The impact of COVID-19 critical illness on new disability, functional outcomes and return to work at 6 months: a prospective cohort study

Background: There are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months. Methods: In a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5LTM. Results: Of 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51–70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06–13.77]; p < 0.001). Thirteen (11.4%) survivors had not returned to work due to poor health. There was a decrease in the EQ-5D-5LTM utility score (MD, − 0.19 [− 0.28 to − 0.10]; p < 0.001). At 6 months, 82 of 115 (71.3%) patients reported persistent symptoms. The independent predictors of death or new disability were higher severity of illness and increased frailty. Conclusions: At six months after COVID-19 critical illness, death and new disability was substantial. Over a third of survivors had new disability, which was widespread across all areas of functioning.Carol L. Hodgson, Alisa M. Higgins, Michael J. Bailey, Anne M. Mather, Lisa Beach, Rinaldo Bellomo, Bernie Bissett, Ianthe J. Boden, Scott Bradley, Aidan Burrell, D. James Cooper, Bentley J. Fulcher, Kimberley J. Haines, Jack Hopkins, Alice Y. M. Jones, Stuart Lane, Drew Lawrence, Lisa van der Lee, Jennifer Liacos, Natalie J. Linke, Lonni Marques Gomes, Marc Nickels, George Ntoumenopoulos, Paul S. Myles, Shane Patman, Michelle Paton, Gemma Pound, Sumeet Rai, Alana Rix, Thomas C. Rollinson, Janani Sivasuthan, Claire J. Tipping, Peter Thomas, Tony Trapani, Andrew A. Udy, Christina Whitehead, Isabelle T. Hodgson, Shannah Anderson, Ary Serpa Neto, and The COVID-Recovery Study Investigators and the ANZICS Clinical Trials Grou

Look after they leap : illustrating the value of retrospective reports in employee turnover

The prevailing methodology for studying employee turnover is limited because it emphasizes prediction rather than understanding. This paper critiques this methodology and draws out the implications of an alternative: retrospective self-reporting, by actual leavers. Retrospective self-reporting has three main advantages. First, it allows direct assessment of actual incidents of turnover, so interventions can be informed by accounts of real events, instead of being based on inference. Second, it offers insight into the dynamic character of decisions to quit, which are often unpredictable or precipitated by sudden events. Third, it allows for assessment of the role of non-work factors. This makes a methodological contribution, allowing greater insight into the decision to quit, which is ontologically, socially and dynamically complex. It has implications for how we construe and manage turnover. The argument is illustrated by a recent study of 352 UK National Health Service nurse leavers but has wider implications for turnover in the public sector

The perceived barriers and facilitators to implementation of ECMO services in acute hospitals

LetterBentley J. Fulcher, Angus J. Nicholson, Natalie J. Linke, Danielle Berkovic, Carol L. Hodgson on behalf of the EXCEL Study Investigators and the International ECMO Networ