ABSTRACT
COVID-19 has brought about major changes to the lives of people around the world. How people engaged in their daily routines, worked, shopped, socialised, and spent time with family shifted. Changes in nearly every aspect of daily life became the norm with no time to adapt. Face-to-face appointments were swapped for online consultations, face masks and physical distancing requirements were standard, and nuanced social interactions changed. People stopped shaking hands and kissing cheeks. They touched elbows or waved from a distance. People fanned out candles on birthday cakes. Sometimes people did not leave the house. With COVID-19, life has become unmistakably different, and adjusting to these changes has required a degree of cognitive flexibility, adaptability, and resilience. But what happens when, as an autistic person, tolerating change is your least favourite thing to do? This chapter has been co-authored by a young adult with autism who struggles with lockdowns, an autistic academic with a quirky sense of humour, an educational and developmental psychologist who loves staying in her pyjamas all day, a therapist who works with autistic individuals (and appreciates her children just a little bit more when they can physically attend school), another educational and developmental psychologist who has been taught a lot about autism from the young people she has assessed and counselled ("How can you sit and listen to people talking at you all day?”), and an inclusive education researcher and behaviour analyst who has the lived experience of psychosocial disability and prefers the company of her dogs. Together we explore the experiences of lockdown through the lived experiences of autistic people leveraging research to create a new and novel perspective. The chapter presents a unique way of integrating research evidence to shed light on the experiences recalled. Living life during a global pandemic calls for a need to deal with unpredictability and change. But what happens when you wish COVID-19 would be quickly eradicated? This chapter will address this question and more. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.
ABSTRACT
Background The Gold Standards Framework1 (GSF) was introduced in The Dudley Group NHS Foundation Trust (DGFT) in 2018;to encourage identification of those at the end of life and promote individualised advanced care planning including consideration of procedures in the last days of life. Method Retrospective audit to look at procedures conducted in the last week of life for patients who died at DGFT. Due to the coronavirus-19 pandemic, a period in Autumn 2019 prior to the pandemic and then a second period during the first-wave in Spring 2020 was studied. A list of adult patients who were coded as having a procedure in the last week of their admission, where the discharge method was death (occurring in November 2019 or April 2020) was compiled by the Informatics Team and information collected from notes using a proforma. Results The majority of patients in both the 2019 (64%) and 2020 (69%) audit had lengths of stays of 7 days or less (they died within a week of admission). Over 90% of patients in both groups had blood tests and imaging. Approximately 50% of patients had at least one admission in the 3 months prior to their final admission in the 2019 group, however, this was half (24%) in the 2020 group. Approximately 40% in both groups had been identified as GSF red or amber, however, up to 80% had documentation indicating recognition that in last year of life and evidence of good communication. Conclusions Implementation of the Gold Standards Framework has provided a structure to support identification of patients in the last year of life. In view of the number of admissions prior to the final admission there needs to be continued work to identify patients in a timely manner to support with the development of an individual plan of care.
ABSTRACT
Background The ongoing Coronavirus-19 (CV-19) pandemic has had worldwide impact with over 240 million cases globally1 to date. As with most the UK, The Dudley Group NHS Foundation Trust (DGFT) has cared for patients with the virus since Spring 2020 and we reviewed if the types of patients who died (all causes) changed in the pandemic on a local level. Method Retrospective review of adult inpatients who died at DGFT - looking at November 2019 (before CV-19) and April 2020 (early in first-wave). A list of adults who were coded as dying as an inpatient in these two periods was compiled by the Informatics Team and data collected from 45 notes for each month. Results There were 148 adult inpatient deaths in November 2019, which increased 77% to 262 in April 2020. Median ages at death were similar (77 years) but fewer females (27%). 4% were known to Specialist Palliative Care before admission. Average lengths of stay were similar (5-6 days) and approaching end of life was recognised in the majority of cases. In April 2020, there was a decreased number of patients with recent hospital admissions (24%) and a threefold increase in those with an unimpaired functional status (29%). Fewer were admitted from home but more from care homes (18%). 25% of those with CV-19 as cause of death had no documented comorbidities (all aged over 74). Conclusions There appears an increase of inpatient deaths at the start of the Coronavirus-19 pandemic in three main groups: care home residents, those with comorbidities and older people with no comorbidities/unimpaired functioning. Promoting advance care planning with these groups as a priority may be beneficial for future waves - especially wishes for hospital admission and preferred place of care. (Assessment of impacts of the CV-19 vaccination programme on these patient groups could be considered).
ABSTRACT
We convened a multidisciplinary Working Party on behalf of the Association of Anaesthetists to update the 2011 guidance on the peri-operative management of people with hip fracture. Importantly, these guidelines describe the core aims and principles of peri-operative management, recommending greater standardisation of anaesthetic practice as a component of multidisciplinary care. Although much of the 2011 guidance remains applicable to contemporary practice, new evidence and consensus inform the additional recommendations made in this document. Specific changes to the 2011 guidance relate to analgesia, medicolegal practice, risk assessment, bone cement implantation syndrome and regional review networks. Areas of controversy remain, and we discuss these in further detail, relating to the mode of anaesthesia, surgical delay, blood management and transfusion thresholds, echocardiography, anticoagulant and antiplatelet management and postoperative discharge destination. Finally, these guidelines provide links to supplemental online material that can be used at readers' institutions, key references and UK national guidance about the peri-operative care of people with hip and periprosthetic fractures during the COVID-19 pandemic.