Barriers to and facilitators of advance care planning implementation for medical staff after the coronavirus disease 2019 pandemic: An overview of reviews (preprint)

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted the capacity for advance care planning between patients, families, and healthcare teams. The barriers to and facilitators of advance care planning vary with settings. This study sought to identify and review the barriers to and facilitators of advance care planning implementation for medical staff in different settings (e.g., hospitals, outpatients, care and nursing homes) during the COVID-19 pandemic. Methods: This study followed an overview of review design and was registered in the International Prospective Register of Systematic Reviews (CRD42022351362). A search of MEDLINE, CENTRAL, Web of Science, and Embase databases was performed through November 14, 2022. AMSTAR 2 was used to assess the risk of bias. Results: The final analyses included seven studies. Common barriers to advance care planning implementation included visitation restrictions, limited resources and personnel, and lack of coordination among health professionals. In care and nursing homes, the lack of palliative care physicians and the psychological burden on staff were identified as barriers. Using telemedicine for information-sharing was a common facilitator. In hospitals, facilitators were short-term training in palliative care and palliative care physicians joining the acute care team; in care homes and nursing homes, they were advance care planning education and emotional support for staff. Conclusions: Although inadequate staff education regarding advance care planning in hospitals and facilities and the lack of community-level information-sharing have long been noted, the pandemic highlighted these issues. Short-term training programs for staff and immediate information-sharing could facilitate advance care planning.

Modeling SARS-CoV-2 infection and its individual differences with ACE2-expressing human iPS cells (preprint)

Genetic differences are a primary reason for differences in the susceptibility and severity of coronavirus disease 2019 (COVID-19). Because induced pluripotent stem (iPS) cells maintain the genetic information of the donor, they can be used to model individual differences in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in vitro. Notably, undifferentiated human iPS cells themselves cannot be infected bySARS-CoV-2. Using adenovirus vectors, here we found that human iPS cells expressing the SARS-CoV-2 receptor angiotensin-converting enzyme 2 (ACE2) (ACE2-iPS cells) can be infected with SARS-CoV-2. In infected ACE2-iPS cells, the expression of SARS-CoV-2 nucleocapsid protein, the budding of viral particles, the production of progeny virus, double membrane spherules, and double-membrane vesicles were confirmed. We also evaluated COVID-19 therapeutic drugs in ACE2-iPS cells and confirmed the strong antiviral effects of Remdesivir, EIDD-2801, and interferon-beta. In addition, we performed SARS-CoV-2 infection experiments on ACE2-iPS/ES cells from 8 individuals. Male iPS/ES cells were more capable of producing the virus as compared with female iPS/ES cells. These findings suggest that ACE2-iPS cells can not only reproduce individual differences in SARS-CoV-2 infection in vitro, but they are also a useful resource to clarify the causes of individual differences in COVID-19 due to genetic differences. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=200 SRC="FIGDIR/small/432218v1_ufig1.gif" ALT="Figure 1"> View larger version (112K): org.highwire.dtl.DTLVardef@165ec06org.highwire.dtl.DTLVardef@6a9d67org.highwire.dtl.DTLVardef@1840dd3org.highwire.dtl.DTLVardef@a7a4bb_HPS_FORMAT_FIGEXP M_FIG C_FIG