https://www.bmj.com/content/369/bmj.m2284
Enviado desde mi iPhone
PARTICIPA
sábado, 27 de junio de 2020
jueves, 25 de junio de 2020
CT imaging and clinical course of asymptomatic cases with COVID-19 pneumonia at admission in Wuhan, China Heng Meng,a Rui Xiong,a Ruyuan He,a Weichen Lin,a Bo Hao,a Lin Zhang,a Zilong Lu,a Xiaokang Shen,a Tao Fan,a Wenyang Jiang,a Wenbin Yang,b Tao Li,b Jun Chen,b and Qing Genga,⁎ Author information Article notes Copyright and License information Disclaimer
lunes, 22 de junio de 2020
sábado, 20 de junio de 2020
Swabs Collected by Patients or Health Care Workers for SARS-CoV-2 Testing | NEJM
Our study shows the clinical usefulness of tongue, nasal, or mid-turbinate samples collected by patients as compared with nasopharyngeal samples collected by health care workers for the diagnosis of Covid-19. Adoption of techniques for sampling by patients can reduce PPE use and provide a more comfortable patient experience. Our analysis was cross-sectional, performed in a single geographic region, and limited to single comparisons with the results of nasopharyngeal sampling, which is not a perfect standard test. Despite these limitations, we think that patient collection of samples for SARS-CoV-2 testing from sites other than the nasopharynx is a useful approach during the Covid-19 pandemic.
jueves, 18 de junio de 2020
Prone Positioning in Awake, Nonintubated Patients With COVID-19 Hypoxemic Respiratory Failure
miércoles, 17 de junio de 2020
martes, 16 de junio de 2020
Covid-19: Low dose steroid cuts death in ventilated patients by one third, trial finds | The BMJ
Covid-19: Low dose steroid cuts death in ventilated patients by one third, trial finds
Low dose dexamethasone reduces deaths in patients hospitalised with covid-19 who need ventilation, according to preliminary results from the RECOVERY trial.
The drug was also found to reduce deaths by one fifth in other hospitalised patients receiving oxygen only, but no benefit was seen among covid-19 patients who did not need respiratory support.
The chief investigators from the University of Oxford trial said that the findings represent a "major breakthrough" which is "globally applicable" as the drug is cheap and readily available.
All NHS hospitals will be told in the next 24 hours how they should act on these results.
For the randomised controlled trial, the team recruited 2104 patients for the dexamethasone arm (6 mg once daily, taken orally or by injection for 10 days) and compared them with 4321 patients receiving standard care.
In a statement outlining the preliminary results, researchers reported that "overall dexamethasone reduced the 28 day mortality rate by 17% (0.83 (0.74 to 0.92); P=0.0007) with a highly significant trend showing greatest benefit among patients needing ventilation (test for trend p<0.001)." Follow up has been completed for over 94% of participants.
Breaking this down they said that dexamethasone "reduced deaths by one third in ventilated patients (rate ratio 0.65 (95% confidence interval 0.48 to 0.88); P=0.0003) and by one fifth in other patients receiving oxygen only (0.80 (0.67 to 0.96); P=0.0021)."
Among the patients who received usual care alone, 28 day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).
The findings suggest that taking dexamethasone reduces mortality from around 41% to 27% for ventilated patients and from 25% to 20% among those needing oxygen.
Based on these results, one death in eight would be prevented by treatment in ventilated patients or around one in 25 patients requiring oxygen alone, the team said.
Martin Landray, professor of medicine and epidemiology at the University of Oxford and one of the chief investigators on the trial, said, "The search has been on for a treatment that can actually reduce the risk of dying and there hasn't been one until today. The results are significantly clear, so people can be treated tonight or tomorrow. That is a major step forward. This is globally applicable. This is not an expensive drug or one where there are supply or manufacturing problems. This is a drug that is locally available. For less than £50 (€56; $63) you can treat eight patients and save a life. It's an incredible result."
Peter Horby, professor of emerging infectious diseases at the University of Oxford and another chief investigator on the trial, added, "This is the only drug that has so far been shown to reduce mortality, and it reduces it significantly. It is a major breakthrough."
There is no pre-print of the findings and the researchers have said that the full results will be published shortly.
Regarding potential side effects, Horby said, "The harm that has been noted in the past with steroids have been related to high doses. The known side effect profile of these drugs at high doses is well known. What was critical with this trial was getting the dose right with the right patients. The doses we gave were either a low or moderate dose, minimising the side effects while maximising the benefits."
Siu Ping Lam, director of licensing at the Medicines and Healthcare Products Regulatory Agency, said that the results were "very encouraging."
The RECOVERY trial, which began in March to assess potential covid-19 treatments, has so far recruited more than 11 500 patients from over 175 NHS hospitals in the UK. It is also evaluating HIV treatment lopinavir and ritonavir, antibiotic azithromycin, anti-inflammatory treatment tocilizumab, and convalescent plasma. It previously looked at hydroxychloroquine but ended that arm of the trial in June after it concluded that there was no benefit in hospitalised patients.1
This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.
https://bmj.com/coronavirus/usage
Cancer prevention with aspirin in hereditary colorectal cancer (Lynch syndrome), 10-year follow-up and registry-based 20-year data in the CAPP2 study: a double-blind, randomised, placebo-controlled trial - The Lancet
domingo, 14 de junio de 2020
viernes, 12 de junio de 2020
Contributed by Mario J. Molina, May 16, 2020 (sent for review May 14, 2020; reviewed by Manish Shrivastava and Tong Zhu)
lunes, 8 de junio de 2020
domingo, 7 de junio de 2020
AHRQ’s Easy-to-Understand Telehealth Consent Form | Agency for Health Research and Quality
AHRQ's Easy-to-Understand Telehealth Consent Form
AHRQ has created a sample telehealth consent form (Word, 27 KB) that is easy to understand. The form includes language for healthcare providers that have curtailed in-person visits due to COVID-19. AHRQ has also created how-to guidance for clinicians on how to obtain informed consent for telehealth.
Some States do not require documented informed consent for telehealth, but there are still advantages to using the AHRQ Easy-to-Understand Telehealth Consent Form.
- Clinicians can use the easy-to-understand language from the form when they are having the consent discussion.
- Clinicians can use the form as a checklist to make sure they have covered all the information required by informed consent rules.
Can we use the AHRQ Easy-to-Understand Telehealth Consent Form as is?
No. The AHRQ Sample Consent Form must be adapted before using it.
- Fill in the areas highlighted in yellow.
- Tailor the form. What is unique about your organization and your target audience?
- Put your logo on the form.
- Check with your lawyer before using the form. Laws on informed consent vary from State to State.
- Translate the form into languages your patients are most comfortable reading. Take care that translated materials are not made more complex.
How do we document consent when we're not having the consent discussion face-to-face?
Patients can give their consent verbally at the beginning of their first telehealth visit, and clinicians can document it in the medical record. In addition to verbal consent, a signature can be obtained through your patient portal and the U.S. mail. Guidance on documenting consent is included in the how-to guidance for clinicians.
- You can arrange for patients to be able to virtually sign the consent form in your patient portal, if you have one. Clinicians will have to check whether patients can access the patient portal, and a staff member will have to give them clear directions on how to sign the form.
- If patients cannot use a patient portal, you can mail consent forms (one to sign and return, one for the patient to keep) and a stamped return envelope. Clinicians can ask patients to sign and mail back the form.
How do we get copies of these materials?
Select the links below.
Widespread covid-19 infection among Spanish healthcare professionals did not occur by chance - The BMJ
articulo seudocientifico del viceconsejero de Madrid(sin conflicto de interes)
Widespread covid-19 infection among Spanish healthcare professionals did not occur by chance
sábado, 6 de junio de 2020
jueves, 4 de junio de 2020
articulo desde AES
Muy interesante ante la dificultad de discernir opinion de información y de desinformación...
http://www.aes.es/blog/2020/06/03/informacion-cientifica-especializada-informacion-publica-y-medios-de-comunicacion-durante-la-crisis-del-coronavirus/ martes, 2 de junio de 2020
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