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1.
Journal of Allergy and Clinical Immunology ; 149(2):AB102-AB102, 2022.
Article in English | Web of Science | ID: covidwho-1798230
2.
Respirology ; 27:197-197, 2022.
Article in English | Web of Science | ID: covidwho-1762099
3.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-330704

ABSTRACT

Secondary bacterial infections, including ventilator-associated pneumonia (VAP), lead to worse clinical outcomes and increased mortality following viral respiratory infections including in patients with coronavirus disease 2019 (COVID-19). Using a combination of tracheal aspirate bulk and single-cell RNA sequencing (scRNA-seq) we assessed lower respiratory tract immune responses and microbiome dynamics in 28 COVID-19 patients, 15 of whom developed VAP, and eight critically ill uninfected controls. Two days before VAP onset we observed a transcriptional signature of bacterial infection. Two weeks prior to VAP onset, following intubation, we observed a striking impairment in immune signaling in COVID-19 patients who developed VAP. Longitudinal metatranscriptomic analysis revealed disruption of lung microbiome community composition in patients with VAP, providing a connection between dysregulated immune signaling and outgrowth of opportunistic pathogens. These findings suggest that COVID-19 patients who develop VAP have impaired antibacterial immune defense detectable weeks before secondary infection onset.

4.
International Journal of Infectious Diseases ; 116:S98, 2022.
Article in English | EMBASE | ID: covidwho-1734447

ABSTRACT

Purpose: An innovative epidemic preparedness model establishing an SMS real-time community-based surveillance (CBS) system enables earlier detection and earlier action to control outbreaks at the outset. Methods & Materials: The One Health preparedness program has been piloted in 5 countries: Guinea, Indonesia, Kenya, Sierra Leone and Uganda, since 2019. A tiered model building on a foundation of volunteer skill-building, community health and epidemic awareness activities, building trust and motivating communities, and establishing connections with local health and veterinary authorities. CBS extends on that foundation establishing a simple, low-cost, real-time system for community volunteers to identify and notify of potentially serious health events triggering investigation and response by local authorities. Communities are prepared to take immediate actions to halt the spread. Materials and methodology are standardised: mobile phone SMS to signal alerts, Kobo application to log and monitor alerts, training packages, and job aids. Results: Volunteers and communities have successfully raised CBS alerts, taken action, and controlled outbreaks of measles, polio, acute watery diarrhoea, anthrax and rabies which minimised the spread and impact. To be effective CBS must achieve timely notification of alerts, accuracy to minimise needless investigation, action must be taken, and volunteers must remain engaged. Results from July 2020 – March 2021 show successful rapid notification: 76% of alerts were communicated to authorities within 24hrs. Volunteers accurately recognised the key signs for 77% of alerts. Owing to the relationships with local Government an average of 75% of alerts were investigated, although human health alerts have higher investigation rates than animal alerts. Volunteer reliability fluctuates from 44% to 88% across the 5 countries. Positive predictive value for human alerts is high in most countries;63% of alerts overall were confirmed positive as epidemic diseases. This established CBS system has readily incorporated detection of COVID-19 and been rapidly scaled-up during Ebola high-alert demonstrating agility for detection of emerging threats. Conclusion: Communities themselves have the potential to identify and combat epidemic threats. Preparedness programs which engage communities, build skills, establish simple and effective surveillance mechanisms and connect with local service providers, can control outbreaks at the outset and communities can enjoy greater resilience.

5.
Physiotherapy (United Kingdom) ; 114:e156-e157, 2022.
Article in English | EMBASE | ID: covidwho-1705925

ABSTRACT

Keywords: Clinician consistency;Clinician perception;Therapeutic alliance Purpose: Best practice guidance acknowledges that clinician consistency has a positive impact on therapeutic alliance (TA) and patient clinical outcome. With the rapid implementation of virtual consultations throughout the Covid-19 pandemic, developing and maintaining TA through clinician consistency has been a new challenge for clinicians. Purpose: While face to face assessment and treatment of MSK patients was limited due to Covid-19 social restrictions, this provided the opportunity to complete a Quality Improvement (QI) project with the purpose of exploring the impact of virtual consultations on clinician consistency and hence TA, develop clinical and operational pathways to support clinician consistency and engrain some lessons learnt when returning to a “Back to Better” model of MSK working post Covid-19. Methods: To establish a baseline perception of clinician consistency with the use of virtual patient consultations, a survey was sent to all clinical and administrative staff. The Model of Improvement methodology was utilised and two cycles completed whereby the survey was repeated six-weekly to inform iteration of the next cycle. The key interventions within these two cycles to enhance clinician consistency, were to devise and implement clinical and operational pathways. This included a standardised process of clinician documentation for the administrative staff to identify a specific timeframe for patient follow up, stipulating the appropriate clinician to ensure “Making Every Contact Count” (MECC) principles and enhancing patient choice on the consultation type i.e. virtual or face to face. Results: After 2 cycles (12 weeks) of using enhanced clinical and operational pathways to support clinician consistency, the clinician surveys demonstrated that 23% of clinical staff perceived an improvement in clinician consistency. Additionally, there was a 29% reduction in negative impact of cross reviews on personal workload, with a 33% increase in appropriate use of cross reviews as clinically indicated. This resulted in a 20% reduction in negative impact on quality of patient care. Conclusion(s): This Quality Improvement project has highlighted that utilising virtual consultations can negatively impact clinicians perception of clinician consistency. However, through installing clinical and operational pathways to enhance clinician consistency, while maintaining MECC principles, positive impact on clinician perception can be demonstrated within 12 weeks. Impact: This Quality Improvement project on clinician consistency has impacted clinical and operational pathways to ensure appropriate use of clinician consistency. This has a positive impact not only on clinician perception but also on creating a therapeutic alliance between therapist and patient. With these clinical and operational pathways now embedded in our clinical practice, the Croydon MSK department is moving towards “blended” clinics where all patients have the choice of consultation type whether that is telephone, video or face to face. This encourages patient choice and engagement throughout their MSK pathway. Funding acknowledgements: No funding required.

7.
Palliat Med ; 36(4): 717-729, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1701285

ABSTRACT

BACKGROUND: Experiences of end-of-life care and early bereavement during the COVID-19 pandemic are poorly understood. AIM: To identify clinical and demographic risk factors for sub-optimal end-of-life care and pandemic-related challenges prior to death and in early bereavement, to inform clinical practice, policy and bereavement support. DESIGN: Online national survey of adults bereaved in the UK (deaths between 16 March 2020 and 2 January 2021), recruited via media, social media, national associations and organisations. SETTING/PARTICIPANTS: 711 participants, mean age 49.5 (SD 12.9, range 18-90). 628 (88.6%) were female. Mean age of the deceased was 72.2 (SD 16.1, range miscarriage to 102 years). 311 (43.8%) deaths were from confirmed/suspected COVID-19. RESULTS: Deaths in hospital/care home increased the likelihood of poorer experiences at the end of life; for example, being unable to visit or say goodbye as wanted (p < 0.001). COVID-19 was also associated with worse experiences before and after death; for example, feeling unsupported by healthcare professionals (p < 0.001), social isolation/loneliness (OR = 0.439; 95% CI: 0.261-0.739), and limited contact with relatives/friends (OR = 0.465; 95% CI: 0.254-0.852). Expected deaths were associated with a higher likelihood of positive end-of-life care experiences. The deceased being a partner or child also increased the likelihood of positive experiences, however being a bereaved partner strongly increased odds of social isolation/loneliness, for example, OR = 0.092 (95% CI: 0.028-0.297) partner versus distant family member. CONCLUSIONS: Four clear risk factors were found for poorer end-of-life care and pandemic-related challenges in bereavement: place, cause and expectedness of death, and relationship to the deceased.


Subject(s)
Bereavement , COVID-19 , Terminal Care , Adult , Aged, 80 and over , Child , Family , Female , Humans , Middle Aged , Pandemics , Risk Factors , SARS-CoV-2
9.
EuropePMC;
Preprint in English | EuropePMC | ID: ppcovidwho-327518

ABSTRACT

Background The COVID-19 pandemic has affected millions of people’s experiences of bereavement. We aimed to identify risk factors for grief and support needs. Methods Online survey of people bereaved in the UK (deaths 16 March 2020-2 January 2021), recruited via media, social media, national associations/organisations. Grief was assessed using the Adult Attitude to Grief (AAG) scale, which calculates an overall index of vulnerability (IOV) (range 0-36). Practical and emotional support needs were assessed in 13 domains. Results 711 participants, mean age 49.5 (SD 12.9, range 18-90). 628 (88.6%) were female. Mean age of the deceased 72.2 (SD 16.1). 311 (43.8%) deaths were from confirmed/suspected COVID-19. Mean IOV was 20.41 (95% CI = 20.06 to 20.77). 28.2% exhibited severe vulnerability (IOV ≥ 24). In six support domains relating to psycho-emotional support, 50% to 60% of respondents reported high/fairly high levels of need. Grief and support needs increased strongly for close relationships with the deceased (versus more distant) and with reported social isolation and loneliness ( P < 0.001), whereas they reduced with age of the deceased above 40 to 50. Other risk factors were place of death and reduced support from health professionals after death ( P < 0.05). Conclusions High overall levels of vulnerability in grief and support needs were observed. Relationship with the deceased, age of the deceased, and social isolation and loneliness are potential indicators of those at risk of even higher vulnerability in grief and support needs. Healthcare professional support after death is associated with more positive bereavement outcomes.

10.
BMJ Supportive & Palliative Care ; 12(Suppl 1):A8, 2022.
Article in English | ProQuest Central | ID: covidwho-1673486

ABSTRACT

IntroductionBereavement support comes in different forms and degrees of formality, reflecting the varying needs of bereaved people. Following the Covid-19 pandemic there is renewed interest in improving the support available for bereaved people, seen in the UK Commission on Bereavement. This (pre-pandemic) Marie Curie funded study identified core outcomes for the evaluation of adult bereavement support interventions. The first part of this study involved a stakeholder-workshop with people from professional and lived experience backgrounds.AimsThe workshop aimed to gather stakeholder views on what good bereavement support looks like and the impacts that it should have for bereaved service users.Method21 bereaved and professional stakeholders were divided into three groups and asked to discuss how support services should benefit their service users. Key themes were identified from these sessions.ResultsThree main themes emerged from the discussions;informal support and self-management;the purpose and impacts of bereavement service support and the timing, accessibility and quality of support. It was agreed that support services should work to promote resilience, enable coping and improve social functioning and relationships, offering practical as well as emotional support. Support should be tailored to individual needs, be accessible to people from diverse socio-cultural backgrounds and be available at different stages of the bereavement process. Identifying and responding to those with more complex grief or mental health problems is vital.ConclusionThis stakeholder workshop identified key support functions, impacts and goals for adult bereavement services, which align with resilience and public health approaches to bereavement support.ImpactWorkshop themes featured centrally in the two core outcomes identified in the wider study (‘ability to cope’ and ‘quality of life and wellbeing’).Identifying the best mechanisms and modalities for achieving these outcomes presents a challenge and opportunity, as we respond to the adaptations and renewed interest in bereavement support brought by the pandemic.

11.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-297038

ABSTRACT

Secondary bacterial infections, including ventilator-associated pneumonia (VAP), lead to worse clinical outcomes and increased mortality following viral respiratory infections. Critically ill patients with coronavirus disease 2019 (COVID-19) face an elevated risk of VAP, although susceptibility varies widely. Because mechanisms underlying VAP predisposition remained unknown, we assessed lower respiratory tract host immune responses and microbiome dynamics in 36 patients, including 28 COVID-19 patients, 15 of whom developed VAP, and eight critically ill controls. We employed a combination of tracheal aspirate bulk and single cell RNA sequencing (scRNA-seq). Two days before VAP onset, a lower respiratory transcriptional signature of bacterial infection was observed, characterized by increased expression of neutrophil degranulation, toll-like receptor and cytokine signaling pathways. When assessed at an earlier time point following endotracheal intubation, more than two weeks prior to VAP onset, we observed a striking early impairment in antibacterial innate and adaptive immune signaling that markedly differed from COVID-19 patients who did not develop VAP. scRNA-seq further demonstrated suppressed immune signaling across monocytes/macrophages, neutrophils and T cells. While viral load did not differ at an early post-intubation timepoint, impaired SARS-CoV-2 clearance and persistent interferon signaling characterized the patients who later developed VAP. Longitudinal metatranscriptomic analysis revealed disruption of lung microbiome community composition in patients who developed VAP, providing a connection between dysregulated immune signaling and outgrowth of opportunistic pathogens. Together, these findings demonstrate that COVID-19 patients who develop VAP have impaired antibacterial immune defense weeks before secondary infection onset. One sentence summary: COVID-19 patients with secondary bacterial pneumonia have impaired immune signaling and lung microbiome changes weeks before onset.

12.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):539-540, 2021.
Article in English | EMBASE | ID: covidwho-1570426

ABSTRACT

Background: Oral food challenge (OFC) is the gold standard for the diagnosis of food allergy. OFC are traditionally performed in hospital, as a day ward procedure, with a high medical caregiver to patient ratio. This is likely to enhance communication and patient satisfaction. Despite the high incidence of adverse reactions, families generally report a positive experience . In Sep-Oct 2020 a novel, high throughput, OFC initiative was carried out by a cross-hospital, multidisciplinary Irish paediatric allergy team. Up to 25 OFCs were performed each day at an offsite, COVID-19 stepdown facility. The unique model was designed in response to the impact of the pandemic, on provision of ambulatory allergy services. It was essential to evaluate the patient experience of this unique, alternative OFC model, compounded by COVID related distancing. Method: An anonymised survey was conducted of randomised cross-section of patients attending. The survey was completed by the primary caregiver of the child attending for the OFC. 178 survey responses were collected from a total of 474 families and included for analysis. The survey was designed to assess patient satisfaction across a number of parameters. Results: 81% of respondents were highly satisfied with ease of use of a non-hospital facility. 81% reported that the site was “child friendly”. Patient experience was scored as “excellent” 82.9% of the time with a further 12.35% reporting it as above average. Communication was effective with 89% of carers reporting good understanding of the results of the OFC. 94.7% stated that their questions were answered by the Allergy Team present. Conclusion: Our results are remarkable for enhanced patient satisfaction despite a reduced medical caregiver to patient ratio. The patient's overall satisfaction was rated overwhelmingly as “excellent” despite almost 30% of patients experiencing allergic reactions. The pandemic has forced health services to seek new ways of doing things. This data reassures, that OFC models can be changed without sacrificing patient experience.

13.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):570-571, 2021.
Article in English | EMBASE | ID: covidwho-1570363

ABSTRACT

Background: Internationally, the COVID-19 pandemic severely curtailed access to hospital facilities for those awaiting elective/semi elective procedures. For allergic children in Ireland, already waiting to 4yr for an elective oral food challenge (OFC), the restrictions signified indefinite delay. At the time of the initiative there were approx 900 children on the Chidren's Health Ireland (CHI) waiting list. In July 2020, a project was facilitated by short term (6wk) access to an empty COVID stepdown facility built, in a hotel conference centre, commandeered by the Health Service Executive Ireland (HSE). The aim was to the achieve rapid rollout of an off-site OFC service, delivering high throughput of long waiting patients, while aligning with hospital existing policies and quality standards, international allergy guidelines and national social distancing standards. Method: The working group engaged key stakeholders to rapidly develop an offsite OFC facility. Consultant Paediatric Allergists, Consultant Paediatricians, trainees and Allergy Clinical Nurse Specialists were seconded from other duties. The facility was already equipped with hospital beds, bedside monitors (BP, Pulse, Oxygen saturation) bedside oxygen. All medication and supplies had to be brought from the base hospital. Daily onsite consultant anaesthetic cover was resourced and a resuscitation room equipped. Standardised food challenge protocols were created. Access to onsite hotel chef facilitated food preparation. A risk register was established. Results: After 6wks planning, the remote centre became operational on 7/9/20, with the capacity of 27 OFC/day. 474 challenges were commenced, 465 (98%) were completed, 9(2%) were inconclusive. 135(29.03%) OFC were positive, 25(5%) causing anaphylaxis. No child required advanced airway intervention. 8 children were transferred to the base hospital. The CHI allergy waiting list was reduced by almost 60% in only 24 days. Conclusion: OFCs remain a vital tool in the care of allergic children, with their cost saving and quality of life benefits negatively affected by delay in their delivery. This project has shown it is possible to have huge impacts on a waiting list efficiently, effectively and safely with good planning and staff buy in -even in a pandemic. Adoption of new, flexible and efficient models of service delivery will be important for healthcare delivery in the post-COVID- 19 era.

14.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):194, 2021.
Article in English | EMBASE | ID: covidwho-1570350

ABSTRACT

Background: The CORAL study is a cross-sectional study of the impact of the Coronavirus pandemic on allergic and autoimmune dysregulation of infants born in March, April and May 2020, during Ireland's 1 st COVID-19 pandemic Lockdown. Method: Invitations were sent to families of 3065 term, singleton babies. Exclusion criteria were ante-natal PCR-proven SARSCoV-2 in a parent or co-dwelling person, IV antibiotics in neonatal period, multiple births and major congenital anomalies. At 6 months babies were invited to attend CHI Connolly for point-of-care SARSCoV-2 antibody testing. Results: Of the 3065 letters sent 353 babies were enrolled.53.7% of enrolled infants were male, 78.4% were white-Irish, average birth weight was 3.506kg. 45% were first-born and 95.5% of mothers were educated at 3 rd level or higher. Babies' average number of close contacts other than household members was 2.3 during lockdown and 5.6 afterwards. 42.5% were reported to be currently breast-fed at enrolment. By 6 months, 97% of infants had solid foods introduced but only 24.5% had tried egg and 9.6% had tried peanut. Complete primary immunisation uptake at 6 months was 99%. Lastly, 3 babies out of 200 (1.3%) tested showed presence of IgM & IgG SARSCoV-2 antibodies;2 were PCR negative, the other PCR positive. Conclusion: Initial breastfeeding and immunisation uptake to 6 months are reassuringly high in this self-selected, highly-educated cohort. The rare positive antibody tests suggest recent or current infection, so newborn babies appear to have been protected from SARSCoV-2 exposure during the 1 st COVID Pandemic lockdown.

15.
2021.
Preprint in English | Other preprints | ID: ppcovidwho-294560

ABSTRACT

There is increasing recognition of the prolonged illness following acute coronavirus disease 2019 (COVID-1). In a longitudinal cohort of 99 patients, 32% reported persistent symptoms and 19% had Long COVID (Defined as fatigue or dyspnoea or chest tightness) at median 240 days after initial infection. There was no significant improvement in symptoms or measures of health-related quality of life between 4 and 8-month assessments. In multivariable analysis, female gender (OR 3.2, 95%CI 1.3-7.8, p=0.01) and acute COVID-19 hospitalisation (OR 3.8, 95% 1.1-13.6, p=0.04) were independently associated with Long COVID at 8-months. Only 80% patients reported full recovery at 8 months. Further research is required to understand the immunologic correlates of abnormal recovery and the long-term significance.

17.
Thorax ; 76(Suppl 2):A140-A141, 2021.
Article in English | ProQuest Central | ID: covidwho-1507095

ABSTRACT

P136 Table 1Results of correlation analysis Correlation analysis 4MGS 1STSreps SpO2% desaturation Results r p-value r p-value r p-value Pre-COVID mMRC dyspnoea score 0(0–1) -0.267** <0.001 -0.285** <0.001 -0.108 0.094 Post-COVID mMRC dyspnoea score 1(0–2) -0.442** <0.001 -0.457** <0.001 -0.143* 0.025 NRS breathlessness 3(0–5) -0.287** <0.001 -0.406** <0.001 -0.490 0.445 NRS fatigue 3(0–5) -0.315** <0.001 -0.379** <0.001 -0.190* 0.003 NRS cough 0(0–2) -0.660 0.292 -0.153* 0.017 0.083 0.194 NRS pain 1(0–4) -0.278** <0.001 -0.346** <0.001 -0.188* 0.003 NRS sleep difficulty 2(0–5) -0.246** <0.001 -0.386** <0.001 -0.122 0.057 Data are presented as median (interquartile range) or frequency (proportion%;95% confidence interval). SpO2% desaturation = SpO2% desaturation from baseline during 1 minute sit to stand test;1STSreps = repetitions per minute during 1 minute sit to stand test;4MGS = 4 metre gait speed;mMRC = modified Medical Research Council;NRS = 0 – 10 numerical rating scale;r = Spearman correlation coefficient. *indicates statistical significance at 0.05 level. **indicates statistical significance at 0.001 level.ConclusionRespiratory symptoms were not strong predictors of 4-metre gait speed and 1-minute sit-to-stand test performance. These data highlight the importance of face-to-face testing to objectively assess functional limitation in patients recovering from severe COVID pneumonia.

18.
Thorax ; 76(Suppl 2):A139-A140, 2021.
Article in English | ProQuest Central | ID: covidwho-1506040

ABSTRACT

P135 Table 1Patient demographics, self-reported scores and functional test results by wave 1st wave 2nd wave p-value Demographics n=167 n=141 Age 59±13 58±12 0.564 Female 60 (35.93;28.94–43.40) 62 (43.97;35.97–52.22) 0.15 BMI (kg/m2) 30.5 (26.6–35.2) 32.1 (28.5–37.9) 0.009 ** BAME 115 (69.7;62.39–76.32) 72 (59.5;50.62–67.94) 0.073 Number of comorbidities 2 (1–3) 2 (1–3) 0.144 Patients Receiving Drugs Dexamethasone 11 (6.63;3.57–11.17) 138 (97.87;94.43–99.40) <0.001 *** Remdesivir 18 (10.84;6.79–16.24) 81 (57.45;49.20–65.39) <0.001 *** Other Immunomodulator 2 (1.20;0.25–3.81) 31 (21.99;15.76–29.35) <0.001 *** Questionnaire Scores n=164 n=132 NRS Breathlessness 2 (0–5) 3 (0–5) 0.153 ≥4 56 (34.78;27.75–42.36) 52 (37.14;29.47–45.34) 0.67 NRS Cough 0 (0–2) 0 (0–3) 0.439 ≥4 17 (10.56;6.52–16.00) 18 (13.64;8.59–20.26) 0.419 NRS Fatigue 3 (0–5) 3 (0–5) 0.867 ≥4 65 (40.63;33.24–48.35) 48 (36.92;28.99–45.43) 0.52 NRS Pain 0 (0–5) 1 (0–3) 0.682 ≥4 44 (27.50;21.03–34.78) 30 (23.08;16.48–30.86) 0.39 NRS Sleep disturbance 2 (0–5) 2 (0–5) 0.558 ≥4 52 (32.50;25.61–40.02) 49 (37.40;29.47–45.89) 0.382 Pre-COVID-19 mMRC 1 (0–2) 1 (1–2) 0.478 Post-COVID-19 mMRC 0 (0–1) 0 (0–1) 0.329 Post-COVID-19 mMRC ≥2 66 (40.99;33.61–48.70) 49 (38.58;30.45–47.23) 0.678 PCFS 2 (0–3) 1 (0–2) 0.055 PCFS ≥2 80 (50.00;42.31–57.69) 51 (42.15;33.62–51.05) 0.191 PHQ-9 ≥10 32 (20.38;14.66–27.19) 29 (23.02;16.33–30.92) 0.592 GAD-7 ≥10 34 (21.38;15.56–28.24) 16 (12.80;7.81- 19.49) 0.059 TSQ ≥6 43 (27.56;21.01–34.94) 27 (22.31;15.60–30.33) 0.319 Functional Tests n=160 n=139 4MGS <0.8 (ms-1) 67 (42.41;34.89–50.19) 47 (35.07;27.38–43.40) 0.201 1STS repetitions 18 (12–23) 17 (12–21) 0.460 <2.5 percentile 96 (60.00;52.29–67.36) 108 (77.70;70.25–84.00) 0.011 * Desaturation ≥4% 52 (34.67;27.40–4 .52) 42 (32.31;24.73–40.67) 0.677 Parametric data are presented as mean ± standard deviation, non-parametric data are presented as median (interquartile range) or frequency (proportion;95% confidence interval). Statistical significance indicated by * (p<0.05), ** (p<0.01), *** (p<0.001). BMI = Body mass index, BAME = Black, Asian or minority ethnic, NRS = Numerical rating scale (0–10), mMRC = modified Medical Research Council for dyspnoea (0–4), PCFS = Post-COVID-19 functional status scale (0–4), PHQ-9 = Patient health questionnaire 9 (0–27), GAD-7 = General Anxiety Disorder-7 scale (0–21), TSQ = Trauma screening questionnaire (0–10), 4MGS = 4-metre gait speed, 1STS = 1-minute sit-to-stand.ConclusionDespite shorter admission duration, and less frequent IMV, the burden of symptoms and functional limitation experienced post-hospitalisation for severe COVID-19 pneumonia was at least as severe during Wave 2 as in Wave 1. Identification of contributing factors and impact on post-COVID rehabilitation outcomes requires further study.

19.
Palliative Medicine ; 35(1 SUPPL):197-198, 2021.
Article in English | EMBASE | ID: covidwho-1477116

ABSTRACT

Background: From March 2020-March 2021 530,000+ people have died from COVID-19 in the EU, and 120,000+ in the UK. In addition, c.4.85 million in the region have died of other causes, leaving c.43.6 million people bereaved at a time of unprecedented social and clinical restrictions. We aimed to inform practice and policy by describing end of life experiences among people bereaved during the pandemic. Methods: National survey of people bereaved in the UK since March 2020, disseminated via media, social media, national associations, community/ charitable organisations. Results: Interim findings from the first 532 participants are reported (full results available by time of conference). 55% of deaths were in hospital;46% were caused by confirmed/suspected COVID-19. Respondents reported high levels of problems specific to the pandemic bereavement context: 56% were unable to visit their loved one prior to death, 59% had limited contact in last days of life, 67% were unable to say goodbye, 67% experienced social isolation and loneliness, 81% had limited contact with other relatives/friends. COVID-19 deaths were associated with higher levels of all these problems compared with other causes of death (all p < 0.05). Experiences of end of life care were variable: 23% were 'never' involved in decisions about their loved one's care, 17% were not at all informed about the approaching death, 36% felt not at all supported by healthcare professionals after the death, 51% were not provided with information about bereavement support. Conclusions: There is evidence of poor end of life care and challenging experiences among people bereaved during the pandemic. To reduce the trauma of negative death experiences, we recommend improved communication by healthcare professionals, with a known point and method of contact, family involvement in decision-making, enabling family visiting as far as possible, and better support after a death, including information about bereavement services.

20.
Palliative Medicine ; 35(1 SUPPL):198, 2021.
Article in English | EMBASE | ID: covidwho-1477067

ABSTRACT

Background: The COVID-19 pandemic represents a global mass bereavement event, on a scale seldom witnessed. National health and social care systems are challenged with supporting large numbers of bereaved people whilst also negotiating the ongoing restrictions to provide this support safely. This review aimed to synthesise the evidence regarding system-level responses to mass bereavement events, including natural and human-made disasters, to inform service provision and policy during the pandemic. Methods: A rapid systematic review was conducted in April 2020, with narrative synthesis of results. MEDLINE, Global Health, PsycINFO and Scopus databases were searched for studies published between 2000 and 2020, reporting evidence on system-level responses to mass bereavement events in OECD countries (plus Singapore, China and Taiwan). Citation and reference tracking was conducted and study quality assessed. Results: Six studies were included, reporting on system responses to man-made disasters (e.g. terror attacks in the US and Norway), as well as natural disasters (e.g. Hurricane Katrina and the South-East Asian Tsunami). Despite differences across disaster types, common approaches were identified and positive impacts were reported across a range of individual and group-based support interventions. Key features of service delivery included: a proactive outreach approach, centrally organised but locally delivered interventions, event-specific professional competencies and an emphasis on psycho-educational content. However, study quality was generally low and reliant on data from retrospective evaluation designs. Conclusion: Co-ordinated responses to bereavement support which include the features we identified are required to meet the needs of bereaved people during and beyond the pandemic. Rigorous primary studies investigating the experiences of the bereaved and the services that support them are essential to inform current and future disaster response efforts.

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