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Survey finds misperceptions associated with palliative care are widespread – stigma may be perpetuated by those who falsely believe they understand its meaning.

11 Oct, 2021 | 23:54h | UTC

Public knowledge and attitudes concerning palliative care – BMJ Supportive & Palliative Care

Commentary on Twitter

Public misperceptions & stigma around palliative care are significant issues even for very well developed health systems. 29% of Canadian sample believed pall care meant doctors were 'giving up'. https://t.co/gpCFwFrk8z pic.twitter.com/TZsqwdbQnt

— Richard Sullivan (@SullivanProf) October 10, 2021

Cluster RCT: An antimicrobial stewardship intervention safely reduced the use of broad-spectrum antibiotics among patients hospitalized with moderately severe community-acquired pneumonia.

11 Oct, 2021 | 23:55h | UTC

Narrow-spectrum antibiotics for community-acquired pneumonia in Dutch adults (CAP-PACT): a cross-sectional, stepped-wedge, cluster-randomised, non-inferiority, antimicrobial stewardship intervention trial – The Lancet Infectious Diseases (link to abstract – $ for full-text)

RCT: Among patients with metastatic colorectal cancer, those randomized to systemic treatment alone had lower sixty-day mortality compared to those randomized to primary tumor resection followed by systemic treatment.

12 Oct, 2021 | 00:01h | UTC

Sixty-Day Mortality of Patients With Metastatic Colorectal Cancer Randomized to Systemic Treatment vs Primary Tumor Resection Followed by Systemic Treatment: The CAIRO4 Phase 3 Randomized Clinical Trial – JAMA Surgery (free for a limited period)

Editorial: Primary Tumor Resection and Patients With Asymptomatic Colorectal Cancer and Nonresectable Metastases: Results of Recent Randomized Trials – JAMA Surgery (free for a limited period)

Commentary: Systemic Therapy Alone Bests Surgical Tx for Metastatic CRC – BreakingMed

Commentary on Twitter

Early mortality in patients with colorectal cancer and unresectable metastases randomized to primary tumor resection followed by systemic treatment is considerably higher than early mortality in patients randomized to systemic treatment only https://t.co/SyfYjmDU7i @DaveKruijssen

— JAMA Surgery (@JAMASurgery) October 11, 2021

RCT: Early treatment with mild aerobic exercise safely speeds recovery from sport-related concussion in adolescents.

11 Oct, 2021 | 23:58h | UTC

Early targeted heart rate aerobic exercise versus placebo stretching for sport-related concussion in adolescents: a randomised controlled trial – The Lancet Child & Adolescent Health

News release: Aerobic exercise after a sport-related concussion speeds recovery in adolescent athletes – University at Buffalo

Randomized Trial: Early Aerobic Exercise for Sport-Related Concussion

RCT: Limiting screen time for young adults after concussion results in shorter duration of symptoms.

Selected issues in sport-related concussion for the team physician: a consensus statement – “Current evidence suggests strict rest after SRC slows recovery and increases the probability of prolonged symptoms”.

RCT: Prescribed light exercise vs. standard management for emergency department patients with acute mild traumatic brain injury

Commentaries on Twitter

RCT study in @TheLancet shows adolescents who sub-threshold aerobic exercise 20 mins/ day for 4 weeks starting within 10 days of a concussion are 48% less likely to get prolonged symptoms. https://t.co/1tafsQHrXt

— Dr Ademola Adejuwon (@SmileySportyDoc) October 2, 2021

Sport-related #concussion is a major public health issue in US adolescents

This new RCT of aerobic exercise vs stretching found exercise sped up recovery and reduced risk for persistent post-concussive symptomshttps://t.co/jP30N1eJEQ pic.twitter.com/ux42VSMfSr

— The Lancet Child & Adolescent Health (@LancetChildAdol) October 1, 2021

Kids are losing school days to quarantines. Here’s a way to keep them in classrooms – “Test-to-stay could dramatically reduce close contact quarantines”.

10 Oct, 2021 | 21:52h | UTC

Kids are losing school days to quarantines. Here’s a way to keep them in classrooms – NPR

New Global Burden of Disease analyses show depression and anxiety among the top causes of health burden worldwide, and a significant increase due to the COVID-19 pandemic.

10 Oct, 2021 | 21:57h | UTC

News release: New Global Burden of Disease analyses show depression and anxiety among the top causes of health burden worldwide, and a significant increase due to the COVID-19 pandemic – Institute for Health Metrics and Evaluation

Original study: Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic – The Lancet

Commentaries:

Depression and anxiety disorders during the COVID-19 pandemic: knowns and unknowns – The Lancet

COVID-19 pandemic led to stark rise in depressive and anxiety disorders globally in 2020: study – The Lancet

Covid crisis dramatically worsened global mental health, study finds – The Guardian

Commentary on Twitter (thread – click for more)

✨🆕–The #COVID19 pandemic led to a stark rise in depressive and anxiety disorders globally in 2020 w/women & younger people most affected, according to a new study by our researchers & collaborators published today in @TheLancet. #GBDstudy #MentalHealth

»https://t.co/qXEDzn3idV pic.twitter.com/4xsofBXyvS

— Institute for Health Metrics and Evaluation (IHME) (@IHME_UW) October 8, 2021

RCT: Therapeutic-dose heparin superior to standard prophylactic or intermediate-dose heparins for thromboprophylaxis in high-risk hospitalized patients with COVID-19.

10 Oct, 2021 | 21:53h | UTC

Efficacy and Safety of Therapeutic-Dose Heparin vs Standard Prophylactic or Intermediate-Dose Heparins for Thromboprophylaxis in High-risk Hospitalized Patients With COVID-19: The HEP-COVID Randomized Clinical Trial – JAMA Internal Medicine

Invited commentary: Anticoagulant Therapy in Patients Hospitalized With COVID-19 – JAMA Internal Medicine

Related studies (some conflicting results)

Another meta-analysis suggests standard-dose prophylactic anticoagulation is the best option for patients hospitalized with Covid-19.

M-A: Safety and efficacy of different prophylactic anticoagulation dosing regimens in critically and non-critically ill patients with COVID-19 – According to this analysis, standard-dose prophylactic anticoagulation should be the standard of care for hospitalized patients with COVID-19 who do not have an indication for therapeutic anticoagulation, irrespective of disease severity.

RCT: In noncritically ill patients hospitalized with Covid-19, therapeutic-dose anticoagulation with heparin increased the probability of survival to hospital discharge compared with usual-care thromboprophylaxis.

RCT: In critically ill patients with Covid-19, therapeutic anticoagulation with heparin did not result in improved outcomes compared to usual-care pharmacologic thromboprophylaxis.

RCT: In patients hospitalized with Covid-19 with elevated D-Dimer, a full-dose anticoagulation strategy based on rivaroxaban (full-dose heparins in unstable patients) + rivaroxaban to day 30 was not better than prophylactic anticoagulation and increased bleeding risk.

Commentary on Twitter

Thromboprophylaxis w therapeutic-dose LMWH reduced major thromboembolism and death by 32% compared with institutional standard heparin without increased major bleeding among #COVID19 inpatients with elevated D-dimers. The effect wasn't seen in ICU patients https://t.co/Wrgj2Ho5lv

— JAMA Internal Medicine (@JAMAInternalMed) October 7, 2021

Heart-inflammation risk from Pfizer COVID vaccine is very low.

10 Oct, 2021 | 21:42h | UTC

Heart-inflammation risk from Pfizer COVID vaccine is very low – Nature

Original studies:

Large cohort study with over 2.5 million individuals showed the incidence of myocarditis after the Pfizer vaccine was 2.13 cases per 100,000 persons.

Study with over 5.1 million vaccinated individuals showed the incidence of myocarditis after the receipt of the Pfizer vaccine was low and more common after the second dose in young male recipients.

[Preprint] COVID-19 in children due to SARS-CoV-2 Delta strain resembles illness due to the Alpha variant, with short duration and similar symptom burden.

10 Oct, 2021 | 21:44h | UTC

Illness characteristics of COVID-19 in children infected with the SARS-CoV-2 Delta variant – medRxiv

Commentary on Twitter

Did you hear “Delta is different”, when it comes to #COVID19 symptom severity in children?

GOOD NEWS 🥳

Turns out there is barely any difference at all between Delta and Alpha in symptom duration, severity, or risk of “long covid”

Myth busted 💥 https://t.co/iPd9AedXaS

— Alasdair Munro (@apsmunro) October 7, 2021

Bioethics | The Trolley Problem and Vaccinating Young People Against COVID-19.

10 Oct, 2021 | 21:50h | UTC

The Trolley Problem and Vaccinating Young People Against COVID-19 – Science-Based Medicine

WHO report highlights global shortfall in investment in mental health.

10 Oct, 2021 | 21:39h | UTC

WHO report highlights global shortfall in investment in mental health – World Health Organization

Report: Mental Health ATLAS 2020 – World Health Organization

Commentary on Twitter (thread – click for more)

The world has failed to provide people with the #MentalHealth services they need: new Mental Health Atlas
Read more➡️https://t.co/J0uKvKWZ46 pic.twitter.com/0wKx6JTV2F

— World Health Organization (WHO) (@WHO) October 8, 2021

World Mental Health Day: prioritize social justice, not only access to care.

10 Oct, 2021 | 21:37h | UTC

World Mental Health Day: prioritise social justice, not only access to care – The Lancet (free registration required)

Commentary on Twitter

"…under the wrong set of social circumstances, everyone is vulnerable to mental health problems."#WorldMentalHealthDay: prioritise social justice, not only access to care—a Comment by Soumitra Pathare @netshrink and colleagues. https://t.co/AwdSXo8y5H pic.twitter.com/Az6AB9vLmm

— The Lancet (@TheLancet) October 10, 2021

M-A: Accuracy of the Patient Health Questionnaire-9 for screening to detect major depression.

10 Oct, 2021 | 21:34h | UTC

Accuracy of the Patient Health Questionnaire-9 for screening to detect major depression: updated systematic review and individual participant data meta-analysis – The BMJ

See calculator: PHQ-9 (Patient Health Questionnaire-9)

Commentary on Twitter

This new study investigates the accuracy of the Patient Health Questionnaire-9 (PHQ-9), the most commonly used depression screening tool in general practice, for detecting major depression https://t.co/9WoI3MofWH

— The BMJ (@bmj_latest) October 10, 2021

Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies.

10 Oct, 2021 | 21:31h | UTC

Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies – Molecular Psychiatry

Commentary: Age at onset of mental disorders: global meta-analysis provides data for targeting effective interventions – The Mental Elf

ACG Clinical Guidelines: Management of Benign Anorectal Disorders

10 Oct, 2021 | 21:29h | UTC

ACG Clinical Guidelines: Management of Benign Anorectal Disorders – The American Journal of Gastroenterology

Commentary on Twitter

🆕 2021 ACG Guidelines for Benign Anorectal Disorders 🍑🍑🍑

👉defecation disorders
👉proctalgia syndromes
👉hemorrhoids
👉anal fissures
👉fecal incontinence #GITwitter

🔗 https://t.co/TeqTWjQkg1 pic.twitter.com/gEfkBsH7kn

— Carl Kay, MD (@CarlKayMD) October 8, 2021

WHO Guidance: Antigen-detection in the diagnosis of SARS-CoV-2 infection.

8 Oct, 2021 | 10:47h | UTC

Antigen-detection in the diagnosis of SARS-CoV-2 infection – World Health Organization

Related infographics:

Use of antigen detection rapid diagnostic testing – World Health Organization

Diagnostic testing for SARS-CoV-2 infection – World Health Organization

Commentary on Twitter (thread – click for more)

Testing remains a critical component to the strategy to end the #COVID19 pandemic, and testing needs to be reliable, accessible, affordable, fast and linked to public health action.

So many around 🌍 have worked hard to increase testing capacities @WHO https://t.co/VDPdU0VK4g

— Maria Van Kerkhove (@mvankerkhove) October 7, 2021

Editorial: Brain health and its social determinants.

10 Oct, 2021 | 21:35h | UTC

Brain health and its social determinants – The Lancet

Commentary on Twitter

Globally, action to tackle the social determinants of mental ill health—including poverty, racism, and discrimination—remains a low priority in too many countries.

On #WorldMentalHealthDay, read our Editorial: https://t.co/VRJkZ8kVn5 #MentalHealth #WMHD2021 pic.twitter.com/hxvrCoMbt0

— The Lancet (@TheLancet) October 10, 2021

WHO Consensus: A clinical case definition of post COVID-19 condition (Long Covid).

8 Oct, 2021 | 10:45h | UTC

A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021 – World Health Organization

Characterizing long COVID: a living systematic review.

Long Covid – The illness narratives.

New guidelines to help doctors manage long COVID patients published.

M-A: More than 50 long-term effects of COVID-19. (several articles on the subject)

Commentary on Twitter (thread – click for more)

🆕 WHO clinical case definition for post #COVID19 condition, also called 'long COVID' https://t.co/WoiLcwsgJX pic.twitter.com/Z0olrHlWPC

— World Health Organization (WHO) (@WHO) October 7, 2021

WHO Launches Strategy to Achieve Global Covid-19 Vaccination by mid-2022.

8 Oct, 2021 | 10:41h | UTC

Strategy to Achieve Global Covid-19 Vaccination by mid-2022 – World Health Organization

News release: WHO, UN set out steps to meet world COVID vaccination targets – World Health Organization

Commentaries:

WHO Believes 70% Vaccination Target is Possible – But Only if Wealthy Countries Make Way for COVAX and Africa – Health Policy Watch

WHO launches global COVID vaccination strategy – CIDRAP

Study shows an increased risk of Guillain-Barré Syndrome with the J&J vaccine; the estimated observed to expected rate ratio was 4.18 for the 42-day window.

8 Oct, 2021 | 10:40h | UTC

Association of Receipt of the Ad26.COV2.S COVID-19 Vaccine With Presumptive Guillain-Barré Syndrome, February-July 2021 – JAMA

Commentary on Twitter

Study suggests a potential small but statistically significant safety concern for #GuillainBarré syndrome following receipt of the @JanssenUS #COVID19 vaccine; findings considered preliminary pending analysis of medical records to establish a definitive Dx https://t.co/yZjJVkp6BA

— JAMA (@JAMA_current) October 7, 2021

Real-world data shows increased reactogenicity in adults after heterologous compared to homologous prime-boost COVID-19 vaccination.

8 Oct, 2021 | 10:29h | UTC

Real-world data shows increased reactogenicity in adults after heterologous compared to homologous prime-boost COVID-19 vaccination, March−June 2021, England – Eurosurveillance

RCT: Safety and immunogenicity of heterologous vs. homologous prime-boost schedules with an adenoviral vectored and mRNA COVID-19 vaccine.

Another study shows increased immune response with heterologous Oxford-AstraZeneca/mRNA vaccination.

Heterologous Oxford–AstraZeneca and Moderna Vaccination induce increased levels of neutralizing antibody compared to 2 doses of Oxford–AstraZeneca.

Heterologous Oxford–AstraZeneca and BioNTech/Pfizer Vaccination induce increased levels of neutralizing antibody compared to 2 doses of Oxford–AstraZeneca.

[Preprint] Mixing Covid jabs has good immune response, study finds – “The Com-Cov trial looked at the efficacy of either two doses of Pfizer, two of AstraZeneca, or one of them followed by the other. All combinations worked well, priming the immune system”.

Phase 2 RCT: Immunogenicity and reactogenicity of a Pfizer-BioNTech booster in patients that have received a single dose of AstraZeneca vaccine – “BNT162b2 (Pfizer) given as a second dose in individuals prime vaccinated with ChAdOx1-S (AstraZeneca) induced a robust immune response, with an acceptable and manageable reactogenicity profile”.

Lab study shows heterologous AstraZeneca/Pfizer vaccination produces strong immune response against SARS-CoV-2 Delta variant.

Lab study shows a heterologous AstraZeneca + Pfizer immunization strategy provides stronger immunogenicity against Covid compared to homologous AZ + AZ or Pfizer + Pfizer strategies.

RCT: Mixing 2 different Covid vaccines is associated with increased risk of side effects.

Commentary on Twitter

As more & more countries consider adding a 3rd #COVID19 vaccine dose into their national immunisation programmes, vaccine reactogenicity will become important, especially if 3rd dose is different to first 2 doses. We need more mix-n-match booster studies 👉https://t.co/G57i9Ej7Nd

— Shamez Ladhani (@ShamezLadhani) October 7, 2021

Ivermectin: How false science created a Covid ‘miracle’ drug.

8 Oct, 2021 | 10:24h | UTC

Ivermectin: How false science created a Covid ‘miracle’ drug – BBC

Commentary on Twitter

Scientists evaluating ivermectin data for #COVID19
"had not found 'a single clinical trial' claiming to show that ivermectin prevented Covid deaths that did not contain 'either obvious signs of fabrication or errors so critical they invalidate the study'." https://t.co/Xndr6Q5LaS

— Isaac Bogoch (@BogochIsaac) October 7, 2021