Background
The objective of this review was to examine the current guidelines for infection prevention and control (IPAC) of coronavirus disease-19 (COVID-19) or other coronaviruses in adults 60 years or older living in long-term care facilities (LTCF).
Methods
EMBASE, MEDLINE, Cochrane library, pre-print servers, clinical trial registries, and relevant grey literature sources were searched until July 31, 2020, using database searching and an automated method called Continuous Active Learning® (CAL®). All search results were processed using CAL® to identify the most likely relevant citations that were then screened by a single human reviewer. Full-text screening, data abstraction, and quality appraisal were completed by a single reviewer and verified by a second.
Results
Nine clinical practice guidelines (CPGs) were included. The most common recommendation in the CPGs was establishing surveillance and monitoring systems followed by mandating the use of PPE; physically distancing or cohorting residents; environmental cleaning and disinfection; promoting hand and respiratory hygiene among residents, staff, and visitors; and providing sick leave compensation for staff.
Conclusions
Current evidence suggests robust surveillance and monitoring along with support for IPAC initiatives are key to preventing the spread of COVID-19 in LTCF. However, there are significant gaps in the current recommendations especially with regard to the movement of staff between LTCF and their role as possible transmission vectors.
Systematic review registration
PROSPERO CRD42020181993
Background/Objectives
Virtual (i.e., telephone or videoconference) care was broadly implemented because of the COVID‐19 pandemic. Our objectives were to compare the diagnostic accuracy of virtual to in‐person cognitive assessments and tests and barriers to virtual cognitive assessment implementation.
Design
Systematic review and meta‐analysis.
Setting
MEDLINE, EMBASE, CDSR, CENTRAL, PsycINFO, and gray literature (inception to April 1, 2020).
Participants and interventions
Studies describing the accuracy or reliability of virtual compared with in‐person cognitive assessments (i.e., reference standard) for diagnosing dementia or mild cognitive impairment (MCI), identifying virtual cognitive test cutoffs suggestive of dementia or MCI, or describing correlations between virtual and in‐person cognitive test scores in adults.
Measurements
Reviewer pairs independently conducted study screening, data abstraction, and risk of bias appraisal.
Results
Our systematic review included 121 studies (15,832 patients). Two studies demonstrated that virtual cognitive assessments could diagnose dementia with good reliability compared with in‐person cognitive assessments: weighted kappa 0.51 (95% confidence interval [CI] 0.41–0.62) and 0.63 (95% CI 0.4–0.9), respectively. Videoconference‐based cognitive assessments were 100% sensitive and specific for diagnosing dementia compared with in‐person cognitive assessments in a third study. No studies compared telephone with in‐person cognitive assessment accuracy. The Telephone Interview for Cognitive Status (TICS; maximum score 41) and modified TICS (maximum score 50) were the only virtual cognitive tests compared with in‐person cognitive assessments in >2 studies with extractable data for meta‐analysis. The optimal TICS cutoff suggestive of dementia ranged from 22 to 33, but it was 28 or 30 when testing was conducted in English (10 studies; 1673 patients). Optimal modified TICS cutoffs suggestive of MCI ranged from 28 to 31 (3 studies; 525 patients). Sensory impairment was the most often voiced condition affecting assessment.
Conclusion
Although there is substantial evidence supporting virtual cognitive assessment and testing, we identified critical gaps in diagnostic certainty.
In a P.1 COVID-19 outbreak in long-term-care, vaccine effectiveness against SARS-CoV-2 infection was 52.5% (95%CI 26.9-69.8%) in residents and 62.2% (95%CI, 2.3-88.3%) in staff. VE against severe illness was 78.6% (95%CI 47.9-91.2) in residents. Two of 19 vaccinated resident cases died. Outbreak management required both vaccination and infection control measures.
BackgroundPrescribing and dispensing of medicines are fundamental processes in providing healthcare for both human and animal patients. There has been recent discussion in the literature to advocate for increased co-operation between pharmacists and veterinarians, however there is little data available about veterinary prescribing and dispensing processes.ObjectiveThe aims of this study were to gain information on veterinary prescribing and dispensing processes for companion animals in the Dunedin region of New Zealand.MethodsOpen interviews were conducted with a selection of five veterinarians at practices in Dunedin. All interviews were transcribed verbatim.ResultsIn New Zealand almost all dispensing of medicines for animals is carried out by veterinarians or their staff. There is a lack of standard treatment guidelines and a lack of regulation around the treatment period for which medicines can be dispensed at one time (i.e. period of supply). Medicines for animals are sometimes dispensed by community pharmacies, where clients are experiencing financial difficulties or when particular medicines are not held by veterinary practices. Record keeping requirements and practices for veterinarians are similar to those for community pharmacies.ConclusionsProcesses undertaken by veterinarians in terms of prescribing and dispensing were similar to pharmacists’ practices for human patients and so there is opportunity for collaboration between the two professions. Pharmacists also have complementary knowledge about dosing and formulating medicines that can assist in delivering optimal healthcare to animal patients.
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