COVID-19 COMMUNITIES OF PRACTICE IN REHABILITATION: 4TH EDITION - Centre de recherche ...
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MARCH 2021 VOL. 04
COVID-19 COMMUNITIES OF PRACTICE
IN REHABILITATION: 4TH EDITION
(ONE YEAR IN COVID-MODE)
Jewish Rehabilitation Hospital-Feil-Oberfeld Research Centre
Clinical support: Best practice
guidelines, sharing of scholarly
articles and resources
As an extension to our Talking Research/Parlons
recherche lunchtime seminars, the CRIR-JRH Feil-
Oberfeld Research Centre of the CISSS Laval is proud to
offer this bulletin which includes:
Practical guidelines adapted to COVID-19
COVID-19 scholarly articles
Resources to support all during these challenging
times,
Look for our periodic bulletin for updates,
Feil-Oberfeld JRH Research Centre
MARCH 2021 VOL.04 Scholarly articles, Best Practice & Resources Literature review of "The impact of vitamin D supplementation on COVID-19" (written by Adina Elena Viadulescu, Dietetics Student, McGill University; Clinical Supervisor: Nadia Tambasco, Dt.P. Dietitian, CVA-Neuro-SINT Program, Jewish Rehabilitation Hospital) COVID-19 pandemic has raised discussions regarding the possible benefits of vitamin D supplementation. As of today, the evidence regarding the influence of vitamin D in preventing and treating the disease is limited. The association between vitamin D deficiency and severity of COVID-19 may be confounded with chronic diseases such as respiratory disorders, heart conditions, hypertension and obesity (Pereira, 2020). A meta-analysis by Pereira et al. selected 27 studies looking at serum vitamin D concentrations of individuals in the adult and elderly group. Increased rates of hospitalization and mortality from COVID-19 were observed in the PHOTO BY MARTIN R. SMITH presence of severe (± 10ng/ml) vitamin D deficiency. However, researchers identified that vitamin D deficiency is not associated with higher rates of infection by COVID-19. Dietitians of Canada (DC) recognizes the possibility that individuals presenting with a vitamin D deficiency might be at increased risk of contracting COVID-19 or experiencing a more severe disease course (Dietitians of Canada, 2020). However, for now, these ideas are based on speculation and indirect evidence. Therefore, DC continues to endorse the recommended intakes for vitamin D of 600 IU for adults (18-70 years old), 800 IU for the elderly (over 71 years old) and 600 IU for pregnant and breastfeeding women. These numbers include vitamin D from both food and supplements (Dietitian of Canada, 2019). Higher doses are not justified and intakes greater than the upper tolerable limit (4000 IU) can lead to toxicity (Dietitians of Canada, 2020). To date, no randomized controlled trials examining the effect of vitamin D to prevent or treat COVID-19 infections have been performed and no consistent beneficial effects for the prevention of respiratory tract infection have been established (Dietitians of Canada, 2020). However, Dr. Francine Ducharme from the CHU Sainte-Justine and Dr. Cécile Tremblay from the CHUM have announced that they will be investigating the possible protective effects of high doses of vitamin D through their study entitled PROTECT. In conclusion, there is no harm in promoting the recommended intakes for vitamin D for general health. However, evidence is lacking to support supplementation with higher doses to prevent or improve the course of COVID-19. References Dietitians of Canada. (2019, Sep 8). What you need to know about Vitamin D. https://www.unlockfood.ca/en/Articles/Vitamins-and-Minerals/What-you-need-to-know-about-Vitamin-D.aspx Dietitians of Canada. Can Vitamin D Supplements Prevent or Improve the Course of COVID-19? In: Practice-based Evidence in Nutrition® [PEN]. 2020 Nov 2 [cited 2021 Feb 8]. Available from: https://www-pennutrition- com.proxy3.library.mcgill.ca/KnowledgePathway.aspx?kpid=28198&trid=28613&trcatid=25#. Access only by subscription. Click Sign Up on PEN login page. Pereira, M., Dantas, D. A., Galvão Azevedo LM, de, A. O. T., & da, M. S. J. (2020). Vitamin d deficiency aggravates covid-19: systematic review and meta-analysis. Critical Reviews in Food Science and Nutrition, 1-9, 1–9. https://doi.org/10.1080/10408398.2020.1841090
MARCH 2021 VOL. 04
Interview of JRH COVID-Unit staff
Courage, leadership & solidarity: JRH COVID Unit staff rose to the challenge
Elizabeth & I approached JRH COVID unit staff to better understand their work experiences having worked on the
COVID unit, and more specifically their resilience strategies. Several staff members participated in this anonymous
interview via questionnaire, and their detailed feedback reflected anecdotes of courage, leadership, & solidarity- a
phenomenological perspective which inspires.
Our JRH COVID Team (By discipline):
MD list- not available; however managed by Dre Lynne Nadeau
Michael Rubino PT
Julie Béland, OT
P H O T OThibault,
Myriam B Y M A R PT
TIN R. SMITH
Judith Roberge, OT
Josée Maltais, TS
Sheila Fishman, SAC
Hélène Tremblay, SLP
Marilyn Ricci, RN
Pamela Houley, RN
Pamela Nassif, RN
Diane Lamontagne, RN
Sophie Marcil, RN
Germaine Danias, RN
Geroge Vertzgarius, Aux. Nurse
Razieh Samsami, Aux. Nurse
Murguette Payoutte, Aux. Nurse
Mona Jean Philippe, Aux. Nurse
Katie Deumaga, Aux. Nurse
Miriam Lindor, PAB
Niyamatullah Ahmadi, PAB
Sammy Cerat, PAB
Guylaine Dubé, Agente Admin.
Houda Manour, Téchnicienne en administration, HJR du CISSS de Laval
Stéphanie Laurin, Coordonnatrice des soins, services et programmes de 2e ligne en déficience physique par intérim,
HJR du CISSS de Laval
Éric Trépanier, Nurse Manager, HJR du CISSS de Laval
Rosa Minichiello, Cheffe du Programme Trauma, HJR du CISSS de Laval
Sheila Fishman, SAC- Programme Trauma, HJR du CISSS de Laval
MARCH 2021 VOL. 04 From left to right: Josée Maltais (SW & newly appointed SAC- Trauma Program), Stéphanie Laurin (Senior JRH Manager), Rosa Minichiello (Trauma Program Head), Michael Rubino (PT- Trauma Program), & Marilyn Ricci (RN & Interim Infection Control Nurse Consultant) « Je félicite les employé(e)s aux services réadaptation pour leur service sous des conditions qui n’étaient pas faciles. Leur capacité d’adaptation a été visible considérant que nous n’avions pas eu accès à une «vraie» unité de soins au rez-de- chaussée pour cet unité clinique de COVID- Zone rouge, et que malgré ceci, la réadaptation, les soins infirmiers ainsi que médicaux ont été dispensés aux chambres. Un merci spécial à Dre Lynne Nadeau qui a géré l’équipe médicale et qui ont d’ailleurs exprimé une appréciation de notre climat de travail à l’HJR; merci aussi à Eric Trépanier- Gestionnaire Infirmier qui a géré l’équipe des soins infirmiers, et finalement à Rosa Minichiello ainsi que Sheila Fishman, Cheffe de Programme Trauma et SAC respectivement qui ont fait la gestion Administrative et clinique pour l’équipe des professionnel(le)s en réadaptation. Bravo à notre équipe en Soins infirmiers qui ont été flexible avec leurs horaires de travail et pour leur esprit d’entraide. » Stéphanie Laurin, Coordonnatrice des soins, services et programmes de 2e ligne en déficience physique par intérim, HJR du CISSS de Laval
MARCH 2021 VOL. 04
How did you become part of the COVID unit staff?
We were solicited by program managers to join the JRH COVID Unit Team and submitted our candidacy individually. We also
noted that The Peds program was entirely redeployed to other programs/institutions within the CISSS, and the idea of
working on the COVID unit offered a stability of sorts in that we would not risk being shuffled to other programs/ to a
CHSLD as many of our colleagues had experienced in the weeks prior to the opening of the «Zone chaude.» Staff members
were concerned at the time: worried about their health & the safety of their families at home. Although we were afraid like
everyone else, we decided to volunteer- at that point, some had to come forward…we felt no different from everyone else
and trusted that our equipment would protect us if we were careful.
What challenges did you face when you worked on the COVID unit?
The biggest challenge was the fear of contamination and becoming infected with the virus. We clearly remember how
scared we felt walking into the unit for the first time- for one professional, «my hands were shaking and my heart was
racing, but once I started working with patients, my fear slowly went way, and I realized that I was doing something
PHOTO BY MARTIN R. SMITH
important.» Other challenges were: the layout & functionality of the unit (since we had to transform office space into a
clinical unit within a couple of weeks and this was no small feat), limited therapeutic equipment, limited space, clients who
were clinically unstable or who were experiencing significant COVID-induced fatigue, client dissatisfaction with isolation
measures, as well as the social isolation of the team from other colleagues in the hospital; this represented a loss of our
support network. Rules/directives changed daily, so we were constantly adjusting. As well, we were being asked to treat
clients with a novel condition which no one was familiar with, and the lack of recognition of our increased contamination
risk given daily contact with COVID clients. Eric did a great job, as he was responsible for the set up of this unit. Although
N95 masks were available for use in case of emergencies, we did not have negative pressure rooms in this new unit space
in case of a medical intervention which could produce aerosols- this is where the Dr. played a key role in transferring clients
to acute care promptly. The SAC did her best but managed our unit remotely, as she was SAC up on 4th as well. Nursing
staff had to go in & out of the hot zone to prepare medication, so this impacted our efficiency in communication. Another
challenge was seeing that relevant information was communicated from the COVID unit to the clinical units upstairs (upon
transfer), as well as team meetings which were held remotely (via speakerphone/«Octopus»). Communication was a
challenge when one could not see who was speaking. Finally, taking notes was a challenge as we were not permitted to
bring a paper & pen in & out of the hot zone.
How did you overcome these?
We quickly looked to one another for support and learned to lower our expectations of the complexity of treatment
dispensed given multiple challenges. We cannot say that the fear of contamination completely abated, but we quickly
developed a buddy system in observing one another don & doff PPE, as most who get contaminated do so during this
process. Unit challenges of having no running water or toilets in the clients’ rooms, bringing medication from a cold to hot
zone, having to monitor confused clients via an infant monitoring system…we had to learn to provide safe care in very
creative ways. Every intervention took much longer to complete than on a conventional clinical unit. Therapy would take
place 2-3 times per day for 10-15 mins at a time to better manage their fatigue & optimize rehab outcomes; sometimes we
had to let them rest & see clients the next day. The SAC used the telephone to lead Rounds and we had a computer which
permitted paperless data entry. Having a doctor onsite at all times was very helpful, as they answered questions we had
and also transferred clients out to acute care if unstable. Rosa would check in daily to monitor issues and brainstormed on
solutions with the SAC.MARCH 2021 VOL. 04
Did you feel supported with the change in your clinical practice?̸ If yes, how? By whom?
Yes, we felt supported by one another on the team, as well as by Éric, Rosa, Sheila, Karla Stéphanie, as well as Sandra who looked
after securing therapeutic equipment. Rosa also provided a team member with a cell phone to facilitate communication at all
times. On the downside, we would have appreciated being less isolated from the rest of the hospital and our colleagues ex.
during lunchtime but understand that this was not possible given the need to follow strict infection control protocol. As well,
hospital-wide Wi-Fi could have really helped so that we could have used Zoom for communicating.
How did you adapt to a new way of working?
We communicated with Nursing staff as well as other team members daily which required facilitation/adaptation to multiple
changes as well as challenges. We learned to do our best with what we had/ the care we could provide. We all adapted our
treatment plans, and every team member was flexible and versatile.
What was positive about working on the unit?
PHOTO BY MARTIN R. SMITH
The fact that we had a small team was good because we quickly learned to work together and had a close connection with our
clients. The constant presence of doctors on the unit was reassuring and they provided expert care in the close follow up of all
COVID clients. Managers saw to it that we had the equipment we needed to remain safe. The experience of working on the
COVID Unit was very positive and was a source of pride for team members. For one staff member: «It was like being a small
family within the hospital.» The team expressed tears of sadness when it closed in August 2020…impressive but true.
What was your role in helping the patients diagnosed with COVID?
We had diverse roles given our professional functions: we all provided clients & families support, however some were
responsible for communicating case info to the clinical units upon transfer, others provided nursing care that entailed close
monitoring of physical, cognitive & emotional status. PTs worked on providing clients with respiratory/chest Physio, progressive
mobilization, gait, endurance balance & stair training, attribution of appropriate walking aids; OTs assessed & treated cognitive
status, mobility status, ADLS and improving their level of function. All communicated their findings to the rest of the team. The
SAC/Clinical Coordinator managed admissions, transfers to the 3rd & 4th floor Clinical units as well as discharges; as well
ensured that all clients had a Plan d’intervention (PII).
How did you know that you had a positive impact on the patients?
Most of the clients and families were appreciative of the care provided. We also made every effort to take the time required to
provide them with updates and to reassure loved ones over the telephone. We also observed that clients improved on a physical
level (more energy and less fatigue).
Did you require new skills to work with this COVID population? If so, please list the new skills or knowledge
required.
We all had to learn how to use the PPE without self-contamination. As well, we had to provide safe, quality care in an
unconventional environment with adherence to strict IPAC protocols. This meant using novel treatment approaches such as: use
of a tablet to communicate with families (both clients & staff). Given that COVID clients presented with various clinical issues, we
had to learn new knowledge-bases rapidly ex. Amputee, CVA, & Pulmonary rehabilitation. The fact that rules were constantly
evolving imposed a learning curve for all regarding testing & contagion.MARCH 2021 VOL. 04
Do you have any other comments?
Overall, we made a good team and working on the COVID Unit was a positive experience. The Doctors on the unit were very
involved in clinical care. The COVID Unit offered a modified Rehab service with multiples clienteles, which meant that all
therapists had to become «polyvalent.» We all lived through a stressful time but the fact that we were not alone made the
experience easier.
Now that we are one year in COVID mode and well into the second wave with vaccinations underway, we know that we have all
championed this collective effort of managing professional development as well as personal risk of COVID exposure through our
work, and so have risen to the challenges that this past year has brought us. On behalf of the JRH-CRIR Feil Oberfeld Research
Centre Staff, thank you to all for your steadfast efforts during this pandemic!
PHOTO BY MARTIN R. SMITH
Article written by: Loredana Campo, pht, Interim Clinical Research Coordinator (JRH), Physiotherapist- JRH Trauma Program,
Candidate- Études supérieures de l’École de Santé Publique de l’Université de Montréal (en ligne pour cadres et professionnels
en exercice), & Clinical CRIR Member (CRIR Research Centre- JRH Site)MARCH 2021 VOL. 04
Recommended
F I G U R E 1 . Ascientific
N G I O T Escholarly
NSIN-CO articles
N V E Ron COVID-19
TIN G ENZYME 2 (ACE2)
EXPRESSION IN THE BRAIN
(Shared by Elizabeth Dannenbaum, pht, MSc- Physiotherapist, JRH Trauma Program (Vestibular) & Clinical CRIR
Member (CRIR Research Centre- JRH Site):
Ahmad, I., Rathore, F.A. (May 24, 2020). Neurological manifestations and complications of
COVID-19: A literature review. Journal of Clinical Neuroscience, 77(2020), p. 8-12
Asadi-Pooya, A.A., Simani, L. (2020). Central nervous system manifestations of COVID-19: A systematic
review, Journal of The Neurological Sciences, 413 (2020) 116832, p. 1-4.
Oxley, T. J. et al. (April 28, 2020). Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young.
New England Journal of Medicine, Case Report, p. 1-3.
Koumpa FS, et al. (Sept. 23, 2020). Case report: Sudden irreversible hearing loss post COVID-19. BMJ, BMJ
Case Rep 2020; 13: e238419. doi:10.1136/bcr-2020-238419.
PHOTO
Zubair, B Y etMal.
A.S. A R(May
T I N R28,
. SM I T H Neuropathogenesis and Neurologic Manifestations of the Coronaviruses in
2020).
the Age of Coronavirus Disease 2019 A Review, JAMA Neurology 2020, Clinical Review & Education
(online publication).
OTHER USEFUL BEST PRACTICE RESOURCES:
McGill University COVID-19 Research Developments: https://www.mcgill.ca/covid19research/
Global Research for Coronavirus disease: https://www.who.int: articles are divided by subheading ex.
COVID-19 PubMed Search Alert: https://www.edc.gov.library/research
COVID RESOURCES FROM CISSS LAVAL:
As of Oct. 2nd, the CISSS Laval has launched a new COVID hotline destined for Managers, Clinical Staff, Student &
Volunteers which can be reached at (450) 975-5070; or internally by dialing # 55070. This COVID telephone line is
meant to respond to questions related to COVID for such issues as:
1. If you are having difficulty or experiencing distress related to COVID
2. If you are experiencing symptoms consistent with viral Gastro-enteritis
3. To signal all absences related to COVID, to obtain an evaluation of your health condition or require recommendations
if you have been in contact with a confirmed COVID-19 case.
4. If you are a Manager and have questions related to recommendations to give to your staff
5. If you would like to take an appointment to take a COVID-19 screening testMARCH 2021 VOL. 04 Psychosocial Help: 11) For Health Care Staff: Service téléphonique de soutien : 450 975-4150, poste 4350 de 9h à 21h, 7 jours sur 7 Service anonyme et confidentiel, donné par des professionnels en intervention psychosociale du CISSS de Laval 2) CRIR : New! Veille informationnelle psychosociale and COVID-19 Question|Answer: consult the internet page of the direction de l’enseignement universitaire et de la recherche du CCSMTL (http://ccsmtl-biblio.ca/; psychosocial help offered for varied patient populations) 3)Inspirational music (songlist) prepared by Loredana Campo, Interim Clinical Research Coordinator & Vira Rose, Administrative Agent (CRIR Research Centre- JRH Site): These songs reflect our path over this challenging year and is also meant to encourage us all to persevere. 1. You Are The Champions by Queen (version Lockdown): Queen Adam Lambert - 'You Are The Champions' (New Lockdown version! Recorded on mobile phones!) - Bing video 2. Lean On Me by Bill Withers: Bill Withers. Lean On Me. - Bing video 3. “Count on Me” by Bruno Mars: Bruno Mars - Count On Me (Official Video) - Bing video 4. Symphonie Confinée- La Tendresse by Valentin Vander : Symphonie confinée - La tendresse - Bing video 5. Requiem (version française) by Alma: Alma - Requiem (Clip officiel) - YouTube 6. Requiem- version de Verdi by Mauro Ivano Benaglia: REQUIEM di Verdi - INTEGRAL VERSION - MAURO IVANO BENAGLIA, Conductor - Duomo Milan - YouTube 7. Amazing Grace by Amira Willighagen: Amira Willighagen ~ Live in Concert ~ Amazing Grace - Bing video 8. Alleluia (version française) by Edith Martel : Alleluia (Hallelujah) version française interprétée par Edith Martel - YouTube 9. Tout Essayer by Zootopie: Tout essayer (Try everything) - Zootopie - French Fandub - YouTube 10. Try Everything by Shakira : Shakira - Try Everything (From "Zootopia") [Official Music Video] - YouTube 11. I’m Still Standing by Sir Elton John: Elton John - I'm Still Standing - Bing video 12. The Prayer by Andrea Bocelli et Céline Dion: Andrea Bocelli, Céline Dion - The Prayer - Bing video 13. Firework by Katy Perry: https://www.youtube.com/watch?v=JdwmJIZyjx4 *Your input to the Research Bulletin is welcome: Contact Loredana Campo, Interim Clinical Research Coordinator (lcampo_hjr@ssss.gouv.qc.ca) or Elizabeth Dannenbaum, Researcher via email (edannenbaum@ssss.gouv.qc.ca)
MARCH 2021 VOL. 04
'Stronger together'
Newsletter Staff:
Chief Editor: Dr. Aliki Thomas
Managing Editor: Loredana Campo
Content contributor: Elizabeth Dannenbaum
Graphic Designer & Formatting: Angeliki Gketsou
Administrative Support: Vira RoseYou can also read
