Articles: covid-19.
-
Randomized clinical trials informing clinical practice (e.g., like large, pragmatic, and late-phase trials) should ideally mostly use harmonized outcomes that are important to patients, family members, clinicians, and researchers. Core outcome sets for specific subsets of ICU patients exist, for example, respiratory failure, delirium, and COVID-19, but not for ICU patients in general. Accordingly, we aimed to develop a core outcome set for adult general ICU patients. ⋯ We developed and internationally validated a core outcome set with six core outcomes to be used in research, specifically clinical trials involving adult general ICU patients.
-
We herein report a case of Systemic Capillary Leak Syndrome (SCLS) attributed to coronavirus disease (COVID-19) that emerged in 2019. A 56-year-old woman presented with a COVID-19 infection 7 days prior to the visit with upper respiratory symptoms, fatigue, and decreased appetite. Secondary SCLS due to COVID-19 was diagnosed, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated as mechanical support, and intravenous immunoglobulin was administered, marking the transition to the recovery phase with the initiation of fluid resuscitation. This case is noteworthy for successfully employing VA-ECMO in treating secondary SCLS due to COVID-19, mimicking the course of fulminant myocarditis.
-
The coronavirus Disease 2019 (COVID-19) pandemic has disproportionately impacted long-term care facilities (LTCFs), revealing vulnerabilities due to residents' advanced age, comorbidities, and facility infrastructures. In Taiwan, the Central Epidemic Control Center implemented a range of strategies to protect LTCF residents. These included early containment measures to allow time for preparing pharmaceutical intervention, the establishment of infection prevention and control guidelines, the implementation of comprehensive screening and testing protocols, the prioritization of vaccination for both residents and staff, and the expansion of the national stockpile of oral antiviral agents. ⋯ All measures were made and adjusted based on community prevalence, evolving knowledge about the virus, and balancing the negative impacts on LTCF residents. These multifaceted efforts effectively mitigated transmission, maintained essential healthcare services, and supported LTCF staff, demonstrating the critical importance of coordinated, adaptive strategies in managing the impact of COVID-19 on vulnerable populations in LTCFs. By learning from the COVID-19 pandemic, we can develop more effective and resilient responses for managing future epidemics in LTCFs in Taiwan.
-
Internal medicine journal · Jan 2025
Clinical practice in an age of medical misinformation and conspiracy theories.
Medical misinformation (false health or medical-related information) has seen a rapid increase in volume recently, with the global surge in social media usage and further exacerbation by the COVID-19 pandemic. This may put more lives at stake, as misinformation is an often-cited reason that people make dangerous health choices, engage in harmful practices and reject beneficial health treatments. In this article, we explore the drivers and consequences, as well as suggest several strategies at the personal, educational and systemic level, for physicians to guide and communicate with patients who subscribe to medical misinformation.
-
Acta Anaesthesiol Scand · Jan 2025
Randomized Controlled Trial Multicenter StudyEfficacy and safety of a 72-h infusion of prostacyclin (1 ng/kg/min) in mechanically ventilated patients with pulmonary infection and endotheliopathy-protocol for the multicenter randomized, placebo-controlled, blinded, investigator-initiated COMBAT-ARF trial.
Acute respiratory failure (ARF) is common in critically ill patients, and 50% of patients in intensive care units require mechanical ventilation [3, 4]. The COVID-19 pandemic revealed that COVID-19 infection induced ARF caused by damage to the microvascular pulmonary endothelium. In a randomized clinical trial, mechanically ventilated COVID-19 patients with severe endotheliopathy, as defined by soluble thrombomodulin (sTM) ≥ 4 ng/mL, were randomized to evaluate the effect of a 72-h infusion of low-dose prostacyclin 1 ng/kg/min or placebo. Twenty-eight-day mortality was 21.9% versus 43.6% in the prostacyclin and the placebo groups, respectively (RR 0.50; CI 0.24 to 0.96 p = .06). The aim of the current trial is to investigate if this beneficial effect and safety of prostacyclin also are present in any patient with suspected pulmonary infection requiring mechanical ventilation and concomitant severe endotheliopathy. ⋯ This trial will investigate the efficacy and safety of prostacyclin vs. placebo for 72-hours in mechanically ventilated patients with any suspected pulmonary infection and severe endotheliopathy, as defined by sTM ≥4 ng/mL. Trial endpoints focus on the potential effect of prostacyclin to reduce 28-day all-cause mortality.