Beit Rivka Geriatric Medical Center

With the spread of coronavirus disease, reports have indicated that young patients are usually asymptomatic with a short convalescence period. The current study compared the time to resolution of infection in symptomatic and asymptomatic patients. Seventy-six patients aged 44.4 ± 23.3 years were admitted to the coronavirus disease 2019 (COVID-19) unit during the study period. Data were collected from patient records. Throat and nasal swabs for COVID-19 were collected for reverse transcriptase-polymerase chain reaction (RT-PCR). Time to resolution of infection was defined as the number of days from the date of the first COVID-19 positive outcome to the second consecutive negative PCR results. Most patients showed COVID-19 signs and symptoms (71.1%) between 1 and 6 days, and the rest were asymptomatic. No association was found between the time to resolution of infection and the presence of COVID-19 signs and symptoms (symptomatic: median [Md] 10.0, 95% confidence interval [CI] 8.4-11.6; asymptomatic: Md 15.0, 95% CI 10.5-15.5; P = 0.54). Age was not correlated with the number of COVID-19 signs and symptoms (r = 0.13, P = 0.37) or with the time to resolution of infection (r = 0.06, P = 0.58). In patients with mild to moderate symptoms, the time to resolution of infection from COVID-19 is not different from that in asymptomatic patients.

Background/Aims: The novel coronavirus SARS-CoV-2 has caused a pandemic threatening millions of people worldwide. This study aimed to describe clinical characteristics, outcomes, and risk factors of SARS-CoV-2-positive, asymptomatic, frail older adults. Methods: A retrospective cohort study was conducted in 6 designated COVID-19 units, in skilled nursing homes. Subjects were severely frail older adults, positive for SARS-CoV-2, and asymptomatic at the time of their admission in these units. Residents’ characteristics and symptoms were obtained via electronic medical records. The primary outcome was a composite of death or hospitalization by day 40. We looked at time to the primary outcome and used Cox regression for a multivariate analysis. Results: During March–November 2020, 849 residents met inclusion criteria. Median age was 84 years. Most were completely dependent for basic activities of daily living and showed cognitive impairment. Six hundred forty-one (75.5%) residents were discharged after considered cured from COVID-19, 125 (14.7%) were hospitalized, and 82 (9.7%) died in the facilities. In survival analysis, 35% reached the primary outcome of death or hospitalization by day 40. Age (hazard ratio [HR] 1.23; 95% confidence interval [CI] 1.1–1.4), male gender (HR 1.41; 95% CI: 1.1–1.88), and COPD (HR 1.8; 95% CI: 1.23–2.67) were significant risk factors. Conclusions: In this large cohort, we report care and prognosis of asymptomatic older adults with major functional or cognitive impairments during the COVID-19 pandemic. Most presymptomatic patients do not develop severe infection, and age stays a predominant risk factor, even in the frailest older adults.

Introduction:Hip fractures are a significant health risk in older adults and a major cause of morbidity, functional decline and mortality. Our aim was to compare clinical outcomes of older patients hospitalized in an ortho-geriatric (OG) unit to those hospitalized in an orthopedic department (OD) for surgical treatment of a hip fracture.Methods:A retrospective cohort study of hip fractured patients hospitalized between 2015-2016 in a single tertiary university-affiliated medical center. Included were patients aged 65 and older who had undergone hip fracture surgery and were admitted to either a geriatric or orthopedic ward.Results:441 patients met the inclusion criteria (195 in the OG unit, 246 in the OD); 257 were transferred to an affiliated geriatric center hospital (107 from the OG unit and 127 from the OD) for rehabilitation. Patients in the OG unit were older, more cognitively and functionally impaired and with more comorbidities. The 1-year mortality rate was significantly lower in the OD group (OR 0.32, CI 95% 0.19-0.53, p < 0.001), however, after propensity matching, the 30-day and 1 year mortality rates were similar in both groups. No difference was found in the rehabilitation length of stay between the groups. The functional independence measure improvement was similar in both groups, with a non-significant trend toward better functional improvement among OG unit patients.Conclusions:Despite the higher complexity of patients, worse baseline functional capacity in the OG unit, improvement after rehabilitation was similar in both groups. These results demonstrate the advantages of the OG unit in treating and stabilizing frail older adults, thus maximizing their chances for a successful recovery after hip fractures.Level of Evidence:Level IV

Abstract BackgroundWhile it is agreed that cognitive decline is underdiagnosed, there is still no single universally accepted and affordable screening method that satisfies all needs in the detection of cognitive impairment. The goal of this presentation is to demonstrate an automatic cognitive decline assessment with Neurosteer Aurora, utilizing a novel EEG analysis as a method for characterization of cognitive activity and detection of early cognitive impairment.MethodNeurosteer has developed a miniature wearable neurological sensor combined with an automatic assessment tool for a wide range of brain monitoring and treatment needs. It is based on a single EEG channel and relies on advanced mathematical analysis for a decomposition of the EEG signal into multiple components. These components are then processed with machine learning algorithms to create high level biomarkers for real‐time brain activity interpretation. Additionally, Neurosteer has developed a fully automatic assessment and biomarkers for cognitive decline. It is based on a verbal and musical cognitive assessment during brain activity recording. Machine learning algorithms analyze the combined data to produce a simple‐to‐read report indicating the level of different aspects of cognitive decline. We applied this technology on three different healthy population (N=14, 40, 215) and cognitively impaired (N=24, 10, 9, 8) undergoing several automatically administered cognitive tasks.ResultA few biomarkers were extracted using machine learning tools on the collected data. The biomarkers distinguished between different levels of cognitive load as well as resting state patterns. The new groups of cognitively impaired populations were examined with Neurosteer Aurora, completing short and automatic auditory assessments. The patterns of the predefined biomarkers were significantly different for each population, differentiating between clinical populations and negatively correlated with the severity of cognitive decline.ConclusionUsing the novel brain activity interpretation and biomarkers enables an automatic and easy‐to‐administer cognitive decline assessment in the clinical population. Such assessment is a step forward towards a wide‐spread screening, allowing early and personalized intervention to slow down cognitive decline, improving health and quality of life outcomes.

Although studied in a few randomized controlled trials, the efficacy of medical cannabis (MC) for chronic pain remains controversial. Using an alternative approach, this multicentre, questionnaire-based prospective cohort was aimed to assess the long-term effects of MC on chronic pain of various aetiologies and to identify predictors for MC treatment success. Patients with chronic pain, licensed to use MC in Israel, reported weekly average pain intensity (primary outcome) and related symptoms before and at 1, 3, 6, 9 and 12months following MC treatment initiation. A general linear model was used to assess outcomes and identify predictors for treatment success (≥30% reduction in pain intensity). A total of 1,045 patients completed the baseline questionnaires and initiated MC treatment, and 551 completed the 12-month follow-up. At 1year, average pain intensity declined from baseline by 20% [-1.97 points (95%CI= -2.13 to -1.81; p<0.001)]. All other parameters improved by 10%-30% (p<0.001). A significant decrease of 42% [reduction of 27mg; (95%CI=-34.89 to18.56, p<0.001)] from baseline in morphine equivalent daily dosage of opioids was also observed. Reported adverse effects were common but mostly non-serious. Presence of normal to long sleep duration, lower body mass index and lower depression score predicted relatively higher treatment success, whereas presence of neuropathic pain predicted the opposite. This prospective study provides further evidence for the effects of MC on chronic pain and related symptoms, demonstrating an overall mild-to-modest long-term improvement of the tested measures and identifying possible predictors for treatment success.

In March 2020, the World Health Organisation declared COVID-19 as a global pandemic. Patients with cardiovascular conditions, including heart failure (HF), are disproportionately impacted by this new disease. Escalating mortality figures and pressures on staff and resources have challenged us on how best to support those affected, and how to deal with death and dying. This short paper will review health practice and policy changes arising from this coronavirus pandemic and signpost a selection of available tools and resources that can assist healthcare professionals in providing optimal palliative and end of life care for HF patients in the current and post COVID-19 eras. As shielding and social distancing of varying degrees was instigated across most European countries, the provision of conventional models of HF service delivery was either suspended, or reconstituted in a virtual format through telephone consultations or the use of telemedicine.1–3 Clinical trial evidence confirms that the integration of telehealth bolsters HF practice,4–6 but today’s service providers noted requests for information from many patient-carer dyads on ‘keeping well’ and ‘who to contact’ if HF symptoms deteriorated. Services also reported the worrying observation of a reduced number of patients across the spectrum of cardiovascular disease attending hospital Emergency Departments. The effect of this trend may become evident later, in an increase in all-cause mortality as further data emerge. Recent position statements released both nationally and internationally have reiterated the importance of maintaining HF specialist services to facilitate prompt healthcare access for patients at points of crisis,3,7,8 requiring professionals to adopt variants of a previously accepted HF service structure.9 As the pandemic subsides and HF services are reconfigured, some effective elements of the new virtual care models could be incorporated, avoiding some of the risks inherent in care transitions, and consolidating a more seamless continuum between hospital-based clinics and primary care.

Background and Purpose. Individuals with stroke often present symptoms of multiple domains, such as weakness of the affected upper extremity (UE) and unilateral spatial neglect (USN), which are both associated with poor functional outcome. The aims of this systematic review were to search and review studies that investigated (1) the relationship between USN and affected UE sensorimotor recovery poststroke and (2) the effectiveness of sensorimotor interventions to improve the affected UE in patients with USN. Methods. An electronic search of databases (MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL) was conducted using a combination of the following terms: stroke, USN, and affected UE. Studies meeting the inclusion criteria were rated using a modified version of the Quality Index, and relevant data were extracted. Results. A total of 850 studies were identified, and 14 were included; 13 studies assessed correlations between USN and the affected UE capacity/recovery, and 1 study assessed an intervention to improve the UE of individuals with USN. An association between presence of USN and UE capacity/recovery was found in most studies and USN did not interfere with recovery of the affected UE in the single experimental study. Conclusions. USN is associated with poor UE motor capacity and less UE recovery poststroke. Therefore, these impairments should be considered when planning rehabilitation and discharge. Because USN is a well-researched phenomenon, the lack of studies and insufficient evidence related to UE interventions in individuals with USN was unexpected. These interventions should be developed and researched to improve UE and overall functional outcome poststroke.

Nurses working in a long-term care facility could be at risk of developing compassion fatigue due to the nature of their work. In this descriptive, cross-sectional survey, we explored the level of compassion fatigue among nurses working in a long-term care facility, as well as the associated sociodemographic and occupational factors. In total, 103 nurses employed in various departments of a long-term care facility in central Israel completed the Hebrew version of the Professional Quality of Life Scale R-IV. Nurses scored moderate-high on the compassion fatigue (mean = 3.6, standard deviation = .5), burnout (mean = 3.5, standard deviation = .5), and compassion satisfaction (mean = 3.8, standard deviation = .5) scales. Older nurses scored lower on compassion fatigue, while nurses with higher qualifications scored higher on compassion satisfaction. In this study, we implicate that it is necessary to raise awareness about compassion fatigue, both in nursing education and training and in long-term care organizations. It is necessary to improve understanding of this phenomenon in order to help nurses acquire appropriate coping skills to address this critical issue.