Experiences of Bereavement Across the UK, What Are the Challenges and What Might the Future Look Like - Findings From the UK Commission on Bereavement

Background/aims: The increased number of deaths due to the COVID-19 pandemic has left many people bereaved. Working in partnership with a number of UK charities and researchers, the UK Bereavement Commission was established to ensure that the voices of those affected by bereavement are heard and considered in future services and supports for bereaved people across the UK. Aims: To explore experiences of people bereaved in the last 5 years and identify recommendations for policy and practice with the aim of improving the experiences of people affected by bereavement. Methods: Two online surveys were launched in September 2021, one collected individuals' personal experiences of bereavement over the last 5 years while the other captured responses from organisations supporting people affected by bereavement. Both surveys captured qualitative and quantitative data. A lived experience advisory forum was established to ensure the voices of people affected by bereavement were included and considered in the both the formulation of survey questions and the identification of themes and recommendations from data collected. Qualitative data from were analysed using thematic analysis. Descriptive statistics summarised demographic characteristics of respondents, types of support received and satisfaction with support received. Results: Challenges experienced and recommendations for future support were identified by analysing individual and organisational perspectives. Conclusions: Understanding the experiences of bereaved people, from a range of different backgrounds and locations across the UK represents an essential first in ensuring that supports and services for those facing bereavement in the future are informed by people with direct experience of bereavement or of supporting those affected by bereavement. The Commissions plans for ensuring update of identified recommendations will also be discussed.

Delivery of Cognitive Behavioral Therapy With Diverse, Underresourced Youth Using Telehealth: Advancing Equity Through Consumer Perspectives

The purpose of this qualitative study was to capture the perspectives of individuals representing an urban, predominantly Latinx community who are underresourced by mental health services about the use of telehealth to deliver mental health treatment. The COVID-19 pandemic required hospital- and community-based mental health programs to pivot to telehealth with alarming speed and very little opportunity to assess the feasibility, acceptability, and disparate impact on unique populations of patients. This study aimed to assess perceived strengths and limitations of telehealth mental health service delivery via qualitative focus group methods. Three focus groups were conducted with 13 youth (aged 8–17) who were being treated at an urban, academic children’s hospital serving a predominantly Latinx community mental health population;two focus groups were conducted with 19 parents of said children;and one focus group was conducted with four mental health providers providing services to this population. A coding schema was designed to capture themes relevant to the following: (1) privacy and confidentiality;(2) perceived limitations of telehealth;(3) comfort with telehealth;(4) therapeutic relationship;(5) perceived strengths of telehealth;(6) perceived safety of telehealth;and (7) advice for providers engaging in telehealth. Findings were illustrative of both perceived strengths and limitations across these domains that can inform optimized telehealth mental health services moving forward.

Navigating the health system during COVID-19: primary care perspectives on delayed patient care

AIM: The primary care response to the coronavirus disease 2019 (COVID-19) pandemic has required significant changes to the delivery of healthcare by general practices. This study explores the experiences of New Zealand general practice teams in their perception of delayed patient care during the early stages of the pandemic. METHOD: We qualitatively analysed a subtheme of delayed patient care of the General Practice Pandemic Experience New Zealand study, where general practice team members nationwide were invited to participate in five surveys between May and August 2020. RESULTS: 164 participants initially enrolled in the study, with 78 (48%) completing all surveys. Four delayedcare themes were identified: patient contributors, health system contributors, impacts and opportunities for minimisation. Respondents noted that patients avoided healthcare, downplayed symptoms and feared going out. Non-essential care was put on hold, allied services were reduced and access to secondary care was variable. Certain diseases and screening were commonly impacted. As lockdown lifted a backlog of work resulted. Flexible review periods, outreach care, self-screening, cross-sector collaboration and improved public awareness were strategies for timely healthcare. CONCLUSION: Reducing barriers to patients seeking care and improving integration and relationships across the health system would minimise future pandemic disruption and delayed patient healthcare.

Incidence of cardiac complications during index hospitalisation with covid-19 in Australia: Aus-covid study

Introduction: Cardiac complications of COVID-19 include acute cardiac injury, myopericarditis, cardiomyopathy and arrhythmias. This study aimed to describe the incidence of cardiac complications in patients admitted to hospital with COVID-19 in Australia. Methods: AUS-COVID is a multicentre observational cohort study across 21 Australian hospitals including all index hospitalisations with laboratory-proven COVID-19 in patients aged 18 years or older. All consecutive patients entered in the AUS-COVID Registry by 28 January 2021 were included in the present study. Results: Six hundred and forty-four hospitalised patients (62.5 ± 20.1 years old, 51.1% male) with COVID-19 were enrolled in the study. Overall in-hospital mortality was 14.3%. Twenty (3.6%) patients developed new atrial fibrillation or flutter during admission and 9 (1.6%) patients were diagnosed with new heart failure or cardiomyopathy. Three (0.5%) patients developed high grade atrioventricular (AV) block. Two (0.3%) patients were clinically diagnosed with pericarditis or myopericarditis. Among the 295 (45.8%) patients with at least one troponin measurement, 99 (33.6%) had a peak troponin above the upper limit of normal (ULN). In-hospital mortality was higher in patients with raised troponin (32.3% vs 6.1%, p<.001). New onset atrial fibrillation or flutter (6.4% vs 1.0%, p=.001) and troponin elevation above the ULN (50.3% vs 16.4%, p<.001) were more common in patients 65 years and older. There was no significant difference in the rate of cardiac complications between males and females. Conclusions: Among patients with COVID-19 requiring hospitalisation in Australia, troponin elevation was common but clinical cardiac sequelae were uncommon. The incidence of atrial arrhythmias and troponin elevation was greatest in patients 65 years and older.

Association of hypertension with mortality in patients hospitalised with covid-19

Introduction: To assess whether hypertension is an independent risk factor for mortality amongst patients hospitalised with COVID-19 and to evaluate the impact of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) on mortality in patients with a background of hypertension. Methods: This observational cohort study included all consecutive index hospitalisations with laboratory proven COVID-19 aged 18 years or older across 21 Australian hospitals entered in the AUS-COVID Registry by 22nd January 2021. Patients were excluded if their past medical or medication history was not available or if they were transferred to another hospital in which case mortality outcomes were not available. Registry data were analysed for in-hospital mortality in patients with comorbidities including hypertension, and baseline treatment with ACE inhibitors or ARBs.Results: 546 consecutive patients (62.9±19.8 years old, 51.8% male) hospitalised with COVID-19 were enrolled. In the multivariable model, significant predictors of mortality were age (aOR 1.09, 95% CI 1.07-1.12, p<.001), heart failure or cardiomyopathy (aOR 2.71, 95% CI 1.13-6.53, p=.026), chronic kidney disease (aOR 2.33, 95% CI 1.02-5.32, p=.044) and chronic obstructive pulmonary disease (aOR 2.27, 95% CI 1.06-4.85, p=.035) (Figure 1). Hypertension was the most prevalent comorbidity (49.5%) but was not independently associated with increased mortality (aOR 0.92, 95% CI 0.48-1.77, p=.81). Amongst patients with hypertension, ACE inhibitors (aOR 1.37, 95% CI 0.61-3.08, p=.61) and ARBs (aOR 0.64, 95% CI 0.27-1.49, p=.30) did not affect mortality. Conclusions: In patients hospitalised with COVID-19, pre-existing hypertension was the most prevalent comorbidity but was not independently associated with mortality. Similarly, the baseline use of ACE inhibitors or ARBs had no independent association with in-hospital mortality.

Palliative care and homelessness-developing communities of practice to address inequity in palliative care access

Background: People in UK homeless hostels experience extremely high rates of multi-morbidity, frailty and age-related conditions at a young age but seldom receive palliative care. The burden of support often falls to hostel staff. Before COVID-19 we evaluated a model embedding palliative specialists into hostels to provide support to staff and residents and facilitate a multidisciplinary approach to care. Subsequent to the pandemic we have adapted our model to develop online communities of practice to facilitate interdisciplinary learning and working. Aims: Improve care and support received by people experiencing homelessness who may benefit from a palliative approach by developing communities of practice to connect and empower those that support them. Methods: A range of homelessness, health and social care professionals within different locations, attended a series of seven online sessions. Presentations from experts were shared and discussed with a focus on how practice in local areas could be adapted to provide a person-centered approach to support those with deteriorating health. Participants were also encouraged to use the sessions as a vehicle for developing a multi-professional response to challenges encountered in real time. Data were collected via surveys and focus groups throughout, and three months after, completion of sessions. Results: We will explore usefulness of component parts of training regarding;understanding and working effectively in a person centered, trauma-informed way and increasing knowledge of a palliative approach. We will also explore feasibility of building communities of practice for connecting professionals supporting people experiencing homelessness for ongoing support and collaboration. Conclusion / discussion: To address the inequity that exists in palliative care access for people experiencing homelessness, a joined up, supportive, multi-professional response is essential.

Clients, consumers or citizens?: The privatisation of adult social care in England

Adult social care was the first major social policy domain in England to be transferred from the state to the market. There is now a forty-year period to look back at to consider the thinking behind the strategy, the impacts on commissioners and providers of care, on the care workforce and on those who use care and support services. In this book, Bob Hudson meticulously charts these shifts. He challenges the dominant market paradigm, explores alternative models for a post-Covid-19 future and locates the debate within the wider literature on political thinking and policy change. © Bristol University Press 2021. All rights reserved.

Empty waiting rooms: the New Zealand general practice experience with telehealth during the COVID-19 pandemic

AIM: The primary care response to the coronavirus disease 2019 (COVID-19) pandemic in early 2020 required significant changes to the delivery of healthcare by general practices. This study explores the experiences of New Zealand general practice teams in their use of telehealth during the early stages of the COVID-19 pandemic in New Zealand. METHOD: We qualitatively analysed a subtheme on telehealth of the General Practice Pandemic Experience New Zealand (GPPENZ) study, where general practice team members across the country were invited to participate in five surveys between 8 May 2020 to 27 August 2020. RESULTS: 164 participants enrolled in the study during survey one, with 78 (48%) completing all surveys. Five telehealth themes were identified: benefits, limitations, paying for consults, changes over time and plans for future use. Benefits included rapid triage, convenience and efficiency, and limitations included financial and technical barriers for practices and patients and concerns about clinical risk. Respondents rapidly returned to in-person consultations and wanted clarification of conditions suited to telehealth, better infrastructure and funding. CONCLUSION: To equitably sustain telehealth use, the following are required: adequate funding, training, processes communicated to patients, improved patient access to technology and technological literacy, virtual physical examination methods and integration with existing primary health care services.

Dynamic tracking of variant frequencies depicts the evolution of mutation sites amongst SARS-CoV-2 genomes from India.

With the exponential spread of the coronavirus disease 2019 (COVID-19) pandemic across the world within the 12 months, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains are continuously trying to adapt themselves to the host environment by random mutations. When doing so, some variants with evolutionary advantages such as better human to human transmissibility potential might get naturally selected. This short communication demonstrates how the mutation frequency patterns are evolving in 2457 SAR-CoV-2 strains isolated from COVID-19 patients across diverse Indian states. We have identified 19 such variants showing contrasting mutational probabilities in the span of 7 months. Out of these, 14 variants are showing increasing mutational probabilities suggesting their propagation with time due to their unexplored evolutionary advantages. However, the mutational probabilities of five variants have significantly decreased in June onward as compared to March/April, suggesting their termination with time. Further in-depth investigation of these identified variants will provide valuable knowledge about the evolution, infection strategies, transmission rates, and epidemiology of SARS-CoV-2.

Dynamic tracking of variant frequencies depicts the evolution of mutation sites amongst SARS-CoV-2 genomes from India (preprint)

With the exponential spread of COVID-19 pandemic across the world within the last six months, SARS-CoV-2 strains are continuously trying to adapt themselves in their host environment by random mutations. While doing so, some variants with evolutionary advantages such as better human to human transmissibility potential should get naturally selected. This short communication demonstrates how the mutation probability patterns are evolving in 864 SAR-CoV-2 strains isolated from COVID-19 patients across diverse Indian states. We have identified 30 such variants showing contrasting mutational probabilities in the span of four months. Out of these, the mutational probabilities of 25 variants including C14408T (in RdRp gene), A23403G (in spike gene), C6312A (nsp3 gene) are continuously increasing suggesting that these mutations are being propagated with time due to their unexplored evolutionary advantages. In contrast, the mutational probabilities of five variants including C6312A (nsp3 gene), G11083T (nsp6 gene), C28311T (N gene) have significantly decreased in May-June as compared to March-April, suggesting these mutations are being terminated with time. Further in-depth investigation of these identified variants will provide valuable knowledge about the evolution, infection strategies, transmission rates, and epidemiology of SARS-CoV-2 in India.