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1.
Cell ; 187(6): 1347-1349, 2024 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-38490177

RESUMO

Dr. Shirin Heidari is the lead author of the Sex and Gender Equity in Research (SAGER) guidelines. In this interview with Dr. Isabel Goldman at Cell, she discusses her research, GENDRO, the SAGER guidelines and importance of considering sex- and gender-related variables in research, and her work on sexual and reproductive health in forced displacement.


Assuntos
Identidade de Gênero , Equidade em Saúde , Feminino , Humanos , Masculino , Guias como Assunto , Sexo
2.
Trials ; 25(1): 183, 2024 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-38475795

RESUMO

BACKGROUND: Evidence to support decisions on trial processes is minimal. One way to generate this evidence is to use a Study Within A Trial (SWAT) to test trial processes or explore methodological uncertainties. SWAT evidence relies on replication to ensure sufficient power and broad applicability of findings. Prompt reporting is therefore essential; however, SWAT publications are often the first to be abandoned in the face of other time pressures. Reporting guidance for embedded methodology trials does exist but is not widely used. We sought therefore to build on these guidelines to develop a straightforward, concise reporting standard, which remains adherent to the CONSORT guideline. METHODS: An iterative process was used to develop the guideline. This included initial meetings with key stakeholders, development of an initial guideline, pilot testing of draft guidelines, further iteration and pilot testing, and finalisation of the guideline. RESULTS: We developed a reporting guideline applicable to randomised SWATs, including replications of previous evaluations. The guideline follows the Consolidated Standards for Reporting Trials (CONSORT) statement and provides example text to ensure ease and clarity of reporting across all domains. CONCLUSIONS: The SWAT reporting guideline will aid authors, reviewers, and journal editors to produce and review clear, structured reports of randomised SWATs, whilst also adhering to the CONSORT guideline. TRIAL REGISTRATION: EQUATOR Network - Guidelines Under Development ( https://www.equator-network.org/library/reporting-guidelines-under-development/reporting-guidelines-under-development-for-clinical-trials/#SWAT ). Registered on 25 March 2021.


Assuntos
Guias como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos
3.
J Integr Complement Med ; 30(2): 133-145, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38300148

RESUMO

Highlights Guidelines have been created to improve the reporting of clinical trials of biofield therapies, e.g. External Qigong, Healing Touch, Reiki, and Therapeutic Touch. Appropriate use of these guidelines is likely to strengthen the evidence base for biofield therapies as well as increase their usage as stand-alone practices and as complementary therapies within mainstream healthcare.


Assuntos
Ensaios Clínicos como Assunto , Guias como Assunto , Terapias Mente-Corpo , Terapias Complementares , Qigong , Toque Terapêutico
4.
Medicine (Baltimore) ; 103(7): e37079, 2024 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-38363902

RESUMO

BACKGROUND: Quality reporting contributes to effective translation of health research in practice and policy. As an initial step in the development of a reporting guideline for scaling, the Standards for reporting stUdies of sCaling evidenCEd-informED interventions (SUCCEED), we performed a systematic review to identify relevant guidelines and compile a list of potential items. METHODS: We conducted a systematic review according to Cochrane method guidelines. We searched the following databases: MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, Web of Science, from their respective inceptions. We also searched websites of relevant organizations and Google. We included any document that provided instructions or recommendations, e.g., reporting guideline, checklist, guidance, framework, standard; could inform the design or reporting of scaling interventions; and related to the health sector. We extracted characteristics of the included guidelines and assessed their methodological quality using a 3-item internal validity assessment tool. We extracted all items from the guidelines and classified them according to the main sections of reporting guidelines (title, abstract, introduction, methods, results, discussion and other information). We performed a narrative synthesis based on descriptive statistics. RESULTS: Of 7704 records screened (published between 1999 and 2019), we included 39 guidelines, from which data were extracted from 57 reports. Of the 39 guidelines, 17 were for designing scaling interventions and 22 for reporting implementation interventions. At least one female author was listed in 31 guidelines, and 21 first authors were female. None of the authors belonged to the patient stakeholder group. Only one guideline clearly identified a patient as having participated in the consensus process. More than half the guidelines (56%) had been developed using an evidence-based process. In total, 750 items were extracted from the 39 guidelines and distributed into the 7 main sections. CONCLUSION: Relevant items identified could inform the development of a reporting guideline for scaling studies of evidence-based health interventions. This and our assessment of guidelines could contribute to better reporting in the science and practice of scaling.


Assuntos
Guias como Assunto , Pesquisa sobre Serviços de Saúde , Humanos , Pesquisa sobre Serviços de Saúde/normas
5.
PLoS One ; 19(2): e0299806, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38421981

RESUMO

Biomedical research reporting guidelines provide a framework by which journal editors and the researchers who conduct studies can ensure that the reported research is both complete and transparent. With more than 16 different guidelines for the 11 major study types of medical and health research, authors need to be familiar with journal reporting standards. To assess the current endorsements of reporting guidelines for biomedical and health research, this study examined the instructions for authors (IFAs) of 559 biomedical journals by 11 prominent publishers that publish original research or systematic reviews/meta-analyses. Data from the above original sources were cleaned and restructured, and analyzed in a database and text miner. Each journal's instructions or information for authors were examined to code if any of five prominent reporting guidelines were mentioned and what form the guideline adherence demonstration took. Seventeen journals published the reporting guidelines. Four of the five reporting guidelines listed journals as endorsers. For journals with open peer review reports, a sample of journals and peer reviews was analyzed for mention of adherence to reporting guidelines. The endorsement of research guidelines by publishers and their associated journals is inconsistent for some publishers, with only a small number of journals endorsing relevant guidelines. Based on the analysis of open peer reviews, there is evidence that some reviewers check the adherence to the endorsed reporting guidelines. Currently, there is no universal endorsement of reporting guidelines by publishers nor ways of demonstrating adherence to guidelines. Journals may not directly inform authors of their guideline endorsements, making it more difficult for authors to adhere to endorsed guidelines. Suggestions derived from the findings are provided for authors, journals, and reporting guidelines to ensure increased adequate use of endorsed reporting guidelines.


Assuntos
Pesquisa Biomédica , Guias como Assunto , Humanos , Bases de Dados Factuais , Fidelidade a Diretrizes , Publicações Periódicas como Assunto
6.
Med Educ Online ; 29(1): 2316986, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-38361490

RESUMO

Academics in medicine are frequently asked to serve on panels to discuss their clinical, research, education, administrative or personal expertise. While panel discussions are often the highlight of a conference or event, in the medical literature, there is very little published on how an individual can effectively prepare and present as an expert panelist. This paper offers guidelines that will enable academics to prepare, deliver, and engage in active dialogue during a panel discussion. Specific tactics include how to accept invitations to serve on a panel, conducting pre-panel conference meetings and background research, preparing concise opening statements and new insights, connecting with the audience, answering questions in a collaborative spirit, and debriefing after the panel. These guidelines will be valuable to any individual invited to serve on a panel discussion and will promote future panelists in engaging in constructive and fulfilling dialogue, with the ultimate goal of leaving the audience with a greater understanding of the topic of discourse.


Assuntos
Comunicação , Processos Grupais , Humanos , Guias como Assunto
7.
Syst Rev ; 13(1): 28, 2024 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-38216987

RESUMO

BACKGROUND: Requiring authors to base their research on a systematic review of the existing literature prevents the generation of redundant scientific studies, thereby avoiding the deprivation of effective therapies for trial participants and the waste of research funds. Scientific medical journals could require this in their author guidelines. While this applies to all areas of research, it is also relevant to physiotherapy and rehabilitation research, which predominantly involve interventional trials in patients. OBJECTIVE: The aim of this study was to determine the extent to which the use of systematic reviews to justify a new trial is already being requested by physiotherapy-related scientific medical journals (PTJs). In addition, a comparison was made between PTJs and scientific medical journals with the highest impact factor in the Science Citation Index Extended (SCIE). METHODS: This meta-research study is based on a systematic examination of the author guidelines of 149 PTJs. The journals were identified and included based on the number of publications with physiotherapy as a keyword in the databases PEDro, and Medline (Pubmed). The included author guidelines were analysed for the extent to which they specified that a new trial should be justified by a systematic review of the literature. Additionally, they were compared with 14 scientific medical journals with the highest impact factor in the SCIE (LJs). RESULTS: In their author guidelines, none of the included PTJs required or recommended the use of a systematic review to justify a new trial. Among LJs, four journals (28.57%), all associated with the Lancet group, required the study justification through a systematic review of the literature. CONCLUSION: Neither PTJs nor LJs require or recommend the use of a systematic review to justify a new trial in their author guidelines. This potentially leaves room for unethical scientific practices and should be critically considered in future research.


Assuntos
Guias como Assunto , Publicações Periódicas como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Humanos , Medicina , Modalidades de Fisioterapia
9.
BMJ Health Care Inform ; 30(1)2023 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-38050422

RESUMO

BACKGROUND: Health information technology (HIT) is increasingly used to enable health service/system transformation. Most HIT implementations fail to some degree; very few demonstrate sustainable success. No guidelines exist for health service leaders to leverage factors associated with success. The purpose of this paper is to present an evidence-based guideline for leaders to test and leverage in practice. METHODS: This guideline was developed from a literature review and refined by a set of eight interviews with people in senior HIT roles, which were thematically analysed. It was refined in the consultancy work of the first author and confirmed after minor refinements. RESULTS: Five key actions were identified: relationships, vision, HIT system attributes, constant evaluation and learning culture. CONCLUSIONS: This guideline presents a significant opportunity for health system leaders to systematically check relevant success factors during the implementation process of single projects and regional/national programmes.


Assuntos
Guias como Assunto , Informática Médica , Humanos
10.
PLoS One ; 18(12): e0285236, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38096166

RESUMO

OBJECTIVE: The overall goal of this work is to produce a set of recommendations (SoNHR-Social Networks in Health Research) that will improve the reporting and dissemination of social network concepts, methods, data, and analytic results within health sciences research. METHODS: This study used a modified-Delphi approach for recommendation development consistent with best practices suggested by the EQUATOR health sciences reporting guidelines network. An initial set of 28 reporting recommendations was developed by the author team. A group of 67 (of 147 surveyed) experienced network and health scientists participated in an online feedback survey. They rated the clarity and importance of the individual recommendations, and provided qualitative feedback on the coverage, usability, and dissemination opportunities of the full set of recommendations. After examining the feedback, a final set of 18 recommendations was produced. RESULTS: The final SoNHR reporting guidelines are comprised of 18 recommendations organized within five domains: conceptualization (how study research questions are linked to network conceptions or theories), operationalization (how network science portions of the study are defined and operationalized), data collection & management (how network data are collected and managed), analyses & results (how network results are analyzed, visualized, and reported), and ethics & equity (how network-specific human subjects, equity, and social justice concerns are reported). We also present a set of exemplar published network studies which can be helpful for seeing how to apply the SoNHR recommendations in research papers. Finally, we discuss how different audiences can use these reporting guidelines. CONCLUSIONS: These are the first set of formal reporting recommendations of network methods in the health sciences. Consistent with EQUATOR goals, these network reporting recommendations may in time improve the quality, consistency, and replicability of network science across a wide variety of important health research areas.


Assuntos
Projetos de Pesquisa , Rede Social , Humanos , Guias como Assunto
11.
Syst Rev ; 12(1): 239, 2023 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-38102710

RESUMO

BACKGROUND: A bibliometric review of the biomedical literature could be essential in synthesizing evidence if thoroughly conducted and documented. Although very similar to review papers in nature, it slightly differs in synthesizing the data when it comes to providing a pile of evidence from different studies into a single document. This paper provides a preliminary guideline for reporting bibliometric reviews of the biomedical literature (BIBLIO). METHODS: The BIBLIO was developed through two major processes: literature review and the consensus process. The BIBLIO started with a comprehensive review of publications on the conduct and reporting of bibliometric studies. The databases searched included PubMed, Scopus, Web of Sciences, and Cochrane Library. The process followed the general recommendations of the EQUATOR Network on how to develop a reporting guideline, of which one fundamental part is a consensus process. A panel of experts was invited to identify additional items and was asked to choose preferred options or suggest another item that should be included in the checklist. Finally, the checklist was completed based on the comments and responses of the panel members in four rounds. RESULTS: The BIBLIO includes 20 items as follows: title (2 items), abstract (1 item), introduction/background (2 items), methods (7 items), results (4 items), discussion (4 items). These should be described as a minimum requirements in reporting a bibliometric review. CONCLUSIONS: The BIBLIO for the first time provides a preliminary guideline of its own kind. It is hoped that it could contribute to the transparent reporting of bibliometric reviews. The quality and utility of BIBILO remain to be investigated further.


Assuntos
Bibliometria , Guias como Assunto , Humanos , Lista de Checagem , Consenso
12.
West Afr J Med ; 40(11): 1232-1239, 2023 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-38099481

RESUMO

BACKGROUND: Early childhood caries (ECC) is characterized by "the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries), or filled surfaces, in any primary tooth in a child 71 months of age or younger". There have been reports of increased incidence of caries in developing countries.A systematic analysis of the global burden of diseases, injuries and risk factors for 195 countries from 1990 to 2015 reported that almost 8% of children globally were affected by untreated ECC. As such, ECC was classified as one of the diseases of public health concern because it affects millions of infants and preschool children worldwide. This study aimed to review the prevalence and associated factors of early childhood caries in Nigeria and also provides current overview alongside globally recommended treatment guidelines. DATA SOURCE: PubMed database, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews (to February 2022) was used for articles search on the guidelines and recommendations for the treatment of ECC. Guidelines and recommendations published by the American Academy of Paediatric Dentistry, International Association of Paediatric Dentistry and European Academy of Paediatric Dentistry from 2017-2020 were retrieved. The following keys used in the MeSH were 'early childhood caries among Nigerian children, 'caries in preschool Nigerian children' 'treatment guidelines', 'treatment policies'and 'treatment recommendations. STUDY SELECTION: A total of 105 (24 plus 81) articles were retrieved but 21(15 plus 6 articles) were selected after the removal of non-specific and duplicated articles. RESULTS: The prevalence of early childhood caries ranged from 4.3-23.5% in Nigeria while the treatment guidelines and recommendations were case-specific. CONCLUSION: The prevalence of early childhood caries varies within the country's geo-political zones.


CONTEXTE: Les caries de la petite enfance (CPE) se caractérisent par "la présence d'une ou de plusieurs surfaces cariées (lésions non cavités ou cavités), manquantes (en raison de caries) ou obturées, sur une ou plusieurs dents primaires chez un enfant de 71 mois ou moins". Des rapports ont fait état d'une incidence accrue de caries dans les pays en développement. Une analyse systématique de la charge mondiale des maladies, des blessures et des facteurs de risque pour 195 pays de 1990 à 2015 a indiqué qu'environ 8 % des enfants dans le monde étaient touchés par des CPE non traitées. En tant que tel, les CPE ont été classées comme l'une des maladies préoccupantes pour la santé publique car elles touchent des millions de nourrissons et de jeunes enfants dans le monde. Cette étude visait à examiner la prévalence et les facteurs associés des caries de la petite enfance au Nigeria et à fournir une vue d'ensemble actuelle ainsi que des lignes directrices de traitement recommandées au niveau mondial. SOURCE DES DONNÉES: La base de données PubMed, le Registre Cochrane central des essais contrôlés et la base de données Cochrane des revues systématiques (jusqu'à février 2022) ont été utilisés pour la recherche d'articles sur les lignes directrices et recommandations pour le traitement des CPE. Les lignes directrices et recommandations publiées par l'American Academy of Paediatric Dentistry, l'International Association of Paediatric Dentistry et l'European Academy of Paediatric Dentistry de 2017 à 2020 ont été récupérées. Les termes suivants ont été utilisés dans le MeSH : 'caries de la petite enfance chez les enfants nigérians', 'caries chez les enfants préscolaires nigérians', 'lignes directrices de traitement', 'politiques de traitement' et 'recommandations de traitement'. SÉLECTION DES ÉTUDES: Un total de 105 (24 plus 81) articles ont été récupérés, mais 21 (15 plus 6 articles) ont été sélectionnés après la suppression des articles non spécifiques et en double. RÉSULTATS: La prévalence des caries de la petite enfance variait de 4,3 % à 23,5 % au Nigeria, tandis que les lignes directrices et recommandations de traitement étaient spécifiques à chaque cas. CONCLUSION: La prévalence des caries de la petite enfance variait au sein des zones géopolitiques du pays. Mots-clés: Caries de la petite enfance, CPE, Lignes directrices de traitement.


Assuntos
Suscetibilidade à Cárie Dentária , Cárie Dentária , Pré-Escolar , Humanos , Lactente , Cárie Dentária/epidemiologia , Cárie Dentária/terapia , Nigéria/epidemiologia , Prevalência , Fatores de Risco , Revisões Sistemáticas como Assunto , Guias como Assunto
13.
Health Res Policy Syst ; 21(1): 114, 2023 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-37915056

RESUMO

BACKGROUND: Guideline adaptation is an emerging field to provide more appropriate recommendations for local clinical practice quality and to promote global health equity. However, its utilization status, adaptation procedures, and related materials remain to be studied. METHODS: This study developed a quality improvement protocol for a study as the Development, Evaluation, and impLemenTation for guideline Adaptation (DELTA) study. Current adapted clinical practice guidelines (CPGs) will be systematically searched. Their characteristics, utilization status, and adaptation procedures will be extracted, compared, and analyzed. Whether these adapted CPGs rigorously followed the instruments and steps of adaptation frameworks will also be appraised. In addition, the advantages and limitations of current adaptation methods and their suitable application situations will be analyzed. In addition, future perspectives as DELTA series and DELTA system, aiming for comprehensively evaluating current needs for guideline adaptation and developing a unified framework and related materials were proposed to improve the acceptability, applicability, and implementation of guideline adaptation in clinical practice. The DELTA series are divided into four phases: phase I in analyzing status, characteristics, and procedures and completeness of adapted CPGs; phase II in analyzing differences, heterogeneity, and implementation between adapted and original CPGs; and phase III in collecting, analyzing, and comparing all available adaptation materials. With these research bases, an international working group will be established in phase IV and will develop unified guideline adaptation materials after Delphi consensus, including adaptation frameworks, appraisal tools and checklists, registries, and databases. DISCUSSION: Guideline adaptation has been advanced as an efficient way to guide local clinical practice. However, it still faces several major challenges. The proposed DELTA study, series, and system will further contribute to this emerging topic. TRIAL REGISTRATION:  This study has been registered by the PROSPERO international database. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=400170 .


Assuntos
Saúde Global , Melhoria de Qualidade , Humanos , Lista de Checagem , Consenso , Bases de Dados Factuais , Guias como Assunto
14.
Nutrients ; 15(21)2023 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-37960307

RESUMO

Evidence-based dietetic practice calls for systematically developed assessment methods for nutritional assessment in dietetic counselling and therapy (DCT). Screeners can provide a quick and easy way to determine a client's diet quality and contribute to quality assurance in DCT. The aim of this systematic review was to give a comparative overview of screeners based on national food-based dietary guidelines (FBDGs) and to derive recommendations for developing an FBDG-based screener for DCT. The literature search in PubMed (MEDLINE), embase and Web of Science was conducted between May and July 2022, and updated in March 2023, in accordance with the consensus-based standards for the selection of health measurement instruments (COSMIN). The analysis focused on characteristics of screener design and measurement properties for screener testing. In total, 13 studies on 11 screeners based on FBDGs were included; 7 screeners were targeted to DCT. The content and scoring of screeners were based on the corresponding national FBDGs. The validity and/or reliability of screeners were investigated in 11 studies; responsiveness was not tested for any screener and practicality was considered in all studies. Based on the screeners reviewed, a systematic rationale to develop, enhance and test screeners based on national FBDGs was established.


Assuntos
Dietética , Alimentos , Humanos , Dieta , Política Nutricional , Reprodutibilidade dos Testes , Guias como Assunto
15.
J Med Internet Res ; 25: e46089, 2023 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-37991819

RESUMO

BACKGROUND: The application of artificial intelligence (AI) in the delivery of health care is a promising area, and guidelines, consensus statements, and standards on AI regarding various topics have been developed. OBJECTIVE: We performed this study to assess the quality of guidelines, consensus statements, and standards in the field of AI for medicine and to provide a foundation for recommendations about the future development of AI guidelines. METHODS: We searched 7 electronic databases from database establishment to April 6, 2022, and screened articles involving AI guidelines, consensus statements, and standards for eligibility. The AGREE II (Appraisal of Guidelines for Research & Evaluation II) and RIGHT (Reporting Items for Practice Guidelines in Healthcare) tools were used to assess the methodological and reporting quality of the included articles. RESULTS: This systematic review included 19 guideline articles, 14 consensus statement articles, and 3 standard articles published between 2019 and 2022. Their content involved disease screening, diagnosis, and treatment; AI intervention trial reporting; AI imaging development and collaboration; AI data application; and AI ethics governance and applications. Our quality assessment revealed that the average overall AGREE II score was 4.0 (range 2.2-5.5; 7-point Likert scale) and the mean overall reporting rate of the RIGHT tool was 49.4% (range 25.7%-77.1%). CONCLUSIONS: The results indicated important differences in the quality of different AI guidelines, consensus statements, and standards. We made recommendations for improving their methodological and reporting quality. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews (CRD42022321360); https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=321360.


Assuntos
Inteligência Artificial , Medicina , Humanos , Consenso , Bases de Dados Factuais , Guias como Assunto
16.
17.
Indian Pediatr ; 60(10): 855-858, 2023 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-37818810

RESUMO

Guidelines for screening and management of congenital hypothyroidism in neonates have been recently updated by the American Academy of Pediatrics (AAP). This article compares new AAP guideline with the Indian Society for Pediatric and Adolescent Endocrinology (ISPAE) Guidelines, 2018 and lists the changes in screening, diagnosis, and management of congenital hypothyroidism suggested in the new guidelines, along with clinical utilization in the Indian scenario.


Assuntos
Hipotireoidismo Congênito , Adolescente , Criança , Humanos , Recém-Nascido , Hipotireoidismo Congênito/diagnóstico , Hipotireoidismo Congênito/terapia , Sociedades Médicas , Estados Unidos , Guias como Assunto
18.
Clin J Oncol Nurs ; 27(2): 199-203, 2023 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-37677841

RESUMO

Since 1986, the American Association of Colleges of Nursing (AACN) has published its Essentials, a framework to guide all levels of nursing education and practice. This brief overview will describe the latest AACN Essentials.


Assuntos
Educação em Enfermagem , Humanos , Estados Unidos , Educação em Enfermagem/normas , Guias como Assunto
19.
Int J Qual Health Care ; 35(4)2023 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-37728256

RESUMO

Oxygen is one of the most commonly used emergency therapies. Like other therapies, oxygen can cause harm if used inappropriately. During the COVID-19 pandemic, guidelines were released to optimize oxygen and medication use. In the current study, we examine whether oxygen and medication use during the first wave of the COVID-19 pandemic was in concordance with new guidelines. A retrospective cross-sectional study was conducted using routinely collected data from University of Birmingham NHS Foundation Trust in England. Patients were admitted between April 2020 and September 2020, were over the age of 18 years, and had a confirmed diagnosis of COVID-19. To assess adherence to the oxygen guidelines (i.e. SpO2 adherence), the percentage of times oxygen therapy was administered within, over, and under guideline specifications were calculated for patients overall, and then for patients with and without chronic obstructive pulmonary disease (COPD)/pulmonary disease separately. Next, two multinomial regression analyses were conducted to assess whether clinical processes, pre-admission diagnoses, and other demographic factors were related to oxygen use. Analysis 1 included patients not diagnosed with COPD/pulmonary disease. Analysis 2 included patients diagnosed with COPD/pulmonary disease. Results are reported as tallies, percentages, and odds ratios with 95% confidence intervals. To assess adherence to a new medication guideline, the percentage of patients administered oxygen and dexamethasone was calculated for those admitted after 25 June 2020. The overall number of patients included in our SpO2 adherence analyses was 8751 (female = 4168). Oxygen was used within guideline specifications less than half the time, i.e. 41.6% (n = 3638/8751); non-adherence involving under-administering (3.5%, n = 304/8751) was markedly lower than over-administering (55.0%, n = 4809/8751). Adherence was higher for patients without COPD (43.7%, n = 3383/7741) than with COPD (25.2%, n = 255/1010). Under-administering was low across groups (non-COPD 3.5%, n = 274/7741 and COPD 2.9%, n = 30/1010). Over-administering was markedly lower for non-COPD (52.3%, n = 4084/7741) than COPD (71.8%, n = 725/1010) patients. Diagnoses associated with over-administering varied across the groups. Regarding the dexamethasone guidelines, of the 6397 patients admitted after the 24th of June, only 12.6% (n = 805) received dexamethasone. Suboptimal use of oxygen and medication were common during the first wave of the COVID-19 pandemic. As found in previous studies, over-administering was more common than under-administering. The new guidelines issued during the COVID-19 pandemic were not by themselves sufficient to optimize oxygen use. Behavioural strategies are explored which may help policymakers optimize oxygen use.


Assuntos
Guias como Assunto , Oxigênio , Doença Pulmonar Obstrutiva Crônica , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , COVID-19/epidemiologia , Estudos Transversais , Dexametasona/uso terapêutico , Oxigênio/uso terapêutico , Pandemias , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Estudos Retrospectivos , Dados de Saúde Coletados Rotineiramente , Cuidados Críticos
20.
Transplantation ; 107(10): 2216-2225, 2023 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-37749811

RESUMO

BACKGROUND: During the perioperative period of living donor liver transplantation, anesthesiologists and intensivists may encounter patients in receipt of small grafts that puts them at risk of developing small for size syndrome (SFSS). METHODS: A scientific committee (106 members from 21 countries) performed an extensive literature review on aspects of SFSS with proposed recommendations. Recommendations underwent a blinded review by an independent expert panel and discussion/voting on the recommendations occurred at a consensus conference organized by the International Liver Transplantation Society, International Living Donor Liver Transplantation Group, and Liver Transplantation Society of India. RESULTS: It was determined that centers with experience in living donor liver transplantation should utilize potential small for size grafts. Higher risk recipients with sarcopenia, cardiopulmonary, and renal dysfunction should receive small for size grafts with caution. In the intraoperative phase, a restrictive fluid strategy should be considered along with routine use of cardiac output monitoring, as well as use of pharmacologic portal flow modulation when appropriate. Postoperatively, these patients can be considered for enhanced recovery and should receive proactive monitoring for SFSS, nutrition optimization, infection prevention, and consideration for early renal replacement therapy for avoidance of graft congestion. CONCLUSIONS: Our recommendations provide a framework for the optimal anesthetic and critical care management in the perioperative period for patients with grafts that put them at risk of developing SFSS. There is a significant limitation in the level of evidence for most recommendations. This statement aims to provide guidance for future research in the perioperative management of SFSS.


Assuntos
Anestesia , Transplante de Fígado , Humanos , Índia , Fígado/cirurgia , Transplante de Fígado/efeitos adversos , Doadores Vivos , Guias como Assunto
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