Adaptations to the British Society of Gastroenterology guidelines on the management of acute severe UC in the context of the COVID-19 pandemic: a RAND appropriateness panel
Autor: | Felix Chua, Ailsa Hart, James O. Lindsay, Mark A Samaan, Susanna Meade, Ian D. Arnott, Kamal V. Patel, Tim Raine, Richard Hansen, R Mark Beattie, Richard Pollok, Shahida Din, Phil Tozer, Laura Hancock, Subrata Ghosh, Andrew Ustianowski, Rachel Cooney, Daniel R. Gaya, Peter M. Irving, Lisa Younge, Shaji Sebastian, Christian P. Selinger, Jimmy K. Limdi, Charles Murray, Chris Probert, Christopher A. Lamb, Alexandra Kent, Philip J Smith, Nick Powell, Mark J.D. Griffiths, James Galloway, Nicholas A. Kennedy, Robin J. Dart, Charlie W. Lees |
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Přispěvatelé: | Din, Shahida [0000-0003-2855-3400], Kent, Alexandra [0000-0003-0577-6177], Pollok, Richard C [0000-0001-6452-6763], Meade, Susanna [0000-0002-8283-6148], Kennedy, Nicholas A [0000-0003-4368-1961], Arnott, Ian [0000-0003-3352-9253], Beattie, R Mark [0000-0003-4721-0577], Chua, Felix [0000-0001-7845-0173], Cooney, Rachel [0000-0003-3710-157X], Dart, Robin J [0000-0003-3470-8210], Galloway, James [0000-0002-1230-2781], Gaya, Daniel R [0000-0003-1942-7568], Ghosh, Subrata [0000-0002-1713-7797], Griffiths, Mark [0000-0002-1615-1896], Hancock, Laura [0000-0002-8399-6646], Hansen, Richard [0000-0002-3944-6646], Hart, Ailsa [0000-0002-7141-6076], Lamb, Christopher Andrew [0000-0002-7271-4956], Lees, Charlie W [0000-0002-0732-8215], Limdi, Jimmy K [0000-0002-1039-6251], Lindsay, James O [0000-0003-3353-9590], Patel, Kamal [0000-0003-2611-4260], Powell, Nick [0000-0003-3231-6950], Murray, Charles D [0000-0001-6736-1546], Probert, Chris [0000-0003-0477-6714], Raine, Tim [0000-0002-5855-9873], Selinger, Christian [0000-0003-2022-5859], Sebastian, Shaji [0000-0002-3670-6545], Smith, Philip J [0000-0003-1568-3978], Tozer, Phil [0000-0002-2532-7267], Younge, Lisa [0000-0002-3436-9696], Samaan, Mark A [0000-0002-4057-9200], Irving, Peter M [0000-0003-0972-8148], Apollo - University of Cambridge Repository |
Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
medicine.medical_treatment Pneumonia Viral Psychological intervention Context (language use) Infection Control/organization & administration clinical decision making Gastroenterology Inflammatory bowel disease Colitis Ulcerative/diagnosis 03 medical and health sciences Betacoronavirus 0302 clinical medicine Maintenance therapy Internal medicine Medicine Humans 030212 general & internal medicine Pandemics/prevention & control Pneumonia Viral/epidemiology Pandemics Societies Medical Colectomy ulcerative colitis Infection Control business.industry SARS-CoV-2 Patient Selection COVID-19 Guideline medicine.disease Ulcerative colitis Infliximab United Kingdom Pneumonia IBD clinical Acute Disease Practice Guidelines as Topic Coronavirus Infections/epidemiology 030211 gastroenterology & hepatology Colitis Ulcerative business Coronavirus Infections medicine.drug |
Zdroj: | Gut GUT Din, S, Kent, A, Pollok, R C, Meade, S, Kennedy, N A, Arnott, I, Beattie, R M, Chua, F, Cooney, R, Dart, R J, Galloway, J, Gaya, D R, Ghosh, S, Griffiths, M, Hancock, L, Hansen, R, Hart, A, Lamb, C A, Lees, C W, Limdi, J K, Lindsay, J O, Patel, K, Powell, N, Murray, C D, Probert, C, Raine, T, Selinger, C, Sebastian, S, Smith, P J, Tozer, P, Ustianowski, A, Younge, L, Samaan, M A & Irving, P M 2020, ' Adaptations to the British Society of Gastroenterology guidelines on the management of acute severe UC in the context of the COVID-19 pandemic : a RAND appropriateness panel ', Gut, vol. 69, no. 10, pp. 1769-1777 . https://doi.org/10.1136/gutjnl-2020-321927 |
ISSN: | 1468-3288 |
Popis: | ObjectiveManagement of acute severe UC (ASUC) during the novel COVID-19 pandemic presents significant dilemmas. We aimed to provide COVID-19-specific guidance using current British Society of Gastroenterology (BSG) guidelines as a reference point.DesignWe convened a RAND appropriateness panel comprising 14 gastroenterologists and an IBD nurse consultant supplemented by surgical and COVID-19 experts. Panellists rated the appropriateness of interventions for ASUC in the context of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Median scores and disagreement index (DI) were calculated. Results were discussed at a moderated meeting prior to a second survey.ResultsPanellists recommended that patients with ASUC should be isolated throughout their hospital stay and should have a SARS-CoV-2 swab performed on admission. Patients with a positive swab should be discussed with COVID-19 specialists. As per BSG guidance, intravenous hydrocortisone was considered appropriate as initial management; only in patients with COVID-19 pneumonia was its use deemed uncertain. In patients requiring rescue therapy, infliximab with continuing steroids was recommended. Delaying colectomy because of COVID-19 was deemed inappropriate. Steroid tapering as per BSG guidance was deemed appropriate for all patients apart from those with COVID-19 pneumonia in whom a 4–6 week taper was preferred. Post-ASUC maintenance therapy was dependent on SARS-CoV-2 status but, in general, biologics were more likely to be deemed appropriate than azathioprine or tofacitinib. Panellists deemed prophylactic anticoagulation postdischarge to be appropriate in patients with a positive SARS-CoV-2 swab.ConclusionWe have suggested COVID-19-specific adaptations to the BSG ASUC guideline using a RAND panel. |
Databáze: | OpenAIRE |
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