Risultati per: Le linfoadenopatie vaccino COVID-19 correlate: ruolo della POCUS in Medicina Generale

Objectives
Research indicates the effectiveness of participatory interventions to address rapid rises in type 2 diabetes in low-income countries. Understanding their transferability to different contexts is a priority. We aimed to analyse how the COVID-19 post-lockdown context and adjustments to a participatory learning and action intervention affected theorised mechanisms of effect in rural Bangladesh and to examine the broader implications of this context and intervention adjustments for developing optimal contexts for participatory interventions.

Design
Mixed methods using longitudinal qualitative and quantitative observation data, focus group discussions and interviews with group and community members and project personnel. We used descriptive content analysis, guided by realist evaluation research questions about context, implementation and mechanisms. We used team reflection to enhance the rigour of our analysis.

Setting
Cluster-randomised trial in Alfadanga upazila, Faridpur district, in the central region of Bangladesh. The intervention was implemented between January 2020 and December 2022, during the COVID-19 pandemic.

Participants
Participatory group members, community members and project personnel (n=32). Structured observations of participatory groups (n=1820) and unstructured observations of groups and their environments (n=15).

Interventions
Participatory learning and action community groups of men and women implemented by community-based facilitators.

Results
Due to COVID-19, the participatory learning and action (PLA) intervention was not implemented as planned, which had major effects on the time available to develop the intervention with communities. Communities learnt about diabetes and were motivated to address its causes at an individual level, but community action was a more challenging mechanism to trigger. The post-pandemic context made it difficult to build community rapport, and strategies to engage communities through home visits were challenging. Communities’ prior negative experience in working together and in working with non-governmental organisations led to low community cohesion and low motivation to address diabetes collectively. This also resulted in expectations that the implementing organisation would implement community actions and incentivise attendance at meetings. This misalignment of expectations further disabled relationship building, and community strategies addressing the social causes of diabetes were largely not enacted.

Conclusion
PLA has optimal effects when time is available to build trust and social cohesion. These are contextual elements and mechanisms that need to be activated to enable critical reflection and community action to develop an enabling environment to address type 2 diabetes.

Trial registration number
ISRCTN42219712.

Objectives
To explore the association between smoking status (current vs former), changes in smoking habits (among current smokers only) and negative changes in dietary and physical activity habits during the initial COVID-19 lockdown in Israel.

Design
A secondary analysis of an online cross-sectional study (6 April 2020 to 28 April 2020). Dependent variables included deteriorations in dietary habits score and odds of reporting worsening of physical activity habits during the first COVID-19 lockdown. The study analysed the association between these variables and ‘smoking status’ (current vs former) and, within smokers, changes in smoking habits, using multivariate logistic and linear regression models. For changes in physical activity habits, there was a significant interaction with baseline physical activity levels (p=0.04), therefore, analysis was stratified accordingly.

Setting
Online data collection.

Participants
660 participants, current or former smokers in Israel, Hebrew speakers and ≥18 years old.

Primary outcomes
Self-reported negative changes in dietary habits and physical activity during the first COVID-19 lockdown.

Results
The sample (n=660) included 66.2% (n=437) current smokers and 33.8% (n=223) former smokers. Among current smokers, 43.5% (n=190) indicated an increase in their smoking habits. Of all respondents, 25% (n=170) reported a negative dietary change and 48% (n=192) spent less time engaging in physical activity, with 66% (n=437) reporting increased levels of stress. No significant association was found between smoking status and the dietary habits score in the multivariate linear regression (B=–0.046, CI –0.493 to 0.401, reference group: former smokers). This indicates that being a current smoker was associated with a non-significant 0.046 point decrease in the dietary habits score compared with former smokers. Similarly, no significant association was found between smoking status and odds of reporting worsening of physical activity, even after stratifying by baseline physical activity levels. Among participants who currently smoke, no significant association was found between changes in smoking habits and the dietary habits score (B=0.391, 95% CI –0.061 to 0.843, p=0.090, reference group: those who smoke the same or less) or with odds of reporting worsening of physical activity (OR=1.16, 95% CI 0.688 to 1.956, p=0.577, reference group: those who smoke the same or less).

Conclusion
Among current and former smokers, high rates of negative health habit changes were found, emphasising the need for interventions during future crises. Smoking status and/or changes in smoking habits among current smokers were not associated with negative changes in dietary and physical activity habits.

Objectives
This study aims to provide an in-depth analysis of the symptoms, coexisting conditions and service utilisation among people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID. The major research questions include the clustering of symptoms, the relationship between key factors and diagnosis time, and the perceived impact of National Institute for Health and Care Excellence (NICE) guidelines on patient care.

Design
Cross-sectional survey using secondary data analysis.

Setting
Community-based primary care level across the UK, incorporating online survey participation.

Participants
A total of 10 458 individuals responded to the survey, of which 8804 confirmed that they or a close friend/family member had ME/CFS or long COVID. The majority of respondents were female (83.4%), with participants from diverse regions of the UK.

Primary and secondary outcome measures
Primary outcomes included prevalence and clustering of symptoms, time to diagnosis, and participant satisfaction with National Health Service (NHS) care, while secondary outcomes focused on symptom management strategies and the perceived effect of NICE guidelines.

Results
Fatigue (88.2%), postexertional malaise (78.2%), cognitive dysfunction (88.4%), pain (87.6%) and sleep disturbances (88.2%) were the most commonly reported symptoms among participants with ME/CFS, with similar patterns observed in long COVID. Time to diagnosis for ME/CFS ranged widely, with 22.1% diagnosed within 1–2 years of symptom onset and 12.9% taking more than 10 years. Despite updated NICE guidelines, only 10.1% of participants reported a positive impact on care, and satisfaction with NHS services remained low (6.9% for ME/CFS and 14.4% for long COVID).

Conclusions
ME/CFS and long COVID share overlapping but distinct symptom clusters, indicating common challenges in management. The findings highlight significant delays in diagnosis and low satisfaction with specialist services, suggesting a need for improved self-management resources and better-coordinated care across the NHS.

Objectives
To assess the prevalence of SARS-CoV-2 antibodies in the residents of Kibera informal settlement in Nairobi, Kenya, before vaccination became widespread, and explore demographic and health-related risk factors for infection.

Design
A cross-sectional study.

Setting
Kibera informal settlement, Nairobi, Kenya.

Participants
Residents of Kibera informal settlement between October 2019 and August 2021, age 1 year and above who reported no current symptoms of COVID-19.

Main outcome measures
Associations were determined between SARS-CoV-2 positive tests measured with one rapid test and two ELISAs and demographic and health-related factors, using Pearson’s 2 test. Crude OR and adjusted OR were calculated to quantify the strength of associations between variables and seropositive status.

Results
A total of 438 participants were recruited. Most (79.2%) were age 18–50 years; females (64.2%) exceeded males. More than one-third (39.1%) were unemployed; only 7.4% were in formal, full-time employment. Less than one-quarter (22.1%) self-reported any underlying health conditions. Nearly two-thirds (64.2%) reported symptoms compatible with COVID-19 in the previous 16 months; only one (0.23%) had been hospitalised with a reported negative COVID-19 test. 370 (84.5%) participants tested positive in any of the three tests. There was no significant difference in SARS-CoV-2 seropositivity across age, sex, presence of underlying health conditions, on medication or those ever tested for SARS-CoV-2. Multiple logistic regression analysis showed that COVID-19 symptoms in the previous 16 months were the only significant independent predictor of seropositivity (p=0.0085).

Conclusion
High SARS-CoV-2 exposure with limited morbidity was found in the residents of Kibera informal settlement. The study confirms other reports of high SARS-CoV-2 exposure with limited morbidity in slum communities. Reasons cited include the high infectious disease burden on the African continent, demographic age structure and underreporting due to limited testing and lack of access to healthcare services; genetic factors may also play a role. These factors require further investigation.

Stroke, Ahead of Print. BACKGROUND:The VIPS (Vascular Effects of Infection in Pediatric Stroke) II prospective cohort study aimed to better understand published findings that common acute infections, particularly respiratory viruses, can trigger childhood arterial ischemic stroke (AIS). The COVID-19 pandemic developed midway through enrollment, creating an opportunity to assess its impact.METHODS:Twenty-two sites (North America, Australia) prospectively enrolled 205 children (aged 28 days to 18 years) with AIS from December 2016 to January 2022, including 100 cases during the COVID-19 pandemic epoch, defined here as January 2020 to January 2022. To assess background rates of subclinical infection, we enrolled 100 stroke-free well children, including 39 during the pandemic. We measured serum SARS-CoV-2 nucleocapsid total antibodies (present after infection, not vaccination; half-life of 3–6 months). We assessed clinical infection via parental interview.RESULTS:The monthly rate of eligible AIS cases declined from spring through fall 2020, recovering in early 2021 and peaking in the spring. The prepandemic and pandemic cases were similar except pandemic cases had fewer clinical infections in the prior month (17% versus 30%;P=0.02) and more focal cerebral arteriopathy (20% versus 11%;P=0.09). Among pandemic cases, 26 of 100 (26%) had positive antibodies, versus 4 of 39 (10%) of pandemic-era well children (P=0.04). The first SARS-CoV-2 positive case occurred in July 2020. Ten of the 26 (38%) positive cases had a recent infection by parental report, and 7 of those 10 had received a diagnosis of COVID-19. Only 1 had multisystem inflammatory syndrome in children. Median (interquartile range) nucleocapsid IgG total levels were 50.1 S/CO (specimen to calibrator absorbance ratio; 26.9–95.3) in the positive cases and 18.8 (12.0–101) in the positive well children (P=0.33).CONCLUSIONS:The COVID-19 pandemic may have had dual effects on childhood AIS: an indirect protective effect related to public health measures reducing infectious exposure in general, and a deleterious effect as COVID-19 emerged as another respiratory virus that can trigger childhood AIS.

Annals of Internal Medicine, Ahead of Print.

Background
Primary glaucoma patients faced many difficulties that affected their treatment during the COVID-19 pandemic. Glaucoma treatment often starts with prescription eye-drops. However, delays in ophthalmic therapy often occur due to poor awareness of the dangers of glaucoma, which subsequently leads to irreversible visual field defects and eventual blindness.

Objective
This study aimed to explore the social, personal and medical factors that contributed to barriers in the treatment of primary glaucoma during the COVID-19 pandemic, with the overarching goal of providing insights to develop measures that can identify the barriers of the treatment process and prevent consequent adverse outcomes.

Methods
We adopted a phenomenological approach and used purposive sampling to recruit 122 patients into our study. Face-to-face, semistructured, one-on-one interviews were conducted in a private office. The data were analysed using Colaizzi’s seven-step method. In cases where classification was difficult, consensus was reached among the three researchers who formed the core assessment team.

Results
A total of 122 glaucoma patients experienced delayed pharmaceutical treatment during the outbreak. Delays were longer among females and patients over 75 years old, highlighting that treatment delays were a significant issue for glaucoma patients during the COVID-19 pandemic, particularly for older females. Coding of the transcripts yielded three themes (eight subthemes): (1) the impact of social support on glaucoma pharmaceutical treatment: (a) the inability to seek pharmaceutical treatment alone and (b) online reservation and payment requirements; (2) the impact of personal reasons on glaucoma pharmaceutical treatment: (c) fear of being infected with COVID-19, (d) being infected with COVID-19 or coming into contact with COVID-19 patients, (e) being busy with work or life; (3) the impact of medical resources on glaucoma pharmaceutical treatment: (f) abnormal diagnosis and treatment processes, (g) insufficient medical manpower and (h) insufficient communication from medical staff.

Conclusions
To prevent medication delays and potential irreversible damage to the visual field in primary glaucoma patients during health crises, it is essential to further explore personalised strategies for coping with the impact of pandemics. Special attention should be given to glaucoma patients facing significant life burdens, such as the elderly and females, and efforts should be made to increase their awareness of the risks of glaucoma. Future studies could explore the feasibility of providing more support to glaucoma patients, such as online payment and appointment scheduling options, to reduce delays and alleviate patient anxiety.

‘Registrato un incremento dalle 4 alle 10 volte’

A meta-analysis offers compelling evidence that awake prone positioning improves outcomes in patients with acute hypoxemic respiratory failure.

Objectives
SARS-CoV-2 poses significant challenges to people living with diabetes (PLWD). This systematic review aimed to explore the impact of COVID-19 on mortality, complications associated with diabetes and haematological parameters among PLWD.

Design
Systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Data sources
EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials and LILACS were searched between 1 December 2019 and 14 January 2025.

Eligibility criteria for selecting studies
Eligible studies included case-control and cohort studies involving PLWD categorised into two groups: those with confirmed SARS-CoV-2 infection and those without.

Data extraction and synthesis
Meta-analyses estimated the odds ratios (ORs) and mean differences (MDs) of outcomes including mortality, intensive care unit (ICU) admission, diabetic ketoacidosis (DKA), acute kidney injury, hospitalisation length and haematological parameters. We pooled results using random-effects models and assessed study quality with the Newcastle-Ottawa Scale. A funnel plot was used to detect potential publication bias. The overall certainty of evidence was assessed using GRADE.

Results
25 of 7266 unique studies were eligible, including 1 154674 PLWD (561 558 with COVID-19 and 593 116 without COVID-19). SARS-CoV-2 infection in PLWD was associated with significantly increased mortality (OR 2.52, 95% CI 1.45 to 4.36, I2=99%), acute kidney injury (3.69, 95% CI 2.75 to 4.94, I2=0%), random plasma glucose in subjects with type 1 diabetes (MD 20.38 mg/dL, 95% CI 7.39 to 33.36, I2=0%), haemoglobin A1C in subjects with type 2 diabetes (0.21%, 95% CI 0.05 to 0.38, I2=13%), creatinine (0.12 mg/dL, 95% CI 0.04 to 0.19, I2=0%), C reactive protein (38.30 mg/L, 95% CI 4.79 to 71.82, I2=82%) and D-dimer (1.52 µg/mL, 95% CI 0.73 to 2.31, I2=0%). No significant differences were observed in the incidence of ICU admission and DKA, hospitalisation length, haemoglobin, leucocyte, lymphocyte, neutrophil to lymphocyte ratio, platelet, blood urea nitrogen, estimated glomerular filtration rate, procalcitonin, albumin, ferritin and bilirubin among PLWD with and without SARS-CoV-2 infection.

Conclusions
SARS-CoV-2 infection is associated with elevated risks of mortality and acute kidney injury and poor glycaemic control in PLWD, alongside increased levels of inflammatory and coagulation biomarkers. These findings underscore the urgent need for tailored clinical management strategies for PLWD with COVID-19.

PROSPERO registration number
CRD42023418039.

Objectives
SARS-CoV-2 poses significant challenges to people living with diabetes (PLWD). This systematic review aimed to explore the impact of COVID-19 on mortality, complications associated with diabetes and haematological parameters among PLWD.

Design
Systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Data sources
EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials and LILACS were searched between 1 December 2019 and 14 January 2025.

Eligibility criteria for selecting studies
Eligible studies included case-control and cohort studies involving PLWD categorised into two groups: those with confirmed SARS-CoV-2 infection and those without.

Data extraction and synthesis
Meta-analyses estimated the odds ratios (ORs) and mean differences (MDs) of outcomes including mortality, intensive care unit (ICU) admission, diabetic ketoacidosis (DKA), acute kidney injury, hospitalisation length and haematological parameters. We pooled results using random-effects models and assessed study quality with the Newcastle-Ottawa Scale. A funnel plot was used to detect potential publication bias. The overall certainty of evidence was assessed using GRADE.

Results
25 of 7266 unique studies were eligible, including 1 154674 PLWD (561 558 with COVID-19 and 593 116 without COVID-19). SARS-CoV-2 infection in PLWD was associated with significantly increased mortality (OR 2.52, 95% CI 1.45 to 4.36, I2=99%), acute kidney injury (3.69, 95% CI 2.75 to 4.94, I2=0%), random plasma glucose in subjects with type 1 diabetes (MD 20.38 mg/dL, 95% CI 7.39 to 33.36, I2=0%), haemoglobin A1C in subjects with type 2 diabetes (0.21%, 95% CI 0.05 to 0.38, I2=13%), creatinine (0.12 mg/dL, 95% CI 0.04 to 0.19, I2=0%), C reactive protein (38.30 mg/L, 95% CI 4.79 to 71.82, I2=82%) and D-dimer (1.52 µg/mL, 95% CI 0.73 to 2.31, I2=0%). No significant differences were observed in the incidence of ICU admission and DKA, hospitalisation length, haemoglobin, leucocyte, lymphocyte, neutrophil to lymphocyte ratio, platelet, blood urea nitrogen, estimated glomerular filtration rate, procalcitonin, albumin, ferritin and bilirubin among PLWD with and without SARS-CoV-2 infection.

Conclusions
SARS-CoV-2 infection is associated with elevated risks of mortality and acute kidney injury and poor glycaemic control in PLWD, alongside increased levels of inflammatory and coagulation biomarkers. These findings underscore the urgent need for tailored clinical management strategies for PLWD with COVID-19.

PROSPERO registration number
CRD42023418039.

Background
Mental health disorders are common among residents of long-term care (LTC). Despite depression being the most common type of mental illness, it is often undiagnosed in LTC. Due to its prevalence, chronicity and associated morbidity, depression poses a considerable service use burden. The COVID-19 pandemic has brought needed attention to the mental health challenges faced by older adults in LTC.

Objectives
To explore the effects of isolation on the mood of LTC residents and compare between both the pre-COVID-19 and COVID-19 periods.

Design
A scoping review.

Methods
PubMed, CINAHL, PsycINFO, SCOPUS, Google Scholar and medRxiv were searched for studies that met the eligibility criteria: (1) articles assessing mood or mental health status of LTC residents; (2) mood disturbance resulting from visitation restrictions/isolation or loneliness; (3) residents were without severe dementia or moderate/severe cognitive impairment and (4) studies were available in English. Studies were excluded if their entire sample was residents with severe cognitive impairment or severe dementia. A total of 31 studies were included in this review. The total number of articles retrieved from the databases searched was 3652 articles, of which 409 duplicates were removed. 3242 article titles and abstracts were screened for eligibility, of which 3063 were excluded. The remaining 180 full-text studies were reviewed for eligibility, where an additional 149 studies were excluded. Data were then extracted from all full-length pieces for analysis, and findings were summarised.

Results
The review identified contradictory views with a diversity of findings highlighting the complexity of factors influencing residents’ mood during a global health crisis such as that of COVID-19. Studies highlighted the importance of quality interactions with others for the well-being of LTC residents. Significant correlations were found between social isolation, loneliness and depression. During COVID-19, visitation restrictions led to increased loneliness, depression and mood problems, especially among residents without cognitive impairment. However, some studies reported no significant adverse effects or even a decrease in depression symptoms during COVID-19 restrictions, possibly due to implemented strategies to maintain social engagement.

Conclusion
The COVID-19 pandemic had a substantial impact on LTC homes, influencing the physical and mental well-being of residents. This highlighted pre-existing challenges in the LTC system, emphasising the importance of comprehensive strategies to safeguard resident mental health. It is important to combine measures to ensure both physical safety and mental well-being.

Objectives
Vitamin D deficiency is prevalent among the population. Previous studies have shown that vitamin D supplementation might be useful for treating COVID-19 infection. Therefore, we performed a meta-analysis to explore vitamin D supplementation efficacy in treating COVID-19 patients with vitamin D deficiency.

Design
Systematic review and meta-analysis

Data sources
PubMed, Cochrane Library, Embase and Web of Science.

Eligibility criteria
Randomised controlled trials exploring vitamin D supplementation for patients with COVID-19 and vitamin D deficiency.

Data extraction and synthesis
Two independent reviewers employed standardised methods to search, screen and code the included studies. The primary outcomes included mortality during follow-up, 28-day mortality, need for mechanical ventilation and intensive care unit (ICU). The secondary outcome included length of stay in hospital and ICU. The risk of bias was assessed using the Risk of Bias 2 tool. Depending on the level of heterogeneity, either a random-effects model or a fixed-effects model was applied. The findings were summarised using Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence profiles and synthesised qualitatively.

Results
A total of nine studies, comprising 870 participants, were included in the analysis. The pooled results indicated that vitamin D supplementation was associated with a lower risk of mortality (risk ratio 0.76; 95% CI 0.60 to 0.97). However, this apparent benefit was not robust when examined through the leave-one-out method and trial sequential analysis. Regarding other outcomes, there was no statistically significant difference between vitamin D supplementation and no supplementation in terms of 28-day mortality, the need for mechanical ventilation and ICU admission. Vitamin D supplementation was associated with a 0.41 day shorter length of stay in the ICU (mean difference –0.41; 95% CI –1.09 to 0.28) and a 0.07 day shorter length of stay in the hospital (mean difference –0.07; 95% CI –0.61 to 0.46) compared with no supplementation; however, neither difference was statistically significant.

Conclusion
Based on evidence of low to moderate quality, vitamin D supplementation reduced the mortality rate during follow-up in COVID-19 patients with vitamin D deficiency. However, it did not improve 28-day mortality, nor did it reduce the need for mechanical ventilation and ICU admission, or the length of stay in the ICU and hospital.

PROSPERO registration number
CRD42024573791.

“Vaccini aiutano a ridurre effetti a lungo termine”

Objectives
Ethical compliance of randomised controlled trials (RCTs) documented as ethics committee (EC) approval is vital for participant protection but is often overlooked by evidence synthesis producers despite regulatory mandates. We aimed to systematically assess reporting of ethics approval and informed consent (IC) in RCTs included in evidence syntheses and examined its potential impact on the study pool as part of a research integrity assessment (RIA).

Design
Meta-epidemiological study.

Setting
Assessment of ethics approval; domain 3 of the RIA tool developed for evidence syntheses.

Participants/subjects
COVID-19 RCTs included in evidence syntheses.

Primary outcomes
We extracted ethical items from study reports, that is, ethics approval statements, EC details, ethics approval numbers (ENs), IC and verified national recognition of ECs. RCTs were assessed regarding ethics approval and categorised as ‘no concern’, ‘awaiting classification’ or ‘exclude’ from the study pool. We also examined the impact of study settings on ethics approval reporting and discussed assessment reliability.

Results
We included 188 RCTs. 93% of primary study reports contained an ethics statement, 70% provided EC details, 44% reported EN and 91% mentioned IC. Trial registration records identified the EC in 8 RCTs and EN in 25 RCTs. Overall, 41% of RCTs reported all ethical items. Authors of 95 RCTs were contacted for missing information, yielding 22 satisfactory responses. Of the 151 RCTs with identified ECs, 88% were nationally recognised. Overall, 53% of RCTs were classified as ‘no concern’, 47% as ‘awaiting classification’ and none were excluded. Most were ‘awaiting classification’ due to reporting-related reasons. No significant differences in ethics approval reporting were observed across study settings, countries, or sample sizes.

Conclusions
Reporting of ethical items in RCTs remains inadequate. Including ethics approval details in reporting guidelines such as Consolidated Standards of Reporting Trials could improve this. Current under-reporting issues limit the reliability of the RIA tool’s ethics approval assessment.

Protocol registration
The protocol is available on OSF (https://osf.io/3bzeg).

Objectives
To determine the occurrence and clinicodemographic associations of hospital-based specialist palliative care (SPC) referral before and during the COVID-19 pandemic, timing of completed SPC consultation and comparative prevalence of ‘no cardiopulmonary resuscitation (CPR)’ orders, and end-of-life medication use, according to SPC involvement.

Design
Cross-sectional secondary analysis of a retrospective cohort study with a pre-pandemic (November 2019 to February 2020) group (Pre-COVID, n=170) and two intra-pandemic (March to August 2020) groups, one without (COVID–ve, n=170) and one with COVID-19 infection (COVID+ve, n=85). In the cohort study, Pre-COVID and COVID–ve group decedents were matched 2:1 on age, sex and care service (internal medicine/intensive care unit (ICU)) at death with COVID+ve decedents. In our current secondary analysis, clinicodemographic variables associated with SPC referral were examined in multivariable logistic regression, reporting adjusted ORs (aORs) and 95% CIs.

Setting
One quaternary and two tertiary acute care hospitals.

Participants
Decedent cohort with a terminal hospital admission (N=425).

Main outcome measures
SPC referral (yes/no) and timing of completed SPC consultation before death. Additional outcomes included ‘no CPR’ status and end-of-life medication prescription and dosing.

Results
SPC referral occurred in 70 (41.2%), 71 (41.8%) and 26 (30.6%) of the Pre-COVID, COVID–ve and COVID+ve groups, respectively (p=0.18). The aORs for SPC referral were lower for deaths in ICU (0.07; 95% CI 0.03 to 0.16) and admissions from nursing homes/long-term care (0.45; 95% CI 0.23 to 0.9), and higher for active cancer (2.5; 95% CI 1.39 to 4.39). Recipients of SPC consultation, compared with non-recipients, more frequently had a ‘no CPR’ order, had it placed earlier and were more frequently prescribed palliative end-of-life medications.

Conclusions
Hospital SPC consultation rates early in the COVID-19 pandemic were largely maintained at pre-pandemic levels. Having active cancer was positively associated with SPC referral, whereas both ICU death and having a nursing home/long-term care pre-admission source were negatively associated with referral.