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1.
Rev. bioét. derecho ; (50): 255-270, nov. 2020.
Artigo em Espanhol | IBECS | ID: ibc-191357

RESUMO

Este artículo evalúa el papel de los científicos en el análisis y la gestión de los asuntos mundiales, en particular durante las crisis sanitarias como la actual pandemia de COVID-19. Las autoridades y la población requieren su asesoramiento basado en el conocimiento adquirido a través del proceso científico para comprender los problemas locales y globales, y facilitar la búsqueda de soluciones. La intervención de los expertos debe estar inscrita en principios éticos y deontológicos del conocimiento científico, y tener en cuenta una serie de aspectos sociales y económicos, para proporcionar respuestas que favorezcan el avance del conocimiento, el bienestar social y la mejora de la salud de las poblaciones


This article evaluates the role of scientists in the analysis and management of global affairs, in particular during health crises such as the current COVID-19 pandemic. Their advice based in the knowledge acquired through the scientific process is required by the authorities and the population to understand local and global issues and to facilitate the search for solutions. Experts' intervention must be inscribed on ethical and deontological principles of scientific knowledge, and take into account a series of social and economic aspects, to provide answers in favor of the advancement of knowledge, social well-being and the improvement of the health of populations


Aquest article avalua el paper dels científics en l'anàlisi I la gestió dels assumptes mundials, en particular durant les crisis sanitàries com l'actual pandèmia de COVID-19. Les autoritats I la població requereixen el seu assessorament basat en el coneixement adquirit a través del procés científic per comprendre els problemes locals I globals, I facilitar la recerca de solucions. La intervenció dels experts ha d'estar inscrita en principis ètics I deontològics del coneixement científic, I tenir en compte un seguit d'aspectes socials I econòmics per proporcionar respostes que afavoreixin l'avanç del coneixement, el benestar social I la millora de la salut de les poblacions


Assuntos
Humanos , Diplomacia em Saúde , Pandemias , Cooperação Técnica , Medicina Baseada em Evidências , Acordos de Cooperação Científica e Tecnológica , Uso da Informação Científica na Tomada de Decisões em Saúde , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Estratégias Mundiais
2.
Rev Col Bras Cir ; 47: e20202705, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33053066

RESUMO

One of the struggles faced by physicians in clinical decisions during the COVID-19 pandemic is how to deal with already available or lacking scientific evidence. The COVID-19 pandemic has a large impact in the routine of the many health services, including surgery, which demanded changes in assist protocols. Questions began to arise about well-established surgery conducts due to situations related to SARS-COV-2 infection, and, according to public health measures that are necessary to fight the pandemic. In situations of scarce available evidence, it is natural for us to have to deal with systematically more fragile, provisory and bias-susceptible information. Considering the principles that guide Evidence Based Medicine and Bioethical, the authors analyze the complexity of the medical decision-making during this time. Medical conducts must be adapted to the context of fighting the pandemic and consider patients and healthcare providers exposure and well-being and, lastly, the conservation of resources. The authors conclude that acceptance and tolerance to divergence is commendable, being a path to achieving unity in the diversity of medicine in times of little safe knowledge.


Assuntos
Infecções por Coronavirus , Medicina Baseada em Evidências , Pandemias , Médicos , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
3.
Recurso educacional aberto em Português | CVSP - Regional | ID: oer-3904
4.
Aten. prim. (Barc., Ed. impr.) ; 52(7): 496-500, ago.-sept. 2020.
Artigo em Espanhol | IBECS | ID: ibc-189918

RESUMO

Varios artículos recientes sugieren que la obesidad es un factor de riesgo para una enfermedad más grave por coronavirus. En este artículo se resume la evidencia científica disponible sobre el papel de la obesidad en COVID-19, con especial atención en las personas más jóvenes y los mecanismos biológicos propuestos para explicar tanto el mayor riesgo observado como la posible mayor contagiosidad de esta población. Se consideran varias implicaciones de la pandemia sobre las personas con obesidad, en relación con las posibles dificultades en el manejo de los pacientes ingresados, las implicaciones del confinamiento sobre el control y tratamiento de la obesidad, y el estigma que sufren estas personas por su condición, y que puede verse aumentado si se confirma la relación de la obesidad con COVID-19. Comprender el papel de la obesidad en COVID-19 debería ser una prioridad de salud pública, dada la alta prevalencia de esta condición en nuestro país


Recent reports suggest that obesity is a risk factor for more severe coronavirus disease. This article summarizes the available scientific evidence on the role of obesity in COVID-19. We focus on implications for younger patients and the proposed biological mechanisms that could explain both the higher risk observed and the possible higher contagiousness of people with obesity. We consider implications of the pandemic for people with obesity in relation to: difficulties in managing hospitalized patients, implications of confinement for the control and treatment of obesity, and the stigma people with obesity suffer, that could increase should the relationship between obesity and COVID-19 be confirmed. Understanding the role of obesity in COVID-19 should be a public health priority, given the high prevalence of this condition in our country


Assuntos
Humanos , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Betacoronavirus , Pandemias , Obesidade/complicações , Índice de Gravidade de Doença , Medicina Baseada em Evidências , Fatores de Risco
5.
J Trauma Stress ; 33(4): 380-390, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32881116

RESUMO

Leveraging technology to provide evidence-based therapy for posttraumatic stress disorder (PTSD), such as prolonged exposure (PE), during the COVID-19 pandemic helps ensure continued access to first-line PTSD treatment. Clinical video teleconferencing (CVT) technology can be used to effectively deliver PE while reducing the risk of COVID-19 exposure during the pandemic for both providers and patients. However, provider knowledge, experience, and comfort level with delivering mental health care services, such as PE, via CVT is critical to ensure a smooth, safe, and effective transition to virtual care. Further, some of the limitations associated with the pandemic, including stay-at-home orders and physical distancing, require that providers become adept at applying principles of exposure therapy with more flexibility and creativity, such as when assigning in vivo exposures. The present paper provides the rationale and guidelines for implementing PE via CVT during COVID-19 and includes practical suggestions and clinical recommendations.


Assuntos
Infecções por Coronavirus , Serviços de Saúde Mental , Pandemias , Pneumonia Viral , Transtornos de Estresse Pós-Traumáticos , Comunicação por Videoconferência , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Medicina Baseada em Evidências , Humanos , Terapia Implosiva , Pneumonia Viral/epidemiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Telemedicina
7.
JCO Glob Oncol ; 6: 1455-1460, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32997540

RESUMO

The core pillars of multimodal care of patients with cancer are surgical, radiation, and medical oncology. The global pandemic of coronavirus disease 2019 (COVID-19) has suddenly resurrected a new pillar in oncology care: teleoncology. With oncologists reaching out to patients through telemedicine, it is possible to evaluate and fulfill patients' needs; triage patients for elective procedures; screen them for influenza-like illness; provide them with guidance for hospital visits, if needed; and bridge oral medications and treatments when a hospital visit is not desirable because of any high risk-benefit ratio. Teleoncology can bring great reassurance to patients at times when reaching an oncology center is challenging, and more so in resource-constrained countries. Evidence-based treatment protocols, dispensable by teleoncology, already exist for many sites of cancer and they can provide a bridge to treatment when patients are unable to reach cancer centers for their standard treatment. The young pillar of teleoncology is going to remain much longer than COVID-19.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Oncologia/organização & administração , Neoplasias/diagnóstico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/organização & administração , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/normas , Medicina Baseada em Evidências/tendências , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Oncologia/métodos , Oncologia/normas , Oncologia/tendências , Neoplasias/terapia , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Telemedicina/normas , Telemedicina/tendências , Triagem/métodos , Triagem/organização & administração , Triagem/normas
10.
Value Health ; 23(9): 1128-1136, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940229

RESUMO

Real-world data (RWD) and the derivations of these data into real-world evidence (RWE) are rapidly expanding from informing healthcare decisions at the patient and health system level to influencing major health policy decisions, including regulatory approvals and coverage. Recent examples include the approval of palbociclib in combination with endocrine therapy for male breast cancer and the inclusion of RWE in the label of paliperidone palmitate for schizophrenia. This interest has created an urgency to develop processes that promote trust in the evidence-generation process. Key stakeholders and decision-makers include patients and their healthcare providers; learning health systems; health technology assessment bodies and payers; pharmacoepidemiologists and other clinical reseachers, and policy makers interested in bioethical and regulatory issues. A key to optimal uptake of RWE is transparency of the research process to enable decision-makers to evaluate the quality of the methods used and the applicability of the evidence that results from the RWE studies. Registration of RWE studies-particularly for hypothesis evaluating treatment effectiveness (HETE) studies-has been proposed to improve transparency, trust, and research replicability. Although registration would not guarantee better RWE studies would be conducted, it would encourage the prospective disclosure of study plans, timing, and rationale for modifications. A joint task force of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the International Society for Pharmacoepidemiology (ISPE) recommended that investigators preregister their RWE studies and post their study protocols in a publicly available forum before starting studies to reduce publication bias and improve the transparency of research methods. Recognizing that published recommendations alone are insufficient, especially without accessible registration options and with no incentives, a group of experts gathered on February 25 and 26, 2019, in National Harbor, Maryland, to explore the structural and practical challenges to the successful implementation of the recommendations of the ISPOR/ISPE task force for preregistration. This positioning article describes a plan for making registration of HETE RWE studies routine. The plan includes specifying the rationale for registering HETE RWE studies, the studies that should be registered, where and when these studies should be registered, how and when analytic deviations from protocols should be reported, how and when to publish results, and incentives to encourage registration. Table 1 summarizes the rationale, goals, and potential solutions that increase transparency, in addition to unique concerns about secondary data studies. Definitions of terms used throughout this report are provided in Table 2.


Assuntos
Medicina Baseada em Evidências , Avaliação de Resultados em Cuidados de Saúde/organização & administração , Pesquisa/tendências , Humanos , Ensaios Clínicos Pragmáticos como Assunto , Desenvolvimento de Programas , Sistema de Registros
14.
Mil Med Res ; 7(1): 41, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32887670

RESUMO

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, coronavirus disease 2019 (COVID-19), affecting more than seventeen million people around the world. Diagnosis and treatment guidelines for clinicians caring for patients are needed. In the early stage, we have issued "A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)"; now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline. We formed a working group of clinical experts and methodologists. The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas: chemoprophylaxis, diagnosis, treatments, and discharge management. We searched the literature for direct evidence on the management of COVID-19, and assessed its certainty generated recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Recommendations were either strong or weak, or in the form of ungraded consensus-based statement. Finally, we issued 34 statements. Among them, 6 were strong recommendations for, 14 were weak recommendations for, 3 were weak recommendations against and 11 were ungraded consensus-based statement. They covered topics of chemoprophylaxis (including agents and Traditional Chinese Medicine (TCM) agents), diagnosis (including clinical manifestations, reverse transcription-polymerase chain reaction (RT-PCR), respiratory tract specimens, IgM and IgG antibody tests, chest computed tomography, chest x-ray, and CT features of asymptomatic infections), treatments (including lopinavir-ritonavir, umifenovir, favipiravir, interferon, remdesivir, combination of antiviral drugs, hydroxychloroquine/chloroquine, interleukin-6 inhibitors, interleukin-1 inhibitors, glucocorticoid, qingfei paidu decoction, lianhua qingwen granules/capsules, convalescent plasma, lung transplantation, invasive or noninvasive ventilation, and extracorporeal membrane oxygenation (ECMO)), and discharge management (including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge). We also created two figures of these recommendations for the implementation purpose. We hope these recommendations can help support healthcare workers caring for COVID-19 patients.


Assuntos
Quimioprevenção/métodos , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Adulto , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Alta do Paciente/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto
16.
Hypertension ; 76(5): 1368-1383, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32921195

RESUMO

Telemedicine allows the remote exchange of medical data between patients and healthcare professionals. It is used to increase patients' access to care and provide effective healthcare services at a distance. During the recent coronavirus disease 2019 (COVID-19) pandemic, telemedicine has thrived and emerged worldwide as an indispensable resource to improve the management of isolated patients due to lockdown or shielding, including those with hypertension. The best proposed healthcare model for telemedicine in hypertension management should include remote monitoring and transmission of vital signs (notably blood pressure) and medication adherence plus education on lifestyle and risk factors, with video consultation as an option. The use of mixed automated feedback services with supervision of a multidisciplinary clinical team (physician, nurse, or pharmacist) is the ideal approach. The indications include screening for suspected hypertension, management of older adults, medically underserved people, high-risk hypertensive patients, patients with multiple diseases, and those isolated due to pandemics or national emergencies.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Hipertensão/tratamento farmacológico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/estatística & dados numéricos , Determinação da Pressão Arterial/métodos , Infecções por Coronavirus/epidemiologia , Gerenciamento Clínico , Medicina Baseada em Evidências , Feminino , Humanos , Hipertensão/diagnóstico , Itália , Masculino , Saúde do Trabalhador , Pandemias/estatística & dados numéricos , Segurança do Paciente , Pneumonia Viral/epidemiologia , Índice de Gravidade de Doença
17.
Recurso educacional aberto em Português | CVSP - Regional | ID: oer-3901

RESUMO

Aula 1 - parte 1 e 2


Assuntos
Pesquisa , Medicina Baseada em Evidências , Bibliotecas Digitais
19.
Neurología (Barc., Ed. impr.) ; 35(6): 57, jul.-ago. 2020. graf
Artigo em Espanhol | IBECS | ID: ibc-190278

RESUMO

INTRODUCCIÓN: La pandemia por SARS-CoV-2 está condicionando los abordajes diagnósticos, terapéuticos y asistenciales establecidos en esclerosis múltiple (EM). Durante las fases inicial y pico de la epidemia, los fármacos modificadores del curso de la EM caracterizados por ser inmunosupresores administrados en pulsos (TIP), vieron pospuesta su administración debido a la incertidumbre sobre su influencia en la infección, principalmente en contagiados/contagiosos asintomáticos/presintomáticos. El objetivo de este trabajo es presentar un algoritmo basado en criterios de seguridad que permita reanudar los TIP durante la fase de desescalado. MÉTODOS: Se elabora un algoritmo, cuya estructura se sustenta en la experiencia clínica en EM de los autores y en una revisión bibliográfica del conocimiento acumulado, que facilita la detección de contagiosos asintomáticos, presintomáticos o con síntomas leves de SARS-CoV-2, con el objetivo de evitar la administración de TIP y contagios por contacto prolongado en hospital de día (HdD). RESULTADOS: Algoritmo con doble filtro clínico-microbiológico consistente en la aplicación telemática de un listado de comprobación de síntomas y después realización de PCR para SARS-CoV-2 en exudado nasofaríngeo, a las 48 y 24 h antes del TIP programado respectivamente. CONCLUSIÓN: Considerando el balance beneficio-riesgo, la aplicación del algoritmo resultaría ventajosa pese a que no se conoce la proporción real de asintomáticos/presintomáticos contagiosos. La realización sistemática de PCR, como test con mayor sensibilidad en la fase presintomática de la infección, en combinación con un sistema de detección precoz de síntomas, reduciría contagios y favorecería la identificación de pacientes con riesgo antes de su exposición a TIP


INTRODUCTION: The COVID-19 pandemic is changing approaches to diagnosis, treatment, and care provision in multiple sclerosis (MS). During both the initial and peak phases of the epidemic, the administration of disease-modifying drugs, typically immunosuppressants administered in pulses, was suspended due to the uncertainty about their impact on SARS-CoV-2 infection, mainly in contagious asymptomatic/presymptomatic patients. The purpose of this study is to present a safety algorithm enabling patients to resume pulse immunosuppressive therapy (PIT) during the easing of lockdown measures. METHODS: We developed a safety algorithm based on our clinical experience with MS and the available published evidence; the algorithm assists in the detection of contagious asymptomatic/presymptomatic cases and of patients with mild symptoms of SARS-CoV-2 infection with a view to withdrawing PIT in these patients and preventing new infections at day hospitals. RESULTS: We developed a clinical/microbiological screening algorithm consisting of a symptom checklist, applied during a teleconsultation 48hours before the scheduled session of PIT, and PCR testing for SARS-CoV-2 in nasopharyngeal exudate 24hours before the procedure. CONCLUSION: The application of our safety algorithm presents a favourable risk-benefit ratio despite the fact that the actual proportion of asymptomatic and presymptomatic individuals is unknown. Systematic PCR testing, which provides the highest sensitivity for detecting presymptomatic cases, combined with early detection of symptoms of SARS-CoV-2 infection may reduce infections and improve detection of high-risk patients before they receive PIT


Assuntos
Humanos , Medidas de Segurança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Betacoronavirus , Pandemias , Esclerose Múltipla/tratamento farmacológico , Imunossupressores/administração & dosagem , Pulsoterapia/normas , Medicina Baseada em Evidências , Equipamentos de Proteção/normas , Algoritmos
20.
Educ. med. (Ed. impr.) ; 21(4): 265-271, jul.-ago. 2020.
Artigo em Espanhol | IBECS | ID: ibc-192657

RESUMO

Aparte de su enorme impacto sanitario y económico, la pandemia de COVID-19 ha modificado la forma de practicar la medicina y la educación médica. Es probable que dicho efecto acelere la transformación que están experimentando ambas actividades. El presente trabajo, escrito en el momento más álgido de la crisis, plantea algunas reflexiones sobre cuatro temas: 1) la publicación de noticias falsas y sensacionalistas; 2) los riesgos de la toma de decisiones médicas no basadas en evidencias; 3) las implicaciones bioéticas cuando no hay suficientes recursos para todos, y 4) los posibles efectos de la crisis en la enseñanza de la medicina. Esta crisis debería servir a médicos, docentes y estudiantes de medicina para extraer conclusiones y estar mejor preparados para el futuro. En primer lugar, es esencial mantener un pensamiento crítico que proteja contra la «infodemia». Además, no deberían rebajarse, sino mantener íntegros, los estándares científicos y éticos aprendidos en la facultad. Por último, debe recordarse que, en una pandemia tan devastadora como la actual, aparte de la medicina científica, la que se practica con el cerebro, debe ejercerse también esa otra medicina que se practica con el corazón


Apart from its enormous health and economic impact, the COVID-19 pandemic has changed the way of practicing medicine and medical education. It is likely that this effect may accelerate the transformation that both activities are experiencing. The present article, written at the peak of the crisis, sets out some thoughts on four topics: 1) the publication of false and sensationalist news; 2) the risks of taking medical decisions not based on the evidence; 3) the bioethical implications when there are sufficient resources available for everybody and; 4) the possible effects of the crisis on the teaching of medicine. This crisis should enable doctors, teachers and, students of medicine to draw conclusions and be better prepared for the future. Firstly, it is essential to maintain critical thinking that may protect against the ‘infodemic’. Furthermore, the scientific and ethical standards learned in the faculty, should not be forgotten. Lastly, it should be remembered that, in a devastating pandemic like the current one, apart from scientific medicine, which is practised with the brain, the other medicine that is practiced with the heart must also be practiced


Assuntos
Humanos , Educação Médica , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Alocação de Recursos para a Atenção à Saúde/ética , Tomada de Decisões , Medicina Baseada em Evidências , Recursos em Saúde/ética
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