Updated guidance on the management of COVID-19:from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020)

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research. METHODS: An International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion. RESULTS: The Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3 months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder. CONCLUSIONS: The Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities.status: Published onlin

Metastatic Prostate Cancer: An Update on Treatments and a Review of Patient Symptom Management.

BACKGROUND Available treatment options have improved overall survival and contributed to delayed progression, but metastatic prostate cancer remains incurable. Treatment strategies are based on disease progression assessed by a combination of biochemical, radiographic, and symptomatic changes. OBJECTIVES The aim of this article is to review metastatic prostate cancer, symptoms representing disease progression, disease treatments, and symptom management. METHODS A PubMed® search restricted to English-language articles published since 1990 was conducted in August 2018 with combinations of the keywords "metastatic prostate cancer," "symptom assessment," and "treatment." Review articles were excluded, but their reference lists were reviewed to identify additional articles. Information from relevant articles published after August 2018 was added as appropriate based on author consensus. FINDINGS Nursing professionals play vital roles in symptom recognition and reporting, identification of disease progression, patient education, and implementation of individualized treatment strategies

Analysis and Temporal Evolution of Extubation Parameters for Patients Undergoing Single-Stage Circumferential Cervical Spine Surgery

Objective Airway obstruction after postoperative extubation is a dreaded but uncommon complication in patients undergoing circumferential cervical spine surgery (CCSS). The cuff leak test (CLT) has been utilized to assess air leak around the endotracheal tube which may reflect airway swelling. In this prospective observational study, we analyze the temporal evolution of CLT and perioperative factors that may influence it. Methods Twenty patients undergoing single-stage CCSS were managed according to our extubation protocol. Patients were maintained intubated overnight following surgery. They were extubated if a CLT > 200 mL and both intensive care unit (ICU) and Neurosurgery teams agreed that it was safe. Patients extubated in the first postoperative day (8 of 20) comprised the early group, and the remaining patients (12 of 20) the delayed group. Patient and operative data were analyzed as a single group and comparing both groups. Results The main indication for surgery was cervical deformity. Median number of levels fused was 5 anteriorly (range, 1–6) and 6 (range, 1–13) posteriorly. Patients were kept intubated for an average of 73.6 hours (range, 26–222 hours) and stayed in the ICU for 119.1 hours (range, 36–360 hours). There were 4 failed extubations and 3 patients (15%) required a tracheostomy. Patient profiles between both groups were very similar across most patient variables but differed significantly regarding infraglottic luminal area (p < 0.05). Patients with larger preoperative cuff leak values tended to have a shorter intubation period (p=0.053). Conclusion This study objectively demonstrates the difficulties in airway management following CCSS and provides useful insight for preoperative planning and counseling. Local anatomic factors influence airway outcome more than operative factors. The study format does not allow for testing of interventions but we suggest that patients with favorable anatomy (larger infraglottic luminal area) may benefit from a less strict airway management protocol

High ENSO sensitivity in tree rings from a northern population of Polylepis tarapacana in the Peruvian Andes

Polylepis tarapacana is the highest-elevation tree species worldwide growing between 4000 and 5000 m a.s.l. along the South American Altiplano. P. tarapacana is adapted to live in harsh conditions and has been widely used for drought and precipitation tree-ring based reconstructions. Here, we present a 400-year tree-ring width (TRW) chronology located in southern Peru (17ºS; 69ºW) at the northernmost limit of P. tarapacana tree species distribution. The objectives of this study are to assess tree growth sensitivity of a northern P. tarapacana population to (1) precipitation, temperature and El Niño Southern Oscillation (ENSO) variability; (2) to compare its growth variability and ENSO sensitivity with southern P. tarapacana forests. Our results showed that this TRW record is highly sensitive to the prior summer season (Nov-Jan) precipitation (i.e. positive correlation) when the South American Summer Monsoon (SASM) reaches its maximum intensity in this region. We also found a positive relationship with current year temperature that suggests that radial growth may be enhanced by warm, less cloudy, conditions during the year of formation. A strong positive relationship was found between el Niño 3.4 and tree growth variability during the current growing season, but negative during the previous growth period. Growth variability in our northern study site was in agreement with other populations that represent almost the full range of P. tarapacana latitudinal distribution (~ 18ºS to 23ºS). Towards the south of the P. tarapacana TRW network there was a decrease in the strength of the agreement of growth variability with our site,with the exception of higher correlation with the two southeastern sites. Similarly, the TRW chronologies recorded higher sensitivity to ENSO influences in the north and southeastern locations, which are wetter, than the drier southwestern sites. These patterns hold for the entire period, as well as for periods of high and low ENSO activity. Overall, P. tarapacana tree growth at the north of its distribution is mostly influenced by prior year moisture availability and current year temperature that are linked to large-scale climate patterns such as the SASM and ENSO, respectively.Fil: Crispín-DelaCruz, Doris B.. Universidad Continental; PerúFil: Morales, Mariano Santos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Provincia de Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Universidad Nacional de Cuyo. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales; Argentina. Universidad Continental; PerúFil: Andreu Hayles, Laia. Columbia University; Estados Unidos. Universitat Autònoma de Barcelona; España. Universidad de Barcelona. Institució Catalana de Recerca i Estudis Avançats; EspañaFil: Duncan, Christopher C.. Universidad Austral de Chile; Chile. Center for Climate and Resilience Research; ChileFil: Guerra, Anthony. Missouri Botanical Garden; PerúFil: Requena Rojas, Edilson Jimmy. Universidad Continental; Per

Recognizing Symptom Burden in Advanced Prostate Cancer: A Global Patient and Caregiver Survey.

BACKGROUND: Bone metastases in men with prostate cancer are often initially asymptomatic, resulting in delayed identification, diagnosis, and appropriate treatment. To assess how patients with advanced prostate cancer (aPC) communicate symptoms to health care providers, an international patient survey was conducted. METHODS: An online and phone survey was conducted by Harris Poll in 11 countries (Brazil, France, Germany, Japan, Italy, Netherlands, Singapore, Spain, Taiwan, United Kingdom, United States) from February 12 to October 27, 2015, in men with aPC (ie, those who reported as having PC beyond the prostate [metastatic]) and their caregivers. Cell weighting was used to ensure equal weight of data across countries. Percentages are based on weighted n values. RESULTS: A total of 927 men with aPC (weighted n = 664) and 400 caregivers completed the survey. Most commonly reported symptoms were fatigue (73%), urinary symptoms (63%), sexual function symptoms (62%), and bone pain (52%). Of 568 patients with bone metastases (weighted n = 421), most (73%) noticed pain before receiving a diagnosis of metastatic PC. Most patients with aPC (56%) were uncertain if their pain was cancer related, 55% felt they had to live with daily pain, 45% sometimes ignored pain, and 39% had difficulty talking about pain. Patients who had a caregiver were more likely than those without to discuss pain at every visit (45% vs. 32%, P < .05). CONCLUSIONS: Disease symptoms in aPC are often underrecognized. Tools encouraging effective communication among patients, caregivers, and health care providers on early symptom reporting may lead to enhanced symptom and disease management