COVID-19

Introduction :

Pulmonary hypertension assessed by echocardiography in patients with COVID-19 has not been adequately studied and it is unknown precisely whether it is linked to worse outcomes.

Materials and Methods :

Retrospective study of 306 adults infected with COVID-19 by antigenic or molecular testing. The main objective was to evaluate the role of the probability of echocardiographic pulmonary hypertension and its relationship with morbidity and mortality according to the ROX index in patients with COVID-19 infection. In the inferential statistical analysis, the OR odds ratios with their confidence intervals greater than 95% were used as measures of association. Qualitative variables were evaluated using the Chi square test or Fisher's exact test, and in the case of numerical or quantitative variables, the Student's T test or Mann-Whitney test was used.

Results :

The highest frequency in gender was Male 78% and Female 22%, the ROX values were higher in survivors at 2 h 5.8 (4.7 - 6.9), in relation to the deceased 4.5 (3.6 - 5 ,6). Likewise, at 12 h the values were higher in the group of survivors 7.8 (5.2 - 8.7) in relation to the deceased 4.9 (3.8 - 6.0). The odds ratio adjusted for age and gender of the ROX index was 8.5, CI (2.0 - 91.4) at 2 h and 17.6, CI (2.8 - 93.6) at 12 h. A statistical correlation was evident between lower values of the ROX index with values of high probability of pulmonary hypertension (p=0.048) as well as higher mortality (p=0.037).

Discussion :

The present study showed a correlation between the ROX index with pulmonary pressure values estimated by transthoracic echocardiogram and older age groups, showing higher mortality in those over 70 years of age and a higher rate of comorbidities and lower ROX.

Conclusions:

A greater probability of pulmonary hypertension is linked to high mortality in COVID-19; studies with larger groups of patients are required to validate the results found here.

 Introduction: The COVID-19 pandemic has raised concerns about its long-term effects, leading to conditions such as "Long COVID." Neurological manifestations, including "Brain Fog" with impaired cognitive function, have been reported, but their relationship with age and memory decline remains unclear. Method: This study aimed to investigate the effects of COVID-19 infection on memory function and explore the relationship between age and memory scores. The research utilized data from the 'COVID-19 Online Rapid Objective Neuro-memory Assessment' (CORONA) study, employing an online survey with a memory task. Ethical approval was obtained, and participants aged 18 and older were recruited globally, with 5,308 participants included in the analysis. Memory scores were obtained through a task featuring four categories. Statistical analysis, including T-tests and linear regression, was employed to evaluate the data. Results: Participants testing positive for COVID-19 (n = 678) exhibited lower mean total memory scores than those testing negative (n = 4,630), with a statistically significant difference (P < 0.05). Hospitalized COVID-19 patients (n = 37) had significantly lower memory scores compared to non-hospitalized patients (n = 641), suggesting a greater impact of hospitalization on memory function. Age was associated with declining memory scores, with an overall trend of decreasing scores as age increased. Three age groups exhibited significant differences in memory scores between COVID-19 positive and negative participants. Conclusion This study provides evidence that COVID-19 infection may be associated with worsened memory outcomes and cognitive function. Hospitalization due to COVID-19 appears to have a more substantial impact on memory than the infection alone. A steeper decline in memory scores with age was observed among COVID-19-positive participants, suggesting potential age-related vulnerability to memory decline associated with COVID-19. However, discrepancies in results may be attributed to sample size limitations, emphasizing the need for larger cohorts in future research. 

Introduction

When COVID-19 first entered our world in March 2020 and the country went into lock down the NHS braced itself for one of its biggest challenges of this century. Older, frail patients were in the highest risk group, with those in care homes not only at higher risk of death, but higher risk of contracting COVID-19, often suffering more psychological disturbances (Hewitt et al., 2020; Numbers & Brodaty, 2021). This study was conceived by two nurse researchers working throughout the pandemic on a COVID ward for predominantly older people, aiming to capture the experiences of patients, families/carers and staff members.

Methods 

Phenomenology was the most appropriate methodology to provide an in-depth lived experience perspective. Full ethical approval was obtained and participants were sampled purposively. In-depth unstructured interviews were conducted and transcribed in full before being analysed hermeneutically using the four steps outlined by Fleming et al. (2003).

Results 

30 participants were recruited (10 patients, 10 relatives, including several bereaved and 10 staff members). Whilst experience varied between and within groups, core themes emerged:

1. Communication difficulties were poignantly expressed, with staff acting as intermediaries between patients and their family members who were kept apart through visiting restrictions, whilst managing clinical care and their own emotional responses.

2. Challenges of care were experienced by all groups, with anxiety around contagion conflicting with feelings of guilt and long-term psychological impact described by staff.

3. Collective experiences of grief and loss were described as participants grappled with coming to terms with encountering death and dying on an unprecedented scale and under such extraordinary conditions.

Conclusion

This study adds to the growing evidence base around experience of the COVID pandemic, adding insight into the triangulated experience of those affected and highlighting the profound effect on patients, relatives and staff.

Introduction:

COVID-19 disease can cause a wide variety of long-term health problems, such as impaired lung function, reduced exercise performance, and decreased quality of life. Our study aimed to investigate the efficacy, feasibility, and safety of pulmonary rehabilitation in patients with COVID-19 and to compare the results between patients with a mild/moderate and severe/critical course of the disease.

Materials and Methods:

Patients in the post-acute phase of a mild to critical course of COVID-19 admitted to a comprehensive pulmonary rehabilitation program were included in this prospective, observational cohort study. Various measures of exercise performance, 6-minute walk distance, lung function (forced vital capacity (FVC)), and quality of life (36-question short-form health survey (SF-36)) were assessed before and after.

Results:

43 patients were included in the study (20 with mild/moderate COVID and 23 with severe/critical COVID-19).

Results:

At admission, patients had reduced walking distance (mild: median 401 m, interquartile range (IQR) 335-467 m; severe: 108 m, 84-132 m), impaired FVC (mild: 72%, severe: 35%,) and a low SF-36 mental health score (mild: 52 points, severe: 32 points. Patients received sessions adjusted to their physical abilities, patients in both subgroups improved on the walking test of 6 min (mild/moderate: +54m, severe/critical: +117m, both p < 0.002), FVC (mild/moderate: +8.9%, p=0.004; severe/critical: +12.4% , p <.003) and mental component sf-36 (mild /> moderate: +6.8 points, p = 0.062; severe / critical: +16.7 points, -p <.005). conclusions: an exercise program well structured results in a benefit the spheres of aerobic capacity, lung volumes and quality life, this sense it is recommended to expand population samples be able apply our protocol other centers charge n rehabilitation covid 19 patients. 

Introduction:

The presence of comorbidities and longevity is associated with worse outcomes in patients with COVID-19 infection.

Materials and Methods:

retrospective study of 306 adults infected by SARSCOV2. The main objective was to evaluate the role of the ROX index as well as comorbidities according to the age group as predictors of respiratory failure and mortality. In the inferential statistical analysis, the odds ratios OR with their confidence intervals greater than 95% were used as association measures. Qualitative variables were evaluated using the Chi-square test or Fisher's exact test, and in the case of numerical or quantitative variables, the Student's T or Mann-Whitney test was used.

Results:

When performing the correlation between comorbidities and ROX index and accumulated mortality of the patients, it was observed that in the group of less than 1 n 89/306, (29.08%) having ROX index values of 5.42 (SD: 3.54 .- 6.5) mortality was 9%. In the group with between 1 and 4 comorbidities, n 167/306 (54.57%), the ROX index values were 4.2. (SD: 3.1-5.3) the accumulated mortality was 21%. Finally, the group with more than 4 comorbidities n 50/306, (16.33%) presented the lowest ROX index levels 2.88 (SD: 2.43-3.33) being the one that showed the highest mortality estimated at 64%. The highest mortality occurred in those over 70 years of age.

Conclusions:

The present study showed a correlation between the ROX index and longer-lived age groups, showing higher mortality in those over 70 years of age and a higher rate of comorbidities and lower ROX. Studies with larger groups are required for better validation..

Introduction:

The use of the ROX index in COVID-19 patients allows evaluating those with a high risk of ventilatory failure, however, it has not been openly validated in patients who use a mask with a Hudson-type reservoir.

Materials and Methods:

retrospective study of 306 adults infected with SARSCOV2 by antigenic or molecular test. The main objective was to evaluate the role of the ROX index as a predictor of respiratory failure and mortality. In the inferential statistical analysis, the odds ratios OR with their confidence intervals greater than 95% will be used as association measures. Qualitative variables were evaluated using the Chi-square test or Fisher's exact test, and in the case of numerical or quantitative variables, the Student's t-test or Mann-Whitney test was used.

Results:

The highest frequency in male gender 78% and female 22%, the ROX values were higher in survivors at 2 h 5.8 (4.7 - 6.9), in relation to the deceased 4.5 (3.6 - 5 ,6). Similarly, at 12 h the values were higher in the group of survivors 7.8 (5.2 - 8.7) in relation to the deceased 4.9 (3.8 - 6.0). The age- and gender-adjusted odds ratio of the ROX index was 8.5, CI (2.0 - 91.4) at 2 h and 17.6, CI (2.8 - 93.6) at 12 h.

Discussion: The present study showed a correlation between the ROX index and older age groups, showing higher mortality in those older than 70 years and a higher rate of comorbidities and lower ROX. Conclusions: The ROX index in this study has proven to be a reliable evaluator of mortality in COVID-19, studies with larger groups of patients are required to validate the results found here.

Introduction

During the COVID-19 pandemic, restricted hospital visitation policies were implemented to reduce the spread of the viral infection. As a result, telephone has become the main communication method despite the complexity of the elderly patients' medical and psychosocial issues. This has heightened anxiety and reduced satisfaction among patients and their families. This quality improvement project aimed at improving communication with patients' families. We introduced several strategies with the aim to update patients' families within 48 hours of admission and then at least once a week during patient's journey from admission to discharge.

Method

Retrospectively, all patients who were admitted to the ACM ward during the study period were included. Multiple Plan-Do-Study-Act (PDSA) cycles were implemented. As the first intervention, we added a new section on "Update patients' families" in our weekly harm free care document to identify patients' families who were not updated. Also, reminder emails were sent to all medical doctors to ensure that we record all discussions with families using "Discussions with patients and families' document". As the second intervention, a poster on "Harm Free Thursday and Update Friday" was displayed in the doctor's office. Face-to-face education was provided to new trainees to emphasise the importance of good communication with patients' families. Data was collected from electronic patient record (EPR) and Microsoft Excel was used for data collection and analysis.

Results

189 patients were included in the baseline audit which showed that only 49% of patients' families were updated weekly throughout the admission. Compliance in communication with families after the first and second cycle was 62% and 69% respectively. Following the second PDSA cycle, the percentage of patients' families who were updated within 48 hours of admission increased from 50% to 56%.

Conclusion

The project showed significant improvement in communication with patients' families with each cycle.

Background: The role of rehabilitation medicine in treating post-acute COVID-19 survivors is currently ill-defined. Recently developed evidence-based initiatives, such as Cochrane REH-COVER, aim to describe the management of COVID-19 patients, but the variance and overlap in intervention types result in clinical uncertainty.

Objective: To provide a summary of delivered rehabilitation services for COVID-19 patients during the pandemic.

Methods: We collected evidence from the full set of REH-COVER Rapid living Systematic Reviews between March 2020 and February 2022 using the supplementary tables. We included studies that reported treatments in rehabilitation care within hospital and community settings. We collected additional information on the intervention type, multidisciplinary care, use of routine data and length of rehabilitation to define our outcomes.

Results: Out of 580 REH-COVER studies, 63 met the inclusion criteria. In-hospital interventions were present in 43 (68%) of cases, 14 (22%) were performed in community or home settings, and 6 (10%) were not explicitly defined. 83% of studies were conducted during the initial wave of COVID-19 in the first half of 2020. Among the intervention categories, pulmonary rehabilitation (N=41, 65%) and physical therapy (N=38, 60%) were the most common. Multidisciplinary interventions were described in 33 (52%) of studies where the median rehabilitation time was 21 (14; 26) days compared to 10 (5; 15) days for single specialisms (p=0.005). However, 27 (43%) studies did not report these data. Works that utilised routine data reported a slightly extended treatment (20 [12; 33]) compared to those that did not (14 [7; 22] days).

Conclusions: There is currently a wide variation in descriptions of rehabilitation interventions for COVID-19 patients. The limited number of papers clearly describing the content and length of rehabilitation programmes reduce the ability to share best practices. Harmonising therapy descriptions could improve the quality and standardisation of research in COVID-19 rehabilitation.

Background

The Covid-19 pandemic led to many consultations being conducted remotely. Cognitive impairment is recognised as a potential barrier to remote healthcare interactions and is common but heterogeneous in Parkinson’s. Little is known about these consultations in real life. We explored the experiences of remote consultations for people with Parkinson’s and cognitive impairment, investigating the perspectives of people with Parkinson’s, caregivers and healthcare professionals.

Method

Semi-structured interviews were conducted remotely (video or telephone) with 11 people with Parkinson’s and cognitive impairment, 10 family caregivers and 24 Healthcare Professionals in 2020-2021, using purposive sampling. Interviews were audio-recorded, transcribed and analysed using thematic analysis.

Results

Four themes were identified: (1) The Nature of Remote Interactions; (2) Challenges Exacerbated by Being Remote; (3) Expectation versus Reality; and (4) Optimising for the Future. Remote consultations were considered ‘transactional’ and less personal, with difficulties building rapport, and perceived to have a different role to in-person consultations. The loss of non-verbal communication and ability of Healthcare Professionals to ‘sense’ led to remote consultations being perceived as riskier by all groups. Specific to this population, issues arise from both communication and cognitive impairment; balancing of the person with Parkinson’s and caregiver voice; and around significant discussions, for example, regarding the future. Remote consultations were reported to have been more successful than anticipated in all three groups. Obstacles were not always as expected, for example age was less of a barrier than anticipated. Potential improvements for these three groups and healthcare services were identified, for example, consideration of camera positioning for video calls; and service flexibility to allow consultations to be timed to optimal medication function.

Conclusion

Advantages and challenges of remote consultations for this population are identified. Consultations could be improved with increased support, practice, preparation, awareness of issues, and more time and flexibility within services.

Introduction: The COVID-19 pandemic has resulted in many people experiencing bereavement in challenging circumstances. In April 2020 at a large London Trust, a “Bereavement Welfare Hub” (BWH) was established to offer support and advice by telephone to relatives and carers of all adults who died as inpatients. Data from these calls has been used to examine and learn from experiences of the bereaved at this time.

Methods: Data from BWH call records regarding 809 adults who died at the Trust in March - May 2020 were collated and analysed quantitatively. A random selection of 149 call records were examined using thematic analysis.

Results: 809 adults died at the Trust between March and May 2020. The mean age at death was 76 (SD=14) and 86% of deaths occurred on medical wards (outside intensive care). Bereavement calls were completed in 663 (82%) of cases. From analysis of call records, several themes that influenced the bereavement experience were identified. These included support from family and community, communication and contact with the dying person, support from bereavement services and ability to carry out usual rituals associated with dying.

Conclusions: Age is a significant risk factor for death from COVID-19 and the majority of deaths have occurred on medical wards. Improving hospital care of dying patients during the pandemic or at any time is relevant to geriatricians and other healthcare professionals working with older people. Our analysis identifies several factors which positively or negatively influenced the experiences of people bereaved during the first wave of COVID-19. From these findings, recommendations have been made which have the potential to improve the bereavement experience, particularly during the pandemic era.