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1.
J Infect Dev Ctries ; 15(8): 1094-1103, 2021 08 31.
Article in English | MEDLINE | ID: covidwho-1405472

ABSTRACT

INTRODUCTION: About 14% of COVID-19 patients experience severe symptoms and require hospitalization. Managing these patients could be challenging for limited-resource countries, such as Palestine. This study aimed to evaluate hospitalized severe COVID-19 patients' treatment outcomes managed with supportive care and steroids. METHODOLOGY: This was a single-center observational retrospective cohort study that enrolled COVID-19 patients admitted to the "Martyrs medical military complex- COVID Hospital" in Palestine. The managing physicians manually collected data through chart reviews, including patients' characteristics, complications, outcomes, and different management modalities. Continuous and categorical variables between those who were discharged alive and who died were compared using t-test and Chi-squares test, respectively. RESULTS: Overall, 334 patients were included in this study. Median (IQR) age was 62(11) years, 49.1% were males, and 29.6% were ICU status patients. The median (IQR) PaO2/FiO2 ratio was 76 (67), and 67.6% of these patients had moderate to severe acute respiratory distress syndrome, and 4.8% of the patients received invasive mechanical ventilation. Most of the patients (78.7%) had at least one comorbidity, and 18.3% developed at least one complication. The overall mortality was 12.3% (95% CI 8.9-16.2%), and the median (IQR) length of hospital stay was 11 (8) days. Age (aOR 1.05, p = 0.08), smoking (aOR 4.12, p = 0.019), IMV (aOR 27.4, p < 0.001) and PaO2/FiO2 ratio (aOR 1.03, p < 0.001) were found to predict higher mortality. CONCLUSIONS: Supportive care for patients with severe COVID-19 pneumonia in a Palestinian hospital with limited resources was associated with in-hospital mortality of 12.3%.


Subject(s)
COVID-19/mortality , COVID-19/therapy , Developing Countries , Health Resources , Hospital Mortality , Palliative Care/statistics & numerical data , Aged , COVID-19/epidemiology , Comorbidity , Critical Care/methods , Critical Care/standards , Critical Care/statistics & numerical data , Female , Hospitalization/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Palliative Care/methods , Palliative Care/standards , Respiration, Artificial , Retrospective Studies
4.
Br J Community Nurs ; 25(7): 358, 2020 Jul 02.
Article in English | MEDLINE | ID: covidwho-1202251
5.
J Contin Educ Nurs ; 52(3): 130-135, 2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1102580

ABSTRACT

BACKGROUND: COVID-19 has highlighted the need for universal palliative care access. Nurses require palliative care education throughout the trajectory of professional training to effectively achieve this vision. METHOD: Review of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care and use of educational exemplars highlight opportunities for improving palliative nursing education in academic and clinical settings. RESULTS: Consistently applying palliative care principles affects nursing outcomes across myriad domains of person-centered services. All nurses are responsible for delivering primary palliative care, but they cannot practice what they do not know. The End-of-Life Nursing Education Consortium Project offers evidence-based education for nursing students and practicing nurses nationally and globally. CONCLUSION: Equipping both nurses and nursing students with palliative care education is critical to improve the overall quality of health care throughout the continuum during COVID-19 and in the face of future health crises. [J Contin Educ Nurs. 2021;52(3):130-135.].


Subject(s)
COVID-19/epidemiology , COVID-19/nursing , Education, Nursing, Continuing/organization & administration , Global Health , Hospice and Palliative Care Nursing/education , Palliative Care/standards , Curriculum , Humans , Pandemics , Practice Guidelines as Topic , SARS-CoV-2 , United States/epidemiology
7.
Palliat Support Care ; 18(4): 400-402, 2020 08.
Article in English | MEDLINE | ID: covidwho-940881

ABSTRACT

The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic has necessitated an interim restructuring of the healthcare system in accordance with public health preventive measures to mitigate spread of the virus while providing essential healthcare services to the public. This article discusses how the Palliative Care Team of the Komfo Anokye Teaching Hospital in Ghana has modified its services in accordance with public health guidelines. It also suggests a strategy to deal with palliative care needs of critically ill patients with COVID-19 and their families.


Subject(s)
Coronavirus Infections/therapy , Hospice and Palliative Care Nursing/standards , Hospitals, Teaching/standards , Palliative Care/standards , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Betacoronavirus , COVID-19 , Ghana , Humans , Pandemics , SARS-CoV-2
8.
Cancer Med ; 9(24): 9193-9204, 2020 12.
Article in English | MEDLINE | ID: covidwho-938402

ABSTRACT

Since the COVID-19 outbreak started, it has been affecting mainly older individuals. Among the most vulnerable older individuals are those with cancer. Many published guidelines and consensus papers deal with prioritizing cancer care. Given the lack of high-quality evidence for management of cancer in older patients also in normal times, it is even more stringent to provide some resources on how to avoid both undertreatment and overtreatment in this population, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID-19 as well as from cancer not adequately addressed and treated. We hereby discuss some general recommendations (implement triage procedures; perform geriatric assessment; carefully assess comorbidity; promote early integration of palliative care in oncology; acknowledge the role of caregivers; maintain active take in charge to avoid feeling of abandonment; mandate seasonal flu vaccination) and discuss practical suggestions for specific disease settings (early-stage and advanced-stage disease for solid tumors, and hematological malignancies). The manuscript provides resources on how to avoid both undertreatment and overtreatment in older patients with cancer, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID-19 as well as from cancer not adequately addressed and treated.


Subject(s)
COVID-19/prevention & control , Medical Oncology/methods , Neoplasms/therapy , SARS-CoV-2/isolation & purification , Aged , COVID-19/epidemiology , COVID-19/virology , Caregivers/standards , Caregivers/statistics & numerical data , Disease Outbreaks , Geriatric Assessment/methods , Geriatric Assessment/statistics & numerical data , Humans , Medical Oncology/standards , Medical Oncology/statistics & numerical data , Neoplasms/diagnosis , Palliative Care/methods , Palliative Care/standards , Palliative Care/statistics & numerical data , SARS-CoV-2/physiology
10.
BMJ Open ; 10(8): e037466, 2020 08 05.
Article in English | MEDLINE | ID: covidwho-695785

ABSTRACT

OBJECTIVE: The COVID-19 pandemic has highlighted ongoing challenges to optimal supportive end-of-life care for adults living in long-term care (LTC) facilities. A supportive end-of-life care approach emphasises family involvement, optimal symptom control, multidisciplinary team collaboration and death and bereavement support services for residents and families. Community-based and palliative care specialist physicians who visit residents in LTC facilities play an important role in supportive end-of-life care. Yet, perspectives, experiences and perceptions of these physicians remain unknown. The objective of this study was to explore barriers and facilitators to optimal supportive end-of-life palliative care in LTC through the experiences and perceptions of community-based and palliative specialist physicians who visit LTC facilities. DESIGN: Qualitative study using semi-structured interviews, basic qualitative description and directed content analysis using the COM-B (capability, opportunity, motivation - behaviour) theoretical framework. SETTING: Residential long-term care. PARTICIPANTS: 23 physicians who visit LTC facilities from across Alberta, Canada, including both in urban and rural settings of whom 18 were community-based physicians and 5 were specialist palliative care physicians. RESULTS: Motivation barriers include families' lack of frailty knowledge, unrealistic expectations and emotional reactions to grief and uncertainty. Capability barriers include lack of symptom assessment tools, as well as palliative care knowledge, training and mentorship. Physical and social design barriers include lack of dedicated spaces for death and bereavement, inadequate staff, and mental health and spiritual services of insufficient scope for the population. CONCLUSION: Findings reveal that validating families' concerns, having appropriate symptom assessment tools, providing mentorship in palliative care and adapting the physical and social environment to support dying and grieving with dignity facilitates supportive, end-of-life care within LTC.


Subject(s)
Coronavirus Infections/therapy , Long-Term Care , Palliative Care/standards , Pandemics , Physicians , Pneumonia, Viral/therapy , Skilled Nursing Facilities , Terminal Care/standards , Adult , Aged , Alberta , Attitude of Health Personnel , Betacoronavirus , COVID-19 , Coronavirus Infections/virology , Family , Female , Frail Elderly , Frailty , Health Services Needs and Demand , Hospice Care , Humans , Male , Middle Aged , Pneumonia, Viral/virology , Qualitative Research , Respect , SARS-CoV-2 , Specialization
11.
Palliat Med ; 34(9): 1249-1255, 2020 10.
Article in English | MEDLINE | ID: covidwho-690192

ABSTRACT

BACKGROUND: The literature contains limited information on the problems faced by dying patients with COVID-19 and the effectiveness of interventions to manage these. AIM: The aim of this audit was to assess the utility of our end-of-life care plan, and specifically the effectiveness of our standardised end-of-life care treatment algorithms, in dying patients with COVID-19. DESIGN: The audit primarily involved data extraction from the end-of-life care plan, which includes four hourly nursing (ward nurses) assessments of specific problems: patients with problems were managed according to standardised treatment algorithms, and the intervention was deemed to be effective if the problem was not present at subsequent assessments. SETTING/PARTICIPANTS: This audit was undertaken at a general hospital in England, covered the 8 weeks from 16 March to 11 May 2020 and included all inpatients with COVID-19 who had an end-of-life care plan (and died). RESULTS: Sixty-one patients met the audit criteria: the commonest problem was shortness of breath (57.5%), which was generally controlled with conservative doses of morphine (10-20 mg/24 h via a syringe pump). Cough and audible respiratory secretions were relatively uncommon. The second most common problem was agitation/delirium (55.5%), which was generally controlled with standard pharmacological interventions. The cumulative number of patients with shortness of breath, agitation and audible respiratory secretions increased over the last 72 h of life, but most patients were symptom controlled at the point of death. CONCLUSION: Patients dying of COVID-19 experience similar end-of-life problems to other groups of patients. Moreover, they generally respond to standard interventions for these end-of-life problems.


Subject(s)
Coronavirus Infections/mortality , Delirium/drug therapy , Drug Therapy/standards , Dyspnea/drug therapy , Hospice Care/standards , Palliative Care/standards , Pneumonia, Viral/mortality , Terminal Care/standards , Aged , Aged, 80 and over , Analgesics, Opioid/therapeutic use , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/nursing , Drug Therapy/statistics & numerical data , Female , Hospice Care/statistics & numerical data , Humans , Hypnotics and Sedatives/therapeutic use , Male , Middle Aged , Morphine/therapeutic use , Palliative Care/statistics & numerical data , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/nursing , Practice Guidelines as Topic , SARS-CoV-2 , Terminal Care/statistics & numerical data , United Kingdom/epidemiology
12.
Crit Care Nurse ; 40(6): e28-e36, 2020 Dec 01.
Article in English | MEDLINE | ID: covidwho-662486

ABSTRACT

BACKGROUND: The coronavirus disease 2019 pandemic has led to escalating infection rates and associated deaths worldwide. Amid this public health emergency, the urgent need for palliative care integration throughout critical care settings has never been more crucial. OBJECTIVE: To promote palliative care engagement in critical care; share palliative care resources to support critical care nurses in alleviating suffering during the coronavirus disease 2019 pandemic; and make recommendations to strengthen nursing capacity to deliver high-quality, person-centered critical care. METHODS: Palliative and critical care literature and practice guidelines were reviewed, synthesized, and translated into recommendations for critical care nursing practice. RESULTS: Nurses are ideally positioned to drive full integration of palliative care into the critical care delivery for all patients, including those with coronavirus disease 2019, given their relationship-based approach to care, as well as their leadership and advocacy roles. Recommendations include the promotion of healthy work environments and prioritizing nurse self-care in alignment with critical care nursing standards. CONCLUSIONS: Nurses should focus on a strategic integration of palliative care, critical care, and ethically based care during times of normalcy and of crisis. Primary palliative care should be provided for each patient and family, and specialist services sought, as appropriate. Nurse educators are encouraged to use these recommendations and resources in their curricula and training. Palliative care is critical care. Critical care nurses are the frontline responders capable of translating this holistic, person-centered approach into pragmatic services and relationships throughout the critical care continuum.


Subject(s)
COVID-19/nursing , Critical Care Nursing/organization & administration , Critical Care Nursing/standards , Nurse's Role , Palliative Care/organization & administration , Palliative Care/standards , Practice Guidelines as Topic , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
13.
Am J Hosp Palliat Care ; 37(11): 980-984, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-659864

ABSTRACT

As the spread of the novel coronavirus disease 2019 (COVID-19) continues worldwide, health care systems are facing increased demand with concurrent health care provider shortages. This increase in patient demand and potential for provider shortages is particularly apparent for palliative medicine, where there are already shortages in the provision of this care. In response to the developing pandemic, our Geriatrics and Palliative (GAP) Medicine team formulated a 2-team approach which includes triage algorithms for palliative consults as well as acute symptomatic management for both patients diagnosed with or under investigation (PUI) for COVID-19. These algorithms provided a delineated set of guidelines to triage patients in need of palliative services and included provisions for acute symptoms management and the protection of both the patient care team and the families of patients with COVID-19. These guidelines helped with streamlining care in times of crisis, providing care to those in need, supporting frontline staff with primary-level palliative care, and minimizing the GAP team's risk of infection and burnout during the rapidly changing pandemic response.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Palliative Care/methods , Pandemics , Patient Care Planning , Pneumonia, Viral/therapy , Triage/methods , Algorithms , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Health Services Accessibility , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Palliative Care/standards , Pandemics/prevention & control , Patient Care Planning/standards , Patient Care Team , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2
14.
J Palliat Med ; 24(1): 46-52, 2021 01.
Article in English | MEDLINE | ID: covidwho-649576

ABSTRACT

Background: Although access to advance care planning (ACP), palliative care, and hospice has increased, public attitudes may still be barriers to their optimal use. Purpose: To synthesize empirical research from disparate sources that describes public perceptions of ACP, palliative care, and hospice in ways that could inform public messaging. Data Sources: Searches of PubMed and other databases were made from January 2011 to January 2020. Study Selection: Studies reporting survey or interview data with the public that asked specifically about awareness and attitudes toward ACP, palliative care, or hospice were included. Data Extraction and Synthesis: Two reviewers independently screened citations, read full texts, and performed data abstraction. Twelve studies met inclusion criteria and included >9800 participants. For ACP, 80% to 90% of participants reported awareness, and a similar proportion considered it important, but only 10% to 41% reported having named a proxy or completed a written document. For palliative care, 66% to 71% of participants reported no awareness of palliative care, and those who reported awareness often conflated it with end-of-life care. However, after being prompted with a tested definition, 95% rated palliative care favorably. For hospice, 86% of participants reported awareness and 70% to 91% rated it favorably, although 37% held significant misconceptions. Limitations: A limited number of studies met inclusion criteria, and some were published in nonpeer reviewed sources. The studies reflect public perceptions pre-COVID-19. Conclusion: Consumer perceptions of ACP, palliative care, and hospice each have a distinct profile of awareness, perceptions of importance, and reports of action taking, and these profiles represent three different challenges for public messaging.


Subject(s)
Advance Directives/psychology , COVID-19 , Hospice Care/psychology , Hospice Care/standards , Palliative Care/psychology , Palliative Care/standards , Patients/psychology , Adult , Advance Directives/statistics & numerical data , Aged , Aged, 80 and over , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Middle Aged , Patients/statistics & numerical data , SARS-CoV-2 , Surveys and Questionnaires , United States , Young Adult
15.
J Gastrointest Cancer ; 51(3): 800-804, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-640099

ABSTRACT

PURPOSE: Today, the rapid outbreak of COVID-19 is the leading health issue. Patients with cancer are at high risk for the development of morbidities of COVID-19. Hence, oncology centers need to provide organ-based recommendations for optimal management of cancer in the COVID-19 era. METHODS: In this article, we have provided the recommendations on management of locally advanced rectal cancer during the COVID-19 pandemic based on our experience in Shohada-e Tajrish Hospital, Iran. RESULTS: We recommend that patients with locally advanced rectal cancer should be managed in an individualized manner in combination with local conditions related to COVID-19. CONCLUSION: Our recommendation may provide a guide for oncology centers of developing countries for better management of locally advanced rectal cancer.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/prevention & control , Medical Oncology/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic/standards , Rectal Neoplasms/therapy , Age Factors , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/standards , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Betacoronavirus/isolation & purification , COVID-19 , Chemotherapy, Adjuvant/standards , Clinical Decision-Making , Consensus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Humans , Infection Control/standards , Iran/epidemiology , Medical Oncology/methods , Neoadjuvant Therapy/standards , Neoplasm Staging , Palliative Care/methods , Palliative Care/standards , Patient Selection , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Proctectomy/standards , Rectal Neoplasms/pathology , Rectum/pathology , Rectum/surgery , SARS-CoV-2
17.
Head Neck ; 42(7): 1507-1515, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-614117

ABSTRACT

INTRODUCTION: The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has altered the health care environment for the management of head and neck cancers. The purpose of these guidelines is to provide direction during the pandemic for rational Head and Neck Cancer management in order to achieve a medically and ethically appropriate balance of risks and benefits. METHODS: Creation of consensus document. RESULTS: The process yielded a consensus statement among a wide range of practitioners involved in the management of patients with head and neck cancer in a multihospital tertiary care health system. CONCLUSIONS: These guidelines support an ethical approach for the management of head and neck cancers during the COVID-19 epidemic consistent with both the local standard of care as well as the head and neck oncological literature.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Head and Neck Neoplasms/therapy , Infection Control/standards , Medical Oncology/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Ambulatory Care/standards , COVID-19 , Combined Modality Therapy , Continuity of Patient Care/standards , Coronavirus Infections/diagnosis , Head and Neck Neoplasms/diagnosis , Humans , Multi-Institutional Systems , Otorhinolaryngologic Surgical Procedures/standards , Palliative Care/standards , Patient Safety , Pennsylvania , Personal Protective Equipment , Pneumonia, Viral/diagnosis , SARS-CoV-2 , Terminal Care/standards , Tertiary Care Centers
18.
JCO Glob Oncol ; 6: 844-851, 2020 06.
Article in English | MEDLINE | ID: covidwho-607188

ABSTRACT

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has imposed a unique challenge to oncology patients and their treatment. There is no study related to the patients' preference for systemic therapy during this pandemic. We have conducted a prospective study to analyze that aspect. METHODS: All consecutive patients who visited during the lockdown period from April 1-10, 2020, for systemic chemotherapy were included in the study for a questionnaire-based survey to evaluate the willingness to continue chemotherapy during this pandemic and factors influencing the decisions. RESULTS: A total of 302 patients were included (median age, 56 years; range, 21-77 years). Most common sites of cancer were breast (n = 114), lung (n = 44), ovary (n = 34), and colon (n = 20). Home address was within the city for 125 patients (42%), outside the city for 138 (46%), and outside the state for 37 (12%). Treatment was curative in 150 patients and palliative in 152. Educational status was primary and above for 231 patients and no formal schooling for 71. A total of 203 patients wanted to continue chemotherapy, 40 wanted to defer, and 56 wanted the physician to decide. Knowledge about COVID-19 strongly correlated with intent of treatment (P = .01), disease status (P = .02), knowledge about immunosuppression (P < .001), home location (P = .02), and education status (P = .003). The worry about catching SARS-CoV-2 was high in those with controlled disease (P = .06) and knowledge about immunosuppression (P = .02). Worry about disease progression was more with palliative intent (P < .001). CONCLUSION: This study shows that oncology patients in our country are more worried about disease progression than the SARS-CoV-2 and wish to continue chemotherapy during this pandemic. The treatment guidelines in the COVID-19 scenario should incorporate patients' perspectives.


Subject(s)
Betacoronavirus/immunology , Coronavirus Infections/prevention & control , Immunotherapy/standards , Neoplasms/therapy , Palliative Care/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Adult , Aged , Antineoplastic Agents, Immunological/adverse effects , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/immunology , Coronavirus Infections/virology , Disease Progression , Female , Health Knowledge, Attitudes, Practice , Humans , Immunotherapy/adverse effects , Immunotherapy/methods , India/epidemiology , Male , Middle Aged , Neoplasms/immunology , Neoplasms/psychology , Palliative Care/psychology , Palliative Care/statistics & numerical data , Patient Preference/psychology , Patient Preference/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/immunology , Pneumonia, Viral/virology , Practice Guidelines as Topic , Prospective Studies , SARS-CoV-2 , Surveys and Questionnaires/statistics & numerical data , Young Adult
19.
J Am Geriatr Soc ; 68(7): 1370-1375, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-232600

ABSTRACT

Early on, geriatricians in Israel viewed with increasing alarm the spread of coronavirus disease 2019 (COVID-19). It was clear that this viral disease exhibited a clear predilection for and danger to older persons. Informal contacts began with senior officials from the country's Ministry of Health, the Israel Medical Association, and the country's largest health fund; this was done to plan an approach to the possible coming storm. A group was formed, comprising three senior geriatricians, a former dean, a palliative care specialist, and a lawyer/ethicist. The members made every effort to ensure that their recommendations would be practical while at the same time taking into account the tenets of medical ethics. The committee's main task was to think through a workable approach because intensive care unit/ventilator resources may be far outstripped by those requiring such care. Recommendations included the approach to older persons both in the community and in long-term care institutions, a triage instrument, and palliative care. Patient autonomy was emphasized, with a strong recommendation for people of all ages to update their advance directives or, if they did not have any, to quickly draw them up. Considering the value of distributive justice, with respect to triage, a "soft utilitarian" approach was advocated with the main criteria being function and comorbidity. Although chronological age was rejected as a sole criterion, in the case of an overwhelming crisis, "biological age" would enter into the triage considerations, but only in the case of distinguishing between people with equal non-age-related deficits. The guideline emphasized that no matter what, in the spirit of beneficence, anyone who fell ill must receive active palliative care throughout the course of a COVD-19 infection but especially at the end of life. Furthermore, in the spirit of nonmaleficence, the frail, very old, and severely demented would be actively protected from dying on ventilation. J Am Geriatr Soc 68:1370-1375, 2020.


Subject(s)
Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Geriatrics/standards , Health Services for the Aged/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Female , Humans , Israel , Long-Term Care/methods , Long-Term Care/standards , Male , Palliative Care/methods , Palliative Care/standards , SARS-CoV-2 , Triage/methods , Triage/standards
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