COVID-19 Knowledge Translation

Long-Term Care Homes: LTC – IPAC+^{In progress}

Funded by: John and Myrna Daniels Foundation, COVID-19 Immunity Task Force, Canadian Immunization Research Network
Knowledge user: Long term care homes, Public Health Ontario
Led by: Drs. Sharon Straus, Sharmistha Mishra, Stef Baral and Tina Fahim, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto; Dr. Adrienne Chan, Sunnybrook Research Institute, Toronto; Dr. Allison McGeer, Mt. Sinai Hospital, Toronto.

Description:
The COVID-19 pandemic has identified critical challenges with preventing and managing outbreaks in long-term care homes (LTCH whose frail and medically complex population is at highest risk of morbidity and mortality). Worldwide, Canada has one of the highest COVID-19 mortality rates for older adults living in LTCH facilities; more than 80% of COVID-19 related deaths are associated with LTCH homes. Guidance from the Ontario Ministry of Health (MOH) mandated that acute care hospitals must provide support to LTC and retirement homes to assist with outbreak preparation and management. The Solution: Our team recently completed a scoping review of infection prevention and control measures (IPAC) that informed the WHO’s guidance document for COVID-19. We have now used this evidence to co-create IPAC+. IPAC+ is a rapidly-scalable, checklist-based tool and implementation strategy to optimize IPAC measures in LTCH along with staff wellness and resilience. It was co-created with end users; specifically, barriers and facilitators to implementation of IPAC measures were identified and mapped to effective intervention strategies. Resources include those focused on optimizing physical and mental wellness for LTCH staff. Partners include the Canadian Foundation for Healthcare Improvement, Public Health Ontario, and the Regional Geriatric Program amongst many others.

We also received funding from the COVID-19 Immunity Task Force to expand our work in this area. With this funding, we will estimate the change in prevalence and correlates of prior SARS-CoV-2 infection and factors associated with infection in a diverse population of LTCH residents, their essential family visitors/caregivers, and LTCH staff and their household members. We will use an integrated KT approach to implement and evaluate a rapidly scalable infection prevention and control intervention (IPAC+) on preventing infections across the four populations.  This project has more than 40 partners, including caregivers of LTCH residents, Family Councils Ontario, Ontario PSW Association, Ontario Long-term Care Association, PHAC, Public Health Ontario, and the National Microbiology Lab, amongst others.

We also received funding to co-create tailored messaging with LTCH staff to reduce COVID-19 (SARS-CoV-2) vaccine hesitancy and to determine the impact of such tools, coupled with tailored facilitation, on rates of LTCH staff vaccinations. Vaccine hesitancy among long-term care home (LTCH) staff presents a significant challenge to COVID-19 vaccine implementation. We will form a working group of diverse LTCH stakeholders to steer the study. We will engage LTCH staff to identify barriers to vaccination including common questions/myths leading to hesitancy. These findings will be used to create accessible, evidence-based tools. Tools will be iteratively created/updated based on need and tailored to LTCH populations as needed. Tools will be disseminated via the ongoing IPAC+ study; intervention sites will receive tailored tools + tailored facilitation, control sites will receive the tailored tools only. We will assess rate of vaccinations and rate of intentions to receive the vaccine, over time.

Products/ results to date:
(1) the creation of a publicly available infection prevention and control tool repository (https://www.rgptoronto.ca/resources/ipac+/),
(2) the development of an interactive tool for LTC self-assessment of IPAC preparedness
(3) infographics addressing common myths/questions related to COVID-19 vaccines created and publicly disseminated.  Link to infographic
(4) partnered with the Ontario Personal Support Workers Association to deliver a town hall link to view, which was attended by:

• Ontario Minister of Long-Term Care Dr. Merrilee Fullerton,
• Chief Coroner (responsible for vaccine rollout) Dr. Dirk Huyer,
• Drs Allison McGeer, Upton Allen
• Infection Prevention And Control leads Erickson Velasco, Shara Junaid

Project partners

CARE+ (In progress)^{In progress}

Funded by: Ontario Ministry of Labour (subagreement with the University of Toronto)
Knowledge user: Long term care homes, Public Health Ontario
Led by: Drs. Sharon Straus, Sharmistha Mishra, Stef Baral and Tina Fahim, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto; Dr. Adrienne Chan, Sunnybrook Research Institute, Toronto; Dr. Allison McGeer, Mt. Sinai Hospital, Toronto

Description:

Our partners in LTC have highlighted concerns that impact IPAC implementation, such as occupational health and safety (OHS) issues, wellness, and mental health challenges. To date, there is no comprehensive repository that provides plain-language, accessible tools to support LTC homes to address such OHS challenges during COVID-19. We will create a repository titled CARE+to compile and create OHS, wellness and mental health resources to support LTC staff (specifically personal support workers (PSWs)) during COVID-19. CARE+ will build on our IPAC+ repository. This work will support tailored implementation efforts at LTCs in Ontario to implement CARE+ and IPAC+ resource recommendations. This work will be completed in partnership with the Ontario PSW Association.

Products/ results to date:
Resources for the CARE+ repository have been compiled and will be posted online via the LTCH HUB website by end of January 2021.

Inforgraphic

Comparing the accuracy of virtual and in-person comprehensive geriatric assessments and determining barriers and facilitators to the conduct of virtual assessments ^{In progress}

Funded by: Mary Trimmer Chair, University of Toronto
Knowledge user: Regional Geriatric Program

Led by: Dr. Jennifer Watt, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto

Description:
With the COVID pandemic, there was a shift from in-person to virtual ambulatory patientcare where possible. In-person assessments were prioritized for those individuals who needed to be seen urgently. This rapid shift to virtual care presented challenges and opportunities. Overnight, physicians focused on supporting patients via telephone/web-platforms. However, this shift also exposed challenges – what is the accuracy of the clinical assessment (such as cognitive testing) when done over the telephone versus in-person? How can patients be assessed as outpatients when they don’t have a computer or smartphone? Does virtual care lead to more health inequities? This project will advance our knowledge of how best to meet the needs of older adults requiring ambulatory care.

Products/ results to date:
In progress

Developing strategies and tools to combat misinformation, fear and stigma in the wake of COVID-19 ^{In Progress}

Funded by: Canadian Institutes of Health Research
Led by: Drs. Tina Fahim, Sharon Straus, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto. In partnership with the University of Laval, University of Ottawa and the Singapore GERI Team

Description:
The primary goal of this study is to develop strategies and tools to combat misinformation as it relates to stigma and fear during an outbreak. To achieve this objective, we have partnered with the Chinese Canadian National Council for Social Justice (CCNC-SJ) and the Chinese Canadian National Council Toronto Chapter (CCNCTO), which are advocacy organizations aiming to eliminate stigma and racism facing Chinese- and Asian-Canadians. Additionally, we have engaged the Yee Hong Center for Geriatric Care to ensure the perspectives of healthcare providers caring for a primarily Chinese-Canadian population are considered.

Read more about this project.

Products/ results to date:
In progress

Care provider models in long-term care: a scoping review ^{In Progress}

Funded by: SPOR Evidence Alliance
Knowledge user: Royal Society of Canada
Led by: Dr. Brian Hutton in partnership with Sharon Straus, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto

Description:
We are working on a rapid scoping review looking at effective models of provider care in long-term care facilities. This builds on the Restoring Trust document, which was published by the Royal Society of Canada.

Products/ results to date:
Publication in preparation

Preventing Respiratory Illness in Older Adults Aged 60 Years and Above Living in Long-Term Care: A Rapid Overview of Reviews ^{In Progress}

Funded by: World Health Organization
Knowledge user: Infection Prevention & Control, Health Emergencies Programme, World Health Organization
Led by: Dr. Andrea Tricco, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto

Description:
This review provides an overview of the effectiveness of infection prevention and control measures that have been studied in systematic reviews.

Products/ results to date:
Journal Article

Guidelines for Preventing Respiratory Illness in Older Adults Aged 60 Years and Above Living in Long-Term Care: A Rapid Review of Clinical Practice Guidelines ^Completed

Funded by: World Health Organization
Knowledge user: Infection Prevention & Control, Health Emergencies Programme, World Health Organization
Led by: Dr. Andrea Tricco, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto

Description:
This review provides a comprehensive overview of existing CPGs for long-term care facilities published across the globe and summarizes their recommendations for infection prevention and management.

Products/ results to date:
Journal Article

Preventing the Transmission of Coronavirus (COVID-19) in Older Adults Aged 60 Years and Above Living in Long-Term Care: A Rapid Review ^Completed

Funded by: Canadian Frailty Network
Knowledge user: Canadian Frailty Network
Led by: Dr. Andrea Tricco, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto

Description:
This review provides a comprehensive review of current evidence and guidelines for infection prevention and control measures specific to COVID-19 populations.

Products/ results to date:
Research brief
Journal Article

Restoring Trust: COVID-19 and the Future of Long-Term Care

Dr. Sharon Straus, KT Program Director, is a co-lead on this report.

• Restoring Trust: COVID-19 and The Future of Long-Term Care - June 2020
• Resilient Research – August 17, 2020 - Royal Society 
• What’s Missing from Discussions on Nursing Homes – May 21, 2020 – Royal Society 
• Unintended Consequences – May 22, 2020 – Royal Society 
• We Must Act Now to Prevent a Second Wave of Long-Term Care Deaths – June 10, 2020 – Royal Society

Publications (completed):

Find the completed publications below:

• Arevalo-Rodriguez I, Tricco AC, Nussbaumer-Streit B, Steingart KR, Kaunelis D, Alonso-Coello P, Bossuyt PM, Javier Z. Developing rapid reviews of diagnostic tests in the time of COVID-19: current knowledge and future steps. In: Collaborating in Response to COVID-19: Editorials and methods initiatives across Cochrane. Cochrane Database of Systematic Reviews, (12 Suppl 1):[32-36]. 2020 Dec 10.
• Rios P, Radhakrishnan A, Williams C, Ramkissoon N, Cormack GV, Grossman MR, Muller MP, Straus SE, Tricco AC. Preventing the transmission of COVID-19 and other coronaviruses in older adults aged 60 years and above living in long-term care: a rapid review. Systematic reviews. 2020 Dec;9(1):1-8.
  Research Brief
• Wang L, Ma H, Yiu KC, Calzavara A, Landsman D, Luong L, Chan AK, Kustra R, Kwong JC, Boily MC, Hwang S. Heterogeneity in testing, diagnosis and outcome in SARS-CoV-2 infection across outbreak settings in the Greater Toronto Area, Canada: an observational study. CMAJ open. 2020 Oct;8(4):E627.
• Tricco AC, Garritty CM, Boulos L, Lockwood C, Wilson M, McGowan J, McCaul M, Hutton B, Clement F, Mittmann N, Devane D. Rapid review methods more challenging during COVID-19: commentary with a focus on 8 knowledge synthesis steps. Journal of clinical epidemiology. 2020 Oct 1;126:177-83.
• Holmes B, Straus SE. Resilient Research. The Globe and Mail. 2020 August 6.
• Mishra S, Wang L, Ma H, Yiu KC, Paterson JM, Kim E, Schull MJ, Pequegnat V, Lee A, Ishiguro L, Coomes E. Estimated surge in hospital and intensive care admission because of the coronavirus disease 2019 pandemic in the Greater Toronto Area, Canada: a mathematical modelling study. CMAJ open. 2020 Jul;8(3):E593.
• Estabrooks C, Flood C, Straus S. We must act now to prevent a second wave of long-term care deaths. The Globe and Mail. 2020 June 10.
• Estabrooks CA, Straus S, Flood CM, Keefe J, Armstrong P, Donner G, Boscart V, Ducharme F, Silvius J, Wolfson M. Restoring trust: COVID-19 and the future of long-term care. A Policy Briefing by the Working Group on long-Term Care. Royal Society of Canada. 2020 June.
• Straus SE, Watt J. Unintended consequences. RSC COVID-19 Series, Publication #11. 2020 May 22.
• Armstrong P, Straus SE. What’s missing from discussions on nursing homes. RSC COVID-19 Series, Publication #10. 2020 May 21.
• Rios P, Radhakrishnan A, Antony J, Thomas SM, Muller M, Straus SE, Tricco AC. Effectiveness and safety of antiviral or antibody treatments for coronavirus. medRxiv. 2020 Jan 1. (pre-print)
• Rios P, Radhakrishnan A, Thomas SM, Darvesh N, Straus SE, Tricco AC. Guidelines for preventing respiratory illness in older adults aged 60 years and above living in long-term care: A rapid review of clinical practice guidelines. medRxiv. 2020 Jan 1. (pre-print)
• Dugas M, Carnovale V, Poirier AA, Mailot B, Skidmore B, Faust L, Costello C, Thomson D, Majnemer A, Goldowitz D, Miller S. COVID-19 in Children with Brain-Based Developmental Disabilities: A Rapid Review. medRxiv. 2020 Jan 1. (pre-print)
• Antony J, Rios P, Williams C, Ramkissoon N, Straus SE, Tricco AC. Safety and effectiveness of dose-sparing strategies for seasonal influenza vaccine: a rapid scoping review of fractional dosing of the intramuscular influenza vaccine. medRxiv. 2020 Jan 1. (pre-print)

Publications (in progress)

Find publications in progress below:

• Conducted a rapid review: Testing for Asymptomatic COVID-19: A rapid systematic review and jurisdictional/ healthcare organizational scan
• Intradermal versus Intramuscular Administration of Influenza Vaccination
• Rapid scoping review of fractional dosing of the intramuscular influenza vaccine
• Preventing the transmission of coronavirus (COVID-19) in older adults aged 60 years and above living in long-term care: a rapid review. Manuscript submitted: currently under revisions with the Systematic Review Journal. Authors : Patricia Rios, Amruta Radhakrishnan, Chantal Williams, Naveeta Ramkissoon, Ba’ Pham, Gordon V. Cormack, Maura R. Grossman
• Updated a review entitled “Transmission of Acute Respiratory Infections During Aerosol Generating Medical Procedures: Update of 2011 CADTH Systematic Review”. The report provides an overview of the 2011 CADTH report and presents a synthesis of updated findings.
• Conducted a rapid scoping review: Rapid scoping review of the effectiveness and safety of treatments for COVID-19 and other coronaviruses that cause serious respiratory tract infections
• Conducted a review: Efficacy and safety of treatments (antivirals and antibodies) for coronavirus (CoV)
• Conducted a review: Digital Health Interventions for the Prevention, Detection and Management of Mental Health Problems in People with Chronic Diseases
• Conducted a review: Rapid and Point-of-Care Diagnostic Test for SARS-COV-2 (COVID-19): A Rapid Summary
• Conducted a review: Risk of Acquiring COVID-19 Associated with Singing in a Choir: A Quick Response Report