PDF(Pubmed)
Abstract：
UNASSIGNED: Clinical practice guidelines were continually changing during the COVID-19 pandemic to reflect the best available evidence for a novel virus. In Kazakhstan, the national clinical guidelines for COVID-19 patient care were regularly modified and it was not known if and to what extent these guidelines were being followed in practice.
UNASSIGNED: We conducted a sub-analysis of data collected from an observational study among people hospitalized with COVID-19 in a large infectious disease hospital in Almaty in four cross-sections of increased COVID-19 incidence: T1 (1 June-30 August 2020); T2 (1 October-31 December 2020); T3 (1 April-31 May 2021); and T4 (1 July-26 October 2021). Modifications to the national COVID-19 treatment guidelines were identified and clinical data were abstracted from electronic medical records. We assessed frequency of antibiotic, glucocorticoid, anticoagulant, and antiviral administered in each period and determined if these aligned with national clinical guidelines. We used multivariable logistic regression to compare practices across periods.
UNASSIGNED: Six modifications were made to national COVID-19 treatment guidelines during this study. Of 1,146 people hospitalized with COVID-19, 14% were in T1, 14% in T2, 22% in T3, and 50% in T4. Anticoagulant treatment was administered to 87% (range: 56%-95%), antibiotic treatment to 60% (range: 58%-64%), glucocorticoid to 55% (range: 43%-64%) and antiviral therapy 15% (range: 7%-22%). Majority of treatments were not aligned with national guidelines, including 98% of anticoagulant use, 95% of antibiotic use, 56% of glucocorticoid use, and 56% of antiviral use. There were no significant changes in practice following changes in guidelines for antibiotic use (64% in T1 to 58% in T2, p = 0.30). There was significant increase in use of anticoagulant (84% in T2 vs. 95% in T3, p < 0.01), glucocorticoid (43% in T2 vs. 64% in T3, p < 0.01), and antiviral treatment (7% in T3 vs. 15% in T4, p < 0.01) after guidelines updates.
UNASSIGNED: The majority of treatments administered to people hospitalized with COVID-19 in four periods of high incidence in Almaty were not aligned with updated clinical guidelines. Antibiotic misuse was markedly high throughout. Increased awareness and training on clinical practice guidelines as updates are released may help improve adoption of evidence-based practices.
UNASSIGNED: We conducted a sub-analysis of data collected from an observational study among people hospitalized with COVID-19 in a large infectious disease hospital in Almaty in four cross-sections of increased COVID-19 incidence: T1 (1 June-30 August 2020); T2 (1 October-31 December 2020); T3 (1 April-31 May 2021); and T4 (1 July-26 October 2021). Modifications to the national COVID-19 treatment guidelines were identified and clinical data were abstracted from electronic medical records. We assessed frequency of antibiotic, glucocorticoid, anticoagulant, and antiviral administered in each period and determined if these aligned with national clinical guidelines. We used multivariable logistic regression to compare practices across periods.
UNASSIGNED: Six modifications were made to national COVID-19 treatment guidelines during this study. Of 1,146 people hospitalized with COVID-19, 14% were in T1, 14% in T2, 22% in T3, and 50% in T4. Anticoagulant treatment was administered to 87% (range: 56%-95%), antibiotic treatment to 60% (range: 58%-64%), glucocorticoid to 55% (range: 43%-64%) and antiviral therapy 15% (range: 7%-22%). Majority of treatments were not aligned with national guidelines, including 98% of anticoagulant use, 95% of antibiotic use, 56% of glucocorticoid use, and 56% of antiviral use. There were no significant changes in practice following changes in guidelines for antibiotic use (64% in T1 to 58% in T2, p = 0.30). There was significant increase in use of anticoagulant (84% in T2 vs. 95% in T3, p < 0.01), glucocorticoid (43% in T2 vs. 64% in T3, p < 0.01), and antiviral treatment (7% in T3 vs. 15% in T4, p < 0.01) after guidelines updates.
UNASSIGNED: The majority of treatments administered to people hospitalized with COVID-19 in four periods of high incidence in Almaty were not aligned with updated clinical guidelines. Antibiotic misuse was markedly high throughout. Increased awareness and training on clinical practice guidelines as updates are released may help improve adoption of evidence-based practices.
摘要：
■在COVID-19大流行期间，临床实践指南不断变化，以反映一种新型病毒的最佳可用证据。在哈萨克斯坦,对COVID-19患者护理的国家临床指南进行了定期修改,目前尚不清楚这些指南在实践中是否以及在多大程度上得到了遵循.
我们在阿拉木图一家大型传染病医院接受COVID-19住院的人群中对一项观察性研究收集的数据进行了分分析，其中COVID-19发病率增加的四个横断面：T1（2020年6月1日至8月30日）；T2（2020年10月1日至12月31日）；T3（2021年4月1日至5月31日）；T4（2021年7月确定了对国家COVID-19治疗指南的修改，并从电子病历中提取了临床数据。我们评估了抗生素的使用频率，糖皮质激素,抗凝剂,和抗病毒在每个时期给药，并确定这些是否符合国家临床指南。我们使用多变量逻辑回归来比较不同时期的实践。
■在这项研究中，对国家COVID-19治疗指南进行了6次修改。在接受COVID-19治疗的1146人中，T1占14%，T2占14%，T3占22%，T4占50%。抗凝治疗的比例为87%（范围：56%-95%），抗生素治疗至60%（范围：58%-64%），糖皮质激素治疗55％（范围：43％-64％）和抗病毒治疗15％（范围：7％-22％）。大多数治疗方法不符合国家指南，包括98%的抗凝剂使用，95%的抗生素使用56%的糖皮质激素使用，56%的抗病毒药物使用。随着抗生素使用指南的改变，实践中没有显著变化(T1为64%，T2为58%，p=0.30)。抗凝剂的使用显着增加（T2中的84％与在T3中为95%，p<0.01)，糖皮质激素(43%在T2与在T3中为64%，p<0.01)，和抗病毒治疗（T3与7％指南更新后，T4为15％，p<0.01）。
在阿拉木图的四个高发时期，对COVID-19住院患者的大多数治疗方法与更新的临床指南不一致。自始至终滥用抗生素明显很高。随着更新的发布，提高对临床实践指南的认识和培训可能有助于改善循证实践的采用。
我们在阿拉木图一家大型传染病医院接受COVID-19住院的人群中对一项观察性研究收集的数据进行了分分析，其中COVID-19发病率增加的四个横断面：T1（2020年6月1日至8月30日）；T2（2020年10月1日至12月31日）；T3（2021年4月1日至5月31日）；T4（2021年7月确定了对国家COVID-19治疗指南的修改，并从电子病历中提取了临床数据。我们评估了抗生素的使用频率，糖皮质激素,抗凝剂,和抗病毒在每个时期给药，并确定这些是否符合国家临床指南。我们使用多变量逻辑回归来比较不同时期的实践。
■在这项研究中，对国家COVID-19治疗指南进行了6次修改。在接受COVID-19治疗的1146人中，T1占14%，T2占14%，T3占22%，T4占50%。抗凝治疗的比例为87%（范围：56%-95%），抗生素治疗至60%（范围：58%-64%），糖皮质激素治疗55％（范围：43％-64％）和抗病毒治疗15％（范围：7％-22％）。大多数治疗方法不符合国家指南，包括98%的抗凝剂使用，95%的抗生素使用56%的糖皮质激素使用，56%的抗病毒药物使用。随着抗生素使用指南的改变，实践中没有显著变化(T1为64%，T2为58%，p=0.30)。抗凝剂的使用显着增加（T2中的84％与在T3中为95%，p<0.01)，糖皮质激素(43%在T2与在T3中为64%，p<0.01)，和抗病毒治疗（T3与7％指南更新后，T4为15％，p<0.01）。
在阿拉木图的四个高发时期，对COVID-19住院患者的大多数治疗方法与更新的临床指南不一致。自始至终滥用抗生素明显很高。随着更新的发布，提高对临床实践指南的认识和培训可能有助于改善循证实践的采用。
