The Problem of Home Therapy during COVID-19 Pandemic in Italy: Government Guidelines versus Freedom of Cure?

After starting in late 2019, COVID-19 spread worldwide, and Italy was one of the first Western nations to be seriously affected. At that time, both the virus and the disease were little known and there were no Evidence-Based Medicine indications for treatment. The Italian Health Ministry guidelines claimed that, unless oxygen saturation fell to <92%, no pharmacological treatment was necessary during the first 72 hours, other than on a purely symptomatic basis, preferably with paracetamol. As later confirmed, that delay in therapeutic intervention may have been responsible for numerous hospital admissions and a very high lethality (3.5 %). To try to remedy this situation, several volunteer groups were formed, managing to promptlycure thousands of patients at home with non-steroidal anti-inflammatory drugs and a variety of re-purposed drugs (principally hydroxychloroquine, ivermectin) and supplements (such as antioxidants, polyphenols and vitamin D). Although not documented by any randomized controlled studies, these approaches were nonetheless based on the best available evidence, were aimed at addressing otherwise unmet major needs and produced a significant reduction of hospitalizations, of symptom duration, and a complete recovery from the disease compared with late treatment, according to some retrospective observational studies and the clinical experience of many physicians. A prompt discussion, with a clear and open exchange between healthcare Institutions and the said groups of voluntary physicians, could clarify the most effective approaches to reduce the number of hospitalizations and the lethality of this disease.

Inflammatory Bowel Disease: Clinical Diagnosis and Pharmaceutical Management.

Inflammatory bowel disease has an enormous impact on public health, medical systems, economies, and social conditions. Biologic therapy has ameliorated the treatment and clinical course of patients with inflammatory bowel disease. The efficacy and safety profiles of currently available therapies are still less that optimal in numerous ways, highlighting the requirement for new therapeutic targets. A bunch of new drug studies are underway in inflammatory bowel disease with promising results. This is an outlined guideline of clinical diagnosis and pharmaceutical therapy of inflammatory bowel disease. Outline delineates the overall recommendations on the modern principles of desirable practice to bolster the adoption of best implementations and exploration as well as inflammatory bowel disease patient, gastroenterologist, and other healthcare provider education. Inflammatory bowel disease encompasses Crohn's disease and ulcerative colitis, the two unsolved medical inflammatory bowel disease-subtypes condition with no drug for cure. The signs and symptoms on first presentation relate to the anatomical localization and severity of the disease and less with the resulting diagnosis that can clinically and histologically be non-definitive to interpret and establish criteria, specifically in colonic inflammatory bowel disease when the establishment is inconclusive is classified as indeterminate colitis. Conservative pharmaceuticals and accessible avenues do not depend on the disease phenotype. The first line management is to manage symptoms and stabilize active disease; at the same time maintenance therapy is indicated. Nutrition and diet do not play a primary therapeutic role but is warranted as supportive care. There is need of special guideline that explore solution of groundwork gap in terms of access limitations to inflammatory bowel disease care, particularly in developing countries and the irregular representation of socioeconomic stratification with a strategic plan, for the unanswered questions and perspective for the future, especially during the surfaced global COVID-19 pandemic caused by coronavirus SARS-CoV2 impacting on both the patient's psychological functioning and endoscopy services. Establishment of a global registry system and accumulated experiences have led to consensus for inflammatory bowel disease management under the COVID-19 pandemic. Painstakingly, the pandemic has influenced medical care systems for these patients. I briefly herein viewpoint summarize among other updates the telemedicine roles during the pandemic and how operationally inflammatory bowel disease centers managed patients and ensured quality of care. In conclusion: inflammatory bowel disease has become a global emergent disease. Serious medical errors are public health problem observed in developing nations i.e., to distinguish inflammatory bowel disease and infectious and parasitic diseases. Refractory inflammatory bowel disease is a still significant challenge in the management of patients with Crohn's disease and ulcerative colitis. There are gaps in knowledge and future research directions on the recent newly registered pharmaceuticals. The main clinical outcomes for inflammatory bowel disease were maintained during the COVID-19 pandemic period.

Assessment of the scope, completeness, and consistency of various drug information resources related to COVID-19 medications in pregnancy and lactation.

BACKGROUND: Drug use in pregnancy and lactation is challenging. It becomes more challenging in pregnant and lactating women with certain critical clinical conditions such as COVID-19, because of inconsistent drug safety data. Therefore, we aimed to evaluate the various drug information resources for the scope, completeness, and consistency of the information related to COVID-19 medications in pregnancy and lactation. METHODS: Data related to COVID-19 medications from various drug information resources such as text references, subscription databases, and free online tools were used for the comparison. The congregated data were analyzed for scope, completeness, and consistency. RESULTS: Scope scores were highest for Portable Electronic Physician Information Database (PEPID), Up-to-date, and drugs.com compared to other resources. The overall completeness scores were higher for Micromedex and drugs.com (p < 0.05 compared to all other resources). The inter-reliability analysis for overall components by Fleiss kappa among all the resources was found to be 'slight' (k < 0.20, p < 0.0001). The information related to the older drugs in most of the resources, provides in-depth details on various components such as pregnancy safety, clinical data related to lactation, the effect of the drug distribution into breast milk, reproductive potential/infertility risk and the pregnancy category/recommendations. However, the information related to these components for newer drugs was superficial and incomplete, with insufficient data and inconclusive evidence, which is a statistically significant observation. The strength of observer agreement for the various COVID-19 medications ranged from poor to fair and moderate for the various recommendation categories studied. CONCLUSION: This study reports discrepancies in the information related to pregnancy, lactation, drug level, reproductive risk, and pregnancy recommendations among the resources directing to refer to more than one resource for information about the safe and quality use of medications in this special population.The present study also emphasizes the need for development of comprehensive, evidence-based, and precise information guide that can promote safe and effective drug use in this special population.

Addressing concerns and adapting psychological techniques for videoconsultations: A practical guide

Objective: The 2020 coronavirus pandemic required many psychologists to rapidly transition to telehealth services to reduce virus exposure. Telepsychology services expanded quickly in Australia. This article seeks to provide simple and practical recommendations for clinicians who are changing their practice. Method: A narrative literature review focusing on psychologists' concerns regarding telehealth-facilitated psychology or telepsychology was undertaken. Results: Research literature and guidelines from peak professional bodies such as The Australian Psychological Society and the American Psychological Association, inform two sections of the article: Common Concerns about Videoconsultations and;Practical Considerations for Effective Videoconsultations. Telepsychology, has numerous benefits, especially during emergency situations. However, concerns regarding efficacy, therapeutic alliance, and the digital divide have contributed to psychologists' unwillingness to use telepsychology. Evidence suggests that efficacy and therapeutic alliance is comparable between telepsychology and in-person services. Simple evidence-based adjustments to therapeutic practice can optimise videoconsultations and increase the effectiveness of telepsychology. Despite the rapid change to videoconsultations, evidence suggests that Australian psychologists need not be concerned about clinical efficacy or therapeutic alliance related to telepsychology. However, it is acknowledged that transitioning to telehealth models of care is disruptive. Conclusion: This paper can assist clinicians in selecting appropriate clients for telepsychology, increase effectiveness and mitigate risks. Key Points: What is already known about this topic: (1) Research supports the clinical efficacy and establishment of therapeutic alliance related to telepsychology services and highlights that concerns regarding the digital divide need to be evidence-based, not based on assumptions. (2) As outlined in this paper, it is important to consider client suitability and ethical considerations prior to delivering telepsychology services. (3) The adaptations to psychological techniques, as highlighted in this paper, can increase the effectiveness of videoconsultations. What this topic adds: (1) An examination of common concerns related to videoconsultations including: efficacy, therapeutic alliance and the digital divide. (2) A practical evidence-based checklist for pre-therapy videoconsultation considerations. (3) An evidence-based checklist of practice adaptations that can increase effectiveness in videoconsultation. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Delivering remote therapy during the COVID-19 pandemic: A qualitative study with service users accessing a community personality disorder service

Purpose: The purpose of this study is to qualitatively explore the views and opinions of service users accessing remote therapy through a community forensic personality disorder service during the COVID-19 pandemic. Design/methodology/approach: A qualitative exploratory approach was adopted. Nine community forensic service users accessing virtual/telephone therapy through a community forensic mental health service were interviewed using semi-structed interviews. Data was analysed using Braun and Clarke (2006) thematic analysis techniques. Findings: Analysis resulted in three overall themes: experience of communication in the therapeutic relationship;impacts of the change to remote working and making the best of what we have. A further seven subthemes were developed. A range of advantages and disadvantages to remote therapy were highlighted. Research limitations/implications: This study was based on a small sample of service users accessing one community forensic service in England, and therefore caution should be taken when generalising the findings. All interviews were conducted remotely and thus may have only supported those who are able to engage in this way. Practical implications: This paper has the potential to inform future remote therapy guidelines. Health services should consider keeping some elements of remote working and offering this as a choice to all service users. Originality/value: This study is, to the best of the authors' knowledge, the first study that attempts to explore the experiences of individuals accessing remote therapy within a forensic population who have personality disorders or traits. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

A comparative analysis of u.S. State government communication and resident compliance to cdc covid-19 guidelines

ABSTRACT As COVID-19 raged through the United States, Americans were inundated with messages from multiple and competing sources, some based on political ideologies, fueled by misinformation, disinformation, and malinformation via cable and social media. This study uses the IDEA model for effective instructional risk and crisis communication to examine the role of state governors in encouraging compliance with public health recommendations. It examines the relationships between messages sent in high- and low-compliance states, between state compliance levels and tendencies in public attitudes, and between messages sent and resident decisions about COVID-19 compliance. We analyzed press release messages from governors of five states with high immigrant populations and surveyed the public in these states to examine compliance rates regarding COVID-19 protective actions. Findings illustrate that perceived source credibility is critical to behavioral compliance regardless of message content adherence and that political ideology may become a competing narrative and may influence resident decisions. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Future directions for psychology in critical care

Recognition of the role of psychology in critical care may be expedited by the international experience of dealing with the COVID-19 pandemic. There has been a surge of both academic and media interest in the experiences of patients hospitalized with severe COVID-19 disease, many of whom have experienced delirium and post-hospital problems such as low mood and posttraumatic stress disorder. In the United Kingdom, several national guidelines on both interdisciplinary rehabilitation and trauma-focused psychological services have prompted an increasing number of critical care departments to create roles for new or extra psychology staff. Community psychology practitioners have been trained in the psychological aspects of hospital and critical care for COVID-19 patients. This chapter's aim is to look at UK guidelines for the provision of psychological support in the critical care setting;to consider how well that guidance is carried out in reality;and to visualize a critical care psychology model where those guidelines are enacted in full. It compares and contrasts this model with guidelines or models practiced in other countries. Finally, the chapter imagines the critical care department of the future-with an environment that is psychologically informed, and where psychologists are fully integrated into the health care team. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Succeeding as a therapist: How to create a thriving practice in a changing world

Before the COVID-19 pandemic, which wreaked devastation and chaos throughout the world, the need for mental health therapists was projected to increase. Regardless of whether the pandemic fades or continues, its profound impact on people's well-being is clear. There is no doubt that COVID-19, subsequent pandemics, and other unforeseen changes in the future will expand, deepen, and intensify the need for mental health services. Preparing therapists to flourish in independent practice is one way to support the growing demand for more providers of psychological services. The pandemic also has changed the practice of therapy from sessions that are typically done in person to those conducted by teleconference. This book is a practical guide to starting, growing, and protecting a therapy practice amidst these changes. It provides essential information to successfully meet the challenges of managing a clinical practice. The book is directed not only to therapists just starting their careers but also to experienced practitioners looking to develop, improve, or change the direction of their practice. It contains most user-friendly, smaller, "bite-size" chapters on the essentials of succeeding as a therapist;each spotlights a different aspect of starting, growing, and protecting a practice. The chapters are organized into seven themes that flow chronologically, from the initial preparations for independent practice to closing or selling a practice. The book provides resources, including professional guidelines relevant to practitioners, recommendations for coping with subpoenas and records testimony, information for professional executors, and semistructured samples of a professional will and of interviews with immigrants. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Strengthening intersecting identities of diverse AAPIs through and post COVID-19: Guidelines for psychological practitioners

This article offers guidelines for psychological practitioners on ways to best support the well-being of Asian American/Pacific Islanders (AAPIs) through the COVID-19 global pandemic. The article argues that strengthening the connection with their intersecting identities is essential to the well-being of diverse AAPIs, especially given three interconnected and added strains: anti-Asian rhetoric and ensuing violence, invisible and intensified structural inequalities, and exacerbated mental health disparity. To facilitate AAPIs ongoing development and connection with their intersecting identities, three complementary theoretical approaches are introduced as the foundation of practice guidelines offered. The approaches include a culturally affirming developmental approach that fosters growth and resilience consistent with AAPIs identities;a multicultural feminist approach that promotes, empowers, and advocates for AAPIs by acknowledging structural power differentials within multiple interlocking systems of oppression;and a social justice-oriented psychoanalytic approach that recognizes structural impacts and offers attentive listening to the voices of AAPIs whose experiences are otherwise unheard. To support AAPIs through and beyond the pandemic, psychological practitioners must familiarize themselves with identity development theories relevant to AAPIs, participate in social advocacy by acknowledging and affirming differences within and external to AAPI communities, and expand on one's ability to listen for the diverse experiences that are unspoken, unheard, or uncomfortable to digest embedded in the oppressive structure. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Impact Statement Strengthening Asian American/Pacific Islanders (AAPIs') connection with intersecting identities is key to AAPIs collective well-being given the three added and interconnected strains (i.e., intensified anti-Asian rhetoric, structural inequality, and mental health disparity) during the COVID-19 pandemic. Practitioners should incorporate advocacy, recognize power differentials, and engage in depthful listening when helping AAPIs develop toward an increasingly mature and nuanced connection with their intersecting identities, which contribute to resilience and healing. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

National Research Institute of Tuberculosis and Lung Disease (NRITLD) Protocol for the Treatment of Patients with COVID-19.

More than a year after the onset of the coronavirus disease pandemic in 2019, the disease remains a major global health issue. During this time, health organizations worldwide have tried to provide integrated treatment guidelines to control coronavirus disease 2019 (COVID-19) at different levels. However, due to the novel nature of the disease and the emergence of new variants, medical teams' updating medical information and drug prescribing guidelines should be given special attention. This version is an updated instruction of the National Research Institute of Tuberculosis and Lung Disease (NRITLD) in collaboration with a group of specialists from Masih Daneshvari Hospital in Tehran, Iran, which is provided to update the information of caring clinicians for the treatment and care of COVID-19 hospitalized patients.

Inflammatory Bowel Disease: Clinical Diagnosis and Surgical Treatment-Overview.

This article is an overview of guidelines for the clinical diagnosis and surgical treatment of predominantly colonic inflammatory bowel diseases (IBD). This overview describes the systematically and comprehensively multidisciplinary recommendations based on the updated principles of evidence-based literature to promote the adoption of best surgical practices and research as well as patient and specialized healthcare provider education. Colonic IBD represents idiopathic, chronic, inflammatory disorders encompassing Crohn's colitis (CC) and ulcerative colitis (UC), the two unsolved medical subtypes of this condition, which present similarity in their clinical and histopathological characteristics. The standard state-of-the-art classification diagnostic steps are disease evaluation and assessment according to the Montreal classification to enable explicit communication with professionals. The signs and symptoms on first presentation are mainly connected with the anatomical localization and severity of the disease and less with the resulting diagnosis "CC" or "UC". This can clinically and histologically be non-definitive to interpret to establish criteria and is classified as indeterminate colitis (IC). Conservative surgical intervention varies depending on the disease phenotype and accessible avenues. The World Gastroenterology Organizations has, for this reason, recommended guidelines for clinical diagnosis and management. Surgical intervention is indicated when conservative treatment is ineffective (refractory), during intractable gastrointestinal hemorrhage, in obstructive gastrointestinal luminal stenosis (due to fibrotic scar tissue), or in the case of abscesses, peritonitis, or complicated fistula formation. The risk of colitis-associated colorectal cancer is realizable in IBD patients before and after restorative proctocolectomy with ileal pouch-anal anastomosis. Therefore, endoscopic surveillance strategies, aimed at the early detection of dysplasia, are recommended. During the COVID-19 pandemic, IBD patients continued to be admitted for IBD-related surgical interventions. Virtual and phone call follow-ups reinforcing the continuity of care are recommended. There is a need for special guidelines that explore solutions to the groundwork gap in terms of access limitations to IBD care in developing countries, and the irregular representation of socioeconomic stratification needs a strategic plan for how to address this serious emerging challenge in the global pandemic.

Lessons Learned: Management of Breast Cancer Patients throughout the COVID-19 Pandemic.

Purpose of Review: The COVID-19 pandemic of 2020 presented a multitude of challenges for physicians nationwide. Standard of care treatment was tailored to protect patients from virus exposure, while delivering safe and adequate care. This article reviews the steps taken to treat and protect breast cancer patients during the pandemic and reentry approaches to resume care. Recent Findings: Breast cancer experts rapidly convened to develop treatment guidelines during the pandemic. These recommendations encompass screening approach, prioritization of breast cancer patients, educational modifications, research and data considerations, and a re-entry treatment approach as the pandemic evolved. Without prior experience with a pandemic of this magnitude, these guidelines were based on expert knowledge and previously established data. Summary: This emergency forced physicians to operate in a more efficient and effective manner to deliver value-based patient care, and future evaluation of these adjustments will determine if overall patient outcomes were compromised.

Clinical Evidence Informing Treatment Guidelines on Repurposed Drugs for Hospitalized Patients During the Early COVID-19 Pandemic: Corticosteroids, Anticoagulants, (Hydroxy)chloroquine.

INTRODUCTION: In early 2020, the coronavirus disease 2019 (COVID-19) pandemic spread worldwide, overwhelming hospitals with severely ill patients and posing the urgent need for clinical evidence to guide patient care. First treatment options available were repurposed drugs to fight inflammation, coagulopathy, and viral replication. A vast number of clinical studies were launched globally to test their efficacy and safety. Our analysis describes the development of global evidence on repurposed drugs, in particular corticosteroids, anticoagulants, and (hydroxy)chloroquine in hospitalized COVID-19 patients based on different study types. We track the incorporation of clinical data in international and national treatment guidelines and identify factors that characterize studies and analyses with the greatest impact on treatment recommendations. METHODS: A literature search in MEDLINE was conducted to assess the clinical evidence on treatment with corticosteroids, anticoagulants, and (hydroxy)chloroquine in hospitalized COVID-19 patients during the first year of the pandemic. Adoption of the evidence from this clinical data in treatment guidelines of the World Health Organization (WHO), Germany, and United States (US) was evaluated over time. RESULTS: We identified 106 studies on corticosteroids, 141 studies on anticoagulants, and 115 studies on (hydroxy)chloroquine. Most studies were retrospective cohort studies; some were randomized clinical trials (RCTs), and a few were platform trials. These studies were compared to studies directly and indirectly referred to in WHO (7 versions), German (5 versions), and US (21 versions) guidelines. We found that initially large, well-adjusted, mainly retrospective cohort studies and ultimately large platform trials or coordinated meta-analyses of RCTs provided best available clinical evidence supporting treatment recommendations. DISCUSSION: Particularly early in the pandemic, evidence for the efficacy and safety of repurposed drugs was of low quality, since time and scientific rigor seemed to be competing factors. Pandemic preparedness, coordinated efforts, and combined analyses were crucial to generating timely and robust clinical evidence that informed national and international treatment guidelines on corticosteroids, anticoagulants, and (hydroxy)chloroquine. Multi-arm platform trials with master protocols and coordinated meta-analyses proved particularly successful, with researchers joining forces to answer the most pressing questions as quickly as possible.

Contingency plan of the Clinical Management Unit for Psychiatry and Mental Health (CMUPMH) of the Infanta Cristina University Hospital (ICUH) for the COVID-19 pandemic

The letter briefs about the strategic steps taken by the Spanish government for the COVID-19 pandemic. The current situation led the Spanish government to decree a state of alarm in March 2020, including a renewable lockdown which, together with the experiences of stress generated by infection, isolation and grieving, are setting off reactions of anxiety, acute stress or aggravation of existing mental problems. Strategic guidelines are planned for three phases: an initial phase during the emergency, a second phase during the reopening, and a final phase of new normality, with different areas of action in each. Those phases could correspond to the different levels of risk established by the Ministry of Health depending on the epidemiological outlook. The Plan has followed the indications and strategic guidelines set out in the ROCMHA Guide. Changing scenarios make new organization of health care necessary at all levels of intervention. The CMUPMH has shown itself to be flexible and permeable during the pandemic, by reassigning functions and modifying procedures. Psychiatrists have acted as general practitioners, and Emotional Support Programmes have been set up for professionals and for family members. Homeworking and telemedicine have been introduced. Having a Contingency Plan for use in emergency situations enables us to prepare for new challenges and to anticipate changes, providing care for the most vulnerable sections of the population under the principles of equity, universality, efficiency and quality. Drawing up this plan enables us to identify a set of measures and concrete steps in response to any states of emergency that might occur in the future, turning a crisis into an opportunity. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Interinstitutional clinical practice guidelines for the treatment of acute myocardial infarction.

INTRODUCTION: Mexico has the highest 30-day mortality due to acute myocardial infarction (AMI), which constitutes one of the main causes of mortality in the country: 28 % versus 7.5 % on average for the Organization for Economic Co-operation and Development member countries. OBJECTIVE: To establish critical pathways and essential interinstitutional pharmacological strategies for the care of patients with AMI in Mexico, regardless of their socioeconomic status. METHOD: A group of experts in AMI diagnosis and treatment, representatives of the main public health institutions in Mexico, as well as the Mexican cardiology societies, the Mexican Red Cross and representatives of the Spanish Society of Cardiology, were brought together in order to optimize strategies based on the best existing evidence. RESULTS: An interinstitutional clinical practice guideline was designed for early diagnosis and timely treatment of AMI with ST-segment elevation, following the clinical horizon of the disease, with the proposal of algorithms that improve the prognosis of patients who attend the emergency services due to an AMI. CONCLUSION: With these clinical practice guidelines, the group of experts proposes to universalize AMI diagnosis and treatment, regardless of patient socioeconomic status. INTRODUCCIÓN: México tiene la mortalidad más alta a 30 días por infarto agudo de miocardio (IAM), el cual constituye una de las principales causas de mortalidad en el país: 28 % versus 7.5 % del promedio de los países de la Organización para la Cooperación y el Desarrollo Económicos. OBJETIVO: Establecer las rutas críticas y las estrategias farmacológicas esenciales interinstitucionales para la atención de los pacientes con IAM en México, independientemente de su condición socioeconómica. MÉTODO: Se reunió a un grupo de expertos en diagnóstico y tratamiento de IAM, representantes de las principales instituciones públicas de salud de México, así como las sociedades cardiológicas mexicanas, Cruz Roja Mexicana y representantes de la Sociedad Española de Cardiología con la finalidad de optimizar las estrategias con base en la mejor evidencia existente. RESULTADOS: Se diseñó una guía de práctica clínica interinstitucional para el diagnóstico temprano y tratamiento oportuno del IAM con elevación del segmento ST, siguiendo el horizonte clínico de la enfermedad, con la propuesta de algoritmos que mejoren el pronóstico de los pacientes que acuden por IAM a los servicios de urgencias. CONCLUSIÓN: Con la presente guía práctica, el grupo de expertos propone universalizar el diagnóstico y tratamiento en el IAM, independientemente de la condición socioeconómica del paciente.

Saliva as an alternate specimen source for detection of SARS-CoV-2 in symptomatic patients using Cepheid Xpert Xpress SARS-CoV-2. (Special Issue: Diagnostic testing for severe acute respiratory syndrome coronavirus 2 and lessons from this pandemic.)

This study compared the test samples with NPS specimens using 3 ml universal transport media (UTM) (Becton, Dickinson and Company, Franklin Lakes, NJ) with unpreserved saliva collected in the emergency department (ED) and from patients in a COVID-positive hospital unit. The specimens were collected prospectively in the ED, when a patient with suspected COVID-19 was being investigated, following institutional and national guidelines for testing (2) or randomly in the hospital COVID-19 unit from patients not requiring mechanical ventilation. A total of 156 paired NPS and saliva specimens were tested. The overall positivity was 50/156 (32.1%);the average age was 47.8 years old with a male/female (M/F) ratio of 90/66. The community rate of positivity during the week of collection was 11.1% (3). A total of 153/156 samples were in overall agreement. Also, 47/49 samples were positive in saliva compared with the NPS, resulting in a positive percent agreement of 96% (95% CI, 86.02% to 99.5%). A total of 105/106 samples had a negative saliva and NPS result. A single sample demonstrated detectable levels of SARS-CoV-2 nucleic acid in the saliva, but the NPS was negative (1/106), resulting in a negative percent agreement of 99%. Thus, saliva is an acceptable alternative source for detecting SARS-CoV-2 nucleic acids. Another advantage to saliva versus NPS is that the process to collect saliva is noninvasive, and a patient, with education and coaching, could self-collect the specimen. These differences could reduce the risk to health care workers, decrease personal protective equipment usage, and provide less discomfort to patients during collection. Furthermore, an important preanalytical variable for SARS-CoV-2 testing is proper nasopharyngeal collection which may have been a contributing factor for the discrepant saliva positive/nasopharyngeal swab negative sample. Because saliva has excellent agreement with NPS in UTM, saliva could potentially be used for the diagnosis of COVID-19 in symptomatic patients using the Cepheid Xpert Xpress SARS-CoV-2 PCR test.

COVID-19 Treatment Guidelines: Do They Really Reflect Best Medical Practices to Manage the Pandemic?

SARS-CoV-2 (COVID-19) has been changing the world since December 2019. A comprehensive search into many COVID-19 treatment guidelines was conducted and reported in this article. This is a review paper to probe differences in COVID-19 managing strategies and explore the most common treatment plans among countries. Published guidelines from 23 countries and three references guidelines-until the end of 2020-were included in this article. The majority of COVID-19 treatment options were reported in this review and it includes antiviral drugs, antimalarial drugs, antibiotics, corticosteroids, immunotherapy, anticoagulants, and other pharmacological treatment. The presence of such information from different countries in a single comprehensive review article could help in understanding and speculation of variation in the recommended treatment in each country. This might be related to the cost of medications, the access to the medications, availability of medication that could potentially be useful in managing COVID-19 cases, and the availability/capacity of healthcare facilities. Finally, although there are various treatment groups listed in the published therapeutic guidelines worldwide, unfortunately, there is no evidence for effectiveness of most of these medications in reducing the COVID-19 mortality curve over more than one year of this global pandemic.

Adapting Management of Sarcomas in COVID-19: An Evidence-Based Review.

With the novel coronavirus disease (COVID-19) being declared a global pandemic by the World Health Organization, the Indian healthcare sector is at the forefront to deliver optimal care. Patients with cancer especially are at serious risk for increased chances of morbidity and mortality due to their immunocompromised state. Currently there is a paucity of definitive guidelines for the management of sarcomas during the pandemic in a resource-constrained and diverse population setting like India. Health care professionals from various specialties involved in the management of sarcomas have collaborated to discuss various aspects of evidence-based sarcoma management during the COVID-19 pandemic. This article provides structured recommendations for HCP to adapt to the situation, optimize treatment protocols with judicious use of all resources while providing evidence-based treatment for sarcoma patients.

Defining and Addressing Gaps in Care for Obsessive-Compulsive Disorder in the United States.

OBJECTIVE: Obsessive-compulsive disorder (OCD) can be a chronic and disabling illness with a lifetime prevalence of 2%, twice that of schizophrenia. Although effective treatments exist, OCD often remains underdetected and undertreated. METHODS: The authors performed a scoping review of the literature (of articles in PubMed and PsycINFO published from January 1, 2000, to February 1, 2020) to define gaps in OCD diagnosis and treatment among U.S. adults. Interventions at the patient, clinician, and health care system levels used to address these gaps are described, and promising approaches from around the world are highlighted. RESULTS: Of 102 potential studies identified in the search, 27 (including five non-U.S. studies) were included. The studies revealed that lack of clinician and patient knowledge about OCD and misdiagnosis contributes to its underdetection. Suboptimal prescribing of selective serotonin reuptake inhibitor medications and limited use of exposure and response prevention, as a first-line psychotherapy, contribute to OCD undertreatment. Digital health technologies show promise in increasing OCD detection and delivery of evidence-based care and in ensuring continuity of care (including during the COVID-19 pandemic). CONCLUSIONS: Given the significant rates of disability, morbidity, and mortality associated with OCD, addressing gaps in OCD care will reduce the U.S. burden of mental illness. Further research is needed to determine how the use of digital health technologies can increase the detection and management of OCD.

Overview of sleep management during COVID-19.

The sleep of millions has suffered during the global COVID-19 pandemic. Prevalence rates of 20-45% are reported globally for insomnia symptoms during the pandemic. Affected populations include the public and health care workers. A sleep deprived society faces the increased burden of COVID-related economic disruption, psychosocial problems, substance abuse, and suicide. Disordered sleep is not expected to disappear with control of infection, making interventions acutely necessary. The question becomes how to manage the sleep dysfunction during and after the pandemic. Depression and anxiety are prominent complaints during pandemic restrictions. Insomnia symptoms and fatigue continue even as mood improves in those who are in recovery from COVID-19 infection. Management of disturbed sleep and mental health is particularly needed in frontline health care workers. This overview describes 53 publications, as of February 2021, on disturbed sleep during the pandemic, treatment studies on COVID-related sleep disturbance, and need to rely on current treatment guidelines for common sleep disorders. The available research during the first year of COVID-19 has generally described symptoms of poor sleep rather than addressing treatment strategies. It covers digital cognitive behavioral therapy for insomnia (CBT-i) for the public and frontline workers, recognizing the need of greater acceptance and efficacy of controlled trials of CBT for affected groups. Recommendations based on a tiered public health model are discussed.