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BackgroundThe optimal timing of tocilizumab treatment during the disease course of COVID-19 has yet to be adequately defined in the context of randomised controlled trials and the effect of tocilizumab on real-world populations remains unclear. We examined the effect of different timing of tocilizumab, on mortality, in a cohort of adults with COVID-19.MethodsAll adults (≥18 years old) with confirmed COVID-19 admitted to four hospitals in the West of Scotland between 8 January 2021 and 31 March 2021 and who received tocilizumab were included in a retrospective observational cohort study. Patients were assigned to either an early (day of admission or first day after admission) or late (days 2–7 of admission) cohort based on tocilizumab initiation. The primary outcome was 90-day all-cause mortality in early versus late cohorts. Secondary outcomes were 28 and 180-day all-cause mortality.Results203 patients were included in the analysis (138 in the early cohort, 65 in the late cohort). Mortality in 90 days in the early cohort was 22% (n=30) compared with 45% (n=29) in the late cohort (p<0.001). The adjusted mortality was significantly higher in the late cohort compared with the early cohort (adjusted OR: 3.33; 95% CI: 1.29 to 8.54; p=0.012). The secondary outcomes demonstrated the same effect with higher rates of death in 28 days (late cohort adjusted OR: 3.28; 95% CI: 1.23 to 8.75; p=0.018) and 180 days (late cohort adjusted OR: 3.70; 95% CI: 1.45 to 9.45; p=0.006). The effect was seen whether the outcome was adjusted or unadjusted.ConclusionEarly administration of tocilizumab within the first 2 days of hospitalisation was associated with a significant survival benefit compared with late exposure. Late administration was associated with particularly high mortality. The observed association may be a result of residual confounders and further research is needed.

The study sought to explore the barriers and facilitators for making physical activity lifestyle choices among Black Asian Ethnic Minority (BAME) students at Teesside University during the COVID-19 pandemic. A qualitative approach was used to capture the in-depth physical activity experiences of BAME individuals. There is a paucity of primary qualitative studies focusing on BAME individuals’ activity lifestyles prior to and during the COVID-19 lockdowns between April and August 2020. BAME individuals faced exacerbated physical, psychological, social, and institutional barriers which are mapped onto the capability, opportunity, and motivation model of behaviour (COM-B). Twelve BAME participants were interviewed via Microsoft Teams using semi-structured interviews lasting 45 to 60 minutes. Using thematic analysis, we identified seven themes; the two primary ones were barriers and facilitators to being active and were successfully mapped onto the modified COM-B. Although existing literature has used the COM-B, these were primary quantitative findings that did not enable an in-depth exploration of BAME individuals lived experiences of physical activity participation during COVID-19. Thus, the COM-B model was modified to reflect this research’ qualitative approach, through which improved policies and implementation strategies may be applied specifically to BAME individuals.

Studies indicated that prior to the COVID-19 pandemic, the majority of adult Black, Asian and Minority Ethnic (BAME) individuals lived a sedentary lifestyle, which exacerbated their physical inactivity behaviours during the COVID-19 subsequent lockdowns. Experiences related to making healthy physical activity (PA) lifestyle choices in adult BAME individuals during the COVID-19 pandemic were mapped onto the capability, opportunity, and motivation model of behaviour (COM-B model). Twelve adult BAME participants were interviewed using one-on-one, semi-structured interviews that lasted 45–60 min, which captured participant perceptions of PA engagement during the pandemic between April and August 2022 via Microsoft Teams. Using thematic analysis, three themes were generated and successfully mapped onto the modified COM-B model. These include the influence of culture on the PA lifestyle, the capability to engage in the PA lifestyle, and the self-reflective determination model. Although existing literature has used both the COM-B and the self-determination models, these have been generalised findings that are not representative of adult BAME individuals’ lived PA participation experiences. This enabled the modification of the COM-B and self-reflective determination models to reflect the experiences of adult BAME individuals with respect to PA participation as well as improving PA culturally related policies.

COVID-19 was declared a global pandemic by the World Health Organisation in March 2022, resulting in over 115,0000 deaths worldwide by October of the same year. Only 25% of adults worldwide undertake the recommended levels of Physical activity (PA) for their respective age ranges, potentially exacerbating the symptoms associated with contraction of COVID-19 and recovery. This review aims to identify specific barriers and facilitators to engagement with PA interventions that were implemented during the pandemic. This quantitative study was undertaken adhering to the Preferred Reporting Items for Systematic Reviews and Meta Analyses. A systematic search was conducted of the following databases: CINAHL, MEDLINE, AMED, Cochrane, SCOPUS and Web of Science. Quality appraisal of selected papers was conducted through the CASP tool, with data extraction by two independent reviewers thereby minimising bias. This was then followed by a meta-analysis of the resulting data; however, no eligible studies were identified. Whilst 258 papers were identified through the database searches, following removal of duplicates (n = 19), the remaining 239 were screened, of these 237 were excluded on title and abstract, with the remaining two subsequently excluded following full read due to failure to meet the inclusion criteria. This review identified research gaps in the study.

Physical activity (PA) is widely recognised as being integral to physical and mental wellbeing. The World Health Organisation recommends around 150–300 minutes of moderately intense PA per week for adults aged 18–64 years. Physical inactivity costs the UK £7.4 billion per year and is associated with one out of every six deaths that occur in the country. The review aims at exploring the barriers and facilitators to making healthy PA lifestyle choices among UK BAME adults during the COVID-19 pandemic. Database searches were conducted in CINAHL, AMED, Medline, SCOPUS, COCHRANE, EMBASE, and Web of Science. There are 53 records that were identified. After removing three duplicates, the titles and abstracts of 50 papers were screened. Of these, all but 50 studies were excluded after reviewing the title and abstracts, resulting in no studies eligible for inclusion. Data extraction using the JBI-QARI data extraction template was performed, followed by a narrative synthesis of the resulting data; however, no eligible studies were identified. This empty systematic review without meta-analysis, highlighted major research gaps and indicated the state of the evidence between 2019–2021. The review has, through the application of theoretical models (COM-B and TTM), highlighted themes that need to be addressed.

BackgroundCritically ill patients often experience several transitions of care following critical illness. Research has explored the challenges which patients have with medication management across these transitions. It is unclear whether patients admitted to critical care due to COVID-19 will have similar challenges. The aim of this study was to explore medication management in critical care survivors following severe COVID-19.MethodsBetween 3 and 7 months post hospital discharge, patients who had been admitted to critical care due to severe COVID-19 were invited to an established recovery service. During the clinic consultation a medication review was performed by a pharmacist. This included medicines reconciliation, assessing the appropriateness of each of the prescribed medications and identification of medication changes. We also assessed changes to pain management in the discharge period.ResultsIn total, 78 patients had a full medication review available. Over 70% of patients were taking an increased dose of medicine or a new medicine at clinic. There was a significant overall increase in new medication during the clinic consultation, across different British National Formulary classifications (OR: 1.73 (95% CI: 1.28 to 2.34), p<0.001). Compared with pre critical care admission, there was a significant increase in the number of patients taking regular analgesia following severe COVID-19 infection (23 (29.5%) vs 39 (50%), p<0.001).ConclusionFollowing severe COVID-19, patients may require new or increasing doses of medicines. Ongoing review of these patients is crucial to ensure optimal outcomes.