scholarly journals Life under lockdown and social restrictions - the experiences of people living with dementia and their carers during the COVID-19 pandemic in England

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Remco Tuijt ◽  
Rachael Frost ◽  
Jane Wilcock ◽  
Louise Robinson ◽  
Jill Manthorpe ◽  
...  
Keyword(s):  
Living Arrangements ◽  
Social Engagement ◽  
Family Carers ◽  
Caring Relationships ◽  
Care Services ◽  
Familial Support ◽  
Increased Risk ◽  
Care Relationships ◽  
Additional Support ◽  
The Impact

Abstract Background The impact of COVID-19 restrictions on people living with dementia and their carers is an emerging focus of recent research determining how we can best support this population. People living with dementia have faced service curtailment, increased risk for COVID-19, as well as potential heightened deterioration. This study reports the experiences of people living with dementia and their family carers during the early months of the COVID-19 pandemic in England and the impact on them. Methods We recruited and remotely interviewed 30 people living with dementia in their own homes and 31 family carers, via video or telephone call in mid-2020. Data were transcribed and analysed using thematic analysis. Results People living with dementia often had a basic understanding of COVID-19 restrictions but could have difficulty translating this into personalised risk-appraisal of their own actions. Managing COVID-19 risks facing people living with dementia at home was largely done by family carers, exemplified by changes to living arrangements, which could strain or sustain caring relationships. Well-established familial caring relationships contributed to the wellbeing of the person living with dementia and their carer, as well as keeping to simple routines that included leaving the home for exercise and stimulation. People living with dementia reported some negative psychological and cognitive effects due to the imposed restrictions, such as increased apathy, irritability, or anxiety, which were fuelled by lack of social engagement. Conclusions Structuring routine (remote) social interactions where possible could increase social engagement and improve wellbeing for people living with dementia, especially those with limited familial support in a post-COVID-19 context. As some care relationships had been restructured to manage COVID-19 risks, additional carer strain may emerge as a result of the impact on the independence of the person living with dementia and come to the attention of professionals in health and care services. People living with dementia and their carers highlighted the importance of maintaining or adapting routines which may be useful learning for professionals, although additional support may be necessary for those who are impacted by more severe or worsening symptoms of dementia.

scholarly journals Health and social care access for adults with learning disabilities across the UK during the COVID-19 pandemic in 2020

2021 ◽  
Vol 26 (3) ◽  
pp. 174-179
Author(s):  
Samantha Flynn ◽  
Chris Hatton
Keyword(s):  
Learning Disabilities ◽  
Northern Ireland ◽  
Social Care ◽  
Family Carers ◽  
Content Type ◽  
Care Services ◽  
Health And Social Care ◽  
Adults With Learning Disabilities ◽  
The Uk ◽  
The Impact

Purpose This paper aims to present data about access to health and social care services during the COVID-19 pandemic for adults with learning disabilities across England, Northern Ireland, Scotland and Wales. Design/methodology/approach Data were collected directly from 621 adults with learning disabilities and through separate proxy reports by family carers and paid support staff of another 378 adults with learning disabilities. The data were collected between December 2020 and February 2021 and concerned the use of health and social care services since the start of the first COVID-19 national lockdown in March 2020. Findings Access to and use of health and social care services significantly reduced for adults with learning disabilities across the UK during the COVID-19 pandemic between March 2020 and February 2021, with many people not receiving any services at all during that period. Similar patterns were seen across England, Northern Ireland, Scotland and Wales. However, data suggest some variations between countries for some services. Practical implications Future pandemic planning must ensure that access to these essential services is not completely lost for adults with learning disabilities and their family carers, as it was in some cases during the COVID-19 pandemic in 2020. Originality/value This is the largest study about the impact of the COVID-19 pandemic on health and social care services for adults with learning disabilities in the UK. The authors primarily collected data directly from adults with learning disabilities, and worked with partner organisations of people with learning disabilities throughout the study.

Prediction of acute care service utilization for patients with hematologic malignancies.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 312-312
Author(s):  
Kai Zu ◽  
Kristina Greenwood ◽  
Joyce Lamori ◽  
Besa Smith ◽  
Tyler C Smith ◽  
...  
Keyword(s):  
Acute Care ◽  
Service Utilization ◽  
Quality Care ◽  
Hematologic Malignancies ◽  
Risk Models ◽  
Quality Reporting ◽  
Care Services ◽  
Increased Risk ◽  
Acute Care Services ◽  
The Impact

312 Background: Improving the ability to predict which patients are at increased risk for acute care services subsequent to hospitalization can lead to more effective interventions and quality care. This study evaluated the performance of risk models to predict 30-day acute service utilization among adult inpatients with newly diagnosed hematologic malignancies. The study explored the impact of medical complications on potentially preventable service utilization, aligned with specifications for proposed measure OP-35 from the CMS Hospital Outpatient Quality Reporting Program. Methods: The study included 933 unique adult patients admitted to four acute care inpatient facilities within a non-profit community based healthcare system during calendar years 2012 to 2017. Risk models integrated a comprehensive set of data elements using clinical information from electronic medical records and facility oncology registries. Predictive models were constructed using a multivariable logistic regression, with calculation of standardized coefficients to rank order variables with the greatest impact on unplanned readmissions. Exploratory data mining techniques were conducted to augment classification of at-risk patients. Results: The mean age of study participants was 65 years and 55.1% were male. In order of prevalence, the types of hematologic malignancy were lymphoma (48.7%), leukemia (35.2%), myeloma (14.0%), and mixed types (2.1%). Approximately one fifth of patients received unplanned acute care services within 30 days after the index hospitalization (lymphoma = 23.1%, myeloma = 22.1%, leukemia = 18.6%). Among the risk models, the most influential predictors included initial length of stay, severity of illness, and consult for social work. Overall, 56.6% of patients who were readmitted within 30 days of hospitalization presented with one or more symptoms associated with the CMS medical complication measure, including cytopenia, infection, negative hydration, and/or pain. Conclusions: Optimizing quality care in a value-based health care environment requires proactive approaches such as risk prediction models for identifying patients who can benefit most from care transition interventions.

scholarly journals Stress and Adjustment during the COVID-19 Pandemic: A Qualitative Study on the Lived Experience of Canadian Older Adults

2021 ◽  
Vol 18 (24) ◽  
pp. 12922
Author(s):  
Alexandra J. Fiocco ◽  
Charlie Gryspeerdt ◽  
Giselle Franco
Keyword(s):  
Older Adults ◽  
Lived Experience ◽  
Social Isolation ◽  
Living Arrangements ◽  
Independent Living ◽  
Community Dwelling ◽  
Behavioral Strategies ◽  
Increased Risk ◽  
The Impact ◽  
Community Dwelling Older Adults

In response to the COVID-19 pandemic, social distancing measures were put into place to flatten the pandemic curve. It was projected that older adults were at increased risk for poor psychological and health outcomes resulting from increased social isolation and loneliness. However, little research has supported this projection among community-dwelling older adults. While a growing body of research has examined the impact of the COVID-19 pandemic on older adults, there is a paucity of qualitative research that captures the lived experience of community-dwelling older adults in Canada. The current study aimed to better understand the lived experience of community-dwelling older adults during the first six months of the pandemic in Ontario, Canada. Semi-structured one-on-one interviews were conducted with independent-living older adults aged 65 years and older. A total of 22 interviews were analyzed using inductive thematic analysis. Following a recursive process, two overarching themes were identified: perceived threat and challenges of the pandemic, and coping with the pandemic. Specifically, participants reflected on the threat of contracting the virus and challenges associated with living arrangements, social isolation, and financial insecurity. Participants shared their coping strategies to maintain health and wellbeing, including behavioral strategies, emotion-focused strategies, and social support. Overall, this research highlights resilience among older adults during the first six months of the pandemic.

scholarly journals Impact of COVID-19 on UK Foundation Doctors: Training and Safety

2020 ◽  
Author(s):  
Ben Blackburn ◽  
James Thomas Ferryman ◽  
Adla Alattas
Keyword(s):  
Rating Scale ◽  
Multiple Choice ◽  
Standard Of Care ◽  
Formal Training ◽  
Personal Safety ◽  
Protective Measures ◽  
Increased Risk ◽  
Additional Support ◽  
The Impact ◽  
Digital Survey

Abstract Objective: To survey Foundation doctors on support, training, and guidance received in relation to COVID-19 during the pandemic.Methods: A 24 question digital survey with a mix of open-ended, multiple-choice, and rating-scale questions was distributed to the 18 UK Foundation Schools. Questions established trainee demographics and the quantity of COVID-19 training received; with focused questions relating to personal safety and support for vulnerable individuals.Results: 714 doctors completed the survey; 55% in FY2, 43% in FY1, and 2% above FY2 level. 74% of respondents reported receiving no formal training on COVID-19. Mean confidence was 84% in diagnosing COVID-19, and 56% in managing it. 75% did not receive formal training on the requisite safety precautions for suspected COVID-19 cases. 67% had not been fit tested and 75% of those who failed their fit test were not provided with alternative equipment. 30 doctors reported being pregnant and none had received additional support regarding protective measures. 47 doctors reported being immunocompromised and 42 of them had received no additional support in view of their increased risk. 93% of doctors had not received definitive guidance regarding the impact of this on their ARCP sign-off and progression of training.Discussion: Alarming proportions of Foundation trainees are not currently being provided with formal training or support for their personal safety during the COVID-19 outbreak. This is remediable through the urgent implementation of formal COVID-19 training, standardised across NHS trusts to ensure a consistent standard of care for the protection of trainees and patients.

scholarly journals Healthcare Providers on the Frontline: A Quantitative Investigation of the Stress and Recent Onset Psychological Impact of Delivering Health Care Services During COVID-19 in Kashmir

2020 ◽  
Vol 42 (4) ◽  
pp. 359-367
Author(s):  
Aaliya Khanam ◽  
Shabir Ahmad Dar ◽  
Zaid Ahmad Wani ◽  
Naveed Nazir Shah ◽  
Inaamul Haq ◽  
...  
Keyword(s):  
Health Care Services ◽  
Psychological Impact ◽  
Healthcare Providers ◽  
Impact Of Event Scale ◽  
Event Scale ◽  
Recent Onset ◽  
Care Services ◽  
Increased Risk ◽  
The Impact ◽  
Patient Department

Background: Frontline healthcare workers (FHCWs) are at an increased risk of contracting COVID-19. We aimed to assess the stress and psychological impact of the COVID-19 pandemic among FHCWs. Methods: This was an exploratory hospital-based study. A semistructured e-questionnaire was developed and shared through emails, WhatsApp groups, Facebook, and Twitter. The study instruments used were stress questionnaire and the impact of event scale—revised. Results: We received 133 valid responses. A total of 81 (61.4%) of the respondents were single, 74 (55.6) were male, 70 (52.6%) were between 20 and 29 years of age, and 91 (68.4%) were from urban background. A total of 83 (62.4%) of respondents were doctors and 28 (21.1%) were registered nurses. A total of 36 (27.1%) were posted in emergency and 34 (25.6%) were in the in-patient department. Feeling sad and pessimistic, feeling of being avoided by others, the burden of change in the quality of work, and worrying whether the family will be cared for in their absence were significantly more in nurses as compared to the doctors. Stress due to burden in an increase in the quantity of work was seen more in FHCWs working in the swab collection center as compared to those working in the in-patient department, emergency, or theaters. Severe psychological impact was seen in 81 (60.9%) of FHCWs. The psychological impact was significantly more in males and in those who were married. It was also significantly related to the place of posting. Conclusion: More than half of the FHCWs had a severe psychological impact owing to COVID-19. The psychological impact was more in males and those who were married, and it was related to the place of posting of the FHCWs. Nurses had significantly higher stress as compared to doctors.

scholarly journals 498. Impact of COVID-19 on UK Foundation Doctors: Education and Safety

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S315-S315
Author(s):  
Ben Blackburn ◽  
James T Ferryman ◽  
Adla Alattas
Keyword(s):  
Rating Scale ◽  
Standard Of Care ◽  
Formal Training ◽  
Personal Safety ◽  
Frontline Staff ◽  
Increased Risk ◽  
Medical Teams ◽  
Novel Coronavirus ◽  
Additional Support ◽  
The Impact

Abstract Background Transmission of a novel coronavirus (SARS-COV2) from China has caused a global pandemic, resulting in an unprecedented burden on healthcare systems worldwide. Frontline healthcare workers face considerable risk due to the potential for repeated exposure to infected individuals, many of whom may be asymptomatic given the lengthy incubation period of 5–10 days. With rising incidence, prevalence, and mortality rates, appropriate training and support is paramount in safeguarding the wellbeing of NHS staff and patients. Foundation doctors are among frontline staff being redeployed to areas of need. They are a vital resource within the NHS; and are uniquely positioned to support and staff medical teams. Methods A 24 question digital survey with a mix of open-ended, multiple-choice, and rating-scale questions was distributed to the 18 UK Foundation Schools. Questions established trainee demographics and the quantity of COVID-19 training received; with focused questions relating to personal safety and support for vulnerable individuals. Results 714 doctors completed the survey; 55% in FY2, 43% in FY1, and 2% above FY2 level. 74% of respondents reported receiving no formal training on COVID-19. Mean confidence was 84% in diagnosing COVID-19, and 56% in managing it. 75% did not receive formal training on the requisite safety precautions for suspected COVID-19 cases. 67% had not been fit tested and 75% of those who failed their fit test were not provided with alternative equipment. 30 doctors reported being pregnant and none had received additional support regarding protective measures. 47 doctors reported being immunocompromised and 42 of them had received no additional support in view of their increased risk. 93% of doctors had not received definitive guidance regarding the impact of this on their ARCP sign-off and progression of training. Conclusion Alarming proportions of Foundation trainees are not currently being provided with formal training or support for their personal safety during the COVID-19 outbreak. This is remediable through the urgent implementation of formal COVID-19 training, standardised across NHS trusts to ensure a consistent standard of care for the protection of trainees and patients. Disclosures All Authors: No reported disclosures

scholarly journals Differences in risk factors and chronic conditions between informal (family) carers and non-carers using a population-based cross-sectional survey in South Australia

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e020173 ◽  
Author(s):  
Anne F Stacey ◽  
Tiffany K Gill ◽  
Kay Price ◽  
Anne W Taylor
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Health Outcomes ◽  
Chronic Conditions ◽  
Population Based ◽  
Computer Assisted ◽  
Family Carers ◽  
Cross Sectional ◽  
Increased Risk ◽  
The Impact

BackgroundThere is growing discussion on the impact of informal caregiving on the health status and morbidity of family carers. Evidence suggests a proportion of carers may be at risk of poor health outcomes. However, there are limited population-based studies that provide representative data on specific risk factors among carers (eg, blood pressure, cholesterol, smoking status, activity and body mass index) and major chronic conditions (eg, asthma, diabetes and arthritis). This study aimed to redress that imbalance.MethodSelf-reported data were from the South Australian Monitoring and Surveillance System (SAMSS), a representative cross-sectional state-wide population-based survey of 600 randomly selected persons per month. SAMSS uses computer-assisted telephone interviewing (CATI) to monitor chronic health-related problems and risk factors and to assess health outcomes. In total, 2247 family carers were identified from 35 195 participants aged 16 years and older for the 5-year period from 2010 to 2015. Logistic regression analyses examined associations of being a carer with self-reported chronic diseases and health risk factors. In addition, the population attributable risk (PAR) of being a carer was examined for selected chronic conditions.ResultsThe prevalence of carers was 6.4%, and peak age group for carers was 50–59 years. Adjusted ORs for chronic conditions in carers were significant for all chronic conditions examined. Although there is a high prevalence of self-reported risk factors and chronic conditions among carers compared with non-carers at the population level, PAR findings suggest that caregiving is associated with a small to moderate increased risk of having these chronic conditions.ConclusionsMonitoring of carer health and morbidity particularly ‘at risk’ individuals such as female carers with asthma or diabetes remains important and provides an ongoing baseline for future surveys. To achieve this, caregiver-based studies need to become part of mainstream biomedical research at both epidemiological and clinical levels.

Zinc Depletion Increases Readmission in Older Patients: An Example of Interactions Between Nutrition and Disease

2017 ◽  
Vol 87 (1-2) ◽  
pp. 10-16 ◽  
Author(s):  
Salah Gariballa ◽  
Awad Alessa
Keyword(s):  
Nutritional Status ◽  
Inductively Coupled Plasma ◽  
Older Patients ◽  
Controlled Trial ◽  
Prognostic Indicators ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Co Morbidity ◽  
The Impact ◽  
Poor Nutrition

Abstract. Background: ill health may lead to poor nutrition and poor nutrition to ill health, so identifying priorities for management still remains a challenge. The aim of this report is to present data on the impact of plasma zinc (Zn) depletion on important health outcomes after adjusting for other poor prognostic indicators in hospitalised patients. Methods: Hospitalised acutely ill older patients who were part of a large randomised controlled trial had their nutritional status assessed using anthropometric, hematological and biochemical data. Plasma Zn concentrations were measured at baseline, 6 weeks and at 6 months using inductively- coupled plasma spectroscopy method. Other clinical outcome measures of health were also measured. Results: A total of 345 patients assessed at baseline, 133 at 6 weeks and 163 at 6 months. At baseline 254 (74%) patients had a plasma Zn concentration below 10.71 μmol/L indicating biochemical depletion. The figures at 6 weeks and 6 months were 86 (65%) and 114 (70%) patients respectively. After adjusting for age, co-morbidity, nutritional status and tissue inflammation measured using CRP, only muscle mass and serum albumin showed significant and independent effects on plasma Zn concentrations. The risk of non-elective readmission in the 6-months follow up period was significantly lower in patients with normal Zn concentrations compared with those diagnosed with Zn depletion (adjusted hazard ratio 0.62 (95% CI: 0.38 to 0.99), p = 0.047. Conclusions: Zn depletion is common and associated with increased risk of readmission in acutely-ill older patients, however, the influence of underlying comorbidity on these results can not excluded.

Thrombophilia and risk of VTE recurrence according to the age at the time of first VTE manifestation

VASA ◽  
2015 ◽  
Vol 44 (4) ◽  
pp. 313-323 ◽  
Author(s):  
Lea Weingarz ◽  
Marc Schindewolf ◽  
Jan Schwonberg ◽  
Carola Hecking ◽  
Zsuzsanna Wolf ◽  
...  
Keyword(s):  
Factor V Leiden ◽  
Cox Proportional Hazards ◽  
First Episode ◽  
Factor V ◽  
Factor V Leiden Mutation ◽  
Younger Patients ◽  
Risk Of Recurrence ◽  
G20210a Mutation ◽  
Increased Risk ◽  
The Impact

Abstract. Background: Whether screening for thrombophilia is useful for patients after a first episode of venous thromboembolism (VTE) is a controversial issue. However, the impact of thrombophilia on the risk of recurrence may vary depending on the patient’s age at the time of the first VTE. Patients and methods: Of 1221 VTE patients (42 % males) registered in the MAISTHRO (MAin-ISar-THROmbosis) registry, 261 experienced VTE recurrence during a 5-year follow-up after the discontinuation of anticoagulant therapy. Results: Thrombophilia was more common among patients with VTE recurrence than those without (58.6 % vs. 50.3 %; p = 0.017). Stratifying patients by the age at the time of their initial VTE, Cox proportional hazards analyses adjusted for age, sex and the presence or absence of established risk factors revealed a heterozygous prothrombin (PT) G20210A mutation (hazard ratio (HR) 2.65; 95 %-confidence interval (CI) 1.71 - 4.12; p < 0.001), homozygosity/double heterozygosity for the factor V Leiden and/or PT mutation (HR 2.35; 95 %-CI 1.09 - 5.07, p = 0.030), and an antithrombin deficiency (HR 2.12; 95 %-CI 1.12 - 4.10; p = 0.021) to predict recurrent VTE in patients aged 40 years or older, whereas lupus anticoagulants (HR 3.05; 95%-CI 1.40 - 6.66; p = 0.005) increased the risk of recurrence in younger patients. Subgroup analyses revealed an increased risk of recurrence for a heterozygous factor V Leiden mutation only in young females without hormonal treatment whereas the predictive value of a heterozygous PT mutation was restricted to males over the age of 40 years. Conclusions: Our data do not support a preference of younger patients for thrombophilia testing after a first venous thromboembolic event.

Percutaneous Coronary Intervention in Patients with Diabetes and Multivessel or Left Main Disease – a Review

2012 ◽  
Vol 7 (1) ◽  
pp. 37
Author(s):  
Donald E Cutlip ◽  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Statistical Significance ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Metal Stents ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Patients With Diabetes ◽  
The Impact

Coronary artery disease in patients with diabetes is frequently a diffuse process with multivessel involvement and is associated with increased risk for myocardial infarction and death. The role of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with diabetes and multivessel disease who require revascularisation has been debated and remains uncertain. The debate has been continued mainly because of the question to what degree an increased risk for in-stent restenosis among patients with diabetes contributes to other late adverse outcomes. This article reviews outcomes from early trials of balloon angioplasty versus CABG through later trials of bare-metal stents versus CABG and more recent data with drug-eluting stents as the comparator. Although not all studies have been powered to show statistical significance, the results have been generally consistent with a mortality benefit for CABG versus PCI, despite differential risks for restenosis with the various PCI approaches. The review also considers the impact of mammary artery grafting of the left anterior descending artery and individual case selection on these results, and proposes an algorithm for selection of patients in whom PCI remains a reasonable strategy.

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