scholarly journals The need for improved discharge criteria for hospitalised patients with COVID-19—implications for patients in long-term care facilities

2020 ◽  
Author(s):  
Shirley Sze ◽  
Daniel Pan ◽  
Caroline M L Williams ◽  
Joseph Barker ◽  
Jatinder S Minhas ◽  
...  
Keyword(s):  
South Africa ◽  
Clinical Outcomes ◽  
Symptom Onset ◽  
Long Term Care ◽  
Term Care ◽  
Hospitalised Patients ◽  
Care Facilities ◽  
The Uk ◽  
Discharge Criteria

Abstract In the COVID-19 pandemic, patients who are older and residents of long-term care facilities (LTCF) are at greatest risk of worse clinical outcomes. We reviewed discharge criteria for hospitalised COVID-19 patients from 10 countries with the highest incidence of COVID-19 cases as of 26 July 2020. Five countries (Brazil, Mexico, Peru, Chile and Iran) had no discharge criteria; the remaining five (USA, India, Russia, South Africa and the UK) had discharge guidelines with large inter-country variability. India and Russia recommend discharge for a clinically recovered patient with two negative reverse transcription polymerase chain reaction (RT-PCR) tests 24 h apart; the USA offers either a symptom based strategy—clinical recovery and 10 days after symptom onset, or the same test-based strategy. The UK suggests that patients can be discharged when patients have clinically recovered; South Africa recommends discharge 14 days after symptom onset if clinically stable. We recommend a unified, simpler discharge criteria, based on current studies which suggest that most SARS-CoV-2 loses its infectivity by 10 days post-symptom onset. In asymptomatic cases, this can be taken as 10 days after the first positive PCR result. Additional days of isolation beyond this should be left to the discretion of individual clinician. This represents a practical compromise between unnecessarily prolonged admissions and returning highly infectious patients back to their care facilities, and is of particular importance in older patients discharged to LTCFs, residents of which may be at greatest risk of transmission and worse clinical outcomes.

scholarly journals Old age psychiatry services: long-stay care facilities in Australia and the UK

2002 ◽  
Vol 26 (1) ◽  
pp. 24-26 ◽  
Author(s):  
John Snowdon ◽  
Tom Arie
Keyword(s):  
Old Age ◽  
Long Term Care ◽  
Focus Attention ◽  
Old People ◽  
Term Care ◽  
What Works ◽  
Care Facilities ◽  
Old Age Psychiatry ◽  
The Uk

We are old age psychiatrists; T.A. based in Britain, J.S. in Australia. A return visit by T.A. to Australia allowed us to focus attention on differences between the two countries in their provision of long-term care for old people with mental disabilities. What works well? What constrains development?

scholarly journals Understanding and Explaining How Staff Promote Quality for Older People Living in Long-Term Care Facilities

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 145-146
Author(s):  
Julienne Meyer ◽  
Kirsty Haunch ◽  
Carl Thompson ◽  
Karen Spilsbury
Keyword(s):  
Older People ◽  
Long Term Care ◽  
Valuable Resource ◽  
Social Psychological ◽  
Term Care ◽  
Care Facilities ◽  
Emotional Dimensions ◽  
The Uk

Abstract Little is known about how the workforce influences quality in long term care facilities for older people. Conceptually, quality is complex, often contested, and dynamic, has overlapping physical, social, psychological and emotional dimensions and can refer to both quality of life and quality of care. Assuming ‘more staff equates to better quality’ is intuitively appealing but research suggests that a more nuanced, non-linear, relationship exists. A programme of research in the UK is developing theoretical and empirical explanations of how staff promote quality for older people living in long-term care facilities. It shifts the debate from numbers of staff and their relationship to quality indicators toward recognising the ways in which staff more broadly influence quality. Our work will be useful for people and organisations making policy and delivering services on the best ways to deploy and support quality in long term care through the most valuable resource: its staff.

scholarly journals COVID-19 in long-term care facilities in South Africa: No time for complacency

2020 ◽  
Vol 110 (10) ◽  
pp. 962
Author(s):  
B Cowper ◽  
W Jassat ◽  
P Pretorius ◽  
L Geffen ◽  
C Legodu ◽  
...  
Keyword(s):  
South Africa ◽  
Long Term Care ◽  
Term Care ◽  
Care Facilities

scholarly journals Clinical Outcomes of Early Treatment With Doxycycline for 89 High-Risk COVID-19 Patients in Long-Term Care Facilities in New York

Cureus ◽  
2020 ◽  
Author(s):  
Mohammud M Alam ◽  
Saborny Mahmud ◽  
Mohammad M Rahman ◽  
JoAnn Simpson ◽  
Sandeep Aggarwal ◽  
...  
Keyword(s):  
New York ◽  
High Risk ◽  
Clinical Outcomes ◽  
Early Treatment ◽  
Long Term Care ◽  
Term Care ◽  
Care Facilities

scholarly journals Optimizing COVID-19 surveillance in long-term care facilities: a modelling study

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
David R. M. Smith ◽  
◽  
Audrey Duval ◽  
Koen B. Pouwels ◽  
Didier Guillemot ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Long Term Care ◽  
Group Testing ◽  
Nosocomial Transmission ◽  
Epidemiological Surveillance ◽  
Baseline Scenario ◽  
Rt Pcr ◽  
Term Care ◽  
Care Facilities

Abstract Background Long-term care facilities (LTCFs) are vulnerable to outbreaks of coronavirus disease 2019 (COVID-19). Timely epidemiological surveillance is essential for outbreak response, but is complicated by a high proportion of silent (non-symptomatic) infections and limited testing resources. Methods We used a stochastic, individual-based model to simulate transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) along detailed inter-individual contact networks describing patient-staff interactions in a real LTCF setting. We simulated distribution of nasopharyngeal swabs and reverse transcriptase polymerase chain reaction (RT-PCR) tests using clinical and demographic indications and evaluated the efficacy and resource-efficiency of a range of surveillance strategies, including group testing (sample pooling) and testing cascades, which couple (i) testing for multiple indications (symptoms, admission) with (ii) random daily testing. Results In the baseline scenario, randomly introducing a silent SARS-CoV-2 infection into a 170-bed LTCF led to large outbreaks, with a cumulative 86 (95% uncertainty interval 6–224) infections after 3 weeks of unmitigated transmission. Efficacy of symptom-based screening was limited by lags to symptom onset and silent asymptomatic and pre-symptomatic transmission. Across scenarios, testing upon admission detected just 34–66% of patients infected upon LTCF entry, and also missed potential introductions from staff. Random daily testing was more effective when targeting patients than staff, but was overall an inefficient use of limited resources. At high testing capacity (> 10 tests/100 beds/day), cascades were most effective, with a 19–36% probability of detecting outbreaks prior to any nosocomial transmission, and 26–46% prior to first onset of COVID-19 symptoms. Conversely, at low capacity (< 2 tests/100 beds/day), group testing strategies detected outbreaks earliest. Pooling randomly selected patients in a daily group test was most likely to detect outbreaks prior to first symptom onset (16–27%), while pooling patients and staff expressing any COVID-like symptoms was the most efficient means to improve surveillance given resource limitations, compared to the reference requiring only 6–9 additional tests and 11–28 additional swabs to detect outbreaks 1–6 days earlier, prior to an additional 11–22 infections. Conclusions COVID-19 surveillance is challenged by delayed or absent clinical symptoms and imperfect diagnostic sensitivity of standard RT-PCR tests. In our analysis, group testing was the most effective and efficient COVID-19 surveillance strategy for resource-limited LTCFs. Testing cascades were even more effective given ample testing resources. Increasing testing capacity and updating surveillance protocols accordingly could facilitate earlier detection of emerging outbreaks, informing a need for urgent intervention in settings with ongoing nosocomial transmission.

scholarly journals Clinical outcomes of COVID-19 in long-term care facilities for people with epilepsy

2020 ◽  
pp. 107602
Author(s):  
Simona Balestrini ◽  
Matthias J. Koepp ◽  
Sonia Gandhi ◽  
Hannah M. Rickman ◽  
Gee Yen Shin ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Long Term Care ◽  
Term Care ◽  
Care Facilities

scholarly journals SEeking AnsweRs for Care Homes during the COVID-19 pandemic (COVID SEARCH)

2020 ◽  
Author(s):  
Karen Spilsbury ◽  
Reena Devi ◽  
Alys Griffiths ◽  
Cyd Akrill ◽  
Anita Astle ◽  
...  
Keyword(s):  
Research Agenda ◽  
Long Term Care ◽  
Care Home ◽  
Discussion Group ◽  
Short Report ◽  
Term Care ◽  
Care And Support ◽  
Care Facilities ◽  
The Uk

Abstract The care and support of older people residing in long-term care facilities during the COVID-19 pandemic has created new and unanticipated uncertainties for staff. In this short report, we present our analyses of the uncertainties of care home managers and staff expressed in a self-formed closed WhatsApp™ discussion group during the first stages of the pandemic in the UK. We categorised their wide-ranging questions to understand what information would address these uncertainties and provide support. We have been able to demonstrate that almost one-third of these uncertainties could have been tackled immediately through timely, responsive and unambiguous fact-based guidance. The other uncertainties require appraisal, synthesis and summary of existing evidence, commissioning or provision of a sector- informed research agenda for medium to long term. The questions represent wider internationally relevant care home pandemic-related uncertainties.

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