Decision support-tools for early detection of infection in older people (aged> 65 years): a scoping review.

BACKGROUND: Infection is more frequent, and serious in people aged > 65 as they experience non-specific signs and symptoms delaying diagnosis and prompt treatment. Monitoring signs and symptoms using decision support tools (DST) is one approach that could help improve early detection ensuring timely treatment and effective care. OBJECTIVE: To identify and analyse decision support tools available to support detection of infection in older people (> 65 years). METHODS: A scoping review of the literature 2010-2021 following Arksey and O'Malley (2005) framework and PRISMA-ScR guidelines. A search of MEDLINE, Cochrane, EMBASE, PubMed, CINAHL, Scopus and PsycINFO using terms to identify decision support tools for detection of infection in people > 65 years was conducted, supplemented with manual searches. RESULTS: Seventeen papers, reporting varying stages of development of different DSTs were analysed. DSTs largely focussed on specific types of infection i.e. urine, respiratory, sepsis and were frequently hospital based (n = 9) for use by physicians. Four DSTs had been developed in nursing homes and one a care home, two of which explored detection of non- specific infection. CONCLUSIONS: DSTs provide an opportunity to ensure a consistent approach to early detection of infection supporting prompt action and treatment, thus avoiding emergency hospital admissions. A lack of consideration regarding their implementation in practice means that any attempt to create an optimal validated and tested DST for infection detection will be impeded. This absence may ultimately affect the ability of the workforce to provide more effective and timely care, particularly during the current covid-19 pandemic.

Development of a COVID-19 virtual community of practice in New South Wales

ON 30 JANUARY 2020, the Director-General of the World Health Organization announced that the outbreak of a novel coronavirus in China had been declared a Public Health Emergency of International Concern.1 At the time of that announcement, there were 7834 confirmed cases, 98 of those outside China.1 By April 5 2020, there were 1,133,758 cases of COVID-19 globally, with 62,784 deaths.2 At that time, Australia had 5805 COVID-19 notifications and 33 associated deaths.2 In the absence of an available vaccine or effective pharmacotherapy for COVID-19 in Australia during 2020, the mainstay of individual case management was prevention of transmission through identification and isolation of cases and, in severe cases, supportive care, including ventilation.3 Community management was recommended for the approximately 80% of patients with mild disease, provided there was capacity for counselling, isolation, support, monitoring and escalation to hospital-based care in the event of deterioration.3 As the principal providers of continuing healthcare for people living in the community, general practice shared community management and monitoring of Australians with COVID-19, in collaboration with public health units, virtual care clinics and hospital-in-the home teams. Implementation of new evidence, guidelines or procedures into clinical practice is a challenge, especially where the change is complex with limited external support (such as facilitation) or previous applicable experience.6 All of these applied to the early stages of the COVID-19 pandemic. [...]as a contribution to addressing the COVID-19 crisis in Australia, in early April 2020 a group of general practitioner (GP) leaders in NSW established a COVID-19 GP virtual community of practice (VCoP). Communities of practice (CoPs) and VCoPs have been demonstrated to be effective in improving processes and outcomes in education, industry and healthcare.7 CoPs are defined as 'groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly'.8 When a CoP is constructed primarily (although not exclusively) through internetbased interaction, it is termed a VCoP.7 The goal of the COVID-19 GP VCoP was to facilitate rapid implementation of the necessary changes in general practices through widespread sharing of knowledge (know-what) and experience of the application of that knowledge in practice (know-how). Analysis Framework analysis was used to analyse the data, using the VCoP framework developed by Barnett et al. to code the data under the following headings: objectives and goals, champion and support, facilitation, a broad church, supportive environment, technology and community, measurement benchmarking and feedback.7'10 Five members of the research team individually coded two FGD transcripts.

Development of a COVID-19 virtual community of practice in New South Wales: A qualitative study.

BACKGROUND AND OBJECTIVES: In April 2020, a group of general practice leaders in NSW, Australia, established a COVID-19 virtual community of practice (VCoP) to facilitate rapid transfer and implementation of clinical guidance into practice. This research aimed to gain an understanding of the experience and effectiveness of the VCoP from leaders and members. METHOD: The study used a qualitative participatory action research methodology. A framework analysis was applied to focus group discussion, semi-structured interview and open-text written response data. RESULTS: Thirty-six participants contributed data. In addition to a positive evaluation of the effectiveness of information transfer and support, a key finding was the importance of the role of the VCoP in professional advocacy. Areas for improvement included defining measures of success. DISCUSSION: This study has reinforced the potential for VCoPs to aid health crisis responses. In future crisis applications, we recommend purposefully structuring advocacy and success measures at VCoP establishment.

Critical observations on and suggested ways forward for healthcare communication during COVID-19: pEACH position paper.

OBJECTIVE: Communication in healthcare has influenced and been influenced by the COVID-19 pandemic. In this position paper, we share observations based on the latest available evidence and experiential knowledge that have emerged during the pandemic, with a specific focus on policy and practice. METHODS: This is a position paper that presents observations relating to policy and practice in communication in healthcare related to COVID-19. RESULTS: Through our critical observations as experts in the field of healthcare communication, we share our stance how healthcare communication has occured during the pandemic and suggest possible ways of improving policy and professional practice. We make recommendations for policy makers, healthcare providers, and communication experts while also highlighting areas that merit further investigation regarding healthcare communication in times of healthcare crises. CONCLUSION: We have witnessed an upheaval of healthcare practice and the development of policy on-the-run. To ensure that policy and practice are evidence-based, person-centred, more inclusive and equitable, we advocate for critical reflection on this symbiotic relationship between COVID-19 and the central role of communication in healthcare. PRACTICE IMPLICATIONS: This paper provides a summary of the key areas for development in communication in healthcare during COVID-19. It offers recommendations for improvement and a call to review policies and practice to build resilience and inclusive and equitable responsiveness in communication in healthcare.