How can healthcare workers adapt non-pharmacological treatment – whilst maintaining safety – when treating people with COVID-19 and delirium?

Delirium may be part of the spectrum of COVID-19 symptoms that patients present with. In some cases, the delirium may be severe and have a rapid onset. Clinicians should have a high level of suspicion of COVID-19 when considering a possible cause of the delirium. Non-pharmacological interventions (See Box 1) are the mainstay for the management of delirium in all settings; there is consistent evidence of benefit in the prevention of delirium Communication and care are compromised by the need for Personal Protection Equipment (PPE) in COVID-19 Use of remote consultations may be necessary and is often feasible (See Box 2

Use of a Smartwatch for Assessment of the QT Interval in Outpatients with Coronavirus Disease 2019.

The coronavirus disease 2019 (COVID-19) pandemic has necessitated rapid implementation of innovative strategies to manage patients remotely to help reduce the risk of community and nosocomial transmission. This case demonstrates the use of an Apple Watch (Apple, Cupertino, CA, USA) to monitor for arrhythmias and QT prolongation in a patient with COVID-19 during home isolation

Home telehealth in older patients with heart failure – costs, adherence, and outcomes

Susanna Spinsante Dipartimento di Ingegneria dell'Informazione, Università Politecnica delle Marche, Ancona, Italy Abstract: This short review discusses the role of telehealth technologies in the management of older patients with heart failure, from different perspectives. Instead of providing a systematic overview of existing literature in the field, this paper provides evidence for a simple, but effective, paradigm upon which a telehealth system may be built, and highlights how such a model may successfully apply to heart failure management, to improve patients' quality of life after discharge, increase independency, and reduce readmissions and costs for the public health institutions. A few examples are discussed, to show the real applicability of the proposed model and further confirm the effectiveness of telehealth, when properly designed and tailored to users' needs. Keywords: remote health care, workflow, requirement

Barriers to Nurses’ Promoting Mobility in Hospitalized Older Adults

Objectives: To examine the association between nurses’ knowledge, attitude and external barriers and the nurse’s mobility-promoting behavior. Nurse perception of the priority organizations place on mobility, and the relationship of nurses’ level of experience to nurse prioritization for promoting mobility was also investigated. Design: Cross-sectional, descriptive, correlation study with convenience sampling. Setting: Two community-based hospitals in the Pacific Northwest of the U.S. Participants: Eighty-five nurses caring for 98 inpatients 65 and older. Measurement: Nurses’ knowledge, attitude and external barriers were examined with a validated 5-point Likert Scale. Patient-related and other clinical barriers and the nurses mobility-promoting behavior was obtained with the validated self-recorded mobility log. Patient Basic Metabolic Index (BMI) and severity of illness was obtained though data extraction. Results: Nurses viewed the promotion of mobility as important, yet mobilizing older patients was infrequent. Nurses perceived a number of barriers to promoting mobility: Patient condition, the perception that patients could be harmed during mobilization, perceptions of heavy workload, difficulty prioritizing nursing care, and staffing shortages. While novice nurses had lower priority to promote mobility compared to more experienced nurses, novice nurses tended to promote more mobility. Conclusion: As nurses care for hospitalized older adults the convergence of interpersonal, patient, and environmental complexities acting as barriers to mobility need to be considered. It is important to understand the needs of beginning, less experienced nurses to overcome the barriers to promoting mobility. This study shows that even experienced nurses need to overcome barriers to promoting mobility. Hospitals need to address the needs of the novice nurse while enhancing the practice of more experienced nurses in order to support nurse-promoted mobility. The findings from this study show that nurses knowledge, attitude, and external barriers could play a role in the low levels of mobility in hospitalized older adults

Complex Care Management Program Overview

This report includes brief updates on various forms of complex care management including: Aetna - Medicare Advantage Embedded Case Management ProgramBrigham and Women's Hospital - Care Management ProgramIndependent Health - Care PartnersIntermountain Healthcare and Oregon Health and Science University - Care Management PlusJohns Hopkins University - Hospital at HomeMount Sinai Medical Center -- New York - Mount Sinai Visiting Doctors Program/ Chelsea-Village House Calls ProgramsPartners in Care Foundation - HomeMeds ProgramPrinceton HealthCare System - Partnerships for PIECEQuality Improvement for Complex Chronic Conditions - CarePartner ProgramSenior Services - Project Enhance/EnhanceWellnessSenior Whole Health - Complex Care Management ProgramSumma Health/Ohio Department of Aging - PASSPORT Medicaid Waiver ProgramSutter Health - Sutter Care Coordination ProgramUniversity of Washington School of Medicine - TEAMcar

Clinical management of COVID-19: Experiences of the COVID-19 epidemic from Groote Schuur Hospital, Cape Town, South Africa

The SARS-CoV-2 pandemic has presented clinicians with an enormous challenge in managing a respiratory virus that is not only capable of causing severe pneumonia and acute respiratory distress syndrome, but also multisystem disease. The extraordinary pace of clinical research, and particularly the surge in adaptive trials of new and repurposed treatments, have provided rapid answers to questions of whether such treatments work, and has resulted in corticosteroids taking centre stage in the management of hospitalised patients requiring oxygen support. Some treatment modalities, such as the role of anticoagulation to prevent and treat potential thromboembolic complications, remain controversial, as does the use of high-level oxygen support, outside of an intensive care unit setting. In this paper, we describe the clinical management of COVID-19 patients admitted to Groote Schuur Hospital, a major tertiary level hospital at the epicentre of South Africa’s SARS-CoV-2 epidemic during its first 4 months

Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs