Background The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. MethodsThe Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing. Multivariable logistic regression was done for the primary outcome of patient-perceived recovery, with age, sex, ethnicity, body-mass index, comorbidities, and severity of acute illness as covariates. A posthoc cluster analysis of outcomes for breathlessness, fatigue, mental health, cognitive impairment, and physical performance was done using the clustering large applications k-medoids approach. The study is registered on the ISRCTN Registry (ISRCTN10980107). Findings We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5•9 months (IQR 4•9-6•5) after discharge. Participants had a mean age of 58 years (SD 13); 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered, 158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and 124 (19%) of 641 experienced a health-related change in occupation. Factors associated with not recovering were female sex, middle age (40-59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial but only weakly associated with the severity of acute illness. Four clusters were identified with different severities of mental and physical health impairment (n=767): very severe (131 patients, 17%), severe (159, 21%), moderate along with cognitive impairment (127, 17%), and mild (350, 46%). Of the outcomes used in the cluster analysis, all were closely related except for cognitive impairment. Three (3%) of 113 patients in the very severe cluster, nine (7%) of 129 in the severe cluster, 36 (36%) of 99 in the moderate cluster, and 114 (43%) of 267 in the mild cluster reported feeling fully recovered. Persistently elevated serum C-reactive protein was positively associated with cluster severity.Interpretation We identified factors related to not recovering after hospital admission with COVID-19 at 6 months after discharge (eg, female sex, middle age, two or more comorbidities, and more acute severe illness), and four different recovery phenotypes. The severity of physical and mental health impairments were closely related, whereas cognitive health impairments w...

No abstract

No abstract

Background Sudden speechlessness is common in critically ill patients with airway intubation or head and neck cancer surgery. Sudden inability to speak poses significant challenges for hospitalized patients as strategies to facilitate communication are often limited and unreliable. Technology- based communication interventions have the potential to facilitate the communication process of hospitalized patients experiencing health events resulting in sudden speechlessness. Methods A quasi-experimental, 4-cohort (control and intervention) repeated measures design was used, with data points occurring daily up to 10 days. The study was conducted in adult critical care units and participants were followed as they were transferred to other units within institutions selected for the study. The impact of a technology-based communication system (intervention) in comparison with a control group (Usual care + Urgent Button) was evaluated. Patient communication outcomes pertinent to communication with nursing staff evaluated in this study included: perception of communication ease, satisfaction with methods used for communication, and frustration with communication. Results A comparison of the intervention and control group indicates that subjects in the intervention group reported lower mean frustration levels (-2.68, SE=0.17; 95% CI -3.02 to -2.34, p=<0.001), and a higher mean satisfaction level (0.59, SE=0.16; 95% CI 0.27 to 0.91; p<0.0001) with use of the communication intervention. Consistent increase of perception of communication ease over the hospital stay was reported by subjects in the intervention group. Conclusions This study facilitated the evaluation of a bedside technology-based communication intervention tailored to the needs of critically ill suddenly speechless patients.