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      La Geriatría de Enlace con residencias en la época de la COVID-19. Un nuevo modelo de coordinación que ha llegado para quedarse Translated title: Liaison geriatrics with nursing homes in COVID time. A new coordination model arrived to stay

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          Abstract

          Las personas mayores residentes en instituciones cumplen criterios de pacientes geriátricos complejos, pero con frecuencia no tienen resueltas sus necesidades sanitarias. La pandemia de COVID-19 ha hecho evidentes los déficits existentes en la atención sanitaria a estas personas. Como respuesta a ello surge la necesidad de mejorar la coordinación entre hospitales y residencias, lo que en Madrid se ha materializado en la implantación de equipos o unidades de Geriatría de Enlace en los hospitales públicos. Respecto a las acciones frente a la pandemia por COVID-19, la Sociedad Española de Geriatría y Gerontología ha definido el papel de los geriatras en esta función y ha dado directrices sobre prevención, detección precoz, aislamiento y sectorización, formación, clasificación de las residencias, coordinación de las derivaciones y papel de los diferentes niveles asistenciales, entre otras. Estas unidades también deben dirigir su actividad hacia otras áreas de atención actualmente deficitarias como la coordinación, las visitas presenciales en los centros, las sesiones de telemedicina, la valoración geriátrica en los servicios de urgencias y la coordinación con atención primaria y salud pública. En este artículo se describe la generación del concepto y la implantación de la Geriatría de Enlace en la Comunidad de Madrid a raíz de la pandemia de COVID-19 y se ilustra con los datos de actividad de una unidad cuyo hospital tiene en su área un elevado número de residencias. El objetivo es ayudar a comprender la necesidad de esta actividad, para evitar la fragmentación de cuidados existente en la actualidad entre hospitales y residencias. Actividad que debería consolidarse y mantenerse en el futuro.

          Translated abstract

          Older people living in nursing homes fulfil the criteria to be considered as geriatric patients, but they often do not have met their health care needs. Current deficits appeared as a result of COVID-19 pandemic. The need to improve the coordination between hospitals and nursing homes emerged, and in Madrid it materialized with the implantation of Liaison Geriatrics teams or units at public hospitals. The Sociedad Española de Geriatría y Gerontología has defined the role of the geriatricians in the COVID-19 pandemic and they have given guidelines about prevention, early detection, isolation and sectorization, training, care homes classification, patient referral coordination, and the role of the different care settings, among others. These units and teams also must undertake other care activities that have a shortfall currently, like nursing homes-hospital coordination, geriatricians visits to the homes, telemedicine sessions, geriatric assessment in emergency rooms, and primary care and public health services coordination. This paper describes the concept of Liaison Geriatrics and its implementation at the Autonomous Community of Madrid hospitals as a result of COVID-19 pandemic. Activity data from a unit at a hospital with a huge number of nursing homes in its catchment area are reported. The objective is to understand the need of this activity in order to avoid the current fragmentation of care between hospitals and nursing homes. This activity should be consolidated in the future.

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          Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility

          Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can spread rapidly within skilled nursing facilities. After identification of a case of Covid-19 in a skilled nursing facility, we assessed transmission and evaluated the adequacy of symptom-based screening to identify infections in residents. Methods We conducted two serial point-prevalence surveys, 1 week apart, in which assenting residents of the facility underwent nasopharyngeal and oropharyngeal testing for SARS-CoV-2, including real-time reverse-transcriptase polymerase chain reaction (rRT-PCR), viral culture, and sequencing. Symptoms that had been present during the preceding 14 days were recorded. Asymptomatic residents who tested positive were reassessed 7 days later. Residents with SARS-CoV-2 infection were categorized as symptomatic with typical symptoms (fever, cough, or shortness of breath), symptomatic with only atypical symptoms, presymptomatic, or asymptomatic. Results Twenty-three days after the first positive test result in a resident at this skilled nursing facility, 57 of 89 residents (64%) tested positive for SARS-CoV-2. Among 76 residents who participated in point-prevalence surveys, 48 (63%) tested positive. Of these 48 residents, 27 (56%) were asymptomatic at the time of testing; 24 subsequently developed symptoms (median time to onset, 4 days). Samples from these 24 presymptomatic residents had a median rRT-PCR cycle threshold value of 23.1, and viable virus was recovered from 17 residents. As of April 3, of the 57 residents with SARS-CoV-2 infection, 11 had been hospitalized (3 in the intensive care unit) and 15 had died (mortality, 26%). Of the 34 residents whose specimens were sequenced, 27 (79%) had sequences that fit into two clusters with a difference of one nucleotide. Conclusions Rapid and widespread transmission of SARS-CoV-2 was demonstrated in this skilled nursing facility. More than half of residents with positive test results were asymptomatic at the time of testing and most likely contributed to transmission. Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission after SARS-CoV-2 introduction into this facility.
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            Interactive telemedicine: effects on professional practice and health care outcomes.

            Telemedicine (TM) is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. As TM applications continue to evolve it is important to understand the impact TM might have on patients, healthcare professionals and the organisation of care.
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              Coronavirus Disease 2019 in Geriatrics and Long-term Care: The ABCDs of COVID-19: COVID-19 in Geriatrics and Long-Term Care

              The pandemic of coronavirus disease of 2019 (COVID-19) is having a global impact unseen since the 1918 worldwide influenza epidemic. All aspects of life have changed dramatically for now. The group most susceptible to COVID-19 are older adults and those with chronic underlying medical disorders. The population residing in long-term care facilities generally are those who are both old and have multiple comorbidities. In this article we provide information, insights, and recommended approaches to COVID-19 in the long-term facility setting. Because the situation is fluid and changing rapidly, readers are encouraged to access frequently the resources cited in this article. J Am Geriatr Soc 68:912-917, 2020.
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                Author and article information

                Journal
                Rev Esp Geriatr Gerontol
                Rev Esp Geriatr Gerontol
                Revista Espanola De Geriatria Y Gerontologia
                SEGG. Published by Elsevier España, S.L.U.
                0211-139X
                1578-1747
                13 January 2021
                13 January 2021
                Affiliations
                [a ]Servicio de Geriatría. Hospital Universitario La Paz, Madrid, España
                [b ]Facultad de Medicina. Universidad Autónoma de Madrid, Madrid, España
                [c ]Instituto de Investigación IdiPAZ, Hospital Universitario La Paz, Madrid, España
                [d ]Unidad de Geriatría de Enlace, Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España
                [e ]Coordinación Sociosanitaria. Consejería de Sanidad,Madrid, España
                Author notes
                [* ]Autor para correspondencia.
                Article
                S0211-139X(21)00003-2
                10.1016/j.regg.2021.01.002
                7836697
                33642134
                c985a75f-fce2-487e-9eae-7194e7cc40e6
                © 2021 SEGG. Published by Elsevier España, S.L.U. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                Punto De Vista

                asistencia geriátrica,residencias de personas mayores,covid-19,recursos de atención sanitaria,geriatric care,nursing homes,health-care resources

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