scholarly journals 600 ESCALATION DECISIONS DURING THE COVID-19 PANDEMIC AMONGST OLDER ADULTS

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
L Bishop ◽  
D Tiwari
Keyword(s):  
Older Adults ◽  
Critical Care ◽  
Retrospective Review ◽  
Decision Aid ◽  
Age Group ◽  
Younger Age ◽  
Nice Guidance ◽  
Treatment Escalation ◽  
Second Wave ◽  
Care Decision

Abstract Introduction NICE guidance recommends that during the COVID-19 pandemic all adults are assessed for frailty, suitability for resuscitation and escalation to critical care on admission to hospital. Risks, benefits and likely outcomes should be discussed with patients/relatives. Aim To investigate impact of intervention on treatment escalation plan (TEP) use during the first wave (W1) and second wave (W2) of pandemic. Intervention W1: An ethically approved TEP and a Critical Care Decision Aid (CCDA) was added to the admission booklet. W2: The TEP update included a ‘confirm discussed with patient/relatives’ section. Method W1: We conducted retrospective review of 62 case-notes of patients admitted through COVID-19 pathway and grouped into >80 and ≤ 80 years old. Resuscitation, TEP, CCDA and communication with patient/relatives were collected. W2: 60 further case-notes of patients with COVID-19 admitted in January 2021 were analysed. Results W1: 100% patients had resuscitation decisions and 95% had TEPs in both groups. Significantly higher proportions of Frailty scores were calculated in >80s (58% vs 35% p = 0.04). On average resuscitation and TEPs were made within 13.8 hours of admission (range 1–72 hours). 53.2% of resuscitation decisions and 30% TEPs were discussed with patients of whom higher proportions were discussed in younger age group, majority were discussed at the time of deterioration. W2: 98.3% patients had resuscitation decisions made and 96.7% had TEPs across both groups. On average resuscitation decisions were made within 14.9 hours of admission. In the >80s, 86.7% of resuscitation decisions were discussed and 63.3% of the TEPs were discussed with patient/relatives. In the <80s, 82.8% of resuscitation decisions were discussed and 71.4% of TEPs were discussed with the patient/relatives. Conclusion We significantly improved Treatment Escalation planning during W1 and W2 of pandemic by introducing the TEP in W1 and adding prompt to improve communication with patients/relatives in W2 (p = 0.02).

The Contextual Nature of Critical Care Judgment

1994 ◽  
Vol 9 (2) ◽  
pp. 58-63 ◽  
Author(s):  
Gilbert M. Goldman ◽  
Thyyar M. Ravindranath
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Clinical Practice ◽  
Clinical Judgment ◽  
Retrospective Review ◽  
Medical Decision Making ◽  
Formal Analysis ◽  
Medical Decision ◽  
Time Constraints ◽  
Care Decision

Critical care decision-making involves principles common to all medical decision-making. However, critical care is a remarkably distinctive form of clinical practice and therefore it may be useful to distinguish those elements particularly important or unique to ICU decision-making. The peculiar contextuality of critical care decision-making may be the best example of these elements. If so, attempts to improve our understanding of ICU decision-making may benefit from a formal analysis of its remarkable contextual nature. Four key elements of the context of critical care decisions can be identified: (1) costs, (2) time constraints, (3) the uncertain status of much clinical data, and (4) the continually changing environment of the ICU setting. These 4 elements comprise the context for the practice of clinical judgment in the ICU. The fact that intensivists are severely constrained by teh context of each case has important ramifications both for practice and for retrospective review. During retrospective review, the contextual nature of ICU judgment may be unfairly neglected by ignoring one or more of the key elements. Such neglect can be avoided if intensivists demand empathetic evaluation from reviewers.

98 A 10-year Retrospective Review of Older Adult Admissions at a Regional Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S64-S65
Author(s):  
Stephanie Campbell ◽  
Trina Andres
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Retrospective Review ◽  
Tap Water ◽  
Burn Injuries ◽  
Age Group ◽  
Prevention Programming ◽  
Burn Center ◽  
Number Of Patients ◽  
Fire Flame

Abstract Introduction A verified regional burn center conducted a 10-year retrospective review of older adult patients admitted to the burn service. The primary goal of the review was to examine trends in mechanisms of injury, demographics, and outcomes to inform burn prevention programming. Methods Admission data from 2009–2018 was retrieved from burn center databases and combined into a Microsoft Excel spreadsheet. Older adults were defined as age 65 years and older. Patients admitted to the burn service for skin disorders or soft tissue infections were excluded. Patients with cutaneous burn injuries or inhalation only injuries were included. Results The total number of patients included was 697. Nearly a third of the patients were 65 to 69 years old, with incidence declining with each subsequent 5-year age group. Males accounted for 61.3% of admissions. Two thirds of the patients were White (67.6%). The other third consisted of Black (18.4%) and Hispanic (9.8%), Asian (1.9%) and Native American (0.14%) patients. Overall mortality was 14%. Mortality generally increased per 5-year age group: 65–69 (7.8%), 70–74 (10.6%), 75–79 (13.7%), 80–84 (20.6%), 85–89 (29.8%), 90–94 (24.2%), and 95–99 (42.9%). Baux scores ranged from 65 to 180. The highest Baux score that lived to discharge was 119. The average Baux score of the mortality group was 114 and the average of the lived group was 82. No patients with a Total Body Surface Area (TBSA) above 43% lived. Fire/flame burns accounted for 72.7%. Scald burns made up 19.9%, contact burns 3%, chemical burns 2.3% and electrical burns < 1%. Nearly a quarter (24.6%) of fire/flame burns were related to smoking on home oxygen therapy (HOT), which was also the overall most common mechanism at 17.8%. Other fire/flame mechanisms included housefires (21.2%), clothing catching on fire (16.9%), and gasoline-related injuries (11.7%). More than 70% of scald burns came from the three mechanisms: hot tap water, boiling water, and hot grease. For the mortality group, a third of patients had been injured in housefires (32.7%), followed by clothing catching on fire (17.4%) and HOT burns (12.2%). Conclusions Incidence rates decline with increasing age but mortality rates climb. Burn injuries with a TBSA greater than 40% are generally fatal in the older adult. Flame burns account for the majority of injuries with HOT and house fire injuries as the leading mechanisms. Scald burns were most often caused by hot tap water or boiling water. White older adults accounted for more than double the number of patients identified in all other races combined. Applicability of Research to Practice The demographics and mechanism of injury insight gained from this review can be utilized to inform prevention programming design in this region. Trends in mortality can help emphasize the seriousness of preventing older adult burn injuries and anticipate the mortality risk for older adults admitted to the burn center.

scholarly journals Hospital Caseload Demand in the Presence of Interventions during the COVID-19 Pandemic: A Modeling Study

2020 ◽  
Vol 9 (10) ◽  
pp. 3065
Author(s):  
Katsuma Hayashi ◽  
Taishi Kayano ◽  
Sumire Sorano ◽  
Hiroshi Nishiura
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Scenario Analysis ◽  
Exponential Growth ◽  
Hospital Admissions ◽  
Age Group ◽  
Hospital Beds ◽  
Second Wave ◽  
Specific Number ◽  
Simplistic Model

A surge in hospital admissions was observed in Japan in late March 2020, and the incidence of coronavirus disease (COVID-19) temporarily reduced from March to May as a result of the closure of host and hostess clubs, shortening the opening hours of bars and restaurants, and requesting a voluntary reduction of contact outside the household. To prepare for the second wave, it is vital to anticipate caseload demand, and thus, the number of required hospital beds for admitted cases and plan interventions through scenario analysis. In the present study, we analyzed the first wave data by age group so that the age-specific number of hospital admissions could be projected for the second wave. Because the age-specific patterns of the epidemic were different between urban and other areas, we analyzed datasets from two distinct cities: Osaka, where the cases were dominated by young adults, and Hokkaido, where the older adults accounted for the majority of hospitalized cases. By estimating the exponential growth rates of cases by age group and assuming probable reductions in those rates under interventions, we obtained projected epidemic curves of cases in addition to hospital admissions. We demonstrated that the longer our interventions were delayed, the higher the peak of hospital admissions. Although the approach relies on a simplistic model, the proposed framework can guide local government to secure the essential number of hospital beds for COVID-19 cases and formulate action plans.

scholarly journals The QuadMax Task: A Novel Parametric Manipulation of Associative Memory Load in Adults Across the Lifespan

2021 ◽  
Author(s):  
Ilana J. Bennett ◽  
Corinna Franco
Keyword(s):  
Older Adults ◽  
Associative Memory ◽  
Memory Load ◽  
Age Groups ◽  
Recognition Task ◽  
Memory Deficits ◽  
Memory Deficit ◽  
Age Group ◽  
Memory Errors ◽  
Younger Age

Whereas adults across the lifespan can accurately recognize previously encountered items, they are worse at remembering precisely which items were previously seen together, and this associative memory deficit is exacerbated in older adults. However, the literature is dominated by studies of pair-wise associations, with very few examinations of higher associative loads and none in older adults. In the present study, 190 adults (18-83 years) completed a novel recognition task in which they studied word pairs, triplets, and quadruplets and were later tested on their memory for repeated, recombined, and novel word sets. Results revealed significantly more incorrect responses to recombined sets that increased from pairs to triplets to quadruplets, with older age groups making significantly more of these associative memory errors than younger age groups. Participants also made significantly more correct responses to repeated pairs compared to triplets and quadruplets, but these recognition memory effects did not vary by age group. These findings replicate and extend the paired-associative memory literature by demonstrating that associative memory deficits increase both with demands on binding processes at higher associative loads and with aging. They further demonstrate the feasibility of manipulating and assessing associative memory load using our novel QuadMax task.

scholarly journals 92 Clinical Frailty Scoring Is Crucial For the COVID-19 Era and Beyond

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
L White ◽  
A Tyler ◽  
A Samji
Keyword(s):  
Critical Care ◽  
Mobile Application ◽  
Inpatient Mortality ◽  
Improvement Project ◽  
Nice Guideline ◽  
Number Of Patients ◽  
Nice Guidance ◽  
Observational Cohort ◽  
Audit Standard ◽  
Treatment Escalation

Abstract Introduction The COVID-19 pandemic placed a new focus on provision of clinical resources. With high mortality and limited capacity; appropriate decisions to escalate to critical care were vital for just resource allocation but also to prevent harm where interventions would not change outcomes. NICE guidance highlighted Clinical frailty scoring (CFS) as central to the decision-making process. 1, Despite initial criticism, recent evidence has confirmed increasing CFS as an independent risk factor to inpatient mortality in COVID-19.2 We conducted a quality improvement project with the aim of improving CFS documentation at the Royal Free Hospital. Methods We reviewed the notes of 71 inpatients over the age of 65 years from 6 wards on 08/05/20–12/05/20 for both a CFS score documentation and clear treatment escalation plan at time points of initial clerking, post-take and following ward admission with an audit standard of 100%. We developed teaching sessions, promoted the CFS mobile application, developed a post-take sticker and an elderly medicine ward admission proforma. We re-audited 66 inpatient notes from the same 6 wards from 25/06/20–07/07/20. Results Documentation.of CFS improved from 7% to 17% for clerking and post-take and from 13% to 24% on the ward admission. The number of patients with treatment escalation plans was 50%. Conclusion CFS is crucial for the COVID-19 era and beyond. We have demonstrated that increased awareness improves use of CFS, though it is not yet being widely used in escalation decisions. 1. Covid-19 Rapid guideline: Critical Care in adults. NICE guideline [NG159]: https://www.nice.org.uk/guidance/ng159 Accessed July 2020 2. Hewitt J et al (2020): The effect of frailty on survival in patients with COVID -19 (COPE): a multicentre, European, observational cohort study; The Lancet: https://doi.org/10.1016/ S2468–2667(20)30146–8.

Breast carcinoma in young females below the age of 35 years - histopathological and prognostic significance

1970 ◽  
Vol 2 (3) ◽  
pp. 198-202
Author(s):  
D Ghartimagar ◽  
A Ghosh ◽  
OP Talwar ◽  
R Narasimhan
Keyword(s):  
Breast Carcinoma ◽  
Young Women ◽  
Early Stage ◽  
Prognostic Significance ◽  
Age Group ◽  
Breast Cancers ◽  
Young Females ◽  
Younger Age ◽  
Grade 3 ◽  
Group Grade

Background: Breast cancers rarely occur in young women but are known to have more aggressive behaviors and poorer outcome. We here compare the significance of breast carcinoma in female below the age of 35 to the age over 35 whose specimens were submitted to Manipal teaching hospital, Pokhara. Materials and Methods: All cases of mastectomy with carcinoma from January 2000 to September 2011 were included in the study. Clinical and histopathological datas of all cases were reviewed and collated. Results: A total of 148 mastectomy specimens were received, among which, 23 cases (16%) were below 35 years; whereas 125 cases (84%) were above 35 years of age. In both groups, Stage II was the commonest stage but stage III was much more common in older group (33% versus 9%) and stage I was more common in younger age group (39% versus 27%). Bloom Richardson grading showed that in the older age group, grade 1 is the commonest grade (50%) while in the younger group; grade 3 is the commonest (39%). Patients were followed for a varying period of 6 months to 5 years. Two cases (2% of followed up cases) in older group and 3 cases (15% of followed up cases) in the younger group showed recurrence. Conclusion: Breast carcinoma in the patients younger than 35 years though presented at an early stage has higher grade tumor and poorer outcome. DOI: http://dx.doi.org/10.3126/jpn.v2i3.6021 JPN 2012; 2(3): 198-202

scholarly journals Even Pacing Is Associated with Faster Finishing Times in Ultramarathon Distance Trail Running—The “Ultra-Trail du Mont Blanc” 2008–2019

2020 ◽  
Vol 17 (19) ◽  
pp. 7074 ◽  
Author(s):  
Daniel Suter ◽  
Caio Victor Sousa ◽  
Lee Hill ◽  
Volker Scheer ◽  
Pantelis Theo Nikolaidis ◽  
...  
Keyword(s):  
General Linear Model ◽  
Performance Level ◽  
Age Group ◽  
Younger Age ◽  
Pacing Strategies ◽  
And Performance ◽  
Group Sex ◽  
The Impact ◽  
Trail Running ◽  
One Way Anova

In recent years, there has been an increasing number of investigations analyzing the effects of sex, performance level, and age on pacing in various running disciplines. However, little is known about the impact of those factors on pacing strategies in ultramarathon trail running. This study investigated the effects of age, sex, and performance level on pacing in the UTMB® (Ultra-trail du Mont Blanc) and aimed to verify previous findings obtained in the research on other running disciplines and other ultramarathon races. Data from the UTMB® from 2008 to 2019 for 13,829 race results (12,681 men and 1148 women) were analyzed. A general linear model (two-way analysis of variance (ANOVA)) was applied to identify a sex, age group, and interaction effect in pace average and pace variation. A univariate model (one-way ANOVA) was used to identify a sex effect for age, pace average, and pace variation for the fastest men and women. In our study, pace average and a steadier pace were positively correlated. Even pacing throughout the UTMB® correlated with faster finishing times. The average pace depended significantly on sex and age group. When considering the top five athletes in each age group, sex and age group also had significant effects on pace variation. The fastest women were older than the fastest men, and the fastest men were faster than the fastest women. Women had a higher pace variation than men. In male competitors, younger age may be advantageous for a successful finish of the UTMB®. Faster male runners seemed to be younger in ultramarathon trail running with large changes in altitude when compared to other distances and terrains.

scholarly journals Cognitive biases, environmental, patient and personal factors associated with critical care decision making: A scoping review

2021 ◽  
Author(s):  
Iris E. Beldhuis ◽  
Ramesh S. Marapin ◽  
You Yuan Jiang ◽  
Nádia F. Simões de Souza ◽  
Artemis Georgiou ◽  
...  
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Scoping Review ◽  
Cognitive Biases ◽  
Personal Factors ◽  
Factors Associated ◽  
Care Decision

scholarly journals 229 Sleep-wake behavior, meal timings and digital media duration of Indians during COVID-19 Lockdown

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A91-A92
Author(s):  
Babita Pande ◽  
Meenakshi Sinha ◽  
Ramanjan Sinha
Keyword(s):  
Digital Media ◽  
Sleep Duration ◽  
Sleep Onset ◽  
Therapeutic Management ◽  
Daily Routine ◽  
Age Group ◽  
Younger Age ◽  
Gender And Age ◽  
Delayed Sleep ◽  
The Impact

Abstract Introduction Lockdown and stay home order has been imposed on people in many countries including India to prevent the community transmission of COVID-19 pandemic. However this social restriction led to disturbed daily routine and lifestyle behaviour that is needed to be attended for proper therapeutic management of overall health during such crisis. The impact of lockdown on the most apparent behavioral changes viz. sleep-wake behaviour, major meal timings, and digital screen duration of Indians were investigated. In addition the effects of gender and age were explored. Methods After seeking permission from Ethical Institution, an online questionnaire based survey was circulated within India in the first week of May, 2020 for which total 1511 male and female (age ≥18 years) subjects participated. The sleep-wake behavior observed were sleep-wake timings, sleep duration, mid sleep time (MST) as function of lockdown, and social (lockdown) jetlag (SJL = MST before lockdown-MST during lockdown). Results The sleep onset-wakeup and meal times were significantly delayed during lockdown, which was more pronounced in younger age group. The sleep duration increased, specifically in young individuals during lockdown. Females showed more delayed sleep onset-waking times and first meal timing with longer sleep duration during lockdown. Increased digital media duration was observed in all age groups, primarily in males. The younger age group and specifically female reported higher SJL and delayed MST. A positive association was obtained between sleep duration & first meal time, and SJL & major meal timings/screen duration, and a significant negative relationship of sleep duration and SJL with age. Conclusion The study shows delayed sleep-wake schedule, meal timings and increased digital media duration among Indians during COVID-19 lockdown compared to before lockdown. Also, gender and age emerged as important mediating factors for this alteration. The pandemic has given opportunity to sleep more and compensate for the sleep. In spite of that, the higher social jetlag in young age group and female showed the compromised sleep and maladaption with societal timing. These findings have applied implications in sleep health during longer social isolation conditions and for proper therapeutic management. Support (if any) No

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