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  1. Article ; Online: Decision-Making in COVID-19 and Frailty.

    Moug, Susan / Carter, Ben / Myint, Phyo Kyaw / Hewitt, Jonathan / McCarthy, Kathryn / Pearce, Lyndsay

    Geriatrics (Basel, Switzerland)

    2020  Volume 5, Issue 2

    Abstract: We write in response to the COVID-19 pandemic and the important recognition of co-existing frailty ... COVID-19 rapid guideline: critical care in adults; NICE NG159] [...]. ...

    Abstract We write in response to the COVID-19 pandemic and the important recognition of co-existing frailty [COVID-19 rapid guideline: critical care in adults; NICE NG159] [...].
    Keywords covid19
    Language English
    Publishing date 2020-05-06
    Publishing country Switzerland
    Document type Editorial
    ISSN 2308-3417
    ISSN (online) 2308-3417
    DOI 10.3390/geriatrics5020030
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Decision-making in COVID-19 and frailty

    Moug, Susan / Carter, Ben / Myint, Phyo Kyaw / Hewitt, Jonathan / McCarthy, Kathryn / Pearce, Lyndsay

    2020  

    Abstract: No abstract available. ...

    Abstract No abstract available.
    Keywords covid19
    Language English
    Publishing date 2020-05-06
    Publisher MDPI
    Publishing country uk
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article: Decision-Making in COVID-19 and Frailty

    Moug, Susan / Carter, Ben / Myint, Phyo Kyaw / Hewitt, Jonathan / McCarthy, Kathryn / Pearce, Lyndsay

    Abstract: We write in response to the COVID-19 pandemic and the important recognition of co-existing frailty ... COVID-19 rapid guideline: critical care in adults; NICE NG159] [...]. ...

    Abstract We write in response to the COVID-19 pandemic and the important recognition of co-existing frailty [COVID-19 rapid guideline: critical care in adults; NICE NG159] [...].
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #186577
    Database COVID19

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  4. Article ; Online: Decision-Making in COVID-19 and Frailty

    Susan Moug / Ben Carter / Phyo Kyaw Myint / Jonathan Hewitt / Kathryn McCarthy / Lyndsay Pearce

    Geriatrics, Vol 5, Iss 30, p

    2020  Volume 30

    Abstract: We write in response to the COVID-19 pandemic and the important recognition of co-existing frailty ... COVID-19 rapid guideline: critical care in adults; NICE NG159] [.] ...

    Abstract We write in response to the COVID-19 pandemic and the important recognition of co-existing frailty [COVID-19 rapid guideline: critical care in adults; NICE NG159] [.]
    Keywords n/a ; Geriatrics ; RC952-954.6 ; covid19
    Language English
    Publishing date 2020-05-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Book ; Online: Decision-Making in COVID-19 and Frailty

    Susan Moug / Ben Carter / Phyo Kyaw Myint / Jonathan Hewitt / Kathryn McCarthy / Lyndsay Pearce

    Geriatrics ; Volume 5 ; Issue 2

    2020  

    Abstract: We write in response to the COVID-19 pandemic and the important recognition of co-existing frailty ... COVID-19 rapid guideline: critical care in adults ... NICE NG159] [.] ...

    Abstract We write in response to the COVID-19 pandemic and the important recognition of co-existing frailty [COVID-19 rapid guideline: critical care in adults

    NICE NG159] [.]
    Keywords n/a ; covid19
    Language English
    Publishing date 2020-05-06
    Publisher Multidisciplinary Digital Publishing Institute
    Publishing country ch
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Decision-making in COVID-19 and frailty

    Moug, Susan / Carter, Ben / Myint, Phyo Kyaw / Hewitt, Jonathan / McCarthy, Kathryn / Pearce, Lyndsay

    2020  

    Abstract: We write in response to the COVID-19 pandemic and the important recognition of co-existing frailty ... on COVID-19, we would like to highlight some points to consider when making clinical decisions based ... COVID-19 rapid guideline: critical care in adults; NICE NG159] [1]. There is no doubt that difficult ...

    Abstract We write in response to the COVID-19 pandemic and the important recognition of co-existing frailty [COVID-19 rapid guideline: critical care in adults; NICE NG159] [1]. There is no doubt that difficult decisions have been made and are continuing to be made across the UK. These decisions will become increasingly difficult with the continued narrowing of the clinical criteria for the escalation of treatment, as has been seen in other countries globally. Frailty has been placed at the forefront, with professional associations responding to the NICE NG159 by proposing a frailty score as part of the clinical assessment [2]. There is no doubt that increasing frailty (irrespective of the scale or score applied) is associated with poorer outcomes in both medical and surgical patients, with increased ITU admissions, prolonged length of stay, increased care needs on discharge and mortality all reported [3,4]. However, these studies were not performed during a viral pandemic and while we, like all clinicians, await published evidence on COVID-19, we would like to highlight some points to consider when making clinical decisions based on frailty
    Keywords covid19
    Language English
    Publishing date 2020-06-30
    Publisher MDPI AG
    Publishing country uk
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: Decision-making in COVID-19 and Frailty

    Moug, Susan / Carter, Ben / Myint, Phyo Kyaw / Hewitt, Jonathan / McCarthy, Kathryn / Pearce, Lyndsay

    2020  

    Abstract: Peer reviewed ... Publisher ... ...

    Abstract Peer reviewed

    Publisher PDF
    Keywords R Medicine ; R ; covid19
    Language English
    Publishing country uk
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article ; Online: End-of-life decision-making in critically ill old patients with and without coronavirus disease 2019.

    Syrous, Alma Nordenskjöld / Gudnadottir, Gudny / Oras, Jonatan / Ferguson, Thalia / Lilja, David / Odenstedt Herges, Helena / Larsson, Emma / Block, Linda

    Acta anaesthesiologica Scandinavica

    2023  Volume 68, Issue 1, Page(s) 63–70

    Abstract: ... in critically ill patients with and without coronavirus disease 2019 (COVID-19). This study aimed to investigate ... Results: There were 394 patients included in this study, 131 in the non-COVID-19 group and 263 ... in the COVID-19 group. For the non-COVID-19 cohort, the univariate analysis demonstrated that age and SAPS 3 ...

    Abstract Background: There are few studies on the differences in end-of-life decisions making in critically ill patients with and without coronavirus disease 2019 (COVID-19). This study aimed to investigate the independent factors that predicted the decision to withdraw or withhold life-sustaining treatments (LST) in critically ill patients and if these decisions were based on different variables for critically ill patients with COVID-19 compared to those for critically ill patients with other diagnoses in a Swedish intensive care unit.
    Methods: This observational pilot study was performed at Sahlgrenska University Hospital, Gothenburg, Sweden. Patients ≥65 years were included from 1 March 2020 to 30 April 2021. The association between a decision to limit LST and a priori selected variables including sex, age, Simplified Acute Physiology Score 3 (SAPS 3), Clinical Frailty Scale ≥4, Charlson Comorbidity Index, Body Mass Index, living at home, invasive and non-invasive mechanical ventilation was assessed using a univariate and multivariable logistic regression model and presented as odds ratio with corresponding 95% confidence intervals.
    Results: There were 394 patients included in this study, 131 in the non-COVID-19 group and 263 in the COVID-19 group. For the non-COVID-19 cohort, the univariate analysis demonstrated that age and SAPS 3 were significantly associated with the decision to withdraw or withhold life-sustaining treatments, and this association remained in the multivariable analysis, with odds ratios of 1.10 (1.03-1.19) p = .009 and 1.06 (1.03-1.10) p < .001, respectively. For the COVID-19 cohort, the univariate analysis indicated that age, SAPS 3, and Charlson comorbidity index were significantly associated with the decision to withdraw or withhold life-sustaining treatments. However, in multivariable analysis, only the Charlson comorbidity index remained independently associated with the decision to withdraw or withhold life-sustaining treatments, with an odds ratio of 1.26 (1.07-1.49), p = .006.
    Conclusion: Decisions to withdraw or withhold life-sustaining treatments were based on other variables for the critically ill COVID-19 cohort compared to those for the critically ill non-COVID-19 cohort. Further studies are warranted to forge a common path for ethical end-of-life decision-making in critically ill patients.
    MeSH term(s) Humans ; COVID-19/therapy ; Critical Illness/therapy ; Death ; Intensive Care Units ; Withholding Treatment ; Pilot Projects
    Language English
    Publishing date 2023-09-05
    Publishing country England
    Document type Observational Study ; Journal Article
    ZDB-ID 80002-8
    ISSN 1399-6576 ; 0001-5172
    ISSN (online) 1399-6576
    ISSN 0001-5172
    DOI 10.1111/aas.14326
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Patients' views on the decision to investigate cancer symptoms in older adults: a qualitative interview study in primary care.

    Jones, Daniel / Ali, Omer M / Honey, Stephanie / Surr, Claire / Scott, Suzanne / De Wit, Niek / Neal, Richard D

    The British journal of general practice : the journal of the Royal College of General Practitioners

    2023  Volume 73, Issue 733, Page(s) e597–e604

    Abstract: ... on age or subjective assessments of frailty. Shared decision making and being involved ... experience of cancer investigations, and the impact of the COVID-19 pandemic on the diagnostic pathway. Older ... included the patients' process of decision making, the value of having a diagnosis, the patients' ...

    Abstract Background: Cancer is predominantly a disease of older adults. To date there has been little research on the experiences of older adults or their views on the diagnostic pathway.
    Aim: To gain an improved understanding of the views and experiences of older adults on all aspects of cancer investigation.
    Design and setting: This was a qualitative study using semi-structured interviews with patients aged ≥70 years. Patients were recruited from primary care in West Yorkshire, UK.
    Method: Data were analysed using a thematic framework analysis.
    Results: The themes identified in participants' accounts included the patients' process of decision making, the value of having a diagnosis, the patients' experience of cancer investigations, and the impact of the COVID-19 pandemic on the diagnostic pathway. Older adults in this study indicated a clear preference for having clarity on the cause of symptoms and the diagnosis, even in the face of unpleasant investigations. Patients suggested they wanted to be involved in the decision process.
    Conclusion: Older adults who present to primary care with symptoms suggestive of cancer may accept diagnostic testing solely for the benefit of knowing the diagnosis. There was a clear patient preference that referrals and investigations for cancer symptoms should not be deferred or delayed based on age or subjective assessments of frailty. Shared decision making and being involved in the decision-making process are important to patients, regardless of age.
    MeSH term(s) Humans ; Aged ; Pandemics ; COVID-19/diagnosis ; Neoplasms/diagnosis ; Qualitative Research ; Primary Health Care ; Decision Making
    Language English
    Publishing date 2023-07-27
    Publishing country England
    Document type Journal Article
    ZDB-ID 1043148-2
    ISSN 1478-5242 ; 0035-8797 ; 0960-1643
    ISSN (online) 1478-5242
    ISSN 0035-8797 ; 0960-1643
    DOI 10.3399/BJGP.2022.0622
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.B 576: Show issues Location:
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  10. Article ; Online: Who to escalate during a pandemic? A retrospective observational study about decision-making during the COVID-19 pandemic in the UK.

    Beresford, Stephanie / Tandon, Aditi / Farina, Sofia / Johnston, Brian / Crews, Maryam / Welters, Ingeborg Dorothea

    Emergency medicine journal : EMJ

    2023  Volume 40, Issue 8, Page(s) 549–555

    Abstract: ... in two separate COVID-19 surges based on the escalation decision made by the treating physician ... remains unclear. We compared age, Clinical Frailty Score (CFS), 4C Mortality Score and hospital mortality ... CFS, 4C Mortality Score and hospital mortality were compared depending on the escalation decision made ...

    Abstract Background: Optimal decision-making regarding who to admit to critical care in pandemic situations remains unclear. We compared age, Clinical Frailty Score (CFS), 4C Mortality Score and hospital mortality in two separate COVID-19 surges based on the escalation decision made by the treating physician.
    Methods: A retrospective analysis of all referrals to critical care during the first COVID-19 surge (cohort 1, March/April 2020) and a late surge (cohort 2, October/November 2021) was undertaken. Patients with confirmed or high clinical suspicion of COVID-19 infection were included. A senior critical care physician assessed all patients regarding their suitability for potential intensive care unit admission. Demographics, CFS, 4C Mortality Score and hospital mortality were compared depending on the escalation decision made by the attending physician.
    Results: 203 patients were included in the study, 139 in cohort 1 and 64 in cohort 2. There were no significant differences in age, CFS and 4C scores between the two cohorts. Patients deemed suitable for escalation by clinicians were significantly younger with significantly lower CFS and 4C scores compared with patients who were not deemed to benefit from escalation. This pattern was observed in both cohorts. Mortality in patients not deemed suitable for escalation was 61.8% in cohort 1 and 47.4% in cohort 2 (p<0.001).
    Conclusions: Decisions who to escalate to critical care in settings with limited resources pose moral distress on clinicians. 4C score, age and CFS did not change significantly between the two surges but differed significantly between patients deemed suitable for escalation and those deemed unsuitable by clinicians. Risk prediction tools may be useful in a pandemic to supplement clinical decision-making, even though escalation thresholds require adjustments to reflect changes in risk profile and outcomes between different pandemic surges.
    MeSH term(s) Humans ; COVID-19 ; Retrospective Studies ; Pandemics ; Hospitalization ; United Kingdom
    Language English
    Publishing date 2023-06-16
    Publishing country England
    Document type Observational Study ; Journal Article
    ZDB-ID 2040124-3
    ISSN 1472-0213 ; 1472-0205
    ISSN (online) 1472-0213
    ISSN 1472-0205
    DOI 10.1136/emermed-2022-212505
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