SARS‐COV‐2

SARS - CoV - 2
  • 文章类型: Journal Article
    目标:2020年10月,欧洲神经病学学会(EAN)发表了关于2019年冠状病毒病(COVID-19)大流行期间神经系统疾病患者管理的共识声明。由于此后发生的重要变化和发展,需要重新评估最初的建议并应对新的挑战。
    方法:在步骤1中,EANCOVID-19工作组对原始项目进行了严格审查。此外,定义了新的建议。在步骤2中,将包含步骤1中伪造的建议的在线调查发送给EAN所有科学和协调小组的管理小组。在步骤3中,提出了最后一组建议。
    结果:在步骤1中,在最初的36项建议中,18人被认为仍然相关。对它们进行了编辑,以反映知识和实践的进步。此外,提出了21项新建议,以应对新的知识和挑战。在步骤2中,在为调查发送的39条建议中,九个被批准了,而其余的则提出了改进建议。在步骤3中,进一步编辑了建议,并形成了一些新项目以适应参与者的建议,最终提出了41项建议。
    结论:2020年EAN声明的修订版为面临SARS-CoV-2感染的神经系统疾病患者的良好临床实践提供了最新的全面和结构化指导。它现在涵盖了COVID-19相关护理的最新领域的问题,疫苗并发症和COVID-19后的情况。
    OBJECTIVE: In October 2020, the European Academy of Neurology (EAN) consensus statement for management of patients with neurological diseases during the coronavirus disease 2019 (COVID-19) pandemic was published. Due to important changes and developments that have happened since then, the need has arisen to critically reassess the original recommendations and address new challenges.
    METHODS: In step 1, the original items were critically reviewed by the EAN COVID-19 Task Force. In addition, new recommendations were defined. In step 2, an online survey with the recommendations forged in step 1 was sent to the Managing Groups of all Scientific and Coordinating Panels of EAN. In step 3, the final set of recommendations was made.
    RESULTS: In step 1, out of the original 36 recommendations, 18 were judged still relevant. They were edited to reflect the advances in knowledge and practice. In addition, 21 new recommendations were formulated to address the new knowledge and challenges. In step 2, out of the 39 recommendations sent for the survey, nine were approved as they were, whilst suggestions for improvement were given for the rest. In step 3, the recommendations were further edited, and some new items were formed to accommodate the participants\' suggestions, resulting in a final set of 41 recommendations.
    CONCLUSIONS: This revision of the 2020 EAN Statement provides updated comprehensive and structured guidance on good clinical practice in people with neurological disease faced with SARS-CoV-2 infection. It now covers the issues from the more recent domains of COVID-19-related care, vaccine complications and post-COVID-19 conditions.
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  • 文章类型: Journal Article
    背景:血清流行病学研究的完整报告对于其在证据综合和公共卫生决策中的应用至关重要。血清流行病学研究报告-SARS-CoV-2(ROSES-S)指南是旨在改善SARS-CoV-2血清流行病学研究报告的清单。对ROSES-S指南的依从性尚未进行评估。
    目的:本研究旨在评估COVID-19大流行期间ROSES-S指南报告的SARS-CoV-2血清流行病学研究的完整性,确定指南发布是否与报告完整性相关,并确定与报告完整性相关的研究特征。
    方法:对来自SeroTracker生活系统评价数据库的随机样本进行了评估。对于指南中的每个报告项目,计算了坚持研究的百分比,以及所有项目和项目领域的中位数和四分位数范围(IQR)依从性。β回归分析用于评估坚持ROSES-S的预测因子。
    结果:分析了109项研究。每个研究的中位依从性为48.1%(IQR40.0%-55.2%),总体依从性为8.8%至72.7%。实验室方法领域的中位依从性最低(33.3%[IQR25.0%-41.7%])。讨论域的中位依从性最高(75.0%[IQR50.0%-100.0%])。在指南发布前后报告对ROSES-S的依从性没有显著变化。出版物来源(p<0.001),研究偏倚风险(p=0.001),和抽样方法(p=0.004)与依从性显著相关。
    结论:SARS-CoV-2血清流行病学研究报告的完整性并不理想。ROSES-S指南的发布与报告实践的变化无关。作者应在利益相关者的支持下提高对ROSES-S指南的依从性。
    BACKGROUND: Complete reporting of seroepidemiologic studies is critical to their utility in evidence synthesis and public health decision making. The Reporting of Seroepidemiologic studies-SARS-CoV-2 (ROSES-S) guideline is a checklist that aims to improve reporting in SARS-CoV-2 seroepidemiologic studies. Adherence to the ROSES-S guideline has not yet been evaluated.
    OBJECTIVE: This study aims to evaluate the completeness of SARS-CoV-2 seroepidemiologic study reporting by the ROSES-S guideline during the COVID-19 pandemic, determine whether guideline publication was associated with reporting completeness, and identify study characteristics associated with reporting completeness.
    METHODS: A random sample from the SeroTracker living systematic review database was evaluated. For each reporting item in the guideline, the percentage of studies that were adherent was calculated, as well as median and interquartile range (IQR) adherence across all items and by item domain. Beta regression analyses were used to evaluate predictors of adherence to ROSES-S.
    RESULTS: One hundred and ninety-nine studies were analyzed. Median adherence was 48.1% (IQR 40.0%-55.2%) per study, with overall adherence ranging from 8.8% to 72.7%. The laboratory methods domain had the lowest median adherence (33.3% [IQR 25.0%-41.7%]). The discussion domain had the highest median adherence (75.0% [IQR 50.0%-100.0%]). Reporting adherence to ROSES-S before and after guideline publication did not significantly change. Publication source (p < 0.001), study risk of bias (p = 0.001), and sampling method (p = 0.004) were significantly associated with adherence.
    CONCLUSIONS: Completeness of reporting in SARS-CoV-2 seroepidemiologic studies was suboptimal. Publication of the ROSES-S guideline was not associated with changes in reporting practices. Authors should improve adherence to the ROSES-S guideline with support from stakeholders.
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  • 文章类型: Randomized Controlled Trial
    目的:评估常规护理加基本护理指南与仅对COVID-19住院患者的常规护理相比对患者体验的影响,护理质量,功能能力,治疗结果,护士道德困扰,患者健康相关的生活质量和成本效益。
    方法:平行双臂,整群随机对照试验。
    方法:在2021年1月18日至12月20日之间,我们招募了(i)18岁及以上患有COVID-19的成年人,不包括侵入性通风者,在英国医院信托基金住院至少三天或三个晚上;(ii)照顾他们的护士。我们随机分配医院使用基本护理指南和常规护理或仅常规护理。我们的患者报告的共同主要结果是护理问卷的关系方面和来自患者观点问卷的质量的四个量表。我们进行了意向治疗分析。
    结果:我们随机分为15组,招募了581名患者和418名护士参与者。主要结果数据可用于14个集群中的570-572名(98.1%-98.5%)患者参与者。我们没有发现任何患者的组间差异的证据,护士或经济结果。随着时间的推移,我们发现了组间的差异,赞成干预,对于我们五个共同主要结果中的三个,和一个主要患者的种族结局的显着相互作用(英国白人与其他)并分配组支持对“其他”种族亚组的干预。
    结论:与常规护理相比,我们没有发现基本护理指南的患者体验总体差异。我们有迹象表明,随着时间的推移,该指南可能有助于维持良好的实践,并对非白人英国患者的护理体验产生了更积极的影响。
    我们不建议在常规护理实践中全面实施我们的指南。进一步的干预发展,可行性,需要进行试点和评估研究。
    结论:基础护理驱动患者体验,但在大流行中受到严重影响。我们的指导方针并不优于常规护理,尽管它可以维持良好的实践,并对非白人英国患者的护理体验产生积极影响。
    CONSORTandCONSERVE.
    有COVID-19住院经历的患者参与了指南的制定和编写,试验管理和结果解释。
    OBJECTIVE: To evaluate the impact of usual care plus a fundamental nursing care guideline compared to usual care only for patients in hospital with COVID-19 on patient experience, care quality, functional ability, treatment outcomes, nurses\' moral distress, patient health-related quality of life and cost-effectiveness.
    METHODS: Parallel two-arm, cluster-level randomized controlled trial.
    METHODS: Between 18th January and 20th December 2021, we recruited (i) adults aged 18 years and over with COVID-19, excluding those invasively ventilated, admitted for at least three days or nights in UK Hospital Trusts; (ii) nurses caring for them. We randomly assigned hospitals to use a fundamental nursing care guideline and usual care or usual care only. Our patient-reported co-primary outcomes were the Relational Aspects of Care Questionnaire and four scales from the Quality from the Patient Perspective Questionnaire. We undertook intention-to-treat analyses.
    RESULTS: We randomized 15 clusters and recruited 581 patient and 418 nurse participants. Primary outcome data were available for 570-572 (98.1%-98.5%) patient participants in 14 clusters. We found no evidence of between-group differences on any patient, nurse or economic outcomes. We found between-group differences over time, in favour of the intervention, for three of our five co-primary outcomes, and a significant interaction on one primary patient outcome for ethnicity (white British vs. other) and allocated group in favour of the intervention for the \'other\' ethnicity subgroup.
    CONCLUSIONS: We did not detect an overall difference in patient experience for a fundamental nursing care guideline compared to usual care. We have indications the guideline may have aided sustaining good practice over time and had a more positive impact on non-white British patients\' experience of care.
    UNASSIGNED: We cannot recommend the wholescale implementation of our guideline into routine nursing practice. Further intervention development, feasibility, pilot and evaluation studies are required.
    CONCLUSIONS: Fundamental nursing care drives patient experience but is severely impacted in pandemics. Our guideline was not superior to usual care, albeit it may sustain good practice and have a positive impact on non-white British patients\' experience of care.
    UNASSIGNED: CONSORT and CONSERVE.
    UNASSIGNED: Patients with experience of hospitalization with COVID-19 were involved in guideline development and writing, trial management and interpretation of findings.
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  • 文章类型: Journal Article
    未经批准:冠状病毒病(COVID-19),由新型冠状病毒严重急性呼吸道综合症冠状病毒2(SARS-CoV-2)引起的传染病,自2020年初以来已在全球范围内传播,但仍没有解决的迹象。日本脓毒症和脓毒性休克管理临床实践指南(J-SSCG)2020特别委员会利用创建J-SSCG的经验,制定了日本关于COVID-19药物管理的快速/生活建议。
    未经批准:推荐等级,评估,发展,使用评估(等级)方法来确定证据的确定性和建议的强度。该指南的第一版于2020年9月9日发布,这是修订版(5.0版;于2022年7月15日发布)。临床问题(CQs)设置为以下10种药物:favipirravir(CQ1),雷姆德西韦(CQ2),皮质类固醇(CQ4),托珠单抗(CQ5),抗凝剂(CQ7),巴利替尼(CQ8),casirivimab/imdevimab(CQ9-1),sotrovimab(CQ9-2),莫努比拉韦(CQ10),和尼马特雷韦/利托那韦(CQ11)。
    未经批准:并非所有COVID-19(2C级)患者都建议使用Favipiravir。对于不需要氧气的轻度COVID-19患者,建议使用Remdesivir,和需要补充氧气/住院的中度COVID-19患者(均为2B级)。皮质类固醇建议用于中度和重度COVID-19(1B级,1A).然而,对于轻度COVID-19(1B级),不建议使用它们。Tocilizumab建议用于中重度COVID-19(2B级,2C).中重度COVID-19建议服用抗凝剂(良好做法声明)。巴利替尼建议用于中度和重度COVID-19(均为2C级)。对于轻度COVID-19(均为2C级),建议使用卡西里维单抗/imdevimab和sotrovimab。Molnupiravir和nirmatrelvir/ritonavir建议用于轻度COVID-19(均为2C级)。SARS-CoV-2突变株偶尔出现,每一次,诊所的治疗政策被迫彻底改变。我们要求该领域的医疗保健专业人员参考这些指南中的建议,并使用这些建议来及时了解COVID-19流行病学信息。
    UNASSIGNED: Coronavirus disease (COVID-19), an infectious disease caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread worldwide since early 2020, and there are still no signs of resolution. The Japanese Clinical Practice Guidelines for the Management of Sepsis and Septic Shock (J-SSCG) 2020 Special Committee created the Japanese Rapid/Living recommendations on drug management for COVID-19 using the experience of creating the J-SSCG.
    UNASSIGNED: The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to determine the certainty of the evidence and strength of recommendations. The first edition of this guideline was released on September 9, 2020, and this is the revised edition (version 5.0; released on July 15, 2022). Clinical questions (CQs) were set for the following 10 drugs: favipiravir (CQ1), remdesivir (CQ2), corticosteroids (CQ4), tocilizumab (CQ5), anticoagulants (CQ7), baricitinib (CQ8), casirivimab/imdevimab (CQ9-1), sotrovimab (CQ9-2), molnupiravir (CQ10), and nirmatrelvir/ritonavir (CQ11).
    UNASSIGNED: Favipiravir is not suggested for all patients with COVID-19 (GRADE 2C). Remdesivir is suggested for patients with mild COVID-19 who do not require oxygen, and patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (both GRADE 2B). Corticosteroids are recommended for moderate and severe COVID-19 (GRADE 1B, 1A). However, their administration is not recommended for mild COVID-19 (GRADE 1B). Tocilizumab is suggested for moderate and severe COVID-19 (GRADE 2B, 2C). Anticoagulant administration is recommended for moderate and severe COVID-19 (Good Practice Statement). Baricitinib is suggested for moderate and severe COVID-19 (both GRADE 2C). Casirivimab/imdevimab and sotrovimab are recommended for mild COVID-19 (both GRADE 2C). Molnupiravir and nirmatrelvir/ritonavir are recommended for mild COVID-19 (both GRADE 2C). SARS-CoV-2 mutant strains emerge occasionally, and each time, the treatment policy at clinics is forced to change drastically. We ask health-care professionals in the field to refer to the recommendations in these guidelines and use these to keep up to date with COVID-19 epidemiological information.
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  • 文章类型: Journal Article
    背景:自2020年初以来,2019年冠状病毒病(COVID-19)已在全球范围内传播,并且仍然没有解决的迹象。日本脓毒症和脓毒性休克管理临床实践指南(J-SSCG)2020特别委员会利用创建J-SSCG的经验,创建了日本关于COVID-19药物管理的快速/生活建议。
    方法:推荐等级,评估,发展,和评估(等级)方法用于确定证据的确定性和建议的强度。本指南的第一版于2020年9月9日发布,本文档为修订版(4.0版;于2021年9月9日发布)。临床问题(CQ)设置为以下七种药物:favipiravir(CQ1),雷姆德西韦(CQ2),皮质类固醇(CQ4),托珠单抗(CQ5),抗凝剂(CQ7),巴利替尼(CQ8),和casirivimab/imdevimab(CQ9)。在此更新版本中检索了两个CQs(羟氯喹[CQ3]和环索奈德[CQ6])。
    结论:并非所有COVID-19患者都建议使用Favipiravir(2C级)。建议将Remdesivir用于需要补充氧气/住院的中度COVID-19患者(2B级)。对于需要补充氧气/住院的中度COVID-19患者(1B级)和需要机械通气/重症监护的重度COVID-19患者(1A级),建议使用皮质类固醇;然而,对于不需要补充氧气的轻度COVID-19患者,不建议使用这种药物(Grade1B).Tocilizumab建议用于需要补充氧气/住院的中度COVID-19患者(2B级)。对于需要补充氧气/住院的中度COVID-19患者和需要机械通气/重症监护的重度COVID-19患者,建议使用抗凝剂(良好做法声明)。巴利替尼建议用于需要补充氧气/住院的中度COVID-19患者(第2C级)。对于不需要补充氧气的轻度COVID-19患者,建议使用Casirivimab/imdevimab(1B级)。我们希望这些更新的临床实践指南将有助于参与COVID-19患者护理的医疗专业人员。
    BACKGROUND: The coronavirus disease 2019 (COVID-19) has spread worldwide since early 2020, and there are still no signs of resolution. The Japanese Clinical Practice Guidelines for the Management of Sepsis and Septic Shock (J-SSCG) 2020 Special Committee created the Japanese rapid/living recommendations on drug management for COVID-19 using the experience of creating the J-SSCG.
    METHODS: The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to determine the certainty of the evidence and strength of the recommendations. The first edition of this guideline was released on September 9, 2020, and this document is the revised edition (version 4.0; released on September 9, 2021). Clinical questions (CQs) were set for the following seven drugs: favipiravir (CQ1), remdesivir (CQ2), corticosteroids (CQ4), tocilizumab (CQ5), anticoagulants (CQ7), baricitinib (CQ8), and casirivimab/imdevimab (CQ9). Two CQs (hydroxychloroquine [CQ3] and ciclesonide [CQ6]) were retrieved in this updated version.
    CONCLUSIONS: Favipiravir is not suggested for all patients with COVID-19 (GRADE 2C). Remdesivir is suggested for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (GRADE 2B). Corticosteroids are recommended for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (GRADE 1B) and for patients with severe COVID-19 requiring mechanical ventilation/intensive care (GRADE 1A); however, their administration is not recommended for patients with mild COVID-19 not requiring supplemental oxygen (GRADE 1B). Tocilizumab is suggested for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (GRADE 2B). Anticoagulant administration is recommended for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization and patients with severe COVID-19 requiring mechanical ventilation/intensive care (good practice statement). Baricitinib is suggested for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (GRADE 2C). Casirivimab/imdevimab is recommended for patients with mild COVID-19 not requiring supplemental oxygen (GRADE 1B). We hope that these updated clinical practice guidelines will help medical professionals involved in the care of patients with COVID-19.
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  • 文章类型: Journal Article
    观察性研究表明,患有COVID-19相关疾病的儿童住院,像成年人一样,静脉血栓栓塞(VTE)的风险增加。美国最近启动了一项针对COVID-19相关疾病住院儿童的抗凝血栓预防的多中心2期临床试验。迄今为止,仍然缺乏高质量的证据来为全世界的临床实践提供信息.因此,本科学声明的目的是就因COVID-19相关疾病住院的儿童使用抗凝血栓预防提供基于共识的建议,并确定未来研究的重点。
    我们调查了来自几大洲的20名儿科血液科医师和儿科重症监护医师,他们被儿科/新生儿止血和血栓形成小组委员会领导认定,在使用抗凝血栓预防和/或管理儿童COVID-19相关疾病方面具有经验和专业知识。还对儿童COVID-19的文献进行了全面审查。
    反应率为90%。基于专家意见的共识,我们建议每天两次皮下注射低剂量低分子量肝素作为抗凝血栓预防(在没有禁忌症的情况下,并结合机械血栓预防与顺序加压装置,在可行的情况下)在因COVID-19相关疾病(包括儿童多系统炎症综合征[MIS-C])住院的儿童中,D-二聚体水平显着升高或叠加了与医院相关的VTE的临床危险因素。对于临床不稳定或有严重肾功能损害的儿童,我们建议通过连续静脉输注使用普通肝素作为抗凝血栓预防.此外,继续努力确定COVID-19儿童的VTE风险和风险因素,并通过合作多中心试验评估COVID-19相关疾病(包括MIS-C)住院儿童抗凝血栓预防策略的安全性和有效性,被确定为未来研究的几个关键优先事项。
    随着高质量证据的出现,这些基于共识的关于在因COVID-19相关疾病住院的儿童中使用抗凝血栓预防的建议以及未来研究的重点将得到更新。
    Observational studies indicate that children hospitalized with COVID-19-related illness, like adults, are at increased risk for venous thromboembolism (VTE). A multicenter phase 2 clinical trial of anticoagulant thromboprophylaxis in children hospitalized with COVID-19-related illness has recently been initiated in the United States. To date, there remains a paucity of high-quality evidence to inform clinical practice world-wide. Therefore, the objective of this scientific statement is to provide consensus-based recommendations on the use of anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illnesses, and to identify priorities for future research.
    We surveyed 20 pediatric hematologists and pediatric critical care physicians from several continents who were identified by Pediatric/Neonatal Hemostasis and Thrombosis Subcommittee leadership as having experience and expertise in the use of anticoagulant thromboprophylaxis and/or the management of COVID-19-related illness in children. A comprehensive review of the literature on COVID-19 in children was also performed.
    Response rate was 90%. Based on consensus of expert opinions, we suggest the administration of low-dose low molecular weight heparin subcutaneously twice-daily as anticoagulant thromboprophylaxis (in the absence of contraindications, and in combination with mechanical thromboprophylaxis with sequential compression devices, where feasible) in children hospitalized for COVID-19-related illness (including the multisystem inflammatory syndrome in children [MIS-C]) who have markedly elevated D-dimer levels or superimposed clinical risk factors for hospitalassociated VTE. For children who are clinically unstable or have severe renal impairment, we suggest the use of unfractionated heparin by continuous intravenous infusion as anticoagulant thromboprophylaxis. In addition, continued efforts to characterize VTE risk and risk factors in children with COVID-19, as well as to evaluate the safety and efficacy of anticoagulant thromboprophylaxis strategies in children hospitalized with COVID-19-related illness (including MIS-C) via cooperative multicenter trials, were identified among several key priorities for future research.
    These consensus-based recommendations on the use of anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illnesses and priorities for future research will be updated as high-quality evidence emerges.
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