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Nilsen A, Eriksen S, Lichtwarck B, Hillestad AH, Julnes SG, Tretteteig S, Rokstad AMM. Treatment and Care for Nursing Home Residents with COVID-19: A Qualitative Study. J Multidiscip Healthc 2024; 17:2935-2946. [PMID: 38933696 PMCID: PMC11199164 DOI: 10.2147/jmdh.s467459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Purpose Coronavirus disease 2019 (COVID-19) placed a significant strain on nursing homes, leading to numerous outbreaks and high mortality rates. This situation created considerable stress and challenges for residents, their physicians and nurses, as well as family caregivers. By understanding these challenges, we can gain new insights and learn valuable lessons. Thus, the purpose of this study is to examine the treatment and care provided to nursing home residents with COVID-19, as experienced by physicians, nurses, and family caregivers. Participants and Methods This study is a secondary analysis of 35 interviews with physicians, nurses, and family caregivers, each with personal experience caring for nursing home residents diagnosed with COVID-19. The interviews took place from December 2020 to April 2021. We analyzed the transcriptions based on Braun and Clarke's reflexive thematic analysis model and followed a qualitative descriptive design as outlined by Sandelowski. Findings The analysis produced three themes: 1) Balancing medical treatment, 2) The need for increased systematic monitoring of vital functions, and 3) Determining the treatment level for nursing home residents. These themes were explored through the unique perspectives of the three participant groups: physicians, nurses, and family caregivers. The findings revealed several challenges related to treatment and care for nursing home residents diagnosed with COVID-19. This applied both to relief of symptoms, monitoring of vital functions, assessment of treatment level and use of advance care planning. Conclusion Drawing from the experiences of physicians, nurses, and family caregivers, there should be a unified plan at the municipal or national level for competency development in nursing homes to prepare for future crises like pandemics or epidemics. Additionally, the safe engagement of family caregivers and relatives should be given priority.
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Affiliation(s)
- Anita Nilsen
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Siren Eriksen
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Bjørn Lichtwarck
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | | | - Signe Gunn Julnes
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Signe Tretteteig
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Anne Marie Mork Rokstad
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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Miller M, Schwab C, Koay T, Lee R. Last 24 hours: opioid use survey. BMJ Support Palliat Care 2024; 13:e739-e740. [PMID: 35365484 DOI: 10.1136/bmjspcare-2022-003603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/16/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Mary Miller
- Palliative Care, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Caroline Schwab
- Palliative Care, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tammy Koay
- Palliative Care, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rachel Lee
- Palliative Care, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Lawlor P, Cohen L, Adeli SR, Besserer E, Gratton V, Murphy R, Warmels G, Bruni A, Kabir M, Noel C, Heidinger B, Anderson K, Arsenault-Mehta K, Wooller K, Lapenskie J, Webber C, Bedard D, Enright P, Desjardins I, Bhimji K, Dyason C, Iyengar A, Bush SH, Isenberg S, Tanuseputro P, Vanderspank-Wright B, Downar J, Parsons H. Comorbidities, symptoms and end-of-life medication use in hospitalised decedents before and during the COVID-19 pandemic: a retrospective regional cohort study in Ottawa, Canada. BMJ Open 2023; 13:e075518. [PMID: 37669840 PMCID: PMC10481717 DOI: 10.1136/bmjopen-2023-075518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVE To compare comorbidities, symptoms and end-of-life (EoL) palliative medication (antisecretories, opioids, antipsychotics and sedatives) use among decedents before and during the COVID-19 pandemic. DESIGN In a retrospective cohort study, decedent records in three acute care hospitals were abstracted, generating a prepandemic (November 2019-February 2020) group (pre-COVID) and two intrapandemic (March-August 2020, wave 1) groups, one without (COVID-ve) and one with COVID-19 infection (COVID+ve). Control group decedents were matched 2:1 on age, sex and care service (medicine/intensive care unit (ICU)) with COVID+ve decedents. SETTING Three regional acute care teaching hospitals in Ottawa, Canada PARTICIPANTS: Decedents (N=425): COVID+ve (n=85), COVID-ve (n=170) and pre-COVID (n=170). MAIN OUTCOME MEASURES Data were abstracted regarding demographics, admission comorbidities and symptoms, and EoL medication use; opioid doses were standardised to parenteral morphine equivalent daily dose (MEDD), and the predictors of upper quartile MEDD in the last 24 hours of life were examined in multivariable logistic regression with adjusted ORs (aORs) and 95% CIs. RESULTS The prevalence of dementia (41% vs 28% and 26%, p=0.03), breathlessness (63.5% vs 42% and 47%, p<0.01), cough (40% vs 27% and 19%, p<0.01) and fever (54% vs 9% and 13.5%) was higher in COVID+ve versus pre-COVID and COVID-ve groups, respectively. The median (IQR) of MEDD over the last 72 hours of life was 16.7 (9-36.5) vs 13.5 (5.7-21.8) and 10.5 (5.3-23.8) for COVID+ve versus pre-COVID and COVID-ve groups, respectively, (p=0.007). Male sex, COVID+ve grouping, ICU death and high-flow nasal cannula use predicted upper quartile MEDD dose, aORs (95% CIs): 1.84 (1.05 to 3.22), 2.62 (1.29 to 5.3), 5.14 (2.47 to 10.7) and 1.93 (1.05 to 3.52), respectively. COVID+ve group decedents used highest lorazepam and propofol doses. CONCLUSIONS COVID-19 decedents, particularly those in ICU, required higher EoL opioid and sedating medication doses than matched prepandemic or intrapandemic controls. These findings should inform and guide clinical practice.
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Affiliation(s)
- Peter Lawlor
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Leila Cohen
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Queensway Carleton Hospital, Ottawa, Ontario, Canada
| | | | - Ella Besserer
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Valérie Gratton
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Department of Medicine, Hopital Monfort, Ottawa, Ontario, Canada
| | - Rebekah Murphy
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Queensway Carleton Hospital, Ottawa, Ontario, Canada
| | - Grace Warmels
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Queensway Carleton Hospital, Ottawa, Ontario, Canada
| | - Adrianna Bruni
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Queensway Carleton Hospital, Ottawa, Ontario, Canada
| | - Monisha Kabir
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Chelsea Noel
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Brandon Heidinger
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Koby Anderson
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | | | - Krista Wooller
- Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, Division of Internal Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Julie Lapenskie
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Daniel Bedard
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Paula Enright
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Isabelle Desjardins
- Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, Division of Internal Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Khadija Bhimji
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Queensway Carleton Hospital, Ottawa, Ontario, Canada
| | - Claire Dyason
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Akshai Iyengar
- Department of Medicine, Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Critical Care, Queensway Carleton Hospital, Ottawa, Ontario, Canada
| | - Shirley H Bush
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Sarina Isenberg
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Brandi Vanderspank-Wright
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Nursing, University of Ottawa Faculty of Health Sciences, Ottawa, Ontario, Canada
| | - James Downar
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Henrique Parsons
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
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Abd El-Hadi HR, Eltanany BM, Zaazaa HE, Eissa MS. Chromatographic impurity profile assessment of dual action binary combination: Ecological analysis with comparative statistics. SUSTAINABLE CHEMISTRY AND PHARMACY 2023; 33:101075. [DOI: 10.1016/j.scp.2023.101075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Laorden D, Gholamian-Ovejero S, Terán-Tinedo JR, Lorente-González M, Cano-Sanz E, Ortega-Fraile MÁ, Alejos RM, Hernández-Nuñez J, De La Calle-Gil I, Navarro-Casado R, Neria F, Zevallos-Villegas A, Mariscal-Aguilar P, Suarez-Ortiz M, Plaza-Moreno MC, Carballo-López D, Gallego-Rodríguez B, Calderón-Alcala M, Latif-Essa A, Churruca-Arróspide M, Valle-Falcones M, Saiz-Lou EM, Rodríguez-Calle C, Funes-Moreno C, Villén-Villegas T, Landete P. Clinical Findings and Outcomes From Subjects With COVID-19 Pneumonia in an Intermediate Respiratory Care Unit. Respir Care 2023; 68:67-76. [PMID: 36347563 PMCID: PMC9993511 DOI: 10.4187/respcare.10193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Many patients with COVID-19 require respiratory support and close monitoring. Intermediate respiratory care units (IRCU) may be valuable to optimally and adequately implement noninvasive respiratory support (NRS) to decrease clinical failure. We aimed at describing intubation and mortality in a novel facility entirely dedicated to COVID-19 and to establish their outcomes. METHODS This was a retrospective, observational study performed at one hospital in Spain. We included consecutive subjects age > 18 y, admitted to IRCU with COVID-19 pneumonia, and requiring NRS between December 2020-September 2021. Data collected included mode and usage of NRS, laboratory findings, endotracheal intubation, and mortality at day 30. A multivariable Cox model was used to assess risk factors associated with clinical failure and mortality. RESULTS A total of 1,306 subjects were included; 64.6% were male with mean age of 54.7 y. During the IRCU stay, 345 subjects clinically failed NRS (85.5% intubated; 14.5% died). Cox model showed a higher clinical failure in IRCU upon onset of symptoms and hospitalization was < 10 d (hazard ratio [HR] 1.59 [95% CI 1.24-2.03], P < .001) and PaO2 /FIO2 < 100 mm Hg (HR 1.59 [95% CI 1.27-1.98], P < .001). These variables were not associated with increased 30-d mortality. CONCLUSIONS The IRCU was a valuable option to manage subjects with COVID-19 requiring NRS, thus reducing ICU overload. Male sex, gas exchange, and blood chemistry at admission were associated with worse prognosis, whereas older age, gas exchange, and blood chemistry were associated with 30-d mortality. These findings may provide a basis for better understanding outcomes and to improve management of noninvasively ventilated patients with COVID-19.
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Affiliation(s)
- Daniel Laorden
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, La Paz University Hospital, Madrid, Spain
| | - Soraya Gholamian-Ovejero
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Anesthesia Department, Severo Ochoa University Hospital, Madrid, Spain
| | - José Rafael Terán-Tinedo
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain, and Pneumology Department, Gregorio Marañón University Hospital, Madrid, Spain; and Complutense University, School of Medicine, Madrid, Spain.
| | - Miguel Lorente-González
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, 12 Octubre University Hospital, Madrid, Spain
| | - Eduardo Cano-Sanz
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Emergency Department, Fundación Alcorcon University Hospital, Madrid, Spain
| | - María Ángeles Ortega-Fraile
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Emergency Department, Fundación Alcorcon University Hospital, Madrid, Spain
| | - Roberto-Martínez Alejos
- Philips France; and Respiratory Physiotherapy and Methodology Research Department, Montpellier University School of Physiotherapy, Montpellier, France
| | - Joaquín Hernández-Nuñez
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Emergency Department, Fundación Alcorcon University Hospital, Madrid, Spain
| | - Isabel De La Calle-Gil
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Anesthesia Department, 12 Octubre University Hospital, Madrid, Spain
| | - Rosalía Navarro-Casado
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Anesthesia Department, 12 Octubre University Hospital, Madrid, Spain
| | - Fernando Neria
- Francisco de Vitoria University, School of Medicine, Madrid, Spain
| | - Annette Zevallos-Villegas
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, 12 Octubre University Hospital, Madrid, Spain
| | - Pablo Mariscal-Aguilar
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, La Paz University Hospital, Madrid, Spain
| | - Miguel Suarez-Ortiz
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, La Paz University Hospital, Madrid, Spain
| | - María Cristina Plaza-Moreno
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, La Paz University Hospital, Madrid, Spain
| | - Daniel Carballo-López
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Anesthesia Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Berta Gallego-Rodríguez
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Anesthesia Department, 12 Octubre University Hospital, Madrid, Spain
| | - Mariara Calderón-Alcala
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, Infanta Leonor University Hospital, Madrid, Spain
| | - Aylaf Latif-Essa
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - María Churruca-Arróspide
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Manuel Valle-Falcones
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Elena María Saiz-Lou
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Internal Medicine Department, Fuenlabrada University Hospital, Madrid, Spain
| | - Carmen Rodríguez-Calle
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Pneumology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Clotilde Funes-Moreno
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Anesthesia Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - Tomas Villén-Villegas
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; and Francisco de Vitoria University, School of Medicine, Madrid, Spain
| | - Pedro Landete
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Pneumology Department, La Princesa University Hospital, Madrid, Spain; and Autónoma de Madrid University, School of Medicine, Madrid, Spain
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Oluyase AO, Bajwah S, Sleeman KE, Walshe C, Preston N, Hocaoglu M, Bradshaw A, Chambers RL, Murtagh FEM, Dunleavy L, Maddocks M, Fraser LK, Higginson IJ. Symptom management in people dying with COVID-19: multinational observational study. BMJ Support Palliat Care 2022; 12:439-447. [PMID: 36418032 PMCID: PMC9691812 DOI: 10.1136/spcare-2022-003799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/28/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe multinational prescribing practices by palliative care services for symptom management in patients dying with COVID-19 and the perceived effectiveness of medicines. METHODS We surveyed specialist palliative care services, contacted via relevant organisations between April and July 2020. Descriptive statistics for categorical variables were expressed as counts and percentages. Content analysis explored free text responses about symptom management in COVID-19. Medicines were classified using British National Formulary categories. Perceptions on effectiveness of medicines were grouped into five categories; effective, some, limited or unclear effectiveness, no effect. RESULTS 458 services responded; 277 UK, 85 rest of Europe, 95 rest of the world, 1 missing country. 358 services had managed patients with confirmed or suspected COVID-19. 289 services had protocols for symptom management in COVID-19. Services tended to prescribe medicines for symptom control comparable to medicines used in people without COVID-19; mainly opioids and benzodiazepines for breathlessness, benzodiazepines and antipsychotics for agitation, opioids and cough linctus for cough, paracetamol and non-steroidal anti-inflammatory drugs for fever, and opioids and paracetamol for pain. Medicines were considered to be mostly effective but varied by patient's condition, route of administration and dose. CONCLUSIONS Services were largely consistent in prescribing for symptom management in people dying with COVID-19. Medicines used prior to COVID-19 were mostly considered effective in controlling common symptoms.
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Affiliation(s)
- Adejoke Obirenjeyi Oluyase
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK,Department of Palliative Care, King’s College Hospital NHS Foundation Trust, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK,Department of Palliative Care, King’s College Hospital NHS Foundation Trust, London, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Mevhibe Hocaoglu
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Andy Bradshaw
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Rachel L Chambers
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Fliss E M Murtagh
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Lorna K Fraser
- Department of Health Sciences, University of York, York, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK,Department of Palliative Care, King’s College Hospital NHS Foundation Trust, London, UK
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Sim J, Goh WY, Wiryasaputra L, Hum AYM, Neo HY, Poi CH. Use of Phenobarbitone for Palliative Sedation in Dyspneic Crises Due to COVID-19 Pneumonia - A Case Series. J Pain Palliat Care Pharmacother 2022; 36:242-248. [PMID: 36005904 DOI: 10.1080/15360288.2022.2113596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Patients who suffer from dyspnea while dying from COVID-19 are treated with opioids and benzodiazepines. In some instances, patients may experience refractory dyspnea at the end of life. Palliative sedation can be prescribed to alleviate such patients' suffering. We describe two patients being treated for severe COVID-19 pneumonia in a tertiary hospital. Both developed intractable dyspneic crises despite high-dose opioids and benzodiazepines. This led to their requirement of palliative sedation in the general ward using subcutaneous phenobarbitone (phenobarbital). We outline clinical considerations for the use of palliative sedation in COVID-19 related dyspnea. In particular, we discuss the evidence for, benefits and limitations of using phenobarbitone for palliative sedation in COVID-19 patients.
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Affiliation(s)
- Jingwei Sim
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wen Yang Goh
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Lynn Wiryasaputra
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Allyn Yin-Mei Hum
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Han Yee Neo
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Choo Hwee Poi
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore
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8
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Peuckmann-Post V, Wiese C, Keszei A, Rolke R, Elsner F. [Perceptions on handling of opioids: focus COVID-19 : A survey among anesthesiologists via the specialist societies DGAI/BDA]. DIE ANAESTHESIOLOGIE 2022; 71:586-598. [PMID: 35294560 PMCID: PMC8924352 DOI: 10.1007/s00101-022-01101-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/16/2022] [Accepted: 01/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Opioids are part of the daily routine in anesthesiology and palliative care; however, treatment of dyspnea with opioids is presented heterogeneously in guidelines. This may result in an uncertainty concerning opioid indications and ethical concerns, especially when caring for COVID-19 patients. OBJECTIVE We aimed to examine the perception of anesthesiologists concerning the handling of morphine as the reference opioid (subsequently termed M/O) for symptom control within and outside of a palliative care setting, including care for COVID-19 patients. MATERIAL AND METHODS Members of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Professional Association of German Anesthesiologists (BDA) received an anonymized online questionnaire (Survey Monkey®; Momentive Inc., San Mateo, CA, USA) in October 2020, containing questions regarding their perception of symptom management with M/O in general, and in particular concerning COVID-19 patients. Participants were asked to rate their perception within and outside a palliative care setting. RESULTS AND DISCUSSION A total of 1365 anesthesiologists participated; 46% women. Most anesthesiologists were 41-60 years old (58%), worked in a hospital setting (78%), in the operating theatre (63%) and in intensive care units (49%). The majority (57%) reported > 20 years of professional experience (52%) and partial involvement in palliative care (57%). Perception of M/O handling was mostly "certain and confident" (88%) and "clearly regulated" (85%) within a palliative care setting but rated substantially lower for outside palliative care (77%/63%). When caring for COVID-19 patients, handling of M/O was even less often rated "certain and confident" (40%) or "clearly regulated" (29%) outside palliative care. Dyspnea (95%/75%), relief of the dying process (84%/51%), agitation (59%/27%) and anxiety/panic (61%/33%) were more frequently rated as general indications for morphine within versus outside palliative care. The majority of anesthesiologists disputed that M/O is given with the intention to hasten death within (87%) and outside (93%) palliative care. Highest difference in route of administration was reported for the subcutaneous administration of M/O within (76%) versus outside (33%) palliative care, followed by the intravenous route (57%/79%), while oral (66/62%) and transdermal (48%/39%) administration were reported to be used comparatively frequently. Most participants (85%) wanted more frequent involvement of palliative care consultation teams but also more team conferences (75%), supervision (72%), and training on opioid management (69%). CONCLUSION Anesthesiologists perceived considerable uncertainty in using M/O for nonpalliative care medical settings. Highest uncertainty was seen for the care of patients with COVID-19. The prevalent use of the subcutaneous route for M/O application in palliative care can serve as inspiration for areas outside palliative care as well. Uniform interdisciplinary guidelines for symptom control including dyspnea, education and involvement of a palliative care consultation team should be more considered in the future.
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Affiliation(s)
- Vera Peuckmann-Post
- Klinik für Palliativmedizin, Medizinische Fakultät, Uniklinik RWTH Aachen, RWTH Aachen University, Aachen, Deutschland.
- Klinik für Anästhesiologie, Medizinische Fakultät, Uniklinik RWTH Aachen, RWTH Aachen University, Aachen, Deutschland.
| | - Christoph Wiese
- Klinik für Anästhesiologie und Intensivmedizin, Stiftung Herzogin Elisabeth Hospital, Braunschweig, Deutschland
| | - András Keszei
- Center for Translational & Clinical Research Aachen, Medizinische Fakultät, Uniklinik RWTH Aachen, RWTH Aachen University, Aachen, Deutschland
| | - Roman Rolke
- Klinik für Palliativmedizin, Medizinische Fakultät, Uniklinik RWTH Aachen, RWTH Aachen University, Aachen, Deutschland
| | - Frank Elsner
- Klinik für Palliativmedizin, Medizinische Fakultät, Uniklinik RWTH Aachen, RWTH Aachen University, Aachen, Deutschland
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9
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Peuckmann-Post V, Scherg A, Krumm N, Hagedorn C, Radbruch L, Keszei A, Rolke R, Elsner F. [Perceptions on the use of opioids in COVID-19 : A survey of members of the German Association for Palliative Medicine]. Schmerz 2022; 36:19-29. [PMID: 34661727 PMCID: PMC8521496 DOI: 10.1007/s00482-021-00596-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Opioids efficiently alleviate pain and dyspnea. However, guidelines on symptom management with opioids differ, which may lead to an uncertainty concerning opioid indication and ethical implication among medical staff, especially when caring for COVID-19 patients. AIMS We aimed to examine the perception of members of the German Association for Palliative Medicine (DGP) concerning the administration of morphine as the gold standard opioid (subsequently termed M/O) for symptom control within and outside of a palliative care (PC) setting, including care for COVID-19 patients. METHODS DGP members received an anonymized online questionnaire (Survey Monkey®) containing questions regarding their perception of symptom management with M/O in general and in particular concerning COVID-19 patients. Participants were asked to rate their perception within and outside of a PC setting. RESULTS Of the 6129 DGP members, N = 506 participated. DGP physicians and nurses perceived handling of M/O as "certain and confident" (98%) and "clearly regulated" within PC (95%) but rated it significantly lower for outside PC (48%/38%). When caring for COVID-19 patients, handling of M/O was even less often rated "certain and confident" (26%) or "clearly regulated" (23%) for outside PC. Dyspnea (99%/52%), relief from the dying process (62%/37%), restlessness (30%/15%) and fear or panic (27%/13%) were more frequently rated as general indications for morphine within versus outside PC. Most participants (89%) wished to involve palliative care consultation teams. CONCLUSIONS DGP members perceived substantial uncertainty in the handling of M/O for medical fields outside PC. Uniform interdisciplinary guidelines for symptom control, more education, and involvement of a PC consultation team should be increasingly considered in the future.
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Affiliation(s)
- Vera Peuckmann-Post
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Pauwelsstr 30, 52074, Aachen, Deutschland.
| | - Alexandra Scherg
- Abteilung für Hämatologie/Onkologie, Evangelisches Krankenhaus Wesel, Wesel, Deutschland
| | - Norbert Krumm
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Pauwelsstr 30, 52074, Aachen, Deutschland
| | - Carolin Hagedorn
- Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Lukas Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Andras Keszei
- Center for Translational & Clinical Research, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | - Roman Rolke
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Pauwelsstr 30, 52074, Aachen, Deutschland
| | - Frank Elsner
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Pauwelsstr 30, 52074, Aachen, Deutschland
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10
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McFarlane P, Halley A, Kano Y, Wade N, Wilson S, Droney J. End-of-Life Experiences for Cancer Patients Dying in Hospital with COVID-19. J Patient Exp 2022; 9:23743735221074171. [PMID: 35111899 PMCID: PMC8801342 DOI: 10.1177/23743735221074171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite a wealth of research regarding COVID-19, little evidence exists about cancer patients' specific needs and experiences at end-of-life. This study retrospectively describes the care of 34 hospitalised cancer patients dying with COVID-19. The palliative care needs of patients were described. The main domains of end-of-life care service provision were evaluated including treatment of pain and other symptoms, communication and decision making at end-of-life and level of involvement of the palliative care team. Physical symptoms were managed with relatively low doses of end-of-life medications. High levels of patient and family anxiety, however, highlight the complexity of death from a stigmatised disease. Prompt acknowledgement of the vulnerability of advanced cancer patients with COVID-19 can facilitate proactive symptom management, anticipatory communication and enhance family support.
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Affiliation(s)
| | | | - Yukie Kano
- Royal Marsden NHS Foundation
Trust, London, UK
| | - Nicola Wade
- Royal Marsden NHS Foundation
Trust, London, UK
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11
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Heath L, Carey M, Lowney AC, Harriss E, Miller M. Pharmacological strategies used to manage symptoms of patients dying of COVID-19: A rapid systematic review. Palliat Med 2021; 35:1099-1107. [PMID: 33983081 PMCID: PMC8189007 DOI: 10.1177/02692163211013255] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND COVID-19 has tragically resulted in over 2.5 million deaths globally. Despite this, there is a lack of research on how to care for patients dying of COVID-19, specifically pharmacological management of symptoms. AIM The aim was to determine the dose ranges of pharmacological interventions commonly used to manage symptoms in adult patients dying of COVID-19, establish how effectiveness of these interventions was measured, and whether the pharmacological interventions were effective. DESIGN This was a rapid systematic review with narrative synthesis of evidence, prospectively registered on PROSPERO (ID: CRD42020210892). DATA SOURCES We searched MEDLINE, EMBASE, CINAHL via the NICE Evidence Health Databases Advanced Search interface; medRxiv; the Cochrane COVID-19 Study Register; and Google Scholar with no date limits. We included primary studies which documented care of patients dying of COVID-19 under the care of a specialist palliative care team. RESULTS Seven studies, documenting the care of 493 patients met the inclusion criteria. Approximately two thirds of patients required a continuous subcutaneous infusion with median doses of 15 mg morphine and 10 mg midazolam in the last 24 h of life. Four studies described effectiveness by retrospective review of documentation. One study detailed the effectiveness of individual medications. CONCLUSIONS A higher proportion of patients required continuous subcutaneous infusion than is typically encountered in palliative care. Doses of medications required to manage symptoms were generally modest. There was no evidence of a standardised yet holistic approach to measure effectiveness of these medications and this needs to be urgently addressed.
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Affiliation(s)
- Laura Heath
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Matthew Carey
- Oxford University Hospitals NHS Foundation Trust, Sir Michael Sobell House Hospice, Oxford, UK
| | - Aoife C Lowney
- Oxford University Hospitals NHS Foundation Trust, Sir Michael Sobell House Hospice, Oxford, UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Mary Miller
- Oxford University Hospitals NHS Foundation Trust, Sir Michael Sobell House Hospice, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mary Miller, Consultant Palliative Medicine, Sir Michael Sobell House Hospice, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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