Was Icu Right for You? An Exploratory Qualitative Study of Patients >=65 Yrs and Next of Kin in Covid-19: The Escalate Study

Introduction The decision to admit an older patient to the intensive care unit (ICU) should reflect shared goals of care. Resource limitations during the Covid-19 pandemic highlighted challenges in selecting candidates for escalation. Patients and next of kin (NoK) who have experienced ICU are well-placed to reflect on whether the admission was right for them. Objective To explore older patients' (>65 years) and their loved ones' views on escalation decision making. Methods Qualitative study involving semi-structured interviews with patients, NoK of survivors and NoK of deceased who experienced UK ICU admission with Covid-19 respiratory failure between March 2020 and February 2021. A preliminary questionnaire was used to maximise sample diversity of age, sex, ethnicity, survival, decision regret and impact of event scores. Interview data were collected via video conferencing or telephone. Transcripts were analysed using framework analysis. Results 30 participants were interviewed. Results Five themes were identified: 'Inevitability' - a sense that the illness and its management are out of the control of the patient or their loved one;'Disconnect' - differences between hospital and lay person narratives;challenges to bridging that gap included effective communication aided by technology;'Acceptance' - of the consequences, good or bad, of an intensive care admission as unalterable;'Beyond comprehension' - participants had not contemplated ill health or ICU prior to admission and even with the benefit of hindsight struggled to describe which potential outcomes would be acceptable or unacceptable if they needed to be involved in similar decision-making around escalation in the future;'Covid-19' - unique impact of a pandemic. Conclusion This study, which includes bereaved NoK as well as patients and NoK of survivors, adds perspective to inform decision making regarding treatment escalation of older people.

Tissue-specific evidence for SARS-CoV-2 within intraocular tissues

Purpose : To systematically investigate ocular changes in autopsied eyes from fatal cases of Coronavirus disease 2019 (COVID-19) and to investigate the localization of severe acute respiratory syndrome coronavirus (SARS-CoV-2) within ocular structures. Methods : Macroscopic and microscopic histopathological evaluation was performed and the localization of SARS-CoV-2 RNA within ocular tissues investigated using an in situ hybridization (ISH) technique in 13 eyes. Contralateral eyes were freshly dissected, and droplet digital polymerase chain reaction (ddPCR) assay was performed on ocular fluids and tissues to quantify SARS-CoV-2 RNA. Results : A total of 21 fatal COVID-19 cases were included (mean age, 60.2 years [range, 27- 91 years];23.8% female). Histopathological abnormalities include vascular changes (61.9%), cytoid bodies (52.4%), and retinal edema (23.8%) with minimal inflammation (0.09%) were observed. Non-CMV viral inclusions were identified in one eye. No CMV positivity was detected. Of the 21 contralateral eyes tested by ddPCR, 14 tested positive for SARS-CoV-2. Using ddPCR and ISH, SARS-CoV-2 localization was observed in the following ocular tissues and fluid: cornea (27.3%), aqueous (26.3%), lens (54.5%), vitreous (15.0%), retina (22.2%), choroid/sclera (47.4%), and optic nerve (50.0%). The choroid/sclera, optic nerve and lens were the most frequent ocular structures found to be ddPCR positive. Evidence of replication was detected in four cases. Conclusions : Our results suggest that SARS-CoV-2 localizes to intraocular tissues. However, histological changes observed are likely a secondary hemodynamic change rather than primary effect of the virus.

Qualitative Research in a Technological Age: Friend or Foe

Introduction: Familiarity with information technology is increasingly widespread. COVID-19 has increased the use of video conferencing social media within the UK population, including by older people1 This evolving scene has the potential to change how research is conducted.2 Social media has been employed for recruitment to qualitative research,3,4 but mostly in a young cohort. Recruitment through interfaces such as Twitter has the potential to access a larger number of participants, but may not reach all groups, such as older people. Video conferencing (VC) is increasingly used for qualitative interviewing.5 It simulates in-person communication while avoiding the need to travel but requires access to costly equipment and confidence in engaging with the technology. Objective: To explore the experience of using technology in a critical care-based qualitative research study. Methods: The ESCAlation of the eLderly (Age-65years) to criTical carE with COVID-19 (ESCALATE) study uses semi-structured interviews with patients and loved ones to explore views on escalation of older people to critical care during the COVID-19 pandemic. Recruitment took place using two routes: UK-wide social media advertising;and postal invitations via local databases with telephone follow up. For the former, the study was advertised directly via the social media platform Twitter using a specifically created study account (@covidescalate), showing a brief advert and link to a questionnaire and contact form. Relevant charities were invited to disseminate the advertisement. In-person interviews were avoided to maximise participant and interviewer safety in the context of the COVID-19 pandemic. Participant preference for mode of interview (VC or telephone) was established. If participants stated in advance that they were not familiar with video technology or found during the interview that they were unable to manage a VC, interviews were conducted by telephone. Results: There was partial uptake by charities and limited 'retweeting' overall. Only one responder meeting eligibility criteria responded via social media advertising, compared with 44 from local postal/telephone recruitment. Ten interviews were conducted via VC and 12 via telephone, where participants were not familiar with VC. There was no difference in interview duration with VC lasting around 45 minutes and telephone calls lasting around 42 minutes. The researchers found that it was more difficult to pick up on social and non-verbal cues without visual contact but all questions in the topic guide were covered using both media. There was no difference between choice of VC vs. telephone according to participant ethnicity (BAME vs Caucasian) or sex. In one case, several participants from one family joined the VC from different locations. Conclusion: In the ESCALATE study, video conferencing and telephone interviews were both valuable interviewing methods. Social media recruitment was of limited use but this may reflect the participant demographic and research team experience and could still be useful for recruiting certain groups in other studies. Information technology has the potential to increase engagement with research but our experience demonstrates that it must be used flexibly and with consideration.

The end is just the beginning: Involving bereaved next of kin in qualitative research

Introduction: Almost half the UK population die in hospital and more than two thirds of these are aged 75 years or more.1 Older people make up an increasing proportion of patients admitted to critical care and often have poorer outcomes, especially in the context of COVID-19.2 Loved ones are an essential support network for older patients but their ability to provide support was compromised by visiting restrictions during COVID-19. Little is known about the experiences of older patients in ICU and there is limited literature on the experiences of bereaved relatives.3 Bereaved relatives may be the only way to access the experiences of patients who do not survive, but there are a number of barriers to including bereaved relatives in research. Researchers may feel inhibited from imposing what might be seen as an additional burden on families during the aftermath of a bereavement. The ongoing ESCAlation of the eLderly (age >65years) to criTical carE with COVID-19) (ESCALATE) study includes semi-structured interviews with bereaved loved ones as well as patients and NoK of survivors in the UK. Objectives: To describe successful involvement of bereaved next of kin in critical care-based research Methods: This qualitative research uses semi-structured interviews and thematic analysis. Patient and public involvement from an intensive-care focused charity and local palliative care team advice was sought in order to develop recruitment strategies such as detailed, sympathetically worded participant information packs.4 In keeping with the literature,5 the window for recruitment and interview was approximately one year following bereavement. Following ethical approval, participants were recruited via postal invitations with follow up telephone calls if no response after a minimum of one week. Results: Recruitment was limited by only 40% of bereaved NoK (next of kin) having postal addresses recorded on the hospital systems. 9 /40 bereaved NoK contacted by letter responded and as well as completing a questionnaire, consented to be interview. A further 5/11 contacted by follow-up telephone call agreed to participate (consistent with response rates for patients and NoK of survivors). All of the interviewed bereaved participants completed the interview according to the interview topic guide, with each interview lasting around 45 minutes. More than half were female, and three quarters were Black, Asian or Minority Ethnic. Bereaved relatives were keen to share their experience and some even volunteered additional information with the interviewers, such as resources they had created for their local community and personal diaries. Participants reported that they were happy to be interviewed if it would help others in a similar position. Conclusion: Bereaved relatives of critical care patients are willing to engage in qualitative research. Recruitment is challenging due to practical constraints, but we suggest could be improved through meticulous documentation of contact details and involvement of bereavement services in research. By seeking the views of bereaved loved ones, we can improve care for critically unwell patients at end of life.

Attitudes Toward COVID-19 Vaccination Among Occupational Therapy Professionals and Students in Early 2021

Purpose: After the widespread transmission of the novel coronavirus that causes COVID-19, the first COVID-19 vaccination received emergency use authorization in the United States in December of 2020. Current research has shown the authorized COVID-19 vaccines to be safe and effective at preventing severe illness. At the time of this study, there appears to be no published research on the attitudes and receipt of COVID-19 vaccinations among occupational therapy professionals and students. The purpose of this study is to describe the attitudes and receipt of COVID-19 vaccinations among occupational therapy professionals and students in early 2021. Methods: A total of 114 occupational therapy professionals and students (age = 41 +/- 15, years of certified experience = 13 +/- 13) opened the survey link and completed the instrument. Participants were sent an electronic survey via email that collected demographic information and assessed attitudes and receipt of COVID- 19 vaccination. Data was downloaded and analyzed using a commercially available statistics package. Results: The majority of occupational therapy professionals in this study agreed on some level that they were comfortable (Strongly Agree = 36.0%, Agree = 16.7%, Somewhat Agree = 10.5%). Most occupational therapy professionals and students stated they had or would receive a COVID-19 vaccination. The majority of participants reported personal, household, and community safety as the primary considerations for receiving a COVID-19 vaccination. In general, these factors were a larger factor for participants than public perception or personal liberties being infringed upon. Conclusions: The findings of this study suggest a majority of occupational therapy professionals and students are comfortable with the current level of approvals for available COVID-19 vaccinations, and at the time of the survey had or intending to be vaccinated. As occupational therapy professionals and students continue to work in day-to-day patient care, it is imperative to consider the best means of educating occupational therapy professionals and students on the potential benefits of COVID-19 vaccinations.

Attitudes and Usage of Face Masks During the COVID-19 Pandemic Among Occupational Therapy Professionals in Texas

Purpose: Following the widespread transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), multiple business and schools drastically reduced face-to-face services. Additionally, many state and local governments enacted face mask mandates and other legislations aimed at decreasing the spread of the virus. Current research is being conducted to evaluate the epidemiology, recognition, treatment, and prevention of coronavirus disease 2019 (COVID-19), the disease associated with SARS-CoV-2. At the time of this study, there is no published research on the attitudes and usage of face masks or face coverings among certified occupational therapy professionals during the COVID-19 Pandemic. The purpose of this study is to describe the attitudes and usage of face masks or face coverings among occupational therapy professionals in the state of Texas during the COVID-19 pandemic. Methods: A total of 107 occupational therapy professionals (age= 42 +/- 12, years of certified experience = 18 +/- 11) opened the survey link and completed the instrument. Participants were sent an electronic survey via email that collected demographic information and assessed attitudes and usage of face masks or face coverings. Data was downloaded and analyzed using a commercially available statistics package. Results: The overwhelming majority of occupational therapy professionals in this study agreed on some level that the use of face masks to mitigate the transmission of SARS-CoV2 was strongly supported by the available evidence (Strongly Agree = 65.4%, Agree = 19.6%, Somewhat Agree = 5.6%). Most occupational therapy professionals also reported that their institutions currently had a mandate in place requiring face masks during patient encounters and coworker interactions (Patient Encounters = 94.4%, Coworker Interactions = 86.9%). Most occupational therapy professionals reported wearing face masks the majority of the time when entering public spaces. Occupational therapy professionals cited the influence of their personal use of face masks was for personal health, health of those in their household, and the health of their patients. Conclusions: The findings of this study suggest a majority of occupational therapy professionals in Texas are wearing face masks or face coverings, even when not actively involved in patient care or other aspects of their jobs. Future research should be conducted to assess the use of face masks among other allied health care professions.