Knowledge and preference of Filipino COPD patients on advance care planning: A cross-sectional survey

Objectives@#To explore the current experiences and perspectives of patients with chronic obstructive pulmonary disease (COPD) with advance care planning (ACP).@*Methods@#A cross-sectional survey was conducted among patients diagnosed with COPD in the Philippine General Hospital. Results were illustrated using descriptive statistics.@*Results@#A total of 90 patients were interviewed and included in the analysis. Nearly all patients were unfamiliar with the terms ACP (95.55%), end-of-life care (99.89%), and do-not-resuscitate order (100%). The majority expressed a desire to have ACP discussions (94.44%) which were not viewed as distressing and were deemed beneficial (96.67%). Patients who were employed were more likely to express readiness to sign legal papers. Patients living with their nuclear family or living alone, and those with higher COPD assessment test (CAT) scores were more likely to relegate health care decisions to their doctors.@*Conclusion@#Most patients with COPD in our cohort are unfamiliar with ACP and have not received ACP discussions. Most think that it will improve healthcare and quality of life. Some demographic and clinical factors may make patients more likely to engage in ACP-related activities.

Should vitamin C/Ascorbic acid infusion be used in the treatment of COVID-19?

Key Findings@#There is no direct evidence available as of this point for efficacy of intravenous vitamin C as an adjunctive treatment in preventing mortality or shortening disease course among adults suspected of, or positive for COVID-19. • Vitamin C is currently not mentioned in the treatment guidelines for COVID. • Currently, there are 3 ongoing trials registered in clinicaltrials.gov studying intravenous vitamin C in COVID-19. No other ongoing or planned trials were registered in the other trial registries. • Most of the available data are from studies on disease populations which may be considered as COVID-19 suspects:  Conflicting results on mortality from indirect evidence among patients with sepsis with or without ARDS with significant reduction in mortality found in only a small subset of patients (n-40) with severe sepsis given high dose Vitamin C infusion.  Strong evidence supporting no mortality benefit from 5 meta-analyses on critically ill patients due to conditions other than or in combination with sepsis who were given Vit C infusion alone or in combinations with other medications. One meta-analysis showed benefit in decreasing duration of ICU stay and mechanical ventilation but sample size is small. Most showed no benefit on and other key endpoints such as acute kidney injury, duration of hospital stay/ ICU stay/ duration of vasopressor use or duration of mechanical ventilation. • The use of Vit C infusion is not mentioned in the treatment guidelines for COVID-19 or ARDS. • The risks or adverse events with short term use of Vitamin C infusion in the general population is negligible or minimal. It should be avoided in patients with G6PD insufficiency. The dose should be carefully adjusted for patients with renal insufficiency.