No abstract

Background and Aim: In the wave of COVID-19 pandemic, the whole world has come to a standstill. This led to a major setback for cancer patients jeopardizing their treatment plans. This study analyzes the coping mechanisms of running outpatient and inpatient palliative care services in these COVID-19 times – the New Normal. Materials and Methods: An observational study was conducted in the pain and palliative care unit at a tertiary care hospital, India. The data were collected from March 23, 2020, to May 22, 2020, of all patients coming to the clinic and inpatient referrals. Using manual and electronic records, demographic data was collected along with clinical data. Additional data were compiled with special attention to the patient's pain and its management. Results: Despite complete lockdown and initial low patient load, we saw a progressive increase in the number of patients coming to the clinic. A total of 108 patients visited our clinic (65 male and 43 female), of which 78% of the patients were from Delhi. The median age was 43.94 years (range 6 years to 76 years). We had 33 new and 75 old registered cases coming. The main reason was new-onset pain because of noncompliance of drugs; the opioid stock finished with the patient. We saw a very high number of patients requiring strong and weak opioids. Proper personal protection and social distancing helped in preventing crossinfection. None of our staff or patients fell ill during this time. Communication skills were modified to convey feelings and empathize patients. Telemedicine using phone and video calls was used and found to be useful. Conclusion: We share our experience and challenges of providing palliative care in our clinic which can be modified as per the individual requirements in other setups.

0.0009. Those referred in for end of life care was 27 vs 35. Of those that died during their admission there was no difference in the length of stay 12.2 vs 10.1 days, p=0.41. There was no significant difference in length of stay prior to starting the care and communication record, 9.4 vs 5.6 days, p=0.06. Conclusions Though there were no differences in numbers of admission during the COVID 19 pandemic. There were significant differences in the length of stay. It was thought that the those coming in during the pandemic were more likely to be coming in for end of life care but as no significant difference between length of stay of patients that died nor in how quickly they were started on the care and communication record this was not the case. This information should be considered when improving current discharge processes.

Background: Globally critically ill COVID-19 (Coronavirus disease-19) patients have stretched critical care services. This study was undertaken to find factors implicated in mortality amongst COVID positive and negative patients presenting with severe acute respiratory illness (SARI) and factors having the probability of indicating COVID positivity. Methods: The demographic parameters, comorbid illness, clinical parameters and laboratory values of 327 patients were retrospectively analyzed to find the risk factors for mortality in COVID positive and negative patients and factors predicting COVID positivity amongst SARI patients. Results: 58% of SARI patients tested positive by RTPCR. Most common comorbidities were diabetes and hypertension, 35.2% and 33% respectively. Duration of swelling and low haemoglobin were significantly associated with mortality in COVID positive group (p=0.01, 0.005). Acidosis and tachycardia (p=0.003, 0.034) were associated with mortality amongst COVID negative. Creatinine, Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) were higher in non-survivors of both groups (p<0.001). Age, history of contact or from containment zone, cough, pain abdomen and P/F ratio were significant predictors of COVID positivity (1.020(1.006–1.035); 3.889(1.316–11.495); 2.908(1.182–7.152); 2.147(1.149–4.012); 0.997(0.994-1.000) respectively) by multivariable regression analysis. Conclusion: A long duration of swelling and low haemoglobin (<12 g%) were responsible for COVID positive mortality while pain abdomen, raised levels of AST, tachycardia and acidosis were associated with mortality in COVID negative. Deranged creatinine, higher SOFA and qSOFA were associated with mortality in both groups. Age, contact history, residence in containment zone, cough, pain abdomen and poor P/F ratio are predictive factors for COVID positivity.