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Insight and Judgement

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41. What evidence is available on the organisation of palliative care services during COVID-19 (or previous pandemics)?

emphasise the importance of providing access to palliative care, clarifying goals in advance, interdisciplinary team decisions and psychosocial and spiritual needs ? A rapid review of previous pandemics and insights from experts in the field both acknowledge the need to respond rapidly and flexibly to changing circumstances, to train non-specialists in palliative care, deploy volunteers, and use technology to support communication with patients and carers ? A case report of a staged model for providing (...) , and was updated on 12 April. Results (Table 1) Rapid evidence checks are based on a simplified review method and may not be entirely exhaustive, but aim to provide a balanced assessment of what is already known about a specific problem or issue. This brief has not been peer-reviewed and should not be a substitute for individual clinical judgement, nor is it an endorsed position of NSW Health. Table One: COVID - 19 Source Title and Organisation Advice Source Link Creating a palliative care inpatient response

2020 Covid-19 Ad hoc papers

42. How will seasonal changes impact the COVID-19 pandemic?

into account other variables that affect COVID-19 transmission, for example; minimal testing per city per country, population density, community structures, social dynamics, government policies and global connectivity. Table One gives insight into modelling used to assess the impact of seasonal changes on COVID-19 transmission. Opinion pieces on the effects of winter on the transmission of COVID-19 are included in Table Two. Rapid evidence checks are based on a simplified review method and may (...) not be entirely exhaustive, but aim to provide a balanced assessment of what is already known about a specific problem or issue. This brief has not been peer-reviewed and should not be a substitute for individual clinical judgement, nor is it an endorsed position of NSW Health. Rapid evidence checks are based on a simplified review method and may not be entirely exhaustive, but aim to provide a balanced assessment of what is already known about a specific problem or issue. This brief has not been peer

2020 Covid-19 Ad hoc papers

43. COVID-19: Good Practice for Surgeons and Surgical Teams

quickly. Our aim is not to be overly prescriptive, but to make broad recommendations which can be adapted to support individual circumstances based on surgeons’ and teams’ professional judgement. Our recommendations are structured around four areas: Adapting surgical services Triage of non-emergency surgery Clinical networks Rotas Virtual outpatient clinics Working in an extended scope of practice Working beyond one’s regular scope of practice as part of a team Retired surgeons and trainees Caring (...) of increased medical support are required to improve a patient’s medical condition. Premature death can be particularly distressing for all and reducing avoidable deaths will always be critical. In some cases, surgical intervention will be appropriate for critically ill and high risk patients. There will, however, be cases where surgical intervention will not increase the quantity or improve the quality of life of the patient. Surgeons should use their professional judgement in these circumstances

2020 Royal College of Surgeons of England

44. Are there risk factors and preventative interventions for acute respiratory distress syndrome (ARDS) in COVID-19?

identified were designed to robustly assess the preventative powers of interventions against ARDS. For instance, the statistically significant differences in oxygen therapy during hospitalisation in Wu are likely a reflection of severity of illness – it doesn’t provide any meaningful insight into the preventative powers of oxygen therapy. Non-invasive mechanical ventilation is used to treat ARDS, so we’re probably simply seeing that people with ARDS are treated for ARDS. Some studies examined (...) definitions of ARDS, others were not explicit and one used a bespoke definition. Disclaimer : the article has not been peer-reviewed; it should not replace individual clinical judgement and the sources cited should be checked. The views expressed in this commentary represent the views of the authors and not necessarily those of the host institution, the NHS, the NIHR, or the Department of Health and Social Care. The views are not a substitute for professional medical advice. AUTHORS Catherine Carver holds

2020 Oxford COVID-19 Evidence Service

45. Starting or resuming cancer treatment after COVID 19 infection: A Rapid Response Report

are unknown, the potential effects of further suppressing or augmenting a patient's immune system quickly after a COVID-19 infection must be weighed heavily against the prognosis and risks of delaying treatment. Clinicians will need to decide locally and on a case-by-case basis based on expert judgement. Kutikov, Weinberg [14] developed the following guidelines based on expert consensus: - Based on low risk of progression in certain cancers, it may be safe to delay for more than 3 months certain (...) ) Bersanelli M. Controversies about COVID-19 and anticancer treatment with immune checkpoint inhibitors. Immunotherapy. 2020. doi:10.2217/imt-2020-0067 (13) Bersanelli M, Scala S, Affanni P, Veronesi L, Colucci E, Banna G, et al. Immunological insights on in?uenza infection and vaccination during immune checkpoint blockade in cancer patients. Immunotherapy. 2020;12(2):105–10. (14) Kutikov A, Weinberg DS, Edelman MJ, Horwitz EM, Uzzo RG, Fisher RI. A war on two fronts: Cancer care in the time of COVID-19

2020 Covid-19 Ad hoc papers

46. Designing mental health facilities that prevent the use of seclusion and restraint

throughout its design, conduct and writing. In particular, a consumer academic (CM) conducted the critical assessment of the publications. The consumer voice is largely missing among the included publications. A consumer commentary has been included in this Evidence Check to offer insight into the consumer experience. Evidence Check questions This review aimed to address the following questions: Question 1: What physical design features of mental health facilities reduce the use of seclusion (...) –consumer interaction. 54 The design of mental health inpatient units has often happened without the input of consumers, their families, friends and supporters. Future designs should include consumers in a co-design process to maximise the potential for change and innovation that is genuinely guided by the insights of lived experience. There is also further potential to consider the needs of particular subgroups of consumers, including but not limited to Aboriginal people, the LGBTQI+ community

2020 Sax Institute Evidence Check

47. CCS/CHFS Heart Failure Guidelines: Clinical Trial Update on Functional Mitral Regurgitation, SGLT2 Inhibitors, ARNI in HFpEF, and Tafamidis in Amyloidosis (Full text)

negative results of the PARAGON-HF primary end point analysis preclude any recommendation for the general use of sacubitril/valsartan in patients with HFpEF. The PARAGON-HF trial has provided a number of interesting insights; further analysis and investigation might inform future specific recommendations on the management of HFpEF. 4. New Evidence for SGLT2 Inhibitors and HF SGLT2 inhibitors lead to a reduction in plasma glucose by inhibiting renal tubular glucose reabsorption, with resultant

2020 Canadian Cardiovascular Society PubMed abstract

48. Safe nurse staffing levels in acute hospitals

care Recent efforts have further aligned clinical reasoning with theoretical models and statistical analysis to gain a more causal insight in the association between nurse staffing and patient outcomes. There is emerging evidence that ‘missed nursing care’ (also referred to as ‘care left undone’, ‘omissions in nursing care’, or ‘implicit rationing of nursing care’) is a mediating factor explaining the association between nurse staffing levels and patient KCE Report 325 Safe nurse staffing levels

2020 Belgian Health Care Knowledge Centre

49. British guideline on the management of asthma

are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge and technology advance and patterns of care evolve. Adherence to guideline recommendations will not ensure a successful outcome in every case, nor should they be construed as including all proper methods of care or excluding other acceptable methods of care aimed at the same results. The ultimate judgement must be made by the appropriate healthcare professional(s) responsible (...) for clinical decisions regarding a particular clinical procedure or treatment plan. This judgement should only be arrived at through a process of shared decision making with the patient, covering the diagnostic and treatment choices available. It is advised, however, that significant departures from the national guideline or any local guidelines derived from it should be fully documented in the patient’s medical records at the time the relevant decision is taken. 1.3.1 Influence of financial and other

2019 SIGN

50. Brentuximab vedotin for treating CD30-positive Hodgkin lymphoma

the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance are at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate

2018 National Institute for Health and Clinical Excellence - Technology Appraisals

51. Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance (Full text)

disorder 9% • Celiac disease 3% Reproduced from Shaw et al. Shaw B.H. Stiles L.E. Bourne K. et al. The face of postural tachycardia syndrome – insights from a large cross-sectional online community-based survey. J Intern Med. 2019; 286 : 438-448 by Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0). 3.4 PSWT • These patients meet the symptoms criteria for POTS but do not meet the hemodynamic criteria for POTS. Although these patients might have orthostatic (...) B.H. Stiles L.E. Bourne K. et al. The face of postural tachycardia syndrome – insights from a large cross-sectional online community-based survey. J Intern Med. 2019; 286 : 438-448 although mortality has rarely been directly attributable to POTS. Although prognosis in POTS can be quite variable, many POTS patients can improve with appropriate treatment. Shaw B.H. Stiles L.E. Bourne K. et al. The face of postural tachycardia syndrome – insights from a large cross-sectional online community-based

2020 Canadian Cardiovascular Society PubMed abstract

54. Management of Dyslipidaemias (Full text)

. The relative strengths of risk factors vary with age and SCORE overestimates risk in older people (that is, those aged >65 years). These Guidelines include illustrative charts for older people (see Figures and ). While older people benefit from smoking cessation, and control of hypertension and hyperlipidaemia (see section 9.3 ), clinical judgement is required to avoid side effects from overmedication. The additional impact of HDL-C on risk estimation is illustrated in and 4 ; HDL-C can be used to increase

2019 European Society of Cardiology PubMed abstract

55. Evidence Brief - Barriers and Facilitators to Use of Medications for Opioid Use Disorder

) Facilitator Sub-categories (n) Stigma (5) 32,36,38,43,47 Social stigma (4) Example - Fear of judgement from others if they knew patient was an addict, not wanting to be seen at treatment center Positive social support from peers and family (3) Self or internalized stigma (1) Example – Patients’ feelings about themselves as they try to access treatment, including the experience of shame related to having OUD and needing treatment Stigma specific to buprenorphine use (3) Example - Buprenorphine as a “crutch

2019 Veterans Affairs Evidence-based Synthesis Program Reports

57. A palliative approach to care in the last 12 months of life

expert panel was interprofessional in composition, including family caregivers G and individuals with knowledge and experience in clinical practice, education, research and policy from a range of health-service and academic organizations, practice areas and sectors. Expert panel members shared their insights on supporting and caring for adults with progressive life-limiting illness across the continuum of care (e.g., community, long-term care and acute care). A systematic and comprehensive analysis

2020 Registered Nurses' Association of Ontario

58. ASTRO Guideline on Definitive and Postoperative Radiation Therapy for Basal and Squamous Cell Cancers of the Skin

of procedure or generalizability or extremely small sample sizes OR • 2 or more observational studies with inconsistent findings, small sample sizes, or other problems that potentially confound interpretation of data. The true effect may be substantially different from the estimate of the effect. There is a risk that future research may significantly alter the estimate of the effect size or the interpretation of the results. Expert Opinion * • Consensus of the panel based on clinical judgement

2020 American Society for Radiation Oncology

60. 2020-2023 Value Assessment Framework

of RCTs provide evidence that is least susceptible to many scientific biases. However, head-to-head RCTs of active comparators are uncommon, especially for interventions near the time of regulatory approval. Without direct head- to-head evidence, insights into comparative clinical effectiveness may require indirect comparisons through formal network meta-analysis. Complementing these sources of information is evidence derived from many different analytic approaches and that are available from a wide (...) For further insight and examples a useful resource is the FasterCures and Avalere Health work on “Integrating the Patient Perspective into the Development of Value Frameworks” available at ©Institute for Clinical and Economic Review, 2020 Page 7 2020-2023 Value Assessment Framework Return to Table of Contents Short-term Affordability With long-term value for money being the dominant element in considerations of value

2020 California Technology Assessment Forum

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