ABSTRACT
Patients transferred out of intensive care recovering from COVID-19 infection are at high risk of malnutrition1.Untreated malnutrition has the potential to increase length of stay and increase morbidity and mortality. To inform service planning we aimed to describe nutritional status and dietetic outcomes of patients recovering from COVID-19 infection post ICU admission. Baseline data was collected retrospectively from patient electronic records and included age, gender, comorbidities, weight, height, Body Mass Index (BMI), Vitamin D status, type of nutrition support, length of stay and discharge destination. Of 51 COVID-19 patients transferred out of ICU, 71% remained as inpatients and had further dietetic follow up. [Formula presented] Of those with data sets available, 82% had a decrease in weight during their ICU stay with an average loss of 7.6kg (9% body weight). Thirty percent moved into a lower BMI category over the course of their ICU stay. On discharge from hospital and dietetic service, 50% were weight stable and 29% had gained weight following dietetic input. Seventy two percent of patients required ongoing artificial nutrition support on transfer out of ICU. Prior to discharge home, 82% required advice on a high protein, high calorie diet with 25% of these requiring additional advice for therapeutic diets such as diabetic diets, no added salt diet, dietary advice for stoma management, renal dietary advice and modified consistency dietary advice. In terms of follow up, 11% were referred to community dietetics, 8% returned to dietetic outpatient clinics and 18% were stable on nutrition care plan and discharged from dietetic caseload at ward level. The data obtained highlights the deterioration in nutritional status and risk of malnutrition in this cohort of patients post COVID-19 infection. Ongoing nutrition support and dietetic input should be considered as integral on transfer from ICU to ward level in preventing, treating and diagnosing malnutrition. References 1. Bedock.D, Bel Lassen.P, Mathian.A, Moreau.P, Couffignal.J, Ciangura.C, Poitour-Bernert.C, Jeannin, AC, Mosbah.h, Fadlallahj, Amoura.Z, Oppert.JM, Faucher.P. Prevalence and severity of malnutrition in hospitalized COVID-19 patients. Clinical Nutrition ESPEN. 2020;Vol. 40 214-219 2. Haraj.NE, EL Aziz.S, Chadli. A, Dafir.A, Mjabber. A, Aissaoulo, Barrou.L, EL Kettanie EL Hamidi.C, Nsiri.A, AL Harrar.R, Ezzouine.H, Charra.B, Abdallaoui. Ms, EL Kebbaj.N, Kamal.N, Mohamed Bennouna.M, EL Filali.KM, Ramdani.B, EL Mdaghri.N, Benghanem Gharbim, Hicham Afif. Nutritional status assessment in patients with COVID-19 after discharge from intensive care unit. Clinical Nutrition ESPEN. 2020;2405-4577
ABSTRACT
Patients recovering from COVID-19 are at high risk of malnutrition, reduced nutritional intake and decline in muscle mass and strength with many requiring significant rehabilitation. The aim of this service evaluation is to quantify the risk of malnutrition and provide an overview of nutritional status and outcomes with dietetic input on a care of the elderly rehab ward. Demographics were collected from patient electronic records. Malnutrition risk, handgrip strength and Vitamin D levels were measured along with calculation of nutritional requirements. Of sixteen patients on the rehab wards post COVID-19, 81% (n=13) required dietetic input. [Formula presented] There was an average weight loss of 5.1kg (6.6%) (p=0.64). Eighty one percent had a reduction in their BMI, with 31% moving into a lower BMI category. Measurably reduced and impaired muscle function was evident when handgrip strength was measured. Eighty five percent required oral nutrition support. Additional advice for dysphagia, diabetes and renal disease was provided to 65% of patients. Following dietetic intervention, energy and protein intake improved in all patients. Sixty four percent were either insufficient or deficient in Vitamin D. The data obtained demonstrates the high prevalence of malnutrition in patients on a rehab ward post COVID-19. Furthermore the data highlights the clear need for dietetic intervention in this nutritionally vulnerable group to optimize nutritional status. References I. Stam. HJ, Stucki.G, Bickenbach.J. COVID-19 and post intensive care syndrome: A call for action. Journal of Rehabilitation Medicine. 2020;52 (4)
ABSTRACT
Purpose: Juvenile court involved youth (JCIY) experience unique psychosocial challenges. The COVID-19 pandemic generated additional stressors for this vulnerable population. Promoting mindfulness strategies may increase well-being among JCIY, but few such interventions have been developed. We sought to evaluate the impact of a longitudinal mindfulness intervention incorporating healing-centered, anti-oppression yoga delivered through a virtual platform on multiple psychological outcomes among JCIY involved in community-based monitoring. Methods: We partnered with YogaRoots on Location (YROL), a healing-centered, anti-oppression yoga instruction group, to implement a longitudinal mindfulness training program to youth aged 11-21 involved in the Allegheny County Community Intensive Supervision Program (CISP). Starting in March 2020, this program transitioned to a remote format in light of the COVID-19 pandemic. Sessions were delivered via Zoom and incorporated Raja yoga practice, breathing techniques, meditation and mindfulness exercises, and strengths-based social justice exploration. Sessions lasted one hour and occurred weekly. Youth attending nine sessions completed end-of-program (EOP) evaluations. Baseline surveys assessed demographic characteristics and prior experiences with racism and trauma. EOP surveys were administered to assess for changes in multiple psychological outcomes: mindfulness, acceptance and action, resilience, future orientation, emotion dysregulation, and psychological distress. Demographic data were summarized with descriptive statistics. McNemar or Wilcoxon signed rank tests were used to compare outcomes at baseline and EOP. Results: 99 youth completed baseline assessments. Mean age of participants was 16.2 (SD: 1.4). 85 (86%) were male. 60 (61%) identified as Black/African-American, 17 (17%) White, and 14 (14%) other racial identities. 7 (7%) were Hispanic/Latino. 74 (75%) youth reported prior experiences of trauma, with 47 (47%) reporting three or more. Perceptions of racism were common, with 63 (64%) youth reporting being treated unfairly by a police officer and 67 (68%) being accused of something they did not do at school. 16 youth (16%) completed EOP surveys. No significant changes in any psychological outcomes were noted from baseline to EOP among this cohort of youth who completed nine or more sessions. Many reported likelihood of using yoga in the future to deal with stress (11;69%), to calm down (12;75%), and to deal with racism (8;50%). Conclusions: JCIY face significant psychosocial stressors, and many report histories of trauma and discrimination. The COVID-19 pandemic may exacerbate existing challenges for these youth, and further supports are needed to engender well-being in this population, including strategies to retain youth in programming. Despite its feasibility and acceptability among JCIY, mindfulness training, particularly in a virtual format, may have limited immediate impact on psychological outcomes due to broader structures of oppression and situational factors. Reflecting the transiency of this population, changing living situations, going “on the run,” and other challenges, retaining youth in ongoing programming is challenging. Additional follow-up is needed to determine the effects of such interventions on long-term youth coping and resilience as well as to elucidate implementation facilitators to increase receipt of such skills-building programs for this population. Sources of Support: Heinz Endowments.
ABSTRACT
Keywords: Clinical Academic;Impact;Workforce Purpose: Research active healthcare organisations have improved patient outcomes compared to their non-research active counterparts (Hanney et al., 2013). To increase this activity there are growing opportunities for physiotherapists to be involved in clinical research. However, there are few roles that include time for that research (Westwood et al., 2018). Further, there are fewer opportunities for band 5 clinicians to gain research experience to foster research awareness. To impact the research awareness and clinical practice of our Band 5 rotational physiotherapists, a mixed research and clinical musculoskeletal rotation was implemented at a London Healthcare Trust. The objective of this service evaluation was to evaluate whether the rotation impacted the activity of these clinicians. Methods: The full time rotation was structured with 2 days research activity alongside 3 days clinical activity within musculoskeletal outpatients. Two band 5 physiotherapists were invited to undertake this 4 month rotation. Any prior research experience related to their physiotherapy qualification. They were trained and mentored by the Lead Clinical Academic for Therapies, and each research activity was supervised by pre-doctoral to post-doctoral Therapy clinical academic fellows. The rotation included completion of research relevant training, fortnightly mentorship, and research activity relating to on-going projects. These projects included two systematic reviews and a scoping review at different stages of completion, analysis of a national survey and conducting a COVID-19 related service evaluation. The physiotherapists were asked to provide feedback of their experience. Results: The therapists reported perceived improvement and new skills in: adapting to change, time management, understanding of research governance, use of reference management and data software, and management of data. The therapists also reported improvement in the ability to read, search, and appraise the literature, and applied these new skills to research projects. Importantly, they reported that all the skills were applied to their clinical workload, in particular to implementation of evidence base care. They reported that this confidence and skill led to evidence based discussions with their musculoskeletal out-patient colleagues. Further impacts have been that to date, the therapists have 1 paper in review and will co-author 2 additional papers. Finally, they have submitted two s for conference. Conclusion(s): The rotation provided an opportunity to develop research skills – both in theory and in practice. The structure of the rotation and time given for learning allowed for consolidation of new knowledge. The skills gained during the rotation had positive impact on approaches to patient care, as well as research activity. Limitations include the timing of research days within the working week, leading to challenges of adapting between clinical and non-clinical settings. This could be addressed by placing research days at the beginning or end of the week. Impact: Early adoption, training and practice of research activity impacts evidence based patient care, and the research awareness of the clinicians and their colleagues. This rotation has been established within the wider Therapies Department. The benefits reported could inspire creation of similar opportunities, and so serve as an important step in the paradigm shift towards research active clinical practice. Funding acknowledgements: No funding was received to conduct this service evaluation.
ABSTRACT
Rationale: Patients recovering from COVID-19 are at high risk of malnutrition, reduced nutritional intake and decline in muscle mass and strength with many requiring significant rehabilitation. The aim of this service evaluation is to quantify the risk of malnutrition and provide an overview of nutritional status and outcomes with dietetic input on a care of the elderly rehab ward. Methods: Demographics were collected from patient electronic records. Malnutrition risk, handgrip strength and Vitamin D levels were measured along with calculation of nutritional requirements. Results: Of sixteen patients on the rehab wards post COVID-19, 81% (n=13) required dietetic input. [Formula presented] There was an average weight loss of 5.1kg (6.6%) (p=0.64). Eighty one percent had a reduction in their BMI, with 31% moving into a lower BMI category. Measurably reduced and impaired muscle function was evident when handgrip strength was measured. Eighty five percent required oral nutrition support. Additional advice for dysphagia, diabetes and renal disease was provided to 65% of patients. Following dietetic intervention, energy and protein intake improved in all patients. Sixty four percent were either insufficient or deficient in Vitamin D. Conclusion: The data obtained demonstrates the high prevalence of malnutrition in patients on a rehab ward post COVID-19. Furthermore the data highlights the clear need for dietetic intervention in this nutritionally vulnerable group to optimize nutritional status. References: 1. Stam. HJ, Stucki.G, Bickenbach.J. COVID-19 and post intensive care syndrome: A call for action. Journal of Rehabilitation Medicine. 2020;52 (4) Disclosure of Interest: None declared.