Articles: covid-19.
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Comment Randomized Controlled Trial
In patients with COVID-19 receiving IMV or ECMO, adding baricitinib to usual care reduced all-cause mortality.
Ely EW, Ramanan AV, Kartman CE, et al. Efficacy and safety of baricitinib plus standard of care for the treatment of critically ill hospitalised adults with COVID-19 on invasive mechanical ventilation or extracorporeal membrane oxygenation: an exploratory, randomised, placebo-controlled trial. Lancet Respir Med. 2022;10:327-36. 35123660.
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Critical care medicine · Jun 2022
Randomized Controlled TrialTherapeutic Hyperthermia Is Associated With Improved Survival in Afebrile Critically Ill Patients With Sepsis: A Pilot Randomized Trial.
To test the hypothesis that forced-air warming of critically ill afebrile sepsis patients improves immune function compared to standard temperature management. ⋯ Participants randomized to external forced-air warming did not have a difference in HLA-DR expression or IFN-γ production. In this pilot study, however, 28-day mortality was lower in the intervention group. Future research should seek to better elucidate the impact of temperature modulation on immune and nonimmune organ failure pathways in sepsis.
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Randomized Controlled Trial Pragmatic Clinical Trial
Effects of a WHO-guided digital health intervention for depression in Syrian refugees in Lebanon: A randomized controlled trial.
Most displaced people with mental disorders in low- and middle-income countries do not receive effective care, and their access to care has deteriorated during the Coronavirus Disease 2019 (COVID-19) pandemic. Digital mental health interventions are scalable when digital access is adequate, and they can be safely delivered during the COVID-19 pandemic. We examined whether a new WHO-guided digital mental health intervention, Step-by-Step, in which participants were supported by a nonspecialist helper, was effective in reducing depression among displaced people in Lebanon. ⋯ In this study, we found that a guided, digital intervention was effective in reducing depression in displaced people in Lebanon. The guided WHO Step-by-Step intervention we examined should be made available to communities of displaced people that have digital access.
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Randomized Controlled Trial
Modelling the risk of hospital admission of lab confirmed SARS-CoV-2-infected patients in primary care: a population-based study.
The objectives of this study are to develop a predictive model of hospital admission for COVID-19 to help in the activation of emergency services, early referrals from primary care, and the improvement of clinical decision-making in emergency room services. The method is the retrospective cohort study of 49,750 patients with microbiological confirmation of SARS-CoV-2 infection. The sample was randomly divided into two subsamples, for the purposes of derivation and validation of the prediction rule (60% and 40%, respectively). ⋯ Based on the risk score, five risk groups were derived with hospital admission ranging from 2.94 to 51.87%. In conclusion, we propose a classification system for people with COVID-19 with a higher risk of hospitalization, and indirectly with it a greater severity of the disease, easy to be completed both in primary care, as well as in emergency services and in hospital emergency room to help in clinical decision-making. Registration: ClinicalTrials.gov Identifier: NCT04463706.
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Randomized Controlled Trial
Limitations of randomized, controlled, double-blinded studies in determining safety and effectiveness of treatments.
Randomized, controlled, double-blinded studies, in which treated subjects are randomly selected from the same pool as controlled (untreated) ones and neither the caregiver nor the patient knows which is which, are widely accepted as the gold standard of experimental medicine. There are well-documented advantages of such studies. ⋯ Some limitations of them are widely known and taught, such as inadequate sample size, failure of proper randomization, et cetera; others are less well-known. We shall focus on the latter.