Creating a Palliative Care Inpatient Response Plan for COVID-19-The UW Medicine Experience.

CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic is stressing health care systems throughout the world. Significant numbers of patients are being admitted to the hospital with severe illness, often in the setting of advanced age and underlying comorbidities. Therefore, palliative care is an important part of the response to this pandemic. The Seattle area and UW Medicine have been on the forefront of the pandemic in the U.S. METHODS: UW Medicine developed a strategy to implement a palliative care response for a multihospital health care system that incorporates conventional capacity, contingency capacity, and crisis capacity. The strategy was developed by our palliative care programs with input from the health care system leadership. RESULTS: In this publication, we share our multifaceted strategy to implement high-quality palliative care in the context of the COVID-19 pandemic that incorporates conventional, contingency, and crisis capacity and focuses on the areas of the hospital caring for the most patients: the emergency department, intensive care units, and acute care services. The strategy focuses on key content areas, including identifying and addressing goals of care, addressing moderate and severe symptoms, and supporting family members. CONCLUSION: Strategy planning for delivery of high-quality palliative care in the context of the COVID-19 pandemic represents an important area of need for our health care systems. We share our experiences of developing such a strategy to help other institutions conduct and adapt such strategies more quickly.

The Effect of Tissue Flossing on Ankle Range of Motion, Jump, and Sprint Performance in Elite Rugby Union Athletes.

CONTEXT: Given the relatively novel technique of tissue flossing is currently lacking in the research literature despite some positive findings in preliminary studies, the modality clearly requires further research. Current evidence suggests that band flossing results in performance improvements and may also be an effective method in injury prevention. OBJECTIVE: Previous research has shown that tissue flossing may result in increased ankle range of motion, jump, and sprinting performance in recreational athletes. The present study aims to extend on this research, within an elite athlete sample. DESIGN: Counterbalanced, cross-over design with experimental and control trials, separated by 1 week. SETTING: University laboratory. PARTICIPANTS: Fourteen professional male rugby union athletes (mean [SD]: age 23.9 [2.7] y). INTERVENTION: Application of a floss band to both ankles (FLOSS) for 2 minutes or without flossing of the ankle joints (CON) on 2 separate occasions. MAIN OUTCOME MEASURES: A weight-bearing lunge test, a countermovement jump test, and a 20-m sprint test at pre and at 5 and 30 minutes post application of the floss band or control. RESULTS: There were no statistically significant interactions between treatment (FLOSS/CON) and time for any of the measured variables (P > .05). Effect size analysis revealed small benefits for FLOSS in comparison with CON for countermovement performance 5 minutes post (d = 0.28) and for 10-m (d = -0.45) and 15-m (d = -0.24) sprint time 30 minutes post. CONCLUSION: Findings from the current study suggest minimal benefits of tissue flossing when applied to the ankle joint in elite athletes for up to 30 minutes following their application.

Tissue flossing on ankle range of motion, jump and sprint performance: A follow-up study.

OBJECTIVES: Previous results from our laboratory suggest that band flossing results in increased ankle range of motion (ROM) and jump performance 5-min following application. However, the time-course of such benefits is yet to be examined. DESIGN: Parallel group design. SETTING: University laboratory. PARTICIPANTS: 69 recreational athletes (32 male/37 female). MAIN OUTCOME MEASURES: Participants performed a weight-bearing lunge test (WBLT), a counter-movement jump (CMJ) and a 15 m sprint test (SPRINT) pre and up to 45-min post application of a floss band to both ankles (FLOSS) or without flossing of the ankle joints (CON). RESULTS: There was a significant intervention × time interaction in favour of FLOSS when compared to CON for the WBLT (p < 0.05). These results were associated with trivial to small effect sizes at all time points. Small, but non-significant (p > 0.05) benefits were seen for FLOSS when compared to CON for CMJ force (mean ± 90%CI: 89 ± 101 N) and 15 m SPRINT times (-0.06 ± 0.04 s) at 45-min post. CONCLUSION: There is a trend towards a benefit for the use of floss bands applied to the ankle joint to improve ROM, jump and sprint performance in recreational athletes for up to 45-min following their application.