Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

A study of job satisfaction levels of staff nurses working in prison physical health teams

Aim: This dissertation will investigate job satisfaction of band 5 staff nurses within physical health teams in prisons in England. This will be a primary research study and will identify overall job satisfaction levels of nurses; and the key contributing factors to job satisfaction. Background: Recruitment and retention is becoming increasingly more difficult both locally and at other prisons in England. This is especially in the case of registered adult nurses employed as staff nurses. Recruitment and retention of nurses within prisons will continue to be of concern as recruitment issues within nursing exist nationally as well as within health and justice. Nursing shortage is not only isolated to the UK, this is a concern internationally and is strongly linked to job satisfaction. Methods: This dissertation is a mixed method primary research study which will utilise a combination of quantitative and qualitative research methods collating data through a combination of questionnaires and 1:1 interviews. A mixed method approach was chosen to provide complementary insights lead to the identification of new problems and possible solutions utilising qualitative methods to contextualise quantitative results (Chan, 2001). The Index of Work Satisfaction (IWS) part B (Stamps, 1997) is a commonly used tool for measuring job satisfaction. The tool which is a reliable and consistent data was used to establish areas of good or poor satisfaction within six components relating to job satisfaction. The qualitative element of the primary research was conducted using semi structured interviewing based upon the six components within the questionnaire; pay, autonomy, task requirements, professional status, interaction, and organisational policy. Transcripts of the interviews were thematically analysed for themes and sub themes. Results: The quantitative methodology utilised a questionnaire of 44 items from the IWS part B, representing statements about the degree of job satisfaction the participants have in their role as band 5 staff nurses. The responses were descriptively analysed using the IWS hand book (Moyer, 2009). The level of job satisfaction amongst band 5 nurses working in prison physical health teams was 3.4 out of a possible score of 5. The higher the mean score the higher the level of job satisfaction (Wai-Tong and Yick, 2016). The variables with the highest bearing of job satisfaction were interaction, both nurse- nurse and nurse- doctor and also professional status. The lowest ranked component suggesting the least levels of satisfaction was pay. Thematic analysis of the transcripts of four interviews utilising a method advised by Braun and Clark (2006) revealed 102 significant statements. 43 sub themes that were identified from the significant statements. 20 of these subthemes could be associated motivational factors influencing job satisfaction; 23 of the sub themes identified demotivational factors. From the subthemes five themes emerged which allowed the depiction of the key impacts upon job satisfaction to band 5 prison nurses. These themes were professional relationships; caring environment; benefits, and rewards; responsibility, autonomy, and professional growth; and coordination management and leadership. Conclusion: The results from this primary research study were coherent with previous literature in this field; the research concluded that Band 5 prison nurses are moderately satisfied with their jobs, this is in line with nurses’ levels of job satisfaction internationally. The research found interaction is a factor which for nurses in all areas positively contributes to job satisfaction. The research concluded that collaboration with doctors, supportive practice environments, supportive managers and levels of autonomy granted by managers were factors prison nurses felt contributed positively towards job satisfaction. Professional status despite being a higher mean score in the quantitative research is a cause for concerns for nurses in prisons as they feel they are not respected by patients, external healthcare providers or prison staff. Prison nurses are happy with the variety and nature of their tasks and do enjoy patient face to face interaction however they fell they lack time to give the holistic care that they aspire to due to the conflicting regime of the prison. Pay is an issue for nurses internationally and not specific to prison nursing, although some nurses feel that they should get more pay for working in a perceived higher risk environment. Implications for practice: Job satisfaction levels Impact upon recruitment and retention according to O’Keeffe (2015) therefore it is important for managers to find ways to improve job satisfaction levels for band 5 nurses working within prisons. The factors which are found to be contributing to the higher levels of job satisfaction such as interaction, professional status and autonomy need to be maintained. Nurse managers need to open up communication amongst health professionals encourage interaction and collaboration. Improving relationships with prison staff to promote the healthcare team, increasing respect for nurses therefore allowing nurses to feel they are supported to do their job. Access to continuing professional development is seen as an alternative to economic remuneration, there should also be opportunities for more feedback of a positive nature from patients and families. Limitations and Future Research: 1. The sample was a convenience sample; 2. The sample group was small; 3. Responses were only received from one category of prison. Due to the very small response for both the quantitative and qualitative parts of the research. As this primary research study designed has been designed so that it can be replicated by anyone, this dissertation can be utilised as a pilot study that could be repeated in order to increase understanding of job satisfaction in prison nursing further still

Identifying the Causes of Unexplained Dyspnea at High Altitude Using Normobaric Hypoxia with Echocardiography

Exposure to high altitude results in hypobaric hypoxia, leading to physiological changes in the cardiovascular system that may result in limiting symptoms, including dyspnea, fatigue, and exercise intolerance. However, it is still unclear why some patients are more susceptible to high-altitude symptoms than others. Hypoxic simulation testing (HST) simulates changes in physiology that occur at a specific altitude by asking the patients to breathe a mixture of gases with decreased oxygen content. This study aimed to determine whether the use of transthoracic echocardiography (TTE) during HST can detect the rise in right-sided pressures and the impact of hypoxia on right ventricle (RV) hemodynamics and right to left shunts, thus revealing the underlying causes of high-altitude signs and symptoms. A retrospective study was performed including consecutive patients with unexplained dyspnea at high altitude. HSTs were performed by administrating reduced FiO2 to simulate altitude levels specific to patients’ history. Echocardiography images were obtained at baseline and during hypoxia. The study included 27 patients, with a mean age of 65 years, 14 patients (51.9%) were female. RV systolic pressure increased at peak hypoxia, while RV systolic function declined as shown by a significant decrease in the tricuspid annular plane systolic excursion (TAPSE), the maximum velocity achieved by the lateral tricuspid annulus during systole (S’ wave), and the RV free wall longitudinal strain. Additionally, right-to-left shunt was present in 19 (70.4%) patients as identified by bubble contrast injections. Among these, the severity of the shunt increased at peak hypoxia in eight cases (42.1%), and the shunt was only evident during hypoxia in seven patients (36.8%). In conclusion, the use of TTE during HST provides valuable information by revealing the presence of symptomatic, sustained shunts and confirming the decline in RV hemodynamics, thus potentially explaining dyspnea at high altitude. Further studies are needed to establish the optimal clinical role of this physiologic method

Improving community-based fisheries management in Pacific island countries

Inshore fisheries are central to the rural economies and food supply of Pacific Island Countries (PICs), supplying food and serving as one of the few sources of cash for rural people. These fisheries are crucial elements in filling the shortfall in fish supply predicted to confront many PICs in the coming decades. No other production sector can fill the shortfall in supply in the medium term so securing a sustainable supply of fish from coastal fisheries is crucial

Key considerations for patient and public involvement and engagement in health research

Patient and public involvement and engagement (PPIE) can provide valuable insights into the experiences of those living with and affected by a disease or health condition. Inclusive collaboration between patients, the public and researchers can lead to productive relationships, ensuring that health research addresses patient needs. Guidelines are available to support effective PPIE; however, evaluation of the impact of PPIE strategies in health research is limited. In this Review, we evaluate the impact of PPIE in the ‘Therapies for Long COVID in non-hospitalised individuals’ (TLC) Study, using a combination of group discussions and interviews with patient partners and researchers. We identify areas of good practice and reflect on areas for improvement. Using these insights and the results of a survey, we synthesize two checklists of considerations for PPIE, and we propose that research teams use these checklists to optimize the impact of PPIE for both patients and researchers in future studies.</p

Therapies for Long COVID in non-hospitalised individuals: from symptoms, patient-reported outcomes and immunology to targeted therapies (The TLC Study).

INTRODUCTION Individuals with COVID-19 frequently experience symptoms and impaired quality of life beyond 4-12 weeks, commonly referred to as Long COVID. Whether Long COVID is one or several distinct syndromes is unknown. Establishing the evidence base for appropriate therapies is needed. We aim to evaluate the symptom burden and underlying pathophysiology of Long COVID syndromes in non-hospitalised individuals and evaluate potential therapies. METHODS AND ANALYSIS A cohort of 4000 non-hospitalised individuals with a past COVID-19 diagnosis and 1000 matched controls will be selected from anonymised primary care records from the Clinical Practice Research Datalink, and invited by their general practitioners to participate on a digital platform (Atom5). Individuals will report symptoms, quality of life, work capability and patient-reported outcome measures. Data will be collected monthly for 1 year.Statistical clustering methods will be used to identify distinct Long COVID-19 symptom clusters. Individuals from the four most prevalent clusters and two control groups will be invited to participate in the BioWear substudy which will further phenotype Long COVID symptom clusters by measurement of immunological parameters and actigraphy.We will review existing evidence on interventions for postviral syndromes and Long COVID to map and prioritise interventions for each newly characterised Long COVID syndrome. Recommendations will be made using the cumulative evidence in an expert consensus workshop. A virtual supportive intervention will be coproduced with patients and health service providers for future evaluation.Individuals with lived experience of Long COVID will be involved throughout this programme through a patient and public involvement group. ETHICS AND DISSEMINATION Ethical approval was obtained from the Solihull Research Ethics Committee, West Midlands (21/WM/0203). Research findings will be presented at international conferences, in peer-reviewed journals, to Long COVID patient support groups and to policymakers. TRIAL REGISTRATION NUMBER 1567490