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Homer CSE, Roach V, Cusack L, Giles ML, Whitehead C, Burton W, Downton T, Gleeson G, Gordon A, Hose K, Hunt J, Kitschke J, McDonnell N, Middleton P, Oats JJN, Shand AW, Wilton K, Vogel J, Elliott J, McGloughlin S, McDonald SJ, White H, Cheyne S, Turner T. The National COVID-19 Clinical Evidence Taskforce: pregnancy and perinatal guidelines. Med J Aust 2022; 217 Suppl 9:S14-S19. [PMID: 36183307 PMCID: PMC9538383 DOI: 10.5694/mja2.51729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/23/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Pregnant women are at higher risk of severe illness from coronavirus disease 2019 (COVID-19) than non-pregnant women of a similar age. Early in the COVID-19 pandemic, it was clear that evidenced-based guidance was needed, and that it would need to be updated rapidly. The National COVID-19 Clinical Evidence Taskforce provided a resource to guide care for people with COVID-19, including during pregnancy. Care for pregnant and breastfeeding women and their babies was included as a priority when the Taskforce was set up, with a Pregnancy and Perinatal Care Panel convened to guide clinical practice. MAIN RECOMMENDATIONS As of May 2022, the Taskforce has made seven specific recommendations on care for pregnant women and those who have recently given birth. This includes supporting usual practices for the mode of birth, umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, and using antenatal corticosteroids and magnesium sulfate as clinically indicated. There are 11 recommendations for COVID-19-specific treatments, including conditional recommendations for using remdesivir, tocilizumab and sotrovimab. Finally, there are recommendations not to use several disease-modifying treatments for the treatment of COVID-19, including hydroxychloroquine and ivermectin. The recommendations are continually updated to reflect new evidence, and the most up-to-date guidance is available online (https://covid19evidence.net.au). CHANGES IN MANAGEMENT RESULTING FROM THE GUIDELINES The National COVID-19 Clinical Evidence Taskforce has been a critical component of the infrastructure to support Australian maternity care providers during the COVID-19 pandemic. The Taskforce has shown that a rapid living guidelines approach is feasible and acceptable.
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Affiliation(s)
- Caroline SE Homer
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneVIC
| | - Vijay Roach
- Royal North Shore HospitalSydneyNSW,Mater HospitalSydneyNSW
| | | | | | - Clare Whitehead
- Royal Women’s HospitalMelbourneVIC,University of MelbourneMelbourneVIC
| | | | - Teena Downton
- Australian College of Rural and Remote MedicineBrisbaneQLD
| | - Glenda Gleeson
- CentralAustraliaHealth ServiceAlice SpringsNT,CRANAplusAdelaideSA
| | - Adrienne Gordon
- Sydney Local Health DistrictSydneyNSW,Sydney Institute for WomenChildren and their FamiliesSydneyNSW
| | | | - Jenny Hunt
- Victorian Aboriginal Health ServiceMelbourneVIC
| | | | - Nolan McDonnell
- King Edward Memorial HospitalPerthWA,University of Western AustraliaPerthWA
| | - Philippa Middleton
- SAHMRI, Women and Children's HospitalAdelaideSA,University of AdelaideAdelaideSA
| | | | - Antonia W Shand
- Royal Hospital for WomenSydneyNSW,University of NSWSydneyNSW
| | | | - Joshua Vogel
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneVIC,CochraneAustraliaMonash UniversityMelbourneVIC
| | - Julian Elliott
- CochraneAustraliaMonash UniversityMelbourneVIC,Monash UniversityMelbourneVIC
| | | | | | - Heath White
- CochraneAustraliaMonash UniversityMelbourneVIC
| | - Saskia Cheyne
- CochraneAustraliaMonash UniversityMelbourneVIC,Australian College of MidwivesCanberraACT,NHMRC Clinical Trials CentreUniversity of SydneySydneyNSW
| | - Tari Turner
- CochraneAustraliaMonash UniversityMelbourneVIC
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Vogel JP, Tendal B, Giles M, Whitehead C, Burton W, Chakraborty S, Cheyne S, Downton T, Fraile Navarro D, Gleeson G, Gordon A, Hunt J, Kitschke J, McDonald S, McDonnell N, Middleton P, Millard T, Murano M, Oats J, Tate R, White H, Elliott J, Roach V, Homer CS. Clinical care of pregnant and postpartum women with COVID-19: Living recommendations from the National COVID-19 Clinical Evidence Taskforce. Aust N Z J Obstet Gynaecol 2020; 60:840-851. [PMID: 33119139 PMCID: PMC7820999 DOI: 10.1111/ajo.13270] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022]
Abstract
To date, 18 living recommendations for the clinical care of pregnant and postpartum women with COVID-19 have been issued by the National COVID-19 Clinical Evidence Taskforce. This includes recommendations on mode of birth, delayed umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, antenatal corticosteroids, angiotensin-converting enzyme inhibitors, disease-modifying treatments (including dexamethasone, remdesivir and hydroxychloroquine), venous thromboembolism prophylaxis and advanced respiratory support interventions (prone positioning and extracorporeal membrane oxygenation). Through continuous evidence surveillance, these living recommendations are updated in near real-time to ensure clinicians in Australia have reliable, evidence-based guidelines for clinical decision-making. Please visit https://covid19evidence.net.au/ for the latest recommendation updates.
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Affiliation(s)
- Joshua P. Vogel
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneVictoriaAustralia
- Cochrane AustraliaSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Britta Tendal
- Cochrane AustraliaSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Michelle Giles
- Alfred HospitalMelbourneVictoriaAustralia
- Monash HealthMelbourneVictoriaAustralia
- Royal Women’s HospitalMelbourneVictoriaAustralia
- Sunshine HospitalMelbourneVictoriaAustralia
- Department of Obstetrics and GynaecologyMonash UniversityMelbourneVictoriaAustralia
| | - Clare Whitehead
- Royal Women’s HospitalMelbourneVictoriaAustralia
- Department of Obstetrics and GynaecologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Wendy Burton
- Morningside General Practice ClinicBrisbaneQueenslandAustralia
| | - Samantha Chakraborty
- Department of General PracticeSchool of Primary and Allied Health CareMonash UniversityMelbourneVictoriaAustralia
| | - Saskia Cheyne
- NHMRC Clinical Trials CentreUniversity of SydneySydneyNew South WalesAustralia
| | - Teena Downton
- Australian College of Rural and Remote MedicineBrisbaneQueenslandAustralia
| | - David Fraile Navarro
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Glenda Gleeson
- Central Australia Primary and Public Health ‐ Midwifery and Women’s HealthAlice SpringsNorthern TerritoryAustralia
| | - Adrienne Gordon
- RPA Newborn CareSydney Local Health DistrictDiscipline of Obstetrics, Gynaecology and NeonatologyCentral Clinical SchoolFaculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
- Charles Perkins CentreUniversity of SydneySydneyNew South WalesAustralia
- Sydney Institute for Women, Children and their FamiliesSydney Local Health DistrictSydneyNew South WalesAustralia
| | - Jenny Hunt
- Victorian Aboriginal Health ServiceMelbourneVictoriaAustralia
| | - Jackie Kitschke
- Australian College of Midwives representative, Midwifery Group PracticeWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
| | - Steven McDonald
- Cochrane AustraliaSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Nolan McDonnell
- Faculty of Health and Medical SciencesObstetrics and GynaecologyUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Philippa Middleton
- SAHMRI, Women and Children’s HospitalAdelaideSouth AustraliaAustralia
- Faculty of Medical and Health SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Tanya Millard
- Cochrane AustraliaSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Melissa Murano
- Cochrane AustraliaSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Jeremy Oats
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Rhiannon Tate
- Cochrane AustraliaSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Heath White
- Cochrane AustraliaSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Julian Elliott
- Cochrane AustraliaSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Alfred HospitalMelbourneVictoriaAustralia
| | - Vijay Roach
- North Shore Private HospitalSydneyNew South WalesAustralia
| | - Caroline S.E. Homer
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneVictoriaAustralia
- Centre for Midwifery, Child and Family Health in the Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
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Sullivan JS, Selleck PW, Downton T, Boehm I, Axell AM, Ayob Y, Kapitza NM, Dyer W, Fitzgerald A, Walsh B, Lynch GW. Heterosubtypic anti-avian H5N1 influenza antibodies in intravenous immunoglobulins from globally separate populations protect against H5N1 infection in cell culture. J Mol Genet Med 2009; 3:217-24. [PMID: 20076794 PMCID: PMC2805843 DOI: 10.4172/1747-0862.1000038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 12/08/2009] [Accepted: 12/11/2009] [Indexed: 11/10/2022] Open
Abstract
With antigenically novel epidemic and pandemic influenza strains persistently on the horizon it is of fundamental importance that we understand whether heterosubtypic antibodies gained from exposures to circulating human influenzas exist and can protect against emerging novel strains. Our studies of IVIG obtained from an infection-naive population (Australian) enabled us to reveal heterosubtypic influenza antibodies that cross react with H5N1. We now expand those findings for an Australian donor population to include IVIG formulations from a variety of northern hemisphere populations. Examination of IVIGs from European and South East-Asian (Malaysian) blood donor populations further reveal heterosubtypic antibodies to H5N1 in humans from different global regions. Importantly these protect against highly pathogenic avian H5N1 infection in vitro, albeit at low titres of inhibition. Although there were qualitative and quantitative differences in binding and protection between globally different formulations, the heterosubtypic antibody activities for the respective IVIGs were in general quite similar. Of particular note because of the relative geographic proximity to the epicentre of H5N1 and the majority of human infections, was the similarity in the antibody binding responses between IVIGs from the Malayan peninsula, Europe and Australia. These findings highlight the value of employing IVIGs for the study of herd immunity, and particularly heterosubtypic antibody responses to viral antigens such as those conserved between circulating human influenzas and emerging influenza strains such as H5N1. They also open a window into a somewhat ill defined arena of antibody immunity, namely heterosubtypic immunity.
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Affiliation(s)
- John S Sullivan
- Biosafety, Immunobiology, Global Health and Pandemic Infections Research, Central Clinical School, Faculty of Medicine, The University of Sydney, Camperdown, NSW 2006, Australia
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Lo DS, Zeldin RA, Skrastins R, Fraser IM, Newman H, Monavvari A, Ung Y, Joseph H, Downton T, Meharchand J. Time to treat: A system redesign focusing on decreasing the time from suspicion of lung cancer to diagnosis in a community hospital. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.17005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17005 Background: Multiple physician visits, numerous investigations, and serial wait times often result in a lengthy process from the onset of lung cancer-related symptoms until diagnosis. An unpublished retrospective chart review from a Toronto community hospital indicated suboptimal delays for patients from onset of symptoms until the diagnosis of lung cancer. Methods: The Time to Treat Program (TTT), consisting of a streamlined referral system and a clerical facilitator to fast-track patients through a diagnostic pathway algorithm, was designed for patients with clinical or radiological suspicion of lung cancer. Data on patient visits and investigations were collected. Pre- and post-implementation data on median wait times were compared. Results: From April 2005 to December 2006 over 120 physicians referred 188 females and 226 males. For the majority of patients (95.2%), the reason for referral was chest x-ray findings suspicious for lung cancer. After TTT implementation, the median time from suspicion of lung cancer to referral for specialist consultation decreased from 19.9 days to 10 days, and the median time from such referral to the actual consultation date decreased from 16.8 days to 5.3 days. The median time from specialist consultation to CT scan decreased from 52.1 days to 4 days and the median time from CT to diagnosis decreased from 39 days to 12.4 days. Overall, the median time from suspicion of lung cancer to diagnosis decreased from 127.8 days to 30 days. For 25% of the patients in the TTT it took 13 or fewer days from suspicion of lung cancer to diagnosis, while for 5% of the patients it took 90 days or more. Half of the patients in the TTT had a diagnosis by 24 days from the time of suspicion. Of all patients in the TTT, 33% were eventually diagnosed with lung cancer. The time from suspicion to diagnosis took longer for patients who eventually had confirmed lung cancer than those who did not: 36.5 days vs. 28.7 days. Conclusions: By addressing process issues in the work-up of lung cancer, the TTT was effective in shortening the time from suspicion of lung cancer to diagnosis and reduced time intervals at each step in the process. Earlier diagnosis of lung cancer may allow increased treatment options for patients. No significant financial relationships to disclose.
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Affiliation(s)
- D. S. Lo
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - R. A. Zeldin
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - R. Skrastins
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - I. M. Fraser
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - H. Newman
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - A. Monavvari
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - Y. Ung
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - H. Joseph
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - T. Downton
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
| | - J. Meharchand
- University of Toronto, Toronto, ON, Canada; Toronto East General Hospital, Toronto, ON, Canada; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada
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