ABSTRACT
Study Objectives: To identify changes in emergency department (ED) visits for opioid-related diagnoses, opioid overdose, and the use of buprenorphine in EDs during the SARS-CoV-2 pandemic. Methods: Electronic health data was collected from 14 geographically distinct emergency departments for ED visits between August 31, 2019 and August 30, 2020. Variables collected include age, sex, race, ICD-10 discharge codes, buprenorphine administrations, buprenorphine prescriptions and SARS-CoV-2 hospital admission rate. The category of opioid-related diagnoses included ED visits with ICD-10 codes for opioid use disorder, opioid dependence, opioid withdrawal, opioid overdose and/or opioid-related infection. Opioid-related infection visits were tabulated as ED visits with ICD-10 code for abscess, cellulitis, endocarditis or osteomyelitis and concurrent ICD-10 code of opioid-related diagnosis for the current ED visit or in the medical history. We used descriptive statistics and paired t-test to evaluate for differences in ED visits for opioid-related diagnoses, opioid overdose and rate of buprenorphine administrations and/or prescriptions between in visit with opioid-related diagnosis between August 31, 2019-February 29, 2020 and March 1, 2020-August 30, 2020. Spearman correlation was used to assess the association of outcomes with hospital SARS-CoV-2 burden from January 1, 2020 through August 30, 2020. Results: We collected information on a total of 911,738 ED visits between August 31, 2019- August 30, 2020 from 14 EDs Total ED visits with opioid-related diagnoses by ICD-10 code were 9,788, including 3,198 for opioid overdose, 1,745 for opioid withdrawal, and 431 for opioid-related infection (Figure 1). Between August 31, 2019-February 29, 2020 and March 1, 2020-August 30, 2020 (N = 13 sites), there was an increase in ED visits for OUD-related visits per 10,000 visits (130.8 (SE: 24.2) vs 101.8 (SE: 21.8);p=0.002) and an increase in ED visits for opioid overdose per 10,000 ED visits (40.8 (SE: 10.3) vs 27.4 (SE: 6.1);p=0.02). No change was detected in the rate of buprenorphine administration and/or prescriptions: 25.8 (SE: 5.3) vs 25.1 (5.5);p=0.80. From January to August 2020, significant correlations were observed between inpatient hospital SARS-CoV-2 rates and ED visits with a positive correlation between opioid-related diagnoses per 10,000 (Spearman r=0.92, p= <0.0001) and opioid overdose per 10,000 visits (r=0.90, p=<0.0001);a negative correlation was found for the rate of ED administration and/or prescription of buprenorphine (r=-0.37, p=0.03). Conclusions: ED visits for opioid-related diagnoses and opioid overdose per 10,000 ED visits increased in EDs between March 1, 2020 – August 30, 2020 compared to the preceding 6 months and correlated with inpatient SARS-CoV-2 burden. Although the overall rate of buprenorphine administered and/or prescribed from the ED highlights a significant practice change in EDs over recent years, buprenorphine provision in EDs did not increase despite likely treatment service disruptions during this period of SARS-CoV-2. [Formula presented]
ABSTRACT
Background: A correlation between social isolation and poorer cognitive function in later life has been increasingly implied in literature. Research indicates that maintaining a socially active lifestyle can enhance cognitive reserve and benefit cognitive function. Whereas social exclusion has been significantly associated with higher risks of cognitive impairment (Evans, et al., 2019). Recent studies reviewed the consequences of restrictive living conditions during COVID-19, finding poorer cognitive performance (Ingram, et al., 2021).However, few services have investigated this. This study intended to explore the impact of social isolation on cognitive function of hospitalised older adults. Methods: Quantitative measures were used. A retrospective review of cognitive results of individuals open to occupational therapy in an acute Care of the Older Person's service in May 2018 (n=23) were compared to cognitive results of individuals open to occupational therapy in the same acute Care of the Older Person's service in May 2021 (n=62). Results: For the purpose of this study, cognitive results were compared by means of assessment results which indicated a mild, moderate or significant cognitive impairment. Of the patients seen in May 2021 (n=62), 9.68% (n=6) had a mild cognitive impairment, 25.81% (n=16) had a moderate cognitive impairment and 32.26% (n=20) presented with a significant cognitive impairment. Comparatively in May 2018 (n=23), 30.43% (n=7) had a mild cognitive impairment, 43.38% (n=10) had a moderate cognitive impairment and just 4.35% (n=1) presented with a significant cognitive impairment. Conclusion: A substantial increase in the number of inpatients presenting with a significant cognitive impairment in an acute Care of the Older Person's service was found between May 2018 (4.35%) and May 2021 (32.26%). This suggests that COVID-19 had a severe impact on cognitive functioning of older adults and implies that this cohort are at a high risk of cognitive decline caused by social isolation. These findings are preliminary and further research is recommended.
ABSTRACT
Background The aging population of Ireland continues to increase rapidly. As the age continues to increase, so too does the need for long-term care (LTC). In 2006 LTC utilisation was estimated between 4.4%–4.8% of the over 65s population. It was proposed that this would increase to between 4.8%–5.3% by 2021 (Wren et al., 2012). This study intended to explore if this projection was evident in discharges from an acute Care of the Older Person’s setting between 2016 and 2021. Methods A random selection approach was used to retrospectively review 45 patients seen by occupational therapy in an Irish acute Care of the Older Person’s service in 2016. Discharge destinations were recorded. These were then compared to the discharge destinations of 45 randomly selected patients open to occupational therapy in the same service during the first half of 2021. Results The review of 2016 found that 15.56% (n = 7) of those seen by occupational therapy discharged to a LTC facility, and 4.45% (n = 2) discharged home with a back-up LTC plan. Additionally, 33.33% (n = 15) transferred to a rehabilitation facility and 42.22% (n = 19) went home with community supports, 4.44% (n = 2) passed away. Contrastingly, in 2021, 28.89% (n = 13) patients discharge to LTC with an additional 6.66% (n = 3) going home with 24/7 private care in place, and 4.45% (n = 2) went home with a LTC back-up plan. Just 22.22% (n = 10) went for rehabilitation and 26.67% (n = 12) went home with community supports. In 2021, 11.11% (n = 5) of those randomly selected passed away during their admission. Conclusion A significant increase of the number of inpatients discharging to LTC between 2016 and 2021 was found. These findings are greater than that previously proposed and may suggest that COVID-19 has caused a further increase in individuals requiring LTC. However, this sample size was small and other factors such as age, physical ability and cognition were not explored. Further studies are recommended.
ABSTRACT
We provide evidence on the consumer staples industry's commitment and accountability to employees prior to the COVID-19 pandemic by analysing their employee-related disclosures in annual reports. A high level of disclosure exists from 2004 to 2019 with 93 percent of the industry disclosing some information about employees. The highest categories of disclosure are remuneration, health and safety, and training and development. We find that total disclosure is significantly related to having employee share ownership, a Big 4 auditor, a larger board of directors, a majority independent board, independent chair, an audit and nomination committee and higher ROA. © 2021 Accounting and Finance Association of Australia and New Zealand