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2.
Maturitas ; 141: 46-52, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33036702

RESUMO

BACKGROUND/OBJECTIVE: The COVID-19 epidemic is particularly serious in older adults. The symptomatology and epidemic profile remain little known in this population, especially in disabled oldest-old people with chronic diseases living in nursing homes. The objective of the present study was to comprehensively describe symptoms and chronological aspects of the diffusion of the SARS-CoV-2 virus in a nursing home, among both residents and caregivers. DESIGN: Five-week retrospective cohort study. SETTING: A middle-sized nursing home in Maine-et-Loire, west of France. PARTICIPANTS: Eighty-seven frail older residents (87.9 ± 7.2years; 71 % female) and 92 staff members (38.3 ± 11.7years; 89 % female) were included. MEASUREMENTS: Mass screening for SARS-CoV-2 was performed in both residents and staff. Attack rate, mortality rate, and symptoms among residents and staff infected with SARS-CoV-2 were recorded. RESULTS: The attack rate of COVID-19 was 47 % in residents (case fatality rate, 27 %), and 24 % in staff. Epidemic curves revealed that the epidemic started in residents before spreading to caregivers. Residents exhibited both general and respiratory signs (59 % hyperthermia, 49 % cough, 42 % polypnea) together with geriatric syndromes (15 % falls, 10 % altered consciousness). The classification tree revealed 100 % COVID-19 probability in the following groups: i) residents younger than 90 with dyspnea and falls; ii) residents older than 90 with anorexia; iii) residents older than 90 without anorexia but with altered consciousness. Finally, 41 % of staff members diagnosed with COVID-19 were asymptomatic. CONCLUSIONS: The pauci-symptomatic expression of COVID-19 in older residents, together with the high prevalence of asymptomatic forms in caregivers, justifies mass screening in nursing homes, possibly prioritizing residents with suggestive combinations of clinical signs including dyspnea, falls, anorexia and/or altered consciousness.


Assuntos
Infecções por Coronavirus/epidemiologia , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Acidentes por Quedas , Idoso de 80 Anos ou mais , Anorexia/virologia , Betacoronavirus , Cuidadores , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Dispneia/virologia , Feminino , Idoso Fragilizado , França/epidemiologia , Humanos , Masculino , Programas de Rastreamento , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Prevalência , Estudos Retrospectivos
3.
Ups J Med Sci ; 125(4): 297-304, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33100083

RESUMO

BACKGROUND: The COVID-19 pandemic has affected the entire health care system, internationally as well as in Sweden. We aimed to study excess deaths (all death causes, but also COVID-19-related deaths) during the COVID-19 pandemic regarding age, socio-economic status, the situation in nursing homes, and place of death for nursing home residents. DESIGN: We performed a descriptive regional registry data study using VAL, the Stockholm Regional Council's central data warehouse, which covers almost all health care use in the county of Stockholm. T tests and chi-square tests were used for comparisons. RESULTS: Compared with 2016-2019, there were excess deaths in March-May 2020 (p < 0.0001), mainly explained by COVID-19, but in April there were also unexplained excess deaths. Individuals dying from COVID-19 were older than patients dying from other causes (p < 0.0001). There were more patient deaths among people residing in less advantaged socio-economic areas (p < 0.0001). Nursing home residents dying from COVID-19 were more often admitted to acute hospitals than residents dying from other causes (p < 0.0001). Also, the proportion of admissions of nursing home residents dying from other causes increased from April to May 2020 (p < 0.0001). CONCLUSIONS: Dying from COVID-19 mainly affects the elderly, nursing home residents, and persons from less advantaged socio-economic groups. The pandemic has resulted in an increase in acute admissions of dying nursing home residents to acute hospitals.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Pandemias , Pneumonia Viral/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Estudos de Coortes , Bases de Dados Factuais , Feminino , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Casas de Saúde/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Sistema de Registros , Fatores Socioeconômicos , Suécia/epidemiologia
4.
BMC Infect Dis ; 20(1): 745, 2020 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-33046011

RESUMO

BACKGROUND: Workers and residents in Care Homes are considered at special risk for the acquisition of SARS-CoV-2 infection, due to the infectivity and high mortality rate in the case of residents, compared to other containment areas. The role of presymptomatic people in transmission has been shown to be important and the early detection of these people is critical for the control of new outbreaks. Pooling strategies have proven to preserve SARS-CoV-2 testing resources. The aims of the present study, based in our local experience, were (a) to describe SARS-CoV-2 prevalence in institutionalized people in Galicia (Spain) during the Coronavirus pandemic and (b) to evaluate the expected performance of a pooling strategy using RT-PCR for the next rounds of screening of institutionalized people. METHODS: A total of 25,386 Nasopharyngeal swab samples from the total of the residents and workers at Care Homes in Galicia (March to May 2020) were individually tested using RT-PCR. Prevalence and quantification cycle (Cq) value distribution of positives was calculated. Besides, 26 pools of 20 samples and 14 pools of 5 samples were tested using RT-PCR as well (1 positive/pool). Pooling proof of concept was performed in two populations with 1.7 and 2% prevalence. RESULTS: Distribution of SARS-CoV-2 infection at Care Homes was uneven (0-60%). As the virus circulation global rate was low in our area (3.32%), the number of people at risk of acquiring the infection continues to be very high. In this work, we have successfully demonstrated that pooling of different groups of samples at low prevalence clusters, can be done with a small average delay on Cq values (5 and 2.85 cycles for pools of 20 and 5 samples, respectively). CONCLUSIONS: A new screening system with guaranteed protection is required for small clusters, previously covered with individual testing. Our proposal for Care Homes, once prevalence zero is achieved, would include successive rounds of testing using a pooling solution for transmission control preserving testing resources. Scale-up of this method may be of utility to confront larger clusters to avoid the viral circulation and keeping them operative.


Assuntos
Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Casas de Saúde/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Humanos , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Espanha/epidemiologia
5.
PLoS One ; 15(10): e0240624, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33045016

RESUMO

BACKGROUND: There is increasing demand for post-acute care services, which is amplified by the COVID-19 pandemic. AIMS: We studied the pattern of spatial association between post-acute care services and acute care facilities and evaluated how geographic variability could influence their use. METHODS: We compiled data on CMS-certified acute care and critical access hospitals and post-acute health care services (nursing homes, home health care services, inpatient rehabilitation facilities, long-term care hospitals, and hospice facilities). We used the colocation quotient (CLQ) to measure the magnitude and direction of association (clustering or segregation) between post-acute care providers and hospitals. This metric allows pairwise comparison of categorical data; a value <1 indicates spatial segregation and a value >1 spatial clustering. Unity marks the lack of spatial dependence (random distribution). RESULTS: With the exception of nursing homes (CLQ 1.26), all other types of post-acute care providers are spatially segregated from rural critical access hospitals. Long-term care facilities ranked first (had the lowest global CLQ, 0.06), hospice facilities ranked last (had the highest global CLQ estimate, 0.54). Instead, post-acute care services either clustered with (inpatient rehabilitation 2.76, long-term care 2.10, nursing homes 1.37) or were only weakly segregated (home health care 0.86) from acute care hospitals. Home health care (1.44), hospice services (1.46), and nursing homes (1.08) spatially clustered with the same category of services. Results were robust in the sensitivity analysis and we provided illustrative examples of local variation for the states of MA and IA. CONCLUSION: Post-acute care services are isolated from critical access hospitals, and have a clustering pattern with the same category services and acute care hospitals. Such misdistribution of resources may result in both underuse and a substitution effect on the type of post-acute care between rural and urban areas and undermine public health during increasing demand, such as the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/patologia , Cuidados Críticos/estatística & dados numéricos , Pneumonia Viral/patologia , Análise Espacial , Cuidados Semi-Intensivos/estatística & dados numéricos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/virologia , Hospitais/estatística & dados numéricos , Humanos , Casas de Saúde/estatística & dados numéricos , Pandemias , Pneumonia Viral/virologia , Estados Unidos
6.
BMJ Open ; 10(10): e038390, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004397

RESUMO

INTRODUCTION: In order to avoid unnecessary hospital admission and associated complications, there is an urgent need to improve the early detection of infection in nursing home residents. Monitoring signs and symptoms with checklists or aids called decision support tools may help nursing home staff to detect infection in residents, particularly during the current COVID-19 pandemic.We plan to conduct a survey exploring views and experiences of how infections are detected and managed in practice by nurses, care workers and managers in nursing homes in England and Sweden. METHODS AND ANALYSIS: An international cross-sectional descriptive survey, using a pretested questionnaire, will be used to explore nurses, care workers and managers views and experiences of how infections are detected and managed in practice in nursing homes. Data will be analysed descriptively and univariate associations between personal and organisational factors explored. This will help identify important factors related to awareness, knowledge, attitudes, belief and skills likely to affect future implementation of a decision support tool for the early detection of infection in nursing home residents. ETHICS AND DISSEMINATION: This study was approved using the self-certification process at the University of Surrey and Linköping University ethics committee (Approval 2018/514-32) in 2018. Study findings will be disseminated through community/stakeholder/service user engagement events in each country, publication in academic peer-reviewed journals and conference presentations. A LAY summary will be provided to participants who indicate they would like to receive this information.This is the first stage of a plan of work to revise and evaluate the Early Detection of Infection Scale (EDIS) tool and its effect on managing infections and reducing unplanned hospital admissions in nursing home residents. Implementation of the EDIS tool may have important implications for the healthcare economy; this will be explored in cost-benefit analyses as the work progresses.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Sobremedicalização/prevenção & controle , Casas de Saúde/estatística & dados numéricos , Pandemias , Administração dos Cuidados ao Paciente , Pneumonia Viral , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Betacoronavirus/isolamento & purificação , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Análise Custo-Benefício , Estudos Transversais , Inglaterra/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/normas , Hospitalização , Humanos , Administração dos Cuidados ao Paciente/economia , Administração dos Cuidados ao Paciente/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Gerenciamento da Prática Profissional/economia , Projetos de Pesquisa , Suécia/epidemiologia
7.
Artigo em Inglês | MEDLINE | ID: mdl-33080869

RESUMO

There are different patterns in the COVID-19 outbreak in the general population and amongst nursing home patients. We investigate the time from symptom onset to diagnosis and hospitalization or the length of stay (LoS) in the hospital, and whether there are differences in the population. Sciensano collected information on 14,618 hospitalized patients with COVID-19 admissions from 114 Belgian hospitals between 14 March and 12 June 2020. The distributions of different event times for different patient groups are estimated accounting for interval censoring and right truncation of the time intervals. The time between symptom onset and hospitalization or diagnosis are similar, with median length between symptom onset and hospitalization ranging between 3 and 10.4 days, depending on the age of the patient (longest delay in age group 20-60 years) and whether or not the patient lives in a nursing home (additional 2 days for patients from nursing home). The median LoS in hospital varies between 3 and 10.4 days, with the LoS increasing with age. The hospital LoS for patients that recover is shorter for patients living in a nursing home, but the time to death is longer for these patients. Over the course of the first wave, the LoS has decreased.


Assuntos
Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Hospitalização/estatística & dados numéricos , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Idoso , Bélgica/epidemiologia , Interpretação Estatística de Dados , Humanos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Casas de Saúde/estatística & dados numéricos , Pandemias , Resultado do Tratamento , Adulto Jovem
8.
Monaldi Arch Chest Dis ; 90(3)2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32875776

RESUMO

Lung Ultrasound (LUS) is regarded to be potentially useful to diagnose lung injury in older adults living in nursing homes with suspected COVID-19 pneumonia. We aimed at evaluating presence lung injury among senior nursing home residents by LUS performed with portable wireless scanner echography. The study population consisted of 150 residents with a mean age of 88 years (85% female) residing in 12 nursing homes in Northern Italy. Subjects had to have a history of recent onset of symptoms compatible with COVID-19 pneumonia or have been exposed to the contagion of patients carrying the disease. COVID-19 testing was performed with SARS-CoV-2 nasal-pharyngeal (NP) swabs. Positive subjects to LUS scanning were considered those with non-coascelent B-lines in >3 zones, coalescent B-lines in >3 zones and with iperdensed patchy non-consolidated lungs. Sixty-three percent had positive NP testing and 65% had LUS signs of pulmonary injury. LUS had a sensitivity of 79% in predicting positive NP testing. Sixteen percent of residents tested negative for SARSCoV-2 carried the signs of COVID-19 lung injury at LUS. There were 92 patients (61%) with current or recent symptoms.Positivity to LUS scanning was reported in 73% of residents with symptoms, while it was 53% in those without (P=0.016). A positive NP testing was observed in 66% of residents with symptoms and in 57% of those without (P=0.27). We conclude that assessment of LUS by portable wireless scanner echography can be profitability utilized to diagnose lung injury among senior nursing home residents with or without symptoms compatible with COVID-19 pneumonia.


Assuntos
Infecções por Coronavirus , Lesão Pulmonar/diagnóstico por imagem , Pandemias , Pneumonia Viral/diagnóstico , Testes Imediatos , Ultrassonografia , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Feminino , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Casas de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Ultrassonografia/instrumentação , Ultrassonografia/métodos , Tecnologia sem Fio
9.
J Am Med Dir Assoc ; 21(10): 1371-1377, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32981663

RESUMO

OBJECTIVES: During the Coronavirus Disease 2019 (COVID-19) pandemic, US nursing homes (NHs) have been under pressure to maintain staff levels with limited access to personal protection equipment (PPE). This study examines the prevalence and factors associated with shortages of NH staff during the COVID-19 pandemic. DESIGN: We obtained self-reported information on staff shortages, resident and staff exposure to COVID-19, and PPE availability from a survey conducted by the Centers for Medicare and Medicaid Services in May 2020. Multivariate logistic regressions of staff shortages with state fixed-effects were conducted to examine the effect of COVID-19 factors in NHs. SETTING AND PARTICIPANTS: 11,920 free-standing NHs. MEASURES: The dependent variables were self-reported shortages of licensed nurse staff, nurse aides, clinical staff, and other ancillary staff. We controlled for NH characteristics from the most recent Nursing Home Compare and Certification and Survey Provider Enhanced Reporting, market characteristics from Area Health Resources File, and state Medicaid reimbursement calculated from Truven data. RESULTS: Of the 11,920 NHs, 15.9%, 18.4%, 2.5%, and 9.8% reported shortages of licensed nurse staff, nurse aides, clinical staff, and other staff, respectively. Georgia and Minnesota reported the highest rates of shortages in licensed nurse and nurse aides (both >25%). Multivariate regressions suggest that shortages in licensed nurses and nurse aides were more likely in NHs having any resident with COVID-19 (adjusted odds ratio [AOR] = 1.44, 1.60, respectively) and any staff with COVID-19 (AOR = 1.37, 1.34, respectively). Having 1-week supply of PPE was associated with lower probability of staff shortages. NHs with a higher proportion of Medicare residents were less likely to experience shortages. CONCLUSIONS/IMPLICATIONS: Abundant staff shortages were reported by NHs and were mainly driven by COVID-19 factors. In the absence of appropriate staff, NHs may be unable to fulfill the requirement of infection control even under the risk of increased monetary penalties.


Assuntos
Betacoronavirus , Infecções por Coronavirus/enfermagem , Casas de Saúde/organização & administração , Recursos Humanos de Enfermagem/provisão & distribução , Reorganização de Recursos Humanos/estatística & dados numéricos , Pneumonia Viral/enfermagem , Recursos Humanos/organização & administração , Infecções por Coronavirus/terapia , Feminino , Humanos , Controle de Infecções/organização & administração , Masculino , Casas de Saúde/estatística & dados numéricos , Pandemias , Pneumonia Viral/terapia , Qualidade da Assistência à Saúde , Estados Unidos
10.
Pflege ; 33(5): 265-275, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32996856

RESUMO

Long-term care during the Corona pandemic - Main results from a nationwide online survey in nursing homes in Germany Abstract. Background: As a highly vulnerable group, people in need of long-term care are particularly affected by the COVID-19 pandemic. Due to their care-dependency, measures of social distancing can only be carried out to a very limited extent. In addition, the social and health consequences of reduced contacts are particularly high for nursing home residents. AIM: The study aims to describe the extent to which nursing homes are affected, the human and material resources of nursing homes, the organizational handling of the situation, and their requests for public support. METHODS: More than 7,000 nursing homes were invited to participate in an online survey with quantitative and qualitative elements. Data analysis applies descriptive statistics. RESULTS: 824 nursing homes participated in the survey. One in five nursing homes has at least one confirmed case of SARS-CoV-2 among its residents and / or employees. The initial lack of protective equipment has now decreased, but the facilities still have to cope with additional corona-related care needs with reduced staff. Nursing homes have banned contacts between residents and relative to an extent that now has to be reduced again. Nursing homes demand the provision and external financing of protective equipment as well as the systematic and regular testing of nursing staff and the provision of uniform guidelines for action throughout Germany. CONCLUSIONS: As about half of all deceased people with COVID-19 have been living in nursing homes, the support of nursing homes in their attempt to restrict the pandemic requires highest attention.


Assuntos
Infecções por Coronavirus/epidemiologia , Casas de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Betacoronavirus , Alemanha , Humanos , Pandemias
11.
Medicine (Baltimore) ; 99(38): e22248, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957372

RESUMO

With the advance of medical care, the duration of dependency on nursing care in later life has increased worldwide. There is a question of whether farm work could extend or shorten the dependency duration. We investigated the association between farm work experience and the duration of dependency on nursing support or care in late life.We randomly selected 600 adults aged ≥65 years, who were independent and not hospitalized, as part of the Yamanashi Healthy-Active Life Expectancy cohort and followed them for 13 years. We defined the duration of dependency as the time from reception of long-term care insurance benefits to death, and we adjusted for multiple covariates.We analyzed data from 225 adults (139 men and 86 women) who died during the follow-up period. Ninety four had received long-term care benefits. Mean age was 79.6 years (standard deviation [SD]: 6.3) in individuals with farm work experience and 80.1 years (SD: 7.2) in individuals without farm work experience. The estimated duration of dependency on long-term care was 1.3 years (standard error [SE]: 0.4) in individuals with farm work experience vs 2.1 years (SE: 0.5) in individuals without farm work experience (P = .01). The estimated duration of dependency in individuals with farm work experience and without farm work experience was 0.4 years (SE: 0.5) vs 1.3 years (SE: 0.6) in men respectively (P = .03) and 1.6 years (SE: 0.9) vs 2.4 years (SE: 0.9) in women, respectively (P = .16). The sensitivity analysis yielded an estimated duration of 1.2 years (SE: 0.5) in those with farm work experience and 2.3 years (SE: 0.5) in those without farm work experience (P = .004).Individuals with farm work experience required less long-term care prior to death, suggesting that agricultural and physical activities promote health. Policymakers focusing on preventing the need for nursing care in older populations could consider promoting farming or gardening.


Assuntos
Utilização de Instalações e Serviços , Fazendeiros/psicologia , Envelhecimento Saudável , Vida Independente , Assistência de Longa Duração/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão/epidemiologia , Expectativa de Vida , Masculino , Fatores de Tempo
12.
MMWR Morb Mortal Wkly Rep ; 69(37): 1300-1304, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32941409

RESUMO

Nursing homes are high-risk settings for outbreaks of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1,2). During the COVID-19 pandemic, U.S. health departments worked to improve infection prevention and control (IPC) practices in nursing homes to prevent outbreaks and limit the spread of COVID-19 in affected facilities; however, limited resources have hampered health departments' ability to rapidly provide IPC support to all nursing homes within their jurisdictions. Since 2008, the Centers for Medicare & Medicaid Services (CMS) has published health inspection results and quality ratings based on their Five-Star Quality Rating System for all CMS-certified nursing homes (3); these ratings might be associated with facility-level risk factors for COVID-19 outbreaks. On April 17, 2020, West Virginia became the first state to mandate and conduct COVID-19 testing for all nursing home residents and staff members to identify and reduce transmission of SARS-CoV-2 in these settings (4). West Virginia's census of nursing home outbreaks was used to examine associations between CMS star ratings and COVID-19 outbreaks. Outbreaks, defined as two or more cases within 14 days (with at least one resident case), were identified in 14 (11%) of 123 nursing homes. Compared with 1-star-rated (lowest rated) nursing homes, the odds of a COVID-19 outbreak were 87% lower among 2- to 3-star-rated facilities (adjusted odds ratio [aOR] = 0.13, 95% confidence interval [CI] = 0.03-0.54) and 94% lower among 4- to 5-star-rated facilities (aOR = 0.06, 95% CI = 0.006-0.39). Health departments could use star ratings to help identify priority nursing homes in their jurisdictions to inform the allocation of IPC resources. Efforts to mitigate outbreaks in high-risk nursing homes are necessary to reduce overall COVID-19 mortality and associated disparities. Moreover, such efforts should incorporate activities to improve the overall quality of life and care of nursing home residents and staff members and address the social and health inequities that have been recognized as a prominent feature of the COVID-19 pandemic in the United States (5).


Assuntos
Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Qualidade da Assistência à Saúde/normas , Idoso , Centers for Medicare and Medicaid Services, U.S. , Humanos , Casas de Saúde/normas , Pandemias , Medição de Risco/métodos , Estados Unidos/epidemiologia , West Virginia/epidemiologia
13.
BMJ Open Qual ; 9(3)2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32883676

RESUMO

BACKGROUND: To analyse a medical accident, much time and experience are needed. However, people without experience in analysis have difficulty understanding its conditions and methods, and as a result it takes longer to establish countermeasures. It must be noted that understanding conditions by simply aligning occurrences in the accident in a chronological order is difficult. PURPOSE: A workflow chart that considers time was proposed so that individuals without adequate experience in analysis could easily carry out root cause analysis. METHODS: In the 'workflow chart (WFC)', the time sequence was described horizontally. On the vertical axis, the business manual, the occurrence of the accident, and the time of the occurrence are displayed. In the bottom column of patient event, information regarding damage to patients was written in accordance with time axis. Regarding the degree of damage, the time of error until the accident was identified was connected using a straight line (when the patient was not affected, a dotted line was used) in order to show the overall picture of the accident. RESULTS: According to the time flow chart, hints to identify potential risks were proposed. Focus was placed not only on the error event, but also on keywords such as manual inadequacy, time gap, degree of error and so on to easily lead to the question 'why?' To visualise this, I proposed an operation flow chart. By using time-WFC, even beginners can easily develop accident countermeasure strategies. CONCLUSION: Using a WFC that considers time, time of error and the occurrence of accident could be visualised. As a result, even individuals without experience in analysis could easily perform an analysis.


Assuntos
Betacoronavirus , Infecções por Coronavirus/transmissão , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Pneumonia Viral/transmissão , Análise de Causa Fundamental/métodos , Humanos , Pandemias
14.
J Korean Med Sci ; 35(34): e317, 2020 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-32864913

RESUMO

BACKGROUND: The novel coronavirus (coronavirus disease 2019 [COVID-19]) outbreak began in China in December last year, and confirmed cases began occurring in Korea in mid-February 2020. Since the end of February, the rate of infection has increased greatly due to mass (herd) infection within religious groups and nursing homes in the Daegu and Gyeongbuk regions. This mass infection has increased the number of infected people more rapidly than was initially expected; the epidemic model based on existing studies had predicted a much lower infection rate and faster recovery. METHODS: The present study evaluated rapid infection spread by mass infection in Korea and the high mortality rate for the elderly and those with underlying diseases through the Susceptible-Exposed-Infected-Recovered-Dead (SEIRD) model. RESULTS: The present study demonstrated early infection peak occurrence (-6.3 days for Daegu and -5.3 days for Gyeongbuk) and slow recovery trend (= -1,486.6 persons for Daegu and -223.7 persons for Gyeongbuk) between the actual and the epidemic model for a mass infection region compared to a normal infection region. CONCLUSION: The analysis of the time difference between infection and recovery can help predict the epidemic peak due to mass (or normal) infection and can also be used as a time index to prepare medical resources.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Modelos Estatísticos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Criança , Pré-Escolar , Infecções por Coronavirus/patologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Casas de Saúde/estatística & dados numéricos , Pandemias , Pneumonia Viral/patologia , República da Coreia/epidemiologia , Fatores de Tempo , Adulto Jovem
15.
J Infect ; 81(4): 621-624, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32735893

RESUMO

BACKGROUND: Care homes have been disproportionately affected by the COVID-19 pandemic and continue to suffer large outbreaks even when community infection rates are declining, thus representing important pockets of transmission. We assessed occupational risk factors for SARS-CoV-2 infection among staff in six care homes experiencing a COVID-19 outbreak during the peak of the pandemic in London, England. METHODS: Care home staff were tested for SARS-COV-2 infection by RT-PCR and asked to report any symptoms, their contact with residents and if they worked in different care homes. Whole genome sequencing (WGS) was performed on RT-PCR positive samples. RESULTS: In total, 53 (21%) of 254 staff were SARS-CoV-2 positive but only 12/53 (23%) were symptomatic. Among staff working in a single care home, SARS-CoV-2 positivity was 15% (2/13), 16% (7/45) and 18% (30/169) in those reporting no, occasional and regular contact with residents. In contrast, staff working across different care homes (14/27, 52%) had a 3.0-fold (95% CI, 1.9-4.8; P<0.001) higher risk of SARS-CoV-2 positivity than staff working in single care homes (39/227, 17%). WGS identified SARS-CoV-2 clusters involving staff only, including some that included staff working across different care homes. CONCLUSIONS: SARS-CoV-2 positivity was significantly higher among staff working across different care homes than those who were working in the same care home. We found local clusters of SARS-CoV-2 infection between staff only, including those with minimal resident contact. Infection control should be extended for all contact, including those between staff, whilst on care home premises.


Assuntos
Infecções por Coronavirus/epidemiologia , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Corpo Clínico/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Exposição Ocupacional/efeitos adversos , Pneumonia Viral/epidemiologia , Betacoronavirus/genética , Infecções por Coronavirus/transmissão , Inglaterra/epidemiologia , Genoma Viral/genética , Humanos , Controle de Infecções/métodos , Londres/epidemiologia , Pandemias , Pneumonia Viral/transmissão , Sequenciamento Completo do Genoma
17.
Tidsskr Nor Laegeforen ; 140(11)2020 08 18.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-32815356

RESUMO

BACKGROUND: Nursing home residents are generally old and frail, and at high risk that COVID-19 will take a serious course. Outbreaks of COVID-19 have not previously been described in Norway, and it is important to identify mechanisms for spread of the infection and course of disease for nursing home residents with this pandemic disease. MATERIAL AND METHOD: We included residents from three nursing homes with outbreaks of COVID-19 in a retrospective observational study, and we retrieved information on the number of staff for whom SARS-CoV-2 was confirmed or who were placed in quarantine. We present resident characteristics, course of disease and mortality associated with COVID-19 in the nursing homes, as well as providing a brief description of the outbreaks. RESULTS: Forty residents were included, 26 of whom were women. The average age was 86.2 years. Thirty-seven of the residents had atypical symptoms, nine of them were asymptomatic at the time of diagnosis, and 21 died during the coronavirus infection. Contact tracing indicated that the outbreaks may have originated from staff in the pre-symptomatic or early and mild phase of the disease. SARS-CoV-2 was detected in forty-two staff members, and a further 115 were placed in quarantine. INTERPRETATION: Many residents had atypical disease presentation, and the mortality from COVID-19 was high. Spread of infection may have originated from staff, also before they displayed obvious symptoms, and contributed to extensive spread of SARS-CoV-2 in the three nursing homes.


Assuntos
Infecções por Coronavirus/epidemiologia , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Idoso de 80 Anos ou mais , Betacoronavirus , Surtos de Doenças , Feminino , Humanos , Masculino , Noruega/epidemiologia , Pandemias , Estudos Retrospectivos
18.
Ned Tijdschr Geneeskd ; 1642020 07 20.
Artigo em Holandês | MEDLINE | ID: mdl-32779925

RESUMO

OBJECTIVE: To describe the diagnosis, symptomatology and disease course of COVID-19 in nursing home (NH) residents in the Netherlands. DESIGN: Prospective cohort study. METHOD: Data on NH residents with suspected COVID-19 were collected from the electronic patient records. Data were collected on diagnostic status (COVID-19: confirmed/excluded (using the RT-PCR test)), symptomatology (typical/atypical and other symptoms, body temperature and oxygen saturation) and, in the case of confirmed COVID-19, on disease course (recovered/clinically improved/deteriorated, deceased). We described and compared the symptomatology in NH residents with confirmed COVID-19 and NH residents in whom COVID-19 had been excluded. We also analysed mortality risk using survival analysis. We used registrations from the period 18 March to15 April 2020 for this study. RESULTS: We reported on 1,969 NH residents with suspected COVID-19. The diagnosis was confirmed in 857 patients (43.5%); diagnosis was excluded in 1,112 (56.5%) patients. Among patients with confirmed COVID-19, 65% had coughs, 70% had fever, 33% had shortness of breath, 28% had delirium/confusion and 10% had a sore throat; in patients in whom COVID-19 was excluded these symptoms were experienced in 70%, 47%, 45%, 26% and 13% of patients, respectively. Of the patients with confirmed COVID-19, 48% died within 30 days (95% CI: 36-44%), versus 20% of the patients in whom COVID-19 was excluded (95% CI: 11-15%). CONCLUSION: There is a lot of overlap in symptomatology between NH residents with COVID-19 and those with other acute diseases. An RT-PCR test is required to be able to make the distinction better. The mortality risk in patients with confirmed COVID-19 is significantly higher than in patients in whom covid-19 is excluded.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Casas de Saúde/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Humanos , Masculino , Países Baixos , Pandemias , Estudos Prospectivos , Análise de Sobrevida
20.
Health Qual Life Outcomes ; 18(1): 244, 2020 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-32693813

RESUMO

BACKGROUND: To develop a Korsakoff-specific measure of quality of life (QoL), to be rated by professional caregivers, and to field-test its psychometric properties in a sample of patients with Korsakoff's syndrome (KS) living in a specialized nursing home. METHODS: A research version of the QUALIKO was developed based on an existing instrument for dementia (the QUALIDEM), literature review and two rounds of surveys among expert professionals involved in the care for patients with KS. Next, QoL was independently rated using the preliminary QUALIKO for 77 patients with KS by two primary caregivers. RESULTS: The research QUALIKO consisted of 48 items describing observable behaviors across ten aspects of QoL relevant to patients with KS. Six items demonstrated poor scalability in the field test. The remaining 42 items all formed subscales with moderate to strong scalability according to Mokken scale analysis. Reliability was acceptable to good across both raters for all subscales (Mokken rho's = 0.70-0.90), except for the two 2-item subscales of negative affect and positive self-image (Mokken rho's = 0.47-0.71). Inter-observer agreement was excellent for five subscales (ICCs = 0.75-0.89) and fair to moderate for the other five subscales (ICCs = 0.59-0.72). The multidimensional internal structure was confirmed and all subscales were significantly correlated with primary caregivers' global ratings of QoL except for positive self-image. Missing item values were low and floor and ceiling effects acceptable for most subscales. CONCLUSIONS: The QUALIKO holds promise as a feasible, reliable, and valid measure of QoL in residential KS patients. Future research in larger samples is needed to confirm the psychometric dimensionality of the instrument, to gather normative data and to examine its test-retest reliability.


Assuntos
Síndrome de Korsakoff/psicologia , Psicometria/instrumentação , Qualidade de Vida , Inquéritos e Questionários/normas , Idoso , Cuidadores/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Casas de Saúde/estatística & dados numéricos , Reprodutibilidade dos Testes
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