ABSTRACT
OBJECTIVES: To examine the psychological and social impact of the COVID-19 pandemic on patients with established anxiety disorders during a period of stringent mandated social restrictions. METHODS: Semi-structured interviews were conducted with 30 individuals attending the Galway-Roscommon Mental Health Services with an International Classification of Diseases diagnosis of an anxiety disorder to determine the impact of the COVID-19 restrictions on anxiety and mood symptoms, social and occupational functioning and quality of life. RESULTS: Twelve (40.0%) participants described COVID-19 restrictions as having a deleterious impact on their anxiety symptoms. Likert scale measurements noted that the greatest impact of COVID-19 related to social functioning (mean = 4.5, SD = 2.9), with a modest deleterious effect on anxiety symptoms noted (mean = 3.8, SD = 2.9). Clinician rated data noted that 8 (26.7%) participants had disimproved and 14 (46.7%) participants had improved since their previous clinical review, prior to commencement of COVID-19 restrictions. Conditions associated with no 'trigger', such as generalised anxiety disorder, demonstrated a non-significant increase in anxiety symptoms compared to conditions with a 'trigger', such as obsessive compulsive disorder. Psychiatric or physical comorbidity did not substantially impact on symptomatology secondary to COVID-19 mandated restrictions. CONCLUSIONS: The psychological and social impact of COVID-19 restrictions on individuals with pre-existing anxiety disorders has been modest with only minimal increases in symptomatology or social impairment noted.
Subject(s)
COVID-19 , Pandemics , Anxiety/epidemiology , Anxiety Disorders/epidemiology , Humans , Quality of Life , SARS-CoV-2 , Secondary CareABSTRACT
Background and Aim: The Australian Therapeutic Goods Administration (TGA) released Therapeutic Goods (Standard for Faecal Microbiota Transplant Products) (TGO 105) Order 2020 as a regulatory framework for fecal microbiota transplantation in Australia in September 2020. BiomeBank established a stool donor screening program and quality management system to produce fecal microbiota transplants as a Class 2 Biological;however, the feasibility of such a screening program was unknown. The aim of this study was to assess the eligibility and retention rates of potential stool donors over a 12-month period. Method(s): Stool donors were recruited in Adelaide through local flyers, targeted online advertising, and word of mouth. Data on the donor screening program were prospectively collected, including donor demographic details, screening and stool donation results at each stage of the screening, and donation process from 1 January to 31 December 2021. Result(s): Of 135 enquiries to the stool donor program during 2021, 55 people were excluded based on age and distance from the collection center. The remaining 80 potential donors were sent a donor screening questionnaire, and 65/80 (81.3%) were deemed ineligible based on established donor screening criteria. The remaining 15 potential donors (11%) underwent physician assessment, 11 (73.3%) of whom passed and progressed to blood, swab, and stool testing. Two of the remaining potential donors failed screening tests (with positive stool screening tests for an extended-spectrum beta lactamase-producing organism, one of whom also tested positive for hepatitis B core antibody on blood), and a third did not complete testing. The final outcome was eight new stool donors (5.9% of initial enquiries) being enrolled in the donor program in 2021. This was in addition to two donors who carried over from 2020. The median age of donors was 36.9 years (range, 27.6-47.1), and 50% of donors were female. The mean weight of accepted donations was higher for male than female donors (212 vs 120 g;P < 0.001). The median number of donations processed per donor was 7.0 (IQR, 1.8-28.8), the median number of 8-week donation periods per donor was 2.5 (IQR, 1-6), and the median number of donations processed per 60-day donation period was 3.2 (IQR, 1-5.1). There were 21 donated samples that were rejected due to issues detected on the day of donation (n = 14) or being too small to process (n = 7). In terms of donor retention in the program, half the donors (5/10) were retained at the end of 2021, with discontinuation being the result of personal choice, poor engagement, or ineligible occupation. In addition, 60% of the donors (6/10) incurred a total of seven temporary suspensions during the year due to various factors: antibiotic exposure (n = 2), ineligible medication (n = 1), gastroenteritis (n = 1), upper respiratory tract infection (n = 1), COVID-19 exposure risk (n = 1), and raw oyster ingestion (n = 1). Conclusion(s): A minority of potential stool donors are eligible to become stool donors. In addition, retention of donors in the program and maximizing the yield from a donation period were difficult due to strict donor screening criteria, frequent exposures to common pathogens, and the ongoing commitment required from donors. Despite this, BiomeBank was able to produce fecal microbiota transplants under the TGA-regulated Class 2 Biologicals framework and meet increasing demand for this product in Australia using a rigorous donor screening program.
ABSTRACT
Aims: To describe the characteristics, symptoms and outcomes for patients with COVID-19 referred to a hospital-based specialist palliative care service and to describe communication and visiting practices. Methods: A descriptive cross-sectional retrospective study, which is a part of the ANTICIPATE study project. Results: 50 patients were referred;49 included in analysis. 38 patients died. 27 patients were male;median age was 81 years. On referral, median Charlson Comorbidity Index was 6;median Australia-modified Karnofsky Performance Status score was 20%. Median number of days from referral to death was 2. Common baseline symptoms (n) were dyspnoea (35), agitation (23), and pain (13). Opioids (100%), benzodiazepines (97.1%) and neuroleptics (61.8%) were most commonly used medications to achieve symptom control. 13/19 patients with serial data had a decrease in Palliative Care Problem Severity Score. 26 patients received a family visit before death;8 had virtual forms of contact. 9 patients had family present at time of death. Conclusion: The short interval from referral to Specialist Palliative Care and death indicates the need for prompt service response. Data on visiting highlights challenges of providing psychosocial support.
ABSTRACT
OBJECTIVES: To examine if the COVID-19 pandemic is associated with a differential effect over time in relation to its psychological and social impact on patients with established anxiety disorders. METHODS: Semi-structured interviews were conducted with 24 individuals attending the Galway-Roscommon Mental Health Services with an International Classification of Diseases (ICD)-10 diagnosis of an anxiety disorder at two time points (six months apart) to determine the impact of the COVID-19 restrictions on anxiety and depressive symptoms, social and occupational functioning and quality of life. RESULTS: No statistical difference in symptomatology was noted between the two time points in relation to anxiety symptoms as measured by utilising psychometric rating scales (BAI and HARS) or utilising a Likert scale. The greatest impact of COVID-19 at both time points is related to social functioning and quality of life. Significant variability was noted for individual participants. Qualitative analysis noted social isolation, concern for the participants' future and increased difficulty managing anxiety with ongoing restrictions. CONCLUSIONS: No significant overall change in symptomatology or functioning over time was noted for individuals with pre-existing anxiety disorders. Variability was, however, demonstrated between individuals, with some individuals describing ongoing anxiety, social isolation and concern for their future. Identifying those with ongoing symptoms or distress and providing multidisciplinary support to this cohort is suggested.