This discussion article highlights the challenges of providing hospice care in nursing homes since the start of the COVID-19 (coronavirus disease 2019) pandemic and illuminates practice changes needed in nursing homes. The article provides an overview of the expectations of hospice care, explains the differences in delivering hospice care during the COVID-19 pandemic, examines social isolation and emotional loneliness and the role of familial caregivers, and describes policy changes related to the COVID-19 affecting hospice care delivery in nursing homes. This article answers the following questions: (1) How did residents receiving hospice care have their needs met during the COVID-19 pandemic? (2) What areas of nursing home care need to be improved through governmental policy and restructuring? This article also summarized the lessons learned as a result of the COVID-19 pandemic and provided practical implications for nursing, specific to changes in hospice care deliveries for nursing home residents.

Introduction Studies have reported higher infection and mortality rates from coronavirus disease 2019 (COVID-19) for disadvantaged groups in the U.S. population. However, racial and ethnic differences in fatality rates, which measure deaths among those infected, are not as clear. Objectives The objectives were to (1) estimate the fatality rate after COVID-19 infection by racial and ethnic groups and (2) determine the extent preexisting health conditions account for differences in fatality rate between the racial and ethnic groups. Methods Data for all adults aged 18 and older (n = 24,834) who had a confirmed COVID-19 infection captured in the electronic health records (EHRs) of a major health care organization (HCO) from the beginning of the pandemic to March 28, 2021 were used to estimate the fatality rates for three racial and ethnic groups: Hispanic, non-Hispanic African American, and non-Hispanic White. Elixhauser's comorbidity index was calculated using the enhanced ICD-9-CM and the ICD-10 diagnosis codes. Logistic regression models were used to compare differences in fatality between racial and ethnic groups. Odds ratios and 95% confidence intervals were reported for all models. Results The age-specific fatality rates non-Hispanic White, non-Hispanic African American, and Hispanic groups were 0.23%, 1.05%, 0.55% for age group 18–59 years old; 2.44%, 4.50%, 5.28% for 60–69; 5.42%, 10.11%, 8.49% for 70–79, and 17.33%, 20.79%, 20.39% for 80–90. After adjusting for age, sex, and preexisting conditions, the fatality risk remains significantly higher for non-Hispanic African American (adjusted odds ratio [adj. OR] = 1.85, 95% CI 1.41–2.44) and Hispanic individuals (adj. OR = 1.91, 95% CI = 1.53–2.39) compared to non-Hispanic White individuals. Conclusion Hispanic and non-Hispanic African American individuals have a higher risk of fatality from COVID-19 compared to non-Hispanic White individuals. The higher risk remains after adjusting for sex, age, and preexisting conditions. Health care providers could help to increase vaccination rates in these vulnerable populations by addressing the social and cultural barriers with their patients.

BackgroundAccording to the American Society of Health System Pharmacists (ASHP) and the American Society of Parenteral and Enteral Nutrition (ASPEN), the pharmacist is responsible for proper preparation of parenteral nutrition (PN), for control during the process and for the final product.The European Medicines Agency (EMA) and the United States Pharmacopoeia (USP) postulate that 100% of PN must be prepared with a gravimetric error <5% for larger volumes of 100 mL.Quality control of the elaboration process includes components and gravimetric tests, which are used to identify areas with potential errors and therefore areas that could be improved.PurposeTo evaluate the quality control established in PN elaboration for 6 months, to determine the number and types of errors, and to identify opportunities for improvement.Material and methodsA data collection notebook was designed for prior checking, which describes the type of error and the number of times it occurs. The process begins with preparation of the components required for each PN by the nursing assistant. Then the pharmacist checks the occurrence of the components, and records any discrepancies found. Finally, the nurse makes a second check before compounding the PN.Regarding control of the finished product, PN solutions were weighed checking that the gravimetric error did not exceed 3%. In the case of this limit being exceeded, possible causes were investigated and the preparation was repeated.Results1238 PN were performed (1127 adults, 111 paediatric). 109 errors were found in 62 PN (5% of the total), with an average of 0.1 errors per PN, distributed as shown in table 1.Abstract PP-026 Table 1Adult PNPaediatric PNError typePharmacistNursePharmacistNurseTotalLack of product3779356 (51%)Extra product861823 (21%)Misrepresentation1401015 (14%)Wrong product623415 (14%)Total65 (60%)15 (14%)14 (13%)15 (14%)109Regarding the gravimetric test, 9 PN (0.7%) had to be prepared again because the gravimetric error exceed the 3% limit.ConclusionQuality control of the PN has proven effective in detecting errors, noting that the second check can correct errors unnoticed in the first checkup. It is highly important that the staff involved are trained in advance to avoid errors during the process.No conflict of interest.

BackgroundMultiple sclerosis is a chronic inflammatory disorder of the central nervous system. Statins have demonstrated anti-inflammatory and immunomodulatory properties in this setting. Several clinical studies of different statins, given alone or in combination with interferon, for relapsing-remitting multiple sclerosis (RRMS) have been conducted with conflicting results.PurposeTo review the efficacy and safety of statins in combination with interferon treatment in patients with RRMS.Material and methodsA systematic review of the literature and meta-analysis was performed by searching in MEDLINE, Cochrane CENTRAL Registry and EMBASE, to October 2014. Trials comparing the use of interferon alone or combined with statins in adult patients with RRMS were identified. Trials with a score ≥3 according to the Jadad scale were considered. Pooled effect was calculated for the following outcomes: risk of relapse, treatment withdrawal due to adverse effects and risk of myalgia.A DerSimonian-Laird random-effects model was used to calculate pooled Odds Ratios. Statistical heterogeneity was examined using the I2 statistic. For significant differences, publication bias was estimated by using the Rosenthal index.ResultsSix trials were included in the analysis (n = 1,484; range of follow-up = 6–36 months). The evaluated statin was simvastatin in three trials and atorvastatin in two trials. The other trial also included pravastatin, lovastatin and fluvastatin. No significant difference was found between the statin and control group regarding the risk of relapse (OR, 1.06; 95% confidence interval [CI], 0.64 to 1.74; p = 0.82), risk of myalgia (OR, 1.56; 95% CI, 0.59, 4.11; p = 0.36) or risk of withdrawal due to adverse effects (OR, 1.37; 95% CI, 0.57 to 3.30; p = 0.49). I2 test revealed that heterogeneity was low for all the analyses performed.ConclusionOur results revealed that the addition of statins to interferon treatment did not significantly affect the risk of relapse, myalgia or treatment withdrawal due to adverse effects in patients with RRMS.References and/or AcknowledgementsNo conflict of interest.

BackgroundPeginterferon beta-1a (PEGIFNβ-1a) is administered subcutaneously biweekly, which is an advantage over other treatment schedules used in multiple sclerosis (MS) patients.PurposeTo compare treatment satisfaction in MS patients treated with interferon beta-1a (IFNβ-1a) intramuscularly (30 µg weekly) after switching to PEGIFNβ-1a 125 µg administered subcutaneously every 2 weeks.Material and methodsThis was a prospective multicentre study. Adult MS patients switching from weekly intramuscular IFNβ-1a to biweekly PEGIFNβ-1a were included. Patient satisfaction was measured according to the Treatment Satis­faction Questionnaire for Medication (TSQM), which consists of 14 items scaled on a 5–7 point bipolar scale. Items are combined into four summary scores: effectiveness, side effects, convenience and overall satisfaction. Higher scores imply higher satisfaction. The Wilcoxon signed rank test was used for evaluating the differences. The study was approved by the ethics committee.Results35 patients were included. Mean age (±SD) was 44.9±8.6 years and 74.4% were women. Intramuscular IFNβ-1a was the firstline treatment for 88.6% of patients. Treatment duration before change was 64.4±50.5 months. Overall satisfaction and satisfaction in terms of effectiveness were higher for IFNβ-1a IM. Convenience was better evaluated for PEGIFNβ-1a. Side effects were reported in a similar percentage (table). 11.4% of patients returned to intramuscular IFNβ-1a.IFNβ-1a IMPEGIFNβ-1a SCp Value Effectiveness16.0±2.914.2±3.90.01Q1. Ability to treat/prevent condition5.4±1.44.9±1.50.03Q2. Ability to relieve symptoms5.3±1.24.9±1.40.06Q3. Time it takes medication to start working5.3±0.94.5±1.4<0.01Side effects13.5±2.812.3±2.90.08% who reported side effects94.193.9Q5. Bothersomeness of side effects3.0±0.72.8±0.80.18Q6. Interfere with physical function2.9±0.83.0±10.64Q7. Interfere with mental function4.0±1.13.7±0.90.18Q8. Impact overall satisfaction3.6±12.8±1.10.01Convenience15.3±2.816.9±2.6<0.01Q9. Ease/difficulty of use4.8±1.25.8±0.9<0.01Q10. Ease/difficulty of planning to use5.2±1.15.6±0.90.05Q11. Convenience of taking as instructed5.3±1.35.6±1.10.15Overall satisfaction13.1±2.411.9±3.20.02Q12. Confidence that taking medication is good4.9±1.53.6±10.01Q13. Certainty that good things outweigh bad4.9±1.43.5±10.02Q14. Satisfaction with medication5.2±1.24.8±1.40.08ConclusionSwitching from intramuscular IFNβ-1a to PEGIFNβ-1a resulted in better convenience and a similar reported rate of adverse effects although overall satisfaction was lower.No conflict of interest

BackgroundCardiotoxicity is a known risk of anthracycline treatment. The probability of developing impaired myocardial function is estimated to be 1–2% at a total cumulative dose of 300 mg/m2 of doxorubicin, whereas the risk dramatically increases (5–20%) when the doxorubicin cumulative dose (DCD) exceeds 450–500 mg/m2 . Although cardiotoxicity may also occur at lower doses, depending on age and pre-existing heart disease, this is considered to be the threshold above which the use of doxorubicin is contraindicated. Although this is a general concern when giving doxorubicin treatment, the likelihood of a patient reaching such a threshold might not be as high as expected.PurposeTo asses, in a clinical setting, the incidence of patients exceeding 450–500 mg/m2 DCD and to describe which protocols and tumour types are involved.Material and methodsPatients treated with doxorubicin from January 2004 to March 2015 were included.DCD was calculated for these patients and, for those exceeding 450 mg/m2 , treatment protocols and tumour types were recorded.Results961 patients were identified, 61% being solid tumour patients.The vast majority (98%) had not reached the maximum threshold of DCD recommended. Among those who did, 42.1% were haematological patients.Altogether, among those haematological patients treated with doxorubicin, only 2.1% surpassed it, all of whom were lymphoma patients. In the same way, solid tumour patients exceeding DCD were 1.9%, mostly sarcoma and breast cancer patients.Among patients diagnosed with sarcoma and treated with doxorubicin, 22.6% exceeded DCD, whereas only 0.6% of breast cancer patients treated with doxorubicin did so.When evaluating the 36 chemotherapy protocols that contained doxorubicin, only 7 were given to patients who surpassed DCD. Thus 20.6% of patients treated with a doxorubicin alone protocol and 3.3% of those who received a CHOP protocol reached DCD. As for the remaining 5 protocols, only 1 patient reached DCD.ConclusionThe risk of surpassing DCD was extremely low. Only in sarcoma patients might this be a concern.No conflict of interest.

No abstract

the chest X-ray at day 3 was observed in 7 of the 9 patients, and no radiological worsening was recorded in the 2 other patients. Median SpO 2 at baseline was 92% (IQR 88-95), with a significant improvement of 97% (IQR 96-98) (p=0.007) at day 3. Significant differences were also observed in various laboratory parameters between days 0 and 3. No serious adverse events were observed. On days 3 and 14, no patient had died and none required invasive ventilation. One patient died after 21 days of hospitalisation; the remaining 8 were discharged (length of stay 6-45 days). Conclusion and relevance In this study of patients with refractory moderate-severe COVID-19, a 3 day course of low dose subcutaneous anakinra was effective and safe, resulting in radiological, clinical and analytical improvement in most cases. These observations require further evaluation in clinical trials.