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10.1136/gutjnl-2020-321927 http://scihub22266oqcxt.onion/10.1136/gutjnl-2020-321927 C7299646!7299646 !32513653     free     free     free Warning: file_get_contents(https://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=32513653 &cmd=llinks): Failed to open stream: HTTP request failed! 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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 |pdf=|usr=}}{{32513653 }} gab.com Text 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 JO: Gut http://www.kidney.de/pget.php?&tw=1&pmid=32513653 #FOAvip OBJECTIVE: Management 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. DESIGN: We 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. RESULTS: Panellists 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. CONCLUSION: We have suggested COVID-19-specific adaptations to the BSG ASUC guideline using a RAND panel. Twit Text FOAVip 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 http://www.kidney.de/pget.php?&tw=1&pmid=32513653 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=32513653 #FOAvip English Wikipedia <ref>{{Cite pmid|32513653 }}</ref> 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 #MMPMID32513653 Din S ; Kent A ; Pollok RC ; Meade S ; Kennedy NA ; Arnott I ; Beattie RM ; Chua F ; Cooney R ; Dart RJ ; Galloway J ; Gaya DR ; Ghosh S ; Griffiths M ; Hancock L ; Hansen R ; Hart A ; Lamb CA ; Lees CW ; Limdi JK ; Lindsay JO ; Patel K ; Powell N ; Murray CD ; Probert C ; Raine T ; Selinger C ; Sebastian S ; Smith PJ ; Tozer P ; Ustianowski A ; Younge L ; Samaan MA ; Irving PM Gut 2020[Oct]; 69 (10 ): 1769-1777 PMID32513653 show ga OBJECTIVE: Management 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. DESIGN: We 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. RESULTS: Panellists 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. CONCLUSION: We have suggested COVID-19-specific adaptations to the BSG ASUC guideline using a RAND panel. |*Betacoronavirus [MESH] |Acute Disease [MESH] |COVID-19 [MESH] |Colitis, Ulcerative/*diagnosis/*therapy/virology [MESH] |Coronavirus Infections/*epidemiology/prevention & control/transmission [MESH] |Gastroenterology [MESH] |Humans [MESH] |Infection Control/*organization & administration [MESH] |Pandemics/prevention & control [MESH] |Patient Selection [MESH] |Pneumonia, Viral/*epidemiology/prevention & control/transmission [MESH] |Practice Guidelines as Topic [MESH] |SARS-CoV-2 [MESH] |Societies, Medical [MESH]Adaptations to the British Society of Gastroenterology guidelines on t(epmc).pdf DeepDyve Pubget Overpricing