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Heeney A, Connolly SP, Dillon R, O’Donnell A, McSweeney T, O’Kelly B, Cotter AG, Sheehan G, Lambert JS, Muldoon EG, McGinty T. Post-COVID care delivery: The experience from an Irish tertiary centre's post-COVID clinic. PLoS One 2023; 18:e0289245. [PMID: 37566585 PMCID: PMC10420355 DOI: 10.1371/journal.pone.0289245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 07/13/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The long-term effects of SARS-CoV-2 infection and optimal follow-up approach are not well-recognised. Here we describe the implementation of a post-COVID clinic in an Irish tertiary centre after the first wave of the pandemic. This study describes the characteristics of our patient cohort and the operations and outcomes of the clinic, exploring some of the risk factors for developing post-COVID syndrome and the appropriateness of the triage system employed. METHODS All SARS-CoV-2 positive patients from March 10th to June 14th 2020 were telephone-triaged as red, amber or green based on ongoing symptoms with clinic appointments scheduled accordingly. All clinic visits were face-to-face with the infectious diseases medical team and a proforma for each patient was completed. Data were collected retrospectively by reviewing the proformas and the electronic medical record (EMR). RESULTS 311 patients attended the clinic. Median time from illness to clinic appointment was 95 days (IQR 77-105.5). 204 patients (66%) were female, 192 (62%) were hospital staff, and the median age was 43 years (IQR 31-53). 138 patients (44%) had required hospital admission. At their first clinic visit 219 patients (70%) had ongoing symptoms. A further appointment was made for 62 patients (20%). 34 patients (11%) were discussed at an MDT meeting, and 55 (18%) were referred onward to a specialist service. 85% of those triaged green, 73% of those triaged amber, and 39% of those triaged red did not receive further follow up after one clinic visit. Patients were more likely to require follow up with reported dyspnoea (OR 5.6; 95% CI 2.8-11.3; p <0.001), cough (OR 3.0; 95% CI 1.1-8.4, p = 0.04), and palpitations (OR 3.6; 95% CI 1.0-12.3; p = 0.04). Female sex was associated with increased odds of a higher triage category (OR 1.8; 95% CI 1.08 to 3.20; p = 0.02), as was requiring admission to hospital (OR 4.0; 95% CI 2.34 to 6.90; p < 0.001). CONCLUSION The long-term effects of COVID-19 are significant with 70% of our cohort experiencing persistent symptoms. Persistent dyspnoea, cough and palpitations were associated with increased need for follow up. This study also suggests that a traffic light telephone-triage service followed by a face-to-face medical-led clinic could be an effective way of identifying patients who require further management.
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Affiliation(s)
- Aoife Heeney
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Stephen P. Connolly
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Rachel Dillon
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Aisling O’Donnell
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Tara McSweeney
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Brendan O’Kelly
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Aoife G. Cotter
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Gerard Sheehan
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - John S. Lambert
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Eavan G. Muldoon
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Tara McGinty
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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Kenny G, McCann K, O’Brien C, Savinelli S, Tinago W, Yousif O, Lambert JS, O’Broin C, Feeney ER, De Barra E, Doran P, Mallon PWG, Cotter A, Muldoon E, Sheehan G, McGinty T, Lambert JS, Green S, Leamy K, Kenny G, McCann K, McCann R, O’Broin C, Waqas S, Savinelli S, Feeney E, Mallon PWG, Garcia Leon A, Miles S, Alalwan D, Negi R, de Barra E, McConkey S, Hurley K, Sulaiman I, Horgan M, Sadlier C, Eustace J, Kelly C, Bracken T, Whelan B, Low J, Yousif O, McNicholas B, Courtney G, Gavin P. Identification of Distinct Long COVID Clinical Phenotypes Through Cluster Analysis of Self-Reported Symptoms. Open Forum Infect Dis 2022; 9:ofac060. [PMID: 35265728 PMCID: PMC8900926 DOI: 10.1093/ofid/ofac060] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/01/2022] [Indexed: 12/14/2022] Open
Abstract
Background We aimed to describe the clinical presentation of individuals presenting with prolonged recovery from coronavirus disease 2019 (COVID-19), known as long COVID. Methods This was an analysis within a multicenter, prospective cohort study of individuals with a confirmed diagnosis of COVID-19 and persistent symptoms >4 weeks from onset of acute symptoms. We performed a multiple correspondence analysis (MCA) on the most common self-reported symptoms and hierarchical clustering on the results of the MCA to identify symptom clusters. Results Two hundred thirty-three individuals were included in the analysis; the median age of the cohort was 43 (interquartile range [IQR], 36–54) years, 74% were women, and 77.3% reported a mild initial illness. MCA and hierarchical clustering revealed 3 clusters. Cluster 1 had predominantly pain symptoms with a higher proportion of joint pain, myalgia, and headache; cluster 2 had a preponderance of cardiovascular symptoms with prominent chest pain, shortness of breath, and palpitations; and cluster 3 had significantly fewer symptoms than the other clusters (2 [IQR, 2–3] symptoms per individual in cluster 3 vs 6 [IQR, 5–7] and 4 [IQR, 3–5] in clusters 1 and 2, respectively; P < .001). Clusters 1 and 2 had greater functional impairment, demonstrated by significantly longer work absence, higher dyspnea scores, and lower scores in SF-36 domains of general health, physical functioning, and role limitation due to physical functioning and social functioning. Conclusions Clusters of symptoms are evident in long COVID patients that are associated with functional impairments and may point to distinct underlying pathophysiologic mechanisms of disease.
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Affiliation(s)
- Grace Kenny
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Kathleen McCann
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Conor O’Brien
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Stefano Savinelli
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Willard Tinago
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
| | - Obada Yousif
- Endocrinology Department, Wexford General Hospital, Carricklawn, Wexford, Ireland
| | - John S Lambert
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Cathal O’Broin
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Eoin R Feeney
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Eoghan De Barra
- Department of Infectious Diseases, Beaumont Hospital, Beaumont, Dublin, Ireland
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Peter Doran
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Patrick W G Mallon
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
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Fox R, Mulcahy Symmons S, De Brún A, Joyce D, Muldoon EG, McGinty T, O'Reilly KMA, O'Connor E, McAuliffe E. Mixed methods protocol to examine the acceptability and clinical characteristics of a remote monitoring programme for delivery of COVID-19 care, among healthcare staff and patients. BMJ Open 2021; 11:e051408. [PMID: 34588258 PMCID: PMC8482534 DOI: 10.1136/bmjopen-2021-051408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/30/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The use of remote monitoring technology to manage the care of patients with COVID-19 has been implemented to help reduce the burden placed on healthcare systems during the pandemic and protect the well-being of both staff and patients. Remote monitoring allows patients to record their signs and symptoms remotely (eg, while self-isolating at home) rather than requiring hospitalisation. Healthcare staff can, therefore, continually monitor their symptoms and be notified when the patient is showing signs of clinical deterioration. However, given the recency of the COVID-19 outbreak, there is a lack of research regarding the acceptance of remote monitoring interventions to manage COVID-19. This study will aim to evaluate the use of remote monitoring for managing COVID-19 cases from the perspective of both the patient and healthcare staff. METHODS AND ANALYSIS Discharged patients from a large urban teaching hospital in Ireland, who have undergone remote monitoring for COVID-19, will be recruited to take part in a cross-sectional study consisting of a quantitative survey and a qualitative interview. A mixed methods design will be used to understand the experiences of remote monitoring from the perspective of the patient. Healthcare staff who have been involved in the provision of remote monitoring of patients with COVID-19 will be recruited to take part in a qualitative interview to understand their experiences with the process. Structural equation modelling will be used to examine the acceptance of the remote monitoring technology. Latent class analysis will be used to identify COVID-19 symptom profiles. Interview data will be examined using thematic analysis. ETHICS AND DISSEMINATION Ethical approval has been granted by the ethical review boards at University College Dublin and the National Research Ethics Committee for COVID-19-related Research. Findings will be disseminated via publications in scientific journals, policy briefs, short reports and social media.
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Affiliation(s)
- Robert Fox
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Sophie Mulcahy Symmons
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - David Joyce
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eavan G Muldoon
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Tara McGinty
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Katherine M A O'Reilly
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Respiratory Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eileen O'Connor
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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O'Kelly B, McLaughlin R, O'Doherty R, Carroll H, Murray R, Dilworth R, Corkery L, Cotter AG, McGinty T, Muldoon EG, Cullen W, Avramovic G, Sheehan G, Sadlier D, Higgins M, O'Gorman P, Doran P, Inzitari R, Holden S, O'Meara Y, Ennis S, Lambert JS. Rapid and Laboratory SARS-CoV-2 Antibody Testing in High-Risk Hospital Associated Cohorts of Unknown COVID-19 Exposure, a Validation and Epidemiological Study After the First Wave of the Pandemic. Front Med (Lausanne) 2021; 8:642318. [PMID: 34513853 PMCID: PMC8427142 DOI: 10.3389/fmed.2021.642318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 07/30/2021] [Indexed: 12/30/2022] Open
Abstract
Objective: We aimed to use SARS-CoV-2 antibody tests to assess the asymptomatic seroprevalence of individuals in high-risk hospital cohorts who's previous COVID-19 exposure is unknown; staff, and patients requiring haemodialysis or chemotherapy after the first wave. Methods: In a single Center, study participants had five SARS-CoV-2 antibody tests done simultaneously; one rapid diagnostic test (RDT) (Superbio Colloidal Gold IgM/IgG), and four laboratory tests (Roche Elecsys® Anti-SARS-CoV-2 IgG [RE], Abbott Architect i2000SR IgG [AAr], Abbott Alinity IgG [AAl], and Abbott Architect IgM CMIA). To determine seroprevalence, only positive test results on laboratory assay were considered true positives. Results: There were 157 participants, of whom 103 (65.6%) were female with a median age of 50 years (range 19–90). The IgG component of the RDT showed a high number of false positives (n = 18), was inferior to the laboratory assays (p < 0.001 RDT vs. AAl/AAr, p < 0.001 RDT vs. RE), and had reduced specificity (85.5% vs. AAl/AAr, 87.2% vs. RE). Sero-concordance was 97.5% between IgG laboratory assays (RE vs. AAl/AAr). Specificity of the IgM component of the RDT compared to Abbott IgM CMIA was 95.4%. Ten participants had positivity in at least one laboratory assay, seven (9.9%) of which were seen in HCWs. Two (4.1%) hematology/oncology (H/O) patients and a single (2.7%) haemodialysis (HD) were asymptomatically seropositive. Asymptomatic seroprevalence of HCWs compared to patients was not significant (p = 0.105). Conclusion: HCWs (9.9%) had higher, although non-significant asymptomatic seroprevalence of SARS-CoV-2 antibodies compared to high-risk patients (H/O 4.1%, HD 2.7%). An IgM/IgG rapid diagnostic test was inferior to laboratory assays. Sero-concordance of 97.5% was found between IgG laboratory assays, RE vs. AAl/AAr.
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Affiliation(s)
- Brendan O'Kelly
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ronan McLaughlin
- Oncology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Roseann O'Doherty
- Haematology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Hailey Carroll
- Oncology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Roisin Murray
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Rachel Dilworth
- Nephrology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Laura Corkery
- Nephrology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Aoife G Cotter
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Tara McGinty
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Eavan G Muldoon
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Walter Cullen
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Gerard Sheehan
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Denise Sadlier
- Nephrology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michaela Higgins
- Oncology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter O'Gorman
- Haematology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter Doran
- Clinical Research Centre, University College Dublin, Dublin, Ireland
| | - Rosanna Inzitari
- Clinical Research Centre, University College Dublin, Dublin, Ireland
| | - Sinead Holden
- Clinical Research Centre, University College Dublin, Dublin, Ireland
| | - Yvonne O'Meara
- Nephrology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Ennis
- School of Medicine, University College Dublin, Dublin, Ireland
| | - John S Lambert
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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5
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Connellan D, Diffley K, McCabe J, Cotter A, McGinty T, Sheehan G, Ryan K, Cullen W, Lambert JS, Callaly EL, Kyne L. Documentation of Do-Not-Attempt-Cardiopulmonary-Resuscitation orders amid the COVID-19 pandemic. Age Ageing 2021; 50:1048-1051. [PMID: 33909020 PMCID: PMC8135469 DOI: 10.1093/ageing/afab075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: The COVID-19 pandemic has brought the decision-making process regarding cardiopulmonary resuscitation (CPR) into focus. The aim of this study is to compare rates of Do-Not-Attempt CPR (DNACPR) documentation in older hospitalised patients before and during the COVID-19 pandemic. Methods: This was a retrospective repeated cross-sectional study. Data including co-morbidities and resuscitation status was collected on 300 patients with COVID-19 hospitalised from March 1st to May 31s t 2020. DNACPR documentation rates in patients aged ≥65 years with a diagnosis of COVID-19 were compared to those without COVID-19 admitted during the same period and also compared to documentation rates pre-COVID-19 pandemic (March 1st to May 31s t 2019). Results: Of 300 COVID-19-positive patients, 28% had a DNACPR order documented during their admission. Of 131 older (≥65 years) patients with COVID-19, 60.3% had a DNACPR order compared to 25.4% of 130 older patients without COVID-19 (p < 0.0001). During a comparable time period pre-pandemic, 15.4% of 130 older patients had a DNACPR order in place (p < 0.0001). Fifty percent of DNACPR orders were recorded within 24 hours of a positive swab result for SARS-CoV-2. Of older COVID-19-positive patients, 39.2% were referred to palliative care services and 70.2% survived. Conclusion: The COVID-19 pandemic has prompted more widespread and earlier decision-making regarding resuscitation status. Although case-fatality-rates were higher for older hospitalised patients with COVID-19, many older patients survived the illness. Advance care planning should be prioritised in all patients and should remain good clinical practice despite the pandemic.
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Affiliation(s)
- David Connellan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Kara Diffley
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - John McCabe
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Aoife Cotter
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Tara McGinty
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Gerard Sheehan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Karen Ryan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Walter Cullen
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - John S Lambert
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | | | - Lorraine Kyne
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
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Connellan D, Diffley K, McCabe J, Cotter A, McGinty T, Sheehan G, Ryan K, Cullen W, Lambert J, Callaly E, Kyne L. 484 CHANGING PRACTICES OF DECISION MAKING REGARDING DO-NOT-ATTEMPT-CARDIOPULMONARY-RESUSCITATION ORDERS AMID THE COVID-19 PANDEMIC. Age Ageing 2021. [PMCID: PMC8344931 DOI: 10.1093/ageing/afab117.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The COVID-19 pandemic has brought the decision-making process regarding cardiopulmonary resuscitation into focus. This study aims to analyse Do-Not-Attempt CPR (DNACPR) documentation in older hospitalised patients before and during the COVID-19 pandemic.
Methods
This was a retrospective repeated cross-sectional study. Data including co-morbidities and resuscitation status was collected on 300 patients with COVID-19 hospitalised from March 1st to May 31 s t 2020. DNACPR documentation rates in patients aged ≥65 years with a diagnosis of COVID-19 were compared to those without COVID-19 admitted during the same period. Pre-COVID-19 pandemic DNACPR documentation rates were also examined. Factors associated with DNACPR order instatement during the first wave of the COVID-19 pandemic were identified.
Results
Of 300 COVID-19-positive patients, 28% had a DNACPR order documented during their admission. 50% of DNAR orders were recorded within 24 hours of a positive swab result for SARS-CoV-2. Of 131 patients aged 65 years or over within the cohort admitted with COVID-19, 60.3% had a DNACPR order compared to 25.4% of 130 patients ≥65 without COVID-19 (p < 0.0001). During a comparable time period pre-pandemic, 15.4% of 130 older patients had a DNACPR order in place (p < 0.0001). Independent associations with DNACPR order documentation included increasing age (Odds Ratio [O.R.] 1.12; 95% CI 1.05-1.21); nursing home resident status (O.R. 3.57; 95% CI 1.02-12.50); frailty (O.R. 3.34; 95% CI 1.16-9.61) and chronic renal impairment (O.R. 5.49; 1.34-22.47). The case-fatality-rate of older patients with COVID-19 was 29.8% versus 5.4% without COVID-19. Of older COVID-19-positive patients, 39.2% were referred to palliative care services and 70.2% survived.
Conclusion
The COVID-19 pandemic has prompted more widespread and earlier decision-making regarding resuscitation status. Although case-fatality-rates were higher for older hospitalised patients with COVID-19, many older patients survived the illness. Advance care planning should be prioritised in all patients and should remain clinical practice despite the pandemic.
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Affiliation(s)
- D Connellan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - K Diffley
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - J McCabe
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - A Cotter
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - T McGinty
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - G Sheehan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - K Ryan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - W Cullen
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - J Lambert
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - E Callaly
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - L Kyne
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
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7
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O’Kelly B, Cronin C, Connellan D, Griffin S, Connolly SP, McGrath J, Cotter AG, McGinty T, Muldoon EG, Sheehan G, Cullen W, Doran P, McHugh T, Vidal L, Avramovic G, Lambert JS. Antibiotic prescribing patterns in patients hospitalized with COVID-19: lessons from the first wave. JAC Antimicrob Resist 2021; 3:dlab085. [PMID: 34223144 PMCID: PMC8242139 DOI: 10.1093/jacamr/dlab085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/25/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND A high proportion of hospitalized patients with COVID-19 receive antibiotics despite evidence to show low levels of true bacterial coinfection. METHODS A retrospective cohort study examining antibiotic prescribing patterns of 300 patients sequentially diagnosed with COVID-19. Patients were grouped into 3 sub-cohorts: Group 1 received no antibiotics, Group 2 received antibiotics for microbiologically confirmed infections and Group 3 was empirically treated with antibiotics for pneumonia. The primary aim was to identify factors that influenced prescription and continuation of antibiotics in Group 3. Secondary aims were to examine differences in outcomes between groups. RESULTS In total, 292 patients were included (63 Group 1, 35 Group 2, 194 Group 3), median age was 60 years (IQR 44-76) and the majority were ethnically Irish (62%). The median duration of antibiotics was 7 days (IQR 5-10). In Group 3, factors associated with prescription IV antibiotics on admission were raised C-reactive protein (CRP) (P = 0.024), increased age (P = 0.023), higher quick SOFA (P = 0.016) score and fever >37.5 °C (P = 0.011). Factors associated with duration of antibiotic course were duration of hypoxia (P < 0.001) and maximum respiratory support requirement (P = 0.013). Twenty-one patients in Group 3 had one or more antibiotic escalation events, most (n = 139) had no escalation or de-escalation of therapy. CONCLUSIONS Duration of hypoxia and need for respiratory support may have acted as surrogate measures of improvement where usual response measures (CRP, neutrophilia, culture clearance) were absent. Continuous review of antibiotic prescriptions should be at the forefront of clinical management of hospitalized patients with COVID-19.
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Affiliation(s)
- Brendan O’Kelly
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
| | - Colm Cronin
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - David Connellan
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Sean Griffin
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Stephen Peter Connolly
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
| | - Jonathan McGrath
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Aoife G Cotter
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Tara McGinty
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Eavan G Muldoon
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Gerard Sheehan
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Walter Cullen
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Peter Doran
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Tina McHugh
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Louise Vidal
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | | | - John S Lambert
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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O’Kelly B, Cronin C, Connolly SP, Cullen W, Avramovic G, McHugh T, O’Connor E, Cotter A, Doran P, McGinty T, O’Callaghan DS, Gaine S, Sheehan G, Brazil E, Marsh B, Lambert JS. What is the clinical course of patients hospitalised for COVID-19 treatment Ireland: a retrospective cohort study in Dublin’s North Inner City (the ‘Mater 100’). HRB Open Res 2020. [DOI: 10.12688/hrbopenres.13138.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Ireland has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While several cohorts from China have been described, there is little data describing the epidemiological and clinical characteristics of Irish patients with COVID-19. To improve our understanding of this infection we performed a retrospective review of patient data to examine the clinical characteristics of patients admitted for COVID-19 hospital treatment. Methods: Demographic, clinical and laboratory data on the first 100 patients admitted to Mater Misericordiae University Hospital for in-patient COVID-19 treatment after onset of the outbreak in March 2020 was extracted from patient records. Results: The median age was 45 years (interquartile range [IQR] =34-64 years), 58% were male, and 63% were Irish nationals. Patients had symptoms for a median of five days before diagnosis (IQR=2.5-7 days), most commonly cough (72%), fever (65%), dyspnoea (37%), fatigue (28%), myalgia (27%) and headache (24%). Of all cases, 54 had at least one pre-existing chronic illness (most commonly hypertension, diabetes mellitus or asthma). At initial assessment, the most common abnormal findings were: C-reactive protein >7.0mg/L (74%), ferritin >247μg/L (women) or >275μg/L (men) (62%), D-dimer >0.5μg/dL (62%), chest imaging (59%), NEWS Score (modified) of ≥3 (55%) and heart rate >90/min (51%). Supplemental oxygen was required by 27 patients, of which 17 were admitted to the intensive care unit - 14 requiring ventilation. Antiviral therapy was administered to 40 patients (most commonly hydroxychloroquine or lopinavir/ritonavir). Four died, 17 were admitted to intensive care, and 74 were discharged home, with nine days the median hospital stay (IQR=6-11). Conclusion: Our findings reinforce the consensus of COVID-19 as an acute life-threatening disease and highlights the importance of laboratory (ferritin, C-reactive protein, D-dimer) and radiological parameters, in addition to clinical parameters. Further cohort studies followed longitudinally are a priority.
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O'Kelly B, McGettrick P, Angelov D, Fay M, McGinty T, Cotter AG, Sheehan G, Lambert JS. Outcome of a patient with refractory Hodgkin lymphoma on pembrolizumab, infected with SARS-CoV-2. Br J Haematol 2020; 190:e1-e3. [PMID: 32379903 PMCID: PMC7267253 DOI: 10.1111/bjh.16798] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Brendan O'Kelly
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Padraig McGettrick
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
| | - Daniel Angelov
- Haematology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Fay
- Haematology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Tara McGinty
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
| | - Aoife G Cotter
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
| | - Gerard Sheehan
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John S Lambert
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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Abstract
INTRODUCTION As the population of people living with HIV ages, the increase in non-AIDs morbidities is expected to increase in parallel. Maintaining bone health in those with HIV will be an important area of focus for the HIV clinician to prevent the morbidity and mortality associated with fragility fractures, the principal clinical sequela of low bone mineral density (BMD). Rates of fractures and prevalence of low bone mineral density, a risk factor for future fragility fractures, are already increased in the HIV positive population. AREAS COVERED This review examines the strategies to maintain bone health in those living with HIV from screening through to managing those with established low BMD or fracture, including the role for choice of or modification of antiretroviral therapy to maintain bone health. Expert commentary: The increasing complexity of managing bone health in the age of succesful antiretroviral therapy and an aging patient population as well as future perspectives which may help achieve the long term aim of minimising the impact of low BMD in those with HIV are discussed and explored.
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Affiliation(s)
- Tara McGinty
- a School of Medicine , University College Dublin , Dublin , Ireland
| | - Patrick Mallon
- a School of Medicine , University College Dublin , Dublin , Ireland
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11
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O'Connor G, McGinty T, Yeung SJ, O'Shea D, Macken A, Brazil E, Mallon P. Cross-sectional study of the characteristics, healthcare usage, morbidity and mortality of injecting drug users attending an inner city emergency department. Emerg Med J 2013; 31:625-9. [PMID: 23625509 DOI: 10.1136/emermed-2012-201934] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The affliction of injecting drug use (IDU) has resulted in the emergence of a subgroup of people with a unique set of medical issues. We aimed to describe the emergency department (ED) presentations of IDUs. METHODS In a prospective observational study over a 3-month period, we identified characteristics of patients with a history of active IDU presenting to the ED. RESULTS From 1 January 2010 to 31 March 2010, 146 patients with a history of IDU were identified. These contributed to 222 acute presentations to the ED. Baseline characteristics revealed that patients were predominantly male, of Irish nationality, with high levels of homelessness, unemployment and lack of stable family or intimate partner relationships. 45% of presentations occurred as a result of infection (95% CI 38.5% to 51.5%). Trauma, pure toxicological issues, thromboembolic phenomena and psychiatric issues comprised the other common acute diagnoses. The burden of comorbid medical illness was substantial with high rates of hepatitis C infection (74%) and HIV infection (13.8%). Healthcare utilisation indices for this cohort are extreme on multiple measures. We found an ED attendance rate of 445 per 100 patient-years, an admission rate of 68.8 per 100 patient-years and mortality rate of 4.86 per 100 patient-years. CONCLUSIONS Our study characterises the emergency presentations of active IDUs. We describe considerable acute and chronic medical consequences and high healthcare utilisation associated with IDU. This study is of particular relevance to any institution that provides acute medical care to this group of patients.
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Affiliation(s)
- Gerard O'Connor
- Department of Emergency Medicine, Mater Misericordiae University Hospital, Dublin, Ireland HIV Molecular Research Group, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Tara McGinty
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sarah Jane Yeung
- Department of Emergency Medicine, Mater Misericordiae University Hospital, Dublin, Ireland Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Daire O'Shea
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Alan Macken
- HIV Molecular Research Group, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Eamon Brazil
- Department of Emergency Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Patrick Mallon
- HIV Molecular Research Group, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
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12
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Rotger M, Glass TR, Junier T, Lundgren J, Neaton JD, Poloni ES, van 't Wout AB, Lubomirov R, Colombo S, Martinez R, Rauch A, Günthard HF, Neuhaus J, Wentworth D, van Manen D, Gras LA, Schuitemaker H, Albini L, Torti C, Jacobson LP, Li X, Kingsley LA, Carli F, Guaraldi G, Ford ES, Sereti I, Hadigan C, Martinez E, Arnedo M, Egaña-Gorroño L, Gatell JM, Law M, Bendall C, Petoumenos K, Rockstroh J, Wasmuth JC, Kabamba K, Delforge M, De Wit S, Berger F, Mauss S, de Paz Sierra M, Losso M, Belloso WH, Leyes M, Campins A, Mondi A, De Luca A, Bernardino I, Barriuso-Iglesias M, Torrecilla-Rodriguez A, Gonzalez-Garcia J, Arribas JR, Fanti I, Gel S, Puig J, Negredo E, Gutierrez M, Domingo P, Fischer J, Fätkenheuer G, Alonso-Villaverde C, Macken A, Woo J, McGinty T, Mallon P, Mangili A, Skinner S, Wanke CA, Reiss P, Weber R, Bucher HC, Fellay J, Telenti A, Tarr PE. Contribution of genetic background, traditional risk factors, and HIV-related factors to coronary artery disease events in HIV-positive persons. Clin Infect Dis 2013; 57:112-21. [PMID: 23532479 DOI: 10.1093/cid/cit196] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Persons infected with human immunodeficiency virus (HIV) have increased rates of coronary artery disease (CAD). The relative contribution of genetic background, HIV-related factors, antiretroviral medications, and traditional risk factors to CAD has not been fully evaluated in the setting of HIV infection. METHODS In the general population, 23 common single-nucleotide polymorphisms (SNPs) were shown to be associated with CAD through genome-wide association analysis. Using the Metabochip, we genotyped 1875 HIV-positive, white individuals enrolled in 24 HIV observational studies, including 571 participants with a first CAD event during the 9-year study period and 1304 controls matched on sex and cohort. RESULTS A genetic risk score built from 23 CAD-associated SNPs contributed significantly to CAD (P = 2.9 × 10(-4)). In the final multivariable model, participants with an unfavorable genetic background (top genetic score quartile) had a CAD odds ratio (OR) of 1.47 (95% confidence interval [CI], 1.05-2.04). This effect was similar to hypertension (OR = 1.36; 95% CI, 1.06-1.73), hypercholesterolemia (OR = 1.51; 95% CI, 1.16-1.96), diabetes (OR = 1.66; 95% CI, 1.10-2.49), ≥ 1 year lopinavir exposure (OR = 1.36; 95% CI, 1.06-1.73), and current abacavir treatment (OR = 1.56; 95% CI, 1.17-2.07). The effect of the genetic risk score was additive to the effect of nongenetic CAD risk factors, and did not change after adjustment for family history of CAD. CONCLUSIONS In the setting of HIV infection, the effect of an unfavorable genetic background was similar to traditional CAD risk factors and certain adverse antiretroviral exposures. Genetic testing may provide prognostic information complementary to family history of CAD.
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Affiliation(s)
- Margalida Rotger
- Institute of Microbiology, University Hospital Center, University of Lausanne, Lausanne, Switzerland
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