RESUMO
The COVID-19 pandemic requires urgent decisions regarding treatment policy in the face of rapidly evolving evidence. In response, the South African Essential Medicines List Committee established a subcommittee to systematically review and appraise emerging evidence, within very short timelines, in order to inform the National Department of Health COVID-19 treatment guidelines. To date, the subcommittee has reviewed 14 potential treatments, and made recommendations based on local context, feasibility, resource requirements and equity. Here we describe the rapid review and evidence-to-decision process, using remdesivir and dexamethasone as examples. Our experience is that conducting rapid reviews is a practical and efficient way to address medicine policy questions under pandemic conditions.
Assuntos
Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Antivirais/uso terapêutico , Tratamento Farmacológico da COVID-19 , Dexametasona/uso terapêutico , Medicamentos Essenciais , Glucocorticoides/uso terapêutico , Formulação de Políticas , Guias de Prática Clínica como Assunto , Monofosfato de Adenosina/uso terapêutico , Alanina/uso terapêutico , Tomada de Decisões , Medicina Baseada em Evidências , Humanos , SARS-CoV-2 , Índice de Gravidade de Doença , África do Sul , Fatores de TempoRESUMO
PURPOSE: Promoting benefits of physical activity independent of weight management may help overweight/obese persons. DESIGN: Pilot randomized-controlled-trial. SUBJECTS: Twenty-six sedentary, overweight/obese persons receiving health-care at Stanford Medical Center, no contraindications for exercise. CONTROL/INTERVENTION GROUPS: Usual medical care and community weight-management/fitness resources versus same plus a brief intervention derived from behavioral-economic and evolutionary psychological theory highlighting benefits of activity independent of weight-management. ANALYSIS: Intent-to-treat. Cohen's d effect-sizes and 95% confidence intervals (95%CI) for changes in moderate-intensity-equivalent physical activity/week, cardiorespiratory fitness, and depression at 3 months relative to baseline. RESULTS: Intervention group participants demonstrated 3.76 hour/week of increased physical activity at study endpoint, controls only 0.7 hours/week (Cohen's d=0.74, 95% CI -0.06 to +1.5). They also improved cardiorespiratory fitness (Cohen's d=0.51, 95% CI -0.3 to +1.3) and reduced depression relative to controls (Cohen's d=0.66, 95% CI -0.1 to +1.4). CONCLUSION: Promoting activity independent of weight-management appears promising for further study.
