Designing clinical guidelines that improve access and satisfaction in the emergency department.

Clinical guidelines are evidence-based clinician decision-support tools that improve health outcomes, reduce patient harm, and decrease healthcare costs, but are often underused in emergency departments (EDs). This article describes a replicable, evidence-based design-thinking approach to developing best practices for guideline design that improves clinical satisfaction and usage. We used a 5-step process to enhance guideline usability in our ED. First, we conducted end-user interviews to identify barriers to guideline usage. Second, we reviewed the literature to identify key principles in guideline design. Third, we applied our findings to create a standardized guideline format, incorporating rapid cycle learning and iterative improvements. Fourth, we ensured the clinical validity of our updated guidelines by using a rigorous process for peer review. Lastly, we evaluated the impact of our guideline conversion process by tracking clinical guidelines access per day from October 2020 to January 2022. Our end-user interviews and review of the design literature revealed several barriers to guideline use, including lack of readability, design inconsistencies, and guideline complexity. Although our previous clinical guideline system averaged 0.13 users per day, >43 users per day accessed the clinical guidelines on our new digital platform in January 2022, representing an increase in access and use exceeding 33,000%. Our replicable process using open-access resources increased clinician access to and satisfaction with clinical guidelines in our ED. Design-thinking and use of low-cost technology can significantly improve clinical guideline visibility and has the potential to increase guideline use.

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)

Immunogenicity of Vaccines Against SARS-CoV-2 In Patients With Rheumatic Diseases.

The problem of coronavirus disease 2019 (COVID-19) still remains relevant even now, after two years. As one of the methods of combating the current COVID-19 pandemic, most experts suggest the widespread use of vaccination. The use of anticovid vaccines in patients with rheumatic diseases raises a number of questions related to efficacy, immunogenicity (especially in patients receiving immunosuppressive therapy), as well as safety of immunization. With that in mind, it is very important to analyze the data on the above-mentioned aspects in real time. This review presents the results of studies on COVID-19 vaccination immunogenicity in rheumatology conducted over the past two years. The ability of a number of antirheumatic drugs to have a negative effect (to varying degrees) on the post-vaccination response has been demonstrated. Interpretation and comparison of the results of vaccine immunogenicity studies are complicated by a number of factors usually associated with the design of works. Within the framework of the problem under consideration, there are still a sufficient number of questions, the answers to which should be found in further research.Copyright © Team of Authors, 2022.

Immunogenicity of Vaccines Against SARS-CoV-2 In Patients With Rheumatic Diseases.

The problem of coronavirus disease 2019 (COVID-19) still remains relevant even now, after two years. As one of the methods of combating the current COVID-19 pandemic, most experts suggest the widespread use of vaccination. The use of anticovid vaccines in patients with rheumatic diseases raises a number of questions related to efficacy, immunogenicity (especially in patients receiving immunosuppressive therapy), as well as safety of immunization. With that in mind, it is very important to analyze the data on the above-mentioned aspects in real time. This review presents the results of studies on COVID-19 vaccination immunogenicity in rheumatology conducted over the past two years. The ability of a number of antirheumatic drugs to have a negative effect (to varying degrees) on the post-vaccination response has been demonstrated. Interpretation and comparison of the results of vaccine immunogenicity studies are complicated by a number of factors usually associated with the design of works. Within the framework of the problem under consideration, there are still a sufficient number of questions, the answers to which should be found in further research.Copyright © Team of Authors, 2022.

Immunogenicity of Vaccines Against SARS-CoV-2 In Patients With Rheumatic Diseases.

The problem of coronavirus disease 2019 (COVID-19) still remains relevant even now, after two years. As one of the methods of combating the current COVID-19 pandemic, most experts suggest the widespread use of vaccination. The use of anticovid vaccines in patients with rheumatic diseases raises a number of questions related to efficacy, immunogenicity (especially in patients receiving immunosuppressive therapy), as well as safety of immunization. With that in mind, it is very important to analyze the data on the above-mentioned aspects in real time. This review presents the results of studies on COVID-19 vaccination immunogenicity in rheumatology conducted over the past two years. The ability of a number of antirheumatic drugs to have a negative effect (to varying degrees) on the post-vaccination response has been demonstrated. Interpretation and comparison of the results of vaccine immunogenicity studies are complicated by a number of factors usually associated with the design of works. Within the framework of the problem under consideration, there are still a sufficient number of questions, the answers to which should be found in further research.Copyright © Team of Authors, 2022.

Making the case for citizenship-oriented mental healthcare for youth in Canada

PurposeVarying stakeholders have highlighted how recovery-oriented mental health services such as youth mental health services have traditionally focused on supporting individual resources to promote recovery (e.g., agency) to the exclusion of addressing structural issues that influence recovery (e.g. poverty). One response to this criticism has been work helping people with mental health problems recover a sense of citizenship and sense of belonging in their communities. Work on citizenship has yet to influence youth mental healthcare in Canada's provinces and territories. This paper aims to highlight ways that youth mental healthcare can better help youth recover a sense of citizenship.Design/methodology/approachThe arguments described in this paper were established through discussion and consensus among authors based on clinical experience in youth mental health and an understanding of Canada's healthcare policy landscape, including current best practices as well as guidelines for recovery-oriented care by the Mental Health Commission of Canada.FindingsHere, this study proposes several recommendations that can help young with mental health problems recover their sense of citizenship at the social, systems and service levels. These include addressing the social determinants of health;developing a citizenship-based system of care;addressing identity-related disparities;employing youth community health workers within services;adapting and delivering citizenship-based interventions;and connecting youth in care to civic-oriented organizations.Originality/valueThis paper provides the first discussion of how the concept of citizenship can be applied to youth mental health in Canada in multiple ways. The authors hope that this work provides momentum for adopting policies and practices that can help youth in Canada recover a sense of citizenship following a mental health crisis.

Implementing clinical guidelines for co-occurring substance use and major mental disorders in Swedish forensic psychiatry: An exploratory, qualitative interview study with mental health care staff.

INTRODUCTION: Patients with substance use disorders (SUD) and co-occurring mental disorders (COD) within forensic psychiatric care often suffer poor treatment outcomes and high rates of criminal recidivism, substance use, and psychiatric problems. This study aimed to describe the conditions for, and mental health care staff's experiences with, implementing integrated SUD-focused clinical guidelines, including assessment and treatment for patients with COD at a high-security forensic mental health services (FMHS) facility in Sweden. METHODS: Study staff conducted nineteen semi-structured interviews with health care staff experienced in administering the new SUD assessment and treatment. The study conducted a thematic analysis to describe the health care staff's experiences with these guidelines and suggestions for improvement. RESULTS: Most participants reported appreciation for the implementation of clinical guidelines with an SUD focus, an area they considered to have previously been neglected, but also noted the need for more practical guidance in the administration of the assessments. Participants reported the dual roles of caregiver and warden as difficult to reconcile and a similar, hindering division was also present in the health care staff's attitudes toward SUD. Participants' reports also described an imbalance prior to the implementation, whereby SUD was rarely assessed but treatment was still initiated. One year after the implementation, an imbalance still existed, but in reverse: SUD was more frequently assessed, but treatment was difficult to initiate. CONCLUSIONS: Despite indications of some ambivalence among staff regarding the necessity of the assessment and treatment guidelines, many participants considered it helpful to have a structured way to assess and treat SUD in this patient group. The imbalance between frequent assessment and infrequent treatment may have been due to difficulties transitioning patients across the "gap" between assessment and treatment. To bridge this gap, mental health services should make efforts to increase patients' insight concerning their SUD, flexibility in the administration of treatment, and the motivational skills of the health care staff working with this patient group. Participants considered important for enhancing treatment quality a shared knowledge base regarding SUD, and increased collaboration between different professions and between in- and outpatient services.

Frailty goes viral: a critical discourse analysis of COVID-19 national clinical guidelines in the United Kingdom

This paper explores how the rationing of medical care for older people by frailty score was justified and operationalised in the UK during the COVID-19 pandemic. COVID-19 was expected to overwhelm the National Health Service (NHS) in the UK. In March 2020, the National Institute for Health and Care Excellence (NICE) published the ‘COVID-19 rapid guideline: critical care in adults', which advised that clinicians use the Clinical Frailty Score (CFS) to inform decisions about which patients over the age of 65 should be offered ventilatory support. We present a Foucauldian Critical Discourse Analysis of this guidance and the supporting online resources. Analysis shows how the guidance merchandises the CFS as a quick and easy-to-use technology that reduces social and physical complexity into a clinical score. This stratifies older people by frailty score and permits the allocation of resources along these lines. We show how this is justified through epidemiological discourses of risk, which are merged with the language of individual mortality prediction. We discuss the proceduralisation of the CFS alongside a growing body of research that problematises its application in resource allocation. We argue that the pandemic has increased the use of the concept of frailty and that this effectively obfuscates the concept's limitations and ambiguities;the ageism implicit in the response to COVID-19 in the UK;and the relative resource scarcity facing the UK's NHS.

Evaluating the Effectiveness of Short-term Clinical Guideline to Treat Sexual Addiction Disorder in People With Sexual Addiction: A Clinical Trial

Objectives Sex addiction is one type of behavioral addiction that is characterized by extreme fantasies and hard-to-control sexual behaviors. This disorder causes problems in the lives of affected people and their victims. The treatment is non-pharmacological and psychological, which are time-consuming and expensive. Short-term interventions are one of the ways to help these people. This study aims to evaluate the effectiveness of short-term clinical guidelines to treat sexual addiction disorder in affected individuals. Methods This was a randomized clinical trial study with pre-test-post-test and follow-up. The studied population in this research included all people with sexual addiction disorder who live in Isfahan City, Iran. The statistical population was those who had the chance to be included in the study. These were individuals who were referred to outpatient and residential drug abuse treatment centers, psychiatric treatment centers, and sexual disorders treatment clinics. Using the balance block randomization method, 30 male subjects who were diagnosed with sex addiction disorder based on the cut-off point of the hypersexual behavior inventory (HBI) with a score of 53 and above were randomly divided into 2 intervention and comparison groups. The intervention group received ten 120-min therapy sessions held weekly. Because of the coronavirus pandemic, the treatment sessions had to be held virtually (Skype). The comparison group was put on hold so that they could benefit from the treatment if the guide was effective. Both groups completed the HBI three times. The first time was immediately before the treat-ment, the second time immediately after the intervention, and the third time 3 months later in the follow-up phase. The results were analyzed via repeated measures analysis of variance (RM-ANOVA) in the SPSS software, v. 22. Results In the present study, there were 30 patients with a sexual addiction disorder, of which 15 were in the intervention group and 15 were in the comparison group (the Mean age of the participants was 26.4 years). The Mean scores of HBI in the intervention group in the pretest, post-test, and follow-up stages were 67, 49, and 57, respectively, while the mean scores of HBI in the comparison group were 64, 60, and 59 for the pretest, post-test, and the follow-up, respectively. Repeated measurement findings showed that this clinical guideline is effective in reducing participants' sexual addiction symptoms (P<0.01). Conclusion Clinical guideline for short-term treatment of sexual addiction disorder is effective in reducing the symptoms of sexual addiction disorder. Using this method, which can be held online, and considering its short time and reduced cost of treatment, allows more people to benefit from it. © 2022, Iran University of Medical Sciences. All rights reserved.

Using Explicit Thresholds were valuable for judging Benefits and Harms in partially contextualized GRADE Guidelines.

OBJECTIVES: Guideline panels must assess the magnitude of health benefits and harms to develop sensible recommendations. However, they rarely use explicit thresholds. In this paper we report on the piloting and the use thresholds for benefits and harms. STUDY DESIGN AND SETTING: We piloted the use of thresholds in a Chilean COVID-19 living guideline. For each of the critical outcomes, we asked panelists to suggest values of the thresholds for large, moderate, small, or trivial or no effect. We collected this information through a survey and an on-line discussion. RESULTS: Twelve panelists decided on thresholds for three critical outcomes (mortality, need for mechanical ventilation and serious adverse events). For all outcomes, an absolute risk reduction was considered larger with more than 50 events, moderate with less than 50 events, small with less than 25 events, and trivial with less than 10 events. Having these a priori thresholds in place significantly impacted on the development of recommendations. CONCLUSION: Explicit thresholds were a valuable addition to the judgment of the certainty in the evidence, to decide the direction and strength of the recommendation and to evaluate the need for update. We believe this is a line of research worth perusing.

NATIONAL EXPERIENCE OF CREATING AND IMPLEMENTING MEDICAL STANDARDS IN CASE EVIDENCE APPEARS «LATER¼ (DURING THE COVID-19 CORONAVIRUS DISEASE PANDEMIC).

OBJECTIVE: The aim: Identification of methodological processes to accelerate the development of clinical guidelines in an emergency situation (in particular, coronavirus disease COVID-19), analysis of the practice of implementing clinical guidelines and clinical pathway. PATIENTS AND METHODS: Materials and methods: The processes of developing COVID-19 clinical guidelines are described on the websites of the developers. Implementing the patient's own clinical pathway. Survey of 117 health professionals involved in medical care at COVID-19 on management information. A retrospective pragmatic study of organizational and clinical aspects of medical care for 9,259 patients over 18 years with COVID-19 from March 18, 2020 to March 31, 2021. RESULTS: Results: Acceleration of the methodology of clinical guidelines, changes in legislation have contributed to the improvement of medical care for patients with COVID-19. Clinical pathway (CPw) professionals surveyed: 88.2% satisfied with the structure of CPw, 91.0% were in favor of local instructions and explanations, templates of registration forms, 72.7% needed on-the-job training, 78.1% needed training on medical features, 74.5% noted the positive impact of remote interaction, 61.6% required standard operating procedures. 9259 patients with suspected COVID-19 confirmed PCR in 55.2%. Among those checked, 31.2% of chest computed tomography confirmed pneumonia in 95.7% of CT; 9.3% were hospitalized; fatalities 5.5% of hospitalized or 0.5% of verified. CONCLUSION: Conclusions: Changes in the methodology of clinical guidelines, changes in legislation, education based on clinical guidelines have contributed to improving the results of management in COVID-19.

Consensus recommendations for opioid agonist treatment following the introduction of emergency clinical guidelines in Ireland during the COVID-19 pandemic: A national Delphi study.

BACKGROUND: Emergency contingency guidelines for opioid agonist treatment (OAT) were introduced in Ireland in March 2020, to ensure rapid and uninterrupted access to treatment while mitigating COVID-19 risk. The contingency guidelines deviated, across multiple clinical domains, from pre-pandemic clinical guidelines published in 2016. The objectives of this study are to (1) identify changes introduced to OAT clinical guidelines in Ireland during the pandemic; and (2) develop consensus on whether the new recommendations should be retained beyond the pandemic, using a national Delphi consensus methodology. METHODS: Clinical guidance recommendations ('statements') were generated by comparing the newly established contingency guidelines with the national 2016 Clinical Guidelines for OAT. Over two rounds of on-line Delphi testing, a panel of experts (people currently accessing OAT, psychiatrists, general practitioners, community pharmacists, a nurse, a psychologist and support/key workers) independently rated their agreement with each statement and provided comments. Statements with a median score of 4 or 5 and a lower quartile of ≥4 were classified as having reached consensus. RESULTS: Forty-eight panel members were recruited, with a high participation level at Round 2 (90%, n=43). Consensus was achieved for 12 of the 19 statements at Round 1. The 7 remaining statements were revised, with 2 new statements, resulting in 9 statements at Round 2. Four statements reached consensus at Round 2. The final list includes 16 clinical guidance statements; 9 relating to assessment, 3 to OAT drug choice and dosing, 1 to take-away doses, 2 to overdose prevention and 1 to the continuation of e-prescriptions. CONCLUSIONS: A wide range of stakeholders involved in the delivery and receipt of OAT agreed on 16 clinical guidance statements for inclusion in OAT clinical guidelines as we move beyond the pandemic, rather than reverting to pre-pandemic guidelines. The agreed statements relate to facilitating safe access to OAT with minimal waiting time, supporting patient-centred care to promote health and well-being, and preventing drug overdose. Notably, consensus was not achieved for OAT drug dosage and frequency of urine testing during the stabilisation and maintenance phase of care.

The Self-Efficacy of Physicians to Communicate With Patients via Telemedicine in Lieu of Face-to-Face Visits in Light of the COVID-19 Pandemic: An Observational Study.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has perpetuated the switch to increased use of telemedicine for initial consultations for physicians out of the necessity of reducing face-to-face contact. It has not been thoroughly studied whether physicians are as self-efficacious in their ability to communicate virtually versus in person considering the natural difficulty of obtaining some objective data points such as those coming from physical examination techniques via telemedicine. METHODS: The Self Efficacy-12 (SE-12) questionnaire, a physician validated objective measure, was used to assess 101 physicians (96% response rate) from 29 specialties for their self-efficacy when communicating with patients when consulting virtually versus in person. RESULTS: There was a significant 32.43% decrease (p=<0.01) in physician self-efficacy when a patient was evaluated via telemedicine for the first time. CONCLUSION: The significant decrease in self-efficacy provides initial evidence that initial consultations should be done in person to maximize physician self-efficacy when communicating with patients.

‘Down to the person, the individual patient themselves’: A qualitative study of treatment decision‐making for shoulder pain

IntroductionMany inconsistencies have been identified in the translation of evidence‐based treatment recommendations for musculoskeletal shoulder pain into healthcare services, with little known about factors influencing decision‐making. The objective of this study was to explore the views and experiences of healthcare providers (HCPs) and people living with shoulder pain on treatment decision‐making.MethodsAdopting a qualitative design, purposeful sampling was employed to recruit 13 individuals with nonspecific musculoskeletal shoulder pain and 30 HCPs. Data were collected through 1:1 semi‐structured interviews and analysed using an approach informed by Constructivist Grounded Theory. To facilitate analysis, two patient and public involvement (PPI) meetings were conducted.ResultsMost participants (69%) had shoulder pain of ≥1‐year duration. Biomechanical beliefs about shoulder pain predominated and were heavily influential in decision‐making for both patients and HCPs. Despite a consensus that therapeutic alliance facilitated decision‐making, the extent of collaboration between HCPs and patients in treatment decision‐making was rather limited. In addition to condition‐specific factors, Individual patient characteristics and resources also influenced treatment decisions.ConclusionFindings revealed the complexity of the decision‐making process for both patients and HCPs, exposing substantial gaps between the reported views and experiences of participants and the principles of client‐centred and evidence‐based practice. There is a pressing need to enhance the translation of evidence‐based knowledge into practice in this clinical area.Patient or Public ContributionIn line with a consultative approach to collaborative data analysis, a subgroup of participants attended two PPI meetings to provide commentary and feedback on preliminary findings.

Insights into urticaria in pediatric and adult populations and its management with fexofenadine hydrochloride.

OBJECTIVE: The present narrative review provides a comprehensive update of the current knowledge on urticaria, both in adult and pediatric populations, and on the safety and efficacy of fexofenadine hydrochloride (HCl) as a treatment option. DATA SOURCE: A literature search was conducted on Embase and Medline. STUDY SELECTION: Clinical studies published in English and published between 1999 and 2020 were selected. RESULTS: Although the exact pathogenesis of urticaria is not fully understood, multiple pathways of mast cell activation are discussed to explain the existence of phenotypically different clinical manifestations of urticaria. An overview of the worldwide prevalence of chronic urticaria, including disease burden and patient's quality of life is provided. The impact of urticaria on patient's life differs on the basis of whether its form is acute or chronic, but pharmacological approaches are most often needed to control the disabling symptoms. A summary of the current management of urticaria recommended by different guidelines across countries (Global; European; American; Australian; Asian; Japanese) is presented. Non-sedating, second-generation H1-antihistamines are the preferred choice of treatment across several guidelines worldwide. Herein, the efficacy and safety of fexofenadine HCl, a representative second-generation H1-antihistamine approved for the treatment of urticaria, is discussed. The occurrence of urticaria manifestations in COVID-19 patients is also briefly presented. CONCLUSION: The burden of acute and chronic urticaria is high for patients. Second generation anti-histamines such as fexofenadine HCl can help managing the symptoms.

Listening and learning from the COVID-19 frontline in one US healthcare system

Purpose>The on-going COVID-19 pandemic has drastically impacted healthcare systems worldwide. Understanding the perspectives and insights of frontline healthcare workers caring for and interacting with patients with COVID-19 represents a timely, topical, and important area of research. The purpose of this qualitative action research study was to assist one US healthcare system that has an expansive footprint with the implementation of a needs assessment among its frontline healthcare workers. The leadership within this healthcare system wanted to obtain a deeper understanding of how the COVID-19 pandemic was impacting the personal and professional lives of its workers. Further, the organisation wanted to solicit employees’ feedback about what they needed, understand the issues they were facing, and solicit their ideas to help the organisation know where to take action.Design/methodology/approach>This qualitative research employed 45 focus groups, referred to as virtual listening calls (LCs) in this organisation, which were held over a four-week period. A total of 241 nursing staff, representing healthcare facilities across the country, attended 26 of the LCs. A total of 19 LCs were held with 116 healthcare workers who are employed in other clinical roles (e.g. therapists) or administrative functions.Findings>Extending beyond the available research at the time, this study was initiated from within a US healthcare system and informed by the frontline healthcare employees who participated in the LCs, the findings of this study include the perspectives of both nursing and other healthcare workers, the latter of which have not received considerable attention. The findings underscore that the COVID-19 pandemic has wreaked havoc on the personal and professional lives of all of these healthcare workers and has exacted an emotional toll as noted in other studies. However, this study also highlights the importance of listening to employees’ concerns, but more importantly, their recommendations for improving their experiences. Notably, the organisation is in the midst of making changes to address these frontline workers’ needs.Originality/value>The study, inclusive of nursing and other healthcare staff, demonstrates how an organisation can adapt to a crisis by listening and learning from its frontline employees.

Neurodisability care in the time of COVID-19.

BACKGROUND: The COVID-19 pandemic resulted in an unprecedented societal and healthcare global crisis. Associated changes in regular healthcare provision and lifestyle through societal lockdown are likely to have affected clinical management and well-being of children/young people with neurodisability, who often require complex packages of multidisciplinary care. METHODS: We surveyed 108 families of children/young people with severe physical neurodisability and multiple comorbidities to understand how the pandemic had affected acute clinical status, routine healthcare provision, schooling and family mental and social well-being. RESULTS: A significant proportion of families reported missing hospital appointments and routine therapy, with subsequent worsening of symptoms and function. Families additionally described worsening stress and anxiety during the pandemic, regardless of their baseline level of socio-economic deprivation. CONCLUSION: This highlights the profound effect of the COVID-19 pandemic on health and function in young people with severe neurodisabilities and emphasizes the clear need to better understand how to support this vulnerable population moving forwards.

HIV and SARS-CoV-2 Co-infection: Epidemiological, Clinical Features, and Future Implications for Clinical Care and Public Health for People Living with HIV (PLWH) and HIV Most-at-Risk Groups.

PURPOSE OF REVIEW: The purpose of this review is to use the currently available clinical and epidemiological data, to identify key aspects to improve both the clinical management and public health response to SARS-CoV-2/HIV co-infection among HIV vulnerable populations and people living with HIV (PLWH). RECENT FINDINGS: While at the beginning of the COVID-19 pandemic, the lack of robust information on SARS-CoV-2/HIV co-infection, prevented a clear picture of the synergies between them, currently available data strongly support the importance of common structural factors on both the acquisition and clinical impact of these infections and the relevance of age, comorbidities, and detectable HIV viral load as associated worse prognostic factors among PLWH. Although more information is needed to better understand the biological, clinical, and epidemiological relationship between both infections, a syndemic approach to prevent SARS-CoV-2 among HIV high-risk groups and PLWH, targeting these populations for SARS-CoV-2 vaccines and protocolizing early identification of PLWH with worse COVID-19 prognosis factors, is crucial strategies to decrease the overall impact of SARS-CoV-2 /HIV co-infection.

It is time for open access in clinical care.

A healthcare center widely sharing its internal guidelines on how to treat COVID-19 patients "just wasn't done." As the pandemic raged at a Boston hospital, the next generation of clinical leaders pushed for change.

In brief

Coventry University's Dr Sally Pezaro and Dr Gemma Pearce, Nottingham Trent University's Dr Karen Maher and Birmingham City University's Dr Liz Bailey collaborated on the research, which found: * Problematic substance use occurred in response to work-related stress and anxiety, bullying, traumatic incidents and the need to function as a midwife * Barriers to seeking help included fear of repercussions, shame, stigma, practicalities and a perceived lack of available or required support. Take part in the new research at bit.ly/SurveyTakePart Clinical trials New pregnancy trial guidelines A new grading system to improve safety during clinical trials involving pregnant women has been co-developed by University College London (UCL) researchers and an international team of experts. MIDIRS Digest 1 A cultural lens on Shared Decision Making (SDM), Sarah Esegbona-Adeigbe 2 Examining the relationship between pregnant women more likely to be affected by severe COVID-19 and uptake of vaccination in pregnancy in the UK, Alice Allen 3 For low-income women receiving prenatal care, race matters, Lindsey Garfi eld, Dina Tell, Lisa Masinter et al 4 Exploring the birth stories of women on the autism spectrum, Laura Foran Lewis, Hannah Schirling, Emma Beaudoin et al 5 Women's experiences of planning a home birth in mid- to high-income countries: a systematic review protocol, Maria Healy, Olufi kayo Bamidele, Patricia Gillen The above papers are published in MIDIRS Digest. Visit bit.ly/ EBMJournal Fetal transmission COVID-19 in the womb Unborn babies could become infected with COVID-19 if their gut is exposed to the virus, fi nds a new study published in An International Journal of Obstetrics & Gynaecology, and led by University College London (UCL) researchers with Great Ormond Street Hospital for Children and the National Institute for Health Research Great Ormond Street Biomedical Research Centre.