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Bárrios H, Nunes JPL, Teixeira JPA, Rêgo G. End-of-Life Care during the COVID-19 Pandemic: Decreased Hospitalization of Nursing Home Residents at the End of Life. Healthcare (Basel) 2024; 12:1573. [PMID: 39201132 PMCID: PMC11353357 DOI: 10.3390/healthcare12161573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 07/29/2024] [Accepted: 08/04/2024] [Indexed: 09/02/2024] Open
Abstract
(1) Background: Nursing homes (NHs) face unique challenges in end-of-life care for their residents. High rates of hospitalization at the end of life are frequent, often for preventable conditions. The increased clinical uncertainty during the pandemic, the high symptom burden of the COVID-19 disease, and the challenges in communication with families and between care teams might impact the option to hospitalize NH residents at the end of life. (2) Materials and methods: The study covered a 3-year period and compared the hospitalization rates of the NH residents of a sample of Portuguese NH during the last year of life before and during the pandemic. A total of 387 deceased residents were included in the study. (3) Results: There were fewer hospitalizations in the last year of life during the pandemic period, although the proportion of deaths at hospitals was the same. Hospitalizations occurred closer to death, and with more serious clinical states. The lower rate of hospitalization was due to lower hospitalization due to infection; (4) Conclusions: The data suggest an improvement in end-of-life care practices during the pandemic period, with the decrease in hospitalizations being due to potentially burdensome hospitalizations. The importance of the role of physicians, nurses, and caregivers in this setting may be relatively independent of each other, and each may be targeted in end-of-life care training. Further study is recommended to clarify the implications of the results and if the changes can be sustained in the long term.
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Affiliation(s)
- Helena Bárrios
- Hospital do Mar Cuidados Especializados Lisboa, 2695-458 Bobadela, Portugal
- Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal; (J.P.L.N.); (J.P.A.T.)
| | - José Pedro Lopes Nunes
- Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal; (J.P.L.N.); (J.P.A.T.)
| | | | - Guilhermina Rêgo
- Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal; (J.P.L.N.); (J.P.A.T.)
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Tchouaket EN, Kruglova K, Létourneau J, Bélanger E, Robins S, Jubinville M, El-Mousawi F, Shen S, Beogo I, Sia D. Factors influencing long-term care facility performance during the COVID-19 pandemic: a scoping review. BMC Health Serv Res 2024; 24:901. [PMID: 39113065 PMCID: PMC11304669 DOI: 10.1186/s12913-024-11331-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 07/19/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic wreaked havoc on long-term care facilities (LTCFs). Some LTCFs performed better than others at slowing COVID-19 transmission. Emerging literature has mostly described infection prevention and control strategies implemented by LTCFs during the pandemic. However, there is a need for a comprehensive review of factors that influenced the performance of LTCFs in containing COVID-19 spread to inform public health policy. OBJECTIVE To build on the existing literature, we conducted a scoping review of factors that influenced LTCF performance during the COVID-19 pandemic using a multidimensional conceptual framework of performance. METHODS We followed the Joanna Briggs Institute's methodology for scoping reviews. We queried CINAHL, MEDLINE (Ovid), CAIRN, Science Direct, Scopus, and Web of Science for peer-reviewed literature in English or French published between January 1st, 2020 and December 31st, 2021. Retrieved records were screened for context (COVID-19 pandemic), population (LTCFs), interest (internal and external factors that influenced LTCF performance), and outcomes (dimensions of performance: equity, accessibility, reactivity, safety, continuity, efficacy, viability, efficiency). Descriptive characteristics of included articles were summarized. Dimensions of performance as well as internal (e.g., facility characteristics) and external (e.g., visitors) factors identified to have influenced LTCF performance were presented. RESULTS We retained 140 articles of which 68% were classified as research articles, 47% originated in North America, and most covered a period between March and July 2020. The most frequent dimensions of performance were "efficacy" (75.7%) and "safety" (75.7%). The most common internal factors were "organizational context" (72.9%) and "human resources" (62.1%), and the most common external factors were "visitors" (27.1%) and "public health guidelines" (25.7%). CONCLUSIONS Our review contributes to a global interest in understanding the impact of the COVID-19 pandemic on vulnerable populations residing and working in LTCFs. Though a myriad of factors were reported, a lack of randomized controlled trials makes it impossible to establish causality between the identified factors and LTCF performance. The use of a multidimensional framework can be recommended to evaluate healthcare system performance not merely in terms of efficacy and safety, but alongside other critical dimensions such as efficiency and equity. TRIAL REGISTRATION Research Registry ID: researchregistry7026.
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Affiliation(s)
- Eric Nguemeleu Tchouaket
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, QC, J7Z 0B7, Canada.
| | - Katya Kruglova
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, QC, J7Z 0B7, Canada
| | - Josiane Létourneau
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, QC, J7Z 0B7, Canada
| | - Emilie Bélanger
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, QC, J7Z 0B7, Canada
| | - Stephanie Robins
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, QC, J7Z 0B7, Canada
| | - Maripier Jubinville
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, QC, J7Z 0B7, Canada
| | - Fatima El-Mousawi
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, QC, J7Z 0B7, Canada
| | - Shiyang Shen
- Faculty of Medicine and Health Sciences, McGill University, 3605 Rue de la Montagne, Montréal, QC, H3G 2M1, Canada
| | - Idrissa Beogo
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
| | - Drissa Sia
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, QC, J7Z 0B7, Canada
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Øien H, Gjesvik J, Skyrud KD, Rotevatn TA, Grøsland M. All-cause mortality and hospital admissions for nursing home residents during the COVID-19 pandemic: a Norwegian register-based cohort study. BMC Med 2024; 22:318. [PMID: 39113056 PMCID: PMC11304764 DOI: 10.1186/s12916-024-03523-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 07/09/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND This paper investigates the consequences of the COVID-19 pandemic on mortality and hospitalization among nursing home residents in Norway. While existing evidence shows that nursing home residents were overrepresented among COVID-19-related deaths, suggesting inadequate protection measures, this study argues that the observed overrepresentation in mortality and hospitalization may partly stem from the inherent frailty of this demographic. Using nationwide administrative data, we assessed excess deaths and hospitalization by comparing pandemic-era rates to those of a pre-pandemic cohort. METHODS We compared mortality and hospitalization rates between a pandemic cohort of nursing home residents as of September 2019 (N = 30,052), and a pre-pandemic cohort as of September 2017 (N = 30,429). Both cohorts were followed monthly for two years, beginning in September 2019 and 2017, respectively. This analysis was conducted at the national level and separately for nursing home residents in areas with low, medium, and high SARS-CoV-2 community transmission. Event studies and difference-in-difference models allowed us to separate the impact of the pandemic on mortality and hospitalization from secular and seasonal changes. RESULTS The pandemic cohort experienced a non-significant 0.07 percentage points (95% confidence interval (CI): - 0.081 to 0.221) increase in all-cause mortality during the 18 months following pandemic onset, compared to the pre-pandemic cohort. Moreover, our findings indicate a substantial reduction in hospitalizations of 0.27 percentage points (95% CI: - 0.464 to - 0.135) and a non-significant decrease of 0.80 percentage points (95% CI: - 2.529 to 0.929) in the proportion of nursing home residents hospitalized before death. The effect on mortality remained consistent across regions with both high and low levels of SARS-CoV-2 community transmission. CONCLUSIONS Our findings indicate no clear evidence of excess all-cause mortality in Norway during the pandemic, neither nationally nor in areas with high infection rates. This suggests that early implementation of nationwide and nursing home-specific infection control measures during the pandemic effectively protected nursing home residents. Furthermore, our results revealed a decrease in hospitalizations, both overall and prior to death, suggesting that nursing homes adhered to national guidelines promoting on-site treatment for residents.
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Affiliation(s)
- Henning Øien
- Cluster of Health Services Research, Norwegian Institute of Public Health, Oslo, Norway.
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
| | - Jonas Gjesvik
- Breast Cancer Screening, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Torill Alise Rotevatn
- Cluster of Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Mari Grøsland
- Cluster of Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
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Goździewicz Ł, Tobis S, Chojnicki M, Wieczorowska-Tobis K, Neumann-Podczaska A. The Value of the COVID-19 Yorkshire Rehabilitation Scale in the Assessment of Post-COVID among Residents of Long-Term Care Facilities. Healthcare (Basel) 2024; 12:333. [PMID: 38338218 PMCID: PMC10855238 DOI: 10.3390/healthcare12030333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
The COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) is a patient-reported outcome measure designed to assess the long-term effects of COVID-19. The scale was validated and is commonly used in the general population. In this study, we assess the utility of the C19-YRS in evaluating the post-COVID burden among residents of long-term care facilities with a mean age of 79. C19-YRS and Barthel index evaluations were performed among 144 residents of long-term care facilities reporting new or worsened symptoms or functioning three months after convalescence from COVID-19. The C19-YRS-based screening showed that 70.9% of COVID-19 convalescents had ≥1 complaint three months after recovery. The highest C19-YRS-scored symptoms (indicating a higher burden) were breathlessness, fatigue, and cognitive and continence problems; however, symptomatology was very heterogeneous, revealing a high complexity of the disease in older persons. The mean total C19-YRS score was higher in hospitalized patients (n = 78) than in the outpatient group (n = 66) (p = 0.02). The functioning subscale of the C19-YRS strongly correlated with the Barthel index, with r = -0.8001 (p < 0.0001). A moderately strong correlation existed between retrospectively reported C19-YRS-based functioning and the Barthel index score reported before illness (r = 0.7783, p < 0.0001). The C19-YRS is instrumental in evaluating the consequences of COVID-19 among long-term-care residents. The assessment allows for a broad understanding of rehabilitation needs.
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Affiliation(s)
- Łukasz Goździewicz
- Geriatric Unit, Department of Palliative Medicine, Poznań University of Medical Sciences, 61-245 Poznań, Poland
| | - Sławomir Tobis
- Department of Occupational Therapy, Poznań University of Medical Sciences, 60-781 Poznań, Poland
| | - Michał Chojnicki
- Department of Immunobiology, Poznań University of Medical Sciences, 60-806 Poznań, Poland
- Department of Infectious Diseases, Józef Struś Hospital, 61-285 Poznań, Poland
| | - Katarzyna Wieczorowska-Tobis
- Geriatric Unit, Department of Palliative Medicine, Poznań University of Medical Sciences, 61-245 Poznań, Poland
- Department of Human Nutrition and Dietetics, Poznań University of Life Sciences, 60-624 Poznań, Poland
| | - Agnieszka Neumann-Podczaska
- Geriatric Unit, Department of Palliative Medicine, Poznań University of Medical Sciences, 61-245 Poznań, Poland
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Orlando S, de Santo C, Mosconi C, Di Gaspare F, Chatzichristou P, Emberti Gialloreti L, Ciccacci F, Morciano L, Varrenti D, Liotta G, Palombi L. COVID-19 infection rate and mortality in a local health authority in Italy: Differences between home-dwelling and residential older adults. PUBLIC HEALTH IN PRACTICE 2023; 6:100448. [PMID: 38028255 PMCID: PMC10663662 DOI: 10.1016/j.puhip.2023.100448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/10/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives The health emergency following the COVID-19 pandemic has seen hospital structures collapse and put in crisis nursing homes and other long-term care facilities worldwide. Our study aims to analyze and comparing the data relating to the infection rate and mortality for COVID-19 in the elderly over 75 living in the long-term care facilities and in the home-dwelling population. Study design The study adopts a retrospective cohort design and was conducted in Italy, in the Lazio region, in the area of the Local Health Authority (LHA) named "Azienda Sanitaria Locale Roma 6". Methods Data were extracted from the COVID-19 surveillance system of the Lazio region. The primary outcome is the SARS-CoV-2 incidence rate in the period between 1st September 2020 and 31st May 2021. The secondary outcome is the mortality rate. Results Living in a residential versus a home-dwelling setting was associated with a higher infection rate (OR 5.03, CI 4.67-5.43; p < 0.001). The mortality rate was higher for individuals living in a residential setting (19.3 %, CI 17.1%-21.7 %) than those living at home (13.0 %, CI 11.7%-14.5 %). Conclusions These findings confirm the high mortality in Long-Term Care Facilities and provide new information on the infection rate. The containment measures adopted in the Long-Term Care Facilities during the COVID-19 pandemic, show limited correlation with reduced risk of contagion, but could have created unintended harm for the residents by increasing the social isolation and all other causes of mortality.
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Affiliation(s)
- Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Carolina de Santo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Claudia Mosconi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Di Gaspare
- Local Health Authority - Rome 6, Department of Prevention, Service of Hygiene and Public Health, Rome, Italy
| | | | | | - Fausto Ciccacci
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Laura Morciano
- Local Health Authority - Rome 6, Department of Prevention, Service of Hygiene and Public Health, Rome, Italy
| | - Donatella Varrenti
- Local Health Authority - Rome 6, Department of Prevention, Service of Hygiene and Public Health, Rome, Italy
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Geyskens L, Declercq A, Milisen K, Flamaing J, Deschodt M. Flanders Nursing Home (FLANH) project: Protocol of a multicenter longitudinal observational study on staffing, work environment, rationing of care, and resident and care worker outcomes. PLoS One 2023; 18:e0293624. [PMID: 37883513 PMCID: PMC10602233 DOI: 10.1371/journal.pone.0293624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND While the demand for high quality of care in nursing homes is rising, it is becoming increasingly difficult to recruit and retain qualified care workers. To date, evidence regarding key organizational factors such as staffing, work environment, and rationing of care, and their relationship with resident and care worker outcomes in nursing homes is still scarce. Therefore, the Flanders Nursing Home (FLANH) project aims to comprehensively examine these relationships in order to contribute to the scientific knowledge base needed for optimal quality of care and workforce planning in nursing homes. METHODS FLANH is a multicenter longitudinal observational study in Flemish nursing homes based on survey and registry data that will be collected in 2023 and 2025. Nursing home characteristics and staffing variables will be collected through a management survey, while work environment variables, rationing of care, and care worker characteristics and outcomes will be collected through a care worker survey. Resident characteristics and outcomes will be retrieved from the Belgian Resident Assessment Instrument for long-Term Care Facilities (BelRAI LTCF) database. Multilevel regression analyses will be applied to examine the relationships between staffing variables, work environment variables, and rationing of care and resident and care worker outcomes. CONCLUSION This study will contribute to a comprehensive understanding of the nursing home context and the interrelated factors influencing residents and care workers. The findings will inform the decision-making of nursing home managers and policymakers, and evidence-based strategies to optimize quality of care and workforce planning in nursing homes.
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Affiliation(s)
- Lisa Geyskens
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium
- Research Foundation–Flanders (FWO), Brussels, Belgium
| | - Anja Declercq
- LUCAS Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium
- CESO Centre for Sociological Research, KU Leuven, Leuven, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Mieke Deschodt
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium
- Competence Center of Nursing, University Hospitals Leuven, Leuven, Belgium
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Lambio C, Schmitz T, Elson R, Butler J, Roth A, Feller S, Savaskan N, Lakes T. Exploring the Spatial Relative Risk of COVID-19 in Berlin-Neukölln. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105830. [PMID: 37239558 DOI: 10.3390/ijerph20105830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/28/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
Identifying areas with high and low infection rates can provide important etiological clues. Usually, areas with high and low infection rates are identified by aggregating epidemiological data into geographical units, such as administrative areas. This assumes that the distribution of population numbers, infection rates, and resulting risks is constant across space. This assumption is, however, often false and is commonly known as the modifiable area unit problem. This article develops a spatial relative risk surface by using kernel density estimation to identify statistically significant areas of high risk by comparing the spatial distribution of address-level COVID-19 cases and the underlying population at risk in Berlin-Neukölln. Our findings show that there are varying areas of statistically significant high and low risk that straddle administrative boundaries. The findings of this exploratory analysis further highlight topics such as, e.g., Why were mostly affluent areas affected during the first wave? What lessons can be learned from areas with low infection rates? How important are built structures as drivers of COVID-19? How large is the effect of the socio-economic situation on COVID-19 infections? We conclude that it is of great importance to provide access to and analyse fine-resolution data to be able to understand the spread of the disease and address tailored health measures in urban settings.
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Affiliation(s)
- Christoph Lambio
- Geography Department, Applied Geoinformation Science Lab, Humboldt-University Berlin, 10099 Berlin, Germany
| | - Tillman Schmitz
- Geography Department, Applied Geoinformation Science Lab, Humboldt-University Berlin, 10099 Berlin, Germany
| | - Richard Elson
- UK Health Security Agency, 61, Colindale Avenue, London NW9 5EQ, UK
- School of Environmental Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - Jeffrey Butler
- Geography Department, Applied Geoinformation Science Lab, Humboldt-University Berlin, 10099 Berlin, Germany
| | - Alexandra Roth
- Local Health Department Berlin-Neukölln, Gesundheitsamt Neukölln, Blaschkoallee 32, 12359 Berlin, Germany
| | - Silke Feller
- Local Health Department Berlin-Neukölln, Gesundheitsamt Neukölln, Blaschkoallee 32, 12359 Berlin, Germany
| | - Nicolai Savaskan
- Local Health Department Berlin-Neukölln, Gesundheitsamt Neukölln, Blaschkoallee 32, 12359 Berlin, Germany
| | - Tobia Lakes
- Geography Department, Applied Geoinformation Science Lab, Humboldt-University Berlin, 10099 Berlin, Germany
- IRI THESys, Integrative Research Institute on Transformations of Human-Environment Systems, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
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Gandhi P, Petropanagos A, Popescu A, Bugaresti D, Nitti T, Chauhan N, Chidwick P, Oliver J. Ethical Issues in Long-term Care in Low-, Middle- and High-Income Countries During the COVID-19 Pandemic. Gerontol Geriatr Med 2023; 9:23337214221146660. [PMID: 36644688 PMCID: PMC9836839 DOI: 10.1177/23337214221146660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/07/2022] [Accepted: 12/04/2022] [Indexed: 01/12/2023] Open
Abstract
Long-term care (LTC) centers experienced an unprecedented emergency involving exponential mortality during the COVID-19 pandemic. Individuals residing in long-term care were particularly vulnerable to the effects of COVID-19, placing residents, staff, families, and organizations in a precarious position. Complex issues surrounding how to manage vulnerable populations during the pandemic have highlighted the importance of gathering information on ethical issues that require effective policy and decision-making. This project sought to identify the ethical issues faced in long-term care by residents, families, staff, and organizations from stakeholders themselves. A total of 305 participants from 45 countries responded, highlighting numerous ethical issues in long-term care during COVID-19. While numerous issues were mentioned, there was an overlap in the themes of responses between stakeholders. Visitation, isolation, harm, staff well-being, and the overall enforcement of policies during the pandemic represented the most often discussed issues. As a preliminary study of this issue, future research is necessary in order to effectively guide pandemic policymaking moving forward.
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Affiliation(s)
- Preet Gandhi
- University of British Columbia, Vancouver, Canada,Preet Gandhi, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada.
| | | | | | | | | | - Nipa Chauhan
- William Osler Health System, Brampton, ON, Canada
| | | | - Jill Oliver
- William Osler Health System, Brampton, ON, Canada
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Rueskov Poulsen V, Juul Nilsson C, Balle Hansen M, Bredal C, Juul-Madsen M, Nabe-Nielsen K. How Risk Management During COVID-19 Influences Eldercare Personnel's Perceptions of Their Work Environment. J Occup Environ Med 2022; 64:957-963. [PMID: 35901217 PMCID: PMC9640244 DOI: 10.1097/jom.0000000000002609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the association between workplace COVID-19 (coronavirus disease 2019) risk management and eldercare workers' perception of their social environment at work. METHODS Cross-sectional questionnaire data from 952 participants were collected by the Danish labor union, FOA, and analyzed using multinomial logistic regression. RESULTS Unclear guidelines, insecurity regarding organization of work, lack of attention to vulnerable employees, and lack of instruction in the use of personal protective equipment were associated with perceived negative changes in the social environment at work. Also, higher local incidence rates of SARS-CoV-2 infections were associated with a weaker sense of community (odds ratio, 1.18; 95% confidence interval, 1.04-1.36). CONCLUSIONS These findings indicate that risk management is important not only for prevention of infection but also for individual and workplace resilience toward external demands and health threats.
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Abstract
Since the beginning of the pandemic spread of the Coronavirus, societies have
been reminded that the impact of Covid-19 and public health measures of
infection containment reflect known gradients of inequality. Measures focusing
only the (acknowledged) frontstage of the pandemic and neglecting its
(unacknowledged) backstage—understood as those framework conditions
indispensable for societies to thrive—have worsened the impact of social
determinants of health on the most vulnerable, as shown by the deleterious
effects of prolonged social isolation of residents of nursing homes. To reflect
this phenomenon ethically, a framework is proposed which is inspired by the
feminist philosopher Margret Little. At its core stands the assumption that
caring for people and moral ends allows us to identify what is morally salient.
This epistemological stance allows a critical look at the alleged dilemmas
invoked to enforce brute, long-lasting policies of closing nursing homes in many
places—especially in the light of their dubious effectiveness in preventing
viral spread and the severe physical and psychological consequences for those
affected. If moral salience is only fully perceived through the closeness of the
caring relationship, the human suffering resulting from these policies reveals
the utter inadequacy of the dilemma rhetoric used to justify them. This insight
is illustrated by the personal experience of the author: He describes his role
as an essential care partner of his mother living in a nursing home and forced
into the role of a “visitor” who witnessed a constant deterioration of care.
Based on an epistemological understanding of caring for making reliable moral
judgments, potentially exclusionary effects of distinguishing essential from
non-essential groups in care will be addressed together with the need to
overcome strict boundaries between front- and backstage. Such efforts will
strengthen the moral community of persons needing care, professional care givers
and essential care partners.
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Affiliation(s)
- Settimio Monteverde
- Bern University of Applied Sciences, Switzerland; University of Zurich, Switzerland
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Pétré B, Paridans M, Gillain N, Husson E, Donneau AF, Dardenne N, Breuer C, Michel F, Dandoy M, Bureau F, Gillet L, Leclercq D, Guillaume M. Factors influencing the adoption and participation rate of nursing homes staff in a saliva testing screening programme for COVID-19. PLoS One 2022; 17:e0270551. [PMID: 35771756 PMCID: PMC9246163 DOI: 10.1371/journal.pone.0270551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/13/2022] [Indexed: 11/19/2022] Open
Abstract
Testing strategies are crucial to prevent and control the spread of covid-19 but suffer from a lack of investment in understanding the human factors that influence their implementation. The aim of this study was to understand the factors that encourage participation and the level of engagement of nursing homes staff in a routine saliva testing programme for COVID-19 In December 2020, nursing homes (n = 571) in Wallonia (Belgium) were invited to participate in a saliva testing programme for their staff. The directors were questioned by telephone at the end of a 3-week pilot phase. 445 nursing homes took part in the evaluation questionnaire, of which 36(8%) answered that they chose not to participate in the testing programme. The average participation rate of nursing staff was 49(±25)%. Perception of the justification of the efforts required for testing and perception of practicability of the procedure were significantly associated with the adoption of the system by the nursing homes directors (OR(95%CI): 5.96(1.97-18.0), p = 0.0016); OR(95%CI): 5.64(1.94-16.4), p = 0.0015 respectively). Staff support, incentives and meetings increased the level of engagement in testing (p<0.05). While the adoption of the programme confirmed the acceptability of salivary testing as a means of screening, the participation rate confirmed the need for studies to understand the factors that encourage health care staff to take part. The results suggested rethinking strategies to consider staff engagement from a health promotion perspective.
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Affiliation(s)
- Benoit Pétré
- Department of Public Health, University of Liege, Liège, Belgium
| | - Marine Paridans
- Department of Public Health, University of Liege, Liège, Belgium
| | - Nicolas Gillain
- Department of Public Health, University of Liege, Liège, Belgium
| | - Eddy Husson
- Department of Public Health, University of Liege, Liège, Belgium
| | - Anne-Françoise Donneau
- Department of Public Health, University of Liege, Liège, Belgium
- Risk Assessment Group COVID-19, Liège University, Liège, Belgium
- University and Hospital Biostatistics Center (B-STAT), Faculty of Medicine, University of Liège, Liège, Belgium
| | - Nadia Dardenne
- Department of Public Health, University of Liege, Liège, Belgium
- University and Hospital Biostatistics Center (B-STAT), Faculty of Medicine, University of Liège, Liège, Belgium
| | | | - Fabienne Michel
- Risk Assessment Group COVID-19, Liège University, Liège, Belgium
- Collection and Analysis of Data and Information of Strategic Utility (RADIUS), Liège University, Liège, Belgium
| | | | - Fabrice Bureau
- Covid-19 Platform, Liège University, Liège, Belgium
- Laboratory of Cellular and Molecular Immunology, GIGA Institute, Liège University, Liège, Belgium
| | - Laurent Gillet
- Covid-19 Platform, Liège University, Liège, Belgium
- Fundamental and Applied Research for Animal and Health (FARAH) Center, Liège University, Liège, Belgium
- Laboratory of Immunology-Vaccinology, Liège University, Liège, Belgium
| | | | - Michèle Guillaume
- Department of Public Health, University of Liege, Liège, Belgium
- Risk Assessment Group COVID-19, Liège University, Liège, Belgium
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12
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Rasing NL, Janus S, Vink A, Zuidema S. The impact of COVID-19 on music therapy provision in Dutch care homes. NORDIC JOURNAL OF MUSIC THERAPY 2022. [DOI: 10.1080/08098131.2022.2084637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Naomi Larissa Rasing
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sarah Janus
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Annemieke Vink
- Department of Music Therapy, ArtEZ University of the Arts, Academy of Music, Enschede, the Netherlands
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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13
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Orlando S, Mazhari T, Abbondanzieri A, Cerone G, Ciccacci F, Liotta G, Mancinelli S, Marazzi MC, Palombi L. Characteristics of nursing homes and early preventive measures associated with risk of infection from COVID-19 in Lazio region, Italy: a retrospective case-control study. BMJ Open 2022; 12:e061784. [PMID: 35667726 PMCID: PMC9170802 DOI: 10.1136/bmjopen-2022-061784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/13/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To understand which organisational-structural characteristics of nursing homes-also referred to as long-term care facilities (LTCFs)-and the preventative measures adopted in response to the pandemic are associated with the risk of a COVID-19 outbreak. SETTING LTCFs in Lazio region in Italy. DESIGN The study adopts a case-control design. PARTICIPANTS We included 141 facilities and 100 provided information for the study. Cases were defined as facilities reporting a COVID-19 outbreak (two or more cases) in March-December 2020; controls were defined as LTCFs reporting one case or zero. The exposures include the structural-organisational characteristics of the LTCFs as reported by the facilities, preventative measures employed and relevant external factors. RESULTS Twenty facilities reported an outbreak of COVID-19. In binary logistic regression models, facilities with more than 15 beds were five times more likely to experience an outbreak than facilities with less than 15 beds OR=5.60 (CI 1.61 to 25.12; p value 0.002); admitting new residents to facilities was associated with a substantially higher risk of an outbreak: 6.46 (CI 1.58 to 27.58, p value 0.004). In a multivariable analysis, facility size was the only variable that was significantly associated with a COVID-19 outbreak OR= 5.37 (CI 1.58 to 22.8; p value 0.012) for larger facilities (>15 beds) versus smaller (<15 beds). Other characteristics and measures were not associated with an outbreak. CONCLUSION There was evidence of a higher risk of COVID-19 in larger facilities and when new patients were admitted during the pandemic. All other structural-organisational characteristics and preventative measures were not associated with an outbreak. This finding calls into question existing policies, especially where there is a risk of harm to residents. One such example is the restriction of visitor access to facilities, resulting in the social isolation of residents.
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Affiliation(s)
- Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Tuba Mazhari
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Alessio Abbondanzieri
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
- Prevention department, public health services, ASL Roma 5, Tivoli, Lazio, Italy
| | - Gennaro Cerone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
- Prevention department, public health services, ASL Roma 5, Tivoli, Lazio, Italy
| | - Fausto Ciccacci
- Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
| | - Sandro Mancinelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
| | | | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
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14
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Barbosa MM, Teixeira L, Paúl C, Yanguas J, Afonso RM. Caring and Working during the COVID-19 Pandemic: Perspective of Portuguese Residential Care Facility Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105963. [PMID: 35627500 PMCID: PMC9142040 DOI: 10.3390/ijerph19105963] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023]
Abstract
Residential care facilities (RCF) for older people are facing high demands due to the COVID-19 pandemic. The aim of this study was to explore the workers’ perspectives on the changes in work and care dynamics amidst the first wave of the pandemic at Portuguese RCF. This is a descriptive, quantitative, and cross-sectional study. An online questionnaire about pandemic-induced changes in work and care dynamics was sent to 2325 RCF. These entities were then asked to share it with their workers. The participants (n = 784) were mostly women (92.7%) and mostly composed of technical directors (41.6%) and direct-care workers (17.1%). The respondents reported that during the first wave of the pandemic, when compared to the pre-pandemic period, there were greater difficulties in providing care related to the basic necessities of older people (52.7%); direct-care workers were required to work more consecutive hours in each shift (69.95%); direct-care workers had to live at RCF (14.8%), and there were changes concerning the possibility of promoting person-centered care (PCC) practices. It also revealed that focusing on disease prevention and sanitary measures alone facilitates practices that reinforce the traditional model of procedure-centered care and have negative consequences on the rights and well-being of those living and working at RCF, exposing and accentuating preexisting vulnerabilities. This study considers the pandemic’s serious implications and alarming questions about basic care, dignity, living, and working conditions at Portuguese RCF. These notions reinforce the need for change through redefining care policies and practices in Portuguese RCF beyond the pandemic. The current situation provides an opportunity to adopt a formal PCC model.
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Affiliation(s)
- Maria Miguel Barbosa
- Instituto de Ciências Biomédicas Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge de Viterbo Ferreira, 228, 4050-313 Porto, Portugal; (L.T.); (C.P.)
- Health Sciences Research Centre, Faculty of Health Sciences, University of Beira Interior (CICS-UBI), Avenida Infante D. Henrique, 6201-506 Covilhã, Portugal
- Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal;
- Correspondence:
| | - Laetitia Teixeira
- Instituto de Ciências Biomédicas Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge de Viterbo Ferreira, 228, 4050-313 Porto, Portugal; (L.T.); (C.P.)
- Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal;
| | - Constança Paúl
- Instituto de Ciências Biomédicas Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge de Viterbo Ferreira, 228, 4050-313 Porto, Portugal; (L.T.); (C.P.)
- Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal;
| | | | - Rosa Marina Afonso
- Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal;
- Department of Psychology and Education, Faculty of Human and Social Sciences, University of Beira Interior, Estrada do Sineiro, s/n, 6200-209 Covilhã, Portugal
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Zanon M, Peruch M, Concato M, Moreschi C, Pizzolitto S, Radaelli D, D’Errico S. Spread of COVID-19 Infection in Long-Term Care Facilities of Trieste (Italy) during the Pre-Vaccination Era, Integrating Findings of 41 Forensic Autopsies with Geriatric Comorbidity Index as a Valid Option for the Assessment of Strength of Causation. Vaccines (Basel) 2022; 10:774. [PMID: 35632530 PMCID: PMC9146610 DOI: 10.3390/vaccines10050774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND in 2020, a new form of coronavirus spread around the world starting from China. The older people were the population most affected by the virus worldwide, in particular in Italy where more than 90% of deaths were people over 65 years. In these people, the definition of the cause of death is tricky due to the presence of numerous comorbidities. OBJECTIVE to determine whether COVID-19 was the cause of death in a series of older adults residents of nursing care homes. METHODS 41 autopsies were performed from May to June 2020. External examination, swabs, and macroscopic and microscopic examination were performed. RESULTS the case series consisted of nursing home guests; 15 men and 26 women, with a mean age of 87 years. The average number of comorbidities was 4. Based only on the autopsy results, the defined cause of death was acute respiratory failure due to diffuse alveolar damage (8%) or (31%) bronchopneumonia with one or more positive swabs for SARS-CoV-2. Acute cardiac failure with one or more positive swabs for SARS-CoV-2 was indicated as the cause of death in in symptomatic (37%) and asymptomatic (10%) patients. Few patients died for septic shock (three cases), malignant neoplastic diseases (two cases), and massive digestive bleeding (one case). CONCLUSIONS Data from post-mortem investigation were integrated with previously generated Geriatric Index of Comorbidity (GIC), resulting in four different degrees of probabilities: high (12%), intermediate (10%), low (59%), and none (19%), which define the level of strength of causation and the role of COVID-19 disease in determining death.
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Affiliation(s)
- Martina Zanon
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.Z.); (M.P.); (M.C.); (D.R.)
| | - Michela Peruch
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.Z.); (M.P.); (M.C.); (D.R.)
| | - Monica Concato
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.Z.); (M.P.); (M.C.); (D.R.)
| | - Carlo Moreschi
- Department of Medicine, Forensic Medicine University of Udine, 33100 Udine, Italy;
| | - Stefano Pizzolitto
- Department of Pathology, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
| | - Davide Radaelli
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.Z.); (M.P.); (M.C.); (D.R.)
| | - Stefano D’Errico
- Department of Medical Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.Z.); (M.P.); (M.C.); (D.R.)
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16
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Levy-Storms L, Mueller-Williams A. Certified Nursing Aides' Training Hours and COVID Case and Mortality Rates Across States in the U.S.: Implications for Infection Prevention and Control and Relationships With Nursing Home Residents. Front Public Health 2022; 10:798779. [PMID: 35462817 PMCID: PMC9024174 DOI: 10.3389/fpubh.2022.798779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Disproportionately high COVID case and mortality rates in skilled nursing facilities (SNFs) have heightened interest in the role of Certified Nursing Aides (CNAs) in the care of residents living in SNFs. This policy brief will make recommendations for CNA training based on an examination of two sources of secondary data using descriptive statistics. From the first source of secondary data, 34% of CNAs report feeling inadequately trained. The second source, U.S. government data, revealed statistically significant negative correlations between the amount of CNA training required across states and COVID mortality rates (Kendall's τb = -0.32; p = 0.002) but not case rates (Kendall's τb = -0.18; p = 0.09). More training for CNAs may not only reduce health risks from infectious diseases but also improve how they relate to SNF residents during care.
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Affiliation(s)
- Lené Levy-Storms
- Geffen School of Medicine, Department of Medicine, Division of Geriatrics, Los Angeles, CA, United States
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
| | - Amelia Mueller-Williams
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
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17
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van Dijk Y, Janus SIM, de Boer MR, Achterberg WP, Roelen CAM, Zuidema SU. Job Demands, Work Functioning and Mental Health in Dutch Nursing Home Staff during the COVID-19 Outbreak: A Cross-Sectional Multilevel Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074379. [PMID: 35410060 PMCID: PMC8998775 DOI: 10.3390/ijerph19074379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/26/2022] [Accepted: 04/02/2022] [Indexed: 12/24/2022]
Abstract
COVID-19 posed enormous challenges for nursing home staff, which may have caused stress and mental health problems. This study aimed to measure the prevalence of mental health problems among nursing home staff and investigate the differences in job demands, work functioning and mental health between staff with and without COVID contact or COVID infection and across different levels of COVID worries. In this cross-sectional study, 1669 employees from 10 nursing home organizations filled in an online questionnaire between June and September 2020. The questionnaire measured the participants’ characteristics, COVID contact, infection and worries, job demands, work functioning, depressive symptoms and burnout. Differences were investigated with multilevel models to account for clustering at the organization level. Of the participants, 19.1% had high levels of depressive symptoms and 22.2% burnout. Job demands, work functioning, depressive symptoms and burnout differed between participants who never worried and participants who often or always worried about the COVID crisis. Differences were smaller for participants with and without COVID contact or infection. Most models improved when clustering was accounted for. Nursing homes should be aware of the impact of COVID worries on job demands, work functioning and mental health, both at the individual and organizational level.
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Affiliation(s)
- Ylse van Dijk
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, 9700 AD Groningen, The Netherlands; (S.I.M.J.); (M.R.d.B.); (S.U.Z.)
- Correspondence:
| | - Sarah I. M. Janus
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, 9700 AD Groningen, The Netherlands; (S.I.M.J.); (M.R.d.B.); (S.U.Z.)
| | - Michiel R. de Boer
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, 9700 AD Groningen, The Netherlands; (S.I.M.J.); (M.R.d.B.); (S.U.Z.)
| | - Wilco P. Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Corne A. M. Roelen
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, 9700 AD Groningen, The Netherlands;
| | - Sytse U. Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, 9700 AD Groningen, The Netherlands; (S.I.M.J.); (M.R.d.B.); (S.U.Z.)
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18
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COVID-19 pandemic and mortality in nursing homes across USA and Europe up to October 2021. Eur Geriatr Med 2022; 13:705-709. [PMID: 35299261 PMCID: PMC8929245 DOI: 10.1007/s41999-022-00637-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/08/2022] [Indexed: 11/10/2022]
Abstract
Purpose We compared the prevalence of COVID-19 and related mortality in nursing homes (NHs) in 14 countries until October 2021. We explored the relationship between COVID-19 mortality in NHs with the average size of NHs and with the COVID-19 deaths at a population level. Methods The total number of COVID-19 cases and COVID-19-related deaths in all NHs as well as the total number of NHs and NH beds were provided by representatives of 14 countries. The population level respective figures in each country were provided up to October 2021. Results There was a wide variation in prevalence of COVID-19 cases and deaths between countries. We observed a significant correlation between COVID-19 deaths in NHs and that of the total population and between the mean size of NHs and COVID-19 deaths. Conclusion Side-by-side comparisons between countries allow international sharing of good practice to better enable future pandemic preparedness.
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19
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Kunasekaran M, Quigley A, Rahman B, Chughtai AA, Heslop DJ, Poulos CJ, MacIntyre CR. Factors associated with SARS-COV-2 attack rates in aged care– a meta-analysis. Open Forum Infect Dis 2022; 9:ofac033. [PMID: 35194554 PMCID: PMC8807324 DOI: 10.1093/ofid/ofac033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant morbidity and mortality in aged-care facilities worldwide. The attention of infection control in aged care needs to shift towards the built environment, especially in relation to using the existing space to allow social distancing and isolation. Physical infrastructure of aged care facilities has been shown to present challenges to the implementation of isolation procedures. To explore the relationship of the physical layout of aged care facilities with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) attack rates among residents, a meta-analysis was conducted. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P), studies were identified from 5 databases using a registered search strategy with PROSPERO. Meta-analysis for pooled attack rates of SARS-CoV-2 in residents and staff was conducted, with subgroup analysis for physical layout variables such as total number of beds, single rooms, number of floors, number of buildings in the facility, and staff per 100 beds. Results We included 41 articles across 11 countries, reporting on 90 657 residents and 6521 staff in 757 facilities. The overall pooled attack rate was 42.0% among residents (95% CI, 38.0%–47.0%) and 21.7% in staff (95% CI, 15.0%–28.4%). Attack rates in residents were significantly higher in single-site facilities with standalone buildings than facilities with smaller, detached buildings. Staff-to-bed ratio significantly explains some of the heterogeneity of the attack rate between studies. Conclusions The design of aged care facilities should be smaller in size, with adequate space for social distancing.
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Affiliation(s)
- Mohana Kunasekaran
- Biosecurity Program, Kirby Institute, The University of New South Wales Sydney, New South Wales, Australia
| | - Ashley Quigley
- Biosecurity Program, Kirby Institute, The University of New South Wales Sydney, New South Wales, Australia
| | - Bayzidur Rahman
- Biosecurity Program, Kirby Institute, The University of New South Wales Sydney, New South Wales, Australia
- School of Medicine, The University of Notre Dame, Australia
| | - Abrar A Chughtai
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - David J Heslop
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - Christopher J Poulos
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
- HammondCare, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- Biosecurity Program, Kirby Institute, The University of New South Wales Sydney, New South Wales, Australia
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20
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A world apart: Levels and determinants of excess mortality due to COVID-19 in care homes: The case of the Belgian region of Wallonia during the spring 2020 wave. DEMOGRAPHIC RESEARCH 2021. [DOI: 10.4054/demres.2021.45.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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21
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Vijh R, Prairie J, Otterstatter MC, Hu Y, Hayden AS, Yau B, Daly P, Lysyshyn M, McKee G, Harding J, Forsting S, Schwandt M. Evaluation of a multisectoral intervention to mitigate the risk of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission in long-term care facilities. Infect Control Hosp Epidemiol 2021; 42:1181-1188. [PMID: 33397533 PMCID: PMC7853754 DOI: 10.1017/ice.2020.1407] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE A Canadian health authority implemented a multisectoral intervention designed to control severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission during long-term care facility (LTCF) outbreaks. The primary objective was to evaluate the effectiveness of the intervention 14 days after implementation. DESIGN Quasi-experimental, segmented regression analysis. INTERVENTION A series of outbreak measures classified into 4 categories: case and contact management, proactive case detection, rigorous infection control practices and resource prioritization and stewardship. METHODS A mixed-effects segmented Poisson regression model was fitted to the incidence rate of coronavirus disease 2019 (COVID-19), calculated every 2 days, within each facility and case type (staff vs residents). For each facility, the outbreak time period was segmented into an early outbreak period (within 14 days of the intervention) and postintervention period (beyond 14 days following the intervention). Model outputs quantified COVID-19 incidence trend and rate changes between these 2 periods. A secondary model was constructed to identify effect modification by case type. RESULTS The significant upward trend in COVID-19 incidence rate during the early outbreak period (rate ratio [RR], 1.07; 95% confidence interval [CI], 1.03-1.11; P < .001) reversed during the postintervention period (RR, 0.73; 95% CI, 0.67-0.80; P < .001). The average trend did not differ by case type during the early outbreak period (P > .05) or the postintervention period (P > .05). However, staff had a 70% larger decrease in the average rate of COVID-19 during the postintervention period than residents (RR, 0.30; 95% CI, 0.10-0.88; P < .05). CONCLUSIONS Our study provides evidence for the effectiveness of this intervention to reduce the transmission of COVID-19 in LTCFs. This intervention can be adapted and utilized by other jurisdictions to protect the vulnerable individuals in LTCFs.
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Affiliation(s)
- Rohit Vijh
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica Prairie
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
- Canadian Field Epidemiology Training Program, Public Health Agency of Canada, Ottawa, Canada
| | - Michael C. Otterstatter
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Yumian Hu
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Althea S. Hayden
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Brandon Yau
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia Daly
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Mark Lysyshyn
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Geoff McKee
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - John Harding
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Sara Forsting
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Michael Schwandt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Communicable Disease Control, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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22
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Dykgraaf SH, Matenge S, Desborough J, Sturgiss E, Dut G, Roberts L, McMillan A, Kidd M. Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence. J Am Med Dir Assoc 2021; 22:1969-1988. [PMID: 34428466 PMCID: PMC8328566 DOI: 10.1016/j.jamda.2021.07.027] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has highlighted the extreme vulnerability of older people and other individuals who reside in long-term care, creating an urgent need for evidence-based policy that can adequately protect these community members. This study aimed to provide synthesized evidence to support policy decision making. DESIGN Rapid narrative review investigating strategies that have prevented or mitigated SARS-CoV-2 transmission in long-term care. SETTING AND PARTICIPANTS Residents and staff in care settings such as nursing homes and long-term care facilities. METHODS PubMed/Medline, Cochrane Library, and Scopus were systematically searched, with studies describing potentially effective strategies included. Studies were excluded if they did not report empirical evidence (eg, commentaries and consensus guidelines). Study quality was appraised on the basis of study design; data were extracted from published reports and synthesized narratively using tabulated data extracts and summary tables. RESULTS Searches yielded 713 articles; 80 papers describing 77 studies were included. Most studies were observational, with no randomized controlled trials identified. Intervention studies provided strong support for widespread surveillance, early identification and response, and rigorous infection prevention and control measures. Symptom- or temperature-based screening and single point-prevalence testing were found to be ineffective, and serial universal testing of residents and staff was considered crucial. Attention to ventilation and environmental management, digital health applications, and acute sector support were also considered beneficial although evidence for effectiveness was lacking. In observational studies, staff represented substantial transmission risk and workforce management strategies were important components of pandemic response. Higher-performing facilities with less crowding and higher nurse staffing ratios had reduced transmission rates. Outbreak investigations suggested that facility-level leadership, intersectoral collaboration, and policy that facilitated access to critical resources were all significant enablers of success. CONCLUSIONS AND IMPLICATIONS High-quality evidence of effectiveness in protecting LTCFs from COVID-19 was limited at the time of this study, though it continues to emerge. Despite widespread COVID-19 vaccination programs in many countries, continuing prevention and mitigation measures may be required to protect vulnerable long-term care residents from COVID-19 and other infectious diseases. This rapid review summarizes current evidence regarding strategies that may be effective.
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Affiliation(s)
- Sally Hall Dykgraaf
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia.
| | - Sethunya Matenge
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Jane Desborough
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Elizabeth Sturgiss
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Garang Dut
- COVID-19 Action Research Team, College of Health & Medicine, Australian National University, Canberra ACT, Australia
| | - Leslee Roberts
- Medical Advisory Unit, Primary Care Division, Australian Government Department of Health, Canberra ACT, Australia
| | - Alison McMillan
- Australian Government Department of Health, Canberra ACT, Australia
| | - Michael Kidd
- Australian Government Department of Health, Canberra ACT, Australia
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23
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Nguyen TT, Zeger WG, Wadman MC, Barksdale AN. Accuracy and Acceptance of a Self-Collection Model for Respiratory Tract Infection Diagnostics: A Concise Clinical Literature Review. J Emerg Nurs 2021; 47:798-806. [PMID: 34530972 PMCID: PMC8238690 DOI: 10.1016/j.jen.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/06/2021] [Accepted: 04/21/2021] [Indexed: 11/15/2022]
Abstract
Background Nurses are the primary clinicians who collect specimens for respiratory tract infection testing. The specimen collection procedure is time and resource-consuming, but more importantly, it places nurses at risk for potential infection. The practice of allowing patients to self-collect their diagnostic specimens may provide an alternative testing model for the current COVID-19 outbreaks. The objective of this paper was to evaluate the accuracy and patient perception of self-collected specimens for respiratory tract infection diagnostics. Methods A concise clinical review of the recently published literature was conducted. Results A total of 11 articles were included the review synthesis. The concept of self-collected specimens has a high patient acceptance rate of 83-99%. Self-collected nasal-swab specimens demonstrated strong diagnostic fidelity for respiratory tract infections with a sensitivity between 80-100%, this is higher than the 76% sensitivity observed with self-collected throat specimens. In a comparative study evaluating a professionally collected to a self-collected specimen for COVID-19 testing, a high degree of agreement (k = 0.89) was observed between the two methods. Conclusion As we continue to explore for testing models to combat the COVID-19 pandemic, self-collected specimens is a practical alternative to nurse specimen collection.
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24
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Chen X, Zhao L, Liu Y, Zhou Z, Zhang H, Wei D, Chen J, Li Y, Ou J, Huang J, Yang X, Ma C. Otago exercise programme for physical function and mental health among older adults with cognitive frailty during COVID-19: A randomised controlled trial. J Clin Nurs 2021:10.1111/jocn.15964. [PMID: 34289524 PMCID: PMC8447213 DOI: 10.1111/jocn.15964] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 12/28/2022]
Abstract
AIMS AND OBJECTIVES Quarantine during the COVID-19 pandemic resulted in longer-term sedentary behaviours and mental health problems. Our study aimed to evaluate the impact of the Otago exercise programme (OEP) on physical function and mental health among elderly with cognitive frailty during COVID-19. BACKGROUND Lockdowns and restrictions during the COVID-19 pandemic result in longer-term sedentary behaviours related disease and mental problem. Older people with cognitive frailty are more vulnerable to be influenced. Timely intervention may achieve better outcomes, OEP exercise was designed as a balance and muscle-strengthening programme for elderly people. DESIGN A parallel-group, assessor-blinded randomised controlled trial was performed according to CONSORT guidelines. METHODS This study was conducted from July 2020 to October 2020 among 62 elderly people with cognitive frailty from a nursing home. Participants were randomly divided into an OEP group (n = 31) or a control group (n = 31). Both groups received sleep- and diet-related health education. The OEP group also received a 12-week group exercise programme. The Five Times Sit to Stand Test (FTSST), Berg Balance Scale (BBS), and Timed Up and Go Test (TUGT) were used to assess physical function. The Geriatric Depression Scale-15 (GDS-15) and the 12-Item Short Form Health Survey Mental Component Summary (SF-12 MCS) were used to assess mental health. Outcomes were measured at 6 and 12 weeks. RESULTS Physical function and mental health were similar in the two groups at baseline. At 12 weeks, the OEP group (difference in change from baseline: FTSST, -2.78; TUGT, -3.73; BBS, 2.17; GDS-15, -0.72; SF-12 MCS, 2.58; all p < .001) exhibited significantly greater improvements than the control group (difference in change from baseline: FTSST, 1.55; TUGT, 1.66; BBS, -0.10; GDS-15, 1.07; SF-12 MCS, -5.95; all p < .001). CONCLUSION Our findings showed the OEP group had better physical function and mental health outcomes than the control group. OEP can be used to improve the physical and mental function among elderly people with cognitive frailty during the COVID-19 pandemic. RELEVANCE TO CLINICAL PRACTICE Otago exercise program intervention programmes should be implemented to improve physical function for cognitive frailty elderly to reduce the harm of longer-term sedentary behaviours, and to ruduce depression symptom and improve mental health, particularly during COVID-19 pandemic period.
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Affiliation(s)
- Xi Chen
- The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Liping Zhao
- The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Youshuo Liu
- The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Zhiming Zhou
- Geriatric Rehabilitation Hospital of ChangshaChangshaChina
| | - Hua Zhang
- Changsha NO.1 Social Welfare InstitutionChangshaChina
| | - Dongli Wei
- Geriatric Rehabilitation Hospital of ChangshaChangshaChina
| | - Jianliang Chen
- Shenzhen Hostal of Integrated Traditional Chinese and Western MedicineShenzhenChina
| | - Yan Li
- The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Jinnan Ou
- The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Jin Huang
- The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Xiaomei Yang
- Guangzhou Development District HospitalGuangzhouChina
| | - Caili Ma
- The Second Xiangya HospitalCentral South UniversityChangshaChina
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Amore S, Puppo E, Melara J, Terracciano E, Gentili S, Liotta G. Impact of COVID-19 on older adults and role of long-term care facilities during early stages of epidemic in Italy. Sci Rep 2021; 11:12530. [PMID: 34131216 PMCID: PMC8206111 DOI: 10.1038/s41598-021-91992-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/07/2021] [Indexed: 12/23/2022] Open
Abstract
Older adults are the main victims of the novel COVID-19 coronavirus outbreak and elderly in Long Term Care Facilities (LTCFs) are severely hit in terms of mortality. This paper presents a quantitative study of the impact of COVID-19 outbreak in Italy during first stages of the epidemic, focusing on the effects on mortality increase among older adults over 80 and its correlation with LTCFs. The study of growth patterns shows a power-law scaling regime for the first stage of the pandemic with an uneven behaviour among different regions as well as for the overall mortality increase according to the different impact of COVID-19. However, COVID-19 incidence rate does not fully explain the differences of mortality impact in older adults among different regions. We define a quantitative correlation between mortality in older adults and the number of people in LTCFs confirming the tremendous impact of COVID-19 on LTCFs. In addition a correlation between LTCFs and undiagnosed cases as well as effects of health system dysfunction is also observed. Our results confirm that LTCFs did not play a protective role on older adults during the pandemic, but the higher the number of elderly people living in LTCFs the greater the increase of both general and COVID-19 related mortality. We also observed that the handling of the crises in LTCFs hampered an efficient tracing of COVID-19 spread and promoted the increase of deaths not directly attributed to SARS-CoV-2.
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Affiliation(s)
- Stefano Amore
- Community of Sant'Egidio, Piazza della Nunziata 4, 16124, Genova, Italy.
| | - Emanuela Puppo
- Community of Sant'Egidio, Piazza della Nunziata 4, 16124, Genova, Italy
| | - Josué Melara
- Community of Sant'Egidio, Piazza della Nunziata 4, 16124, Genova, Italy
| | - Elisa Terracciano
- Biomedicine and Prevention Department, University of Rome "Tor Vergata", Rome, Italy
| | - Susanna Gentili
- School of Doctorate in Nursing Science and Public Health, University of Rome "Tor Vergata", Rome, Italy
| | - Giuseppe Liotta
- Biomedicine and Prevention Department, University of Rome "Tor Vergata", Rome, Italy
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26
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Huang CY, Kuo YH, Chuang ST, Yen HR, Tou SI. The experience of executing preventive measures to protect a nursing home in Taiwan from a COVID-19 outbreak. Eur Geriatr Med 2021; 12:609-617. [PMID: 33751454 PMCID: PMC7983345 DOI: 10.1007/s41999-021-00459-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE We share our strategies for preventing the COVID-19 outbreak in a nursing home in Taiwan. METHODS We compared the number of outpatient department visits, the days of prescription from the outpatient department, the number of emergency department visits of the nursing home residents and staff, the number of admissions, and the days of admission of the residents for respiratory tract infection treatment between 2019 and 2020 to examine the effect of our preventive measures in the nursing home. Residents and staff who continuously lived and worked in the nursing home from 2019 to 2020 were included. The differences in outcomes between 2019 and 2020 were examined using paired sample t tests. The multivariate analyses were presented through generalized estimating equation analysis. RESULTS A cohort of 183 residents and 127 staff was included and their electronic medical documentation was analyzed in two periods: January-September 2019 and January-September 2020. These residents had lower numbers of outpatient department visits (P < 0.001), days of prescription from the outpatient department (P < 0.001), number of emergency department visits (P < 0.001), number of admissions (P < 0.001), and days of admission (P < 0.001) to treat respiratory tract infections from January-September 2020 than January-September 2019. These staff members had lower numbers of outpatient department visits (P = 0.015) and days of prescription from the outpatient department (P = 0.009) to treat respiratory tract infections from January-September 2020 than January-September 2019. CONCLUSION The association between our preventive measures and decreasing the risk of respiratory tract infection in nursing home residents and staff could be found. Sharing these experiences is valuable, as they provide important insights related to clinical practice during the COVID-19 pandemic.
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Affiliation(s)
- Chia-Yu Huang
- Department of Family Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, 427, Taiwan
- School of Medicine, Tzu Chi University, Hualien, 970, Taiwan
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 404, Taiwan
| | - Yu-Hung Kuo
- Department of Research, Taichung Tzu Chi Hospital, Taichung, 404, Taiwan
| | - Shu-Ting Chuang
- Department of Nursing, Taichung Tzu Chi Hospital, Taichung, 404, Taiwan
- Office of Superintendent, Taichung Tzu Chi Hospital, Taichung, 404, Taiwan
| | - Hung-Rong Yen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 404, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, 404, Taiwan
- Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, 404, Taiwan
- Chinese Medicine Research Center, China Medical University, Taichung, 404, Taiwan
| | - Sio-Ian Tou
- Department of Pediatrics, Chung Kang Branch, Cheng-Ching General Hospital, No. 966, Sec. 4, Taiwan Blvd., Xitun Dist. 404, Taichung, 407211, Taiwan.
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27
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Baker TL, Greiner JV. Guidelines for Reopening a Nation in a SARS-CoV-2 Pandemic: A Path Forward. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:496. [PMID: 34068853 PMCID: PMC8153561 DOI: 10.3390/medicina57050496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/26/2021] [Accepted: 05/04/2021] [Indexed: 02/06/2023]
Abstract
Background and Objectives: Action, not fear, is the path forward in the coronavirus infectious disease 2019 (COVID-19) pandemic. Since early 2020, the world's nations have faced conundrums over severe acute respiratory syndrome corona virus type 2 (SARS-CoV-2) infections resulting in COVID-19 resulting in national closures, and thus, a clear understandable plan that nations can implement is required to reopen. The healthcare benefits of reopening a nation more likely than not exceed the benefits of continued pandemic-related closure. Pandemic-related closures have resulted in countless delayed or avoided urgent care evaluations. Furthermore, routine care of acute and chronic illnesses, including evaluations, diagnoses, and treatments, has also been delayed. Isolation, loss of income, and fear have resulted in mental health conditions or exacerbated existing conditions. The magnitude of untoward ramifications is unknown and may ultimately represent an inestimable degree of danger and morbidity, and even death. The pandemic of SARS-CoV-2 has created an atmosphere of fear of COVID-19 that has directly and indirectly injured the world's population. Since this has resulted in increasing morbidity and mortality, creating economic chaos, and near systemic collapse of educational systems with no well described plan forward, it is the purpose of this study to provide guidelines that provide a path forward to safely open a nation. Physicians often equipped by their education, training, and experiences across disciplines are uniquely positioned to comprehend, coordinate, and teach other physicians, business owners, and municipal and government leaders from guidelines. As such, physicians may take the lead in a path forward to reopening a nation, including opening businesses, educational facilities, and religious establishments, while minimizing the risk of SARS-CoV-2 infection. Materials and Methods: Reviews of the literature among the disciplines of environmental air, sanitation, social interaction, medical testing, vaccination, protection, and disease prevention and safety allowed for the conceptualization and eventual genesis of identifiable interventions which either reduce the viral load in the environment or inactivate the virus from replication. Each of the guidelines was selected based on the principle that it involved the elimination or inactivation of the viral particle. With a reduction in viral load or inactivation of replication, the implementation of these guidelines is expected to allow for reopening a nation with an increased level of safety. Results: The guidelines identified, including air exchange (ventilation), air filtration, personal protective filtering devices (masks), hand hygiene, social distancing, screening and testing, vaccines, high-risk patient protection, medical management, and adjunctive therapies, are described and referenced. Conclusions: In that the pandemic is primarily a public health issue, the path forward is best coordinated by local, regional, and national physicians. Many physicians with a breadth of experiences are uniquely positioned to coordinate the implementation of these interdisciplinary guidelines. Using these guidelines as a planned, coordinated action, not fear, is a path forward. Nations have a decision to make: closuring versus opening.
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Affiliation(s)
- Terrance L. Baker
- Johns Hopkins Community Physician, Baltimore, MD 21287, USA;
- School of Nursing, University of Maryland, Baltimore, MD 20742, USA
- School of Nursing, State University of New York at Stony Brook, Brookhaven, NY 11794, USA
- Sollay Medical Center, Sollay Kenyan Foundation, Katani Hospital, Katani, Kenya
| | - Jack V. Greiner
- Eye Research Institute of Massachusetts Eye & Ear, 20 Staniford St., W239, Boston, MA 02114, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA 02115, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02155, USA
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28
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van Hensbergen M, den Heijer CDJ, Wolffs P, Hackert V, Ter Waarbeek HLG, Oude Munnink BB, Sikkema RS, Heddema ER, Hoebe CJPA. COVID-19: first long-term care facility outbreak in the Netherlands following cross-border introduction from Germany, March 2020. BMC Infect Dis 2021; 21:418. [PMID: 33947332 PMCID: PMC8094983 DOI: 10.1186/s12879-021-06093-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/20/2021] [Indexed: 01/10/2023] Open
Abstract
Background The Dutch province of Limburg borders the German district of Heinsberg, which had a large cluster of COVID-19 cases linked to local carnival activities before any cases were reported in the Netherlands. However, Heinsberg was not included as an area reporting local or community transmission per the national case definition at the time. In early March, two residents from a long-term care facility (LTCF) in Sittard, a Dutch town located in close vicinity to the district of Heinsberg, tested positive for COVID-19. In this study we aimed to determine whether cross-border introduction of the virus took place by analysing the LTCF outbreak in Sittard, both epidemiologically and microbiologically. Methods Surveys and semi-structured oral interviews were conducted with all present LTCF residents by health care workers during regular points of care for information on new or unusual signs and symptoms of disease. Both throat and nasopharyngeal swabs were taken from residents suspect of COVID-19, based on regional criteria, for the detection of SARS-CoV-2 by Real-time Polymerase Chain Reaction. Additionally, whole genome sequencing was performed using a SARS-CoV-2 specific amplicon-based Nanopore sequencing approach. Moreover, twelve random residents were sampled for possible asymptomatic infections. Results Out of 99 residents, 46 got tested for COVID-19. Out of the 46 tested residents, nineteen (41%) tested positive for COVID-19, including 3 asymptomatic residents. CT-values for asymptomatic residents seemed higher compared to symptomatic residents. Eleven samples were sequenced, along with three random samples from COVID-19 patients hospitalized in the regional hospital at the time of the LTCF outbreak. All samples were linked to COVID-19 cases from the cross-border region of Heinsberg, Germany. Conclusions Sequencing combined with epidemiological data was able to virtually prove cross-border transmission at the start of the Dutch COVID-19 epidemic. Our results highlight the need for cross-border collaboration and adjustment of national policy to emerging region-specific needs along borders in order to establish coordinated implementation of infection control measures to limit the spread of COVID-19. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06093-9.
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Affiliation(s)
- Mitch van Hensbergen
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, PO-Box 33, 6400 AA, Heerlen, The Netherlands. .,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, PO-Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Casper D J den Heijer
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, PO-Box 33, 6400 AA, Heerlen, The Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, PO-Box 616, 6200 MD, Maastricht, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), PO-Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Petra Wolffs
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), PO-Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Volker Hackert
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, PO-Box 33, 6400 AA, Heerlen, The Netherlands
| | - Henriëtte L G Ter Waarbeek
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, PO-Box 33, 6400 AA, Heerlen, The Netherlands
| | - Bas B Oude Munnink
- Department of Viroscience, Erasmus MC - University Medical Center Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Reina S Sikkema
- Department of Viroscience, Erasmus MC - University Medical Center Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Edou R Heddema
- Department of Medical Microbiology, Zuyderland Medical Center Heerlen/Sittard-Geleen, 6162 BG, Geleen, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, PO-Box 33, 6400 AA, Heerlen, The Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, PO-Box 616, 6200 MD, Maastricht, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), PO-Box 5800, 6202 AZ, Maastricht, The Netherlands
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29
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Kherbache A, Mertens E, Denier Y. Moral distress in medicine: An ethical analysis. J Health Psychol 2021; 27:1971-1990. [PMID: 33938314 DOI: 10.1177/13591053211014586] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Moral distress is a negative emotional response that occurs when physicians know the morally correct action but are prevented from taking it because of internal or external constraints. Moral distress undermines a physician's ethical integrity, leading to anger, poor job satisfaction, reduced quality of care and burnout. Scarce literature exists on the ethical aspects of moral distress in medicine. We conducted an ethical analysis of moral distress as experienced by physicians and analysed it from the literature using two predominant ethical theories: principlism and care ethics. Finally, we consider the emergence of moral distress in medicine during the COVID-19 pandemic.
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30
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Jahn B, Sroczynski G, Bicher M, Rippinger C, Mühlberger N, Santamaria J, Urach C, Schomaker M, Stojkov I, Schmid D, Weiss G, Wiedermann U, Redlberger-Fritz M, Druml C, Kretzschmar M, Paulke-Korinek M, Ostermann H, Czasch C, Endel G, Bock W, Popper N, Siebert U. Targeted COVID-19 Vaccination (TAV-COVID) Considering Limited Vaccination Capacities-An Agent-Based Modeling Evaluation. Vaccines (Basel) 2021; 9:434. [PMID: 33925650 PMCID: PMC8145290 DOI: 10.3390/vaccines9050434] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/21/2022] Open
Abstract
(1) Background: The Austrian supply of COVID-19 vaccine is limited for now. We aim to provide evidence-based guidance to the authorities in order to minimize COVID-19-related hospitalizations and deaths in Austria. (2) Methods: We used a dynamic agent-based population model to compare different vaccination strategies targeted to the elderly (65 ≥ years), middle aged (45-64 years), younger (15-44 years), vulnerable (risk of severe disease due to comorbidities), and healthcare workers (HCW). First, outcomes were optimized for an initially available vaccine batch for 200,000 individuals. Second, stepwise optimization was performed deriving a prioritization sequence for 2.45 million individuals, maximizing the reduction in total hospitalizations and deaths compared to no vaccination. We considered sterilizing and non-sterilizing immunity, assuming a 70% effectiveness. (3) Results: Maximum reduction of hospitalizations and deaths was achieved by starting vaccination with the elderly and vulnerable followed by middle-aged, HCW, and younger individuals. Optimizations for vaccinating 2.45 million individuals yielded the same prioritization and avoided approximately one third of deaths and hospitalizations. Starting vaccination with HCW leads to slightly smaller reductions but maximizes occupational safety. (4) Conclusion: To minimize COVID-19-related hospitalizations and deaths, our study shows that elderly and vulnerable persons should be prioritized for vaccination until further vaccines are available.
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Affiliation(s)
- Beate Jahn
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, A-6060 Hall in Tirol, Austria; (B.J.); (G.S.); (N.M.); (J.S.); (M.S.); (I.S.)
| | - Gaby Sroczynski
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, A-6060 Hall in Tirol, Austria; (B.J.); (G.S.); (N.M.); (J.S.); (M.S.); (I.S.)
| | - Martin Bicher
- dwh GmbH, dwh Simulation Services, Neustiftgasse 57–59, A-1070 Vienna, Austria; (M.B.); (C.R.); (C.U.); (N.P.)
- Institute of Information Systems Engineering, TU Wien, Favoritenstraße 11, A-1050 Vienna, Austria
| | - Claire Rippinger
- dwh GmbH, dwh Simulation Services, Neustiftgasse 57–59, A-1070 Vienna, Austria; (M.B.); (C.R.); (C.U.); (N.P.)
| | - Nikolai Mühlberger
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, A-6060 Hall in Tirol, Austria; (B.J.); (G.S.); (N.M.); (J.S.); (M.S.); (I.S.)
| | - Júlia Santamaria
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, A-6060 Hall in Tirol, Austria; (B.J.); (G.S.); (N.M.); (J.S.); (M.S.); (I.S.)
| | - Christoph Urach
- dwh GmbH, dwh Simulation Services, Neustiftgasse 57–59, A-1070 Vienna, Austria; (M.B.); (C.R.); (C.U.); (N.P.)
| | - Michael Schomaker
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, A-6060 Hall in Tirol, Austria; (B.J.); (G.S.); (N.M.); (J.S.); (M.S.); (I.S.)
- Center for Infectious Disease Epidemiology and Research, University of Cape Town, Barnard Fuller Building, Anzio Rd, Observatory, Cape Town 7935, South Africa
| | - Igor Stojkov
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, A-6060 Hall in Tirol, Austria; (B.J.); (G.S.); (N.M.); (J.S.); (M.S.); (I.S.)
| | - Daniela Schmid
- Division for Quantitative Methods in Public Health and Health Services Research, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, A-6060 Hall in Tirol, Austria;
| | - Günter Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria;
| | - Ursula Wiedermann
- Center of Pathophysiology, Infectiology & Immunology (OEL), Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria;
| | - Monika Redlberger-Fritz
- Center of Virology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria;
| | - Christiane Druml
- UNESCO Chair on Bioethics, Medical University of Vienna, Waehringerstrasse 25, 1090 Vienna, Austria;
| | - Mirjam Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands;
| | - Maria Paulke-Korinek
- Ministry of Social Affairs, Health, Care and Consumer Protection, Stubenring 1, 1010 Vienna, Austria;
| | - Herwig Ostermann
- Austrian National Public Health Institute/Gesundheit Österreich GmbH, Stubenring 6, 1010 Vienna, Austria; (H.O.); (C.C.)
| | - Caroline Czasch
- Austrian National Public Health Institute/Gesundheit Österreich GmbH, Stubenring 6, 1010 Vienna, Austria; (H.O.); (C.C.)
| | - Gottfried Endel
- Austrian Federation of Social Insurances, Kundmanngasse 21, 1030 Vienna, Austria;
| | - Wolfgang Bock
- Department of Mathematics, TU Kaiserslautern, Gottlieb-Daimler-Straße 48, 67663 Kaiserslautern, Germany;
| | - Nikolas Popper
- dwh GmbH, dwh Simulation Services, Neustiftgasse 57–59, A-1070 Vienna, Austria; (M.B.); (C.R.); (C.U.); (N.P.)
- Institute of Information Systems Engineering, TU Wien, Favoritenstraße 11, A-1050 Vienna, Austria
- Association for Decision Support for Health Policy and Planning, DEXHELPP, Neustiftgasse 57–59, A-1070 Vienna, Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, A-6060 Hall in Tirol, Austria; (B.J.); (G.S.); (N.M.); (J.S.); (M.S.); (I.S.)
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St., Boston, MA 02114, USA
- Center for Health Decision Science, Departments of Epidemiology and Health Policy & Management, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, Boston, MA 02115, USA
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Kaelen S, van den Boogaard W, Pellecchia U, Spiers S, De Cramer C, Demaegd G, Fouqueray E, Van den Bergh R, Goublomme S, Decroo T, Quinet M, Van Hoof E, Draguez B. How to bring residents' psychosocial well-being to the heart of the fight against Covid-19 in Belgian nursing homes-A qualitative study. PLoS One 2021; 16:e0249098. [PMID: 33770110 PMCID: PMC7997017 DOI: 10.1371/journal.pone.0249098] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/10/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Nursing homes (NH) for the elderly have been particularly affected by the Covid-19 pandemic mainly due to their hosted vulnerable populations and poor outbreak preparedness. In Belgium, the medical humanitarian organization Médecins Sans Frontières (MSF) implemented a support project for NH including training on infection prevention and control (IPC), (re)-organization of care, and psychosocial support for NH staff. As psychosocial and mental health needs of NH residents in times of Covid-19 are poorly understood and addressed, this study aimed to better understand these needs and how staff could respond accordingly. METHODS A qualitative study adopting thematic content analysis. Eight focus group discussions with direct caring staff and 56 in-depth interviews with residents were conducted in eight purposively and conveniently selected NHs in Brussels, Belgium, June 2020. RESULTS NH residents experienced losses of freedom, social life, autonomy, and recreational activities that deprived them of their basic psychological needs. This had a massive impact on their mental well-being expressed in feeling depressed, anxious, and frustrated as well as decreased meaning and quality of life. Staff felt unprepared for the challenges posed by the pandemic; lacking guidelines, personal protective equipment and clarity around organization of care. They were confronted with professional and ethical dilemmas, feeling 'trapped' between IPC and the residents' wellbeing. They witnessed the detrimental effects of the measures imposed on their residents. CONCLUSION This study revealed the insights of residents' and NH staff at the height of the early Covid-19 pandemic. Clearer outbreak plans, including psychosocial support, could have prevented the aggravated mental health conditions of both residents and staff. A holistic approach is needed in NHs in which tailor-made essential restrictive IPC measures are combined with psychosocial support measures to reduce the impact on residents' mental health impact and to enhance their quality of life.
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Affiliation(s)
- Sanne Kaelen
- Belgium Covid-19 Project, Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Wilma van den Boogaard
- Médecins Sans Frontières, Operational Centre Brussels, Operational Research Unit (LuxOR), Luxembourg, Luxembourg/Brussels, Belgium
| | - Umberto Pellecchia
- Médecins Sans Frontières, Operational Centre Brussels, Operational Research Unit (LuxOR), Luxembourg, Luxembourg/Brussels, Belgium
| | - Sofie Spiers
- Belgium Covid-19 Project, Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Caroline De Cramer
- Belgium Covid-19 Project, Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Gwennin Demaegd
- Belgium Covid-19 Project, Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Edouard Fouqueray
- Belgium Covid-19 Project, Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Rafael Van den Bergh
- Belgium Covid-19 Project, Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Stephanie Goublomme
- Belgium Covid-19 Project, Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Tom Decroo
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Muriel Quinet
- Iriscare, Public Health Institute, Brussels, Belgium
| | - Elke Van Hoof
- Working Group on the Psychosocial Impact of the COVID-19 Pandemic Within the Superior Health Council, Brussels, Belgium
- Mental Health Sub-working Group, GEES, Brussels, Belgium
- Vrije Universiteit Brussel, Brussels, Belgium
| | - Bertrand Draguez
- Belgium Covid-19 Project, Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
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Suppan M, Abbas M, Catho G, Stuby L, Regard S, Achab S, Harbarth S, Suppan L. Impact of a Serious Game (Escape COVID-19) on the Intention to Change COVID-19 Control Practices Among Employees of Long-term Care Facilities: Web-Based Randomized Controlled Trial. J Med Internet Res 2021; 23:e27443. [PMID: 33685854 PMCID: PMC7996198 DOI: 10.2196/27443] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/07/2021] [Accepted: 03/07/2021] [Indexed: 01/20/2023] Open
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.
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Affiliation(s)
- Mélanie Suppan
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Mohamed Abbas
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Gaud Catho
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Simon Regard
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of the Surgeon General, Geneva Directorate of Health, Geneva, Switzerland
| | - Sophia Achab
- Specialized Facility in Behavioral Addictions ReConnecte, University of Geneva Hospitals, Geneva, Switzerland
- WHO Collaborating Center in Training and Research in Mental Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Miralles O, Sanchez-Rodriguez D, Marco E, Annweiler C, Baztan A, Betancor É, Cambra A, Cesari M, Fontecha BJ, Gąsowski J, Gillain S, Hope S, Phillips K, Piotrowicz K, Piro N, Sacco G, Saporiti E, Surquin M, Vall-Llosera E. Unmet needs, health policies, and actions during the COVID-19 pandemic: a report from six European countries. Eur Geriatr Med 2021; 12:193-204. [PMID: 33057981 PMCID: PMC7557304 DOI: 10.1007/s41999-020-00415-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/29/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE The United Nations (UN) has published a Policy Brief on the impact of the Coronavirus Disease 2019 (COVID-19) that identifies policies and responses to protect older adults. Our objective was to summarize actions, health policies and clinical guidelines adopted by six European countries (Belgium, France, Italy, Poland, Spain and United Kingdom) during the pandemic, and to assess the impact of national policies on reducing adverse effects of the COVID-19 pandemic in older populations. METHODS Reports by geriatricians on the measures and actions undertaken by governmental institutions in each country between March and July 2020, as well as the role of primary care during the pandemic, covered three areas: (a) general health strategies related to the pandemic; (b) impact of COVID-19 on health inequity; and (c) initiatives and challenges for the COVID-19 pandemic and beyond. RESULTS In the six countries, COVID-19 mortality in nursing homes ranged from 26 to 66%. Although all countries endorsed the World Health Organization general recommendations, the reports identified the lack of harmonized European guidelines and policies for nursing homes, with competencies transferred to national (or regional) governments. All countries restricted visits in nursing homes, but no specific action plans were provided. The role of primary care was limited by the centralization of the crisis in hospital settings. CONCLUSIONS The older population has been greatly affected by COVID-19 and by the policies initiated to control its spread. The right to health and dignity are transgenerational; chronological age should not be the sole criterion in policy decisions.
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Affiliation(s)
- Oriol Miralles
- Geriatrics and Palliative Care Department, Hospital General de L'Hospitalet de Llobregat-Consorci Sanitari Integral, L'Hospitalet de Llobregat, Av. Josep Molins, 29 L'Hospitalet de Llobregat, 08906, Barcelona, Spain.
| | - Dolores Sanchez-Rodriguez
- Clinical Research Unit, CHU Brugmann, Brussels, Belgium
- WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Geriatrics Department, Rehabilitation Research Group, Hospital Del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Esther Marco
- Physical Medicine and Rehabilitation Departament, Parc de Salut Mar. Hospital del Mar Research Institute (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
- UPRES EA 4638, University of Angers, Angers, France
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Robarts Research Institute, The University of Western Ontario, London, ON, Canada
| | - Ainhoa Baztan
- Primary Care Center La Florida, Costa Ponent Unit, Institut Català de La Salut, Catalan Health Institute, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Évora Betancor
- Geriatrics and Palliative Care Department, Hospital General de L'Hospitalet de Llobregat-Consorci Sanitari Integral, L'Hospitalet de Llobregat, Av. Josep Molins, 29 L'Hospitalet de Llobregat, 08906, Barcelona, Spain
| | - Alicia Cambra
- Geriatrics and Palliative Care Department, Hospital General de L'Hospitalet de Llobregat-Consorci Sanitari Integral, L'Hospitalet de Llobregat, Av. Josep Molins, 29 L'Hospitalet de Llobregat, 08906, Barcelona, Spain
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Benito J Fontecha
- Geriatrics and Palliative Care Department, Hospital General de L'Hospitalet de Llobregat-Consorci Sanitari Integral, L'Hospitalet de Llobregat, Av. Josep Molins, 29 L'Hospitalet de Llobregat, 08906, Barcelona, Spain
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Medical College, Jagiellonian University, Kraków, Poland
| | - Sophie Gillain
- Geriatrics Department, Liège University Hospital, University of Liège, Liège, Belgium
| | - Suzy Hope
- Department of Healthcare for Older People, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Karolina Piotrowicz
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Medical College, Jagiellonian University, Kraków, Poland
| | - Niccolò Piro
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Guillaume Sacco
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
- UPRES EA 4638, University of Angers, Angers, France
| | - Edoardo Saporiti
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Murielle Surquin
- Beacon Medical Centre, Sidmouth, Devon, UK
- Geriatrics Department, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Estel Vall-Llosera
- Geriatrics and Palliative Care Department, Hospital General de L'Hospitalet de Llobregat-Consorci Sanitari Integral, L'Hospitalet de Llobregat, Av. Josep Molins, 29 L'Hospitalet de Llobregat, 08906, Barcelona, Spain
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Suppan L, Abbas M, Catho G, Stuby L, Regard S, Harbarth S, Achab S, Suppan M. Impact of a Serious Game on the Intention to Change Infection Prevention and Control Practices in Nursing Homes During the COVID-19 Pandemic: Protocol for a Web-Based Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e25595. [PMID: 33296329 PMCID: PMC7744143 DOI: 10.2196/25595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nursing home residents are at high risk of complications and death due to COVID-19. Lack of resources, both human and material, amplifies the likelihood of contamination in these facilities where a single employee can contaminate dozens of residents and colleagues. Improving the dissemination of and adhesion to infection prevention and control (IPC) guidelines is therefore essential. Serious games have been shown to be effective in developing knowledge and in increasing engagement, and could motivate nursing home employees to change their IPC practices. OBJECTIVE Our aim is to assess the impact of "Escape COVID-19," a serious game designed to enhance knowledge and application of IPC procedures, on the intention of nursing home employees to change their IPC practices. METHODS We will carry out a web-based randomized controlled trial following the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) guidelines and incorporating relevant elements of CHERRIES (Checklist for Reporting Results of Internet E-Surveys). Participants will be randomized to either the control or the serious game (intervention) group. First, both groups will be asked to answer a questionnaire designed to gather demographic data and assess baseline knowledge. The control group will then receive a quick reminder of the current national guidelines and links to IPC guidelines for health care professionals, while the other group will play the game. Both groups will then have to answer a second questionnaire designed to assess their willingness to change their IPC practices after having followed their respective material. After completing this questionnaire, they will be granted access to the material presented to the group they were not assigned to and receive a course completion certificate. The primary outcome will be the proportion of participants willing to change their IPC practices according to group. Secondary outcomes will include the analysis of specific questions detailing the exact changes considered by the participants. Factors associated with participant willingness or reluctance to change behavior will also be assessed. Attrition will also be assessed at each stage of the study. RESULTS The study protocol has been presented to our regional ethics committee (Req-2020-01262), which issued a declaration of no objection as such projects do not fall within the scope of the Swiss federal law on human research. Data collection began on November 5, 2020, and should be completed by December 4, 2020. CONCLUSIONS This study should determine whether "Escape COVID-19," a serious game designed to improve compliance with COVID-19 safe practices, modifies the intention to follow IPC guidelines among nursing home employees. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/25595.
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Affiliation(s)
- Laurent Suppan
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Mohamed Abbas
- Infection Control Programme, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Gaud Catho
- Infection Control Programme, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Simon Regard
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.,Division of General Surgeon, Geneva Directorate of Health, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Sophia Achab
- Specialized Facility in Behavioral Addictions ReConnecte, Geneva University Hospitals, Geneva, Switzerland.,WHO Collaborating Center in Training and Research in Mental Health, University of Geneva, Geneva, Switzerland
| | - Mélanie Suppan
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Abstract
Aim In many countries nursing home populations have accounted for half of all deaths during the first wave of COVID-19. Findings Infection and risk of death are not the only risks related to COVID-19. The lockdown causes risks of cognitive decline, depression, anxiety, frailty and disabilities. Message The risks of prolonged isolation should be weighted against the COVID-19 risks.
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Suppan M, Catho G, Robalo Nunes T, Sauvan V, Perez M, Graf C, Pittet D, Harbarth S, Abbas M, Suppan L. A Serious Game Designed to Promote Safe Behaviors Among Health Care Workers During the COVID-19 Pandemic: Development of "Escape COVID-19". JMIR Serious Games 2020; 8:e24986. [PMID: 33242312 PMCID: PMC7717924 DOI: 10.2196/24986] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/12/2020] [Accepted: 11/26/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND As many countries fear and even experience the emergence of a second wave of COVID-19, reminding health care workers (HCWs) and other hospital employees of the critical role they play in preventing SARS-CoV-2 transmission is more important than ever. Building and strengthening the intrinsic motivation of HCWs to apply infection prevention and control (IPC) guidelines to avoid contaminating their colleagues, patients, friends, and relatives is a goal that must be energetically pursued. A high rate of nosocomial infections during the first COVID-19 wave was detected by IPC specialists and further cemented their belief in the need for an engaging intervention that could improve compliance with COVID-19 safe behaviors. OBJECTIVE Our aim was to develop a serious game that would promote IPC practices with a specific focus on COVID-19 among HCWs and other hospital employees. METHODS The first 3 stages of the SERES framework were used to develop this serious game. A brainswarming session between developers and IPC specialists was used to identify the target audience and acquisition objectives. Nicholson's RECIPE mnemonic (reflection, engagement, choice, information, play, exposition) for meaningful gamification was used to guide the general design. A common and simple terminology was used to suit the broad target audience. The game was tested on various platforms (smartphones, tablets, laptops, desktop computers) by different users during each development loop and before its final release. RESULTS The game was designed to target all hospital staff who could be in direct contact with patients within the Geneva University Hospitals. In total, 10 acquisition objectives were defined by IPC specialists and implemented into the game according to the principles of meaningful gamification. A simple storyboard was first created using Microsoft PowerPoint and was progressively refined through multiple iteration loops. Articulate Storyline was then used to create two successive versions of the actual game. In the final version, a unique graphic atmosphere was created with help from a professional graphic designer. Feedback mechanisms were used extensively throughout the game to strengthen key IPC messages. CONCLUSIONS The SERES framework was successfully used to create "Escape COVID-19," a serious game designed to promote safe IPC practices among HCWs and other hospital employees during the COVID-19 pandemic. This game can be obtained free of charge for research and educational purposes. A SCORM (shareable content object reference model) package is available to facilitate results and completion tracking on most current learning management systems.
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Affiliation(s)
- Mélanie Suppan
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Gaud Catho
- Infection Control Program, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Tomás Robalo Nunes
- Infection Control Program, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
- Infectious Diseases Department, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - Valérie Sauvan
- Infection Control Program, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Monique Perez
- Infection Control Program, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Christophe Graf
- Department of Rehabilitation and Geriatrics, Geneva University Hospital, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Program, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Program, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Mohamed Abbas
- Infection Control Program, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Blain H, Rolland Y, Schols JMGA, Cherubini A, Miot S, O'Neill D, Martin FC, Guérin O, Gavazzi G, Bousquet J, Petrovic M, Gordon AL, Benetos A. August 2020 Interim EuGMS guidance to prepare European Long-Term Care Facilities for COVID-19. Eur Geriatr Med 2020; 11:899-913. [PMID: 33141405 PMCID: PMC7608456 DOI: 10.1007/s41999-020-00405-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/16/2020] [Indexed: 12/23/2022]
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.
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Affiliation(s)
- Hubert Blain
- Department of Geriatrics, Centre Antonin Balmes, Pôle de Gérontologie du Centre Hospitalier Universitaire de Montpellier, Montpellier University Hospital, Montpellier University, 39 avenue Charles Flahault, 34295, Montpellier Cedex 5, France.
| | - Yves Rolland
- INSERM 1027, Toulouse University, Toulouse, France
| | - Jos M G A Schols
- Department of Health Services Research and Department of Family Medicine, CAPHRI-Maastricht University, Maastricht, The Netherlands
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Stéphanie Miot
- Department of Geriatrics, Centre Antonin Balmes, Pôle de Gérontologie du Centre Hospitalier Universitaire de Montpellier, Montpellier University Hospital, Montpellier University, 39 avenue Charles Flahault, 34295, Montpellier Cedex 5, France
- CESP, INSERM U1178, Centre de recherche en Epidemiologie et Santé des Populations, Paris, France
| | - Desmond O'Neill
- Trinity College Dublin Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
| | - Finbarr C Martin
- Population Health Sciences I King's College London, London, England
| | - Olivier Guérin
- Department of Geriatric Medicine, CHU Nice, University of Nice Sophia Antipolis, Nice, France
| | - Gaëtan Gavazzi
- Department of Geriatric Medicine, University Hospital of Grenoble-Alpes, Grenoble, France
- GREPI TIMC-IMAG CNRS UMR5525, University of Grenoble-Alpes, Grenoble, France
| | - Jean Bousquet
- Department of Dermatology and Allergy, Charité, Universitätsmedizin Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany
- MACVIA-France, Montpellier, France
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - Athanase Benetos
- Department of Geriatrics, CHRU de Nancy and Inserm DCAC, Université de Lorraine, Nancy, France
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38
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Heudorf U, Müller M, Schmehl C, Gasteyer S, Steul K. COVID-19 in long-term care facilities in Frankfurt am Main, Germany: incidence, case reports, and lessons learned. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc26. [PMID: 33214991 PMCID: PMC7656980 DOI: 10.3205/dgkh000361] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract: As of August 30, 2020, the World Health Organisation (WHO) reported 24,822,800 COVID-19 infections world wide. Severe disease and deaths occur especially in older people with chronic illnesses. Residents of nursing homes are considered to be the most vulnerable group. In this paper, the experiences with COVID-19 in nursing homes in Frankfurt will be presented and discussed. Materials and methods: Based on the data of the statutory reporting obligation, the reported COVID-19 cases are presented and incidences are calculated in different age groups and among residents of nursing homes. Outbreaks in various homes are described in detail based on the documentation from the public health department. Results: By August 28, 2020, 2,665 COVID-19 infections were reported in Frankfurt am Main (incidence 351/100,000 inhabitants), including 116 (4.3%) residents of nursing homes (2,416/100,000 residents). Almost half (39%) of all deaths in Frankfurt (n=69; incidence 9.1/100,000) were among nursing home residents (n=27; incidence 558/100,000 nursing home residents), with 22 of them in just one long-term care facility (LTCF). Compared to previous years, the mortality rate in nursing homes did not increase in the first half of 2020. In one home, 75% of residents tested positive for SARS-CoV-2 and 25% died; in two other homes, 6.7% and 14.1% of the residents became infected, and the mortality rate was 0.5% and 1%, resp. In the other 42 homes in the city (3,906 beds), the infection rate remained below 1% and the death rate was 0.1%. Discussion: In many countries, 30–70% of all deaths occur among nursing home residents, including Frankfurt (39%). An increase in overall mortality compared to previous years was not observed in Frankfurt as a whole or in the nursing homes in the city specifically. Due to the measures taken (monitoring of residents and staff, nursing care in protective clothing, prohibition or restriction of visits, physical distancing, isolation of infected people and quarantining of contact persons), only individual cases of COVID-19 illnesses occurred in nursing home residents in most homes and the outbreaks in the three homes could be stopped. We do not recommend regular nontargeted testing in nursing homes, but rather vigilance and the implementation of good hygiene as well as immediate targeted testing if COVID-19 is suspected in residents or staff. In order to mitigate the considerable negative effects of these measures on the residents, a good balance should be sought between infection prevention and the goal of ensuring self-determination and the residents’ quality of life.
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Affiliation(s)
- Ursel Heudorf
- Public Health Department of the City of Frankfurt am Main, Germany
| | - Maria Müller
- Public Health Department of the City of Frankfurt am Main, Germany
| | - Cleo Schmehl
- Public Health Department of the City of Frankfurt am Main, Germany
| | | | - Katrin Steul
- Public Health Department of the City of Frankfurt am Main, Germany
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