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1.
Crit Care ; 25(1): 382, 2021 11 08.
Article in English | MEDLINE | ID: covidwho-1506095

ABSTRACT

BACKGROUND: There are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months. METHODS: In a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5LTM. RESULTS: Of 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51-70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06-13.77]; p < 0.001). Thirteen (11.4%) survivors had not returned to work due to poor health. There was a decrease in the EQ-5D-5LTM utility score (MD, - 0.19 [- 0.28 to - 0.10]; p < 0.001). At 6 months, 82 of 115 (71.3%) patients reported persistent symptoms. The independent predictors of death or new disability were higher severity of illness and increased frailty. CONCLUSIONS: At six months after COVID-19 critical illness, death and new disability was substantial. Over a third of survivors had new disability, which was widespread across all areas of functioning. Clinical trial registration NCT04401254 May 26, 2020.


Subject(s)
COVID-19/epidemiology , Critical Illness/epidemiology , Disabled Persons , Recovery of Function/physiology , Return to Work/trends , Aged , Aged, 80 and over , Australia/epidemiology , COVID-19/diagnosis , COVID-19/therapy , Cohort Studies , Critical Illness/therapy , Female , Follow-Up Studies , Health Status , Humans , Male , Middle Aged , Mortality/trends , Prospective Studies , Time Factors , Treatment Outcome
2.
BMJ Leader ; 4(Suppl 1):A67, 2020.
Article in English | ProQuest Central | ID: covidwho-1318156

ABSTRACT

The FMLM Trainee Steering Group (TSG) sought to capture the lessons learnt through a series of interviews and blogs from individuals stepping forward into the leadership challenges during the COVID19 Pandemic. This included clinicians from Interim Foundation doctors through to chief executives to give a wide view of leadership-in-action and understand what lessons have been learnt so far from those individuals. This opportunity enabled those individuals to take stock and reflect on their own behaviours and of their team/organisation and was documented through a series of blogs.Each of the roles interviewed offered unique challenges and viewpoints. A thematic analysis analysing the behaviours and skills described was performed on the transcripts of these interviews and coded according to the domains from the FMLM standards.The transcripts were then coded using these categories and the percentage breakdown of each category identified and mapped to FMLM standards.Interviewees at all levels had experience or observed behaviours that represented the four overarching leadership domains as described by FMLM Leadership standards for healthcare professionals. There was awareness and experience at all levels up to and including systems leadership despite the individuals position. These interviews underline the importance of good leadership at times of crisis. Some interviewees displayed leadership behaviours that exceeded those that would normally be expected for their clinical position.Specific challenges relating to senior leaders included maintaining visibility and managing anxieties. Nearly all of the leaders interviewed said they were drawing on prior experience. Others interviewees reflected on the importance of having trust in your team and taking a collaborative approach to leading delivery of projects. Another consistent challenge across the interviews was the change to working virtually and how this can change the team dynamics.

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