A Patient Navigation Model to Improve Complex Wound Care Outcomes.

OBJECTIVE: To create a blended format model to navigate interprofessional team assessments of patients with complex wounds during COVID-19 as a quality improvement process. METHODS: During clinical assessments, patients were interviewed in their homes with representation from their circle of care and primary nurse on site linked to a live virtual interprofessional blended remote team model (wound care nurse specialist, advanced wound care doctor). Eligible patients had completed a wound care clinical pathway without wound closure. Palliative patients with complex wounds and patients without precise/accurate diagnoses were also included. This process addressed the components of Wound Bed Preparation 2021: manage the cause, address patient-centered concerns, determine the ability to heal, optimize local wound care, and evaluate outcomes on an ongoing basis. RESULTS: Since April 2020, 48 patients were referred to the Home and Community Care Support Services patient navigation interprofessional team. Patients' home-care services were initiated between 2012 and 2021. The team provided closure in 29% of patients and the wound surface area reduced in 66%. Pain was reduced in 73% of patients and appropriate infection management was implemented in 79%. In addition, nursing visits were reduced by 73% and there was a 77% decrease in supply usage. CONCLUSIONS: This project validated the Wound Bed Preparation Paradigm 2021 as a process for assessing patients with complex wounds using a blended virtual and home-based assessment. Patient navigation with this blended model benefited patients and improved healthcare system utilization with projected cost savings.

Evaluation of a Virtual Team-Based Project Designed to Improve Chronic Wound Patient Care in Ontario, Canada.

OBJECTIVE: To evaluate the effectiveness of the Extension for Community Healthcare Outcomes Ontario Skin and Wound Care project, a virtual team-based endeavor designed to improve the care of patients with chronic wounds. METHODS: The study team conducted phone interviews with healthcare professionals (n = 8) regarding their patients (n = 10). The management recommendations were grouped, and the study participants questioned concerning the implementation of the recommendations. Interviews were recorded and transcribed, and the transcripts were analyzed for common themes. The Queen's University Research Ethics Board approved this study. RESULTS: Interviews documented improvement in 50% of patients; the other half of the patients did not improve because of patient- and healthcare-system barriers. Three of five nonhealing patients were nonadherent regarding compression, and only one of six suggested biopsies were carried out. The investigators noted three primary reasons for the lack of recommendation implementation: (1) could not obtain a diagnostic procedure, (2) lack of a diagnosis, and (3) patient was reluctant to make a lifestyle change. Major themes included problems in care coordination and suboptimal patient and provider education, along with other obstacles to management. CONCLUSIONS: Participants stated that the project provided a beneficial learning experience. The findings highlighted a lack of integrated and coordinated interprofessional chronic wound care.

Virtual reality in palliative care

IntroductionCOVID-19 pushed us as an organisation to step-up our ability to change and adapt. Our workforce has embraced the opportunities generated by digital transformations during the pandemic. Virtual Reality (VR) is revolutionising healthcare. We wanted to explore the use of VR as part of a non-pharmacological approach to symptom management and start to measure patient outcomes in a meaningful way while improving the patient’s overall experience.ActionsOur initial proposal was that the use of the VR headset could positively impact on patient wellbeing. Our living well centre team commenced a pilot in conjunction with our inpatient unit. As new technology becomes more accessible use of these as part of the patient’s overall plan of care is a realistic possibility even for small organisations.Utilising freely available innovative apps the team supported patients in immersive experiences including guided relaxation meditation and visits to locations such as white sandy beaches, forests and mountain ranges. Initial outcomes were positive utilising a simple wellbeing score and numerical pain scoring. This has led us, in conjunction with a digital fabrication laboratory based at a local college, to look at opportunities for using emerging technologies in interventions and training. Our next project is a VR tour of our inpatient unit and grounds filmed using a 360 degree camera for patients to watch at home to try and alleviate some of the worries and anxieties they may have about staying with us or accessing our services.ConclusionThe use of VR in healthcare has endless possibilities. Working with our local education partners is an opportunity to explore this for our patients. Positive outcomes have provided the impetus to try new approaches that will have real impact on patient wellbeing and symptom management.

Compton vs COVID: stepping up

Background and AimsIn March 2020 our hospice was faced with an unprecedented challenge. The COVID-19 pandemic affected every aspect of our work, from patient care to fundraising, but proactive cooperation with local services enabled us to ‘Step Up’ our support for patients and families.Method and ResultsThe ‘Stepping Up’ appeal found innovative ways to raise funds and engage with the public, from virtual events to gathering messages of support for our hard-working staff. Our Compassionate Communities team launched a telephone befriending service and virtual bereavement information hubs, reaching out to those isolated by the pandemic. Our inpatient unit expanded to better facilitate admissions from local hospitals and the community, overseen by a dedicated flow co-ordinator. The team was rapidly upskilled in managing more acutely unwell patients, including those with COVID-19, and challenging situations such as withdrawal of NIV.Our Living Well Centre, temporarily closed due to the pandemic, was transformed into a nurse-led unit for COVID-19-positive patients awaiting care home placement. As well as being redeployed, our Living Well nurses embraced new technology to support their patients remotely. Our community team provided additional support to local district nursing teams, taking over personal care for some of their more complex palliative patients. Training in procedures such as catheter insertion and venepuncture was also expedited. Working collaboratively with NHS colleagues we were able to manage more complex medical situations at home, reducing the need for inpatient admissions. Video consultations and a professional support line allowed the medical team to become more responsive.ConclusionDespite the many challenges, we have taken the opportunity to improve continuity of care and build better working relationships within our organisation. Cooperation with external partners, a keystone of good palliative care, has been vital to our ability to respond and adapt, and we hope to see these positive changes continue.

Filtration of viral aerosols via a hybrid carbon nanotube active filter

Exposure to expired particles and droplets carrying infectious viruses is a primary transmission pathway for respiratory diseases. Removal of particles and droplets via filtration from a volume can drastically reduce the exposure to viruses, but viruses may remain active on filtration surfaces as potential resuspension or fomite risks. Here, we report the development of macroscopic carbon nanotube air filters synthesized using ultra-thin carbon nanotube electrically conductive membranes, mechanically supported by a porous polyester backing. Filtration efficiencies were measured up to 99.999%, while ultra-thin materials with low areal density (0.1 g m─2) exhibited pressure drops comparable to commercial High-Efficiency Particulate Air (HEPA) filters. These electrically conductive filters are actively self-sanitized by thermal flashes via resistive heating to temperatures above 80 °C within seconds or less. Such temperatures were proven to achieve full deactivation of a betacoronavirus and an adeno-associated virus retained on filter surfaces. A filtration unit prototype equipped with a CNT filter module (∼1.2 m2) was shown to achieve air purification of 99% of a room within 10 min at 26 air changes per hour. [Display omitted] [ABSTRACT FROM AUTHOR] Copyright of Carbon is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Teaching Acting in the Face of COVID-19: Designing Instruction for Variable Acting Studios

What learning objectives and practices do we most value in our acting classrooms and studios, and which will be most challenging to preserve in the face of shifting modalities and new constraints? How would factors beyond the instructor's control such as unequal access to the internet, appropriate learning spaces, privacy issues, and others impact our ability to hold students accountable? First pass at universal principles of voice and movements studios. * Questions Finding Tool, 7:47: Since both Kaye and Bucs are teaching face to face in fall 2020, they discuss agreed-upon best practices for in-person teaching while following the existing published guidelines for safety.

Polyester nasal swabs collected in a dry tube are a robust and inexpensive, minimal self-collection kit for SARS-CoV-2 testing.

BACKGROUND: In order to identify an inexpensive yet highly stable SARS-CoV-2 collection device as an alternative to foam swabs stored in transport media, both contrived ("surrogate") CoV-positive and patient-collected spun polyester swabs stored in dry tubes were evaluated for time- and temperature-stability using qPCR. METHODS: Surrogate specimens were prepared by combining multiple, residual SARS-CoV-2-positive clinical specimens and diluting to near-LOD levels in either porcine or human mucus ("matrix"), inoculating foam or polyester nasal swabs, and sealing in dry tubes. Swabs were then subjected to one of three temperature excursions: (1) 4°C for up to 72 hours; (2) 40°C for 12 hours, followed by 32°C for up to 60 hours; or (3) multiple freeze-thaw cycles (-20°C). The stability of extracted SARS-CoV-2 RNA for each condition was evaluated by qPCR. Separate usability studies for the dry polyester swab-based HealthPulse@home COVID-19 Specimen Collection Kit were later conducted in both adult and pediatric populations. RESULTS: Polyester swabs stored dry demonstrated equivalent performance to foam swabs for detection of low and moderate SARS-CoV-2 viral loads. Mimicking warm- and cold- climate shipment, surrogate specimens were stable following either 72 hours of a high-temperature excursion or two freeze-thaw cycles. In addition, usability studies comprised of self-collected patient specimens yielded sufficient material for molecular testing, as demonstrated by RNase P detection. CONCLUSIONS: Polyester nasal swabs stored in dry collection tubes offer a robust and inexpensive self-collection method for SARS-CoV-2 viral load testing, as viral RNA remains stable under conditions required for home collection and shipment to the laboratory.