Emergency Department Use by Young Adults With Chronic Illness Before and During the COVID-19 Pandemic

The Necessity of Palliative Care Interventions in Emergency Departments: A Literature Review

Palliative care, a beacon of relief and comfort, ensures the best quality of life for patients nearing death, a patient population that often presents to emergency departments, by providing interventions to promote comfort and support final wishes. The purpose of this literature review was to examine the outcomes of palliative care interventions for adult patients with chronic illnesses who have died in emergency departments. The literature review was conducted in CINAHL, PubMed, SCOPUS, OVID, and APA Psych using the keywords "palliative," "emergency department," "adult," and "chronic disease." The search was limited to English language publications with no date limits and performed according to Preferred Reporting Items for Systematic reviews and Meta-Analysis statement standards. The search yielded 531 articles, with 226 duplicates excluded. After a review, only 16 articles met the inclusion criteria. Common interventions included implementing screening tools, enhancing communication skills, providing end-of-life care education, and health record alerts for palliative care criteria. This review highlights how critical palliative care interventions are needed in emergency departments. The inevitability of seriously ill patients presenting to emergency departments underscores the urgency and importance of palliative care interventions, leading to increased comfort and decreasing distressing symptoms experienced by dying patients.

Shift in emergency department utilization by frequent attendees with sickle cell disease during the COVID-19 pandemic: A multicentre cohort study

While the coronavirus disease-2019 (COVID-19) might have increased acute episodes in people living with sickle cell disease (SCD), it may also have changed their reliance on emergency department (ED) services. We assessed the impact of the COVID-19 pandemic and lockdowns on ED visits in adult SCD people followed in five French reference centres, with a special focus on 'high users' (≥10 visits in 2019). We analysed the rate of ED visits from 1 January 2015 to 31 December 2021, using a self-controlled case series. Among 1530 people (17 829 ED visits), we observed a significant reduction in ED visits during and after lockdowns, but the effect vanished over time. Compared to pre-pandemic, incidence rate ratios for ED visits were 0.59 [95% CI 0.52-0.67] for the first lockdown, 0.66 [95% CI 0.58-0.75] for the second and 0.85 [95% CI 0.73-0.99] for the third. High users (4% of people but 33.7% of visits) mainly drove the reductions after the first lockdown. COVID-19 lockdowns were associated with reduced ED visits. While most people returned to their baseline utilization by April 2021, high users had a lasting decrease in ED visits. Understanding the factors driving the drop in ED utilization among high users might inform clinical practice and health policy.

The impact of the COVID-19 pandemic and associated disruptions in health-care provision on clinical outcomes in people with diabetes: a systematic review

The COVID-19 pandemic triggered disruptions to health care and lifestyles that could conceivably impact diabetes management. We set out to identify the impact of disruptions caused by COVID-19 on clinical outcomes in people with diabetes. We performed a systematic review of the available literature in the MEDLINE and OVID databases from Jan 1, 2020, to June 7, 2023, and included 138 studies (n>1 000 000 people). All but five studies were judged to be at some risk of bias. All studies compared prepandemic with pandemic periods. All-cause mortality (six studies) and diabetes-related mortality (13 studies) showed consistent increases, and most studies indicated increases in sight loss (six studies). In adult and mixed samples, data generally suggested no difference in diabetic ketoacidosis frequency or severity, whereas in children and adolescents most studies showed increases with some due to new-onset diabetes (69 studies). Data suggested decreases in hospital admissions in adults but increases in diabetes-related admissions to paediatric intensive care units (35 studies). Data were equivocal on diabetic foot ulcer presentations (nine studies), emergency department admissions (nine studies), and overall amputation rates (20 studies). No studies investigated renal failure. Where reported, the impact was most pronounced for females, younger people, and racial and ethnic minority groups. Further studies are needed to investigate the longer-term impact of the pandemic and the on potential differential impacts, which risk further exacerbating existing inequalities within people with diabetes.