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Aims To describe readmissions of hospitalised patients with COVID-19, define predictors of readmission and explore the long term outcomes using the SF-12 score compared to patients who were not readmitted and those not hospitalised. Methods A single centre retrospective in North Inner-City Dublin. Recruitment was done through a COVID follow up clinic. Predictors of readmission and SF-12 scores at two timepoints post follow up at median 3 months and 12 months. Results Seventy (45%) participants were admitted, with a median age of 49.5 years (IQR 41.3-56.9), 36(51%) of whom were female. Unscheduled readmissions at ≤30 days in COVID-19 patients were 9(12.9%) and length of stay was four days (IQR 2-5). Readmissions were due to ongoing symptoms(n=9(64.3%)) or new complications(n=5(35.7%)). Mechanical ventilation and having symptoms of nausea and vomiting on index admission were predictive of readmission. (p=0.002). SF-12 scores at one year of readmitted patients were not different to patients who were never admitted at median one year follow up, p=.089. Conclusions Most readmissions were of short duration. Early follow up of patients post MV or who had nausea and vomiting on index admission should be prioritised. Wellbeing of readmitted patients was not different to those never hospitalised, at one year.
Subject(s)
COVID-19 , Adult , Female , Humans , Male , Middle Aged , Nausea , Patient Readmission , Retrospective Studies , Risk Factors , VomitingABSTRACT
Persistent symptomatic COVID-19 is a multi-system condition that affects approximately 10% of those with acute COVID-19 infection. Affected patients often have complex care needs requiring holistic and multidisciplinary care approaches, the kind routinely provided in general practice. However, there is a lack of evidence of appropriate general practice interventions for the condition. A scoping review was conducted using Arksey and O'Malley's 2005 five-stage framework[1], with later recommendations by Levac et al.[2] to examine the literature and identify knowledge gaps in general practice management of persistent COVID-19. Nineteen papers were selected for review. The studies spanned numerous geographical locations, encompassing several study designs, and a range of populations and sample sizes. The included studies used various definitions for persistent symptomatic COVID-19. The literature was analysed qualitatively, and six major themes were identified. These themes were (i) GP uncertainty, (ii) Listening and empathy, (iii) Assessment and monitoring of symptoms, (iv) Coordinating access to appropriate services, (v) Facilitating provision of continual and integratedmulti-disciplinary care and (vi) Need to facilitate psychological support. Overall, the findings show that general practitioners play a key role in the management of persistent COVID-19, but that more clinical guidance on appropriate interventions is necessary to enhance care. There is a need for scientifically accepted definitions for persistent COVID-19 to ensure that patients can be recognized, assessed and managed appropriately. Patient and public involvement should guide policy makers when developing future care models. Meanwhile, future research should evaluate the implementation and effectiveness of proposed management strategies and interventions.
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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.
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The revitalization of the global economy after the COVID-19 era presents Environmental Geotechnics with the opportunity to reinforce the need for a change in paradigm toward a green, circular economy and to promote aggressively the use and development of sustainable technologies and management practices. This paper aims to assist in this effort by concentrating on several thematic areas where sustainability solutions and future improvements are sought. These include the re-entry of construction and demolition waste, excavated material, industrial waste, and marine sediments into the production cycle and the reuse of existing foundations. Despite the recent trend in advanced countries toward recycling and waste-to-energy thermal treatment, landfills still constitute the most common municipal solid waste management practice, especially in low-and-middle-income countries, and technological solutions to improve their environmental footprint are presented. At the same time, remediation solutions are required to address the multitude of contaminated sites worldwide. Advanced developments that incorporate environmental, economic, and social dimensions are expounded, together with sustainable ground improvement solutions for infrastructure projects conducted in soft and weak soils. The topic of thermo-active geostructures concludes this paper, where, apart from their infrastructure utility, these structures have the potential to contribute as a renewable energy source. © 2021 ICE Publishing: All rights reserved.
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Covid-19 is proving to be an unprecedented disaster for human health, social contacts and the economy worldwide. It is evident that SARS-CoV-2 may spread through municipal solid waste (MSW), if collected, bagged, handled, transported or disposed of inappropriately. Under the stress placed by the current pandemic on the sanitary performance across all MSW management (MSWM) chains, this industry needs to re-examine its infrastructure resilience with respect to all processes, from waste identification, classification, collection, separation, storage, transportation, recycling, treatment and disposal. The current paper provides an overview of the severe challenges placed by Covid-19 onto MSW systems, highlighting the essential role of waste management in public health protection during the ongoing pandemic. It also discusses the measures issued by various international organisations and countries for the protection of MSWM employees (MSWEs), identifying gaps, especially for developing countries, where personal protection equipment and clear guidelines to MSWEs may not have been provided, and the general public may not be well informed. In countries with high recycling rates of MSW, the need to protect MSWEs' health has affected the supply stream of the recycling industry. The article concludes with recommendations for the MSW industry operating under public health crisis conditions. © 2021 ICE Publishing: All rights reserved.
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The coronavirus disease 2019 pandemic has posed severe threats to humans and the geoenvironment. The findings of severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) traces in waste water and the practice of disinfecting outdoor spaces in several cities in the world, which can result into the entry of disinfectants and their by-products into storm drainage systems and their subsequent discharge into rivers and coastal waters, raise the issue of environmental, ecological and public health effects. The aims of the current paper are to investigate the potential of water and waste water to operate as transmission routes for Sars-CoV-2 and the risks of this to public health and the geoenvironment. Additionally, several developing countries are characterised by low water-related disaster resilience and low household water security, with measures for protection of water resources and technologies for clean water and sanitation being substandard or not in place. To mitigate the impact of the pandemic in such cases, practical recommendations are provided herein. The paper calls for the enhancement of research into the migration mechanisms of viruses in various media, as well as in the formation of trihalomethanes and other disinfectant by-products in the geoenvironment, in order to develop robust solutions to combat the effects of the current and future pandemics. © 2021 ICE Publishing: All rights reserved.
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The outbreak of the coronavirus disease 2019 (Covid-19) pandemic not only has created a health crisis across the world but is also expected to impact negatively the global economy and societies at a scale that is maybe larger than that of the 2008 financial crisis. Simultaneously, it has inevitably exerted many negative consequences on the geoenvironment on which human beings depend. The current paper articulates the role of environmental geotechnics in elucidating and mitigating the effects of the current pandemic. It is the belief of all authors that the Covid-19 pandemic presents not only significant challenges but also opportunities for the development of the environmental geotechnics field. This discipline should make full use of geoenvironmental researchers' and engineers' professional skills and expertise to look for development opportunities from this crisis, to highlight the irreplaceable position of the discipline in the global fight against pandemics and to contribute to the health and prosperity of communities, to serve humankind better. In order to reach this goal while taking into account the specificity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the uncertainty of its environmental effects, it is believed that more emphasis should be placed on the following research directions: pathogen-soil interactions;isolation and remediation technologies for pathogen-contaminated sites;new materials for pathogen-contaminated soil;recycling and safe disposal of medical wastes;quantification of uncertainty in geoenvironmental and epidemiological problems;emerging technologies and adaptation strategies in civil, geotechnical and geoenvironmental infrastructures;pandemic-induced environmental risk management;and modelling of pathogen transport and fate in geoenvironment, among others. Moreover, Covid-19 has made it clear to the environmental geotechnics community the importance of urgent international co-operation and of multidisciplinary research actions that must extend to a broad range of scientific fields, including medical and public health disciplines, in order to meet the complexities posed by the Covid-19 pandemic. © 2021 ICE Publishing: All rights reserved.