Comparative-effectiveness research of COVID-19 treatment: a rapid scoping review.

OBJECTIVES: The COVID-19 pandemic has stimulated growing research on treatment options. We aim to provide an overview of the characteristics of studies evaluating COVID-19 treatment. DESIGN: Rapid scoping review DATA SOURCES: Medline, Embase and biorxiv/medrxiv from inception to 15 May 2021. SETTING: Hospital and community care. PARTICIPANTS: COVID-19 patients of all ages. INTERVENTIONS: COVID-19 treatment. RESULTS: The literature search identified 616 relevant primary studies of which 188 were randomised controlled trials and 299 relevant evidence syntheses. The studies and evidence syntheses were conducted in 51 and 39 countries, respectively.Most studies enrolled patients admitted to acute care hospitals (84%), included on average 169 participants, with an average age of 60 years, study duration of 28 days, number of effect outcomes of four and number of harm outcomes of one. The most common primary outcome was death (32%).The included studies evaluated 214 treatment options. The most common treatments were tocilizumab (11%), hydroxychloroquine (9%) and convalescent plasma (7%). The most common therapeutic categories were non-steroidal immunosuppressants (18%), steroids (15%) and antivirals (14%). The most common therapeutic categories involving multiple drugs were antimalarials/antibiotics (16%), steroids/non-steroidal immunosuppressants (9%) and antimalarials/antivirals/antivirals (7%). The most common treatments evaluated in systematic reviews were hydroxychloroquine (11%), remdesivir (8%), tocilizumab (7%) and steroids (7%).The evaluated treatment was in favour 50% and 36% of the evaluations, according to the conclusion of the authors of primary studies and evidence syntheses, respectively. CONCLUSIONS: This rapid scoping review characterised a growing body of comparative-effectiveness primary studies and evidence syntheses. The results suggest future studies should focus on children, elderly ≥65 years of age, patients with mild symptoms, outpatient treatment, multimechanism therapies, harms and active comparators. The results also suggest that future living evidence synthesis and network meta-analysis would provide additional information for decision-makers on managing COVID-19.

Coronavirus Disease 2019 (COVID-19) Outbreak Associated With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) P.1 Lineage in a Long-Term Care Home After Implementation of a Vaccination Program-Ontario, Canada, April-May 2021.

In a P.1 coronavirus disease 2019 (COVID-19) outbreak in a long-term care home, vaccine effectiveness against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was 52.5% (95% confidence interval: 26.9%-69.1%) in residents and 66.2% (2.3%-88.3%) in staff. Vaccine effectiveness against severe illness was 78.6% (47.9%-91.2%) in residents. Two of 19 vaccinated resident case patients died. Outbreak management required both vaccination and infection control measures.

Safety and effectiveness of dose-sparing strategies for intramuscular seasonal influenza vaccine: a rapid scoping review.

BACKGROUND: The objective of this rapid scoping review was to identify studies of dose-sparing strategies for administration of intramuscular seasonal influenza vaccines in healthy individuals of all ages. METHODS: Comprehensive literature searches were executed in MEDLINE, Embase and the Cochrane library. The grey literature was searched via international clinical trial registries for relevant studies published in English in the last 20 years. We included studies in healthy humans of any age that used any dose-sparing strategy to administer intramuscular seasonal influenza vaccines. Title/abstract and full-text screening were carried out by pairs of reviewers independently. Data extraction was conducted by a single reviewer and verified by a second reviewer. Our outcomes were influenza infections, intensive care unit admission, pneumonia, hospitalisations, adverse events and mortality. Results were summarised descriptively. RESULTS: A total of 13 studies with 10 351 participants were included in the review and all studies were randomised controlled trials (RCTs) conducted between 2006 and 2019. The most common interventions were the trivalent influenza vaccine (n=10), followed by the quadrivalent influenza vaccine (n=4). Nine studies included infants/toddlers 6-36 months old and one of these studies also included children and adolescents. In these nine studies, no clinical effectiveness outcomes were reported. Of the four adult studies (≥18 years), two studies reported on effectiveness outcomes, however, only one RCT reported on laboratory-confirmed influenza. CONCLUSIONS: Due to the low number of studies in healthy adults and the lack of studies assessing confirmed influenza and influenza-like illness, there remains a need for further evaluation.

Diagnostic accuracy of virtual cognitive assessment and testing: Systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: Virtual (i.e., telephone or videoconference) care was broadly implemented because of the COVID-19 pandemic. Our objectives were to compare the diagnostic accuracy of virtual to in-person cognitive assessments and tests and barriers to virtual cognitive assessment implementation. DESIGN: Systematic review and meta-analysis. SETTING: MEDLINE, EMBASE, CDSR, CENTRAL, PsycINFO, and gray literature (inception to April 1, 2020). PARTICIPANTS AND INTERVENTIONS: Studies describing the accuracy or reliability of virtual compared with in-person cognitive assessments (i.e., reference standard) for diagnosing dementia or mild cognitive impairment (MCI), identifying virtual cognitive test cutoffs suggestive of dementia or MCI, or describing correlations between virtual and in-person cognitive test scores in adults. MEASUREMENTS: Reviewer pairs independently conducted study screening, data abstraction, and risk of bias appraisal. RESULTS: Our systematic review included 121 studies (15,832 patients). Two studies demonstrated that virtual cognitive assessments could diagnose dementia with good reliability compared with in-person cognitive assessments: weighted kappa 0.51 (95% confidence interval [CI] 0.41-0.62) and 0.63 (95% CI 0.4-0.9), respectively. Videoconference-based cognitive assessments were 100% sensitive and specific for diagnosing dementia compared with in-person cognitive assessments in a third study. No studies compared telephone with in-person cognitive assessment accuracy. The Telephone Interview for Cognitive Status (TICS; maximum score 41) and modified TICS (maximum score 50) were the only virtual cognitive tests compared with in-person cognitive assessments in >2 studies with extractable data for meta-analysis. The optimal TICS cutoff suggestive of dementia ranged from 22 to 33, but it was 28 or 30 when testing was conducted in English (10 studies; 1673 patients). Optimal modified TICS cutoffs suggestive of MCI ranged from 28 to 31 (3 studies; 525 patients). Sensory impairment was the most often voiced condition affecting assessment. CONCLUSION: Although there is substantial evidence supporting virtual cognitive assessment and testing, we identified critical gaps in diagnostic certainty.

Preventing the transmission of COVID-19 and other coronaviruses in older adults aged 60 years and above living in long-term care: a rapid review.

BACKGROUND: The objective of this review was to examine the current guidelines for infection prevention and control (IPAC) of coronavirus disease-19 (COVID-19) or other coronaviruses in adults 60 years or older living in long-term care facilities (LTCF). METHODS: EMBASE, MEDLINE, Cochrane library, pre-print servers, clinical trial registries, and relevant grey literature sources were searched until July 31, 2020, using database searching and an automated method called Continuous Active Learning® (CAL®). All search results were processed using CAL® to identify the most likely relevant citations that were then screened by a single human reviewer. Full-text screening, data abstraction, and quality appraisal were completed by a single reviewer and verified by a second. RESULTS: Nine clinical practice guidelines (CPGs) were included. The most common recommendation in the CPGs was establishing surveillance and monitoring systems followed by mandating the use of PPE; physically distancing or cohorting residents; environmental cleaning and disinfection; promoting hand and respiratory hygiene among residents, staff, and visitors; and providing sick leave compensation for staff. CONCLUSIONS: Current evidence suggests robust surveillance and monitoring along with support for IPAC initiatives are key to preventing the spread of COVID-19 in LTCF. However, there are significant gaps in the current recommendations especially with regard to the movement of staff between LTCF and their role as possible transmission vectors. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020181993.

A COMPARISON OF PATIENT AND HEALTHCARE PROFESSIONAL VIEWS WHEN ASSESSING QUALITY OF INFORMATION ON PITUITARY ADENOMA AVAILABLE ON THE INTERNET.

OBJECTIVE: Patients are increasingly turning to the internet to seek reliable sources of health information and desire guidance in assessing the quality of information as healthcare becomes progressively more complex. Pituitary adenomas are a rare, diverse group of tumors associated with increased mortality and morbidity whose management requires a multidisciplinary approach. As such, patients with this disorder are often searching for additional sources of healthcare information. We undertook a study to assess the quality of information available on the internet for patients with pituitary adenoma. METHODS: After exclusion, 42 websites were identified based on a search engine query with various search terms. Each website was assessed in triplicate: once by a health professional, once by a simulated patient, and once by a patient who had a pituitary adenoma and underwent medical and surgical treatment. The assessment tools included a content-specific questionnaire, the DISCERN tool, and the Ensuring Quality Information for Patients tool. The readability of the information was assessed with the Flesch-Kincaid grade level. RESULTS: We found that the overall quality of information on pituitary adenoma on the internet was variable and written at a high grade level. Correlation between the different assessors was poor, indicating that there may be differences in how healthcare professionals and patients view healthcare information. CONCLUSION: Our findings highlight the importance of assessment of the health information by groups of the intended user to ensure the needs of that population are met. Abbreviation: EQIP = Ensuring Quality Information for Patients.

Comparison of prescribing and dispensing processes between veterinarians and pharmacists in New Zealand: Are there opportunities for cooperation? / Comparación de los procesos de prescripción y dispensación entre veterinarios y farmacéuticos en Nueva Zelanda: ¿hay oportunidades de cooperación?

Background: Prescribing and dispensing of medicines are fundamental processes in providing healthcare for both human and animal patients. There has been recent discussion in the literature to advocate for increased co-operation between pharmacists and veterinarians, however there is little data available about veterinary prescribing and dispensing processes. Objective: The aims of this study were to gain information on veterinary prescribing and dispensing processes in companion animals in the Dunedin region of New Zealand. Methods: Open interviews were conducted with a selection of five veterinarians at practices in Dunedin. All interviews were transcribed verbatim. Results: In New Zealand almost all dispensing of medicines for animals is carried out by veterinarians or their staff. There is a lack of standard treatment guidelines and a lack of regulation around the treatment period for which medicines can be dispensed at one time (i.e. period of supply). Medicines for animals are sometimes dispensed by community pharmacies, where clients are experiencing financial difficulties or when particular medicines are not held by veterinary practices. Record keeping requirements and practices for veterinarians are similar to those for community pharmacies. Conclusions: Processes undertaken by veterinarians in terms of prescribing and dispensing were similar to pharmacists’ practices for human patients and so there is opportunity for collaboration between the two professions. Pharmacists also have complementary knowledge about dosing and formulating medicines that can assist in delivering optimal healthcare to animal patients (AU)

Antecedentes: La prescripción y la dispensación de medicamentos son procesos fundamentales en la provisión de cuidados de salud tanto para humanos como para animales. Recientemente se ha discutido en la literatura para abogar por el aumento de cooperación entre farmacéuticos y veterinarios, sin embargo hay pocos datos disponibles sobre los procesos de la prescripción y la dispensación veterinaria. Objetivo: Los objetivos de este estudio fueron obtener información sobre los procesos de prescripción y dispensación veterinaria en animales de compañía en la región de Dunedin en Nueva Zelanda. Métodos: Se realizaron entrevistas abiertas a una selección de cinco veterinarios en clínicas de Dunedin. Todas las entrevistas se transcribieron literalmente. Resultados: En Nueva Zelanda, casi todas las dispensaciones de medicamentos para animales son realizadas por veterinarios o su personal. Hay una falta de guías de tratamientos estandarizados y de legislación sobre el periodo de tratamiento que puede ser dispensado cada vez (i.e. periodo de provisión). Los medicamentos para animales a veces se dispensan en farmacias comunitarias, cuando los clientes sufren dificultades financieras o cuando las clínicas veterinarias carecen de ellos. Los requisitos de registro y las prácticas de los veterinarios son similares a los de las farmacias comunitarias. Conclusiones: Los procesos realizados por veterinarios para la prescripción y dispensación fueron similares a las prácticas para pacientes humanos, así que hay una oportunidad de colaboración entre las dos profesiones. Los farmacéuticos pueden tener conocimientos complementarios sobre dosificación y formulación de los medicamentos que pueden ser de ayuda para proporcionar los cuidados de salud óptimos para los pacientes animales (AU)

Comparison of prescribing and dispensing processes between veterinarians and pharmacists in New Zealand: Are there opportunities for cooperation?

BACKGROUND: Prescribing and dispensing of medicines are fundamental processes in providing healthcare for both human and animal patients. There has been recent discussion in the literature to advocate for increased co-operation between pharmacists and veterinarians, however there is little data available about veterinary prescribing and dispensing processes. OBJECTIVE: The aims of this study were to gain information on veterinary prescribing and dispensing processes for companion animals in the Dunedin region of New Zealand. METHODS: Open interviews were conducted with a selection of five veterinarians at practices in Dunedin. All interviews were transcribed verbatim. RESULTS: In New Zealand almost all dispensing of medicines for animals is carried out by veterinarians or their staff. There is a lack of standard treatment guidelines and a lack of regulation around the treatment period for which medicines can be dispensed at one time (i.e. period of supply). Medicines for animals are sometimes dispensed by community pharmacies, where clients are experiencing financial difficulties or when particular medicines are not held by veterinary practices. Record keeping requirements and practices for veterinarians are similar to those for community pharmacies. CONCLUSIONS: Processes undertaken by veterinarians in terms of prescribing and dispensing were similar to pharmacists' practices for human patients and so there is opportunity for collaboration between the two professions. Pharmacists also have complementary knowledge about dosing and formulating medicines that can assist in delivering optimal healthcare to animal patients.