Patterns of SARS-CoV-2 circulation revealed by a nationwide sewage surveillance programme, the Netherlands, August 2020 to February 2022.

BackgroundSurveillance of SARS-CoV-2 in wastewater offers a near real-time tool to track circulation of SARS-CoV-2 at a local scale. However, individual measurements of SARS-CoV-2 in sewage are noisy, inherently variable and can be left-censored.AimWe aimed to infer latent virus loads in a comprehensive sewage surveillance programme that includes all sewage treatment plants (STPs) in the Netherlands and covers 99.6% of the Dutch population.MethodsWe applied a multilevel Bayesian penalised spline model to estimate time- and STP-specific virus loads based on water flow-adjusted SARS-CoV-2 qRT-PCR data for one to four sewage samples per week for each of the more than 300 STPs.ResultsThe model captured the epidemic upsurges and downturns in the Netherlands, despite substantial day-to-day variation in the measurements. Estimated STP virus loads varied by more than two orders of magnitude, from ca 1012 virus particles per 100,000 persons per day in the epidemic trough in August 2020 to almost 1015 per 100,000 in many STPs in January 2022. The timing of epidemics at the local level was slightly shifted between STPs and municipalities, which resulted in less pronounced peaks and troughs at the national level.ConclusionAlthough substantial day-to-day variation is observed in virus load measurements, wastewater-based surveillance of SARS-CoV-2 that is performed at high sampling frequency can track long-term progression of an epidemic at a local scale in near real time.

A randomised controlled trial to test the analgesic efficacy of topical morphine on minor superficial and partial thickness burns in accident and emergency departments.

OBJECTIVES: To test the analgesic efficacy of topical morphine on superficial burns within the emergency department by comparing pain scores, comfort ratings and analgesia taken by participants. METHOD: A placebo-controlled three-treatment randomised controlled trial was undertaken. 59 participants were randomly allocated to receive a dressing containing Intrasite gel and morphine sulphate, Intrasite gel and water or the conventional Jelonet dressing. The study design enabled double-blinding between the two Intrasite gel treatments. RESULTS: 49 participants were included in the final analysis as 10 were lost to follow-up. No significant differences were observed between the pain scores or comfort ratings of the three treatments. Participants receiving Jelonet and the placebo reduced their pain scores by the greatest amount overall. However, participants receiving morphine were the only group to reduce pain scores by >20 mm on two consecutive time intervals (2 and 6 h). At 12 h the morphine group reported the highest pain scores. Only 4/15 participants receiving topical morphine administered additional analgesia compared with 12/17 receiving the Jelonet dressing and 6/17 receiving Intrasite and water (p = 0.055). However, when all analgesia was taken into account, the morphine group was administered the greatest amount. Overall, the placebo group reported their dressings to be the most comfortable and took the least amount of analgesia. Minor adverse reactions included itching, burning and a rash. No serious adverse reactions were reported. CONCLUSIONS: Topical morphine sulphate does not seem to be as effective when used for the pain associated with superficial burns as when used for the pain associated with chronic inflammatory wounds. (The European Clinical Trials Database number for this study is 2005-003285-42.).

Registered children's nurses in emergency departments in England: an exploratory survey.

UNLABELLED: Recent reports suggest that emergency departments in England are some way from achieving universal provision of specific facilities for children and young people staffed by practitioners with appropriate qualifications. In 1998, 74 per cent of emergency departments employed children's nurses, but only 8 per cent employed them in sufficient numbers to provide 24-hour cover (Smith 1998). AIM: To establish whether there has been an increase in the number of children's nurses employed within emergency departments and to identify their specific roles and responsibilities. METHOD: A postal questionnaire was sent to senior managers of 99 general emergency departments in England with annual new attendance figures of between 45,000 and 100,000. Specific paediatric emergency departments and general departments in the London region were excluded. RESULTS: Analysis of data from the 52 valid responses suggest that although children comprise around 25 per cent of workload, registered children's nurses make up 10 per cent of the workforce in general emergency departments. The number employed in each department varied from one to 13 whole time equivalents (WTEs), and three departments did not employ any at all. In 11 of the 52 departments children's nurses were employed to specifically care for children; in other departments their main responsibilities were training other staff and developing and implementing policies and protocols. Fifty one of the 52 departments employed emergency nurse practitioners (ENPs). Children's nurses were employed as ENPs in 30 of the departments (total 46), a mean of 1.5 WTE per department. A quarter of the ENPs who were not registered children's nurses were reported to have received no additional training before being deemed competent to assess and treat children. CONCLUSION: There has been an increase in the numbers of children's nurses employed in general emergency departments but the numbers are still too low to comply with policy requirements. Managers should ensure that the skills of children's nurses are used to the full, and ENPs need to consider legal and accountability issues if they are asked to assess and treat children without having accessed appropriate training.