COVID-19 pandemic in long-term care: An international perspective for policy considerations.

This paper identifies key factors rooted in the systemic failings of the long-term care sector amongst four high income countries during the COVID-19 pandemic. The goal is to offer practice and policy solutions to prevent future tragedies. Based on data from Australia, Canada, Spain and the United States, the findings support evidence-based recommendations at macro, meso and micro levels of practice and policy intervention. Key macro recommendations include improving funding, transparency, accountability and health system integration; and promoting not-for-profit and government-run long-term care facilities. The meso recommendation involves moving from warehouses to "green houses." The micro recommendations emphasize mandating recommended staffing levels and skill mix; providing infection prevention and control training; establishing well-being and mental health supports for residents and staff; building evidence-based practice cultures; ensuring ongoing education for staff and nursing students; and fully integrating care partners, such as families or friends, into the healthcare team. Enacting these recommendations will improve residents' safety and quality of life, families' peace of mind, and staff retention and work satisfaction.

Surgical treatment of type 0 radial longitudinal deficiency.

PURPOSE: The purpose of this study was 2-fold: (1) to describe the surgical anatomy associated with type 0 radial longitudinal deficiency (radially deviated hand in the presence of a normal-length radius) and (2) to report the results of a surgical procedure designed to improve the alignment of the hand and forearm. METHODS: Since 1986 there have been 6 cases of type 0 radial longitudinal deficiency in 5 children seen at the St. Louis Shriner's Hospital. These children were treated with a surgical procedure to release the radial soft tissues and correct the alignment with tendon transfers. Age at surgery ranged from 12 to 40 months, with an average age of 21 months. The average follow-up period was 21 months. The tight radial wrist extensors were detached at their distal insertion and the tight radial wrist capsule was released dorsally and volarly, thus relieving the radial tether. The extensor carpi ulnaris (ECU) tendon also was detached just proximal to its insertion and sutured to the dorsal wrist capsule to augment wrist extension. The radial wrist extensor tendon was reattached to the ECU tendon at its insertion, converting it into an ulnar deviator. RESULTS: In each case the radial wrist extensor was noted to be hypoplastic and the radial wrist capsule was noted to be tight, tethering the hand in radial deviation. In 4 cases there was only a single radial wrist extensor tendon. Average radial deviation at rest improved from 58 degrees to 12 degrees . Improvement in radial deviation at rest averaged 47 degrees , ranging from 25 degrees to 75 degrees . Improvement in active wrist extension averaged 53 degrees and improvement in passive wrist extension averaged 28 degrees . CONCLUSIONS: For children with type 0 radial longitudinal deficiency a soft-tissue procedure that releases the radial tether and augments ulnar deviation and wrist extension by tendon transfer satisfactorily improves wrist alignment with minimal morbidity.

Ligament reconstruction with trapezium retention arthroplasty for carpometacarpal arthritis.

PURPOSE: The purpose of this study is to provide a qualitative and quantitative assessment of results in a consecutive series of patients with carpometacarpal arthritis using a trapezium-retaining interposition arthroplasty. METHODS: Between 1999 and 2002, 16 patients with basal joint arthritis were treated with a trapezium-retaining interposition arthroplasty. Fourteen of these patients were evaluated at a mean follow-up time of 20 months (minimum, 12 months) and were compared based on clinical outcome, presurgical and postsurgical x-ray evaluation, and range of motion, grip-strength, and pinch-strength values. RESULTS: Average trapezial height values as quantified by the trapezial space to proximal phalanx ratio were very similar before and after surgery. Average grip-strength values improved significantly. Although average pinch-strength and average range of motion values improved neither of these comparison values were significant. Thirteen of the 14 patients (93%) were satisfied with their results as quantified by postsurgical Disabilities of the Arm, Shoulder, and Hand questionnaires. CONCLUSIONS: Ligament reconstruction with trapezium retention arthroplasty of the basal joint not only successfully maintains trapezial height but also yields patient satisfaction rates comparable to those achieved with other forms of basal joint arthroplasty.