Characteristics of primary care practices associated with patient education during COVID-19: results of the cross-sectional PRICOV-19 study in 38 countries.

BACKGROUND: In response to the COVID-19 pandemic, the World Health Organization established a number of key recommendations such as educational activities especially within primary care practices (PCPs) which are a key component of this strategy. This paper aims to examine the educational activities of PCPs during COVID-19 pandemic and to identify the factors associated with these practices across 38 countries. METHODS: A "Patient Education (PE)" score was created based on responses to six items from the self-reported questionnaire among PCPs (n = 3638) compiled by the PRICOV-19 study. Statistical analyses were performed on 3638 cases, with PCPs with missing PE score values were excluded. RESULTS: The PE score features a mean of 2.55 (SD = 0.68) and a median of 2.50 (2.16 - 3.00), with a maximum of 4.00, and varies quite widely between countries. Among all PCPs characteristics, these factors significantly increase the PE score: the payment system type (with a capitation payment system or another system compared to the fee for service), the perception of average PCP with patients with chronic conditions and the perception of adequate governmental support. CONCLUSION: The model presented in this article is still incomplete and requires further investigation to identify other configuration elements favorable to educational activities. However, the results already highlight certain levers that will enable the development of this educational approach appropriate to primary care.

Vaccine hesitancy for the COVID-19 vaccine booster dose among nursing home staff fully vaccinated with the primary vaccination course in Belgium.

In Belgium, nursing home (NH) staff (NHS) and residents were prioritised for the initial COVID-19 vaccination and successive booster doses. The vaccination campaign for the first booster started in September 2021 in Belgian NH. Our first study about vaccine hesitancy towards the COVID-19 vaccine in Belgian NHS already showed a degree of fear for the primary vaccination course (T1). This new study aims to evaluate vaccine hesitancy to get the first booster (T2) in a population of fully vaccinated (with two doses) NHS. A random stratified sample of NHS who received the primary vaccination course (N = 954) completed an online questionnaire on COVID-19 booster hesitancy (between 25/11/2021 and 22/01/2022). NHS who hesitated or refused the booster were asked for the main reason for their hesitation/refusal. Overall, 21.0 % of our population hesitated before, were still hesitating or refused the booster, NHS that were not hesitant at T1 being 5.7 times less likely to hesitate to get the first booster dose (Adjusted OR 0.179, 95 % CI: 0.120, 0.267). Although there was a slight reduction (23.5 % to 20.1 %) in the proportion of NHS who hesitated/refused vaccination at T1 compared to T2 (p = 0.034), the fear of unknown effects was the principal reason for hesitation/refusal, already mentioned in our first study. NHS were not reassured concerning their initial fears. Given the likelihood that booster vaccinations will be necessary over the coming years, a communication strategy specific to NHS should be implemented.

Convalescent Plasma for Covid-19-Induced ARDS in Mechanically Ventilated Patients.

BACKGROUND: Passive immunization with plasma collected from convalescent patients has been regularly used to treat coronavirus disease 2019 (Covid-19). Minimal data are available regarding the use of convalescent plasma in patients with Covid-19-induced acute respiratory distress syndrome (ARDS). METHODS: In this open-label trial, we randomly assigned adult patients with Covid-19-induced ARDS who had been receiving invasive mechanical ventilation for less than 5 days in a 1:1 ratio to receive either convalescent plasma with a neutralizing antibody titer of at least 1:320 or standard care alone. Randomization was stratified according to the time from tracheal intubation to inclusion. The primary outcome was death by day 28. RESULTS: A total of 475 patients underwent randomization from September 2020 through March 2022. Overall, 237 patients were assigned to receive convalescent plasma and 238 to receive standard care. Owing to a shortage of convalescent plasma, a neutralizing antibody titer of 1:160 was administered to 17.7% of the patients in the convalescent-plasma group. Glucocorticoids were administered to 466 patients (98.1%). At day 28, mortality was 35.4% in the convalescent-plasma group and 45.0% in the standard-care group (P = 0.03). In a prespecified analysis, this effect was observed mainly in patients who underwent randomization 48 hours or less after the initiation of invasive mechanical ventilation. Serious adverse events did not differ substantially between the two groups. CONCLUSIONS: The administration of plasma collected from convalescent donors with a neutralizing antibody titer of at least 1:160 to patients with Covid-19-induced ARDS within 5 days after the initiation of invasive mechanical ventilation significantly reduced mortality at day 28. This effect was mainly observed in patients who underwent randomization 48 hours or less after ventilation initiation. (Funded by the Belgian Health Care Knowledge Center; ClinicalTrials.gov number, NCT04558476.).

Quadriceps handheld dynamometry during the post-ICU trajectory: using strictly the same body position is mandatory for repeated measures.

BACKGROUND: The level of quadriceps strength (QS) generated in the supine or seated position is not similar. For QS follow-up from intensive care unit (ICU) stay to recovery, getting comparable measures is essential. This study aimed to develop and validate new equations for estimating QS in a given position based on the measurement taken in another one. METHODS AND RESULTS: Isometric QS was measured using a handheld dynamometer and a standardized protocol in a supine and in a seated position. In a first cohort of 77 healthy adults, two QS conversion equations were developed using a multivariate model integrating independent parameters such as age, sex, body mass index (BMI) and baseline QS. These equations were tested in two cohorts for external validation, using the interclass correlation coefficient (ICC) and Bland-Altman graphical method. Only one was validated in the second cohort (62 different healthy adults): the ICC was 0.87 (95% CI 0.59-0.94) and the bias was - 0.49 N/Kg (limits of agreement: - 1.76-0.78 N/kg). However, this equation did not perform well in the third cohort (50 ICU survivors): the ICC was 0.60 (95% CI 0.24-0.78), and the bias was - 0.53 N/Kg (limits of agreement: - 1.01-2.07 N/kg). CONCLUSIONS: As no conversion equation has been validated in the present study, repeated QS measurements should be performed strictly in the same standardized and documented position.

Sham-controlled randomized multicentre trial of transcranial direct current stimulation for prolonged disorders of consciousness.

BACKGROUND AND PURPOSE: Transcranial direct current stimulation (tDCS) has been shown to improve signs of consciousness in a subset of patients with disorders of consciousness (DoC). However, no multicentre study confirmed its efficacy when applied during rehabilitation. In this randomized controlled double-blind study, the effects of tDCS whilst patients were in rehabilitation were tested at the group level and according to their diagnosis and aetiology to better target DoC patients who might repond to tDCS. METHODS: Patients received 2 mA tDCS or sham applied over the left prefrontal cortex for 4 weeks. Behavioural assessments were performed weekly and up to 3 months' follow-up. Analyses were conducted at the group and subgroup levels based on the diagnosis (minimally conscious state [MCS] and unresponsive wakefulness syndrome) and the aetiology (traumatic or non-traumatic). Interim analyses were planned to continue or stop the trial. RESULTS: The trial was stopped for futility when 62 patients from 10 centres were enrolled (44 ± 14 years, 37 ± 24.5 weeks post-injury, 18 women, 32 MCS, 39 non-traumatic). Whilst, at the group level, no treatment effect was found, the subgroup analyses at 3 months' follow-up revealed a significant improvement for patients in MCS and with traumatic aetiology. CONCLUSIONS: Transcranial direct current stimulation during rehabilitation does not seem to enhance patients' recovery. However, diagnosis and aetiology appear to be important factors leading to a response to the treatment. These findings bring novel insights into possible cortical plasticity changes in DoC patients given these differential results according to the subgroups of patients.

Bruxism as a new risk factor of musculo-skeletal disorders?

OBJECTIVES: Musculoskeletal disorders (MSDs), particularly neck and low back pain, constitute a major public health issue worldwide with a heavy morbidity and economic impact. However, the relationships between the stomatognathic system and MSDs are subjected to debate, data sorely lacking. The study objective was to investigate the association between bruxism (BR) and MSDs. Secondary objective includes the study of the association between tooth wear (TW) and MSDs. METHODS: This is a cross-sectional study on 425 participants frequenting a university dental clinic. The presence of MSDs was evaluated with the standardized Nordic questionnaire. The sleep and awake BR assessments were based on clinical examination and self-report. TW was measured with the BEWE index. Socio-demographic factors, medical history, life habits and stress were analyzed as potential confounding variables. RESULTS: 91% of patients reported at least one MSD during the preceding 12 months and 75.5% were diagnosed as bruxers. In multivariate analyses, BR was associated with a 5-fold increased risk of prevalent MSD (OR=5.88 (2.7-12.5), p<0.0001). Regarding TW, for a one-point increase in anterior BEWE score, the risk to present an MSD was increased by 53% (OR=1.53 (1.12-2.08), p = 0.0076). Moreover, BR was independently associated with neck, shoulder, upper back, low back, hip & thigh and knee MSDs. Anterior TW was independently associated with neck, low back and hip & thigh MSDs, and global TW with knee MSDs. CONCLUSIONS: BR and TW were shown to be associated with MSDs. The cause-and-effect relationships between those factors needs to be analyzed to optimize prevention and therapeutic care. CLINICAL SIGNIFICANCE: Results suggest that the body is a whole, a balanced muscular system, where every part constitutes a link of the chain. MSDs management and prevention may require a multidisciplinary team approach and future perspectives include defining the dentist's role in this context, particularly with respect to BR diagnostic and treatment.

Incidence of near-death experiences in patients surviving a prolonged critical illness and their long-term impact: a prospective observational study.

BACKGROUND: So far, the few prospective studies on near-death experience (NDE) were carried out only in intensive care unit (ICU) patients with homogeneous aetiologies, such as cardiac arrest or trauma survivors. The aims of this 1-year prospective and monocentric study were to investigate the incidence of NDE in ICU survivors (all aetiologies) as well as factors that may affect its frequency, and to assess quality of life up to 1 year after enrolment. METHODS: We enrolled adults with a prolonged ICU stay (> 7 days). During the first 7 days after discharge, all eligible patients were assessed in a face-to-face interview for NDE using the Greyson NDE scale, dissociative experiences using the Dissociative Experience Scale, and spirituality beliefs using the WHOQOL-SRPB. Medical parameters were prospectively collected. At 1-year after inclusion, patients were contacted by phone to measure quality of life using the EuroQol five-dimensional questionnaire. RESULTS: Out of the 126 included patients, 19 patients (15%) reported having experienced a NDE as identified by the Greyson NDE scale (i.e. cut-off score ≥ 7/32). In univariate analyses, mechanical ventilation, sedation, analgesia, reason for admission, primary organ dysfunction, dissociative and spiritual propensities were associated with the emergence of NDE. In multivariate logistic regression analysis, only the dissociative and spiritual propensity strongly predicted the emergence of NDE. One year later (n = 61), the NDE was not significantly associated with quality of life. CONCLUSIONS: The recall of NDE is not so rare in the ICU. In our cohort, cognitive and spiritual factors outweighed medical parameters as predictors of the emergence of NDE. Trial registration This trial was registered in Clinicaltrials.gov in February 2020 ( NCT04279171 ).

Feasibility and Acceptability of a Home-Based Sensory Perception Training Game for Patients with Fibromyalgia: A Pilot Study.

Objective: The primary aim of this pilot study was to test the feasibility and acceptability of a prototype of a novel digital system enabling somatosensory training at home by means of a gamified mobile application in patients with chronic pain. The secondary aims were to test the effect size of the intervention on clinical outcomes to power a subsequent randomized controlled trial. Materials and Methods: We conducted a pilot randomized controlled trial in patients with fibromyalgia. This was an 8-week crossover study, which included a 4-week somatosensory training phase (daily use with the novel digital system) and a 4-week control phase (no use of this new system) in a random order. Feasibility was tested by objectively measuring the adherence and retention rates. Acceptability and changes in pain and disability were measured through data from subjective questionnaires. Results: Thirty-five patients completed the study. The satisfaction questionnaire indicated high training enjoyment, ease of use for daily training and interest to continue to use the intervention after the study. The adherence (93%) and retention (94%) rates were high. The effect sizes were moderate for pain intensity (0.57). Conclusion: The novel gamified technology for remotely delivered somatosensory training is feasible in a group of patients with fibromyalgia, and results in high engagement, satisfaction, and adherence. A subsequent clinical trial with the final version of the technology platform, including a longer training with more sensory training tasks and a bigger sample size is necessary.

Bone Marrow-Derived Mesenchymal Stromal Cell Therapy in Severe COVID-19: Preliminary Results of a Phase I/II Clinical Trial.

Background: Treatment of acute respiratory distress syndrome (ARDS) associated with COronaVIrus Disease-2019 (COVID-19) currently relies on dexamethasone and supportive mechanical ventilation, and remains associated with high mortality. Given their ability to limit inflammation, induce immune cells into a regulatory phenotype and stimulate tissue repair, mesenchymal stromal cells (MSCs) represent a promising therapy for severe and critical COVID-19 disease, which is associated with an uncontrolled immune-mediated inflammatory response. Methods: In this phase I-II trial, we aimed to evaluate the safety and efficacy of 3 intravenous infusions of bone marrow (BM)-derived MSCs at 3-day intervals in patients with severe COVID-19. All patients also received dexamethasone and standard supportive therapy. Between June 2020 and September 2021, 8 intensive care unit patients requiring supplemental oxygen (high-flow nasal oxygen in 7 patients, invasive mechanical ventilation in 1 patient) were treated with BM-MSCs. We retrospectively compared the outcomes of these MSC-treated patients with those of 24 matched control patients. Groups were compared by paired statistical tests. Results: MSC infusions were well tolerated, and no adverse effect related to MSC infusions were reported (one patient had an ischemic stroke related to aortic endocarditis). Overall, 3 patients required invasive mechanical ventilation, including one who required extracorporeal membrane oxygenation, but all patients ultimately had a favorable outcome. Survival was significantly higher in the MSC group, both at 28 and 60 days (100% vs 79.2%, p = 0.025 and 100% vs 70.8%, p = 0.0082, respectively), while no significant difference was observed in the need for mechanical ventilation nor in the number of invasive ventilation-free days, high flow nasal oxygenation-free days, oxygen support-free days and ICU-free days. MSC-treated patients also had a significantly lower day-7 D-dimer value compared to control patients (median 821.0 µg/L [IQR 362.0-1305.0] vs 3553 µg/L [IQR 1155.0-6433.5], p = 0.0085). Conclusions: BM-MSC therapy is safe and shows very promising efficacy in severe COVID-19, with a higher survival in our MSC cohort compared to matched control patients. These observations need to be confirmed in a randomized controlled trial designed to demonstrate the efficacy of BM-MSCs in COVID-19 ARDS. Clinical Trial Registration: (www.ClinicalTrials.gov), identifier NCT04445454.

Factors influencing the adoption and participation rate of nursing homes staff in a saliva testing screening programme for COVID-19.

Testing strategies are crucial to prevent and control the spread of covid-19 but suffer from a lack of investment in understanding the human factors that influence their implementation. The aim of this study was to understand the factors that encourage participation and the level of engagement of nursing homes staff in a routine saliva testing programme for COVID-19 In December 2020, nursing homes (n = 571) in Wallonia (Belgium) were invited to participate in a saliva testing programme for their staff. The directors were questioned by telephone at the end of a 3-week pilot phase. 445 nursing homes took part in the evaluation questionnaire, of which 36(8%) answered that they chose not to participate in the testing programme. The average participation rate of nursing staff was 49(±25)%. Perception of the justification of the efforts required for testing and perception of practicability of the procedure were significantly associated with the adoption of the system by the nursing homes directors (OR(95%CI): 5.96(1.97-18.0), p = 0.0016); OR(95%CI): 5.64(1.94-16.4), p = 0.0015 respectively). Staff support, incentives and meetings increased the level of engagement in testing (p<0.05). While the adoption of the programme confirmed the acceptability of salivary testing as a means of screening, the participation rate confirmed the need for studies to understand the factors that encourage health care staff to take part. The results suggested rethinking strategies to consider staff engagement from a health promotion perspective.

Clinical prediction models for diagnosis of COVID-19 among adult patients: a validation and agreement study.

BACKGROUND: Since the beginning of the pandemic, hospitals have been constantly overcrowded, with several observed waves of infected cases and hospitalisations. To avoid as much as possible this situation, efficient tools to facilitate the diagnosis of COVID-19 are needed. OBJECTIVE: To evaluate and compare prediction models to diagnose COVID-19 identified in a systematic review published recently using performance indicators such as discrimination and calibration measures. METHODS: A total of 1618 adult patients present at two Emergency Department triage centers and for whom qRT-PCR tests had been performed were included in this study. Six previously published models were reconstructed and assessed using diagnostic tests as sensitivity (Se) and negative predictive value (NPV), discrimination (Area Under the Roc Curve (AUROC)) and calibration measures. Agreement was also measured between them using Kappa's coefficient and IntraClass Correlation Coefficient (ICC). A sensitivity analysis has been conducted by waves of patients. RESULTS: Among the 6 selected models, those based only on symptoms and/or risk exposure were found to be less efficient than those based on biological parameters and/or radiological examination with smallest AUROC values (< 0.80). However, all models showed good calibration and values above > 0.75 for Se and NPV but poor agreement (Kappa and ICC < 0.5) between them. The results of the first wave were similar to those of the second wave. CONCLUSION: Although quite acceptable and similar results were found between all models, the importance of radiological examination was also emphasized, making it difficult to find an appropriate triage system to classify patients at risk for COVID-19.

Acceptability of Community Saliva Testing in Controlling the COVID-19 Pandemic: Lessons Learned from Two Case Studies in Nursing Homes and Schools.

Current public health debate centers on COVID-19 testing methods and strategies. In some communities, high transmission risk may justify routine testing, and this requires test methods that are safe and efficient for both patients and the administrative or health-care workers administering them. Saliva testing appears to satisfy those criteria. There is, however, little documentation on the acceptability of this method among beneficiaries. This article presents the lessons learned from a pilot study on the use of saliva testing for routine screening of nursing home and secondary school personnel in Wallonia (the French-speaking part of Belgium), conducted in December 2020 to April 2021, respectively. Administrators at the facilities in question seemed to think highly of saliva testing and wished to continue it after the pilot study was over. This result reinforces the criteria (the noninvasive aspect, in particular) supporting a key role for saliva testing in monitoring community spread of the virus. Nevertheless, wider-scale deployment of this particular method will only be possible if the testing strategy as a whole takes a health promotion approach.

Prevention of ventilator-associated pneumonia by noble metal coating of endotracheal tubes: a multi-center, randomized, double-blind study.

BACKGROUND: Ventilator-associated pneumonia (VAP) causes increased mortality, prolonged hospital stay and increased healthcare costs. Prevention of VAP in intensive care units (ICUs) is currently based on several measures, and application of noble metal coating on medical devices has been shown to inhibit the bacterial adherence of microorganisms to the surface. The objective of this study was to evaluate the potential benefit of noble metal coating of endotracheal tubes for the prevention of VAP. METHODS: This was a multi-center, randomized, controlled, double-blind, prospective study including ventilated patients from nine ICUs from four hospital sites in Belgium. Patients were randomly intubated with identical appearing noble metal alloy (NMA) coated (NMA-coated group) or non-coated (control group) endotracheal tubes (ETT). Primary endpoint was the incidence of VAP. Secondary endpoints were the proportion of antibiotic days during ICU stay and tracheal colonization by pathogenic bacteria. RESULTS: In total, 323 patients were enrolled, 168 in the NMA-coated group and 155 in the control group. During ventilation, VAP occurred in 11 patients (6.5%) in the NMA-coated group and in 18 patients (11.6%) in the control group (p = 0.11). A higher delay in VAP occurrence was observed in the NMA-coated group compared with the control group by Cox proportional hazards regression analysis (HR 0.41, 95% CI 0.19-0.88, p = 0.02). The number of antibiotic days was 58.8% of the 1,928 ICU days in the NMA-coated group and 65.4% of the 1774 ICU days in the control group (p = 0.06). Regarding tracheal colonization, bacteria occurred in 38 of 126 patients in the NMA-coated group (30.2%) and in 37 of 109 patients in the control group (33.9%) (p = 0.57). CONCLUSIONS: This study provides preliminary evidence to support the benefit of noble metal coating in the prevention of VAP. A confirmatory study in a larger population would be valuable. TRIAL REGISTRATION: Clinical trial number: NCT04242706 ( http://www.clinicaltrials.gov ).

Current practice for safe return-to-play after lateral ankle sprain: A survey among French-speaking physicians.

BACKGROUND: Recommendations are available for assessment criteria for safe return-to-play (RTP) after a lateral ankle sprain. However, their current use among physicians is unknown. METHODS: French-speaking physicians in Belgium, France and Switzerland were asked to complete an online survey and report their clinical assessment of selected RTP criteria. RESULTS: The respondent sample (n=109) included physicians with and without Sports Medicine education, varied level of experience and proportion of athletes in their practice population. Pain was the most selected criterion for safe RTP (90% of physicians), followed by ability to engage in functional tasks (82%), functional instability (73%), range of motion (61%), proprioception (47%), mechanical instability (39%), strength (38%) and swelling (31%). A low proportion of physicians use quantitative measures to assess these criteria (between 4% and 53%). CONCLUSIONS: A large proportion of physicians consider the recommended criteria for RTP decisions. However, physicians do not frequently use quantitative measures.

Validation of a French-language version of TeamSTEPPS® T-TPQ and T-TAQ questionnaires.

Teamwork training and evaluation are essential to enhance safety and quality of care. The lack of the psychometric testing of the TeamSTEPPS® Teamwork Attitudes Questionnaire (T-TAQ) and Teamwork Perceptions Questionnaire (T-TPQ) across different language and cultural settings has questioned their widespread use because such attitudes and perceptions are highly subjective and context-bound. The present study aims to translate the T-TAQ and T-TPQ into the French language and validate the psychometric properties of the two questionnaires in a public health context. A forward-backward translation process, panel reviewing, and pilot testing in two rounds were followed to develop the French versions. Confirmatory factor analysis (CFA) and Cronbach's alpha were used to examine the factor structure and internal consistency, whereas two-way mixed Intraclass Correlation Coefficient (ICC) was performed to assess test-retest reliability. A total of 235 healthcare professionals in the French-speaking community of Belgium completed the T-TAQ and T-TPQ. After two to four weeks, 102 participants took part in the second round. Despite good fit indices as revealed by the CFA and Cronbach's alpha from 0.53 to 0.75 for the five dimensions of the T-TAQ and 0.76 to 0.79 for the T-TPQ, the squared correlations among the constructs were higher than the average variance extracted. Two-way mixed ICCs indicated fair to good test-retest reliability for all the five constructs of the two questionnaires, except the leadership scale of the T-TAQ. The French-language versions of the T-TAQ and T-TPQ were semantically equivalent and culturally relevant with adequate test-retest reliability as compared to the English versions. These two instruments might be used to capture the overall attitude toward teamwork and perceptions of team skills and behaviors. Yet, further research is advisable to refine the scales to establish the discriminant validity of the different dimensions and discriminative power of the instruments.

Virtual reality and hypnosis for anxiety and pain management in intensive care units: A prospective randomised trial among cardiac surgery patients.

BACKGROUND: Virtual reality and hypnosis are little studied in complex contexts, such as intensive care, where patients need significant physical and psychological assistance. OBJECTIVES: To compare and combine hypnosis and virtual reality benefits on anxiety and pain on patients before and after cardiac surgery. DESIGN: Prospective randomised controlled clinical trial. SETTING: The study was conducted in the University Hospital of Liege (Belgium) from October 2018 to January 2020. PATIENTS: One hundred patients (66 ±â€Š11.5 years; 24 women, 76 men) were included. Participants were adults undergoing cardiac surgery. Exclusion criteria: psychiatric diseases, claustrophobia, acrophobia, hearing loss, visual impairment, extreme fatigue, confusion surgery cancelled. INTERVENTIONS: Patients were randomly assigned to four arms (control; hypnosis; virtual reality; virtual reality hypnosis) and had 20 min of one of the techniques the day before and the day after surgery. MAIN OUTCOMES MEASURES: Anxiety, pain, fatigue, relaxation, physiological parameters, and opioid use were evaluated before and after each session. RESULTS: The main results did not show any significant differences between the groups. In all groups, anxiety decreased and pain increased from baseline to the postoperative day. Relaxation increased in all groups in the pre-operative (P < 0.0001) and postoperative period (P = 0.03). There were no significant differences for fatigue, physiological measures, or opioid use. CONCLUSION: As there were no significant differences between groups for the measured variables, we cannot affirm that one technique is better than another. Additional studies are required to compare and evaluate the cost-effectiveness of these techniques for critical care patients and caregivers. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03820700. https://clinicaltrials.gov/ct2/show/NCT03820700. Retrospectively registered on 29 January 2019.

Physical capacities assessment in critically ill patients: An exploratory study.

BACKGROUND: The severity of muscle weakness after critical illness is very heterogeneous. To identify those patients who may maximally benefit from early exercises would be highly valuable. This implies an assessment of physical capacities, comprised at least of strength measurement and functional tests. OBJECTIVES: The objective of this study was to investigate the relationship between muscle strength and functional tests in an intensive care unit (ICU) setting. METHODS: Adults with ICU length of stay ≥2 days were included. Handgrip strength (HG) and maximal isometric quadriceps strength (QS) were assessed using standardised protocols as soon as patients were alert and able to obey commands. At the same time, their maximal level of mobilisation capabilities and their autonomy were assessed using ICU Mobility Scale (ICU-MS) and Barthel Index, respectively. RESULTS: Ninety-three patients with a median age of 64 [57-71.5] years, body mass index of 26.4 [23.4-29.6] kg/m2, and Simplified Acute Physiology Score II of 33 [27.7-41] were included. Absolute and relative QS were, respectively, 146.7 [108.5-196.6] N and 1.87 [1.43-2.51] N/kg. HG was 22 [16-31] kg. The ICU-MS score was 4 [1-5]. A significant positive correlation was observed between HG and absolute QS (rs = 0.695, p < 0.001) and between HG and relative QS (rs = 0.428, p < 0.001). The ICU-MS score correlated with HG, with a weak positive relationship (rs = 0.215, p = 0.039), but not with QS. The ICU-MS score did not statistically differ between the weakest and strongest patients for absolute or relative QS, but was lower in patients with the lowest HG values (p = 0.01). A weak positive correlation was observed between the Barthel Index and muscle strengths (maximum rs = 0.414, p < 0.001). CONCLUSIONS: The present results suggest that, during ICU stay, there is no strong association between muscle strength and functional test such as the ICU-MS or Barthel Index. Muscle dynamometry and functional tests are probably complementary tools for physical capacities quantification.

A systematic review of prediction models to diagnose COVID-19 in adults admitted to healthcare centers.

BACKGROUND: The COVID-19 pandemic is putting significant pressure on the hospital system. To help clinicians in the rapid triage of patients at high risk of COVID-19 while waiting for RT-PCR results, different diagnostic prediction models have been developed. Our objective is to identify, compare, and evaluate performances of prediction models for the diagnosis of COVID-19 in adult patients in a health care setting. METHODS: A search for relevant references has been conducted on the MEDLINE and Scopus databases. Rigorous eligibility criteria have been established (e.g., adult participants, suspicion of COVID-19, medical setting) and applied by two independent investigators to identify suitable studies at 2 different stages: (1) titles and abstracts screening and (2) full-texts screening. Risk of bias (RoB) has been assessed using the Prediction model study Risk of Bias Assessment Tool (PROBAST). Data synthesis has been presented according to a narrative report of findings. RESULTS: Out of the 2334 references identified by the literature search, 13 articles have been included in our systematic review. The studies, carried out all over the world, were performed in 2020. The included articles proposed a model developed using different methods, namely, logistic regression, score, machine learning, XGBoost. All the included models performed well to discriminate adults at high risks of presenting COVID-19 (all area under the ROC curve (AUROC) > 0.500). The best AUROC was observed for the model of Kurstjens et al (AUROC = 0.940 (0.910-0.960), which was also the model that achieved the highest sensitivity (98%). RoB was evaluated as low in general. CONCLUSION: Thirteen models have been developed since the start of the pandemic in order to diagnose COVID-19 in suspected patients from health care centers. All these models are effective, to varying degrees, in identifying whether patients were at high risk of having COVID-19.

The Vienna self-assessment questionnaire: a usable tool towards more health-literate hospitals? Explorative case studies in three hospitals in Belgium.

BACKGROUND: Strengthening the capacity of hospitals to take into account the level of health literacy of their public is a necessity to improve the quality of care. One way to develop adequate health literacy responsive policy and strategies in hospitals is the use of self-assessment tools to raise awareness, help prioritise action and mobilise stakeholders. The Vienna Health Literate Organisation (V-HLO) questionnaire, recently translated and adapted into French, is designed to meet this objective. In this study we have piloted the French version of the V-HLO (V-HLO-fr) tool in the main hospitals of Liège (Belgium) to explore its feasibility and gain a first insight into the strengths and weaknesses of the health literacy responsiveness of the participating hospitals. METHODS: We performed explorative case studies in three hospitals. Our mode of application of the V-HLO-fr was inspired by the 'RAND Appropriateness' method: first, individual members of an internal multidisciplinary panel filled out the questionnaire and then the results were discussed collectively in each hospital during a 'round table' meeting. The feasibility of the process was assessed by direct observation of the round tables and with semi-structured phone interviews. RESULTS: The V-HLO-fr tool was fully applied in the three targeted hospitals and the process seems to be acceptable, practicable and integrable. Strengths (e.g. the facilitation of patient navigation to the hospital) and weaknesses (e.g. the provision of easy to read, understand and act on health information materials) in terms of health literacy responsiveness have been highlighted. CONCLUSION: V-HLO-fr can be a suitable tool for a needs assessment that allows hospitals to create awareness and formulate targeted actions to further strengthen their health literacy responsiveness. Its mode of application, formalised by taking inspiration from the RAND method, could be further improved by paying more attention to recruiting and supporting participants. The V-HLO-fr and its added value in real-world projects should now be further tested in a larger number of hospitals.

Exploring the relationship between first-year nursing student self-esteem and dropout: A cohort study.

AIM: To describe nursing student self-esteem prior to the influence of nursing education and to explore the relationship between self-esteem and dropout. DESIGN: Cohort study. METHODS: At the beginning of their first year of study, in October 2017, 464 nursing students completed a questionnaire that assessed their self-esteem level via Tafarodi & Swann Scale and self-esteem profile following Mruk's model, along with sociodemographic information, state anxiety, self-efficacy, intention to continue and social support. One year later, data on grades and re-enrolment were collected. Multivariate analyses explored the factors influencing self-esteem level (multiple regression), self-esteem profile (multinomial logistic regression) and dropout (binary logistic regression). RESULTS/FINDINGS: The mean level of self-esteem was 50.8 (9.0), scale of 16 to 80. Forty-nine per cent of self-esteem profiles were classified as 'high', 20.1% as 'defensive acceptance based', 11.2% as 'defensive achievement based' and 19.6% as 'low'. State anxiety (p < 0.0001), self-efficacy about completion of the nursing programme (p < 0.0001) and self-efficacy about internship (p < 0.0001) were associated with self-esteem. The dropout rate was 21.5%. Self-esteem level (p = 0.039) and academic performance (p < 0.0001) were associated with dropout. CONCLUSION: While nursing student self-esteem is often described as low, we know little about its baseline before entering the nursing programme and the factors that influence it. The dropout rate among first-year nursing students is high, but self-esteem is rarely explored as a possible explanation. We found that students had medium, and potentially fragile, self-esteem when starting their nursing education, and that self-esteem was associated with dropout. IMPACT: Given that association and the impact of self-esteem on well-being and professional behaviour, educational institutions should foster self-esteem both generally and in students with anxiety or low self-efficacy. Future research should explore nursing student self-esteem using a longitudinal mixed methods approach. Society should value nurses and nursing students.