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1.
PLoS One ; 17(1): e0262807, 2022.
Article in English | MEDLINE | ID: covidwho-1629520

ABSTRACT

The coronavirus disease 2019 (COVID-19) has had devastating consequences worldwide, including a spike in global mortality. Residents of long-term care homes have been disproportionately affected. We conducted a retrospective cohort study to determine the scale of pandemic-related deaths of long-term care residents in the province of Ontario, Canada, and to estimate excess mortality due to a positive COVID-19 test adjusted for demographics and regional variations. Crude mortality rates for 2019 and 2020 were compared, as were predictors of mortality among residents with positive and negative tests from March 2020 to December 2020. We found the crude mortality rates were higher from April 2020 to June 2020 and from November 2020 to December 2020, corresponding to Wave 1 and Wave 2 of the pandemic in Ontario. There were also substantial increases in mortality among residents with a positive COVID-19 test. The significant differences in excess mortality observed in relation to long-term care home ownership category and geographic region may indicate gaps in the healthcare system that warrant attention from policymakers. Further investigation is needed to identify the most relevant factors in explaining these differences.


Subject(s)
COVID-19/epidemiology , COVID-19/mortality , Frail Elderly , Frailty/epidemiology , Nursing Homes , Pandemics , SARS-CoV-2/isolation & purification , Aged , Aged, 80 and over , COVID-19/virology , Comorbidity , Female , Humans , Long-Term Care/methods , Male , Ontario/epidemiology , Retrospective Studies , Risk , Time Factors
2.
Nurs Leadersh (Tor Ont) ; 34(2): 21-25, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1444522

ABSTRACT

Loch Lomond Villa is one of the largest long-term care communities within the province of New Brunswick. Our organization supports caring living environments for over 450 clients and their family members along with 354 employees.


Subject(s)
COVID-19/prevention & control , Chief Executive Officers, Hospital/psychology , Long-Term Care/methods , Nurse Administrators/psychology , COVID-19/nursing , Humans , Long-Term Care/psychology , New Brunswick , Nurse's Role/psychology
3.
J Am Geriatr Soc ; 69(10): 2766-2777, 2021 10.
Article in English | MEDLINE | ID: covidwho-1434765

ABSTRACT

BACKGROUND/OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has taken a disproportionate toll on long-term care facility residents and staff. Our objective was to review the empirical evidence on facility characteristics associated with COVID-19 cases and deaths. DESIGN: Systematic review. SETTING: Long-term care facilities (nursing homes and assisted living communities). PARTICIPANTS: Thirty-six empirical studies of factors associated with COVID-19 cases and deaths in long-term care facilities published between January 1, 2020 and June 15, 2021. MEASUREMENTS: Outcomes included the probability of at least one case or death (or other defined threshold); numbers of cases and deaths, measured variably. RESULTS: Larger, more rigorous studies were fairly consistent in their assessment of risk factors for COVID-19 outcomes in long-term care facilities. Larger bed size and location in an area with high COVID-19 prevalence were the strongest and most consistent predictors of facilities having more COVID-19 cases and deaths. Outcomes varied by facility racial composition, differences that were partially explained by facility size and community COVID-19 prevalence. More staff members were associated with a higher probability of any outbreak; however, in facilities with known cases, higher staffing was associated with fewer deaths. Other characteristics, such as Nursing Home Compare 5-star ratings, ownership, and prior infection control citations, did not have consistent associations with COVID-19 outcomes. CONCLUSION: Given the importance of community COVID-19 prevalence and facility size, studies that failed to control for these factors were likely confounded. Better control of community COVID-19 spread would have been critical for mitigating much of the morbidity and mortality long-term care residents and staff experienced during the pandemic. Traditional quality measures such as Nursing Home Compare 5-Star ratings and past deficiencies were not consistent indicators of pandemic preparedness, likely because COVID-19 presented a novel problem requiring extensive adaptation by both long-term care providers and policymakers.


Subject(s)
COVID-19 , Homes for the Aged/organization & administration , Long-Term Care , Nursing Homes/organization & administration , Risk Adjustment , Skilled Nursing Facilities/organization & administration , Aged , COVID-19/mortality , COVID-19/prevention & control , Civil Defense/organization & administration , Humans , Infection Control/methods , Infection Control/standards , Long-Term Care/methods , Long-Term Care/trends , Outcome Assessment, Health Care , SARS-CoV-2
4.
Respiration ; 100(9): 909-917, 2021.
Article in English | MEDLINE | ID: covidwho-1270908

ABSTRACT

BACKGROUND: During the first wave of the SARS-CoV-2 pandemic in Switzerland, confinement was imposed to limit transmission and protect vulnerable persons. These measures may have had a negative impact on perceived quality of care and symptoms in patients with chronic disorders. OBJECTIVES: To determine whether patients under long-term home noninvasive ventilation (LTHNIV) for chronic respiratory failure (CRF) were negatively affected by the 56-day confinement (March-April 2020). METHODS: A questionnaire-based survey exploring mood disturbances (HAD), symptom scores related to NIV (S3-NIV), and perception of health-care providers during confinement was sent to all patients under LTHNIV followed up by our center. Symptom scores and data obtained by ventilator software were compared between confinement and the 56 days prior to confinement. RESULTS: Of a total of 100 eligible patients, 66 were included (median age: 66 years [IQR: 53-74]): 35 (53%) with restrictive lung disorders, 20 (30%) with OHS or SRBD, and 11 (17%) with COPD or overlap syndrome. Prevalence of anxiety (n = 7; 11%) and depressive (n = 2; 3%) disorders was remarkably low. Symptom scores were slightly higher during confinement although this difference was not clinically relevant. Technical data regarding ventilation, including compliance, did not change. Patients complained of isolation and lack of social contact. They felt supported by their relatives and caregivers but complained of the lack of regular contact and information by health-care professionals. CONCLUSIONS: Patients under LTHNIV for CRF showed a remarkable resilience during the SARS-CoV-2 confinement period. Comments provided may be helpful for managing similar future health-care crises.


Subject(s)
COVID-19 , Communicable Disease Control , Home Care Services/standards , Noninvasive Ventilation , Respiratory Insufficiency , Aged , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Chronic Disease , Communicable Disease Control/methods , Communicable Disease Control/statistics & numerical data , Female , Health Services Needs and Demand , Humans , Long-Term Care/methods , Male , Mood Disorders/epidemiology , Mood Disorders/physiopathology , Noninvasive Ventilation/methods , Noninvasive Ventilation/statistics & numerical data , Qualitative Research , Quality of Health Care/statistics & numerical data , Respiratory Insufficiency/epidemiology , Respiratory Insufficiency/etiology , Respiratory Insufficiency/psychology , Respiratory Insufficiency/therapy , SARS-CoV-2 , Social Support , Switzerland/epidemiology , Symptom Assessment/methods , Symptom Assessment/statistics & numerical data
5.
J Alzheimers Dis ; 80(4): 1395-1399, 2021.
Article in English | MEDLINE | ID: covidwho-1194581

ABSTRACT

The rapid emergence of COVID-19 has had far-reaching effects across all sectors of health and social care, but none more so than for residential long-term care homes. Mortality rates of older people with dementia in residential long-term care homes have been exponentially higher than the general public. Morbidity rates are also higher in these homes with the effects of government-imposed COVID-19 public health directives (e.g., strict social distancing), which have led most residential long-term care homes to adopt strict 'no visitor' and lockdown policies out of concern for their residents' physical safety. This tragic toll of the COVID-19 pandemic highlights profound stigma-related inequities. Societal assumptions that people living with dementia have no purpose or meaning and perpetuate a deep pernicious fear of, and disregard for, persons with dementia. This has enabled discriminatory practices such as segregation and confinement to residential long-term care settings that are sorely understaffed and lack a supportive, relational, and enriching environment. With a sense of moral urgency to address this crisis, we forged alliances across the globe to form Reimagining Dementia: A Creative Coalition for Justice. We are committed to shifting the culture of dementia care from centralized control, safety, isolation, and punitive interventions to a culture of inclusion, creativity, justice, and respect. Drawing on the emancipatory power of the imagination with the arts (e.g., theatre, improvisation, music), and grounded in authentic partnerships with persons living with dementia, we aim to advance this culture shift through education, advocacy, and innovation at every level of society.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Communicable Disease Control/trends , Dementia/epidemiology , Dementia/therapy , Long-Term Care/trends , COVID-19/psychology , Communicable Disease Control/methods , Dementia/psychology , Homes for the Aged/trends , Humans , Long-Term Care/methods , Nursing Homes/trends
6.
J Hum Nutr Diet ; 34(4): 660-669, 2021 08.
Article in English | MEDLINE | ID: covidwho-1140262

ABSTRACT

BACKGROUND: During the global COVID-19 pandemic, UK dietitians have delivered the best care to help patients recover from the infection. The present study examined the development and evaluation of care pathways to manage nutritional care of patients following COVID-19 infection prior to and after discharge. METHODS: Registered UK dietitians completed an online questionnaire comprising 26 questions about the development of a pathway, its use, evaluation and training needs. RESULTS: Of 57 responses from organisations, 37 (65%) were involved in the planning/management of nutritional care. Only 19 responses had a new or adapted COVID-19 pathway. Of these, 74% reported involvement of dietetic services, 47% reported > 1 eligibility criteria for pathway inclusion and 53% accepted all positive or suspected cases. All respondents used nutritional screening, first-line dietary advice (food first) and referral for further advice and monitoring. Weight and food intake were the most used outcome measure. All pathways addressed symptoms related to nutrition, with the most common being weight loss with poor appetite, not being hungry and skipping meals in 84% of pathways. Over half of respondents (54%) planned to evaluate their pathway and 83% reported that they were 'very or reasonably confident' in their team's nutritional management of COVID-19. Less than half (42%) reported on training needs. CONCLUSIONS: Despite challenges encountered, pathways were developed and implemented. Dietitians had adapted to new ways of working to manage nutritional care in patients prior to and after discharge from hospital following COVID-19 infection. Further work is needed to develop strategies for evaluation of their impact.


Subject(s)
COVID-19/diet therapy , Critical Pathways , Nutrition Therapy/statistics & numerical data , Nutritionists/statistics & numerical data , Patient Discharge , Humans , Length of Stay , Long-Term Care/methods , Long-Term Care/statistics & numerical data , Nutrition Therapy/methods , SARS-CoV-2 , Surveys and Questionnaires , United Kingdom
7.
J Med Internet Res ; 23(3): e27443, 2021 03 25.
Article in English | MEDLINE | ID: covidwho-1123732

ABSTRACT

BACKGROUND: Most residents of long-term care facilities (LTCFs) are at high risk of complications and death following SARS-CoV-2 infection. In these facilities, viral transmission can be facilitated by shortages of human and material resources, which can lead to suboptimal application of infection prevention and control (IPC) procedures. To improve the dissemination of COVID-19 IPC guidelines, we developed a serious game called "Escape COVID-19" using Nicholson's RECIPE for meaningful gamification, as engaging serious games have the potential to induce behavioral change. OBJECTIVE: As the probability of executing an action is strongly linked to the intention of performing it, the objective of this study was to determine whether LTCF employees were willing to change their IPC practices after playing "Escape COVID-19." METHODS: This was a web-based, triple-blind, randomized controlled trial, which took place between November 5 and December 4, 2020. The health authorities of Geneva, Switzerland, asked the managers of all LTCFs under their jurisdiction to forward information regarding the study to all their employees, regardless of professional status. Participants were unaware that they would be randomly allocated to one of two different study paths upon registration. In the control group, participants filled in a first questionnaire designed to gather demographic data and assess baseline knowledge before accessing regular online IPC guidelines. They then answered a second questionnaire, which assessed their willingness to change their IPC practices and identified the reasons underlying their decision. They were then granted access to the serious game. Conversely, the serious game group played "Escape COVID-19" after answering the first questionnaire but before answering the second one. This group accessed the control material after answering the second set of questions. There was no time limit. The primary outcome was the proportion of LTCF employees willing to change their IPC practices. Secondary outcomes included the factors underlying participants' decisions, the domains these changes would affect, changes in the use of protective equipment items, and attrition at each stage of the study. RESULTS: A total of 295 answer sets were analyzed. Willingness to change behavior was higher in the serious game group (82% [119/145] versus 56% [84/150]; P<.001), with an odds ratio of 3.86 (95% CI 2.18-6.81; P<.001) after adjusting for professional category and baseline knowledge, using a mixed effects logistic regression model with LTCF as a random effect. For more than two-thirds (142/203) of the participants, the feeling of playing an important role against the epidemic was the most important factor explaining their willingness to change behavior. Most of the participants unwilling to change their behavior answered that they were already applying all the guidelines. CONCLUSIONS: The serious game "Escape COVID-19" was more successful than standard IPC material in convincing LTCF employees to adopt COVID-19-safe IPC behavior. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/25595.


Subject(s)
COVID-19/prevention & control , COVID-19/transmission , Disease Transmission, Infectious/prevention & control , Infection Control/methods , Long-Term Care/methods , Video Games , COVID-19/epidemiology , Female , Humans , Infection Control/statistics & numerical data , Intention , Internet , Long-Term Care/standards , Male , SARS-CoV-2/isolation & purification
8.
S Afr Fam Pract (2004) ; 63(1): e1-e5, 2021 02 08.
Article in English | MEDLINE | ID: covidwho-1079745

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on elderly patients, and thus, adequate treatment plans are essential. This qualitative report provides recommendations for the supportive care and treatment of residents in long-term care facilities (LTCF) with COVID-19. A treatment protocol was developed in response to an outbreak of COVID-19 in an LTCF based in Johannesburg and was implemented over a 3-month period.


Subject(s)
COVID-19/therapy , Homes for the Aged/organization & administration , Infection Control/organization & administration , Long-Term Care/organization & administration , Nursing Homes/organization & administration , Patient Care Management/methods , Aged , Aged, 80 and over , COVID-19/prevention & control , Female , Frail Elderly , Health Plan Implementation , Humans , Infection Control/methods , Long-Term Care/methods , Male , SARS-CoV-2 , South Africa
9.
Chest ; 159(5): 1894-1901, 2021 05.
Article in English | MEDLINE | ID: covidwho-1051537

ABSTRACT

The COVID-19 pandemic has presented novel challenges for the entire health-care continuum, requiring transformative changes to hospital and post-acute care, including clinical, administrative, and physical modifications to current standards of operations. Innovative use and adaptation of long-term acute care hospitals (LTACHs) can safely and effectively care for patients during the ongoing COVID-19 pandemic. A framework for the rapid changes, including increasing collaboration with external health-care organizations, creating new methods for enhanced communication, and modifying processes focused on patient safety and clinical outcomes, is described for a network of 94 LTACHs. When managed and modified correctly, LTACHs can play a vital role in managing the national health-care pandemic crisis.


Subject(s)
Critical Care/methods , Intensive Care Units , Long-Term Care , COVID-19/epidemiology , COVID-19/therapy , Duration of Therapy , Humans , Intensive Care Units/organization & administration , Intensive Care Units/trends , Long-Term Care/methods , Long-Term Care/organization & administration , Long-Term Care/trends , Organizational Innovation , SARS-CoV-2
11.
Eur Geriatr Med ; 11(6): 899-913, 2020 12.
Article in English | MEDLINE | ID: covidwho-898206

ABSTRACT

PURPOSE: The European Geriatric Medicine Society (EuGMS) is launching a second interim guidance whose aim is to prevent the entrance and spread of COVID-19 into long-term care facilities (LTCFs). METHODS: The EuGMS gathered experts to propose a guide of measures to prevent COVID-19 outbreaks in LTCFs. It is based on the specific features of SARS-CoV-2 transmission in LTCFs, residents' needs, and on experiences conducted in the field. RESULTS: Asymptomatic COVID-19 residents and staff members contribute substantially to the dissemination of COVID-19 infection in LTCFs. An infection prevention and control focal point should be set up in every LTCF for (1) supervising infection prevention and control measures aimed at keeping COVID-19 out of LTCFs, (2) RT-PCR testing of residents, staff members, and visitors with COVID-19 symptoms, even atypical, and (3) isolating subjects either infected or in contact with infected subjects. When a first LCTF resident or staff member is infected, a facility-wide RT-PCR test-retest strategy should be implemented for detecting all SARS-CoV-2 carriers. Testing should continue until no new COVID-19 cases are identified. The isolation of residents should be limited as much as possible and associated with measures aiming at limiting its negative effects on their mental and somatic health status. CONCLUSIONS: An early recognition of symptoms compatible with COVID-19 may help to diagnose COVID-19 residents and staff more promptly. Subsequently, an earlier testing for SARS-CoV-2 symptomatic and asymptomatic LTCF staff and residents will enable the implementation of appropriate infection prevention and control. The negative effects of social isolation in residents should be limited as much as possible.


Subject(s)
COVID-19 , Geriatrics , Long-Term Care , Skilled Nursing Facilities , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19/therapy , COVID-19/transmission , Europe , Geriatrics/methods , Geriatrics/organization & administration , Humans , Long-Term Care/classification , Long-Term Care/methods , Palliative Care , Pandemics , Practice Guidelines as Topic , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2 , Social Isolation
12.
J Pediatr Rehabil Med ; 13(3): 371-376, 2020.
Article in English | MEDLINE | ID: covidwho-890315

ABSTRACT

The COVID-19 pandemic is exacerbating longstanding challenges facing children with tracheostomies and their families. Myriad ethical concerns arising in the long-term care of children with tracheostomies during the COVID-19 pandemic revolve around inadequate access to care, healthcare resources, and rehabilitation services. Marginalized communities such as those from Black and Hispanic origins face disproportionate chronic illness because of racial and other underlying disparities. In this paper, we describe how these disparities also present challenges to children who are technology-dependent, such as those with tracheostomies and discuss the emerging ethical discourse regarding healthcare and resource access for this population during the pandemic.


Subject(s)
COVID-19/epidemiology , Health Status Disparities , Long-Term Care/methods , Pandemics , SARS-CoV-2 , Tracheostomy/ethics , COVID-19/therapy , Child , Humans
13.
Am J Case Rep ; 21: e926101, 2020 Sep 28.
Article in English | MEDLINE | ID: covidwho-802888

ABSTRACT

BACKGROUND The novel coronavirus disease (COVID-19) has been declared a pandemic. With the ever-increasing number of COVID-19 patients, it is imperative to explore the factors related to the disease to aid patient management until a definitive vaccine is ready, as the disease is not limited to the respiratory system alone. COVID-19 has been associated with various cardiovascular complications including acute myocardial injury, myocarditis, arrhythmias, and venous thromboembolism. The infection is severe in patients with pre-existing cardiovascular disease, and a systemic inflammatory response due to a cytokine storm in severe COVID-19 cases can lead to acute myocardial infarction. CASE REPORT We present the case of a 56-year-old man with cardiovascular risk factors including coronary artery disease, hypertension, ischemic cardiomyopathy, and hyperlipidemia, who had COVID-19-induced pneumonia complicated with acute respiratory distress syndrome. He subsequently developed myocardial infarction during his hospitalization at our facility. He had a significant contact history for COVID-19. He was managed with emergent cardiac revascularization after COVID-19 was confirmed by real-time reverse transcription-polymerase chain reaction testing from a nasopharyngeal swab as per hospital policy for admitted patients. Apart from dual antiplatelet therapy, tocilizumab therapy was initiated due to the high interleukin-6 levels. His hospitalization was complicated by hemodialysis and failed extubation and intubation, resulting in a tracheostomy. Upon improvement, he was discharged to a long-term facility with a plan for outpatient follow-up. CONCLUSIONS In high-risk patients with COVID-19-induced pneumonia and cardiovascular risk factors, a severe systemic inflammatory response can lead to atherosclerotic plaque rupture, which can manifest as acute coronary syndrome.


Subject(s)
Coronavirus Infections/complications , Inferior Wall Myocardial Infarction/complications , Inferior Wall Myocardial Infarction/therapy , Percutaneous Coronary Intervention/methods , Pneumonia, Viral/complications , Severe Acute Respiratory Syndrome/complications , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Coronary Angiography/methods , Coronavirus Infections/diagnosis , Critical Illness , Follow-Up Studies , Humans , Inferior Wall Myocardial Infarction/diagnostic imaging , Long-Term Care/methods , Male , Middle Aged , Multimorbidity , Pandemics , Pneumonia, Viral/diagnosis , Respiration, Artificial/methods , Risk Assessment , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/therapy , Time Factors , Tracheostomy/methods , Treatment Outcome
14.
Age Ageing ; 50(1): 16-20, 2021 01 08.
Article in English | MEDLINE | ID: covidwho-780321

ABSTRACT

In the COVID-19 pandemic, patients who are older and residents of long-term care facilities (LTCF) are at greatest risk of worse clinical outcomes. We reviewed discharge criteria for hospitalised COVID-19 patients from 10 countries with the highest incidence of COVID-19 cases as of 26 July 2020. Five countries (Brazil, Mexico, Peru, Chile and Iran) had no discharge criteria; the remaining five (USA, India, Russia, South Africa and the UK) had discharge guidelines with large inter-country variability. India and Russia recommend discharge for a clinically recovered patient with two negative reverse transcription polymerase chain reaction (RT-PCR) tests 24 h apart; the USA offers either a symptom based strategy-clinical recovery and 10 days after symptom onset, or the same test-based strategy. The UK suggests that patients can be discharged when patients have clinically recovered; South Africa recommends discharge 14 days after symptom onset if clinically stable. We recommend a unified, simpler discharge criteria, based on current studies which suggest that most SARS-CoV-2 loses its infectivity by 10 days post-symptom onset. In asymptomatic cases, this can be taken as 10 days after the first positive PCR result. Additional days of isolation beyond this should be left to the discretion of individual clinician. This represents a practical compromise between unnecessarily prolonged admissions and returning highly infectious patients back to their care facilities, and is of particular importance in older patients discharged to LTCFs, residents of which may be at greatest risk of transmission and worse clinical outcomes.


Subject(s)
COVID-19 , Disease Transmission, Infectious/prevention & control , Long-Term Care , Patient Discharge , Patient Transfer , Skilled Nursing Facilities/statistics & numerical data , Aged , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Testing/methods , Convalescence , Female , Hospitalization/statistics & numerical data , Humans , Internationality , Long-Term Care/methods , Long-Term Care/statistics & numerical data , Male , Needs Assessment , Patient Discharge/standards , Patient Discharge/trends , Patient Transfer/methods , Patient Transfer/standards , Quality Improvement/organization & administration , SARS-CoV-2/isolation & purification
15.
Age Ageing ; 50(2): 335-340, 2021 02 26.
Article in English | MEDLINE | ID: covidwho-766513

ABSTRACT

The care and support of older people residing in long-term care facilities during the COVID-19 pandemic has created new and unanticipated uncertainties for staff. In this short report, we present our analyses of the uncertainties of care home managers and staff expressed in a self-formed closed WhatsApp™ discussion group during the first stages of the pandemic in the UK. We categorised their wide-ranging questions to understand what information would address these uncertainties and provide support. We have been able to demonstrate that almost one-third of these uncertainties could have been tackled immediately through timely, responsive and unambiguous fact-based guidance. The other uncertainties require appraisal, synthesis and summary of existing evidence, commissioning or provision of a sector- informed research agenda for medium to long term. The questions represent wider internationally relevant care home pandemic-related uncertainties.


Subject(s)
Attitude of Health Personnel , COVID-19 , Delivery of Health Care , Health Personnel , Homes for the Aged/organization & administration , Long-Term Care , Nursing Homes/organization & administration , Uncertainty , Aged , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/therapy , Delivery of Health Care/ethics , Delivery of Health Care/methods , Delivery of Health Care/organization & administration , Focus Groups , Health Personnel/economics , Health Personnel/ethics , Health Personnel/psychology , Health Services Needs and Demand , Humans , Long-Term Care/ethics , Long-Term Care/methods , Long-Term Care/psychology , Qualitative Research , SARS-CoV-2 , United Kingdom/epidemiology
17.
Br J Surg ; 107(10): 1245-1249, 2020 09.
Article in English | MEDLINE | ID: covidwho-726269

ABSTRACT

The battle of COVID-19 is currently at different levels of intensity in each country and even each city. The authors have prepared succinct recommendations regarding the care of patients with breast cancer, divided into phases that can easily be adapted to each units' needs and resources, and stepped up or stepped down according to escalating and de-escalating circumstances. The structure can also be transposed easily to different cancer types, enabling continued provision of best standards of care despite unprecedented stressors. Surgery must go on.


Subject(s)
Betacoronavirus , Breast Neoplasms/complications , Coronavirus Infections/epidemiology , Disease Management , Long-Term Care/methods , Pneumonia, Viral/epidemiology , Telemedicine/methods , Breast Neoplasms/therapy , COVID-19 , Coronavirus Infections/complications , Female , Humans , Pandemics , Pneumonia, Viral/complications , SARS-CoV-2
18.
Geriatr Gerontol Int ; 20(7): 715-719, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-682347

ABSTRACT

AIM: To clarify the association of cluster number and size of coronavirus disease 2019 (COVID-19) in long-term care (LTC) hospitals/facilities, general medical/welfare facilities and non-medical/welfare facilities with morbidity and mortality in 47 prefectures during 16 January to 9 May 2020 in Japan. METHODS: Information on COVID-19 clusters (n ≥2), and morbidity and mortality of COVID-19 was collected. RESULTS: A total of 381 clusters with 3786 infected cases were collected, accounting for 23.9% of 15 852 cumulated cases on 9 May 2020. Although the cluster number (/107 subjects) in LTC hospitals/facilities was significantly smaller compared with those in the other two groups, the cluster size in LTC hospitals/facilities was significantly larger than that in non-medical/welfare facilities. Cluster numbers in general medical/welfare facilities and in non-medical/welfare facilities were significantly positively correlated with morbidity (/105 ), indicating relatively early identification of clusters in these facilities. Unlike in these facilities, cluster size in LTC hospitals/facilities was significantly positively correlated with morbidity, indicating that clusters in LTC hospitals/facilities were finally identified after already having grown to a large size in areas where infection was prevalent. Multivariate logistic regression analysis showed that both cluster number and cluster size only in LTC hospitals/facilities were independently associated with higher mortality (≥median 0.64/105 subjects) after adjustment. CONCLUSIONS: Preventive efforts against COVID-19 outbreaks even at the early phase of the epidemic are critically important in LTC hospitals/facilities, as both the larger number and size of clusters only in LTC hospitals/facilities were independently linked to higher mortality in prefectures in Japan. Geriatr Gerontol Int 2020; 20: 715-719.


Subject(s)
Coronavirus Infections , Hospitals, Chronic Disease/statistics & numerical data , Long-Term Care , Pandemics , Pneumonia, Viral , Skilled Nursing Facilities/statistics & numerical data , Aged , Betacoronavirus/isolation & purification , COVID-19 , Cluster Analysis , Coronavirus Infections/mortality , Coronavirus Infections/prevention & control , Female , Humans , Infection Control/organization & administration , Japan/epidemiology , Long-Term Care/methods , Long-Term Care/organization & administration , Long-Term Care/trends , Male , Mortality , Pandemics/prevention & control , Pneumonia, Viral/mortality , Pneumonia, Viral/prevention & control , SARS-CoV-2
20.
J Nutr Health Aging ; 24(8): 812-816, 2020.
Article in English | MEDLINE | ID: covidwho-640975

ABSTRACT

BACKGROUND: Guidance aiming at limiting the entry and spread of the COVID-19 have been widely communicated to Long-term Care Facilities (LTCFs). However, no clinical research has investigated their relevance. OBJECTIVE: Our objective was to compare the guidance applied for the prevention of the COVID-19 epidemic between the LTCFs having been contaminated by COVID-19 and LTCFs having not been contaminated. METHODS: A questionnaire was sent and systematically accompanied by phone call to the 132 LTCFs of Haute-Garonne (Occitania region, South-West of France). The questionnaire focused on the preventive measures implemented before March 23, 2020 (first LTCFs contaminated in this area). The questionnaire focused on physician support, implementation of usual guidance (eg, masks, hydro-alcoholic solute used), training on hygiene, containment in residents' rooms and other distancing measures, use of temporary workers, compartmentalization within zones of residents and staff and a self-assessment analogic scale on the quality of the application of the preventive measures. We compared implementation of the guidance between the LTCFs with at least one case of COVID-19 among residents and/or health care professionals and LTCFs without COVID-19 case (between March 23rd and May 6th). RESULTS: 124 LTCFs participated (93.9%). 30 LTCFs (24.19%) were contaminated with COVID-19. Large heterogeneity of the application of the guidance was observed. Public LTCFs (OR= 0.39 (0.20-0.73), LTCFs which organized staff compartmentalization within zones (OR= 0.19 (0.07-0.48)), and LTCF with a staff who self-assessed a higher quality implementation of the preventive measures (OR= 0.65 (0.43-0.98)) were significantly more likely to avoid contamination by the COVID-19 outbreak. CONCLUSION: Our study supports the relevance of guidance to prevent the entry of COVID-19, in particular the staff compartmentalization within zones, as well as the perception of the staff regarding the quality of implementation of those measures in LTCFs.


Subject(s)
Coronavirus Infections/prevention & control , Health Facility Administration/methods , Long-Term Care/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Primary Prevention/methods , Betacoronavirus , COVID-19 , France , Health Facilities , Humans , Male , Prospective Studies , SARS-CoV-2 , Surveys and Questionnaires
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