Discordance of COVID-19 guidelines for patients with cancer: A systematic review.
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ABSTRACT:
SUBMITTER: Garg PK
PROVIDER: S-EPMC7405271 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:AimsIndividuals taking immunosuppressants are at increased susceptibility to viral infections in general. However, due to the novel nature of the COVID-19, there is a lack of evidence about the specific risks of the disease in this patient group. This systematic review aims to summarize the current international clinical guidelines to highlight areas where research is needed through critical appraisal of the evidence base of these guidelines.MethodsWe conducted a systematic review of clinical practice guidelines about the usage of immunosuppressants during the COVID-19 pandemic. Electronic databases including MEDLINE and the websites of relevant professional bodies were searched for English language guidelines that were published or updated between March 2020 and May 2020 in this area. We assessed the quality and consistency of guidelines. The evidence base underpinning these guidelines was critically appraised using GRADE criteria.ResultsTwenty-three guidelines were included. Most guidelines (n = 15, 65.2%) informed and updated evidence based on expert opinion. The methodological quality of the guidelines varied, ranging from 'very low' to 'moderate'. Guidelines consistently recommended that high-risk patients, including those who are taking high doses of steroids for more than a month, or a combination of two or more immunosuppressants, should be shielding during the outbreak. Most guidelines stated that steroids usage should not be stopped abruptly and advised on individualized risk-benefit analysis considering the risk of the effect of COVID-19 infection and the relapse of the autoimmune condition in patients.DiscussionClinical practice guidelines on taking immunosuppressants during the COVID-19 outbreak vary in quality. The level of evidence informing the available guidelines was generally low. Given the novel nature of COVID-19, the guidelines draw on existing knowledge and data, refer to the use of immunosuppressants and risks of serious infections of other aetiologies and have extrapolated these to form their evidence base.
| S-EPMC7882764 | biostudies-literature
Project description:The coronavirus disease 2019 (COVID-19) pandemic has challenged health systems globally and prompted the publication of several guidelines. The experiences of our international colleagues should be utilized to protect patients and healthcare workers. The primary aim of this article is to appraise national guidelines for the perioperative anesthetic management of patients with COVID-19 so that they can be enhanced for the management of any resurgence of the epidemic. PubMed and EMBASE databases were systematically searched for guidelines related to SARS-CoV and SARS-CoV-2. Additionally, the World Federation Society of Anesthesiologists COVID-19 resource webpage was searched for national guidelines; the search was expanded to include countries with a high incidence of SARS-CoV. The guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation II tool. Guidelines from Australia, Canada, China, India, Italy, South Africa, South Korea, Taiwan, the United Kingdom, and the United States of America were evaluated. All the guidelines focused predominantly on intubation and infection control. The scope and purpose of guidelines from China were the most comprehensive. The UK and South Africa provided the best clarity. Editorial independence, the rigor of development, and applicability scored poorly. Heterogeneity and gaps pertaining to preoperative screening, anesthesia technique, subspecialty anesthesia, and the lack of auditing of guidelines were identified. Evidence supporting the recommendations was weak. Early guidelines for the anesthetic management of COVID-19 patients lacked quality and a robust reporting framework. As new evidence emerges, national guidelines should be updated to enhance rigor, clarity, and applicability.
| S-EPMC7714635 | biostudies-literature
Project description:BackgroundNearly a year after COVID-19 was initially detected, guidance for pregnant and new mothers remains varied.ObjectiveThe goal of this systematic review is to summarize recommendations for three areas of maternal and fetal care-breastfeeding, post-partum social distancing, and decontamination.Search strategyWe searched PubMed, Embase and Web of Science spanning from inception to November 9, 2020.Selection criteriaArticles were included if they focused on COVID-positive mothers, commented on at least one of the three areas of interest, and were published in English.Data collection and analysisOur combined database search yielded 385 articles. After removing duplicates and articles that did not cover the correct populations or subject matter, a total of 74 articles remained in our analysis.Main resultsMost articles recommended direct breastfeeding with enhanced precaution measures. Recommendations regarding post-partum social distancing varied, although articles published more recently often recommended keeping the mother and newborn in the same room when possible. Decontamination recommendations emphasized mask wearing, good hand hygiene, and proper cleaning of surfaces.ConclusionIn general, there was a focus on shared decision making when approaching topics such as breastfeeding and post-partum social distancing. Guidelines for decontamination were fairly uniform.
| S-EPMC9087670 | biostudies-literature
Project description: Not available
| S-EPMC8554423 | biostudies-literature
Project description:PurposeCancer patients with COVID-19 likely express biomarker changes in circulation. However, the biomarkers used in SARS-CoV-2 infected cancer patients for COVID-19 severity and prognosis are largely unclear. Therefore, this systematic review aims to determine what biomarkers were measured in cancer patients with COVID-19 and their prognostic utility.MethodsA systematic literature review in PubMed, Embase, and Scopus was performed on June 16th, 2021. The search keywords coronavirus, neoplasm, biomarkers, and disease progression were used to filter out 17 eligible studies, which were then carefully evaluated.ResultsA total of 4,168 patients, 16 types of cancer, and 60 biomarkers were included. Seven up-regulated markers, including CRP, d-dimer, ferritin, IL-2R, IL-6, LDH, and PCT, were identified in eligible studies. Albumin and hemoglobin were significantly down-regulated in cancer patients with COVID-19. Moreover, we observed that the SARS-CoV-2 infected cancer patients with lower CRP, ferritin, and LDH levels successfully survived from COVID-19 treatments.ConclusionSeveral important clinical biomarkers, such as CRP, ferritin, and LDH, may serve as the prognostic markers to predict the outcomes following COVID-19 treatment and monitor the deterioration of COVID-19 in cancer patients.
| S-EPMC9057983 | biostudies-literature
Project description:IntroductionCOVID-19 is a highly infectious disease, characterised by respiratory, physical and psychological dysfunctions. Rehabilitation could effectively alleviate the symptoms and promote recovery of the physical and mental health of patients with COVID-19. Recently, rehabilitation medical institutions have issued clinical practice guidelines (CPGs) and expert consensus statements involving recommendations for rehabilitation assessments and rehabilitation therapies for COVID-19. This systematic review aims to assess the methodological quality and reporting quality of the guidance documents, evaluate the heterogeneity of the recommendations and summarise the recommendations with respect to rehabilitation assessments and rehabilitation therapies for COVID-19 to provide a quick reference for front-line clinicians, therapists and patients as well as reasonable suggestions for future guidelines.Methods and analysisThe electronic databases including PubMed, Embase, Chinese Biomedical Literature Database (CBM), Chinese Science and Technology Periodical Database (VIP), Wanfang Database and China National Knowledge Infrastructure (CNKI) and websites of governments or organisations (eg, National Guideline Clearinghouse, Guidelines International Network, National Institute for Health and Clinical Excellence, Scottish Intercollegiate Guidelines Network and WHO) will be searched for eligible CPGs and expert consensus statements from inception to August 2022. CPGs and expert consensus statements published in Chinese or English and presenting recommendations for modern functional rehabilitation techniques and/or traditional Chinese medicine rehabilitation techniques for COVID-19 will be included. Reviews, interpretations, old versions of CPGs and expert consensus statements and those for the management of other diseases during the pandemic will be excluded. Two reviewers will independently review each article, extract data, appraise the methodological quality following the Appraisal of Guidelines for Research & Evaluation II tool and assess the reporting quality with the Reporting Items for Practice Guidelines in Healthcare statement. The Measurement Scale of Rate of Agreement will be used to evaluate the heterogeneity of the recommendations in different CPGs and expert consensus statements. Agreement between reviewers will be calculated using the intraclass correlation coefficient. We will also summarise the recommendations for rehabilitation in patients with COVID-19. The results will be narratively described and presented as tables or figures.Ethics and disseminationEthics approval is not needed for this systematic review because information from published documents will be used. The findings will be submitted for publication in a peer-reviewed journal and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Prospero registration numberCRD42020190761.
| S-EPMC9358617 | biostudies-literature
Project description:BackgroundCoronavirus disease 2019 (COVID-19) has affected >210 million people worldwide. An optimal therapeutic approach for COVID-19 remains uncertain, to date. Since the history of cancer was linked to higher mortality rates due to COVID-19, the establishment of a safe and effective vaccine coverage is crucial in these patients. However, patients with cancer (PsC) were mostly excluded from vaccine candidates' clinical trials. This systematic review aims to investigate the current available evidence about the immunogenicity of COVID-19 vaccines in PsC.Patients and methodsAll prospective studies that evaluated the safety and efficacy of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included, with immunogenicity after the first and the second dose as the primary endpoint, when available.ResultsVaccination against COVID-19 for PsC seems overall safe and immunogenic after well-conducted vaccination schedules. Yet the seroconversion rate remains lower, lagged or both compared to the general population. Patients with hematologic malignancies, especially those receiving B-cell-depleting agents in the past 12 months, are the most at risk of poor seroconversion.ConclusionA tailored approach to vaccination may be proposed to PsC, especially on the basis of the type of malignancy and of the specific oncologic treatments received.
| S-EPMC8552625 | biostudies-literature
Project description:Treatment management of cancer patients in the radiation oncology departments during the current COVID-19 pandemic is challenging. A systematic review of published consensus/guidelines on the role of radiotherapy prioritization, suggested treatment protocols, and set up management was undertaken based on the PRISMA protocol and through PubMed/PMC, Scopus, Google Scholar, Web of Science databases until 01/20/2021. One hundred and sixty-eight publications or regional consensus were included. Summary of recommendations contained: (1) using hypo-fractionated (Hypo-F) regimens for therapeutic/palliative indications, (2) delaying radiotherapy for several weeks or until pandemic over, (3) omitting radiotherapy by replacement of alternative therapies or active surveillance, (4) applying safer patients' setup and preparation protocols, (5) developing telemedicine/telehealth service. To conclude, it is essential to carefully weigh the risk of exposure to COVID-19 infection and the benefit of treating cancer patients during the pandemic. Trying to have a global guideline facing this or any other probable crisis is crucial for health care service.
| S-EPMC8242203 | biostudies-literature
Project description: Not available
| S-BSST416 | biostudies-other
Project description:BackgroundWith the continuation of the COVID-19 pandemic, some COVID-19 patients have become reinfected with the virus. Viral gene sequencing has found that some of these patients were reinfected by the different and others by same strains. This has raised concerns about the effectiveness of immunity after infection and the reliability of vaccines. To this end, we conducted a systematic review to assess the characteristics of patients with reinfection and possible causes.MethodsA systematic search was conducted across eight databases: PubMed, Embase, Web of Science, The Cochrane Library, CNKI, WanFang, VIP and SinoMed from December 1, 2019 to September 1, 2021. The quality of included studies were assessed using JBI critical appraisal tools and Newcastle-Ottawa Scale.ResultsThis study included 50 studies from 20 countries. There were 118 cases of reinfection. Twenty-five patients were reported to have at least one complication. The shortest duration between the first infection and reinfection was 19 days and the longest was 293 days. During the first infection and reinfection, cough (51.6% and 43.9%) and fever (50% and 30.3%) were the most common symptoms respectively. Nine patients recovered, seven patients died, and five patients were hospitalized, but 97 patients' prognosis were unknown. B.1 is the most common variant strain at the first infection. B.1.1.7, B.1.128 and B.1.351 were the most common variant strains at reinfection. Thirty-three patients were infected by different strains and 9 patients were reported as being infected with the same strain.ConclusionsOur research shows that it is possible for rehabilitated patients to be reinfected by SARS-COV-2. To date, the causes and risk factors of COVID-19 reinfection are not fully understood. For patients with reinfection, the diagnosis and management should be consistent with the treatment of the first infection. The public, including rehabilitated patients, should be fully vaccinated, wear masks in public places, and pay attention to maintaining social distance to avoid reinfection with the virus.
| S-EPMC9051013 | biostudies-literature