ABSTRACT
Background/aims: Short-term specialized palliative homecare that is initiated timely based on complex needs has been advocated for older people with frailty. But there is insufficient evidence on the feasibility of such an intervention. To assess the feasibility and preliminary effectiveness of a timely shortterm specialized palliative homecare intervention (i.e., Frailty+) for older people with frailty and family. Methods: Pilot randomised controlled trial and process evaluation. Eligible patients were 70 years or older, had a clinical frailty score 5-7, complex needs and about to be discharged home from hospital. They were randomly assigned (1:1) to Frailty+ or standard care. The Frailty+ group received specialized palliative care by a palliative homecare nurse over 8 weeks, who followed guides for home visits. The primary endpoint was change on a sum score based on five key symptoms, i.e., breathlessness, pain, anxiety, constipation, drowsiness, over 8 weeks. Feasibility, implementation, mechanisms and context were assessed post-intervention using mixed methods. We used thematic and descriptive statistical analyses. Results: 37 patients were randomly assigned to Frailty+ group (n=19, mean age 84y) or standard care (n=18, mean age 84y) and 26 family carers. The Frailty+ group received at least one home visit, as intended. Hospital care staff reported difficulties in patient identification. Patients and family reported positive views on the home visits, nurses that the guides were often not useful. Most important contextual factors were related to the COVID-19 crisis e.g., less continuity of care. Mean sum scores on primary outcome at baseline was 6.0 in Frailty+ and 5.6 in the control group, at 8-weeks was 4.5 in Frailty+ and 4.1 in the control group (adjusted ratio 1.0). Conclusions: Frailty+ was well received by patients and family and to a lesser extent healthcare providers. Based on these results, further refinement of Frailty+ and RCT design is needed to optimize the intervention and evaluation.
ABSTRACT
INTRODUCTION: We present the results of the COVID-19 rule-out protocol at Ghent University Hospital, a step-wise testing approach which included repeat NFS SARS-CoV-2 rRT-PCR, respiratory multiplex RT-PCR, low-dose chest CT and bronchoscopy with BAL to confirm or rule-out SARS-CoV-2 infection in patients admitted with symptoms suggestive of COVID-19. RESULTS: Between 19 March 2020 and 30 April 2020, 455 non-critically ill patients with symptoms suspect for COVID-19 were admitted. The initial NFS for SARS-CoV-2 rRT-PCR yielded 66.9%, the second NFS 25.4% and bronchoscopy with BAL 5.9% of total COVID-19 diagnoses. In the BAL fluid, other respiratory pathogens were detected in 65% (13/20) of the COVID-19 negative patients and only in 1/7 COVID-19 positive patients. Retrospective antibody testing at the time around BAL sampling showed a positive IgA or IgG in 42.9 % of the COVID-19 positive and 10.5% of the COVID-19 negative group. Follow-up serology showed 100% COVID-19 positivity in the COVID-19 positive group and 100% IgG negativity in the COVID-19 negative group. CONCLUSION: In our experience, bronchoscopy with BAL can have an added value to rule-in or rule-out COVID-19 in patients with clinical and radiographical high-likelihood of COVID-19 and repeated negative NFS testing. Furthermore, culture and respiratory multiplex PCR on BAL fluid can aid to identify alternative microbial etiological agents in this group. Retrospective analysis of antibody development in this selected group of patients suggests that the implementation of serological assays in the routine testing protocol will decrease the need for invasive procedures like bronchoscopy.