ABSTRACT
The COVID-19 pandemic forced universities worldwide to move their teaching online within an unprecedentedly short timeframe. Whilst the move online learning has increased the reach of tertiary educational delivery it has also raised significant issues of equity, accessibility and student engagement. This includes concerns around access to technology and reliable internet connectivity, academic and digital literacy, and other factors such as mental health and work-life balance. This paper examines two studies of student engagement with online learning during 2020 when then pandemic began. One study was conducted in South Africa the other in a small regional university in South-Eastern Australia. A mixed method approach was used in both studies and then student responses were analysed using the student engagement framework presented by Kahu and Nelson (2018). A key focus in this analysis is the critical importance the educational interface and shared mutually formative experience of learning between students and universities. Findings show that despite the two different contexts, student concerns around digital literacy and engagement in an online learning environment share many similarities.
ABSTRACT
Background: Bereavement support is an important facet of palliative medicine. Many patients who receive end of life care in our hospital are not known to the hospice or hospital social workers. As a result, their families and carers do not avail of bereavement follow-up. This is particularly relevant as Covid-19 restrictions have interrupted the traditional community orientated bereavement process. Aim and objectives: The goal is to quantify this cohort and facilitate a collaborative MDT quality improvement approach to acknowledge and address bereavement follow-up in the context of Covid-19 and beyond. Methods: We quantified the weekly average number of families or carers who would not avail of bereavement follow-up prior to and during the Covid-19 surge. We reviewed the advice regarding bereavement support as per the Irish National Clinical Program for Palliative care 2018. The palliative team discussed this service gap with different stakeholders including the hospice, cancer care west, medical social work and the bereavement officer. A number of quality improvement methods were employed;such as stakeholder map, fishbone analysis, driver diagrams and the 5 whys. Results: The average weekly number of families/carers who did not avail of bereavement follow-up prior to Covid-19 was 3 and during the Covid- 19 surge was 10. Quality improvement methodologies revealed that the gap in bereavement follow-up was due to a lack of a palliative care social worker. To address this gap short-term a bereavement information leaflet was designed which will promote self-recognition of prolonged grief and signpost options available for support. Conclusion: Bereavement support is an important component of palliative care, which is often lacking. This project utilised a multidisciplinary quality improvement approach to improve this service gap with a bereavement information leaflet in the short-term and a long-term plan aimed at funding a palliative care social worker. P Posters Volunteering.
ABSTRACT
Background: Covid-19 patients at end of life (EoL) suffer predominantly from rapidly escalating dyspnoea and agitation. An unusual symptom of Covid-19 is isolated extreme overwhelming cerebral agitation and Helms et al,1 report an observational series of 58 patients admitted to Intensive Care Unit with associated encephalopathy, prominent agitation and confusion. Case presentation: Male 74 year old patient with end-stage leukaemia, admitted to hospital with mild flu like symptoms. Tested positive Covid- 19.Hospitalised for two weeks, then discharged to a Nursing Home. Only symptom remained was insomnia, however this was impacting with increasing irritability in a previously calm man. The irritability escalated to extreme agitation, screaming out in deep distress. No headache or signs of meningism. Patient hospitalised, Palliative Medical phone advice requested. The agitation was not associated with dyspnoea, chest secretions or pain. Management & outcomes: A continuous sub-cutaneous infusion (CSCI) was commenced with opioid and midazolam and symptoms did not settle with increasing doses. The patient's close relative was an Oncology Nurse Specialist and was the only visitor allowed on ward. The patient's extreme agitation was deeply distressing and on day 3 phenobarbitone was commenced and within hours the patient settled and slept for the first time in three weeks. Phenobarbitone was delivered via stat dose and CSCI. The following day the patient required a third CSCI with diclofenac for resistant hyperpyrexia not controlled on regular paracetamol. The patient remained comfortable and passed away a few days later. Discussion: This isolated symptom appeared to present with extremely poor sleep for weeks, then escalating into extreme overwhelming agitation. At EoL this isolated symptom is an indication for use of Phenobarbitone, that renders sustained benefit. Conclusion: For 'patients with reversibility' it may indicate earlier than usual need for ventilation.
ABSTRACT
Background: Phenobarbital is classed as a sedative anti-epileptic that has an overall effect of depressing the central nervous system. It has a dual action of prolonging the opening of chloride channels on GABA receptor complex as well as inhibiting glutamate transmission at non- NMDA receptor channels. Phenobarbitone is licenced for treatment of epilepsy. In palliative care phenobarbitone is considered in patients with seizures and those with terminal agitation not responding to high dose benzodiazepines and anti-psychotics. Aims and objectives: To identify the frequency, duration of treatment , dosing regime and goal of phenobarbitone prescribed by specialist Palliative Care team in the acute hospital setting and identify demographics of this cohort. Another aim to identify whether it was used as an adjuvant or a single agent and establish any side effects. Method: A Retrospective analysis of patients prescribed phenobarbitone between May 2020 and February 2021 was carried out. We identified initial dose prescribed, titration to effect, duration of treatment, PRN requirements pre and post introduction. We recorded each diagnosis and response in the first 24 hours. Side effects were also analysed. Results: 46 phenobarbitone prescriptions were issued in the 9 month period. 25 were female and 21 were male. Majority of the patients had a malignant diagnosis or covid. The most common indication for phenobarbitone prescription was management of agitation at end of life not responding to high dose benzodiazepine/ anti-psychotics. All patients received stat dose of phenobarbitone 100mg followed by initiation of continuous subcutaneous infusion. Conclusion: Phenobarbitone is a valuable and effective drug in management of terminal refractory agitation in selected cohort of patients.
ABSTRACT
Introduction Management of Covid-19 has been among the biggest challenges in our medical careers. Unfortunately, it has led to a rapid end of life for some. Our aim was to describe symptomatology and medication requirements at the End of Life for patients with COVID-19 and explore the value of education, with Specialist Palliative Medical availability around the clock for all medical staff. Case 1 A male patient with End Stage Kidney Disease (ESKD) and COVID-19 deteriorated rapidly on day 8 of his illness. The main symptoms were dyspnea and agitation. Case 2 A male patient with ESKD and COVID-19 had progressive dyspnea over the first 5 days of his illness and his symptoms later escalated rapidly over a period of hours. Case 3 A female patient with multiple co-morbidities who developed COVID-19 and initially appeared to be recovering well later deteriorated rapidly, over hours, on day 16 of her illness. Her main symptoms were dyspnea and agitation. Outcome Patients with Covid-19 experienced rapidly escalating dyspnoea and agitation in the End of Life phase, with respiratory secretions being less prominent in this cohort. Medication requirements to achieve symptom control varied considerably. Discussion Major obstacles encountered were the need for strict isolation with Personal Protective Equipment (PPE) for staff and family, and restricted visiting to reduce external exposure to Covid-19. Prior End of Life care education delivered to medical staff focusing on symptom management and medications, may have positively influenced early symptom assessment, proactive initiation of appropriate medications and methods of medication delivery. The availability of around the clock Specialist Palliative Medical advice may have helped other Medical staff cope with this new illness for patients in the dying phase.