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1.
Palliative Medicine in Practice ; 16(3):131-133, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2202820
3.
Progress in Palliative Care ; 30(6):341-348, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2187211

RESUMO

Nearly a quarter-million children are siblings to children living with serious illness. Intense physical, emotional, social and psychological concerns are introduced when a brother or sister is diagnosed with a serious illness or disease. Support services for siblings are critical to promote positive outcomes and decrease negative consequences and align with parents' desires to support all of their children. These include services offered to the sibling or family to provide comfort or enhance the quality of life during a child's serious illness. Despite national standards, sibling support services are often difficult for families to access. The aim of this study was to describe sibling support activities provided through teaching children's hospitals across the United States using a cross-sectional, descriptive design. Results indicate most hospitals surveyed offer sibling support services that focus on sibling education about the illness;parent education on how to anticipate the siblings needs;and activities for families to do together, yet face barriers to delivery. Services focused directly on siblings and actively supporting their adaptation were least often provided and less than half reported screening siblings for psychosocial distress. Findings suggest that sibling support services may be an important resource to minimize distress and promote adaptation for siblings. This description of current and available sibling support services is an important starting point for enhancing services, policies, and institutions that fully envelope siblings into patient- and family-centered care. Copyright © 2022 Informa UK Limited, trading as Taylor & Francis Group.

4.
European Geriatric Medicine ; 13(Supplement 1):S178, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2175562

RESUMO

Introduction: & Methods: We conducted a retrospective analysis of all patients with Parkinson's disease (PD) who died while admitted at the Oxford University NHS Foundation Trust between March 2019 and Feb 2022. This period was selected to include one year before, during and after the COVID-19 pandemic. Our objective was to investigate how the pandemic affected overall inpatient PD mortality, the causes of death and the quality of end-of-life (EOL) care provided. Result(s): There were a total of 166 inpatient PD deaths over the 3-year period. PD deaths increased by 17.4% during the pandemic, with a further increase of 22.2% after the pandemic. Pneumonia (excluding COVID-19) was the leading cause of death every year, responsible for 57% (pre-pandemic), 46% (pandemic) and 53% (post-pandemic) of inpatient PD deaths. COVID-19 was the second-most common cause of death during the pandemic, accounting for 13% of deaths, declining to 3% of deaths after the pandemic. 62% of terminal patients were seen by a dedicated palliative care service before the pandemic, dropping to 46% during the pandemic. This increased to 61% in the year after the pandemic. The prescription of end-of-life medications saw a decline, changing from 83 to 76% to 79%, over the same 3-year period. Conclusion(s): Inpatient PD mortality increased significantly both during and after the height of the COVID-19 pandemic, and this is not solely attributable to COVID-19. The pandemic also had a deleterious effect on the service delivery of EOL care in terminal PD patients.

5.
European Geriatric Medicine ; 13(Supplement 1):S228, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2175467

RESUMO

Introduction: Tensions during the COVID-19 crisis (particularly in the geriatric population) posed the problem of limiting care for older, frail and polypathological patients. The unpredictable evolution of the COVID-19 infection made decision making difficult, especially for physicians not familiar with geriatric practice, which often resulted in difficult communication with families. Method(s): Mrs L, 91 years, polypathological, suffering from hippocampal advanced neurocognitive disorders, loss of autonomy transferred from the emergency department for COVID-19 infection, desaturation at 88% on a pulmonary embolism. After 7 days, the patient still in poor general condition, congested, difficult to swallow per os, still on 2L oxygen, was transferred to palliative care. Despite the patient's condition, the unfavourable evolution and her transfer to palliative care, no discussion on the limitation of care and possible palliative management if decompensation is mentioned in the patient's file. Result(s): Mrs L, arrived on a Friday evening, had a precarious condition. Despite curative management with monitoring of the biological balance, the patient's condition remained stationary and she finally died on Sunday morning. During these few hours of hospitalisation in palliative care, her family was very demanding, not seeming to understand the seriousness of her condition, and the possibility of limiting care to avoid unreasonable obstinacy and relentless treatment. Conclusion(s): This case study of a polypathological COVID + patient demonstrates the importance of anticipating what to do in case of aggravation and decompensation. Communication with relatives seems to us to be essential for optimal management.

6.
BMJ Open Ophthalmology Conference: Tierarztl Prax Ausg K Kleintiere Heimtiere Virtual ; 7(Supplement 2), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2167520

RESUMO

The proceedings contain 38 papers. The topics discussed include: impact of COVID-19 on a national serum eyedrops program in the UK;the impact of COVID-19 on corneal transplantation in England;crisis becomes the norm: how a non-profit network withstands the pandemic;new strategies in the Barcelona eye bank to minimize the impact of the COVID-19 pandemic;emergency salvage of time expired clinical corneas during the covid-19 pandemic;supply of non-clinical ocular tissue from a tissue and eye services research tissue bank;the donor of tomorrow: challenges posed by the pandemic, demographic change, and increased transplant requirements;growing together in diversity - Indo-German cooperation enhancing eye donation in north India;eye donation in palliative and hospice care settings: patient views and missed opportunities!;and the potential for eye donation from hospice and palliative care clinical settings in England - a retrospective case notes review of deceased patient records.

7.
Neurological Sciences ; 43(Supplement 1):S309-S310, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2174346

RESUMO

Objective: Vaccines represented the breakthrough in the fight against COVID-19 allowing a reduction of COVID-19 related hospitalizations and deaths. Based on high frequency of headache attacks reported in the days following vaccination, both in randomized controlled trials and in our clinical experience, we focused on the effects of COVID-19 vaccine administration in migraine population and we speculated on the putative pathophysiological mechanisms. Materials: A self-administered electronic 15 points questionnaire was developed to collect in patients with migraine: i) demographic and clinical parameters;ii) data related to previous COVID-19 infection and vaccination;and finally iii) headache episodes occurring in the days immediately following COVID-19 vaccination focusing on the differences between these headache attacks and those generally experienced by patients in terms of intensity, duration, and response to pain-killers. Method(s): An on-line questionnaire was created using "Google questionnaires" form and administered to 20 non-headache healthy subjects, to assess its readability. Subsequently, the questionnaire link was published on Italian Facebook groups oriented to headache patients with at least 1000 members for 10 days, and the answers were collected in an online database. Result(s): Among 841 migraine patients filling-in the questionnaire, 66% and 60% experienced a headache attack within 7 days after, respectively, the first and the second vaccine dose. Over the half of patients perceived the headache attacks as more severe, long-lasting, resistant to symptomatic treatment compared to usually experienced episodes. Discussion(s): Headache worsening following COVID-19 vaccination could be related to the production of inflammatory mediators such as type Ibeta- interferon known to be involved in migraine occurrence or worsening, along with IL-6, NO pathway activation and cortical dysexcitability, altogether recognized as critical moments of migraine pathophysiology. Conclusion(s): Considering the high prevalence of migraine in the general population, the awareness of the possibility of headache worsening following COVID-19 vaccine administration in these patients could make a reduced waste of resources employed in an inappropriate healthcare.

8.
Palliative Medicine in Practice ; 16(3):150-155, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2164107

RESUMO

Background: The perspective of palliative care has changed dynamically over the years, and palliative medicine, which was originally concerned with patients with advanced oncology diseases, has become an interdisciplinary area. Many societies have published guidelines for the use of palliative medicine in intensive care units. Method(s): This article presents indications and methods for implementing the principles of palliative medicine in intensive care units. Particular attention is devoted to the consultations of palliative medicine for current medical trends - COVID-19 infection, oncological diseases, fragility syndrome, and end-stage circulatory failure. Conclusion(s): Elements of palliative medicine are necessary for everyday practices in the intensive care unit. The most important task in cooperation is to present classifications that can help in the objective identification of patients requiring palliative care. It seems that creating a checklist of the qualifications for a palliative medicine consultation can be the next step towards making decisions about this form of therapy. Copyright © Via Medica.

9.
Rassegna di Patologia dell'Apparato Respiratorio ; 37(3):145-146, 2022.
Artigo em Italiano | EMBASE | ID: covidwho-2156216
10.
European Psychiatry ; 65(Supplement 1):S541, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2154106

RESUMO

Introduction: The Covid-19 pandemic has had a deleterious impact on populations across the world. Yet it remains unclear how this pandemic is affecting the psychological health of people with a previous history of mental illness. Objective(s): This study aims to investigate the impact of Covid-19 on patients with established mental disorders. Method(s): The PubMed and science direct databases were systematically searched using the keywords combination "Covid-19" and "psychiatric disorders", "the pandemic" and "mental disorders ", from inception up to November 2021. We adopted a broad inclusion criterion for the study requiring patients to have a pre-existing mental disorder, excluding narrative reviews and preclinical studies. In addition, a search of google scholar was conducted to identify any additional relevant publications. Result(s): We have found 26 studies but only 19 met our inclusion criteria. Included studies were published between 2020 and 2021. 2 major results were identified. Symptoms deterioration was reported in individuals with severe mental disorders and those with schizophrenia in particular, such as depressive or anxiety symptoms, substance use and suicidal ideation, due to the psychological stress and physical distancing measures associated with the Covid- 19 outbreak. The symptomatic treatments used in Covid-19 had frequent interactions with the most used antipsychotic drugs leading to a substantial increase in relapse rates in people with mental disorders. Conclusion(s): The Covid-19 pandemic has a serious impact on individuals with pre-existing mental illness reinforcing symptom severity and psychological stress. Additional studies are needed to strengthen current findings with pre-pandemic records.

11.
British Journal of Surgery ; 109(Supplement 5):v94, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2134960

RESUMO

Introduction: Major limb amputation (MLA) is The highest risk lower limb surgical procedure performed in The United Kingdom with reported in hospital mortality 9.1%. For patients with non-reconstructable arterial disease it of fers palliation of symptoms. The primary aim of The current work was to define if surgical palliation with major limb amputation is being of fered to patients who may have been best managed medically Methods: Retrospective review of major limb amputations (March 2019 to October 2021). Historical datasets have also been scrutinised (2008-2010). Specific variables of interest included The annual number of major limb amputations, mortality on The index admission and place of discharge. Result(s): A complete dataset was available for 282 patients during The COVID period. Patient demographics were as anticipated-206 (73%) male, mean age 63-years (range 23 to 90-years). Peripheral arterial disease (190) and diabetes mellitus (149) were common. The number of major limb amputations was comparable with The historical series. In-hospital mortality was 7% (n=20). The median duration of admission for patients who survived was 26-days and 38% of patients were limb-fitted (which was also comparable with historical data). Most patients (71%) were discharged to their own home. Conclusion(s): The outcomes described are better than The comparable local historical and national data both in terms of in-hospital mortality and place of discharge. These data imply that we make The correct decision about MLA more of ten than we don't.

12.
Asia-Pacific Journal of Clinical Oncology ; 18(Supplement 3):119-120, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2136600

RESUMO

Aim: The COVID-19 pandemic triggered rapid implementation of telehealth (telephone and videoconference) in Australia. Psycho-oncology clinicians report a need for greater guidance on adapting in person psycho-oncology therapies to telehealth. We aimed to establish consensus on elements of psycho-oncology therapy that can be adapted for telehealth for inclusion in an educational resource incorporating clinical practice recommendations. Method(s): Draft recommendations were developed based on existing literature, reviews and guidelines. These were refined using a co-design process involving expert consultation (n = 13) with psychooncology clinicians and researchers. This process identified some uncertainty around key recommendations. A two round Delphi consensus process was conducted to confirm the relative importance and therapeutic appropriateness of content for inclusion in clinical practice recommendations. Participants included psycho-oncology clinicians with telehealth experience. Respondents rated their level of agreement with each statement on a 5-point Likert scale. Consensus was defined as>80%of respondents scoringwithin two points on the Likert scale. Result(s): The co-design approach identified key topics for inclusion in the recommendations: (1) preparation for telehealth (e.g., privacy, security, technical considerations);(2) clinical and cultural considerations (e.g., safety considerations, therapeutic alliance, vulnerable/ underserved communities);(3) adaptations to therapeutic assessment and intervention;(4) specific client considerations (e.g., clients in palliative care). 32 clinicians participated in Delphi Round 1, where thirteen recommendations were presented and consensus reached for nine. Recommendations where consensus was not reached were re-presented in Round 2.We will present the consensus recommendations based on the Delphi. Conclusion and clinical implication: The clinical practice recommendations will provide a robust expert-endorsed educational resource to guide psycho-oncology clinicians tailoring their practice to telehealth. This will support delivery of evidence-based treatments to people living with cancer, increasing the sustainability of, and confidence in, psycho-oncology telehealth.

13.
Anti-Infective Agents ; 20(4):24-35, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2065293

RESUMO

Background: Coronavirus disease 2019 (Covid-19) is caused by a novel coronavirus (SARS-CoV-2) infection, while influenza viruses cause the flu. SARS-CoV-2 and influenza virus co-infection seems to be a real and serious concern. Objective(s): This study aims to evaluate the clinical features, laboratory investigations, computed tomography scans, and interventions of Covid-19 patients during seasonal influenza. Method(s): This was a multi-center prospective cohort study that collected data from hospitals, clinics, and laboratories on measurements, treatments, and outcomes from Covid-19 patients admitted to temporary Covid-19 care centers. Result(s): A total of 480 individuals (female, 231 [48.12%];male, 249 [51.88%]) were recruited from March 31st to May 14th, 2021 at five hospitals/clinics in Uttar Pradesh, North India. The patients were divided into six groups based on their age (65+ years [25.41% of cases] being the most affected age) and five groups based on their conditions (asymptomatic 65 [13.54%], mild 94 [19.58%], moderate 206 [42.91%], severe 84 [17.50%] and critical 31 [6.45%]). Patients' outcomes were documented as death (19 [3.95%]), recovery (421 [87.71%]) and under-treatment (40 [8.34%]). Conclusion(s): The most common clinical symptoms reported were fever, sore throat, and dyspnea. The severity was linked to hypoxemia, lymphocytopenia, thrombocytopenia, elevated erythrocyte sedimentation rate (ESR), and high blood urea nitrogen (BUN). The vast majority of patients were given symptomatic treatment. Any onset of fever should be suspected and examined for the viral strain to distinguish between Covid-19 and the seasonal flu. Copyright © 2022 Bentham Science Publishers.

14.
Clinical Toxicology ; 60(Supplement 2):121, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2062721

RESUMO

Background: Palytoxin poisoning is an uncommon exposure in the US, and is most frequently encountered amongst hobbiests and professionals in the aquarium industry. The toxin is produced by the microalgae Ostreopsis as well as the coral Palythoa toxica. Discovered in Hawaii, the name limu-make-o-Hana translates to "seaweed of death from Hana." Palytoxin interrupts Na+/ K+ ATPase pump, resulting in widespread cellular dysfunction. Persons are at highest risk when cleaning a fish tank housing the coral that produces palytoxin, resulting in cutaneous or inhalational exposure. We present a case of palytoxin inhalational exposure with computed tomography (CT) imaging. Case report: A 41-year-old male presented to the emergency department (ED) with dyspnea, cough, and wheezing after cleaning his saltwater fish tank. He reported that he maintains Zoanthid corals in his home saltwater fish tank and typically wears personal protective equipment when cleaning the tank. He had taken off his mask directly after using hot water to clean the tank, and quickly developed shortness of breath. He contacted Poison Control and was instructed to take loratadine with initial improvement in his symptoms. He then developed decreased appetite, nausea, and chills. The following day, in addition to these symptoms, he developed a fever of 102.5 degreeF and an oxygen saturation of 88% measured with an at-home pulse oximeter. He then proceeded to the ED where he was found to be hypoxic to 91% on room air, tachycardic to 120 bpm, hypotensive to 93/ 70mmHg, febrile to 100.9 degreeF and tachypneic at a respiratory rate of 30. Physical exam revealed clear lung sounds. Application of supplemental oxygen at 2 L resulted in improvement in his oxygen saturation and his hypotension and tachycardia responded to intravenous fluids. Significant laboratory results included WBC count of 20.4 with bands of 14%, elevated lactate of 2.4mmol/L, elevated D-dimer of 0.48 mug/mL and a negative COVID PCR test. CTA thorax revealed patchy ground-glass opacities in the bilateral upper and lower lobes with mosaicism. The patient received doxycycline in addition to broad spectrum antibiotics due to concern for inhalational marine toxicity. He was also started on 60mg prednisone, inhaled steroids, and bronchodilators for symptomatic treatment, with improvement in his symptoms. During his hospitalization, a respiratory viral panel was negative for common viruses associated with atypical pneumonia including influenza, coronavirus, metapneumovirus, rhinovirus, enterovirus, adenovirus, parainfluenza, bocavirus, Chlamydophila pneumoniae, and Mycoplasma pneumonia. His dyspnea gradually improved and he was weaned off supplemental oxygen prior to discharge home on hospital day 2. Discussion(s): It is unclear what changes are expected on thoracic imaging in patients with inhalational palytoxin exposure. Chest radiographs in two previous cases displayed scattered infiltrates, and a chest CT in another case showed pleural based consolidations. The ground-glass mosaicism suggests that a more diffuse reactive airway process after an inhalational palytoxin insult. Conclusion(s): Patients with inhalational palytoxin exposure may be found to have reactive airway symptoms along with ground glass opacities with mosaicism on CT imaging.

15.
Chest ; 162(4):A1506-A1507, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2060835

RESUMO

SESSION TITLE: Respiratory Care: Oxygen, Rehabilitation, and Inhalers SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Background More than 1.5 million Americans live with supplemental oxygen that improves quality of life in adults living with chronic lung disease. After hospitalization for serious illness such as pneumonia (especially COVID), heart failure, COPD exacerbation or other lung disease, patients are discharged on supplemental oxygen. Hypoxemia often resolves after recovery from the illness and supplemental oxygen is no longer needed. As a part of “Choosing Wisely” campaign from ABIM, ATS/ACCP recommends “For patients recently discharged on supplemental home oxygen following hospitalization for an acute illness, don’t renew the prescription without assessing the patient for ongoing hypoxemia within 90 days after discharge. Objectives The primary objective of the study is to improve home oxygen reassessment after discharge from the hospital. METHODS: Study Design Subjects will be identified by electronic medical records (EMR) report and will include data from the 1st of January 2021 to 30th June 2021 (period of 6 months) Inclusion Criteria Subjects 18 years and older who were discharged from the RPH on supplemental oxygen Exclusion: Subjects 18 years and older on oxygen for palliation and hospice Study Outcomes The primary outcome measure will be assessed as percent of patients in whom oxygen requirement reassessed and percent in whom oxygen requirement was not reassessed. The secondary outcome measure will be assessed as percent of patients who had PCP follow up and percent of patients on continuous oxygen without reassessment Quality improvement PDSA: Phase I: pre-intervention data Phase II: Intervention-> education session to the providers and new epic order inclusion (BPA for reassessment and discontinuation) Phase III: post-intervention survey RESULTS: Based on chart review, 155 patients qualified for the study criteria. Among 155 patients, regarding the primary outcome-> 63 patients (40.6%) 90 days oxygen reassessment was done, 64 patients (41.2%) oxygen reassessment was not done, 10 patients (6%) died within the 90 days reassessment period and 19 patients were 90 days reassessment was not applicable (12%- 19 patients-on long term oxygen). Regarding the secondary outcomes, 113 patients (72.9%) were followed up with PCP, 16 patients (10.3%) did not have follow up, 19 patients (12.2%- no information available) had outside PCP follow up, 7 patients (4.5%- 2 died on same admission, 5 opted for hospice). Regarding patient who continued to use oxygen, 74 patients (47.7%) were continued on oxygen, 47 patients (30.3%) were discontinued of oxygen and 34 patients (22%) did not have any information available regarding oxygen use. CONCLUSIONS: From the above data, There is room for improvement regarding oxygen reassessment by educating primary care providers. Post intervention survey will be done in 6 months. CLINICAL IMPLICATIONS: Improve oxygen reassessment in patients after discharge with oxygen DISCLOSURES: No relevant relationships by Anam Aqeel No relevant relationships by Mansur Assaad No relevant relationships by Apurwa Karki No relevant relationships by Shobha Mandal No relevant relationships by Rajamurugan Meenakshisundaram

16.
Bangladesh Journal of Medical Science ; 21(4):883-892, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2043411

RESUMO

Respiratory illness is one of the most important public health problems in many countries worldwide. Even though most of the ailments are treatable with normal care, respiratory-related mortality continues to increase year after year. The global situation is deteriorating as a result of the COVID-19 epidemic. Numerous Unani formulations are beneficial against a variety of respiratory disorders, but they must be clinically researched before they can obtain widespread acceptance in the modern world. At the moment, no antiviral medication is either available for each respiratory disease or is costly and not easy to use in pandemics like COVID-19 on large scale, although Unani medicines may be considered an option. Khamira Banafsha (KB) is a semi-solid blend of three dried flowers, Viola odorata L., Borago officinalis L., and Rosa damascena Mill and the distillate of Rosa damascena, and sugar. The components in this formulation are well-known and frequently utilized in the treatment of respiratory problems.The formulation has been used to treat a wide range of illnesses for decades. This review will discuss the pharmacology, ethnopharmacology, and repurposing of KB as an adjuvant or symptomatic treatment for Covid-19 illness.The chemical composition of the ingredients may be evaluated In-silico to identify their eligibility for Covid-19 disease symptomatic management.

17.
Journal of the Intensive Care Society ; 23(1):116-117, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2043062

RESUMO

Introduction: Almost half the UK population die in hospital and more than two thirds of these are aged 75 years or more.1 Older people make up an increasing proportion of patients admitted to critical care and often have poorer outcomes, especially in the context of COVID-19.2 Loved ones are an essential support network for older patients but their ability to provide support was compromised by visiting restrictions during COVID-19. Little is known about the experiences of older patients in ICU and there is limited literature on the experiences of bereaved relatives.3 Bereaved relatives may be the only way to access the experiences of patients who do not survive, but there are a number of barriers to including bereaved relatives in research. Researchers may feel inhibited from imposing what might be seen as an additional burden on families during the aftermath of a bereavement. The ongoing ESCAlation of the eLderly (age >65years) to criTical carE with COVID-19) (ESCALATE) study includes semi-structured interviews with bereaved loved ones as well as patients and NoK of survivors in the UK. Objectives: To describe successful involvement of bereaved next of kin in critical care-based research Methods: This qualitative research uses semi-structured interviews and thematic analysis. Patient and public involvement from an intensive-care focused charity and local palliative care team advice was sought in order to develop recruitment strategies such as detailed, sympathetically worded participant information packs.4 In keeping with the literature,5 the window for recruitment and interview was approximately one year following bereavement. Following ethical approval, participants were recruited via postal invitations with follow up telephone calls if no response after a minimum of one week. Results: Recruitment was limited by only 40% of bereaved NoK (next of kin) having postal addresses recorded on the hospital systems. 9 /40 bereaved NoK contacted by letter responded and as well as completing a questionnaire, consented to be interview. A further 5/11 contacted by follow-up telephone call agreed to participate (consistent with response rates for patients and NoK of survivors). All of the interviewed bereaved participants completed the interview according to the interview topic guide, with each interview lasting around 45 minutes. More than half were female, and three quarters were Black, Asian or Minority Ethnic. Bereaved relatives were keen to share their experience and some even volunteered additional information with the interviewers, such as resources they had created for their local community and personal diaries. Participants reported that they were happy to be interviewed if it would help others in a similar position. Conclusion: Bereaved relatives of critical care patients are willing to engage in qualitative research. Recruitment is challenging due to practical constraints, but we suggest could be improved through meticulous documentation of contact details and involvement of bereavement services in research. By seeking the views of bereaved loved ones, we can improve care for critically unwell patients at end of life.

18.
Journal of the Intensive Care Society ; 23(1):51-52, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2043031

RESUMO

Introduction: The ISARIC4C score1 and APACHE II score are used widely to predict mortality in critically ill patients with COVID-19 pneumonitis. These scores, however, do not predict response to specific treatments. Non-invasive respiratory support (NRS) in the form of CPAP/NIV/HFNC has been extensively used to treat COVID-19 pneumonitis. ROX index2 (SpO2/FiO2/Respiratory Rate) is used to predict failure of HFNC in treatment of Acute Hypoxaemic Respiratory Failure and ARDS. However, there are limited data on its efficacy to predict NRS failure in COVID-19 infection. Objective: Whether ROX index can be used to predict response to NRS in both patients for escalation to mechanical ventilation and those where NRS is ceiling of care. Methods: A retrospective study of individuals, SARSCOV-2 positive by RT-PCR, admitted to the ICU and requiring CPAP/NIV/HFNC, in a single centre between October 2020 to January 2021. Respiratory parameters were obtained at initiation of NRS followed by 2, 6 and 12 hours post initiation. NRS failure was defined as the need for mechanical ventilation in those for escalation of support or death in those where NRS was set as ceiling of care. Results: Data (Table 1) for 104 patients (70 men) were analysed. The mean age and BMI were 58.0 years and 31.4kg/m2, respectively, mean Respiratory Rate was 31 and mean SpO2/FiO2 of 144 on admission. In 10 out of 104 NRS was set as ceiling of care. Most patients were treated with CPAP/NIV, and they often used HFNC for breaks and while eating and drinking. Of the 62 patients that failed NRS, 10 had NRS as ceiling of care and a further 10 died without receiving mechanical ventilation. 42 patients underwent mechanical ventilation. 70 were discharged and 34 (32.7%) died in hospital. Baseline and 12 hour ROX index was not significantly different but the mean change between 0 and 12 hour ROX (2.2, 95% CI 0.99 to 3.46;p=0.0005) was significantly higher in those with NRS success. NRS success was predicted by a ROX index value of >5(OR 2.59, 95% CI 1.15-5.85;p= 0.01) and improvement in ROX score by >1 at 12 hours (OR 3.25, 95% CI 1.43 to 7.4;p=0.025). Conclusion: There was a significantly higher increase in ROX index at 12 hours in those with NRS success. A 12 hour ROX index of > 5 or an improvement by >1 are good predictors of success. Patients where NRS failed were older, had higher APACHE II and slightly higher ISARIC-4C score as expected. Discussion: This was a real life study where patients were treated with a combination of CPAP/NIV and HFNC as opposed to just HFNC or CPAP. The advantage of ROX index over P/F ratio is that arterial blood gases are not needed. It can be scored easily by routinely collected vital observations. A large number of patients are likely to be treated outside critical care in light of results from RECOVERY-RS trial3. In these settings, ROX index could be a useful tool for escalation to critical care or planning for symptom palliation as appropriate.

19.
Annals of Oncology ; 33:S1133, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2041548

RESUMO

Background: Care in hospitals is generally focused on prolonging life and may not adequately address the needs of dying patients. The incidence of oncologic diseases is rising, and efforts should be made to guarantee a better quality of death and dying. Aim: to evaluate the end-of-life care in patients with cancer under gastroenterologist care. Methods: Cross-sectional study including all in-patients with cancer who deceased in a Gastroenterology department in Portugal between 2012-2021. Demographic characteristics, clinical attitudes, therapeutic interventions and symptom control up to 6 months prior to the patient’s death were assessed. Results: We included 120 patients, 73% male, mean age 71±12.5 years. The most common cancers were hepatocellular carcinoma (35%), gastric cancer (16%), pancreatic cancer (15%) and cholangiocarcinoma (14%). One third of the patients had ECOG of 0-1 at admission and 77% (n=92) had advanced disease (stage IV or Barcelona Clinic Liver Cancer C/D). The median number of emergency consultations and hospitalizations in the 6 months before death was 2 (IQR 1-4). In their last month of life, the median time of hospitalization was 21.5 (IQR 12-25) days. It was documented the presence of an available caregiver in 56%(n=68) and spiritual support in only 2% (n=2) of the cases. One quarter of the patients experienced not adequately controlled pain and 72% received opioids. Palliative care consultation occurred in 60% (n=72) with a median time between that and death of 12 (IQR 3-18) days. Invasive procedures (diagnostic and therapeutic endoscopy, ERCP and EUS) were performed in half of the patients, achieving technical and clinical success in 62% (n=38) and 32% (n=19) of the cases, respectively. The mean time between those interventions and death was 12±10 days. The prognosis was discussed with the patient and family in 35% and 68% of the cases, respectively. At least 73% of the patients had visits at the end of life, which was negatively affected by the COVID-19 pandemic (p=0.022). Conclusions: In our cohort, we found a high hospitalization length of stay in the last month of life and high percentage of invasive treatments until shortly before dying. Thus, it is urgent to define and implement metrics of quality of death to prevent futile/potentially inappropriate treatment. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

20.
BMJ Supportive and Palliative Care ; 11:A90, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2032540

RESUMO

Social prescribing is a fundamental aspect of the NHS Long Term Plan. The roll-out of social prescribing is underpinned by the belief that individuals have the capacity to define and solve their own problems and that local communities are rich in social assets, skills and talents which can be tapped into to enhance and improve health and wellbeing. Social Prescribing Link Workers (SPLWs) aim to focus on what matters to each client holistically, looking at social, economic and environmental factors and creating personalised care plans to improve wellbeing linking in to local community resources and assets. This philosophy aligns with both the person centred ethos of hospice care and the Public Health model of Palliative Care. Aims To adopt a partnership approach to develop and deliver social prescribing through hospice partnerships with local VCSE organisations and local PCNs to develop and deliver social prescribing. Commitment to learning and developing together rather than 'doing' social prescribing through service provision, drawing on the strengths of the local community and the partner organisations. Actions•Social prescribers in post fully funded through PCN with commitment for five years - links built with GPs, hospice and other services.•Partnership approach embedded, service launch in March 2020 - impacted by COVID-19 pandemic, an opportunity and a threat. Outcomes•Social prescribing now embedded in local community and GP practices. Over 500 referrals received in year 1: bereavement, end-of-life care plans, carers support identified as some of the key challenges people face.•Data and case studies support difference Social Prescribing is making on individual and system perspective.•NHS Graduate evaluation report completed. Conclusion Involvement in a partnership approach to social prescribing is supporting the hospice in facilitating a public health model to palliative and end-of-life care being adopted as part of the wider system change.

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