ABSTRACT
COVID-19 was declared a global pandemic in March 2020. Resulting containment protocols altered the day-to-day lives of people around the globe, impacting typical physical activity patterns. The purpose of this mixed-method study was to understand how physical activity changes occurred during the first few months of the COVID-19 pandemic. Participants (n = 271) completed a survey including a qualitative item asking for descriptions of how their physical activity had changed, as well as a categorical item asking whether they had become more active, stayed equally as active, or become less active during the pandemic. Qualitative responses were analyzed to identify emergent themes, and chi-squared analyses were used to compare proportional differences in themes according to self-reported physical activity classification. Analysis revealed 10 themes: (1) decreased transportation-related physical activity, (2) change in location, (3) loss of resources, (4) discrepancies between self-reported changes in activity level and description of activities, (5) increased transportation-related physical activity, (6) changes in routines, (7) adapting exercise, (8) avoiding contact, (9) changes unrelated to COVID-19, and (10) illness or injury. Significant differences existed between groups for all themes except for avoiding contact, changes unrelated to COVID-19, and injury or illness. Empowering individuals to overcome barriers may be important during a pandemic to help people maintain or increase physical activity levels. Future research should explore the continued experience of people during the COVID-19 pandemic and investigate its impact on levels of physical activity going forward. © 2023, Western Kentucky University. All rights reserved.
ABSTRACT
Introduction: Intensive care patients often have complex swallowing and communication needs. These require coordinated input from the multi-disciplinary team. Increasing evidence highlights the role of speech and language therapy (SLT) within the critical care environment1 and this is represented well in national recommendations specific to patients with tracheostomies. Approximately 10-15% of ICU patients will have a tracheostomy nationally.2 SLT provide expertise in assessment and management of communication and swallowing difficulties, which can vastly improve psychosocial well-being and promote early safe enteral feeding for our patients.3 In 2014 On the right trache?4 found that 52% of patients with a tracheostomy suffered with dysphagia, however only 27% critical care patients had input from SLT. Objectives: To improve the assessment of swallowing and communication in patients undergoing tracheostomy ventilation at the Royal Infirmary of Edinburgh, to comply with Scottish Intensive Care Society Audit Group (SICSAG) quality indicator 2.3. This guidance stipulates all tracheostomy patients should have communication and swallowing needs assessed during ventilator wean.5 Methods: Four distinct areas of intervention were implemented. Pre-populated review text was added to NHS Lothian's clinical notation system (InterSystems TrakCare®), prompting nursing staff to consider swallowing, tracheostomy issues and SLT referral. These were refined between audit cycles. SLT were invited to join safety briefs to identify tracheostomy patients, as well as other patients with complex swallowing needs. This was an opportunity to raise awareness, educate, and prioritise workload. New guidelines for nurse-led swallowing observations were developed and disseminated amongst teams. Finally, staff were offered relevant educational sessions. Baseline data was collected in 2019;serial data collection was then during October - November 2020 and in June - July 2021 following the interventions. Results: All patients who received tracheostomy ventilation were audited (n=31). This showed that very few patients had swallowing and communication assessed adequately. Only 16.1% (n=5) patients had a regular nursing swallowing assessment on the majority of critical care days (>50%). Referral to SLT was often very late when patients were approaching de-cannulation and on many occasions by the time the SLT team were involved patients had already been de-cannulated. Following the intervention period, it became apparent that awareness of swallowing requirements had improved. By mid 2021, 58.9% more patients had swallowing assessed as part of daily care. Additionally, 81.2% of patients had SLT reviews on the unit demonstrating a sustained increase from late 2020. There was a notable increase in the quality of assessments after initial SLT review. Conclusion: Using quality improvement methodology our multidisciplinary team was able to substantially increase the quality of swallowing assessment within our ICU, despite the challenges of the COVID-19 pandemic. Our unit now complies with SICSAG quality indicator 2.3. This is in keeping with national recommendations for a multidisciplinary approach to care of tracheostomy patients. Patients with increased risk of dysphagia are being identified earlier and are more likely to progress and be established on enteral feeding early, which may subsequently reduce the burden of nasogastric feeding, total parenteral nutrition and even related invasive IV access.
ABSTRACT
The correlates of COVID-19 illness severity following infection with SARS-Coronavirus 2 (SCoV2) are poorly understood. While several demographic and underlying clinical variables increase risk for severe outcomes, at the onset of symptoms, it is challenging to identify those who will progress to requiring intensive care support. We conducted a pilot study to understand peripheral blood gene expression correlates of COVID19 illness across the spectrum of disease severity. We assessed gene expression in 53 confirmed SCoV2-infected adult participants during acute illness (within 28 days of onset). We found global gene expression patterns in participants with mild and moderate illness were highly similar, but significantly different from participants with severe illness. When comparing gene expression in those with severe as compared to non-severe illness, we identified >4000 genes significantly differentially expressed (FDR<0.05). Biological pathways represented by genes significantly increased in severe COVID19 were associated with platelet activation and coagulation, while those significantly decreased in severe COVID19 were associated with T cell signaling and differentiation (Figure 1). We used statistical modeling with crossvalidation to identify an 18-gene signature which classified severe illness (ROC AUC=0.98) in our training cohort, and strongly predicted hospitalization in an independent test cohort (ROC AUC=0.85). A weighted gene expression risk score (WGERS) provided 100% sensitivity and 85% specificity for classifying severe illness in our training cohort, and only mis-classified (5/19) participants with moderate illness. Importantly, the WGERS demonstrated 84% sensitivity and 74% specificity for predicting hospitalization in the test cohort. These data indicate that gene expression classifiers may provide clinical utility for identifying participants likely to require intensive care following SCoV2 infection.
ABSTRACT
Introduction: Maintaining physical activity is a modifiable risk factor for cognitive impairment. However, despite numerous public health interventions, older adults do not routinely meet activity guidelines. Online interventions offer an alternative means of engaging with this group. The role of an online intervention holds particular value in the context of a global pandemic where people have become accustomed to digital living. Furthermore, such an intervention negates barriers frequently faced by older adults in attending face to face interventions, whilst providing an economically viable option. This study explored the factors which maximise engagement in an online programme to promote physical activity. Methods: A qualitative study was conducted with adults aged 50 and over. Individual were recruited through the online UK PROTECT study cohort. Four focus groups (n=21) examined key contributors to engagement with a digital programme to promote physical activity. Iterative Categorization was utilised to identify categories and themes of the focus group data. Semi-structured interviews were subsequently conducted (n=5) whereby participants were asked to comment on a concept-stage online intervention. Results: Four major themes emerged from the focus group data: interaction at the fore, incentives as foundations, fitting around me and identity is critical. The semi-structured interviews identified further key areas of programme acceptability and specific needs for enhancing engagement. Conclusions: Older adults are open to using digital physical activity programmes, with the recent COVID-19 pandemic driving an appetite for online delivery. Any interventionmust be tailored to individual usability preferences and take account of the fitness, health and lifestyle needs specific to older adults. Furthermore, the conceptual-stage intervention used in this study was found to be acceptable, with key changes needed to maximise engagement.