Health Care Workers' Knowledge, Attitudes, and Beliefs Related to COVID-19 in Palliative Medicine and Hospice Care.

Background: Although coronavirus disease 2019 (COVID-19) has impacted on a global scale, the knowledge, attitudes, and beliefs of the health care workers who provide the care at the end of life have not been evaluated. Objectives: To assess and understand palliative medicine and hospice care health care workers' knowledge, attitudes, and beliefs related to COVID-19. Design: A web-based survey was created. Primary outcomes included attitudes, beliefs, and knowledge. Secondary outcomes included comparison in between health care workers who described themselves at high risk versus not at high risk of complications related to COVID-19 infection. Setting/Subjects: In total, 1262 adult hospice workers in the United States were invited. Results: A total of 348 workers completed the survey. Of them, 321 were analyzed, 54.52% were over the age of 50 years, 84.74% were females, 41.75% were nurses, 29.6% were administrative staff, and 6.54% were physicians. Of these workers, 39.56% considered themselves at high risk to develop complications related to COVID-19 infection, 74.46% felt neutral to uncomfortable treating these patients, 77.57% believed that the recommended personal protective equipment (PPE) was adequate, 89.41% supported the risk-reduction strategies, 84.73% obtained information from health authorities, 25.55% from social media, 31.46% believed COVID-19 was likely created in a laboratory or intentionally, and 66.14% of hospice workers who considered themselves at high risk of complications felt available PPE was adequate to protect them compared with 85.05% of responders who did not consider themselves at high risk (p < 0.0001). The majority of respondents were incorrect in seven of the eight clinical scenarios. Conclusion: Improving staff knowledge and information related to COVID-19 would enhance staff safety, improve patient care, and relieve anxiety.

Hypoglycemia management in nondiabetic adults at the end of life #291.

Hypoglycemia can be both an uncomfortable symptom and a life-limiting condition. In patients with altered mental status who have a fair to good functional capacity, this could significantly detract from their ability to enjoy life. There are a variety of treatment options, including corrective action and management of the side effects of the adrenergic discharge that should be considered, as long as they are consistent with the patient's goals of care and comfort.

Multisystem atrophy made worse by lithium treatment in a hospice patient: a case report.

Multisystem atrophy is a neurologic condition defined as an adult-onset, progressive, neurodegenerative disease of unknown etiology. It carries a multisystem clinical course, including autonomic, urogenital, cerebellar, and parkinsonian features. Lithium toxicity, classically manifesting as increased thirst, polyuria, gastric distress, weight gain, tremor, fatigue, and mild cognitive impairment, can present in a similar manner.(1) We would like to present a patient diagnosed with progressive neurologic features typical of multisystem atrophy that also had bipolar disorder and had been taking lithium for many years. Despite normal lithium levels, it appeared as though a subclinical lithium toxicity was manifesting in the patient, and once lithium was discontinued, the patient was discharged from hospice with significant improvement in his presenting symptoms.