Characteristics, symptom management and outcomes in Covid-19 patients referred to palliative care in a tertiary hospital: A retrospective observational study

INTRODUCTION

Coronavirus disease 2019 (COVID-19) variants pose unique challenges with inevitable premature death when cases of severe disease exponentially rise in a healthcare system. It is imperative that palliative care is provided with a proactive approach to symptom recognition, assessment, management and treatment escalation to ensure comfort throughout the course of this illness.

OBJECTIVES

To evaluate the characteristics, symptom burden, palliative care management and outcomes of COVID-19 patients referred to a palliative care unit (PCU) in a single tertiary hospital. Clinical outcomes specifically observed the management of agitation in these patients based on their Richmond Agitation and Sedation Scale (RASS) scores.

METHODS

A retrospective observational study was conducted in a tertiary hospital by reviewing electronic medical records and extracting data from 1st June 2021to 31st July 2021 of all COVID-19 patients referred to the PCU.

RESULTS

A cohort of 154 (75 males, 79 females) COVID-19 patients was referred to the PCU with a mean age of 67 (20- 95) years. The median number of days of COVID-19 illness before referral was 7(4-11), with 79.3% of patients being in categories 4 and 5. The median duration of the PCU involvement was 4(1-24) days; 74% of families were engaged in virtual platform communication. The most prevalent symptoms were dyspnoea (73.4%) and agitation (41.6%). Common medications used were opioids, antipsychotics and benzodiazepines. Among agitated patients, none had RASS scores above +2 in the last encounter. Palliative care doctors in the team reported complete effectiveness in patient's symptom control in 74% of patients.

CONCLUSIONS

A hallmark of severe COVID-19 is rapid deterioration, which calls for proactive assessment and urgent palliation. Breathlessness and agitation are priority symptoms to address. Among agitated patients, benzodiazepines and antipsychotics are highly effective in addressing agitation and reducing RASS scores. Communication with families using virtual platforms is effective in providing a supportive presence and closure when face-to-face communication is not possible.

Preparation and Catalytic Properties of Amphiphilic Copolymer-Stabilized Platinum Metals Colloids

Several metal colloids stabilized by an amphiphilic copolymer, poly(1-vinylpyrrolidone-co-acrylic acid) (abbreviated as PVPAA), were prepared by refluxing alcohol-water mixed solutions of the corresponding metal precursors. They had small particle sizes and narrow size distributions. Their catalytic activity was tested by hydrogenation of cyclooctene, 1-dodecene, and ortho-chloronitrobenzene (o-CNB). With the introduction of nickel(II) ions to a PVPAA-stabilized platinum catalytic system, selective hydrogenation of o-CNB to ortho-chloroaniline (o-CAN) with 97.1% selectivity and 100% conversion was obtained. Copyright 2000 Academic Press.