ABSTRACT
A significant reduction in hospitalizations for acute exacerbations of COPD (AECOPD) is seen during the COVID-19 pandemic. It remains unclear whether this reduction is the result of avoidance of medical care by patients, or of infection prevention and control (IPC) measures. This study used a real-life inpatient pulmonary rehabilitation (PR) setting to explore the impact of COVID-19-related IPC measures on the incidence of AECOPD, thereby mitigating the potential effect of care avoidance. Patients with COPD admitted for eight weeks of inpatient PR at Ciro (Horn, the Netherlands) were included in this retrospective study. Patients admitted between October 1st 2020 and March 1st 2021, the first winter season with COVID-19-related IPC measures in place, were compared to patients admitted during the same periods in previous years (2017-2018, 2018-2019 and 2019-2020). Electronic medical records were retrospectively screened for the incidence of moderate to severe AECOPD, drop-out and mortality during the PR period. A total of 501 patients with COPD (median age 66.6 [IQR 60.3-71.9] years, 43.1% male, FEV1 35.9 [26.8-50.6] % predicted) were analyzed. During 2020-2021, 22 patients (31.0%) experienced >=1 AECOPD compared to 43 patients (33.6%) in 2019-2020, 55 patients (36.9%) in 2018-2019 and 83 patients (54.2%) in 2017-2018, p=0.077. No differences in the mean AECOPD rate, AECOPD severity, drop-out nor mortality rates were observed. This study is the first to demonstrate that COVID-19-related IPC measures do not affect the incidence of AECOPD during inpatient PR. These findings may therefore suggest that the reduction of AECOPD observed in hospital settings may be related to care avoidance.
ABSTRACT
Long COVID is seen in a growing group of patients who experience a large number of symptoms after previous infection with SARS-CoV-2. The symptoms persist and are accompanied by impaired functioning without a sufficient pathophysiological explanation. While the condition is more commonly seen in patients who have been critically ill, predictive factors for long COVID are lacking. There are also no objective, diagnostic criteria, evidence-based interventions or scientifically based advice for the follow-up of this group. Recent research shows that most symptoms and limitations diminish over time, but also that there is a small group with permanent physical, psychological and/or cognitive problems. This article describes the current definition, epidemiology, and symptoms of long COVID. The functional and structural abnormalities and additional health risks are also discussed. Finally, it mentions a number of challenges that will have to be addressed to prevent this condition from having adverse consequences not only for individual patients but also casting a large shadow on health care and economic recovery.
ABSTRACT
The COVID-19 pandemic and its impact on older and frail people underlines the importance of advance care planning (ACP). ACP is a dynamic communication process involving patients, families and healthcare providers, which serves to discuss and document wishes and goals for future care. Currently, ACP practice is often suboptimal. This implies that important decisions about care and treatment may need to be made acutely in crises. Many factors contribute to suboptimal ACP practice. One such factor is ambiguity regarding roles and responsibilities of different disciplines in the ACP-process. The perception that having ACP conversations is primarily a physician's task is a misconception. Specific skills that could contribute to a holistic and person-centered ACP-process are largely lacking in nursing curricula and therefore, may be insufficient and under-utilized. For instance, nursing staff could involve persons in conversations about meaning, quality of life, loss and grief as a part of ACP. Moreover, they may communicate a patient's wishes to other healthcare providers including physicians. Acknowledgement of this potential role, by physicians as well as by nursing staff themselves, is needed for ACP to become a truly interprofessional process.