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2.
S Afr Med J ; 111(10): 934-937, 2021 08 17.
Article in English | MEDLINE | ID: covidwho-1478412

ABSTRACT

Some clinicians prescribe ivermectin for COVID-19 despite a lack of support from any credible South African professional body. They argue that when faced by clinical urgency, weak signals of efficacy should trigger action if harm is unlikely. Several recent reviews found an apparent mortality benefit by including studies at high risk of bias and with active rather than placebo controls. If these studies are discounted, the pooled mortality effect is no longer statistically significant, and evidence of benefit is very weak. Relying on this evidence could cause clinical harm if used to justify vaccine hesitancy. Clinicians remain responsible for ensuring that guidance they follow is both legitimate and reliable. In the ivermectin debate, evidence-based medicine (EBM) principles have largely been ignored under the guise thatin a pandemic the 'rules are different', probably to the detriment of vulnerable patients and certainly to the detriment of the profession's image. Medical schools and professional interest groups are responsible for transforming EBM from a taught but seldom-used tool into a process of lifelong learning, promoting a consistent call for evidence-based and unconflicted debate integral to clinical practice.


Subject(s)
COVID-19/drug therapy , Ivermectin/administration & dosage , Practice Patterns, Physicians'/standards , /psychology , COVID-19 Vaccines/administration & dosage , Evidence-Based Medicine/standards , Humans , Ivermectin/adverse effects , Research Design , South Africa
3.
Journal of Cystic Fibrosis ; 20:S65, 2021.
Article in English | EMBASE | ID: covidwho-1368825

ABSTRACT

Objectives: The impact of the SARS-CoV-2 pandemic on people living with cystic fibrosis (PWCF) in Ireland was investigated by comparing the utilisation of regular hospital facilities in 2020, with data collected in 2019. Methods: All data were collated by the Cystic Fibrosis Registry of Ireland (CFRI). Comparisons were made between PWCF's access to regular hospital facilities utilised for the treatment and management of their condition prior to the outbreak of the pandemic in 2019, and preliminary data during the pandemic in 2020. A descriptive analysis of the differences between key outcome measure data was conducted. The outcome measures analysed were (i) the number and type of encounters, (ii) the number of virtual clinics, (iii) the number of pulmonary function tests (PFTs) carried out, (iv) the number of hospital admissions, and (v) the number of individuals receiving home intravenous antibiotic treatment. Results: In 2019, encounter data were recorded for 1,254 individuals, compared to 1,143 in 2020. Overall, fewer encounters took place in 2020 (5,346) than in 2019 (7,947). Decreases were observed across all in-person hospital encounter types in 2020, when compared with 2019 (annual review: 273 vs 747;day-unit review: 1,792 vs 2,864;drop-in: 115 vs 277;OPD appointment: 1,064 vs 3,289). However, since the outbreak of the pandemic, 1,696 virtual encounters occurred. Significantly, the number of PFTs carried out decreased by 58% in 2020 (2,283), when compared with 2019 (5,458). Of the 1,696 virtual encounters, only 183 (10.8%) saw PFTs carried out. Conclusion: Our analysis has shown a clear reduction in the utilisation of usually regular hospital resources by PWCF in 2020 when compared with 2019. In-person hospital encounters have decreased by 55% in total, highlighting the significant impact that the SARS-CoV-2 pandemic has had on PWCF.

5.
Samj South African Medical Journal ; 110(11):1077-1080, 2020.
Article in English | Web of Science | ID: covidwho-979208

ABSTRACT

The COVID-19 pandemic requires urgent decisions regarding treatment policy in the face of rapidly evolving evidence. In response, the South African Essential Medicines List Committee established a subcommittee to systematically review and appraise emerging evidence, within very short timelines, in order to inform the National Department of Health COVID-19 treatment guidelines. To date, the subcommittee has reviewed 14 potential treatments, and made recommendations based on local context, feasibility, resource requirements and equity. Here we describe the rapid review and evidence-to-decision process, using remdesivir and dexamethasone as examples. Our experience is that conducting rapid reviews is a practical and efficient way to address medicine policy questions under pandemic conditions.

6.
GMP Review ; 19(2):4-7, 2020.
Article in English | Scopus | ID: covidwho-964226

ABSTRACT

This paper describes how the exclusive focus on non-clinical and clinical data collection during the development of medicines and healthcare products results in supply chains that are riddled with risk and issues. In the main, this is due to little awareness among actors in the development process of the seminal impact decisions taken here can have on the quality, cost and lead-time performance of the future commercial supply chain. In the author’s experience, things will only begin to improve if product developers open their minds to a totally new model for product development – one that begins with its end-users – patients and healthcare professionals. The paper concludes with a call for strategic supply chain management being exercised from the inception of a development programme. © 2020, Euromed Communications. All rights reserved.

8.
S Afr Med J ; 110(9): 842-845, 2020 07 17.
Article in English | MEDLINE | ID: covidwho-743542

ABSTRACT

Antibody tests for the novel coronavirus, SARS-CoV2, have been developed both as rapid diagnostic assays and for high-throughput formal serology platforms. Although these tests may be a useful adjunct to a diagnostic strategy, they have a number of limitations. Because of the antibody and viral dynamics of the coronavirus, their sensitivity can be variable, especially at early time points after symptom onset. Additional data are required on the performance of the tests in the South African population, especially with regard to development and persistence of antibody responses and whether antibodies are protective against reinfection. These tests may, however, be useful in guiding the public health response, providing data for research (including seroprevalence surveys and vaccine initiatives) and development of therapeutic strategies.


Subject(s)
Betacoronavirus , Clinical Laboratory Techniques , Coronavirus Infections , Immunologic Tests/methods , Pandemics , Pneumonia, Viral , Serologic Tests/methods , Betacoronavirus/genetics , Betacoronavirus/immunology , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Clinical Laboratory Techniques/standards , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/immunology , Humans , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/immunology , Reproducibility of Results , SARS-CoV-2 , Sensitivity and Specificity , Seroepidemiologic Studies , South Africa/epidemiology
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