HSE Library Summaries of EvidenceEvidence summaries and reviews on the management and treatment of Novel Coronavirus Covid-19 and other clinical topicshttp://hdl.handle.net/10147/6272862024-03-21T18:09:25Z2024-03-21T18:09:25Z[Evidence summary:] What strategies or interventions are effective in reducing the impact of seasonal/temporal surge in demand for unscheduled or urgent care in emergency departments or other acute hospital services?Health Library Ireland: EvidenceLeen, BrendanMcKeown, DeclanWhite, Gethinhttp://hdl.handle.net/10147/6372002023-08-31T02:25:27Z2023-05-05T00:00:00Z[Evidence summary:] What strategies or interventions are effective in reducing the impact of seasonal/temporal surge in demand for unscheduled or urgent care in emergency departments or other acute hospital services?
Health Library Ireland: Evidence; Leen, Brendan; McKeown, Declan; White, Gethin
Main Points 1. There is no single intervention or explicit series of interventions — no ‘silver bullet’ — to resolve the problem of seasonal or temporal surges in demand for unscheduled emergency services. Instead, a broad spectrum of potential incremental contributors to an amelioration of the problem is presented. 2. In our analysis, PEOPLE-FOCUSSED interventions relate to specific demographics, populations, or chronic conditions where consideration of the needs of a discrete sub-group and provision of appropriate services or supports has been demonstrated to reduce utilisation of ED and/or acute hospital services; PROBLEM-FOCUSSED interventions confront and mitigate specific problems associated with surges in demand for unscheduled care; and PROCESS- or SERVICE-FOCUSSED interventions are constructed around health service re-design, reconfiguration, or innovation. 3. Implementation of micro-, meso-, and macro-level mitigation strategies is comprehended according to complex adaptive systems (CASs) theory in which behaviours are influenced by cross-scale interactions and dependencies, and according to which EDs are co-reliant on and operate in synergy with preventative and proactive care, primary and community care, and other acute hospital departments.
2023-05-05T00:00:00Z[Evidence Summary] What guidance is available for healthcare workers on the provision of CPR for patients with confirmed or suspected COVID-19 in hospital settings, focussing primarily on the evidence relating to CPR as an aerosol-generating procedure? [v3.1]National Health Library & Knowledge Service (NHLKS)Madden, AnneMorgan, MargaretFlynn, MauraLeen, Brendanhttp://hdl.handle.net/10147/6278722022-11-16T15:30:33Z2022-08-04T00:00:00Z[Evidence Summary] What guidance is available for healthcare workers on the provision of CPR for patients with confirmed or suspected COVID-19 in hospital settings, focussing primarily on the evidence relating to CPR as an aerosol-generating procedure? [v3.1]
National Health Library & Knowledge Service (NHLKS); Madden, Anne; Morgan, Margaret; Flynn, Maura; Leen, Brendan
1. Updated American Heart Association (AHA)(2022) guidance recommends that all health care personnel should wear a respirator (eg, N95) along with other PPE (gown, gloves, and eye protection) for patients with suspected or confirmed COVID-19 infection when performing AGPs or in a setting where AGPs are regularly performed. 2. Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) offers significant protection to health care providers, including those involved in resuscitation of patients with suspected or confirmed COVID-19. 3. ILCOR advise that national, regional and local resuscitation councils should consider the values and preferences of their local communities, prevalence of disease, uptake of vaccination, availability of PPE, training needs of their workforce, and infrastructure and resources to provide ongoing care for patients resuscitated after cardiac arrest.
2022-08-04T00:00:00ZDoes a two-dose HPV vaccination schedule provide non-inferior efficacy or effectiveness against HPV infection and associated clinical outcomes and non-inferior immune response (immunogenicity) compared to a three-dose schedule for individuals aged 15 years and older?Clark, HelenReynolds, JuliaLeen, BrendanWalsh, GillianBrennan, MargaretÓ Broinn, CathalJessop, LucyKelleher, KevinWard, Maryhttp://hdl.handle.net/10147/6334312022-08-07T02:07:14Z2022-07-15T00:00:00ZDoes a two-dose HPV vaccination schedule provide non-inferior efficacy or effectiveness against HPV infection and associated clinical outcomes and non-inferior immune response (immunogenicity) compared to a three-dose schedule for individuals aged 15 years and older?
Clark, Helen; Reynolds, Julia; Leen, Brendan; Walsh, Gillian; Brennan, Margaret; Ó Broinn, Cathal; Jessop, Lucy; Kelleher, Kevin; Ward, Mary
Main Points 1. Two doses of the HPV-16/18 vaccine offer similar protection against cervical HPV-16/18 infections as that provided by the three-dose schedule, and similar durability of vaccine effectiveness and immunogenicity. 2. Hazard ratios for histologically confirmed pre-invasive cervical disease are similar for two and three vaccine doses. 3. Women vaccinated with three compared to two doses of quadrivalent HPV vaccine showed a reduced risk of severe cervical lesions if they were vaccinated before age 20, with a further reduced risk if vaccinated before age 17. Vaccination with two doses, with the second dose 5 months or longer after the first dose, did not yield an increased risk of severe cervical lesions compared to three doses. For individuals at or after age 20, there is limited evidence of any protective effect against cervical disease for either a two- or three-dose vaccination schedule.
2022-07-15T00:00:00ZWhat recent systematic reviews are available on the transition of care from paediatric to adult health services? What is the optimal age of transition? For which diseases/conditions are transition of care models recommended, and what are the elements of the transition process?Health Library Ireland Evidence ServiceSurkau, MelanieBarrett, ShaunaLeen, Brendanhttp://hdl.handle.net/10147/6320242022-06-03T01:49:31Z2022-06-01T00:00:00ZWhat recent systematic reviews are available on the transition of care from paediatric to adult health services? What is the optimal age of transition? For which diseases/conditions are transition of care models recommended, and what are the elements of the transition process?
Health Library Ireland Evidence Service; Surkau, Melanie; Barrett, Shauna; Leen, Brendan
Main Points 1. Yassaee et al (2019) found that a delayed age of transfer resulted in improved outcomes, and that age 18 was an appropriate time of transfer. 2. Thomsen et al (2020) found strong consensus among young people with chronic conditions, service managers and healthcare professionals that young people should be actively involved in decisions about their treatment, and encouraged and supported to ask questions about their illness and treatment. 3. Marani et al (2020) compared the design features of existing transition of care models that positively impact clinical outcomes and found that most studies focused on a standardized multidisciplinary transition process that emphasized care coordination.
2022-06-01T00:00:00Z[HTML TEST] What is the latest national and international evidence about the existence of long COVID or post-COVID and its persistence for COVID-19 survivors?National Health Library & Knowledge Service (NHLKS)http://hdl.handle.net/10147/6319332022-05-24T02:53:40Z2022-04-28T00:00:00Z[HTML TEST] What is the latest national and international evidence about the existence of long COVID or post-COVID and its persistence for COVID-19 survivors?
National Health Library & Knowledge Service (NHLKS)
2022-04-28T00:00:00ZSummary Document: COVID-19 General ManagementNational Health Library & Knowledge Service (NHLKS)http://hdl.handle.net/10147/6318972022-05-13T01:52:11Z2020-03-16T00:00:00ZSummary Document: COVID-19 General Management
National Health Library & Knowledge Service (NHLKS)
The following information resources have been selected by the National Health Library and Knowledge Service
Evidence Virtual Team in response to a request to collate the best available evidence and guidance pertaining to the
general management of COVID-19 infections. The resources are listed in our estimated order of relevance to
practicing healthcare professionals confronted with this scenario in an Irish context. In respect of the evolving global
situation and rapidly changing evidence base, the Evidence Team has provided link-outs to continually updating
sources of information rather than prescriptive or static statements of evidence; it is therefore advised to use the
hyperlinks in this document to ensure that the information you are disseminating to the public is the most current,
valid and accurate.
2020-03-16T00:00:00ZWhen should broader community testing be implemented?National Health Library & Knowledge Service (NHLKS)http://hdl.handle.net/10147/6318962022-05-13T01:52:05Z2020-03-23T00:00:00ZWhen should broader community testing be implemented?
National Health Library & Knowledge Service (NHLKS)
The following information resources have been selected by the National Health Library and Knowledge Service Evidence Virtual Team in response to your question. The resources are listed in our estimated order of relevance to practicing healthcare professionals confronted with this scenario in an Irish context. In respect of the evolving global situation and rapidly changing evidence base, it is advised to use hyperlinked sources in this document to ensure that the information you are disseminating to the public or applying in clinical practice is the most current, valid and accurate.
2020-03-23T00:00:00Z[Evidence summary:] What is the evidence to support prone positioning of awake COVID-19 patients receiving non-invasive ventilation or ventilating on room air? [v1.0]National Health Library & Knowledge Service (NHLKS)http://hdl.handle.net/10147/6318952022-05-13T01:51:59Z2020-04-28T00:00:00Z[Evidence summary:] What is the evidence to support prone positioning of awake COVID-19 patients receiving non-invasive ventilation or ventilating on room air? [v1.0]
National Health Library & Knowledge Service (NHLKS)
The prone position consists of placing the patient on his or her stomach with
the head on the side during sessions lasting several hours a day with the aim
of assisting in the spontaneous ventilation7.
Based on improvements observed with mechanically ventilated patients, it
has been postulated that adopting the prone position for conscious COVID-19
patients requiring basic respiratory support may also improve oxygenation,
reduce the need for invasive ventilation and potentially reduce mortality3,.
Guérin et al.14 state that in patients with severe acute respiratory distress
syndrome (ARDS), early application of prolonged prone positioning sessions
significantly decreased 28-day and 90-day mortality.
Sun et al10 report on a study from China that outlines how adopting the
awake prone position in novel coronavirus pneumonia patients showed
significant effects in improving oxygenation and pulmonary heterogeneity.
Ding et al12 conclude that early application of prone positioning with high-
flow nasal cannula, especially in patients with moderate ARDS and baseline
SpO2>95%, may help avoid intubation. Prone positioning was well tolerated,
and the efficacy on PaO2/FiO2 of the four support strategies was HFNC <
HFNC+PP ≤ NIV < NIV+PP. Severe ARDS patients were not appropriate
candidates for HFNC/NIV+PP.
Some experts are suggesting that the hospitalized patient spend as much
time as is feasible and safe in the prone position while receiving oxygen; their
rationale is based on limited direct evidence and anecdotal observations in
the field as well as indirect evidence of the efficacy of prone positioning in
ventilated patients6.
2020-04-28T00:00:00ZWhat is the impact of diabetes mellitus among people infected with COVID-19? [v1.2]National Health Library & Knowledge Service (NHLKS)http://hdl.handle.net/10147/6318942022-05-13T01:51:52Z2020-04-29T00:00:00ZWhat is the impact of diabetes mellitus among people infected with COVID-19? [v1.2]
National Health Library & Knowledge Service (NHLKS)
Patients with diabetes are considered to be at higher risk for severe illness.
They are more likely to need intensive care if they develop COVID-19
compared with patients who do not have diabetes and have a higher case
fatality rate10, 19.
Diabetes may not increase the risk of COVID-19 infection but it can lead to
enhanced disease severity. Preliminary findings from the United States14
suggest that persons with underlying health conditions or other recognized
risk factors for severe outcomes from respiratory infections appear to be at
a higher risk for severe disease from COVID-19 than are persons without
these conditions. The most commonly reported conditions were diabetes
mellitus, chronic lung disease and cardiovascular disease. The Centre for
Evidence-Based Medicine5 states that there is little evidence on how people
with diabetes can reduce their risk of COVID-19 infection beyond following
general infection control guidance. Significant disruptions to routine care
may also contribute to poorer outcomes during and following the pandemic.
Hyperglycemia should not be overlooked, but adequately treated to improve
the outcomes of COVID-19 patients with our without diabetes25.
Both the HPSC1 and WHO3 highlight evidence suggesting there are two
groups of people at a higher risk of acquiring a more severe disease; older
people and those with an underlying medical condition such as diabetes.
Clinical guidance from the CDC4 also highlights risk factors for severe illness
and reports that fatality is higher for patients with diabetes. Diabetes as a
distinctive comorbidity is associated with more severe disease, acute
respiratory distress syndrome and increased mortality12. In a nationwide analysis on comorbidity and its impact on patients in China23, Guan et al
found that the most prevalent comorbidity was hypertension followed by
diabetes. The study concludes that patients with any comorbidity yielded
poorer clinical outcomes than those without, and that a greater number of
comorbidities also correlated with poorer clinical outcomes. Discussing two
earlier CoV infections SARS and MERS Bloomgarden et al34 report that
regardless of the potential for the spread of COVID-19, as with influenza-
reported mortality diabetes is an important risk factor for adverse outcome.
Diabetes should be considered a risk factor and more intensive attention
should be paid to patients with diabetes, in case of rapid deterioration.
2020-04-29T00:00:00Z[Evidence summary:] What are the considerations regarding ophthalmic procedures with suspected or confirmed COVID-19 patients? [v2.0]National Health Library & Knowledge Service (NHLKS)Surkau, MelanieLeen, Brendanhttp://hdl.handle.net/10147/6284272022-05-13T01:51:46Z2020-06-29T00:00:00Z[Evidence summary:] What are the considerations regarding ophthalmic procedures with suspected or confirmed COVID-19 patients? [v2.0]
National Health Library & Knowledge Service (NHLKS); Surkau, Melanie; Leen, Brendan
Ocular symptoms may occur in severe COVID-19 pneumonia and the virus can be isolated from the conjunctival sac. Conjunctivitis is not a common manifestation of the disease, but contact with infected eyes can be a route of transmission. Ophthalmic practice carries some unique risks and clinicians must have effective prevention strategies in place14, 32.
For outpatient care, Lim et al31 recommend that a stringent screening and triaging process is carried out to identify high-risk patients, with proper isolation implemented for such patients. For surgical and laser procedures, 5% topical povidone-iodine applied pre-operatively inactivates virus on the ocular surface. It is not suitable for intra-ocular application. There is no evidence that the virus is present in aqueous or vitreous humour. Aerosol generation during cataract, glaucoma, and vitreo-retinal procedures is of low risk to the surgeon. External cautery should be minimised to reduce the risk of aerosolising blood and if used should be combined with irrigation in order to dilute any aerosol produced10, 20.
For asymptomatic patients with no risk factors, the American Academy of Ophthalmology and the Royal College of Ophthalmologists recommend generic measures to protect ophthalmologists from infection; these include scrupulous disinfection practices, protective plastic slit-lamp breath shields, reducing or eliminating conversations with the patient during slit-lamp examination, limiting the time spent with the patient at the slit lamp, and considering whether ophthalmic investigations such as ocular imaging are critical to the decision-making process. Both organizations recommend cancelling non-urgent treatment11.
The role of telemedicine in mitigating risk of transmission of SARS-CoV-2 in eye care is an emerging theme in the literature. Digital communication technology is particularly relevant for two reasons: 1. prolonged exposure in close proximity on the slit lamp may increase the risk of transmission and viral load; and 2. the ability to make clinical decisions based on structured examination metrics such as palpebral aperture, intraocular pressure, cup-disc ratios, and images6. Virtual video visits may be used to manage a range of ophthalmic complaints; remote within-clinic visual acuity testing and consultations can be undertaken with minimal specialist equipment and appears to provide useful information while being acceptable to patients.
2020-06-29T00:00:00Z