COVID, Communication and Care Homes: A Staffs' Perspective of Supporting the Emotional Needs of Families

An important part of care home life is the support given to older residents by their families/friends through regular visiting. Social visits to residents by their families ceased in response to the COVID-19 pandemic and residents were confined to their rooms. This paper reports on how care home staff improvised to address this situation during the first wave of the pandemic. It focuses on steps taken to maintain communication between residents and families to support emotional well-being. We undertook in-depth café-style interviews with twenty-one staff to explore creative practices that they introduced. It was part of a wider Scottish study examining the effect of lockdown on families whose relative was living/dying in a care home (May–October, 2020). Findings reveal the enormous effort by care staff to maintain family connections and the rapid acclimatisation involved working with a number of different on-line platforms, the pulling together of staff from across the care home, and, the attention to emotional well-being of residents living and dying in the care home. Findings highlight the professionalism and commitment of the leadership and staff involved. Whilst some of the staff accounts need no further comment, we draw on some themes from the care home research literature to make sense of the findings in terms of what we might learn going forward. This in-depth qualitative study emphasises the importance of recognising, fostering and nurturing relational compassionate care within long-term care. There is however little evidence whether health and social care policies recognise the importance of this on-going relationship. © 2021 The Author(s).

Water insecurity compounds the global coronavirus crisis

Household water insecurity may exacerbate the COVID-19 pandemic and exact an even greater toll on people, especially in Africa, Asia and Latin America, simply because too many people do not have access to safe and secure water services, including water supply and sanitation, at home. Recent studies have shown that as many as a quarter of households in the Global South may be unable to practise necessary hand hygiene. Megacities may be at particular risk of being unable to manage the COVID-19 pandemic due to sheer population density as well as a lack of reliable clean water and sanitation. Problems of water insecurity are not restricted to the Global South but extend into higher-income countries as well. The steady decline in provision of public sanitation around the world, even in wealthy countries, makes adequate hygiene an even more intractable problem.

A retrospective study of critically ill patients with COVID-19 and anticoagulation used throughout crrt

Background: Studies indicate that 5% of patients with COVID-19 develop critical illness, warranting ICU level of care. Up to 15% of these critically ill patients develop acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). COVID-19 also appears to generate a pro-thrombotic state in some patients and thrombosis during CRRT could prevent life sustaining clearance and fluid removal. Methods: In this single center study, we performed a retrospective chart review of patients admitted to Montefiore Medical Center, with a confirmed diagnosis of COVID19 in an ICU requiring CRRT between 3/10/2020 - 4/28/2020. Subsequently, we categorized the different anticoagulation (AC) types that were used for each CRRT treatment: no AC, heparin, bivalirudin, apixiban. The primary outcome was to determine the percent of achieved versus prescribed CRRT in patients treated without AC, heparin, or bivalirudin (dosing >;0.25 mg/kg/hr, versus < 0.25 mg/kg/hr). The secondary outcome was to determine the percent reduction in BUN and potassium within 10 hours of CRRT. Results: We excluded patients with renal failure requiring renal replacement therapy (RRT) that did not have a confirmed diagnosis of COVID19, as well as patients with a previous history of thrombosis. We were left with 69 patients, whom we analyzed the first three RRT treatments of each patient. The average age was 59.48 years, 81.2% male, 18.8% female. 15% of patients were African American, 5% Caucasian, 31% Hispanic, and 17% identified as other. The average BMI was 30.2. 40% of patients had diabetes mellitus, 49% hypertension, and 14% CKD or ESRD. We analyzed a total of 162 RRT treatments. Of these 162 treatments, 49% of patients received bivalirudin, 27% heparin, and 23.4% did not receive AC. We found that 84.5% of patients receiving bivalirudin completed their CRRT treatment, 77.7% receiving heparin completed treatment, and 59.3% of patients not on AC completed treatment. Conclusions: Patients with a confirmed diagnosis of COVID 19 that are critically ill and receive CRRT are more likely to finish their CRRT treatment, and therefore achieved improved clearance, if they were given some form of AC to prevent clotting.