outpatients

A comparison of the impact of various treatments for COVID-19 on rates of hospitalizations. Figure 5 provides the best summary. James W. Mold, MD, MPH

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This COVID-19 outpatient randomized controlled trials (RCTs) systematic review compares hospitalization outcomes amongst four treatment classes over pandemic period, geography, variants, and vaccine status. Outpatient RCTs with hospitalization endpoint were identified in Pubmed searches through May 2023, excluding RCTs <30 participants (PROSPERO-CRD42022369181). Risk of bias was extracted from COVID-19-NMA, with odds ratio utilized for pooled comparison. Searches identified 281 studies with 61 published RCTs for 33 diverse interventions analyzed. RCTs were largely unvaccinated cohorts with at least one COVID-19 hospitalization risk factor. Grouping by class, monoclonal antibodies (mAbs) (OR = 0.31 [95% CI = 0.24-0.40]) had highest hospital reduction efficacy, followed by COVID-19 convalescent plasma (CCP) (OR = 0.69 [95% CI = 0.53-0.90]), small molecule antivirals (OR = 0.78 [95% CI = 0.48-1.33]), and repurposed drugs (OR = 0.82 [95% CI: 0.72-0.93]). Earlier in disease onset interventions performed better than later. This meta-analysis allows approximate head-to-head comparisons of diverse outpatient interventions. Omicron sublineages (XBB and BQ.1.1) are resistant to mAbs Despite trial heterogeneity, this pooled comparison by intervention class indicated oral antivirals are the preferred outpatient treatment where available, but intravenous interventions from convalescent plasma to remdesivir are also effective and necessary in constrained medical resource settings or for acute and chronic COVID-19 in the immunocompromised.

Author/s:

Daniele Focosi, David J. Sullivan, Daniel F. Hanley, Mario Cruciani, Massimo Franchini, Jiangda Ou, Arturo Casadevall, Nigel Paneth

Confidently rule out CAP in the outpatient setting

Aubrey Delammermore — Thu, 13 Oct 2022 05:00:00 +0000

Date Added:

October 13, 2022

Journal/Publication:

The Journal of Family Practice

Publisher:

The Family Physicians Inquiries Network

Publication Date:

April 1, 2021

Issue:

Volume:

Pages:

140-142

URL:

Confidently rule out CAP in the outpatient setting (Select PDF to view whole article)

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.12788/jfp.0174

Keywords

Physician-Patient Relations

Health Status

risk assessment

community-acquired pneumonia

outpatients

PMID (1):

34314338

MeSH

Ambulatory Care / organization & administration*

Community-Acquired Infections / diagnosis*

Family Practice / methods*

Practice Patterns

Physicians' / organization & administration*

Outpatients / statistics & numerical data

It is possible to accurately rule-out pneumonia in outpatients without a CXR. James W. Mold, MD, MPH

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A focus on specific signs and symptoms-without imaging-may rule out community-acquired pneumonia in outpatients.

Author/s:

Mott, T., Echeverri, D., Fondren, L., Hunter, A.

Transmission of SARS-CoV-2: A Review of Viral, Host, and Environmental Factors

Brian Desmarais — Tue, 22 Sep 2020 14:23:46 +0000

Date Added:

September 22, 2020

Journal/Publication:

Annals of Internal Medicine

Publication Date:

September 17, 2020

URL:

Transmission of SARS-CoV-2: A Review of Viral, Host, and Environmental Factors

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.7326/M20-5008

Keywords

Pulmonary diseases

Infectious diseases

respiratory tract infections

A review of what we know at this point about the transmission of COVID-19. James W. Mold, MD, MPH

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Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of coronavirus disease 2019 (COVID-19), has spread globally in a few short months. Substantial evidence now supports preliminary conclusions about transmission that can inform rational, evidence-based policies and reduce misinformation on this critical topic. This article presents a comprehensive review of the evidence on transmission of this virus. Although several experimental studies have cultured live virus from aerosols and surfaces hours after inoculation, the real-world studies that detect viral RNA in the environment report very low levels, and few have isolated viable virus. Strong evidence from case and cluster reports indicates that respiratory transmission is dominant, with proximity and ventilation being key determinants of transmission risk. In the few cases where direct contact or fomite transmission is presumed, respiratory transmission has not been completely excluded. Infectiousness peaks around a day before symptom onset and declines within a week of symptom onset, and no late linked transmissions (after a patient has had symptoms for about a week) have been documented. The virus has heterogeneous transmission dynamics: Most persons do not transmit virus, whereas some cause many secondary cases in transmission clusters called “superspreading events.” Evidence-based policies and practices should incorporate the accumulating knowledge about transmission of SARS-CoV-2 to help educate the public and slow the spread of this virus.

Author/s:

Meyerowitz, Eric A., Richterman, Aaron

Management of Outpatient Test Results

Jeffrey Wilson — Wed, 03 Oct 2018 17:26:38 +0000

Date Added:

October 3, 2018

Publication Date:

October 3, 2018

Type:

Community-Based Research Results

Format:

Article

Keywords

outpatients

test results

MeSH

outpatients

A summary of the key principles and best techniques we identified for managing test results. The study was conducted in OKPRN practices several years ago, but the information still seems relevant.

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From published literature, we identified four key steps in the management of test results:
1. Tracking all results to make sure they are received and reviewed by an appropriate person in the practice.
2. Notification of all patients of both normal and abnormal test results in a timely and convenient (for both practice and patients) manner.
3. Documentation of patient notification in the patient’s record.
4. Tracking patients with significantly abnormal test results requiring additional testing or follow-up to be sure that occurs.

Author/s:

Mold, James W.