ABSTRACT
Background: At 140 million, India has the second largest population of old people in the world, as per the 2011 census.1 The covid 19 pandemic has wreaked havoc in millions of lives. Elderly are especially vulnerable to COVID-19 and experience high morbidity and mortality as a result of immunosenescence. Age is independently linked with mortality, but age alone does not adequately capture the robustness of older adults who are a heterogeneous group. The current research was done in a tertiary healthcare hospital in Maharashtra to understand the clinical profile and factors that affected the outcome of elderly during the second wave of the COVID pandemic. Method: This was a single centre retrospective observational study done in a tertiary hospital which was admitting both covid and non-covid patients during the time of this study. All elderly patients admitted with COVID 19 disease in Covid ward and covid ICU (Intensive care unit) were included in the study. Their Demographic details, duration of illness, vital parameters, oxygen saturation, partial pressure of arterial oxygen compared to fraction of inspired oxygen (PaO2-FiO2 ratio) were recorded and also relevant investigations such as complete blood count, kidney function tests, liver function tests, arterial blood gases, chest X-rayand ECG (Electrocardiogram),CT scan of the brain, CSF(cerebrospinal fluid) studies and other tests where relevant were recorded. Inflammatory markers such as C-Reactive Protein (CRP), Ferritin, D-Dimer and Chest CT scan were noted. Clinical profiles and outcomes were noted till discharge or death. Results: Among 231 patients that were included in this study, 81(35%) were female and 150 (65%) were male. Ninety-two patients died (39.8%) while 139 patients (60.2%) survived in our study. Majority of our patients (211;91.3%) presented in category E(pneumonia with respiratory failure) or category F(pneumonia with respiratory failure and multiorgan dysfunction syndrome). Factors which had a major impact on mortality were- a low PaO2-FiO2 ratio on admission, high C-Reactive Protein (CRP) levels, high d-dimer levels, a finding of bilateral ground glass opacities on x-ray, and need for invasive ventilation on admission. Conclusions: Elderly remain vulnerable to severe consequences of COVID-19 infection owing to the increasing comorbidities and immunosenescence in them. Prolonged oxygen therapy and intensive respiratory rehabilitation are the mainstays of effective management. Given the constant threat of mutating virus, masking, maintaining hand sanitization, vaccination and also caring for our elders while still maintaining social distance are our best bet against a fatal third wave. © 2022 Journal of Association of Physicians of India. All rights reserved.
ABSTRACT
Purpose: Lung cancer referral pathways aim to reduce delays and improve referral patterns of people with suspected lung cancer. As part of implementing lung cancer referral pathway at a regional Australian hospital, this study aimed to explore the experiences and perceptions of people with lung cancer and their carers. Methods : In this cross-sectional qualitative study, we used an in-depth interview technique to elicit data for thematic analysis. Semi-structured interviews were conducted with newly diagnosed lung cancer patients and their carers at an academic cancer centre. Fourteen interviews were conducted by telephone and five were conducted face-to-face (according to patient preference), at a time convenient to the patient/carer. Interviews were audio-recorded, transcribed, and qualitatively analysed. Descriptive phrases were used to generate initial inductive codes and themes about topics such as communication, timeliness, support, and satisfaction. Results : Out of the 36 potential participants approached, 19 agreed to take part in the study. Themes important for participants were quality of communication from clinicians, timeliness of investigations and specialist referrals, patient advocacy, psycho-social support, and co-ordination of care. Some patients and their carers experienced various difficulties which reduced their perception of quality of care. Due to the COVID 19 pandemic, tele-Healthconsultations, including telephone consultations were being used widely. Good communication, timeliness and patient advocacy and support were factors that positively impacted the care experience. Negative experiences included improper communication, long waiting times for investigations and appointments, uncertainty about the process and inconsistent providers. Participants preferred face to face or video-linked consultations over telephone consultations. Conclusion: Proper communication, timeliness and adequate psycho-social support were perceived as important factors in improving satisfaction of lung cancer patients and their carers during the referral pathway. Methods to improve communication by clinicians, reduce delays and provide support care during the referral pathway should be explored further.