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A patient’s respiratory rate is one of the critical vital signs that is a determinant of patient well-being. However, it is all too often neglected or misreported by health care professionals. This study presents the design, build and testing of a low-cost, portable monitor to facilitate accurate reporting of respiratory rate. The monitor comprised a thermistor-based transducer to capture the breath cycle of patients based on the temperature differential created across the thermistor. The signal was conditioned and processed such that the signal could be analysed to identify the peaks and ultimately determine the respiratory rate. For a total cost at the time of development of less than C40, the integrated system demonstrated a modest average error of 5.6% across a range of different ambient temperatures, rate and depth of breathing, and orifice of breathing. This is comparable with other commercial and custom devices. The presented monitor may be of interest for use in an emergency room or clinical setting, especially in severely resource-constrained countries.

Background: COVID-19 added to healthcare provider (HCP) distress, but patterns of change remain unclear. This study sought to determine if and how emotional distress varied among HCP between March 28, 2021 and December 1, 2023. Methods: This longitudinal study was embedded within the 42-month prospective COVID-19 Cohort Study that recruited HCP from four Canadian provinces. Information was collected at enrollment, from annual exposure surveys, and vaccination and illness surveys. The 10-item Kessler Psychological Distress Scale (K10) was completed approximately every six months after March 28, 2021. Linear mixed effects models, specifically random intercept models, were generated to determine the impact of time on emotional distress while accounting for demographic and work-related factors. Results: Between 2021 and 2023, the mean K10 score fell by 3.1 points, indicating decreased distress, but scores increased during periods of high levels of mitigation strategies against transmission of SARS-CoV-2, during winter months, and if taking antidepression, anti-anxiety or anti-insomnia medications. K10 scores were significantly lower for HCP who were male, older, had more children in their household, experienced prior COVID-19 illness(es), and for non-physician but regulated HCP versus nurses. A sensitivity analysis that included only those who had submitted at least five K10 surveys consisted of the factors in the full model excluding previous COVID-19 illness, occupation, and season, after adjustment. Models were also created for K10 anxiety and depression subscales. Conclusions: K10 scores decreased as the COVID-19 pandemic continued but increased during periods of high mitigation and the winter months. Personal and work-place factors also impacted HCP distress scores. Further research into best practices in distress identification and remediation is warranted to ensure future public health disasters are met with healthcare systems that are able to buffer HCP against short- and long-term mental health issues. [ABSTRACT FROM AUTHOR]

The global emergence of carbapenemase-producing Enterobacteriaceae (CPE) poses a threat to the achievements of modern medicine. The Centers for Disease Control and Prevention and the World Health Organization have recently [...]

Thoracic endovascular aortic repair (TEVAR) has emerged as a viable option of treatment for uncomplicated type B aortic dissection (UTBAD) due to the potential for inducing favorable aortic remodeling. The aim of this study is to compare outcomes of UTBAD treated medically or with TEVAR in either the acute (1 to 14 days) or subacute period (2 weeks to 3 months). Patients with UTBAD between 2007 and 2019 were identified using the TriNetX Network. The cohort was stratified by treatment type (medical management; TEVAR during the acute period; TEVAR during the subacute period). Outcomes including mortality, endovascular reintervention, and rupture were analyzed after propensity matching. Among 20,376 patients with UTBAD, 18,840 were medically managed (92.5%), 1099 patients were in the acute TEVAR group (5.4%), and 437 patients were in the subacute TEVAR group (2.1%). The acute TEVAR group had higher rates of 30-day and 3-year rupture (4.1% vs 1.5%; P <.001; 9.9% vs 3.6%; P <.001) and 3-year endovascular reintervention (7.6% vs 1.6%; P <.001), similar 30-day mortality (4.4% vs 2.9%; P <.068), and lower 3-year survival compared with medical management (86.6% vs 83.3%; P =.041). The subacute TEVAR group had similar rates of 30-day mortality (2.3% vs 2.3%; P = 1), 3-year survival (87.0% vs 88.8%; P =.377) and 30-day and 3-year rupture (2.3% vs 2.3%; P = 1; 4.6% vs 3.4%; P =.388), with significantly higher rates of 3-year endovascular reintervention (12.6% vs 7.8%; P =.019) compared with medical management. The acute TEVAR group had similar rates of 30-day mortality (4.2% vs 2.5%; P =.171), rupture (3.0% vs 2.5%; P =.666), significantly higher rates of 3-year rupture (8.7% vs 3.5%; P =.002), and similar rates of 3-year endovascular reintervention (12.6% vs 10.6%; P =.380) compared with the subacute TEVAR group. There was significantly higher 3-year survival (88.5% vs 84.0%; P =.039) in the subacute TEVAR group compared with the acute TEVAR group. Our results found lower 3-year survival in the acute TEVAR group compared with the medical management group. There was no 3-year survival benefit found in patients with UTBAD who underwent subacute TEVAR compared with medical management. This suggests the need for further studies looking at the necessity for TEVAR when compared with medical management for UTBAD as it is non-inferior to medical management. Higher rates of 3-year survival and lower rates of 3-year rupture in the subacute TEVAR group compared with the acute TEVAR group suggest superiority of subacute TEVAR. Further investigations are needed to determine the long-term benefit and optimal timing of TEVAR for acute UTBAD. [ABSTRACT FROM AUTHOR]

Background Adults previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) develop short-term immunity and may have increased reactogenicity to coronavirus disease 2019 (COVID-19) vaccines. This prospective, multicenter, active-surveillance cohort study examined the short-term safety of COVID-19 vaccines in adults with a prior history of SARS-CoV-2. Methods Canadian adults vaccinated between 22 December 2020 and 27 November 2021 were sent an electronic questionnaire 7 days post–dose 1, dose 2, and dose 3 vaccination. The main outcome was health events occurring in the first 7 days after each vaccination that prevented daily activities, resulted in work absenteeism, or required a medical consultation, including hospitalization. Results Among 684 998 vaccinated individuals, 2.6% (18 127/684 998) reported a prior history of SARS-CoV-2 infection a median of 4 (interquartile range: 2–6) months previously. After dose 1, individuals with moderate (bedridden) to severe (hospitalized) COVID-19 who received BNT162b2, mRNA-1273, or ChAdox1-S vaccines had higher odds of a health event preventing daily activities, resulting in work absenteeism or requiring medical consultation (adjusted odds ratio [95% confidence interval]: 3.96 [3.67–4.28] for BNT162b2, 5.01 [4.57–5.50] for mRNA-1273, and 1.84 [1.54–2.20] for ChAdox1-S compared with no infection). Following dose 2 and 3, the greater risk associated with previous infection was also present but was attenuated compared with dose 1. For all doses, the association was lower or absent after mild or asymptomatic infection. Conclusions Adults with moderate or severe previous SARS-CoV-2 infection were more likely to have a health event sufficient to impact routine activities or require medical assessment in the week following each vaccine dose. [ABSTRACT FROM AUTHOR]