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1.
JAMA Pediatr ; 176(3): 253-261, 2022 Mar 01.
Article in English | MEDLINE | ID: covidwho-1864300

ABSTRACT

IMPORTANCE: Childhood community-acquired pneumonia (CAP) is usually treated with 10 days of antibiotics. Shorter courses may be effective with fewer adverse effects and decreased potential for antibiotic resistance. OBJECTIVE: To compare a short (5-day) vs standard (10-day) antibiotic treatment strategy for CAP in young children. DESIGN, SETTING, AND PARTICIPANTS: Randomized double-blind placebo-controlled clinical trial in outpatient clinic, urgent care, or emergency settings in 8 US cities. A total of 380 healthy children aged 6 to 71 months with nonsevere CAP demonstrating early clinical improvement were enrolled from December 2, 2016, to December 16, 2019. Data were analyzed from January to September 2020. INTERVENTION: On day 6 of their originally prescribed therapy, participants were randomized 1:1 to receive 5 days of matching placebo or 5 additional days of the same antibiotic. MAIN OUTCOMES AND MEASURES: The primary end point was the end-of-treatment response adjusted for duration of antibiotic risk (RADAR), a composite end point that ranks each child's clinical response, resolution of symptoms, and antibiotic-associated adverse effects in an ordinal desirability of outcome ranking (DOOR). Within each DOOR rank, participants were further ranked by the number of antibiotic days, assuming that shorter antibiotic durations were more desirable. Using RADAR, the probability of a more desirable outcome was estimated for the short- vs standard-course strategy. In a subset of children, throat swabs were collected between study days 19 and 25 to quantify antibiotic resistance genes in oropharyngeal flora. RESULTS: A total of 380 children (189 randomized to short course and 191 randomized to standard course) made up the study population. The mean (SD) age was 35.7 (17.2) months, and 194 participants (51%) were male. Of the included children, 8 were Asian, 99 were Black or African American, 234 were White, 32 were multiracial, and 7 were of unknown or unreported race; 33 were Hispanic or Latino, 344 were not Hispanic or Latino, and 3 were of unknown or unreported ethnicity. There were no differences between strategies in the DOOR or its individual components. Fewer than 10% of children in either strategy had an inadequate clinical response. The short-course strategy had a 69% (95% CI, 63-75) probability of a more desirable RADAR outcome compared with the standard-course strategy. A total of 171 children were included in the resistome analysis. The median (range) number of antibiotic resistance genes per prokaryotic cell (RGPC) was significantly lower in the short-course strategy compared with the standard-course strategy for total RGPC (1.17 [0.35-2.43] vs 1.33 [0.46-11.08]; P = .01) and ß-lactamase RGPC (0.55 [0.18-1.24] vs 0.60 [0.21-2.45]; P = .03). CONCLUSIONS AND RELEVANCE: In this study, among children responding to initial treatment for outpatient CAP, a 5-day antibiotic strategy was superior to a 10-day strategy. The shortened approach resulted in similar clinical response and antibiotic-associated adverse effects, while reducing antibiotic exposure and resistance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02891915.


Subject(s)
Community-Acquired Infections , Pneumonia , Anti-Bacterial Agents/adverse effects , Child , Child, Preschool , Community-Acquired Infections/drug therapy , Double-Blind Method , Female , Humans , Male , Outpatients , Pneumonia/drug therapy
2.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):488-489, 2021.
Article in English | EMBASE | ID: covidwho-1570396

ABSTRACT

Background: The COVID-19 pandemic has enhanced the growth of telemedicine in an unexpected speed. Our study compares the service and cost effectiveness of telephone clinics (TC) to standard face to face clinics (FTFC) in the paediatric allergy service. Method: This retrospective study looked into paediatric allergy clinic activities from April 1-October 1, 2020 in the Great North Children Hospital, Newcastle. We also collected data from standard FTFCs in the pre-COVID period as comparative group. Clinic activities were reviewed by looking into patients' clinic notes and letters. Results: Clinic attendance rate in both groups was similar (91%, 94%). 9% of the patients were not available at the time of TC appointment. Majority did not answer but 4 consultations were discontinued due to language barrier. Up to 73% of patients did not have allergy tests after TC, despite being clinically indicated in half of them. Serum IgEs (sIgE) has become the preferable diagnostic option in TC. The median of sIgEs ordered per patient is 7 in TCs, as compared to 6 in control (p < 0.05). This has resulted in a 20% increase in laboratory cost. Clinic discharge rate is higher in FTFC (41%) as compared to TC (25%). The average follow-up time interval after TC is shorter than FTFC, 7.6 months and 9.4 months respectively (p < 0.05). More regular follow-ups in TC group has led to an increase of average clinician follow-up cost per patient by 32%. Conclusion: A telemedicine-based allergy service model can be more time-effective and improve patient access to specialist care, only with well-designed framework and planning. Screening criteria for selecting suitable TC patients can be the key to success. We present an example of recommended screening criteria based on patients' diagnosis and certain special circumstances. (Figure Presented).

3.
BJS Open ; 5(SUPPL 1):i22, 2021.
Article in English | EMBASE | ID: covidwho-1493719

ABSTRACT

Introduction: In response to the disruption to medical education caused by COVID-19, there is a need for wide-scale robust medical education research and the generation of research capacity for the future. Trainee research collaboratives have demonstrated they can nurture the research skills of students and trainees while delivering high quality research outputs. However, we have been unable to identify a permanent medical education research collaborative for trainees and students. Methods: We started the MedEd Collaborative in September 2020 to fill this gap, consisting of a trainee-and student-led medical education research collaborative supported by senior medical education experts and clinicians. Results: Our vision is to increase engagement of students and trainees in high-quality medical education research that informs practice. The MedEd Collaborative will engage students and trainees in medical education research by completing at least one national multicentre study per year, the first being the COVID Ready 2 study. This is a national cross-sectional survey of the educational impact of medical student volunteering during the COVID-19 pandemic. Conclusions: We anticipate the MedEd collaborative will: increase exposure to medical education research, thereby increasing the number of medical students and trainees aiming to pursue an academic medical education career;provide training in medical education research methodologies, such as qualitative analysis;improve the quality of medical education research outputs from students and trainees;encourage collaboration between medical schools and deaneries;and provide support to other trainee research collaboratives that aim to explore education research in their own specialties.

4.
BJS Open ; 5(SUPPL 1):i11, 2021.
Article in English | EMBASE | ID: covidwho-1493706

ABSTRACT

Introduction: COVID-19 led to global disruption of healthcare and many students volunteered to provide clinical support. Volunteering to work was a unique medical education opportunity;however, it is unknown whether this was a positive learning experience. Methods: The COVID Ready 2 study is a national cross-sectional study of all medical students at UK medical schools. We will compare opinions of those who did and did not volunteer to determine the educational benefit and issues they faced. We will use thematic analysis to identify themes in qualitative responses, in addition to quantitative analysis. Results: The primary objective is to explore the effect of volunteering during the pandemic on medical education in comparison to those who did not volunteer. Our secondary objectives are to identify: whether students would be willing to assume similar roles in a non-pandemic setting;if students found the experience more or less beneficial than traditional hospital placements and reasons for this;what the perceived benefits and disadvantages of volunteering were;the difference in perceived preparedness between students who did and did not volunteer for foundation training year one and the next academic year;training received by volunteers;and to explore issues associated with volunteering, including safety issues and issues with role and competence. Conclusions: We anticipate this study will help identify volunteer structures that have been beneficial for students, so that similar infrastructures can be used in the future;and help determine whether formal voluntary roles should be introduced into the non-pandemic medical curriculum.

5.
Clin Infect Dis ; 72(12): 2225-2240, 2021 06 15.
Article in English | MEDLINE | ID: covidwho-889502

ABSTRACT

In this article, the editors of Clinical Infectious Diseases review some of the most important lessons they have learned about the epidemiology, clinical features, diagnosis, treatment and prevention of SARS-CoV-2 infection and identify essential questions about COVID-19 that remain to be answered.


Subject(s)
COVID-19 , Humans , SARS-CoV-2
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