Summary Background Hospital admissions for non-coronavirus disease 2019 (COVID-19) pathology have decreased significantly. It is believed that this may be due to public anxiety about acquiring COVID-19 infection in hospital and the subsequent risk of mortality. Aim To identify patients who acquire COVID-19 in hospital (nosocomial COVID-19 infection (NC)) and their risk of mortality compared to those with community-acquired COVID-19 (CAC) infection. Methods The COPE-Nosocomial Study was an observational cohort study. The primary outcome was the time to all-cause mortality (estimated with an adjusted hazard ratio (aHR)), and secondary outcomes were day 7 mortality and the time-to-discharge. A mixed-effects multivariable Cox's proportional hazards model was used, adjusted for demographics and comorbidities. Findings The study included 1564 patients from 10 hospital sites throughout the UK, and one in Italy, and collected outcomes on patients admitted up to April 28 th , 2020. In all, 12.5% of COVID-19 infections were acquired in hospital; 425 (27.2%) patients with COVID died. The median survival time in NC patients was 14 days compared with 10 days in CAC patients. In the primary analysis, NC infection was associated with lower mortality rate (aHR: 0.71; 95% confidence interval (CI): 0.51–0.98). Secondary outcomes found no difference in day 7 mortality (adjusted odds ratio: 0.79; 95% CI: 0.47–1.31), but NC patients required longer time in hospital during convalescence (aHR: 0.49, 95% CI: 0.37–0.66). Conclusion The minority of COVID-19 cases were the result of NC transmission. No COVID-19 infection comes without risk, but patients with NC had a lower risk of mortality compared to CAC infection; however, caution should be taken when interpreting this finding.

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Aim Measure weight gain in preterm infants after introduction of a nutritional care bundle. Methods 509 infants less than 32 weeks gestation were studied until discharge home from the tertiary unit or their local neonatal unit. Growth and feeding data were prospectively collected for 18 months before and after the intervention. The intervention consisted of increasing the urgency of parenteral nutrition, routine introduction of enteral feeds from the first day of life, standardised weight-based daily increments of enteral feeds, use of donor human milk until at least 34 weeks corrected gestation (if insufficient mothers' own milk) and routine fortification of human milk from 120 ml/kg/day. Results After the intervention, growth velocity by discharge home increased by 1 g/kg/day to 12.7 ± 2.2 g/kg/day (p<0.00002) and weight z score change reduced from -1.38 ± 0.77 to -1.16 ± 0.76 (p=0.005). The largest effect was seen in infants discharged home from the tertiary unit (z score change from -1.35 ± 0.73 to -1.04 ± 0.77, p=0.007) and in those discharged home on exclusive human milk (z score change from -1.65 ± 0.8 to -1.20 ± 0.9, p=0.006, growth velocity from 10.8 ± 2.2 g/kg/day to 13.0 ± 2.8 g/kg/day, p<0.00001). The significant differences in growth previously seen between infants discharged on exclusive human milk compared to any infant formula were eliminated. Conclusion Introduction of a simple nutritional bundle was associated with improved weight gain, particularly in those fed exclusive human milk at discharge. In order to achieve international growth recommendations further intensification of macronutrient provision may be required.

ResultsThe most common reasons for patients not accepting a CBT referral were referral to the Trust's inpatient neuropsychiatry ward, or non-attendance at assessment or treatment sessions. We identified a total of 98 patients with mFND and 76 ONP patients treated with CBT. 56.1% of mFND and 56.6% of ONP patients attended all sessions offered. There were no socio-demographic characteristics associated with mFND patients who completed all therapy sessions versus those who dropped out early. Compared to controls, mFND patients were more likely to be female (72.4% v.

Background Around 10% of school-aged children experience mental health difficulties. Many more are ‘vulnerable’: experiencing emotional and/or behavioural problems reaching clinical levels, and thus at greatest risk of future mental illness. The trial aim is to evaluate the effectiveness of the CUES for schools programme in reducing emotional and behavioural problems in vulnerable children. Methods The “CUES for Schools” study is a multicentre cluster randomised controlled trial in primary schools in south east England. Schools will be randomised to receive the usual school curriculum, or the CUES programme (1:1). We aim to enrol 74 schools (5550 children including 2220 vulnerable children). CUES is a whole-class teacher-facilitated interactive digital cognitive-behavioural intervention, delivered as 24 short (20-min) modules over 12 weeks, targeting emotional/behavioural regulation skills. Children self-report emotional/behavioural problems at baseline, 8, and 16 weeks, and wellbeing and cognitive vulnerability at 0 and 16 weeks. Adverse events are assessed at 8 and 16 weeks. Teachers rate classroom behaviour at baseline and 16 weeks. School senior leadership teams and individual teachers consent to involvement in the study; parents can opt their child out of CUES sessions, assessments, or research. Children can similarly opt out and assent to research participation. The primary objective of this trial is to evaluate the effectiveness of CUES for schools compared to the usual school curriculum in improving emotional/behavioural problems for vulnerable Year 4 (8–9 years old) children at 16 weeks post-randomisation, as measured using a standardised questionnaire designed for primary schools. The secondary objective is to investigate the impact of the CUES for schools programme on both vulnerable and non-vulnerable children on wellbeing and teacher-rated classroom behaviour. Discussion The study will show whether CUES for schools is more effective than the usual curriculum in reducing emotional and behavioural problems in vulnerable Year 4 children, and thus reducing the risk of mental health difficulties in later adolescent and adult life. As a digital, teacher-facilitated intervention, CUES for schools can be readily implemented, at minimal cost. If effective, CUES for schools therefore has the potential to reduce the impact of emotional/behavioural difficulties on children’s learning, behaviour, and relationships and the burden of future mental health morbidity. Trial registration Trial Registration ISRCTN11445338. Registered on September 12, 2022.