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1.
Kontakt ; 24(4):331-338, 2022.
Artigo em Inglês | Scopus | ID: covidwho-2205971

RESUMO

Background: Working in hospice facilities is very difficult both physically and mentally. Workers are often confronted with difficult and borderline living situations, and the burden of the Covid-19 pandemic has now been added to the equation. It is essential to look for factors that increase the resilience of these workers and support their well-being. Purpose: The aim of this paper is to create a model of impact of mindfulness and coping strategies on the well-being of hospice workers in Slovakia. Results: Mindfulness correlated with negative coping strategies. The multiple regression model indicated that the combined effect of mindfulness, negative coping strategies, and positive control strategies explain the 39% variance in well-being. The negative coping strategies and control strategies mediated the relationship between mindfulness and well-being. Conclusions: Mindfulness contributes to the well-being of hospice staff both directly and indirectly through negative coping strategies and positive strategies (control). Mindful individuals are less inclined to use negative strategies and, on the contrary, they are more prone to use positive coping strategies (particularly the control strategies). Implications for hospice providers are discussed. © 2022 The Authors. Published by University of South Bohemia in České Budějovice, Faculty of Health and Social Sciences.

2.
Journal of Family Medicine and Primary Care ; 11(8):4168-4173, 2022.
Artigo em Inglês | Web of Science | ID: covidwho-2201967

RESUMO

End-of-life medical services in the form of Hospice or Palliative care were initiated in the middle of 1900 in order to comfort the dying patients and support their families. There are a lot of similarities and differences between the two services. Many healthcare providers, including physicians, physician assistants, and nurses. are not fully trained or have comprehensive knowledge of these two types of end-of-life medical care. Through this paper, we aim to provide a thorough review of Hospice and Palliative care for internist and primary care physicians both in terms of indications or eligibility criteria;the similarities and differences between the two types of care;factors that disqualify an enrolled patient;and lastly, the role or use of Hospice and palliative care during COVID-19 pandemic.

3.
Gerontechnology ; 21, 2022.
Artigo em Inglês | Scopus | ID: covidwho-2201292

RESUMO

Purpose Nurses experience insufficient preparation for dealing with the death of their patients (Ferguson & Cosby, 2017). For proper learning, it is necessary for them to expose to the clinical environment during end-of-life care education. However, It is difficult for students to have sufficient end-of-life care training during the clinical training period because of short clinical practice hours, difficulty to access to patients or caregivers in the dying situation, and hardship to guarantee opportunities to experience dying situations (Randall et al., 2018;Smith et al., 2018). Thus, this study aims to examine the effects of an integrated end-of-life education program for nursing students. Method This is a pretest-posttest quasi-experimental design with two intervention groups and no control group. There were 16 participants in the group 1 while 14 in group 2. Group 1 received both the web-based virtual simulation and a clinical case study seminar on end-of-life care, while group 2 received only the web-based virtual simulation. In order to confirm the effect of the educational program, nursing students' end-of-life care knowledge, attitude toward end-of-life care, and educational self-efficacy were measured and compared through a survey which conducted before and after the program. The analysis included a paired T-test, an independent T-test and a Spearman's rank correlation test in order to compare changes in knowledge, attitude, and self-efficacy of the nursing students. Results and Discussion The mean age of participants was 21.73 (SD=1.57), of which 86.7% were women. The satisfaction with the virtual simulation was 3.93 (SD=0.73) in group 1 and 3.75 (SD=0.86) in group 2. There were significant changes in the end-of-life care knowledge (p=0.003) and attitude (p≤0.001) toward end-of-life care in group 1. There was a significant difference only in end-of-life care knowledge (p=0.037) group 2. Self-efficacy did not change significantly in either group, and each change did not show a significant correlation with satisfaction. Also, among each change, only the change in the end-of-life care attitude showed a significant difference between groups, and there was no significant difference in changes of end-of-life care knowledge and educational self-efficacy between both groups. The findings indicate that web-based virtual simulation alone may improve nursing students' knowledge. In particular, due to COVID-19 pandemic in recent years, it is important for students to access to patients and families and have learning opportunities for clinical practice through innovative ways. Virtual simulation may help them improve their clinical competency such as dealing with dying situations, caring for older patients, and communicating with their caregivers. Further research is necessary to examine the effects of not only virtual simulation but also integrated programs that includes clinical components such as case studies in the area of clinical education of end-of-life care for older adults. © 2022, Gerontechnology. All Rights Reserved.

4.
Critical Care Medicine ; 51(1 Supplement):600, 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2190681

RESUMO

INTRODUCTION: The COVID-19 pandemic disrupted access and delivery of routine continuing care for sepsis recovery, including provision of postacute services like skilled nursing facility (SNF) discharge, home healthcare (HH), and outpatient follow up. We hypothesized pandemic-related precautions and care disturbances would disparately impact postacute care for adults with sepsis due to COVID-19 vs non-COVID-19 pneumonia. METHOD(S): ENCOMPASS is an ongoing hybrid trial to test implementation of a multidisciplinary postsepsis transitional care program at 8 diverse hospitals (NCT04495946). In the current study, we analyzed community-dwelling trial participants (i.e., adults with clinically defined sepsis) enrolled July 2020-Nov 2021 with discharge diagnoses of COVID-19 (ICD10 U07.1) or non-COVID-19 pneumonia (ICD10 J13-18). Using EHR data, we examined discharge care setting (SNF or inpatient rehab, HH, or home with self care) and outpatient follow up within 14 days (in-person, virtual, or none) as primary and secondary outcomes. For each outcome, we fit multinomial regression models adjusted for patient (age, insurance), clinical (comorbidity burden, organ failure, length of stay) and community factors (rurality by zip code). RESULT(S): Among 410 participants with COVID-19 (n=151) or non-COVID-19 (n=259) pneumonia (median, at enrollment: age=70, CCI=5, SOFA score=4), 52 (13%) died in hospital and 18 (4%) discharged to hospice. of remaining patients, 134 (39%) were discharged to home with self care, 118 (35%) to HH, and 88 (26%) to SNF or inpatient rehab. Survivors with vs without COVID-19 had similar adjusted odds of discharge to HH (OR=1.17 95%CI=0.65-2.10) and SNF or inpatient rehab (OR=1.60 95%CI=0.81-3.14) compared to home. Outpatient visit completion was similar for COVID-19 and non-COVID-19 survivors (26% vs 30%, p=0.43), but patients with vs without COVID-19 had higher odds of virtual (OR=4.76 95%CI=2.11-10.75) compared to no completed follow-up. CONCLUSION(S): In an ongoing postsepsis care trial, COVID-19 and non-COVID-19 survivors had similar provision of postacute services. COVID-19 was associated with increased virtual outpatient follow up, highlighting the value of telehealth to reduce exposure risk while maintaining close follow up of patients recovering from serious illness during the pandemic.

5.
Critical Care Medicine ; 51(1 Supplement):599, 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2190680

RESUMO

INTRODUCTION: COVID-19-related organ dysfunction is increasingly recognized as sepsis of viral origin and is a common complication among those requiring hospitalization, with estimated prevalence of over 50% among the latter. However, the population-level association of COVID-19 with short-term mortality among septic patients is unknown. METHOD(S): We used a statewide dataset to identify hospitalizations aged >=18 years with sepsis in Texas during April 1-December 31, 2020. Sepsis was defined by "explicit" and ICD-10 codes for severe sepsis (R65.20) and septic shock (R65.21) and COVID-19 by ICD-10 code U07.1. A hierarchical, mixed-effects model was fit to estimate the association of COVID-19 with short-term mortality (defined as in-hospital death or discharge to hospice) among sepsis hospitalizations. Sensitivity analyses of the sepsis hospitalization subsets with septic shock and ICU admission were performed using a similar modeling approach. RESULT(S): Among 55,145 sepsis hospitalizations, 13,149 (23.8%) had COVID-19. Compared to those without COVID-19, sepsis hospitalizations with COVID-19 were younger (aged >=65 years 53.6% vs 55.0%), more commonly male (59.5% vs 50.4%) and racial/ethnic minority (66.1% vs. 46.2%), with lower burden of chronic illness (mean [SD] Charlson comorbidity index 1.8 [1.9] vs 2.8 [2.6]), but with higher mean [SD] number of organ dysfunctions (3.1 [1.4] vs 2.7 [1.6]) [p < 0.0001 for all comparisons]. Short-term mortality among sepsis hospitalizations with and without COVID-19 was 52.7% vs 30.2%, respectively. On adjusted analysis, COVID-19 remained associated with higher risk of short-term mortality (adjusted odds ratio [aOR] 2.54 [95% 2.39-2.70]), with findings on sensitivity analyses consistent with the primary model among sepsis hospitalization subsets with septic shock ([aOR] 2.70 [95% 2.51-2.91]) and ICU admission ([aOR] 2.67 [95% 2.30-3.10]). CONCLUSION(S): COVID-19 infection was associated with over 250% higher odds of short-term mortality among septic patients. Additional studies are needed to determine the mechanisms underlying these observations in order to inform future efforts to reduce the observed outcome disparities.

6.
Critical Care Medicine ; 51(1 Supplement):586, 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2190678

RESUMO

INTRODUCTION: Decreasing case fatality among septic patients has been documented in the United States (US). The strain on healthcare resources brought by the COVID-19 pandemic has been associated with a rise in adverse health outcomes in non-COVID patients. However, the populationlevel impact of the COVID-19 pandemic on the case fatality in sepsis among non-COVID patients is unknown. METHOD(S): We used a statewide dataset to identify hospitalizations aged >=18 years in Texas during April 1-December 31, for each year of 2016-2020 (to align each year with the date of introduction of COVID-19-specific ICD-10 code [U071] in the US). Sepsis was defined by "explicit" ICD-10 codes for severe sepsis (R65.20) and septic shock (R65.21). COVID-19 hospitalizations were excluded. Hierarchical models were fit to estimate the changes in shortterm mortality (defined as in-hospital death or discharge to hospice) of sepsis hospitalizations using 2 approaches: 1) using the 2016-2019 data to forecast risk-adjusted shortterm mortality in 2020 and then comparing the predicted and observed 2020 mortality 2) using the 2019-2020 data to estimate the change in short-term mortality in 2020. RESULT(S): There were 207,953 sepsis hospitalizations without a diagnosis of COVID-19 during the study period (45,826 in 2019 and 41,996 in 2020). Short-term mortality has decreased between 2016 and 2019 from 29.7% to 26.6% (adjusted odds ratio [aOR]/year 0.93 [95% CI 0.92-0.94]). The predicted and observed short-term mortality among sepsis hospitalizations in 2020 was 25.8% (95% CI 25.6-26.0) vs 30.8%, respectively (p < 0.0001). Following adjustment for confounders, the risk of short-term mortality among sepsis hospitalizations was higher in 2020 than in 2019 (aOR 1.30 [95% CI 1.25-1.35]). CONCLUSION(S): The COVID-19 pandemic was associated with reversal of the progressive pre-pandemic downtrend in case fatality of septic patients, with 30% higher odds of short-term mortality in 2020 compared to the preceding year among sepsis hospitalizations without COVID-19. Further studies are needed to determine the patient-, health system-, and policy-related contributors to these findings in order to inform potential scalable strategies to reduce pandemicrelated adverse impact on outcomes of septic patients without COVID-19.

7.
Critical Care Medicine ; 51(1 Supplement):512, 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2190655

RESUMO

INTRODUCTION: Social determinants of health have been under-reported in critically ill patients during the pandemic. We hypothesized that geospatial factors and baseline health status in our community would significantly impact outcomes from Covid-19 infection. METHOD(S): We conducted an urban, single-center, observational study of patients with Covid-19 infection admitted to our adult ICU over ten months (March 23, 2020 to January 21, 2021, after approval by our hospital's Institutional Review Board. Weekly prospective data on the Covid-19 study population were entered in our ICU's quality assurance database. Data specific to test our hypothesis-zip code of residence, functional status, and Canadian Frailty Score (1-7)-were collected from retrospective chart review. The studied population was dichotomized to access patients who resided in long-term care facilities or home residence. Five zip code regions based on sample size and the distance from the patient's residence to the hospital allowed random sampling. Statistical significance was determined using ANOVA and T-test as indicated. RESULT(S): A total of 300 patients were enrolled. Across the designated cohort-based zip code regions, the mean frailty score of patients who resided at home differed significantly (2.9+/- SE.98 vs. 3.8+/- SE. 1.28, p< 0.01). Favorable frailty scores of 1-2 had a combined death and hospice rate of 23%. Of the survivors, 30% were transferred to skilled nursing facilities (SNF) and 26% were discharged to home. Patients with frailty scores of 6-7 had a final mortality rate of 83%. Of the survivors, only 2% were transferred to a SNF and 6% were discharged to home. Compared to admitting frailty scores between 1-3, a frailty score of 4 or greater (which represented 35% of all Covid ICU patients admitted from home) had a 1.8 relative risk of death (p< 0.0001). CONCLUSION(S): In our adult Covid-19 population, geospatial factors were associated with significant variances in frailty determined on ICU admission. Worsening frailty scores were associated with marked differences in both survival and final disposition, with combined death and hospice rates as high as 80%. We recommend that these metrics be added to routine data reporting to help better characterize ICU populations and stimulate efforts to improve frailty in vulnerable populations.

8.
Critical Care Medicine ; 51(1 Supplement):102, 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2190491

RESUMO

INTRODUCTION: Rural residence has been associated with increased risk of COVID-19-related mortality. However, the population-level prognostic implications of rural residence among critically ill patients with COVID-19 are lacking, and the impact of inter-hospital transfer and hospitals' location on the outcomes of these patients is unknown. METHOD(S): We used a statewide dataset to identify ICU admissions aged >=18 years with a diagnosis of COVID-19 in Texas during April 1-December 31, 2020. COVID-19 was defined by ICD-10 code U07.1. We used dichotomized (rural vs urban) ZIP Code-level Rural-Urban Commuting Area categories, linked to hospitalization data, to identify rural residence. Hierarchical, mixed-effects models were fit to estimate the association of rural residence with shortterm mortality (defined as in-hospital death or discharge to hospice) for the whole cohort and among hospitalizations with and without transfer from another hospital. Similar modeling was used to examine the association of care in rural hospitals among rural residents without transfer to another facility with short-term mortality. RESULT(S): Among 58,485 ICU admissions with COVID-19, 9,495 (16.2%) were rural residents. Among rural residents, 8,607 (90.6%) were managed in non-rural hospitals, and 1,827 (19.2%) were transferred from another hospital. The unadjusted short-term mortality among rural and urban residents was 25.9% vs 23.9%, respectively. Following adjustment for confounders, rural residence was associated with higher short-term mortality for the whole cohort (adjusted odds ratio [aOR] 1.093 [95% CI 1.003-1.191]) and among those transferred from another hospital (aOR 1.349 [95% CI 1.106-1.646]), but not among those without inter-hospital transfer (aOR 1.052 [95% CI 0.955-1.159]). Management of critically ill rural residents with COVID-19 in rural hospitals, without inter-hospital transfers was not associated with shortterm mortality on adjusted analyses (aOR 0.672 [95% CI 0.393-1.149]). CONCLUSION(S): The observed increased short-term mortality among critically ill patients with COVID-19 residing in rural areas is confounded by inter-hospital transfers and the geographic location of hospitals, with no adverse prognostic impact of rural residence in non-transferred patients and those managed in rural facilities.

9.
Critical Care Medicine ; 51(1 Supplement):101, 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2190490

RESUMO

INTRODUCTION: Recent reports suggest very low to no hospital survival among COVID-19 patients with in-hospital cardiac arrest (IHCA). However, studies to date included generally very small number of IHCA events and were often single-centered. The population-level outcomes of IHCA among COVID-19 patients is unknown. METHOD(S): We used a statewide data set to identify hospitalizations aged >=18 years in acute care hospitals in Texas with a diagnosis of COVID-19 between April 1st and December 31st, 2020. COVID-19 infection was identified using ICD-10 code U071. Cardiopulmonary resuscitation was identified using ICD-10 code 5A12012. Hospitalizations with cardiac arrest as a primary diagnosis and those without a primary diagnosis of COVID-19 were excluded. Mixed-effects multivariable logistic regression modelling was used to identify predictors of hospital survival among those with IHCA. RESULT(S): Among 65,482 hospitalizations with COVID-19, 893 (1.4%) had IHCA. Among those with IHCA, 57.1% were aged >= 65 years, 64.2% male, 70.9% racial/ethnic minority, and 7.1% had shockable rhythm. IHCA occurred in 12.7% [95% CI 11.8-13.6] of terminal hospitalizations. Hospital survival was 7.3% [95%CI 5.6-9.3], ranging from 6.7% [95% CI 4.6-9.3] among those aged >=65 years to 10.7% [95% CI 4.6-21.0] among those aged < 45 years. On adjusted analyses, among examined patient and hospital characteristics, only shockable rhythm (adjusted odds ratio [aOR] 2.63 [95% CI 1.05-6.56]) and management in hospitals with 200-399 beds (aOR 0.14 [95% CI 0.03- 0.58]), but not demographics, comorbidities, or illness severity, were associated with hospital survival. Among hospital survivors, 23.1% were transferred to hospice and 35.4% were discharged home. CONCLUSION(S): Resuscitation of IHCA among COVID-19 patients occurred more selectively compared to the general population. Hospital survival was very low, and less than 3% of those with IHCA were discharged home. Once developing among patients with COVID-19, the short-term survival of IHCA was no longer affected by demographic characteristics, comorbidity burden, or illness severity. Further large studies, using granular data, are needed to better guide clinicians', patients', and surrogates' decision-making and to improve patients' outcomes.

10.
Critical Care Medicine ; 51(1 Supplement):101, 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2190489

RESUMO

INTRODUCTION: The adverse impact of comorbid conditions on the development of severe illness and risk of death among hospitalized patients with COVID-19 has been well-documented. However, the population-level epidemiology and outcomes of previously healthy [PH] adults compared to those with prior comorbidities [PC] among COVID-19 patients requiring ICU admission are unknown. METHOD(S): We used a statewide dataset to identify hospitalizations aged >=18 years with ICU admission and a diagnosis of COVID-19 in Texas during April 1-December 31, 2020. COVID-19 was defined by ICD-10 code U07.1. PH was defined as absence of the comorbidities included in the Charlson Comorbidity Index, and of obesity, malnutrition, mental disorders, and substance and alcohol use disorders. A hierarchical, mixed-effects model was fit to estimate the association of PH with short-term mortality (defined as in-hospital death or discharge to hospice) among ICU admissions. A similar approach was used to identify predictors of short-term mortality among the PH group. RESULT(S): Among 58,845 ICU admissions with COVID-19, 6,760 (11.6%) were PH. Compared to those with PC, those with PH were younger (aged >=65 years 36.1% vs 49.4%), more commonly racial/ethnic minority (63.8% vs 61.5%), and with lower mean [SD] number of organ dysfunctions (1.2 [1.1] vs 1.8 [1.4]) [p< 0.001 for all comparisons]. Short-term mortality was lower among PH than among PC (16.4% vs 25.0%). However, following adjustment for confounders, the risk of short-term mortality was higher among PH (adjusted odds ratio [aOR] 1.37 [95% CI 1.25-1.51]). Among PH ICU admissions, short-term mortality increased with age ([aOR] 35.20 [95% CI 22.09-56.09];>=65 vs 18-44 years) and management at facilities with >=50 ICU beds ([aOR] 4.43 [95% CI 1.07-18.32] vs < 10 ICU beds). CONCLUSION(S): PH was uncommon among critically ill adults with COVID-19 and PH patients had substantially lower short-term mortality than those with PC. However, once risk-adjusted, the odds of short-term mortality were, unexpectedly, 37% higher among PH, with the latter facing higher risk of death when managed at hospitals with higher number of ICU beds. Additional studies are needed to identify the patient-, care process-, and health system-related contributors to these findings.

11.
Nursing Outlook ; 70(6S2):S161-S171, 2022.
Artigo em Inglês | MEDLINE | ID: covidwho-2182011

RESUMO

BACKGROUND: During the initial phase of the pandemic, we identified a critical gap in the Military Health System's access to palliative care. Our team of nurse scientists and evidence-based practice (EBP) facilitators aimed to develop and implement an evidence-based point of care palliative care toolkit for frontline workers in inpatient settings lacking established palliative care specialists.

12.
European Geriatric Medicine ; 13(Supplement 1):S55, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2175432

RESUMO

As known after the Resolution NdegreeIX/1479 sitting of 30/03/2011 (Italy Lombardy Region Council) Regarding: Management determination of regional health services for the year 2011-IIdegree Measure of update in the health sector, approves Annex 1: Clinical and organizational indications for the conduct of Sub Acute care activities. This is a taking charge, which takes place in a context of sheltered hospitalization, of patients suffering from the sequelae of an acute event or a clinically uncomplicated decompensation of a chronic disease aimed at achieving specific health objectives. Sub Acute cares require the formulation of a treatment plan for each patient that leads to the achievement of specific goals by qualified professionals. Sub Acute cares should not be confused with social-health activities in favor of dependent patients in rehabilitation departments. Enrollment criteria are necessary in addition to the evaluation of the patient's actual clinical condition. Known exclusion factors. In the year 2021 at the U.O. Cure Sub Acute of the Cuggiono Presidio Ospedaliero were admitted 327 patients, M:158, F:169 Noted AII. Evaluated with Braden Scale, Brass Scale and Conley Scale. Our data indicate: 47% discharged home, 8.5% deceased, 17% transferred to RSA 5,8% transferred to Hospice, 5,8% transferred to Rehabilitation Institute, 8,9% medical relapse and transferred back to medical area, 1,8% surgical relapse and transferred back to surgical area, 4 patients showed COVID 19 infection.

13.
BMJ Open Ophthalmology Conference: Tierarztl Prax Ausg K Kleintiere Heimtiere Virtual ; 7(Supplement 2), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2167520

RESUMO

The proceedings contain 38 papers. The topics discussed include: impact of COVID-19 on a national serum eyedrops program in the UK;the impact of COVID-19 on corneal transplantation in England;crisis becomes the norm: how a non-profit network withstands the pandemic;new strategies in the Barcelona eye bank to minimize the impact of the COVID-19 pandemic;emergency salvage of time expired clinical corneas during the covid-19 pandemic;supply of non-clinical ocular tissue from a tissue and eye services research tissue bank;the donor of tomorrow: challenges posed by the pandemic, demographic change, and increased transplant requirements;growing together in diversity - Indo-German cooperation enhancing eye donation in north India;eye donation in palliative and hospice care settings: patient views and missed opportunities!;and the potential for eye donation from hospice and palliative care clinical settings in England - a retrospective case notes review of deceased patient records.

14.
Palliat Care Soc Pract ; 16: 26323524221096691, 2022.
Artigo em Inglês | MEDLINE | ID: covidwho-2195966

RESUMO

Background: Dementia is a life-limiting illness, but the trajectory of dying can be difficult to establish and care at end of life can be variable and problematic. Methods: This UK study was carried out to explore the end-of-life-care experiences of people with dementia from the perspective of their family carers. In-depth interviews were conducted with 40 bereaved family carers of people with dementia. Results: Forty family carers (male n = 9, female n = 31) age range: 18-86 years were interviewed. Issues with poor communication were common. The hard work of caring and issues regarding unpredictability of living and dying with dementia were also commonplace within the study. Only three patients were referred for specialist palliative care support at the end of life, all of whom had a dual diagnosis of dementia and cancer. Conclusion: This qualitative study has identified that there are several gaps in the end-of-life care of people with dementia, and frequently, there is poor communication during the last year of life. The need for high-quality integrated care for people dying with dementia with appropriate support during the last year of life is identified. COVID-19 has disproportionately affected people with dementia, and in the post-pandemic era, there is an urgent need to ensure every person dying with dementia is supported to die in their preferred place and that family members are supported and enabled to be treated as the 'expert' in terms of their knowledge of their relatives' care and preferences.

15.
Palliat Care Soc Pract ; 16: 26323524221095102, 2022.
Artigo em Inglês | MEDLINE | ID: covidwho-2195965

RESUMO

Background: There is an urgent need for community-based interventions that can be scaled up to meet the growing demand for palliative care. The purpose of this study was to scale out a volunteer navigation intervention called Nav-CARE by replicating the program in multiple contexts and evaluating feasibility, acceptability, sustainability, and impact. Methods: This was a scale-out implementation and mixed-method evaluation study. Nav-CARE was implemented in 12 hospice and 3 nonhospice community-based organizations spanning five provinces in Canada. Volunteers visited clients in the home approximately every 2 weeks for 1 year with some modifications required by the COVID-19 public health restrictions. Qualitative evaluation data were collected from key informants (n = 26), clients/family caregivers (n = 57), and volunteers (n = 86) using semistructured interviews. Quantitative evaluation data included volunteer self-efficacy, satisfaction, and quality of life, and client engagement and quality of life. Findings: Successful implementation was influenced by organizational capacity, stable and engaged leadership, a targeted client population, and skillful messaging. Recruitment of clients was the most significant barrier to implementation. Clients reported statistically significant improvements in feeling they had someone to turn to, knowing the services available to help them in their community, being involved in things that were important to them, and having confidence in taking care of their illness. Improvements in clients' quality of life were reported in the qualitative data, although no statistically significant gains were reported on the quality of life measure. Volunteers reported good self-efficacy and satisfaction in their role. Conclusion: The feasibility, acceptability, and sustainability of the program were largely dependent on strong intraorganizational leadership. Volunteers reported that their involvement in Nav-CARE enabled them to engage in ongoing learning and have a meaningful and relational role with clients. Clients and families described the positive impact of a volunteer on their engagement and quality of life.

16.
Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration ; 23(Supplement 1):187, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2160821

RESUMO

Background: Multidisciplinary care has been shown to improve life expectancy and quality of life in patients with ALS (pALS) and is the cornerstone of pALS management. During the COVID 19 pandemic public safety precautions patients on noninvasive ventilation (NIV) and invasive ventilation were not seen in person due to hospital-wide infectious disease guidelines. Additionally, only one caregiver was permitted with each pALS during multidisciplinary clinic appointments. Objective(s): To facilitate the adoption of video-based telemedicine for discussion of goals of care in advanced ALS. Method(s): During the COVID 19 pandemic period ranging from 3/15/2020 to 5/10/2022, pALS enrolled in the VCU Health ALS clinic participated in in-person clinic visits as well as videobased telemedicine visits with the multi-disciplinary team. The pALS on NIV and invasive ventilation were seen, per VCU ALS clinic protocols, every 1-2 months by home care respiratory therapists (RT). The home care RT protocols alerted the team to a pALS vital capacity approaching 30% of normal. This triggered a goals of care discussion with the patient, family members, and caregivers. The neurologist, nurse navigator, respiratory therapist, and social worker discussed the two options for goals of care at this point in the disease process. One option involved discussion of all aspects of choosing a scheduled tracheostomy and long-term 24-hour care requirements for pALS by their caregivers. The second goals of care option presented to pALS was palliative care to manage symptoms and hospice at home. Telemedicine also enabled pALS to DocuSign Durable Do Not Resuscitate forms that were reviewed by the hospital attorney and placed in the electronic medical record. Out of the 53 patients who died during this time frame, 33 had the goals of care discussion via telemedicine. In-person discussions took place with 7 pALS. One pALS committed suicide 2 months after diagnosis and 2 pALS were lost to follow up. Ten pALS had no documented goals of care discussion prior to their death, per chart review. Two pALS, one via telemedicine and one in person, chose tracheostomy after the goals of care discussion. Conclusion(s): More patients had goals of care discussion via telemedicine (62%) than in person (13.2%) suggesting that video technology telemedicine with the multi-disciplinary team helped establish relationships with the team members and facilitated rapid access to the team for pALS. Telemedicine allowed the multi-disciplinary team to discuss at length with pALS and all their family members goals of care when pre-specified clinical end points of their disease were reached. Telemedicine was adopted by our clinic for discussion of withdrawal of invasive ventilator support on one patient who had been ventilated for several years. Further studies would be beneficial to gauge patient and caregiver satisfaction with goals of care discussion via telemedicine appointments.

17.
Hepatology ; 76(Supplement 1):S1161-S1163, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2157801

RESUMO

Background: MELD and Child-Pugh scores have traditionally been used as prognostic indicators in patients with cirrhosis. Albumin infusions in outpatients have been associated with improved outcomes, but not in transplant waitlisted patients or inpatients. This aim of this study was to assess whether low serum albumin (sAlb) on admission alone is a poor prognostic indicator among cirrhotic inpatients from a new multi-national cohort. Method(s): The CLEARED study is a global study that enrolled consecutive non-electively admitted inpatients without organ transplant or COVID-19 from 6 continents. Admission demographics, medical history, laboratory data, inpatient course, death/hospice transfer and mortality at 30 days post-discharge were recorded. Patients were divided into 3 groups: sAlb <28gm/L(A), sAlb >=28 but <35gm/L (B), and sAlb>=35gm/L (C) were compared. Multi-variable logistic regression was performed using inpatient mortality and overall 30-day mortality as outcomes. Result(s): 2429 patients were enrolled from 21 countries worldwide. The distribution was A:49%, B:39%, C:12%. Gp A patients were significantly younger (54yrs vs. 57yrs vs 58yrs p<0.0001) but with similar gender distribution, and higher MELD-Na score of 25 vs. 20 vs. 17 (p<0.0001). Gp A patients were more likely to have alcohol as etiology of cirrhosis (49% vs. 45% vs 38%, p=0.004), and were more likely to have either infection (27% vs. 18% vs. 13%, p<0.0001), HE (39% vs. 33% vs. 23%, p=0.005) or fluid related issues as a reason for admission (p<0.0001). More patients in Gp A received albumin infusion during their hospital stay (120gm vs. 100gm vs. 100gm p=0.0004), mostly for the indications of AKI (47% vs. 49% vs. 47%, p=0.79) and performance of large volume paracentesis (44% vs. 42% vs. 41%, p=0.80), followed by bacterial peritonitis indication (22% vs. 17% vs. 11%, p=0.01). Group A patients had longer hospital stays (9 days vs. 8 days vs. 7 days (p<0.001), but similar ICU transfer (23% vs. 22% vs. 20%, p=0.55). group A patients were more likely to die while inpatients (19% vs. 11% vs. 5%, p<0.0001), or by 30 days post-discharge (29% vs. 20% vs. 9%, p<0.0001). Table shows the admission variables associated with a poor outcome. Conclusion(s): Hypoalbuminemia is extremely common among admitted cirrhotic patients, with sAlb of <28gm/L occurring in almost half. Together with MELD-Na score and infection at admission, a low sAlb is associated with a poor outcome in these patients. Future studies will need to validate these findings and to assess whether albumin infusions will improve the outcome of these patients. (Figure Presented).

18.
Hepatology ; 76(Supplement 1):S1127-S1128, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2157776

RESUMO

Background: ICU outcomes, especially related to infections, remains unclear in those with and without cirrhosis. With the emergence of resistant and fungal organisms, the changes in infection profiles over time is important to analyze. Method(s): Inpatients admitted to ICUs throughout 2015-2021 were analyzed. Cirrhosis was diagnosed using clinical and radiological features and were matched 1:1 by age, gender, and admission qSOFA to non-cirrhotic patients;COVID positive patients were excluded. Admission demographics and labs, hospital course were obtained for each patient. Comparisons were made between patients with and without cirrhosis and those who died/hospice versus not. Result(s): 1669 patients;833 cirrhosis and 836 non-cirrhosis patients were included, of which 456 (27%) died or were referred to hospice. Cirrhosis versus not comparison: Patients with cirrhosis had a higher rate of infection, positive cultures, abdominal infections, and bacteremia. They also had higher gram-positive and fungal infections with higher rate of VRE. Admission WBC, demographics, altered mental status, nosocomial or second infections or LOS were similar between cirrhosis/not groups.Death and hospice versus not comparison: 74% of patients who died had cirrhosis vs 41% of those who survived. Conversely, 41% out of 1213 patients who survived had cirrhosis (p<0.0001). People who died were more likely to have nosocomial infections, higher UTIs, bacteremia and respiratory infection and those with positive cultures, >1 organisms, VRE and MRSA isolation. Patients who died had higher LOS and all organ failures. On Logistic regression for death/hospice, cirrhosis (OR 4.0, p<0.0001), admission qSOFA (1.60, p<0.0001) and WBC (1.02, p=0.003), reasons for ICU (altered mental status 1.69, hypotension 1.79, renal support 2.77, respiratory failure 1.79 & CVA 1.96, all p<0.0001) with Infection (1.77, p<0.0001, >1 microbe isolated 1.86, p=0.05) were risk factors while skin and soft-tissue infections had a lower risk of death/hospice (0.39, p=0.02). Time trend in cirrhosis for infections: There was a significant decrease over time with positive culture and gram-negative infections and increase in fungal and gram-positive infections. Conclusion(s): Despite matching for demographics and qSOFA, patients with cirrhosis had a higher risk of death and organ failures, and were more likely to develop infections due to gram-positive and fungal infections with > 1 organisms and VRE, compared to those without cirrhosis. Patients who died were more likely to have cirrhosis, infections and higher qSOFA compared to those who survived. Time trends in cirrhosis showed lower rate of positive cultures and gram-negative infections and increase in fungal and gram-positive infections over time, which should encourage re-evaluation of diagnostic and prophylactic strategies in cirrhosis-related infections. (Figure Presented).

19.
NPG Neurologie - Psychiatrie - Geriatrie ; 22(128):102-106, 2022.
Artigo em Francês | APA PsycInfo | ID: covidwho-2131979

RESUMO

(French) Lors de la periode du premier confinement, la mobilisation des soignants a ete forte. Nous avons pris des decisions collegialement afin de reorganiser certains soins et revoir notre maniere de fonctionner. Il nous semble que nous avons pu faire preuve de << sollicitude collective . Dans un premier temps, nous avons determine ce qui est constitutif de ce mouvement de sollicitude. Nous nous sommes appuyes sur la definition de Paul Ricoeur dans son ouvrage, Soi-meme comme un autre et notamment sur l'importance qu'il accorde a l'estime de soi. Nous avons egalement situe la place fondamentale de l'autre dans la construction de la sollicitude et plus largement dans la relation de soin. Dans un deuxieme temps, nous avons cherche a savoir si cette mobilisation pouvait etre partagee. Nous offrons des pistes de reponse et surtout de reflexion. Comment definir un << nous soignant autre que ce que l'institution nous offre ? L'institution, chez Ricoeur, est definie comme un lieu ou les relations interpersonnelles sont depassees. Quelles sont alors les ressources, les conditions pour reussir a << faire corps ? Cette periode a ete marquee pour les soignants par une forte reconnaissance de leur fonction mais aussi par une forte vulnerabilite. De plus, nous avons espere faire preuve d'une << solidarite active . (PsycInfo Database Record (c) 2022 APA, all rights reserved)

20.
Journal of the American Society of Nephrology ; 33:884, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2126214

RESUMO

Background: Abnormal potassium (K) levels are strongly associated with higher mortality rates among all hospitalized patients. In this study we aim to identify a correlation between abnormal K levels and mortality in coronavirus disease (COVID-19) patients may likely optimize inpatient management. Method(s): Using an observational database, we analyzed 3310 unvaccinated hospitalized COVID-19 PCR-positive patients at Methodist Health System from March 2020 to December 2020. We compared in-hospital death or hospice referral rates between patients with normal K levels (K= 3.5 to 5.0meQ/L), hypokalemia (K < 3.5meQ/L), or hyperkalemia (K > 5.0meQ/L) on first encounter. Chi-square (X2) and odds ratio tests were used to analyze observed variables. Result(s): Of the 3310 COVID-19 patients, 463 (14.0%) died in the hospital or were discharged to hospice and 2747 (86.0%) were discharged home or to a post-acute care facility. In this study cohort, 285 (8.6%) patients had hyperkalemia, 453 (13.7%) had hypokalemia, and 2572 (77.7%) had normal K levels. Patients with abnormal K levels on initial encounter had a higher mortality rate than those who had normal K levels (OR 1.32, 95% CI 1.05 - 1.64, p = 0.02). However, upon closer examination we found that hyperkalemia had a strong association with increased mortality in COVID-19 patients compared to normal K levels (OR 2.00, 95% CI 1.49 - 2.69, p < 0.001);however, hypokalemia did not (p = 0.66). Conclusion(s): Hyperkalemia on presentation is associated with a significantly increased risk of in-hospital death or hospice discharge among hospitalized COVID-19 patients.

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