Subject(s)Biomedical Research , COVID-19 , Evidence-Based Medicine , Translational Research, Biomedical , Biomedical Research/ethics , Biomedical Research/methods , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Evidence-Based Medicine/ethics , Evidence-Based Medicine/methods , Humans , Knowledge , Philosophy, Medical , Politics , SARS-CoV-2 , Translational Research, Biomedical/ethics , Translational Research, Biomedical/standards , Translational Research, Biomedical/trends
BACKGROUND: Systematic reviews are vital to the pursuit of evidence-based medicine within healthcare. Screening titles and abstracts (T&Ab) for inclusion in a systematic review is an intensive, and often collaborative, step. The use of appropriate tools is therefore important. In this study, we identified and evaluated the usability of software tools that support T&Ab screening for systematic reviews within healthcare research. METHODS: We identified software tools using three search methods: a web-based search; a search of the online "systematic review toolbox"; and screening of references in existing literature. We included tools that were accessible and available for testing at the time of the study (December 2018), do not require specific computing infrastructure and provide basic screening functionality for systematic reviews. Key properties of each software tool were identified using a feature analysis adapted for this purpose. This analysis included a weighting developed by a group of medical researchers, therefore prioritising the most relevant features. The highest scoring tools from the feature analysis were then included in a user survey, in which we further investigated the suitability of the tools for supporting T&Ab screening amongst systematic reviewers working in medical research. RESULTS: Fifteen tools met our inclusion criteria. They vary significantly in relation to cost, scope and intended user community. Six of the identified tools (Abstrackr, Colandr, Covidence, DRAGON, EPPI-Reviewer and Rayyan) scored higher than 75% in the feature analysis and were included in the user survey. Of these, Covidence and Rayyan were the most popular with the survey respondents. Their usability scored highly across a range of metrics, with all surveyed researchers (n = 6) stating that they would be likely (or very likely) to use these tools in the future. CONCLUSIONS: Based on this study, we would recommend Covidence and Rayyan to systematic reviewers looking for suitable and easy to use tools to support T&Ab screening within healthcare research. These two tools consistently demonstrated good alignment with user requirements. We acknowledge, however, the role of some of the other tools we considered in providing more specialist features that may be of great importance to many researchers.
Subject(s)Abstracting and Indexing/methods , Software , Systematic Reviews as Topic/methods , Biomedical Research , Delivery of Health Care , Evidence-Based Medicine/methods , Humans , Surveys and Questionnaires
Subject(s)COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Evidence-Based Medicine/standards , Immunization, Secondary/standards , SARS-CoV-2/pathogenicity , COVID-19/epidemiology , COVID-19/immunology , COVID-19/virology , COVID-19 Vaccines/adverse effects , COVID-19 Vaccines/immunology , Evidence-Based Medicine/methods , Evidence-Based Medicine/statistics & numerical data , Humans , Immunity , Immunization, Secondary/methods , Immunization, Secondary/statistics & numerical data , Immunogenicity, Vaccine , Observational Studies as Topic , Pandemics/prevention & control , Randomized Controlled Trials as Topic , SARS-CoV-2/immunology , Treatment Outcome
In response to the COVID-19 pandemic, the Scientific Medical Policy Committee (SMPC) of the American College of Physicians (ACP) began developing "practice points" to provide clinical advice based on the best available evidence for the public, patients, clinicians, and public health professionals. As one of the first organizations in the United States to develop evidence-based clinical guidelines, ACP continues to lead and advance the science of evidence-based medicine by implementing new methods to rapidly publish practice points and maintain them as living advice that regularly assesses and incorporates new evidence. The overarching aim of practice points is to answer targeted key questions for which there is a timely need to synthesize evidence for decision making. The SMPC believes these methods can potentially be adapted to address various clinical and public health topics beyond the COVID-19 pandemic. This article presents an overview of the SMPC's living, rapid practice points development process, which includes a rapid systematic review, use of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method, use of stringent policies on the disclosure of interests and management of conflicts of interest, incorporating a public (nonclinician) perspective, and maintenance of the documents as living through ongoing surveillance and synthesis of new evidence as it emerges.
Subject(s)COVID-19/diagnosis , COVID-19/therapy , Evidence-Based Medicine/methods , Practice Guidelines as Topic , COVID-19 Testing , Clinical Decision-Making , Conflict of Interest , Humans , Pandemics , Systematic Reviews as Topic/methods , United States
The pandemic COVID-19 presents a major challenge to identify effective drugs for treatment. Clinicians need evidence based on randomized trials regarding effective medical treatments for this infection. Currently no effective therapies exist for the progression of the mild forms to severe disease. Knowledge however is rapidly expanding. Remdesivir, an anti- retroviral agent has in vitro activity against this virus and has shown to decrease the duration of ICU care in patients with severe disease, while low dose dexamethasone also showed a decrease in the duration of stay in cases of severe disease requiring assisted ventilation. At the time of writing this article, two mRNA-based vaccines have shown an approximate 95 % efficacy in preventing infection in large clinical trials. At least one of these drugs has regulatory permission for vaccination in high-income countries. Low and middle-income countries may have difficulties in initiating vaccine programs on large scales because of availability, costs, refrigeration and dissemination. Adequately powered randomized trials are required for drugs with in vitro activity against the virus. Supportive care should be provided for stable, hypoxia and pneumonia free patients on imaging. Vaccines are of obvious benefit and given the preliminary evidence of the efficacy of over 95 %, Low and middle-income countries must develop links with the WHO COVAX program to ensure global distribution of vaccines.
Subject(s)Antiviral Agents/therapeutic use , COVID-19 Vaccines/therapeutic use , COVID-19/therapy , Evidence-Based Medicine/methods , Pandemics/prevention & control , Angiotensin Receptor Antagonists/pharmacology , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme 2/antagonists & inhibitors , Angiotensin-Converting Enzyme 2/metabolism , Angiotensin-Converting Enzyme Inhibitors/pharmacology , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Antimalarials/pharmacology , Antimalarials/therapeutic use , Antiviral Agents/pharmacology , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , COVID-19 Vaccines/immunology , Clinical Trials as Topic , Evidence-Based Medicine/trends , Global Health , Humans , International Cooperation , SARS-CoV-2/drug effects , SARS-CoV-2/immunology , SARS-CoV-2/pathogenicity , Severity of Illness Index , Spike Glycoprotein, Coronavirus/metabolism , Treatment Outcome , Virus Internalization/drug effects
BACKGROUND: In recent years, more and more reports are focused on the application of traditional Chinese medicine injection (TCMJ) for the treatment of viral pneumonia. There are about 200 million cases of viral pneumonia worldwide every year, half of which are children. At present, many kinds of TCMJ are created for the treatment of viral pneumonia in children, with good therapeutic effects. However, there are many kinds of TCMJ, and the treatment advantages are different, thus bringing difficulties to the selection of clinical drugs. In order to provide evidence-based evidence support for the clinical selection of TCMJ for the treatment of viral pneumonia in children, this study selected the commonly used TCMJ for clinical treatment of viral pneumonia for meta-analysis to evaluate its efficacy. METHODS: The Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Data, Viper information databases, Cochran library Web of Science, PubMed, MEDLINE and EMBASE will be searched. The literature will be searched, with language restriction in English and Chinese. The related reference will be retrieved as well. Two reviewers will independently extract data and perform quality assessment of included studies. Review Manager 5.3 will be applied to conduct this meta-analysis. RESULTS: The results of this systematic review and meta-analysis will be published in a peer-reviewed journal once we finish this study. CONCLUSIONS: This study provides reliable evidence-based evidence for the efficacy of TCMJ in the treatment of viral pneumonia in children. ETHICS AND DISSEMINATION: We will not be allowed to publish private information from individuals. This kind of systematic review should not harm the rights of participants. No ethical approval was required. The results can be published in peer-reviewed journals or at relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/795MB.
Subject(s)Drugs, Chinese Herbal/administration & dosage , Evidence-Based Medicine/methods , Pneumonia, Viral/drug therapy , Child , Clinical Decision-Making , Decision Support Techniques , Humans , Injections , Lung/diagnostic imaging , Meta-Analysis as Topic , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Systematic Reviews as Topic , Treatment Outcome
Adequate iron intake is essential for optimal child development, but iron deficiency and anemia among infants and young children are widespread in low- and middle-income countries. Large-scale food fortification strategies hold great promise for reducing micronutrient deficiencies; however, for children <2 y of age, the impact of such strategies is limited because their intake of staple foods is relatively low and fortification levels are targeted at the adult population. Iron supplementation, iron fortification of foods targeted to infants, and point-of-use fortification with iron-containing products such as multiple micronutrient powders (MNPs) and small-quantity lipid-based nutrient supplements are evidence-based approaches recommended to reduce anemia among infants and young children when used in the right context. Since 2003, the WHO, with support from UNICEF, has recommended the use of MNPs to control iron deficiency. However, the percentage of children with anemia has changed very little over the past 10 y. Five years ago the UN declared a decade of action on nutrition, including World Health Assembly (WHA) targets for maternal, infant, and young child nutrition, yet the WHA set no anemia targets for children. In July 2020 the leaders of 4 UN agencies issued a call for action to protect children's right to nutrition in the face of the COVID-19 pandemic and beyond. Given persistently high rates of anemia among young children, the negative developmental impact, the challenge of meeting iron needs from typical complementary food diets, and the availability of successful evidence-based fortification strategies for this age group, we encourage planners, speakers, and donors at this year's UN Food Systems Summit and the Tokyo Nutrition for Growth Summit to 1) call for the WHA to set anemia targets for infants and young children and 2) promote investment in evidence-based interventions to improve the iron status of young children.
Subject(s)Anemia/prevention & control , Food, Fortified/standards , Infant Food/standards , Iron, Dietary/administration & dosage , COVID-19/complications , Evidence-Based Medicine/methods , Global Health , Humans , Infant
Coronavirus disease is a potentially deadly disease and of significant apprehension for global communal health because of its lethality. Vaccines and antiviral medications are still under trial to prevent or treat human coronavirus (HCoV) till date. The virus HCoV originated in 2003, SARS-CoV, which causes respiratory syndrome having distinctive pathogenesis and infections of the respiratory tract. A mechanism was projected for the evolution of SARS virus, and a handy association with bats was found. When this virus reaches the respective host system, the infection starts with spike protein binding to its complementary receptor of the host cell. The coronavirus spike protein's association with its host cell receptor complement is crucial in deciding the virus infectivity, tissue tropism and species variety. Recent studies show that SARS Coronavirus 2 or COVID-19 requires protease to get into cells, offering a new therapeutic target. Distinctive attention and exertions should be given to defending or reducing transmission in vulnerable populaces, including those directly associated with caregiving and treatment and also aged one. Researchers are planning to develop a vaccine for COVID-19, and in this approach are also considered developing a vaccine that sensitizes our immune system preventing from this pandemic. The present review focuses on the role of S-spike protein in COVID-19, which helps the virus intruding the enzyme ACE2 (Angiotensin-Converting Enzyme 2). Passive antibody therapy is an additional alternative to use blood donors from hale and hearty people who have already recovered from COVID-19 and therapeutic advancement in handling the COVID-19 pandemic.
Subject(s)COVID-19 Drug Treatment , COVID-19/epidemiology , Evidence-Based Medicine/methods , SARS-CoV-2/drug effects , Angiotensin-Converting Enzyme 2/antagonists & inhibitors , Angiotensin-Converting Enzyme 2/metabolism , Angiotensin-Converting Enzyme Inhibitors/pharmacology , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Animals , Antiviral Agents/pharmacology , Antiviral Agents/therapeutic use , COVID-19/metabolism , COVID-19 Vaccines/therapeutic use , Humans , SARS-CoV-2/isolation & purification , SARS-CoV-2/metabolism
Subject(s)COVID-19 , Clinical Decision-Making/methods , Clinical Trials as Topic/methods , Evidence-Based Medicine/methods , SARS-CoV-2 , Uncertainty , COVID-19/mortality , Child, Preschool , Clinical Trials as Topic/standards , Dexamethasone/therapeutic use , Evidence-Based Medicine/standards , Female , Humans , Hydroxychloroquine/adverse effects , Hydroxychloroquine/therapeutic use , Pregnancy , Reproducibility of Results , Sample Size
Subject(s)Bell Palsy/chemically induced , Evidence-Based Medicine/methods , Publication Bias/statistics & numerical data , Vaccines/adverse effects , COVID-19/diagnosis , COVID-19/mortality , COVID-19/prevention & control , COVID-19/virology , Female , Humans , Journalism, Medical/standards , Male , Randomized Controlled Trials as Topic , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification
Subject(s)Leadership , Pneumonia, Viral/therapy , China/epidemiology , Critical Care/history , Critical Care/methods , Critical Care/organization & administration , Critical Illness/therapy , Evidence-Based Medicine/history , Evidence-Based Medicine/methods , Evidence-Based Medicine/organization & administration , History, 20th Century , History, 21st Century , Humans , Male , Pandemics/history , Pandemics/prevention & control , Physicians , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Pulmonary Medicine/history , Pulmonary Medicine/methods , Pulmonary Medicine/organization & administration , Research Personnel , Severity of Illness Index
The UK government recently decided to extend the interval between the first dose of the Pfizer BioNTech and AstraZeneca COVID-19 vaccines from 3 weeks to 12 weeks to maximise the number of people receiving the initial dose, despite the trials only providing vaccine efficacy data based on a schedule of 21 days between doses. This editorial discusses whether there is evidence to support this policy change.
Subject(s)COVID-19 Vaccines , COVID-19 , Immunogenicity, Vaccine , Vaccination Coverage , Vaccination , COVID-19/epidemiology , COVID-19/immunology , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/immunology , Drug Administration Schedule , Evidence-Based Medicine/methods , Evidence-Based Medicine/standards , Government Regulation , Health Policy/legislation & jurisprudence , Humans , Policy Making , SARS-CoV-2 , United Kingdom/epidemiology , Vaccination/methods , Vaccination/standards , Vaccination/statistics & numerical data , Vaccination Coverage/methods , Vaccination Coverage/standards
The current pandemic of coronavirus disease 2019 (COVID-19) has had unprecedented reach and shown the need for strong, compassionate and evidence-based decisions to effectively stop the spread of the disease and save lives. While aggressive in its response, Rwanda prioritized the lives of its people - a human right that some governments forget to focus on. The country took significant steps, before the first case and to limit the spread of the disease, rolled out a complete nationwide lockdown within one week of the first confirmed case, while also providing social support to vulnerable populations. This pandemic highlights the need for leaders to be educated on implementation science principles to be able to make evidence-based decisions through a multi-sectoral, integrated response, with consideration for contextual factors that affect implementation. This approach is critical in developing appropriate preparedness and response strategies and save lives during the current threat and those to come.
Subject(s)COVID-19/prevention & control , Communicable Disease Control/methods , Evidence-Based Medicine/methods , Leadership , Empathy , Humans , Rwanda , SARS-CoV-2
Subject(s)Evidence-Based Medicine , Medical Informatics Applications , Research Design/trends , Evidence-Based Medicine/methods , Evidence-Based Medicine/trends , Humans , Outcome Assessment, Health Care/methods , Outcome Assessment, Health Care/trends , Patient Safety , Pragmatic Clinical Trials as Topic , Reproducibility of Results , Research Report , Treatment Outcome
The COVID-19 pandemic has led to a surge of information being presented to clinicians regarding this novel and deadly disease. There is a clear urgency to collate, review, appraise and act on this information if we are to do the best for clinicians and patients. However, the speed of the pandemic is a threat to traditional models of knowledge translation and practice change. In this concepts paper, we argue that clinicians need to be agile in their thinking and practice in order to find the right time to change. Adoption of new methods should be based on clinical judgement, the weight of evidence and the balance of probabilities that any new technique, test or treatment might work. The pandemic requires all of us to reach a new level of evidence-based medicine characterised by scepticism, thoughtfulness, responsiveness and clinically agility in practice.