Clinical medicine (London, England)
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Palliative care is an important component of the medical response to pandemics and other health emergencies. The principles of palliative care do not change, but the practice of palliative care has to change as a result of factors such as greater demand and infection control measures. This article makes suggestions for palliative care provision during a pandemic (in developed countries), based on a limited review of the literature and personal experience of the ongoing pandemic (COVID-19 infection).
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As the UK shields 'high risk' patients and enforces social distancing measures, patients will be at risk of significantly reducing physical activity levels. We explore the evidence base for COVID-19-specific recommendations and exercise interventions to 'precondition' patients prior to infection and appraise the role of maximal oxygen uptake (VO2 max) as a risk-stratifying triage tool. We conclude that structured exercise programmes can be used to maintain physical activity levels and prevent deconditioning and that VO2 max has the potential to be used as a clinically relevant triage tool during the COVID-19 outbreak.
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There has been the need to make major modifications to the way cardiology is practised in light of the COVID-19 pandemic. There has also been the need to recognise the complex cardiovascular manifestations and complications of COVID-19. ⋯ There is also a focus on indications and interpretation of commonly performed cardiac investigations in the setting of COVID-19. References are included from a number of specialist societies and groups.
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Tragically, many of the infections and deaths recorded in the global coronavirus disease 2019 (COVID-19) pandemic have occurred in healthcare workers. Some have attributed this to inadequate provision of personal protective equipment (PPE). ⋯ Despite recent revisions to these guidelines, concerns remain that they offer insufficient protection to frontline NHS healthcare workers. In this report, we evaluate whether these concerns are merited, through critical appraisal of the available evidence, review of international PPE guidance, and consideration of the ethical implications.
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The coronavirus disease of 2019 (COVID-19) pandemic has placed many healthcare systems, including the NHS, under unprecedented pressure. Mortality appears to be highest among older people and those with comorbidities, who are also often the most at risk of undernutrition in society. Despite international efforts to identify a specific treatment, therapy remains supportive and is principally focused on optimising respiratory function. ⋯ This piece outlines why nutritional status may be particularly compromised during this crisis, among both the population and hospital inpatients. Practical steps to improve nutritional status at a time when hospital services are particularly stretched are also considered. Finally, the case is made for behaviour change at all levels including government, the general population and healthcare professionals.