and optimal strategies to increase testing. These barriers and strategies were then used to develop hypothetical choice scenarios in a discrete choice experiment. Data regarding preferences for testing were collected from an online panel (n=780) and oversampled in rural populations. We used quota sampling for age, gender, household income, and race: 50% of household incomes were above and below the median rural income of $52k per year 2023, and the maximum number of White, non-Hispanic respondents was 615. The data were analyzed using a conditional logit model (CL) and latent class analysis (LCA).

We found that the attributes for testing locations were almost all significant and had the expected signs. As hypothesized, respondents were less likely to choose a test location that had a higher wait time (coefficient -0.183, SE 0.006); more travel time to get tested (coefficient -1.129, SE0.054); that was higher cost (coefficient -0.020, SE 0.000); where someone else would collect the sample (coefficient -0.230, SE 0.036); where it would take more time to receive results (coefficient -0.032, SE 0.006); and where the tests would cause more discomfort (coefficient -0.125, SE 0.007). They were more likely to choose a mail-order option (coefficient 0.494, SE 0.075) and options that had higher test accuracy (coefficient 0.026, SE 0.001). While respondents cared about these structural factors, these were not the primary drivers of choice for testing. Some important covariates were driving preferences, including age, gender, medical vulnerability, insurance status, trust in government organizations, and previous flu vaccination, which may be a proxy for compliance. These covariates helped explain the observed preference heterogeneity.

The results suggest that important social, behavioral, and policy factors affect choice for testing. Contrary to our hypotheses, rurality did not significantly impact preferences for testing; however, attitudes toward government and other beliefs did. Health care interventions intended to reduce rural health disparities that do not reflect the underlying values of individuals in those subpopulations are unlikely to be successful.

A tracheostomy is an important intervention for trauma patients referred to intensive care units (ICUs). Trauma patients often require prolonged intubation; timing of tracheostomy remains debated.The purpose of this study is to determine the impact of early tracheostomy on critical metrics such as mechanical ventilation duration, ICU length of stay (LOS) and ventilator acquired pneumonia (VAP) in trauma patients in ICU settings.

We conducted a retrospective cohort study of 383 trauma patients who underwent tracheostomy in a tertiary teaching hospital ICU (January 2018-December 2022). Inclusion: trauma patients with temporary tracheostomy; Exclusion: permanent tracheostomies. Early tracheostomy (ET) was defined as ≤7 days of mechanical ventilation, late (LT) as >7 days. The dataset includes demographic information, Acute physiology and chronic health evaluation II score, Simplified acute physiology score II, Glasgow coma scale score, Injury severity Score, type and cause of injuries, ICU outcomes, length of stay and rates of ventilator-associated pneumonia (VAP). Data were analyzed using Mann-Whitney U and Chi-square tests; significance at p < 0.05.. The study involved a comparison of the duration of mechanical ventilation, ICU LOS, VAP rates and extubation trials between patients who underwent ET and LT.

Of the 804 patients who underwent tracheostomies from January 2018 to December 2022, 383 were trauma patients and were included in the study. There were no significant differences between the two groups in terms of age, sex, Acute physiology and chronic health evaluation II score, Simplified acute physiology score II and Injury severity score. The incidence of VAP was lower in the ET cohort (15.9%) than in the LT cohort (47.4%). The percentage of extubation trials was found to be higher in the LT cohort (43.1%) than in the ET cohort (9.3%), resulting in prolonged ICU LOS. Patients with an ET had a significantly shorter ICU LOS median of 15 days (IQR 13,17) and a mechanical ventilation median of 13 days (IQR 11,14) than LT patients who had an ICU LOS median of 33 days (IQR 30,36) and a mechanical ventilation median of 31 days (IQR 27,33) respectively.

Implementing an early tracheostomy protocol for trauma patients in the ICU is associated with a decreased incidence of VAP, shorter duration of mechanical ventilation and shorter ICU LOS while maintaining consistent ICU and hospital outcomes. The adoption of a standardized approach to perform early tracheostomy helps in improving resource utilization and patient outcomes in trauma patients.

The SARS-CoV-2 pandemic beginning in 2020 led to significant restrictions on social life and mobility, raising concerns about increased substance use across the general population. To investigate whether the pandemic resulted in quantitative or qualitative changes in alcohol and/or drug use in the context of road traffic, a retrospective analysis of toxicological findings was conducted in the city of Munich, considering the local pandemic-related restrictions.

A total of 6,210 blood samples were analyzed from individuals suspected of committing substance-related administrative traffic offences under §24a of the German Road Traffic Act between January 1, 2019, and July 31, 2021. Samples were examined for the presence of substances, their concentrations, and the type of vehicle involved. The cohort was stratified into pre-pandemic and pandemic periods, with March 16, 2020 set as the cut-off date. The pandemic period was further subdivided based on the severity of imposed restrictions. Statistical comparisons were performed using Fisher's exact test, t-tests, ANOVA, and logistic regression.

Cannabis was the most frequently detected substance (66.2% pre-pandemic; 67.4% during the pandemic), followed by alcohol (11.7% vs. 10.8%) and cocaine (5.7% vs. 5.2%). Only minor differences were observed between the pre-pandemic and pandemic periods, as well as across phases of mild versus severe restrictions. Notably, THC-COOH concentrations were higher during the pandemic. Alcohol levels were elevated during phases of light restrictions and reduced during periods of strict lockdown. Cannabis was most commonly detected in car drivers, whereas alcohol was more frequently found in e-scooter riders, particularly during less restrictive phases.

Substance detection patterns among drivers in Munich showed overall stability during the COVID-19 pandemic, with cannabis remaining the most commonly identified drug. However, shifts in substance concentrations and differences by vehicle type and restriction severity suggest subtle changes in consumption behavior. These findings underscore the need for continued surveillance and context-specific traffic safety measures.

Historical analogies (HAs) are cultural tools for making sense of a current situation by drawing comparisons to a past event. Their use in communication and understanding can be observed since ancient times and in societies around the world, especially in times of crisis. The present paper explores the role they played in people's everyday thinking during the COVID-19 pandemic, including what HAs were used, how they changed over time, who used them, and to what effect. To do this it draws on a longitudinal project in Germany that included a national representative survey (N = 1080) and follow-up interviews (N = 38) done at three data collection points. The interviews were coded for HAs, the results of which are presented in three steps: first, an overview of the HAs used and their change over time is given; second, characteristics of the most frequent users are outlined; and third, a case study of the most frequent user is presented. The article highlights the everyday use of HAs by people through time, their social distribution between majorities and active minorities, their link to conspiracy mentality and their personal psychological functions.

Postoperative pulmonary complications (PPCs) following liver surgery are associated with considerable morbidity and mortality. Nevertheless, data regarding the effectiveness of short-term, self-conducted preoperative respiratory training on pulmonary function and its influence on postoperative recovery are limited.

Patients scheduled for liver surgery at the University Hospital Dresden, were screened for eligibility and randomized 1:1 to the intervention or control group. The intervention consisted of self-conducted respiratory training with an incentive spirometer for 14 consecutive days before surgery. Pulmonary function was assessed using longitudinal bodyplethysmography. The feasibility of the study design and clinical outcomes were evaluated.

Sixty-two patients were screened, 50 participants (81%) were randomized. Twenty control and 21 intervention participants (66.1%) completed all assessments and were included in the final analysis. Participants in the intervention group were highly compliant with the proposed inhalation training. Preoperative risk stratification for PPCs conducted according to the ARISCAT score revealed a high risk for PPCs in > 90% of all patients. Pneumonia occurred in 0 of intervention patients compared to 5 (25%) in the control group (p = 0.016). Pleural effusion was observed in 8 (38.1%) of intervention patients versus 16 (80%) in the control group (p = 0.007).

This pilot trial establishes the feasibility of a definitive randomized controlled trial to investigate the effect of short-term, self-conducted preoperative respiratory training on pulmonary function for the prevention of PPCs after hepatic resection.

New drugs and vaccines usually come with the promise and hope of benefit. We explore stories about the variable and sometimes disappointing effects of Covid-19 vaccines in the context of post-Covid-19 syndrome ('long Covid'), aiming to understand how people with long Covid made sense of unexpected vaccine responses and how these experiences impacted their trust in vaccination.

We carried out 33 interviews with people who described both positive and negative unexpected vaccine experiences connected to long Covid.

Trust and distrust in the multiple potential roles of Covid vaccines in relation to long Covid impacted perspectives on future vaccine uptake. Some participants feared being labelled as anti-vaxx if they discussed unexpected vaccine impacts. Disengagement by healthcare professionals in discussions about the possibility of individual vaccine harms had the inverse consequence of limiting uptake of further Covid vaccines. Distrust could also grow in relation to unrealised benefits of vaccination-in this case, the official role as protection from severe infection and the unofficial role of treatment. Participants who trusted vaccines as a form of treatment struggled to access them for this use.

The gap between scientific discourse-which recognised potential benefits and potential harms of vaccines in relation to long Covid-and public health discourse, which tended to focus on protection from infection, contributed to difficulties in maintaining trust after unexpected vaccine experiences. Further research to better characterise who is likely to benefit from vaccination and who might be at risk of worsening long Covid symptoms would enable better conversations between patients and healthcare professionals when making decisions about further vaccination.

The study was guided by a patient and public involvement and engagement (PPIE) group from project development through to dissemination. People with long Covid supported recruitment strategies, informed the development of topic guides, reviewed findings and offered suggestions for dissemination. Study participants were also invited to review and feedback on findings.

COVID-19 impacted care delivery in rehabilitation services including speech-language pathology. The purpose of this study was to examine speech-language pathologists'(SLPs) perspectives on the effectiveness of virtual care delivered during the pandemic in Canada, their experiences with therapy delivered virtually and their views on future models of care.

We carried out a cross-sectional survey with SLPs in Canada who had delivered virtual services to children during the pandemic. The survey questions were based on information collected in a previous study involving focus group interviews with SLPs. The survey elicited responses related to SLPs' perception of effectiveness, their experiences with virtual care including perceived barriers and facilitators to implementing virtual care, and their vision for future speech-language services. Quantitative responses were compiled descriptively, and qualitative responses were reviewed and categorized.

Seventy-five SLPs returned completed questionnaires. A majority (57.4%) reported that virtual care was very/extremely effective and 33.3% somewhat effective. The main barriers to providing virtual services were limited access to technology (family), limited workspace for the session at home, and limited availability of the caregiver for sessions. Services for children with complex developmental needs were viewed as more difficult to deliver virtually. Several positive aspects were highlighted including caregiver engagement in sessions and better work-life balance. The majority (84%) of SLPs indicated they would prefer to continue to use virtual care by adopting a hybrid model of service, while 8% of SLPs favored virtual care only and 8% in-person care only.

Most SLPs reported that speech-language services via virtual care were effective. Practitioners indicated a preference for a hybrid model of care for post-pandemic services. Further research is needed to better identify what components of virtual care enhance services to better adapt service models in the future.

What is already known on this subject Virtual care has been provided in speech-language pathology for many years but primarily in select circumstances for children living in remote areas. Speech-language care dramatically changed in many countries due to the required lock-down during the COVID-19 pandemic. What this paper adds to the existing knowledge This study provides updated information about the perceptions of effectiveness of virtual care for children based on the unplanned experiences of speech-language pathologists in Canada who were forced to rapidly implement a new service model. The findings suggest that overall practitioners adapted quickly and judged their services to be effective. Positive aspects of care included improved caregiver coaching, greater caregiver engagement and better work-life balance for practitioners. Primary barriers included the family's access to technology and the challenges of delivering care to children with complex needs. What are the potential or actual clinical implications for this work? This study supports the feasibility and effectiveness of speech-language care delivered virtually to children. This service model may result in improvements in both caregiving coaching and caregiver engagement. Most practitioners prefer shifting their post-pandemic services to hybrid models of care.