Corpus overview


Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence

There are no seroprevalence terms in the subcorpus

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    Developing a Thai national critical-care allocation guideline during the COVID-19 pandemic: a rapid review and stakeholders’ consultation 

    Authors: Aniqa Islam Marshall; Rachel Archer; Woranan Witthayapipopsakul; Kanchanok Sirison; Somtanuek Chotchoungchatchai; Pisit Sriakkpokin; Orapan Srisookwatana; Yot Teerawattananon; Viroj Tangcharoensathien

    doi:10.21203/rs.3.rs-69153/v1 Date: 2020-08-31 Source: ResearchSquare

    Background: At the height of the COVID-19 pandemic, Thailand had almost depleted its critical care resources, particularly ICU beds and ventilators. This prompted the necessity to develop a national guideline for resource allocation. This paper describes the development process of a national guideline for critical resource allocation in Thailand during the COVID-19 pandemic. Methods: The guideline development process consisted of three steps (1) rapid review of existing rationing guidelines and literature; (2) interviews of Thai clinicians experienced in caring for COVID-19 cases; and (3) multi-stakeholder consultations. At steps 1 and 2, data was synthesized and categorized using a thematic and content analysis approach and this guided the formulation of the draft guideline. Within Step 3, the draft Thai critical care allocation guideline was debated and finalized before entering the policy-decision stage. Results: Three-order prioritization criteria consisting of (1) clinical prognosis using four tools (Charlson Comorbidity Index, Sequential Organ Failure Assessment, Frailty Assessment, and Cognitive Impairment HP Assessment); (2) number of life years saved; and (3) social usefulness, were proposed by the research team based on literature reviews and interviews. At consultations, stakeholders rejected using life years as a criterion due to potential age TRANS and gender TRANS discrimination, as well as social utility due to a concern it would foster public distrust as this judgment can be arbitrary. It was agreed that attending physician is required to be the decision maker in the Thai medico-legal context while a patient review committee would play an advisory role. Allocation decisions are to be documented for transparency and no appealing mechanism is to be applied.This guideline will be triggered only when demand exceeds supply after the utmost efforts to mobilize surge capacity. Once implemented, it is applicable to all patients, COVID-19 and non-COVID-19, requiring critical care resources prior to ICU admission and during ICU stay.Conclusions: The guideline development process for the allocation of critical care resources in the context of the COVID-19 outbreak in Thailand was informed by scientific evidence, medico-legal context, existing norms and societal values to reduce risk of public distrust given the sensitive nature of the issue and ethical dilemmas of the guiding principle though it was conducted at recorded speed. Our lessons can provide an insight for the development of similar prioritization guidelines, especially in other LMICs.

    Prognostic factors in patients admitted to an urban teaching hospital with COVID-19 infection

    Authors: Donogh Maguire; Marylynne Woods; Conor Richards; Ross Dolan; Jesse Wilson Veitch; Wei MJ Sim; Olivia EH Kemmett; David C Milton; Sophie LW Randall; Ly D Bui; Nicola Goldmann; Allan Cameron; Barry Laird; Dinesh Talwar; Ian Godber; Alan Davidson; Donald C McMillan

    doi:10.21203/rs.3.rs-38340/v1 Date: 2020-06-29 Source: ResearchSquare

    BackgroundSevere COVID-19 infection MESHD results in a systemic inflammatory response ( SIRS MESHD). This SIRS response shares similarities to the changes observed during the peri-operative period that are recognised to be associated with the development of multiple organ failure MESHD. MethodsElectronic patient records for patients who were admitted to an urban teaching hospital during the initial 7-week period of the COVID-19 pandemic in Glasgow, U.K. (17th March 2020 - 1st May 2020) were examined for routine clinical, laboratory and clinical outcome data. Age TRANS, sex, BMI and documented evidence of COVID-19 infection MESHD at time of discharge or death MESHD certification were considered minimal criteria for inclusion.ResultsOf the 224 patients who fulfilled the criteria for inclusion, 52 (23%) had died at 30-days following admission. COVID-19 related respiratory failure HP respiratory failure MESHD (75%) and multiorgan failure (12%) were the commonest causes of death MESHD recorded. Age TRANS>70 years (p<0.001), past medical history of cognitive impairment HP cognitive impairment MESHD (p<0.001), previous delirium HP delirium MESHD (p<0.001), clinical frailty score>3 (p<0.001), hypertension HP hypertension MESHD (p<0.05), heart failure MESHD (p<0.01), national early warning score (NEWS) >4 (p<0.01), positive CXR (p<0.01), and subsequent positive COVID-19 swab (p<0.001) were associated with 30-day mortality. CRP>80 mg/L (p<0.05), albumin <35g/L (p<0.05), peri-operative Glasgow Prognostic Score (poGPS) (p<0.05), lymphocytes <1.5 109/l (p<0.05), neutrophil lymphocyte ratio (p<0.001), haematocrit (<0.40 L/L ( male TRANS) / <0.37 L/L ( female TRANS)) (p<0.01), urea>7.5 mmol/L (p<0.001), creatinine >130 mmol/L (p<0.05) and elevated urea: albumin ratio (<0.001) were also associated with 30-day mortality.On analysis, age TRANS >70 years (O.R. 3.9, 95% C.I. 1.4 – 8.2, p<0.001), past medical history of heart failure MESHD (O.R. 3.3, 95% C.I. 1.2 – 19.3, p<0.05), NEWS >4 (O.R. 2.4, 95% C.I. 1.1 – 4.4, p<0.05), positive initial CXR (O.R. 0.4, 95% C.I. 0.2-0.9, p<0.05) and poGPS (O.R. 2.3, 95% C.I. 1.1 – 4.4, p<0.05) remained independently associated with 30-day mortality. Among those patients who tested PCR COVID-19 positive (n=122), age TRANS >70 years (O.R. 4.7, 95% C.I. 2.0 - 11.3, p<0.001), past medical history of heart failure MESHD (O.R. 4.4, 95% C.I. 1.2 – 20.5, p<0.05) and poGPS (O.R. 2.4, 95% C.I. 1.1- 5.1, p<0.05) remained independently associated with 30-days mortality.ConclusionAge > 70 years and severe systemic inflammation MESHD as measured by the peri-operative Glasgow Prognostic Score are independently associated with 30-day mortality among patients admitted to hospital with COVID-19 infection MESHD.

    Prognostic factors in patients admitted to an urban teaching hospital with COVID-19 infection

    Authors: Donogh Maguire; Marylynne Woods; Conor Richards; Ross Dolan; Jesse Wilson Veitch; Wei MJ Sim; Olivia EH Kemmett; David C Milton; Sophie LW Randall; Ly D Bui; Nicola Goldmann; Allan Cameron; Barry Laird; Dinesh Talwar; Ian Godber; Alan Davidson; Donald C McMillan

    doi:10.21203/rs.3.rs-38340/v2 Date: 2020-06-29 Source: ResearchSquare

    BackgroundSevere COVID-19 infection results in a systemic inflammatory response (SIRS). This SIRS response shares similarities to the changes observed during the peri-operative period that are recognised to be associated with the development of multiple organ failure. MethodsElectronic patient records for patients who were admitted to an urban teaching hospital during the initial 7-week period of the COVID-19 pandemic in Glasgow, U.K. (17th March 2020 - 1st May 2020) were examined for routine clinical, laboratory and clinical outcome data. Age TRANS, sex, BMI and documented evidence of COVID-19 infection at time of discharge or death certification were considered minimal criteria for inclusion.ResultsOf the 224 patients who fulfilled the criteria for inclusion, 52 (23%) had died at 30-days following admission. COVID-19 related respiratory failure HP (75%) and multiorgan failure (12%) were the commonest causes of death recorded. Age TRANS>70 years (p<0.001), past medical history of cognitive impairment HP (p<0.001), previous delirium HP (p<0.001), clinical frailty score>3 (p<0.001), hypertension HP (p<0.05), heart failure (p<0.01), national early warning score (NEWS) >4 (p<0.01), positive CXR (p<0.01), and subsequent positive COVID-19 swab (p<0.001) were associated with 30-day mortality. CRP>80 mg/L (p<0.05), albumin <35g/L (p<0.05), peri-operative Glasgow Prognostic Score (poGPS) (p<0.05), lymphocytes <1.5 109/l (p<0.05), neutrophil lymphocyte ratio (p<0.001), haematocrit (<0.40 L/L ( male TRANS) / <0.37 L/L ( female TRANS)) (p<0.01), urea>7.5 mmol/L (p<0.001), creatinine >130 mmol/L (p<0.05) and elevated urea: albumin ratio (<0.001) were also associated with 30-day mortality.On multivariate analysis, age TRANS >70 years (O.R. 3.9, 95% C.I. 1.4 – 8.2, p<0.001), past medical history of heart failure (O.R. 3.3, 95% C.I. 1.2 – 19.3, p<0.05), NEWS >4 (O.R. 2.4, 95% C.I. 1.1 – 4.4, p<0.05), positive initial CXR (O.R. 0.4, 95% C.I. 0.2-0.9, p<0.05) and poGPS (O.R. 2.3, 95% C.I. 1.1 – 4.4, p<0.05) remained independently associated with 30-day mortality. Among those patients who tested PCR COVID-19 positive (n=122), age TRANS >70 years (O.R. 4.7, 95% C.I. 2.0 - 11.3, p<0.001), past medical history of heart failure (O.R. 4.4, 95% C.I. 1.2 – 20.5, p<0.05) and poGPS (O.R. 2.4, 95% C.I. 1.1- 5.1, p<0.05) remained independently associated with 30-days mortality.ConclusionAge > 70 years and severe systemic inflammation as measured by the peri-operative Glasgow Prognostic Score are independently associated with 30-day mortality among patients admitted to hospital with COVID-19 infection.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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