Delirium is a common clinical manifestation of SARS-CoV-2 (COVID-19) in older inpatients. We assessed the prevalence of delirium in inpatients aged over 65 years with confirmed COVID-19 infection to identify its clinical correlations and association with in-hospital mortality and admission duration. Data were extracted retrospectively from electronic health records. The prevalence of delirium was found to be 23.9% (158 out of 662 patients). Factors associated with delirium included older age, dementia (including cases of suspected dementia), frailty and concurrent infection. Delirium was not associated with higher mortality. Admission duration was approximately 1.5 times longer in patients who experienced delirium (median 14 days; interquartile range (IQR) 8-30) compared with those who did not (median 9 days; IQR 5-17; p<0.001). We confirmed that delirium is common in older inpatients with COVID-19 and has significant implications for patient care and planning services and rehabilitation.
BackgroundGeneral Practices in England have continued to care for patients throughout the Covid-19 pandemic by instigating major changes to service delivery. Immunisations have continued, though the number of vaccines delivered initially dropped in April 2020.AimEvaluate how Covid-19 impacted the delivery of immunisations in London and identify innovative practices to inform future delivery, including for Covid-19 vaccines.Design & settingA mixed-methods study of immunisation delivery in London.MethodAn online survey of London General Practices was undertaken in May 2020 to produce a descriptive analysis of childhood immunisation delivery and identify innovative delivery models. Semi-structured interviews were conducted between August and November 2020 to explore innovative immunisation models which were analysed thematically.Results68% (n=830) of London practices completed the survey and 97% reported having continued childhood immunisation delivery. Common delivery adaptations included spaced-out appointments, calling parents beforehand and having only one parent attend. Forty-three practices were identified as having innovative models such as delivering immunisations outside practice buildings or offering drive-through services. The thematic analysis of fourteen semi-structured interviews found that, alongside adaptations to immunisation delivery within practices, existing local networks collaborated to establish new immunisation delivery models. Local population characteristics affected delivery and provide insights for large-scale vaccine deployment.ConclusionImmunisations continued during 2020 with practices adapting existing services. New delivery models were developed by building on existing local knowledge, experiences and networks. Immunisation delivery during the pandemic, including for Covid-19 vaccines, should be tailored to local population needs by building on primary care immunisation expertise.
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