Background The following position statement from the Union of the European Phoniatricians, updated on 25th May 2020 (superseding the previous statement issued on 21st April 2020), contains a series... Show moreBackground The following position statement from the Union of the European Phoniatricians, updated on 25th May 2020 (superseding the previous statement issued on 21st April 2020), contains a series of recommendations for phoniatricians and ENT surgeons who provide and/or run voice, swallowing, speech and language, or paediatric audiology services. Objectives This material specifically aims to inform clinical practices in countries where clinics and operating theatres are reopening for elective work. It endeavours to present a current European view in relation to common procedures, many of which fall under the aegis of aerosol generating procedures. Conclusion As evidence continues to build, some of the recommended practices will undoubtedly evolve, but it is hoped that the updated position statement will offer clinicians precepts on safe clinical practice. Show less
Objective: Contagious disease outbreaks and related restrictions can lead to negative psychological outcomes, particularly in vulnerable populations at risk due to pre-existing medical conditions.... Show moreObjective: Contagious disease outbreaks and related restrictions can lead to negative psychological outcomes, particularly in vulnerable populations at risk due to pre-existing medical conditions. No randomised controlled trials (RCTs) have tested interventions to reduce mental health consequences of contagious disease outbreaks. The primary objective of the Scleroderma Patient-centered Intervention Network COVID-19 Home-isolation Activities Together (SPIN-CHAT) Trial is to evaluate the effect of a videoconference-based program on symptoms of anxiety. Secondary objectives include evaluating effects on symptoms of depression, stress, loneliness, boredom, physical activity, and social interaction.Methods: The SPIN-CHAT Trial is a pragmatic RCT that will be conducted using the SPIN-COVID-19 Cohort, a sub-cohort of the SPIN Cohort. Eligible participants will be SPIN-COVID-19 Cohort participants without a positive COVID-19 test, with at least mild anxiety (PROMIS Anxiety 4a v1.0 T-score >= 55), not working from home, and not receiving current counselling or psychotherapy. We will randomly assign 162 participants to intervention groups of 7 to 10 participants each or waitlist control. We will use a partially nested RCT design to reflect dependence between individuals in training groups but not in the waitlist control. The SPIN-CHAT Program includes activity engagement, education on strategies to support mental health, and mutual participant support. Intervention participants will receive the 4-week (3 sessions per week) SPIN-CHAT Program via video-conference. The primary outcome is PROMIS Anxiety 4a score immediately post-intervention.Ethics and dissemination: The SPIN-CHAT Trial will test whether a brief videoconference-based intervention will improve mental health outcomes among at-risk individuals during contagious disease outbreak. Show less
Objective We evaluated the early impact of COVID-19 on people with self-reported eating disorders. Method Participants in the United States (US,N= 511) and the Netherlands (NL,N= 510), recruited... Show moreObjective We evaluated the early impact of COVID-19 on people with self-reported eating disorders. Method Participants in the United States (US,N= 511) and the Netherlands (NL,N= 510), recruited through ongoing studies and social media, completed an online survey that included both quantitative measures and free-text responses assessing the impact of COVID-19 on situational circumstances, eating disorder symptoms, eating disorder treatment, and general well-being. Results Results revealed strong and wide-ranging effects on eating disorder concerns and illness behaviors that were consistent with eating disorder type. Participants with anorexia nervosa (US 62% of sample; NL 69%) reported increased restriction and fears about being able to find foods consistent with their meal plan. Individuals with bulimia nervosa and binge-eating disorder (US 30% of sample; NL 15%) reported increases in their binge-eating episodes and urges to binge. Respondents noted marked increases in anxiety since 2019 and reported greater concerns about the impact of COVID-19 on their mental health than physical health. Although many participants acknowledged and appreciated the transition to telehealth, limitations of this treatment modality for this population were raised. Individuals with past histories of eating disorders noted concerns about relapse related to COVID-19 circumstances. Encouragingly, respondents also noted positive effects including greater connection with family, more time for self-care, and motivation to recover. Discussions COVID-19 is associated with increased anxiety and poses specific disorder-related challenges for individuals with eating disorders that require attention by healthcare professionals and carers. Show less
During the outbreak of the COVID-19 pandemic many clinical trials were abruptly halted. Measures to contain the pandemic are currently taking effect and societies in general and healthcare systems... Show moreDuring the outbreak of the COVID-19 pandemic many clinical trials were abruptly halted. Measures to contain the pandemic are currently taking effect and societies in general and healthcare systems in particular are considering how to return to normalcy. This opens up the discussion when and how clinical trials should be restarted while the COVID-19 pandemic has not yet resolved, and what should happen in case of a resurgence of the virus in the coming months. This article uses the four ethical principles framework as a structured approach to come to a set of practical, ethically grounded guidelines for halting and relaunching clinical trials during the COVID-19 pandemic. The framework applied provides a structured approach for all clinical trials stakeholders and thereby prevents unclear reasoning in a complex situation. While it is essential to prevent the virus from resurging and focus on developing a COVID-19 treatment as soon as possible, it is just as important to our society that we continue developing new drugs for other conditions. In this article we argue that the situation for clinical trials is not essentially different from the pre-COVID-19 era and that an overcautious approach will have negative consequences. Show less
This article is part of the point-of-care ultrasound (POCUS) series. During the Coronavirus Disease 2019 (COVID-19) pandemic, we have been managing large numbers of infected patients whilst... Show moreThis article is part of the point-of-care ultrasound (POCUS) series. During the Coronavirus Disease 2019 (COVID-19) pandemic, we have been managing large numbers of infected patients whilst maintaining high-quality healthcare. In this article we aim to provide a short and practical description on how point-of-care lung ultrasound can be of use to facilitate diagnosis and treatment in critically ill patients diagnosed with COVID-19. Show less
The global coronavirus disease 2019 pandemic continues to escalate at a rapid pace inundating medical facilities and creating substantial challenges globally. The risk of severe acute respiratory... Show moreThe global coronavirus disease 2019 pandemic continues to escalate at a rapid pace inundating medical facilities and creating substantial challenges globally. The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with cancer seems to be higher, espe- cially as they are more likely to present with an immuno- compromised condition, either from cancer itself or from the treatments they receive. A major consideration in the delivery of cancer care during the pandemic is to balance the risk of patient exposure and infection with the need to provide effective cancer treatment. Many aspects of the SARS-CoV-2 infection currently remain poorly characterized and even less is known about the course of infection in the context of a patient with cancer. As SARS-CoV-2 is highly contagious, the risk of infection directly affects the cancer patient being treated, other cancer patients in close prox- imity, and health care providers. Infection at any level for patients or providers can cause considerable disruption to even the most effective treatment plans. Lung cancer pa- tients, especially those with reduced lung function and cardiopulmonary comorbidities are more likely to have increased risk and mortality from coronavirus disease 2019 as one of its common manifestations is as an acute respi- ratory illness. The purpose of this manuscript is to present a practical multidisciplinary and international overview to assist in treatment for lung cancer patients during this pandemic, with the caveat that evidence is lacking in many areas. It is expected that firmer recommendations can be developed as more evidence becomes available. (C) 2020 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved. Show less
Background: Different countries have adopted different containment and testing strategies for SARS-CoV-2. The difference in testing makes it difficult to compare the effect of different containment... Show moreBackground: Different countries have adopted different containment and testing strategies for SARS-CoV-2. The difference in testing makes it difficult to compare the effect of different containment strategies. This study proposes methods to allow a direct comparison and presents the results.Design: Publicly available data on the numbers of reported COVID-19-related deaths between 01 January and 17 April 2020 were compared between countries.Results: The numbers of cases or deaths per 100,000 inhabitants gave severely biased comparisons between countries. Only the number of deaths expressed as a percentage of the number of deaths on day 25 after the first reported COVID-19-related death allowed a direct comparison between countries. From this comparison clear differences were observed between countries, associated with the timing of the implementation of containment measures.Conclusions: Comparisons between countries are only possible when simultaneously taking into account that the virus does not arrive in all countries simultaneously, absolute numbers are incomparable due to different population sizes, rates per 100,000 of the population are incomparable because not all countries are affected homogeneously, susceptibility to death by COVID-19 can differ between populations, and a death is only reported as a COVID-19-related death if the patient was diagnosed with SARS-CoV-2 infection. With the current methods, all these factors were accounted for and an unbiased direct comparison between countries was established. This comparison confirmed that early adoption of containment strategies is key in flattening the curve of the epidemic. (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. Show less
This paper offers the Introduction to the Special Issue “Economic and Financial Governance in the European Union after a decade of Economic and Political Crises.” We introduce the five papers. We... Show moreThis paper offers the Introduction to the Special Issue “Economic and Financial Governance in the European Union after a decade of Economic and Political Crises.” We introduce the five papers. We distill three important lessons they offer for EU integration. Show less
The coronavirus disease 2019 (COVID-19) pandemic has created major challenges for all countries around the globe. Retrospective studies have identified hypertension, cardiovascular disease,... Show moreThe coronavirus disease 2019 (COVID-19) pandemic has created major challenges for all countries around the globe. Retrospective studies have identified hypertension, cardiovascular disease, diabetes and older age as risk factors for high morbidity and mortality from COVID-19. There is a general concern that patients with immune-mediated kidney diseases, namely those on immunosuppressive therapies and/or those with more advanced kidney failure, could particularly be at risk for adverse outcomes due to a compromised antiviral immunity. Uncertainties exist on how management routines should be reorganized to minimize the risk of severe acute respiratory syndrome coronavirus 2 infection and what measures are necessary for infected patients. The aim of the present review of the Immunonephrology Working Group of the European Renal Association-European Dialysis and Transplant Association is to provide recommendations for the management of patients with immune-mediated kidney diseases based on the available evidence, similar circumstances with other infectious organisms and expert opinions from across Europe. Such recommendations may help to minimize the risk of encountering COVID-19 or developing complications during COVID-19 in patients with immune-mediated kidney disease. Show less
Vinkers, C.H.; Amelsvoort, T. van; Bisson, J.I.; Branchi, I.; Cryan, J.F.; Domschke, K.; ... ; Wee, N.J.A. van der 2020
The epidemic of the 2019 novel coronavirus SARS-CoV-2, causing the coronavirus disease 2019 (COVID-19) is a global public health emergency with multifaceted severe consequences for people's lives... Show moreThe epidemic of the 2019 novel coronavirus SARS-CoV-2, causing the coronavirus disease 2019 (COVID-19) is a global public health emergency with multifaceted severe consequences for people's lives and their mental health. In this article, as members of the European College of Neuropsychopharmacology (ECNP) Resilience, we will discuss the urgent need for a focus on resilience during the current coronavirus pandemic. Resilience is pivotal to cope with stress and vital to stay in balance. We will discuss the importance of resilience at the individual and societal level, but also the implication for patients with a psychiatric condition and health care workers. We not only advocate for an increased focus on mental health during the coronavirus pandemic but also highlight the urgent need of augmenting our focus on resilience and on strategies to enhance it. (C) 2020 The Authors. Published by Elsevier B.V. Show less
The study was about the economic impact of covid-19 lockdown and the sustenance of commercial motorcycle operators in Ile-Ife, Osun State, Nigeria. The objective of the study was to compare the... Show moreThe study was about the economic impact of covid-19 lockdown and the sustenance of commercial motorcycle operators in Ile-Ife, Osun State, Nigeria. The objective of the study was to compare the economic position of respondents during the compulsory stay at home order relative to what it was before lockdown. The study was a descriptive survey where questionnaire administration and focus group discussions were employed in order to get necessary information that was used for this study. Results from the study had it that the commercial motorcycle operators made a living within their income earning capacity in their transport operations before the COVID-19 pandemic days. However, due to the lockdown their economic life had been greatly affected because income plunged to zero; this has consistently thrown them into poverty. It was observed that the longer the lockdown, the deeper they are submerged into further depth of poverty. Respondents already concluded that it is certain that some routine basic economic activities that they indulge in cannot resume as soon as the lockdown is eased. This study therefore recommends that government should see to how they can subsidize tuition fee payment for school children as soon as schools resume. This hopefully will minimize idleness which if not look into may lead to breeding social miscreants in the face of inability of parents to quickly raise tuition fees. Show less
Elens, L.; Langman, L.J.; Hesselink, D.A.; Bergan, S.; Moes, D.J.A.R.; Molinaro, M.; ... ; Lemaitre, F. 2020
Background: COVID-19 is a novel infectious disease caused by the severe acute respiratory distress (SARS)-coronavirus-2 (SARS-CoV-2). Several therapeutic options are currently emerging but none... Show moreBackground: COVID-19 is a novel infectious disease caused by the severe acute respiratory distress (SARS)-coronavirus-2 (SARS-CoV-2). Several therapeutic options are currently emerging but none with universal consensus or proven efficacy. Solid organ transplant recipients are perceived to be at increased risk of severe COVID-19 because of their immunosuppressed conditions due to chronic use of immunosuppressive drugs (ISDs). It is therefore likely that solid organ transplant recipients will be treated with these experimental antivirals. Methods: This article is not intended to provide a systematic literature review on investigational treatments tested against COVID-19; rather, the authors aim to provide recommendations for therapeutic drug monitoring of ISDs in transplant recipients infected with SARS-CoV-2 based on a review of existing data in the literature. Results: Management of drug-drug interactions between investigational anti-SARS-CoV-2 drugs and immunosuppressants is a complex task for the clinician. Adequate immunosuppression is necessary to prevent graft rejection while, if critically ill, the patient may benefit from pharmacotherapeutic interventions directed at limiting SARS-CoV-2 viral replication. Maintaining ISD concentrations within the desired therapeutic range requires a highly individualized approach that is complicated by the pandemic context and lack of hindsight. Conclusions: With this article, the authors inform the clinician about the potential interactions of experimental COVID-19 treatments with ISDs used in transplantation. Recommendations regarding therapeutic drug monitoring and dose adjustments in the context of COVID-19 are provided. Show less
With societies around the world tackling the Coronavirus pandemic, the role of digital technology has come into focus as a means of augmenting efforts to manage disease and its impacts. What can... Show moreWith societies around the world tackling the Coronavirus pandemic, the role of digital technology has come into focus as a means of augmenting efforts to manage disease and its impacts. What can apps, big data, and digital analytics contribute to such efforts, and what risks do they pose? Asia provides important lessons. Not only have societies in the region long been at the forefront of technological development, but they have also proactively adopted digital solutions as they confront COVID-19. Importantly, Asia has a history of managing highly contagious diseases, and outbreaks like SARS in 2002 or H1N1 in 2009 have provided experiences in risk management and health provision that now powerfully inform both digital and non-digital responses to the current pandemic. The result is a diverse range of different approaches that can teach us much about the advantages and disadvantages of designing tech solutions to fight pandemics. Show less
Sadhu, S.; Agrawal, R.; Pyare, R.; Pavesio, C.; Zierhut, M.; Khatri, A.; ... ; Biswas, J. 2020
After the outbreak of the disease COVID-19, it has reached pandemic proportions within a very short time. It is mainly transmitted human-to-human through direct contact with secretions from an... Show moreAfter the outbreak of the disease COVID-19, it has reached pandemic proportions within a very short time. It is mainly transmitted human-to-human through direct contact with secretions from an infected person or through inhalation of droplets containing SARS-CoV-2. It is controversial whether the virus may be transmitted via tears. Exposed ocular surface can serve as a gateway in transmission and acquiring respiratory diseases. Considering the reported cases on healthcare workers indicating nosocomial transmission and the anatomical and physiological aspects it is perceived that ophthalmic healthcare professionals are at higher risk of contracting the virus by virtue of their job. In this narrative review we discuss current evidence around detection of SARS-CoV-2 in human tears and forms of transmissions reported to date. We also provide a comprehensive approach that may be implemented in an ophthalmic care facility to protect healthcare personnel, as well as patients, from contracting the virus. Show less
Against the background of the corona pandemic, the Swiss Academy of Medical Sciences Foundation and the Swiss Society for Intensive Care Medicine Association have specified the guidelines ... Show moreAgainst the background of the corona pandemic, the Swiss Academy of Medical Sciences Foundation and the Swiss Society for Intensive Care Medicine Association have specified the guidelines "Intensive Care Measures" with regard to the handling of scarce resources. Among other things, the age of a patient plays a role in the decision on the allocation of such resources. This appears problematic from the perspective of discrimination law. Instead of age, the chances of survival, which depend on the respective state of health, should be considered. Show less
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