TWO YEARS IN THE DEVELOPMENT OF A NEW INTERDISCIPLINARY PEDIATRIC CHRONIC PAIN PROGRAM: OPPORTUNITIES, INITIATIVES, AND CHALLENGES

Abstract BACKGROUND “…The field of paediatric pain medicine has demonstrated the benefits of interdisciplinary collaboration more than any other endeavour” (Law, Palermo, & Walco, 2013). Recently, the Ontario Ministry of Health and Long-term Care announced the funding of specialty paediatric chronic pain programs in several children’s hospitals across the province of Ontario, including McMaster Children’s Hospital. The Pediatric Chronic Pain Program includes Physicians (Pediatricians, Psychiatrist, Anesthesiologist), Psychologists, Child Life Specialist, Registered Nurse, Nurse Practitioner, Occupational Therapist, Physiotherapist, Social Workers, Pharmacist, and a Clinical Manager. OBJECTIVES The purpose of this poster is to highlight new initiatives within our clinic, including the development of a pain education session for families, group treatments (e.g., a 5 week Rise Above Pain Group; a 5-week Parenting Group), and a research database (to allow for program evaluation integrated within our clinical work). DESIGN/METHODS Challenges in developing a new clinic/new programs and providing care to complex families (e.g., professional roles and competencies, diagnostic discrepancies) will be discussed. CONCLUSION Implications for program development in new and established clinics will be highlighted.

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Investigation of a Prolonged Group A Streptococcus Outbreak Among Residents and Outpatients Receiving Wound Care at a Long-Term Care Facility (LTCF)

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.890 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s305-s306

Author(s):

Alana Cilwick ◽

April Burdorf ◽

Wendy Bamberg ◽

Christopher Czaja ◽

Alexis Burakoff ◽

...

Keyword(s):

Infection Control ◽

Staff Member ◽

Long Term Care ◽

Wound Care ◽

Care Facility ◽

Term Care ◽

Term Care Facility ◽

Long Term Care Facility ◽

Group A

Background: In February 2019, the Colorado Department of Public Health and Environment (CDPHE) identified a cluster of 3 invasive group A Streptococcus (GAS) infections in residents receiving wound care in a long-term care facility (LTCF). An investigation revealed a larger outbreak that extended to nonresidents receiving outpatient wound care at the LTCF. Methods: A case was defined as a positive culture for GAS emm type 82 from an individual with exposure to the LTCF between January and June 2019. Cases were categorized as clinical (symptoms of GAS disease or GAS isolated from a wound or sterile site) or carriage (no symptoms). Carriers were identified via samples collected from throat and skin lesions. Screening occurred in 2 rounds and included residents of affected units followed by screening of all wound-care staff and residents facility-wide. Available isolates were sent for emm type testing and whole-genome sequencing (WGS) at the CDC. CDPHE staff performed infection control observations. Results: We identified 14 cases: 8 clinical and 6 carriage (from 5 residents and 1 staff member). Two patients with invasive GAS died. Of 8 patients with clinical GAS, 6 resided in the facility on or 1 day prior to symptom onset; 2 were not residents but received outpatient therapy at the LTCF. All 8 patients with clinical GAS (100%) and 3 carriers had received wound care. The staff member with emm 82 carriage had provided wound care and occupational therapy to the affected residents and the 2 outpatients. Two additional cases were detected with onset dates following staff member decolonization. Moreover, 13 of the 14 emm 82 isolates were found to be identical by WGS. Infection control observations identified lapses in staff wound care and hand hygiene practices in the residential and outpatient settings of the facility. Conclusions: This investigation details a large GAS outbreak in an LTCF associated with asymptomatic carriage in residents and staff that included patients who had only received care in the outpatient portion of the facility. The outbreak was halted following decolonization of a staff member and improvements in infection control, including in the outpatient setting. Outpatient services, particularly wound care, provided by LTCFs should be considered when investigating LTCF-related GAS cases and outbreaks.Funding: NoneDisclosures: None

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Long-term stroke incidence in proximal thoracic aorta aneurysm survivors

International Journal of Stroke ◽

10.1177/1747493019840944 ◽

2019 ◽

Vol 15 (4) ◽

pp. 421-428

Author(s):

Jin-Yi Hsu ◽

Yuan-Chih Su ◽

Jen-Hung Wang ◽

Boon Lead Tee

Keyword(s):

Ischemic Stroke ◽

Thoracic Aorta ◽

Hemorrhagic Stroke ◽

Study Cohort ◽

Research Database ◽

Term Care ◽

Term Survival ◽

Stroke Incidence ◽

Increased Risk

Background Aneurysm of proximal thoracic aorta (pTAA) is an often indolent, yet fatal disease. Although advancements in aneurysmal repair techniques have increased long-term survival rates, studies have proven that there are increases in perioperative risk for stroke incidence after pTAA surgery. Conversely, there is little evidence regarding the long-term stroke incidence in pTAA individuals, which strongly influences the morbidity, mortality, and usage of antithrombotic agents. Methods Using the Taiwan National Health Insurance Research Database, a nationwide population-based cohort, we recruited 3013 pTAA survivors hospitalized from 1 January 2000 to 31 December 2012. To ensure study cohort quality, only patients aged 20 years and above who underwent aneurysmal repair surgery are included. The control cohort is identified by matching background features (comorbidities, age, gender) at a 1:4 ratio through the use of frequency matching. The primary outcomes include incidence of ischemic stroke and intracranial hemorrhage one month after aneurysmal repair surgery. Results The mortality of pTAA survivors is nearly twice of the matched controls despite aneurysmal repair (28.5 % vs. 15.2%, p < 0.001). Long-term follow-up of participants indicated that pTAA survivors had a higher risk for hemorrhage stroke (adjusted hazard ratio (aHR): 1.93; 95% confidence interval (CI): 1.47–2.53), but no significant increase in risk for ischemic stroke (aHR: 1.07; 95% CI: 0.92–1.25). Hemorrhagic stroke occurrence was found to be associated with age and diabetes mellitus. Comparison on hemorrhagic stroke subtypes between study and matched cohorts showed no statistical differences in intracerebral hemorrhage and subarachnoid hemorrhage. Conclusions Despite the advancement of aneurysmal repair surgery, this study suggests that pTAA patients may still face an increased risk of hemorrhage stroke. Further investigation is warranted to provide better long-term care for the pTAA population.

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The Impact of an Educational Program on Improving Diabetes Knowledge and Changing Behaviors of Nurses in Long-Term Care Facilities

The Diabetes Educator ◽

10.1177/014572179502100608 ◽

1995 ◽

Vol 21 (6) ◽

pp. 541-545 ◽

Cited By ~ 11

Author(s):

Monica Turner Parker ◽

Nancy Leggett-Frazier ◽

Pauline A. Vincent ◽

Melvin S. Swanson

Keyword(s):

Treatment Group ◽

Diabetes Care ◽

Educational Program ◽

Long Term Care ◽

Control Group ◽

Term Care ◽

Care Facilities ◽

Group A ◽

The Impact

Nursing staffs from two long-term care facilities attended a multisession educational program about the care of residents with diabetes (treatment group). A control group consisted of the nursing staffs from two other similar facilities who did not participate in the educational program. Both groups were given a knowledge pretest and posttest. A chart review also was conducted following the educational intervention to determine any changes in the diabetes care provided by the treatment group. Following the educational program, the treatment group had a significant increase in their mean score on the knowledge test compared with the control group. However, a. review of the residents' charts revealed no significant increases in specific behaviors related to diabetes care. The findings suggest that, in addition to educational programs, more focused training concerning diabetes care is needed to improve the care of residents with diabetes in long-term care facilities. Implications for diabetes educators are discussed.

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A randomized clinical trial comparing hip abductors strengthening and manual therapy in patients with plantar fasciitis: a study protocol

Revista Pesquisa em Fisioterapia ◽

10.17267/2238-2704rpf.v11i4.3886 ◽

2021 ◽

Vol 11 (4) ◽

Author(s):

Kirti Hooda ◽

Manu Goyal ◽

Asir John Samuel

Keyword(s):

Manual Therapy ◽

Plantar Fasciitis ◽

Term Care ◽

Hip Abductor ◽

Group A ◽

Foot Function ◽

Conventional Physiotherapy ◽

Group B ◽

Positive Results

BACKGROUND: Plantar fasciitis (PF) is a common cause of heel pain and deformity of the ankle joint. More than 11%-15% of the population with foot symptoms need long-term care. Various physical therapy intervention with conventional therapy, including manual therapy, has been proven to help this condition. OBJECTIVE: To evaluate the effect of Hip abductor strengthening and Manual therapy (MT) in a patient with Plantar Fasciitis (PF). METHODS: The design of the study will be A Two Group Pretest-Posttest randomized control trial. A total of 30 male and female participants aging above 18-60 years experiencing pain provoked by taking the first few steps in the morning, pain in the plantar heel region, will be allocated randomly into two groups- Group A will receive Manual therapy (MT) with conventional physiotherapy while Group B will receive hip abductors strengthening with conventional physiotherapy. Both groups will receive 16 sessions of treatment for 4 days each week for 4 weeks. “Foot function index,” “Podia scan,” “Navicular drop test” will be used as outcome measures and will be evaluated at the first week and fourth week of treatment in both the groups. CONCLUSION: The patients who receive Hip Abductor Strengthening intervention may have positive results compared to the MT intervention among patients with PF. That will be the first study to compare the effect of hip abductors strengthening and manual therapy.

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COVID-19 related mortality and spread of disease in long-term care: a living systematic review of emerging evidence

10.1101/2020.06.09.20125237 ◽

2020 ◽

Cited By ~ 5

Author(s):

Maximilian Salcher-Konrad ◽

Arnoupe Jhass ◽

Huseyin Naci ◽

Marselia Tan ◽

Yousef El-Tawil ◽

...

Keyword(s):

Systematic Review ◽

Long Term Care ◽

Case Fatality ◽

Mortality Rates ◽

Primary Data ◽

Research Database ◽

Term Care ◽

The Impact ◽

Related Mortality

AbstractBackgroundPolicy responses to mitigate the impact of the COVID-19 pandemic on long-term care (LTC) require robust and timely evidence on mortality and spread of the disease in these settings. The aim of this living systematic review is to synthesise early international evidence on mortality rates and incidence of COVID-19 among people who use and provide LTC.MethodsWe report findings of a living systematic review (CRD42020183557), including studies identified through database searches up to 5 June 2020. We searched seven databases (MEDLINE; Embase; CINAHL Plus; Web of Science; Global Health; WHO COVID-19 Research Database; medRxiv) to identify all studies reporting primary data on COVID-19 related mortality and incidence of disease among LTC users and staff. We excluded studies not focusing on LTC. Included primary studies were critically appraised and results on number of deaths and COVID-19 related mortality rates, case fatality rates, and excess deaths (co-primary outcomes), as well as incidence of disease, hospitalisations, and ICU admissions were synthesised narratively. We further included official figures on number of deaths in LTC.FindingsA total of 33 study reports for 30 unique primary studies or outbreak reports were included. Outbreak investigations in LTC facilities found COVID-19 incidence rates of between 0.0% and 71.7% among residents and between 1.5% and 64.0% among staff. Mortality rates varied from 0.0% to 9.5% of all residents at outbreak facilities, with case fatality rates between 0.0% and 33.7%. In included studies, no LTC staff members had died. LTC residents accounted for between 0% (Hong Kong) and 85% (Canada) of COVID-related deaths, according to official figures.InterpretationLong-term care users have been particularly vulnerable to the COVID-19 pandemic. However, we found wide variation in spread of disease and mortality rates between outbreaks at individual LTC facilities. Further research into the factors determining successful prevention and containment of COVID-19 outbreaks is needed to protect long-term care users and staff.FundingThis work was partially conducted as part of the “Strengthening responses to dementia in developing countries” (STRiDE) project, supported by the UK Research and Innovation’s Global Challenges Research Fund (ES/P010938/1). The funders had no role in the design and execution of this study, interpretation of its results, and decision to submit this work to be published.

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Three-Group Pretest-Posttest Design to Investigate Aromatherapy Hand Massage for Older Adults With Chronic Pain Living in Long-Term Care

10.4135/9781526414014 ◽

2017 ◽

Author(s):

Kathleen Cino

Keyword(s):

Older Adults ◽

Chronic Pain ◽

Long Term Care ◽

Term Care ◽

Hand Massage

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Urban community vignette

10.1332/policypress/9781447352563.003.0004 ◽

2021 ◽

pp. 45-50

Author(s):

Lillian Wells

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Community Development ◽

Long Term Care ◽

Clinical Work ◽

Term Care ◽

Empowerment Model ◽

Model Of Practice

This chapter focuses on Lillian Wells's experience as a social worker in the early 1960s with older adults, in which she learned how to live her life and how to optimize life as she grew older. It discusses Wells' practice that deals with clinical work and community development, particularly in the areas of health and gerontology. It also refers to the development of an empowerment model of practice in long-term care with resident councils, initiatives with families, and staff training. The chapter talks about Lillian Wells' membership of the Toronto Council on Aging, where she aimed to raise awareness of the needs of older adults, improve their quality of life, foster their involvement in all aspects of community life, and support the experience of aging through education and leadership. It examines the reality that older people have often outlived family and friends, and it can be difficult to reach out on their own to new experiences, when familiar supports are unavailable.

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