7
|
Jin YH, Zhan QY, Peng ZY, Ren XQ, Yin XT, Cai L, Yuan YF, Yue JR, Zhang XC, Yang QW, Ji J, Xia J, Li YR, Zhou FX, Gao YD, Yu Z, Xu F, Tu ML, Tan LM, Yang M, Chen F, Zhang XJ, Zeng M, Zhu Y, Liu XC, Yang J, Zhao DC, Ding YF, Hou N, Wang FB, Chen H, Zhang YG, Li W, Chen W, Shi YX, Yang XZ, Wang XJ, Zhong YJ, Zhao MJ, Li BH, Ma LL, Zi H, Wang N, Wang YY, Yu SF, Li LY, Huang Q, Weng H, Ren XY, Luo LS, Fan MR, Huang D, Xue HY, Yu LX, Gao JP, Deng T, Zeng XT, Li HJ, Cheng ZS, Yao X, Wang XH. Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline (updated version). Mil Med Res 2020; 7:41. [PMID: 32887670 PMCID: PMC7472403 DOI: 10.1186/s40779-020-00270-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/25/2020] [Indexed: 02/08/2023] Open
Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, coronavirus disease 2019 (COVID-19), affecting more than seventeen million people around the world. Diagnosis and treatment guidelines for clinicians caring for patients are needed. In the early stage, we have issued "A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)"; now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline. We formed a working group of clinical experts and methodologists. The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas: chemoprophylaxis, diagnosis, treatments, and discharge management. We searched the literature for direct evidence on the management of COVID-19, and assessed its certainty generated recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Recommendations were either strong or weak, or in the form of ungraded consensus-based statement. Finally, we issued 34 statements. Among them, 6 were strong recommendations for, 14 were weak recommendations for, 3 were weak recommendations against and 11 were ungraded consensus-based statement. They covered topics of chemoprophylaxis (including agents and Traditional Chinese Medicine (TCM) agents), diagnosis (including clinical manifestations, reverse transcription-polymerase chain reaction (RT-PCR), respiratory tract specimens, IgM and IgG antibody tests, chest computed tomography, chest x-ray, and CT features of asymptomatic infections), treatments (including lopinavir-ritonavir, umifenovir, favipiravir, interferon, remdesivir, combination of antiviral drugs, hydroxychloroquine/chloroquine, interleukin-6 inhibitors, interleukin-1 inhibitors, glucocorticoid, qingfei paidu decoction, lianhua qingwen granules/capsules, convalescent plasma, lung transplantation, invasive or noninvasive ventilation, and extracorporeal membrane oxygenation (ECMO)), and discharge management (including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge). We also created two figures of these recommendations for the implementation purpose. We hope these recommendations can help support healthcare workers caring for COVID-19 patients.
Collapse
Affiliation(s)
- Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Qing-Yuan Zhan
- National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 10029, China
| | - Zhi-Yong Peng
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xue-Qun Ren
- Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China
| | - Xun-Tao Yin
- Department of Medical Imaging, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Lin Cai
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China
- Departments of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yu-Feng Yuan
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China
- Department of Hepatobiliary Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ji-Rong Yue
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Department of Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xiao-Chun Zhang
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Qi-Wen Yang
- Department of Clinical Laboratory, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College, Chinese Academy of Medical Sciences (CAMS), Beijing, 100730, China
| | - Jianguang Ji
- Center for Primary Health Care Research, Lund University and Region Skåne, 25002, Malmö, Sweden
| | - Jian Xia
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, 403371, China
| | - Yi-Rong Li
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Fu-Xiang Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, 43071, China
| | - Ya-Dong Gao
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Zhui Yu
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Feng Xu
- Department of Emergency Medicine and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, 250002, China
| | - Ming-Li Tu
- Department of Respiratory and Critical Care Medicine, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, 441300, Hubei, China
| | - Li-Ming Tan
- Department of Clinic Pharmacy, Second People's Hospital of Huaihua City, Huaihua, 418000, Hunan, China
| | - Min Yang
- Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China
| | - Fang Chen
- Department of Internal Medicine, Zhengzhou University Hospital, Zhengzhou, 450001, China
| | - Xiao-Ju Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, 450003, China
| | - Mei Zeng
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Yu Zhu
- Department of Infectious Disease, West China Second Hospital, Sichuan University, Chengdu, 610041, China
| | - Xin-Can Liu
- Department of Cardiology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450000, China
| | - Jian Yang
- Department of Cardiology, Yichang NO.1 Hospital, Renmin Hospital of China Three Gorges University, Yichang, 443000, Hubei, China
| | - Dong-Chi Zhao
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yu-Feng Ding
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ning Hou
- Department of Pharmacy, Shandong Provincial Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250021, China
| | - Fu-Bing Wang
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hao Chen
- Laboratory of Integrated Acupuncture and Drugs, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Yong-Gang Zhang
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Department of Periodical Press, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wei Li
- Department of Clinical Laboratory, Yantai Yuhuangding Hospital, Qingdao University, Yantai, 264000, Shandong, China
| | - Wen Chen
- Department of Radiology, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei, China
| | - Yue-Xian Shi
- School of Nursing, Peking University, Beijing, 100191, China
| | - Xiu-Zhi Yang
- Department of Respiratory and Critical Care Medicine, Kaifeng Central Hospital, Kaifeng, 475000, Henan, China
| | - Xue-Jun Wang
- Department of Emergency, Beijing Electric Power Hospital, Beijing, 100073, China
| | - Yan-Jun Zhong
- ICU Center, The Second Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Ming-Juan Zhao
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Bing-Hui Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lin-Lu Ma
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Department of Haematology, Zhongnan Hospital, Wuhan University, Wuhan, 430071, China
| | - Hao Zi
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China
| | - Na Wang
- Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China
- College of Nursing and Health, Henan Medical School, Henan University, Kaifeng, 475000, Henan, China
| | - Yun-Yun Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Shao-Fu Yu
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Department of Clinic Pharmacy, Second People's Hospital of Huaihua City, Huaihua, 418000, Hunan, China
| | - Lu-Yao Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hong Weng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xiang-Ying Ren
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China
- College of Nursing and Health, Henan Medical School, Henan University, Kaifeng, 475000, Henan, China
| | - Li-Sha Luo
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Man-Ru Fan
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Di Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hong-Yang Xue
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lin-Xin Yu
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jin-Ping Gao
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- School of Nursing, Shanxi Medical University, Taiyuan, 030001, China
| | - Tong Deng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institutes of Evidence-based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, Henan, China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China.
| | - Hong-Jun Li
- Department of Diagnostic Radiology, Beijing You'an Hospital, Capital Medical University, Beijing, 100069, China.
| | - Zhen-Shun Cheng
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China.
- Department of Respiratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
| | - Xiaomei Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, L8S 4L8, Canada.
| | - Xing-Huan Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Leishenshan Hospital in Wuhan, Wuhan, 430200, China.
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
| |
Collapse
|
8
|
Nikelski A, Keller A, Schumacher-Schönert F, Dehl T, Laufer J, Sauerbrey U, Wucherer D, Dreier-Wolfgramm A, Michalowsky B, Zwingmann I, Vollmar HC, Hoffmann W, Kreisel SH, Thyrian JR. Supporting elderly people with cognitive impairment during and after hospital stays with intersectoral care management: study protocol for a randomized controlled trial. Trials 2019; 20:543. [PMID: 31470912 PMCID: PMC6716860 DOI: 10.1186/s13063-019-3636-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The sectorization of health-care systems leads to inefficient treatment, especially for elderly people with cognitive impairment. The transition from hospital care to primary care is insufficiently coordinated, and communication between health-care providers is often lacking. Consequences include a further deterioration of health, higher rates of hospital readmissions, and institutionalization. Models of collaborative care have shown their efficacy in primary care by improving patient-related outcomes. The main goal of this trial is to compare the effectiveness of a collaborative care model with usual care for people with cognitive impairment who have been admitted to a hospital for treatment due to a somatic illness. The aim of the intervention is to improve the continuity of treatment and care across the transition between the in-hospital and adjoining primary care sectors. METHODS/DESIGN The trial is a longitudinal multisite randomized controlled trial with two arms (care as usual and intersectoral care management). Inclusion criteria at the time of hospital admission due to a somatic illness are age 70+ years, cognitive impairment (Mini Mental State Examination, MMSE ≤26), living at home, and written informed consent. Each participant will have a baseline assessment at the hospital and two follow-up assessments at home (3 and 12 months after discharge). The estimated sample size is n = 398 people with cognitive inmpairement plus their respective informal caregivers (where available). In the intersectoral care management group, specialized care managers will develop, implement, and monitor individualized treatment and care based on comprehensive assessments of the unmet needs of the patients and their informal caregivers. These assessments will occur at the hospital and in participants' homes. Primary outcomes are (1) activities of daily living, (2) readmission to the hospital, and (3) institutionalization. Secondary outcomes include (a) frailty, (b) delirium, (c) quality of life, (d) cognitive status, (e) behavioral and psychological symptoms of dementia, (f) utilization of services, and (g) informal caregiver burden. DISCUSSION In the event of proving efficacy, this trial will deliver a proof of concept for implementation into routine care. The cost-effectiveness analyses as well as an independent process evaluation will increase the likelihood of meeting this goal. The trial will enable an in-depth analysis of mediating and moderating effects for different health outcomes at the interface between hospital care and primary care. By highlighting treatment and care, the study will provide insights into unmet needs at the time of hospital admission, and the opportunities and barriers to meeting those needs during the hospital stay and after discharge. TRIAL REGISTRATION ClinicalTrials.gov, NCT03359408 ; December 2, 2017.
Collapse
Affiliation(s)
- Angela Nikelski
- Division of Geriatric Psychiatry, Evangelisches Klinikum Bethel, Bethesdaweg 12, 33617 Bielefeld, Germany
| | - Armin Keller
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Fanny Schumacher-Schönert
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Terese Dehl
- Department of Epidemiology and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Jessica Laufer
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Ulf Sauerbrey
- Institute of General Practice and Family Medicine, University Hospital Jena, Bachstr. 18, 07743 Jena, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Adina Dreier-Wolfgramm
- Department of Epidemiology and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Ina Zwingmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, University Hospital Jena, Bachstr. 18, 07743 Jena, Germany
- Institute of General Practice and Family Medicine, Faculty of Medicine, Ruhr-University Bochum (RUB), Gebäude MA, Universitätsstraße 150, 44801 Bochum, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
- Department of Epidemiology and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Stefan H. Kreisel
- Division of Geriatric Psychiatry, Evangelisches Klinikum Bethel, Bethesdaweg 12, 33617 Bielefeld, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
- Department of Epidemiology and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| |
Collapse
|