INLEIDING In deze module worden behandeladviezen gegeven voor de Post-COVID-19 ambulante behandeling in de geriatrische revalidatie gericht op somatische-, functionele- en psychische status. Deze module is een onderdeel van het behandeladvies post-COVID-19 (geriatrische) revalidatie-Verenso. Deze module is in een zeer korte tijd tot stand gekomen en heeft de status van groeidocument. Zorgvuldigheid is betracht om zowel de (beperkte) ervaringskennis, als de actuele stand van de wetenschappelijke literatuur hierin te betrekken. Voor dit behandeladvies is gebruik gemaakt van het door GRZPLUS ontwikkeld ambulant revalidatieprogramma CO FIT+. Bij GRZPLUS is een doorontwikkeling gemaakt op basis van de update behandeladvies post-COVID-19 geriatrische revalidatie van Verenso (Verenso, 19-05-2020) welke is gebaseerd op de principes van longrevalidatie zoals vertaald in het Behandelprogramma geriatrische COPD-revalidatie (van Damvan Isselt et al.) en het Behandelprogramma COVID-19 Post IC, van Revalidatiecentrum de Hoogstraat (Brouwers, de Graaf). Dit is aangevuld met behandeladviezen en leidraden vanuit de beroepsverenigingen en kennis uit wetenschappelijk onderzoek (long-revalidatie) en vanuit het REACH netwerk (REhabilitation After Critical illness and Hospital discharge). De komende maanden zullen zowel de nieuwe wetenschappelijke literatuur als de ervaringen uit de praktijk gebruikt worden om de handreiking te verbeteren en zo nodig aan te vullen. Dat zullen wij doen met specialisten ouderengeneeskunde, revalidatieartsen, klinisch-geriaters, paramedici, longartsen, verpleegkundigen, infectie deskundigen, en andere betrokken beroepsgroepen. De revalidatie van ambulante post-COVID-19 patiënten vereist vooral afstemming binnen de multidisciplinaire zorg. De complexiteit en ernst van de problematiek en de interactie van beperkingen op diverse domeinen maakt dat interdisciplinaire behandeling essentieel is.
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Abstract Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has challenged healthcare globally. An acute increase in the number of hospitalized patients has neces‑ sitated a rigorous reorganization of hospital care, thereby creating circumstances that previously have been identifed as facilitating prescribing errors (PEs), e.g. a demanding work environment, a high turnover of doctors, and prescrib‑ ing beyond expertise. Hospitalized COVID-19 patients may be at risk of PEs, potentially resulting in patient harm. We determined the prevalence, severity, and risk factors for PEs in post–COVID-19 patients, hospitalized during the frst wave of COVID-19 in the Netherlands, 3months after discharge. Methods: This prospective observational cohort study recruited patients who visited a post-COVID-19 outpatient clinic of an academic hospital in the Netherlands, 3months after COVID-19 hospitalization, between June 1 and October 1 2020. All patients with appointments were eligible for inclusion. The prevalence and severity of PEs were assessed in a multidisciplinary consensus meeting. Odds ratios (ORs) were calculated by univariate and multivariate analysis to identify independent risk factors for PEs. Results: Ninety-eight patients were included, of whom 92% had ≥1 PE and 8% experienced medication-related harm requiring an immediate change in medication therapy to prevent detoriation. Overall, 68% of all identifed PEs were made during or after the COVID-19 related hospitalization. Multivariate analyses identifed ICU admission (OR 6.08, 95% CI 2.16–17.09) and a medical history of COPD / asthma (OR 5.36, 95% CI 1.34–21.5) as independent risk fac‑ tors for PEs. Conclusions: PEs occurred frequently during the SARS-CoV-2 pandemic. Patients admitted to an ICU during COVID19 hospitalization or who had a medical history of COPD / asthma were at risk of PEs. These risk factors can be used to identify high-risk patients and to implement targeted interventions. Awareness of prescribing safely is crucial to prevent harm in this new patient population.
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Key summary points Aim To describe a guidance on the management of post-acute COVID 19 patients in geriatric rehabilitation. Findings This guidance addresses general requirements for post-acute COVID-19 geriatric rehabilitation and critical aspects for quality assurance during the COVID-19 pandemic. Furthermore, the guidance describes relevant care processes and procedures divided in five topics: patient selection; admission; treatment; discharge; and follow-up and monitoring. Message This guidance is designed to provide support to care professionals involved in the geriatric rehabilitation treatment of post-acute COVID-19 patients.
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In our Guest Editorial “The COVID-19 Pandemic: A Family Affair,” which was published in the Journal of Family Nursing by members of the FAMily Health in Europe–Research in Nursing (FAME-RN) group (Luttik et al., 2020), we highlighted the impact on nurses and families.The pandemic was at its beginning, and we described the situation of patients and families and the need for family nursing. Furthermore, we addressed the effect on the mental health of nurses and other health care professionals, due to the increasing workload they needed to manage. In this Guest Editorial, we discuss the impact of the COVID-19 on families during and post pandemic.
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Skeletal muscle-related symptoms are common in both acute coronavirus disease (Covid)-19 and post-acute sequelae of Covid-19 (PASC). In this narrative review, we discuss cellular and molecular pathways that are affected and consider these in regard to skeletal muscle involvement in other conditions, such as acute respiratory distress syndrome, critical illness myopathy, and post-viral fatigue syndrome. Patients with severe Covid-19 and PASC suffer from skeletal muscle weakness and exercise intolerance. Histological sections present muscle fibre atrophy, metabolic alterations, and immune cell infiltration. Contributing factors to weakness and fatigue in patients with severe Covid-19 include systemic inflammation, disuse, hypoxaemia, and malnutrition. These factors also contribute to post-intensive care unit (ICU) syndrome and ICU-acquired weakness and likely explain a substantial part of Covid-19-acquired weakness. The skeletal muscle weakness and exercise intolerance associated with PASC are more obscure. Direct severe acute respiratory syndrome coronavirus (SARS-CoV)-2 viral infiltration into skeletal muscle or an aberrant immune system likely contribute. Similarities between skeletal muscle alterations in PASC and chronic fatigue syndrome deserve further study. Both SARS-CoV-2-specific factors and generic consequences of acute disease likely underlie the observed skeletal muscle alterations in both acute Covid-19 and PASC.
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BACKGROUND: Covid-19 has had a major negative impact on children's engagement in health-related behaviors. This study examines trends in children's screen time, outdoor play and sports club membership in pre- (2016-19), mid- (2020-21) and post- (2021-22) Covid years. Also, predicting factors (gender, age and active commuting) of these health-related behaviors are examined.METHODS: Data were collected via yearly self-report questionnaires among pupils in Grades 3-6 (mean age 10.14 ± 1.25 years; total n over the five cohorts = 6351, 50.8% girls). Multilevel path models were constructed in Mplus to examine whether children's screen time, outdoor play and sports club membership differed between pre-, mid- and post-Covid years; and which factors predicted engagement in these health-related behaviors (using data of all cohorts).RESULTS: During and after Covid-19, children's screen time was higher, while they engaged less in outdoor play and were less often member of a sports club than before. Although these negative trends peaked during Covid-19, they slowly seem to be returning to pre-Covid levels in recent year. Younger children, girls and active commuters had less minutes screen time per day and played outdoors more days per week; boys and active commuters were more often sports club member.CONCLUSIONS: Although in the first year post-Covid children seem to be engaging more in health-related behaviors than during Covid-19, we still found lower levels of engagement than in the years before Covid-19, underlining the importance of early intervention to ensure an appropriate amount of engagement in health-related behaviors for all children.
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The Covid-19 pandemic triggered governments and designers to revalue and redesign public spaces. This paper focuses on the various design responses to Covid-19 proposed and implemented in public spaces. In particular, we identify the kinds of challenges that such design responses address and the strategies that they use. We selected 56 design examples, largely collected from internet sources. By analyzing the design examples we identified five Covid-related challenges that were addressed in public space: sustaining amenities, keeping a distance, feeling connected, staying mentally healthy, and expanding health infrastructures. For each challenge, we articulated 2 to 6 design strategies. The challenges highlight the potential of public space to contribute to more resilient cities during times of pandemic, also in the future. The design strategies show the possible ways in which this potential can be fulfilled. In our next steps, we will use our findings to develop a program of possibilities; this program will contain a wide range of design strategies for responding to future pandemics and will be made publically accessible in an online database. The program contributes to more resilient post-Covid cities, by offering a variety of possibilities for coping with, and adapting to, pandemic-related shocks and stressors.
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Samenvatting Doel Door de COVID-19-pandemie is een nieuwe groep revalidanten ontstaan waarbij voor een deel intensieve multidisciplinaire geriatrische revalidatie cruciaal lijkt te zijn. Gezien de nog beperkt beschikbare wetenschappelijke kennis en ervaring met het ziektebeeld, was er behoefte aan een praktijkgericht groeidocument en een continu cyclisch proces om praktijkkennis en nieuwe wetenschappelijke kennis direct te implementeren in de praktijk. Dit artikel beschrijft het proces van ontwikkeling, implementatie, evaluatie en doorontwikkeling daarvan in de praktijk, welke onder bijzondere omstandigheden heeft plaatsgevonden. Methode Het hele proces van de totstandkoming van het multidisciplinaire CO-FIT+ revalidatieprogramma bestond uit multipele iteraties van de PDCA-cyclus op zowel projectorganisatie-, projectuitvoerings- als implementatieniveau. Het behandeladvies post COVID-19-geriatrische revalidatie van Verenso is gebruikt als leidraad. Dit is aangevuld met de kennis en expertise van de GRZPLUS-professionals, ketenpartners, aanbevelingen vanuit de beroepsverenigingen en kennis uit wetenschappelijk onderzoek onder andere op het gebied van geriatrische (long-)revalidatie en post IC-revalidatie. Resultaten Een multidisciplinair geriatrisch revalidatieprogramma CO-FIT+ welke is geïmplementeerd in de praktijk. Dit heeft geresulteerd in een uniforme werkwijze en een continue verbetercyclus.
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Diaries have been used regularly in various intensive care units (ICUs) in international settings. Hard copy diaries written by relatives became impractical during the COVID-19 pandemic due to ICU visiting restrictions and infection control considerations. The implementation of a web based application, named the “Post-ICU” diary, offered relatives the ability to collaboratively write in a digital diary, to easily upload photos, video and audio clips and to feel engaged with the patient at a safe distance. In addition it allowed nurses to easily provide up-to-date information. The aim of this pilot study was to explore the experiences of ICU nurses with the implementation process and application of the Post-ICU diary.
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Guest post by Lieke Wissink. Lieke is an anthropologist and philosopher who works at the Youth and Society knowledge center, University of Applied Sciences, Amsterdam. She engages in an action-research project with undocumented youths at a day shelter, and carries-out participant observation, group workshops and interviews with residents. This blogpost reflects on feelings of empowerment and precarity as expressed by the shelter members during the Covid-19 pandemic. This post is part of our new themed series on border control and Covid-19.
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