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3.
Crit Care ; 25(1): 106, 2021 03 16.
Artículo en Inglés | MEDLINE | ID: covidwho-1136238

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. METHODS: Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square (χ2) test (p < 0·05 was considered as unstable). RESULTS: Agreement was achieved for 27 (73%) management strategies which were then used to develop expert clinical practice statements. Experts agreed that COVID-19-related acute respiratory distress syndrome (ARDS) is clinically similar to other forms of ARDS. The Delphi process yielded strong suggestions for use of systemic corticosteroids for critical COVID-19; awake self-proning to improve oxygenation and high flow nasal oxygen to potentially reduce tracheal intubation; non-invasive ventilation for patients with mixed hypoxemic-hypercapnic respiratory failure; tracheal intubation for poor mentation, hemodynamic instability or severe hypoxemia; closed suction systems; lung protective ventilation; prone ventilation (for 16-24 h per day) to improve oxygenation; neuromuscular blocking agents for patient-ventilator dyssynchrony; avoiding delay in extubation for the risk of reintubation; and similar timing of tracheostomy as in non-COVID-19 patients. There was no agreement on positive end expiratory pressure titration or the choice of personal protective equipment. CONCLUSION: Using a Delphi method, an agreement among experts was reached for 27 statements from which 20 expert clinical practice statements were derived on the respiratory management of C-ARF, addressing important decisions for patient management in areas where evidence is either absent or limited. TRIAL REGISTRATION: The study was registered with Clinical trials.gov Identifier: NCT04534569.


Asunto(s)
/complicaciones , Consenso , Técnica Delfos , Insuficiencia Respiratoria/terapia , Insuficiencia Respiratoria/virología , Humanos
4.
Ann Fam Med ; 19(2): 135-140, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1123691

RESUMEN

The use of big data containing millions of primary care medical records provides an opportunity for rapid research to help inform patient care and policy decisions during the first and subsequent waves of the coronavirus disease 2019 (COVID-19) pandemic. Routinely collected primary care data have previously been used for national pandemic surveillance, quantifying associations between exposures and outcomes, identifying high risk populations, and examining the effects of interventions at scale, but there is no consensus on how to effectively conduct or report these data for COVID-19 research. A COVID-19 primary care database consortium was established in April 2020 and its researchers have ongoing COVID-19 projects in overlapping data sets with over 40 million primary care records in the United Kingdom that are variously linked to public health, secondary care, and vital status records. This consensus agreement is aimed at facilitating transparency and rigor in methodological approaches, and consistency in defining and reporting cases, exposures, confounders, stratification variables, and outcomes in relation to the pharmacoepidemiology of COVID-19. This will facilitate comparison, validation, and meta-analyses of research during and after the pandemic.


Asunto(s)
/epidemiología , Consenso , Bases de Datos Factuales/normas , Sistemas de Registros Médicos Computarizados/normas , Atención Primaria de Salud/organización & administración , Vigilancia en Salud Pública , Macrodatos , Humanos , Farmacoepidemiología , Salud Pública , Reino Unido/epidemiología
5.
Nucleic Acids Res ; 49(6): 3092-3108, 2021 04 06.
Artículo en Inglés | MEDLINE | ID: covidwho-1123330

RESUMEN

The rapid spread of COVID-19 is motivating development of antivirals targeting conserved SARS-CoV-2 molecular machinery. The SARS-CoV-2 genome includes conserved RNA elements that offer potential small-molecule drug targets, but most of their 3D structures have not been experimentally characterized. Here, we provide a compilation of chemical mapping data from our and other labs, secondary structure models, and 3D model ensembles based on Rosetta's FARFAR2 algorithm for SARS-CoV-2 RNA regions including the individual stems SL1-8 in the extended 5' UTR; the reverse complement of the 5' UTR SL1-4; the frameshift stimulating element (FSE); and the extended pseudoknot, hypervariable region, and s2m of the 3' UTR. For eleven of these elements (the stems in SL1-8, reverse complement of SL1-4, FSE, s2m and 3' UTR pseudoknot), modeling convergence supports the accuracy of predicted low energy states; subsequent cryo-EM characterization of the FSE confirms modeling accuracy. To aid efforts to discover small molecule RNA binders guided by computational models, we provide a second set of similarly prepared models for RNA riboswitches that bind small molecules. Both datasets ('FARFAR2-SARS-CoV-2', https://github.com/DasLab/FARFAR2-SARS-CoV-2; and 'FARFAR2-Apo-Riboswitch', at https://github.com/DasLab/FARFAR2-Apo-Riboswitch') include up to 400 models for each RNA element, which may facilitate drug discovery approaches targeting dynamic ensembles of RNA molecules.


Asunto(s)
Consenso , Modelos Moleculares , Conformación de Ácido Nucleico , ARN Viral/química , /genética , Regiones no Traducidas 3'/genética , Regiones no Traducidas 5'/genética , Algoritmos , Aptámeros de Nucleótidos/genética , Secuencia de Bases , Sitios de Unión , Microscopía por Crioelectrón , Conjuntos de Datos como Asunto , Evaluación Preclínica de Medicamentos/métodos , Sistema de Lectura Ribosómico/genética , Genoma Viral/genética , Estabilidad del ARN , ARN Viral/genética , Reproducibilidad de los Resultados , Riboswitch/genética , Bibliotecas de Moléculas Pequeñas/química
6.
BMC Public Health ; 21(1): 447, 2021 03 05.
Artículo en Inglés | MEDLINE | ID: covidwho-1119419

RESUMEN

BACKGROUND: Amidst the COVID-19 pandemic, governments, health experts, and ethicists have proposed guidelines about ICU triage and priority access to a vaccine. To increase political legitimacy and accountability, public support is important. This study examines what criteria beyond medical need are deemed important to be perceived of priority COVID-19 healthcare access. METHOD: Two conjoint experiments about priority over ICU treatment and early COVID-19 vaccination were implemented in a probability-based sample of 1461 respondents representative of the Netherlands. Respondents were asked who should receive treatment out of two fictitious healthcare claimants that differed in in age, weight, complying with corona policy measures, and occupation, all randomly assigned. Average marginal coefficient effects are estimated to assess the relative importance of the attributes; attributes were interacted with relevant respondent characteristics to find whether consensus exists in this relative ranking. RESULTS: The Dutch penalize those not complying with coronavirus policy measures, and the obese, but prioritize those employed in 'crucial' sectors. For these conditions, there is consensus among the population. For age, young people are prioritized for ICU treatment, while the middle-aged are given priority over a vaccine, with younger respondents favoring healthcare for elderly claimants, while older respondents favor support for young cohorts. CONCLUSION: People who have no control over their social risk and are able to reciprocate to society are considered as more deserving of priority of COVID-19 healthcare. Our findings provide fair support for the implemented ethical guidelines about ICU-treatment and COVID-19 vaccines.


Asunto(s)
/prevención & control , Cuidados Críticos/normas , Prestación de Atención de Salud/normas , Instituciones de Salud/normas , Accesibilidad a los Servicios de Salud/normas , Vacunación/normas , Adulto , Anciano , Anciano de 80 o más Años , Consenso , Cuidados Críticos/estadística & datos numéricos , Prestación de Atención de Salud/estadística & datos numéricos , Femenino , Instituciones de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Pandemias , Guías de Práctica Clínica como Asunto , Vacunación/estadística & datos numéricos
7.
J Neurosurg Anesthesiol ; 33(2): 100-106, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1117146

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of neuroscience research. At the 2020 Society of Neuroscience in Anesthesiology and Critical Care (SNACC) Annual Meeting, the SNACC Research Committee met virtually to discuss research challenges encountered during the COVID-19 pandemic along with possible strategies for facilitating research activities. These challenges and recommendations are included in this Consensus Statement. The objectives are to: (1) provide an overview of the disruptions and challenges to neuroscience research caused by the COVID-19 pandemic, and; (2) put forth a set of consensus recommendations for strengthening research sustainability during and beyond the current pandemic. Specific recommendations are highlighted for adapting laboratory and human subject study activities to optimize safety. Complementary research activities are also outlined for both laboratory and clinical researchers if specific investigations are impossible because of regulatory or societal changes. The role of virtual platforms is discussed with respect to fostering new collaborations, scheduling research meetings, and holding conferences such that scientific collaboration and exchange of ideas can continue. Our hope is for these recommendations to serve as a valuable resource for investigators in the neurosciences and other research disciplines for current and future research disruptions.


Asunto(s)
/prevención & control , Neurociencias/métodos , Investigación , Consenso , Humanos , Pandemias , Sociedades Médicas
8.
Ital J Pediatr ; 47(1): 45, 2021 Feb 27.
Artículo en Inglés | MEDLINE | ID: covidwho-1105727

RESUMEN

The availability of a COVID-19 vaccine has raised the issue of its compatibility with breastfeeding. Consequently, the Italian Society of Neonatology (SIN), the Italian Society of Pediatrics (SIP), the Italian Society of Perinatal Medicine (SIMP), the Italian Society of Obstetrics and Gynecology (SIGO), the Italian Association of Hospital Obstetricians-Gynecologists (AOGOI) and the Italian Society of Infectious and Tropical Diseases (SIMIT) have made an ad hoc consensus statement. Currently, knowledge regarding the administration of COVID-19 vaccine to the breastfeeding mother is limited. Nevertheless, as health benefits of breastfeeding are well demonstrated and since biological plausibility suggests that the health risk for the nursed infant is unlikely, Italian scientific societies conclude that COVID-19 vaccination is compatible with breastfeeding.


Asunto(s)
Lactancia Materna , /prevención & control , Consenso , Femenino , Humanos , Italia , Sociedades Médicas
11.
Catheter Cardiovasc Interv ; 96(2): 336-345, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-730300

RESUMEN

The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 has resulted in a new and lethal disease termed coronavirus disease 2019 (COVID-19). Although there is an association between cardiovascular disease and COVID-19, the majority of patients who need cardiovascular care for the management of ischemic heart disease may not be infected with this novel coronavirus. The objective of this document is to provide recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the COVID-19 pandemic. There is a recognition of two major challenges in providing recommendations for AMI care in the COVID-19 era. Cardiovascular manifestations of COVID-19 are complex with patients presenting with AMI, myocarditis simulating an ST-elevation myocardial infarction (STEMI) presentation, stress cardiomyopathy, non-ischemic cardiomyopathy, coronary spasm, or nonspecific myocardial injury, and the prevalence of COVID-19 disease in the US population remains unknown with risk of asymptomatic spread. This document addresses the care of these patients focusing on (a) varied clinical presentations; (b) appropriate personal protection equipment (PPE) for health care workers; (c) the roles of the emergency department, emergency medical system, and the cardiac catheterization laboratory (CCL); and (4) regional STEMI systems of care. During the COVID-19 pandemic, primary percutaneous coronary intervention (PCI) remains the standard of care for STEMI patients at PCI-capable hospitals when it can be provided in a timely manner, with an expert team outfitted with PPE in a dedicated CCL room. A fibrinolysis-based strategy may be entertained at non-PCI-capable referral hospitals or in specific situations where primary PCI cannot be executed or is not deemed the best option.


Asunto(s)
Betacoronavirus , Cardiología , Consenso , Angiografía Coronaria , Infecciones por Coronavirus/complicaciones , Infarto del Miocardio/terapia , Intervención Coronaria Percutánea/métodos , Neumonía Viral/complicaciones , Infecciones por Coronavirus/epidemiología , Manejo de la Enfermedad , Electrocardiografía , Humanos , Incidencia , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico , Pandemias , Neumonía Viral/epidemiología , Sociedades Médicas , Tasa de Supervivencia/tendencias , Estados Unidos/epidemiología
12.
J Occup Environ Med ; 62(8): e467-e468, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-325072

RESUMEN

BACKGROUND: Workers whose occupations put them in contact with infected persons and the public are at increased risk of coronavirus disease (COVID-19) infection. RECOMMENDATIONS: The Collegium Ramazzini calls on governments at all levels to protect worker health by strengthening public health systems; maintaining comprehensive social insurance systems; establishing policies that presume all COVID-19 infections in high-risk workers are work-related; enforcing all occupational health standards; and developing pandemic preparedness plans.The Collegium Ramazzini calls on all employers-large and small, public and private-to protect the health of all workers by developing disease preparedness plans; implementing basic infection control measures; establishing disease identification and isolation policies; reducing hazardous exposures; supporting personal protective equipment (PPE) programs; and restricting unnecessary travel. CONCLUSION: Governments and employers have legal obligations to protect worker health. They are not relieved of these duties during pandemics.


Asunto(s)
Betacoronavirus , Control de Enfermedades Transmisibles , Consenso , Infecciones por Coronavirus , Salud Laboral , Pandemias/prevención & control , Neumonía Viral , Control de Enfermedades Transmisibles/legislación & jurisprudencia , Control de Enfermedades Transmisibles/organización & administración , Humanos , Salud Pública , Responsabilidad Social
14.
BMC Public Health ; 21(1): 276, 2021 02 03.
Artículo en Inglés | MEDLINE | ID: covidwho-1063192

RESUMEN

BACKGROUND: Policymakers and health professionals prefer to use summarized evidence of practice recommendations. The aim of this scoping review is therefore to identify available guidelines, consensus statements, the standard of practice, and practice recommendations on reproductive health service provision during the COVID-19 pandemics. METHODS: We searched guideline databases and websites of professional associations and international organizations working on sexual and reproductive health. We looked for practice recommendations on sexual reproductive health services (SRH) during COVID-19 pandemics. Additionally, we searched: MEDLINE, EMBASE, and Google Scholar. Data extraction was done by two independent reviewers using a customized tool that was developed to record the key information of the source that's relevant to the review question. The difference between the two authors on data extraction was resolved by discussion. RESULTS: A total of 21 records were included in the review. Identified recommendations were classified into thematic areas. The records addressed approaches to antenatal care, labour and delivery, postnatal care, safe abortion, contraception, gender-based violence, and artificial reproduction. CONCLUSIONS: There were consistent consensus statements and recommendations that there should be access to sexual and reproductive health services like antenatal care (ANC), postnatal care (PNC), contraception service, safe abortion care, and clinical management of rape survivors during the COVID-19 pandemics with the concerted effort of service re-organization. The practice recommendations focus on innovative ways of service provision to minimize patient and staff exposure to COVID-19 as well as alleviate the burden on the health care system. These include utilizing telemedicine and community/home-based care or self-care.


Asunto(s)
Servicios de Salud Reproductiva , Consenso , Humanos , Guías de Práctica Clínica como Asunto
17.
Midwifery ; 95: 102922, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: covidwho-1039497

RESUMEN

The purpose of this project was to identify gaps in the current evidence base and to identify research priorities in the local context during the Covid-19 pandemic. This paper reports on the application and adaptation of the CHNRI methodology which follows a series of criteria setting, filtering and scoring exercises. The views of maternity care professionals, midwifery managers and leaders, women and families were continually sought throughout the project stages. We found the CHNRI methodology to be a useful framework to highlight topics with greater or smaller consensus within a relatively short time frame and with minimal burden to participants. The criteria were defined to focus on research topics where no existing or on-going studies were identified and topics likely to lead to improvements in care with relevance beyond the Covid-19 pandemic.


Asunto(s)
Investigación sobre Servicios de Salud/organización & administración , Servicios de Salud Materna , Partería , Proyectos de Investigación , Investigación/organización & administración , Consenso , Femenino , Humanos , Embarazo , Reino Unido
19.
Adv Ther ; 38(2): 1011-1023, 2021 02.
Artículo en Inglés | MEDLINE | ID: covidwho-1033629

RESUMEN

The rapid spread of novel coronavirus (COVID-19) has posed complex challenges to global public health. During this pandemic period, access to essential services including post-abortion care (PAC) has been disrupted. Along with the clinical management of the disease in women, protection of the healthcare workers and medical staff from nosocomial infection is important to ensure infection control. Thus, in order to implement the proper contraceptive measures and to reduce the rate of repeated abortion, the family planning group of minimally invasive gynecological branch of the Liaoning Medical Association organized a committee of experts to formulate guidance and suggestions to ensure the timely treatment and surgery of women opting for abortion, the implementation of PAC, implementation of safe contraceptive measures after surgery, and the protection of healthcare professionals and medical staff from infection. We believe these guidelines might be helpful for obstetrics and gynecology departments in China and globally, as well for women who wish to undergo abortion during these unprecedented times.


Asunto(s)
Aborto Inducido , Cuidados Posteriores/métodos , Anticoncepción/métodos , Servicios de Planificación Familiar/métodos , Control de Infecciones , Guías de Práctica Clínica como Asunto , Telemedicina , Abortivos/uso terapéutico , China , Consenso , Anticonceptivos , Femenino , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Pandemias , Equipo de Protección Personal , Embarazo , Automanejo , Triaje
20.
J Med Internet Res ; 22(12): e20064, 2020 12 29.
Artículo en Inglés | MEDLINE | ID: covidwho-1007075

RESUMEN

Following the rapid spread of a new type of coronavirus (SARS-CoV-2), nearly all countries have introduced temporary restrictions affecting daily life, with "social distancing" as a key intervention for slowing the spread of the virus. Despite the pandemic, the development or actualization of medical guidelines, especially in the rapidly changing field of oncology, needs to be continued to provide up-to-date evidence- and consensus-based recommendations for shared decision making and maintaining the treatment quality for patients. In this viewpoint, we describe the potential strengths and limitations of online conferences for medical guideline development. This viewpoint will assist guideline developers in evaluating whether online conferences are an appropriate tool for their guideline conference and audience.


Asunto(s)
Consenso , Humanos , Pandemias , Guías de Práctica Clínica como Asunto
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