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This study aimed to evaluate the type, content, accessibility and quality of information available via the internet for patients with head and neck cancer. The Google search engine was used to generate lists of the first 100 websites for general head and neck cancer and the first ten for head and neck cancers by anatomical location (160 total). Websites were evaluated with the validated DISCERN and LIDA instruments, the SMOG (Simple measure of gobbledygook) readability score and against the JAMA (Journal of the American Medical Association) criteria. 40 of the 160 websites ranked by Google were suitable for analysis. Seven websites (17.5%) partially or fully achieved all four JAMA benchmarks and only one (2.5%) site achieved none. 28 (70%) included reference to quality of life factors. Correlations were identified between Google site rank and all four of our appraisal tools; LIDA (-0.966, p = 0.006), JAMA (-5.93, p = 0.028), DISCERN (-0.568, p = 0.037) and SMOG (4.678, p = 0.04). Google site rank and both government run sites (-35.38, p = 0.034) and sites run by universities or hospitals (-27.32, p = 0.016) also showed an association. Comparing our observations with those of Riordain in 2008, there has been little improvement in the quality of head and neck cancer information available online over this time. Given the variability in quality of information online, patients would benefit from being directed to reliable websites by clinicians.
Introduction
The epidemiology and clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection are different in children and adolescents compared with adults. Although coronavirus disease 2019 (COVID‐19) appears to be less common in children, with milder disease overall, severe complications may occur, including paediatric inflammatory multisystem syndrome (PIMS‐TS). Recognising the distinct needs of this population, the National COVID‐19 Clinical Evidence Taskforce formed a Paediatric and Adolescent Care Panel to provide living guidelines for Australian clinicians to manage children and adolescents with COVID‐19 and COVID‐19 complications. Living guidelines mean that these evidence‐based recommendations are updated in near real time to give reliable, contemporaneous advice to Australian clinicians providing paediatric care.
Main recommendations
To date, the Taskforce has made 20 specific recommendations for children and adolescents, including definitions of disease severity, recommendations for therapy, respiratory support, and venous thromboembolism prophylaxis for COVID‐19 and for the management of PIMS‐TS.
Changes in management as a result of the guidelines
The Taskforce currently recommends corticosteroids as first line treatment for acute COVID‐19 in children and adolescents who require oxygen. Tocilizumab could be considered, and remdesivir should not be administered routinely in this population. Non‐invasive ventilation or high flow nasal cannulae should be considered in children and adolescents with hypoxaemia or respiratory distress unresponsive to low flow oxygen if appropriate infection control measures can be used. Children and adolescents with PIMS‐TS should be managed by a multidisciplinary team. Intravenous immunoglobulin and corticosteroids, with concomitant aspirin and thromboprophylaxis, should be considered for the treatment of PIMS‐TS.
The latest updates and full recommendations are available at http://www.covid19evidence.net.au.
Background: Within the IMPACT-AD BC study, we sought to address the gap in knowledge around how the use of Alzheimer’s disease (AD) CSF biomarker testing impacts clinical management. Methods: IMPACT-AD BC (NCT05002699, impactAD.org) is an observational, longitudinal study examining the role of AD CSF biomarker testing (i.e., amyloid-beta and tau proteoforms) in medical and personal decision-making, and health economics. For medical decision-making, physicians completed surveys on patient management plans before and after receiving the biomarker findings. Overall change in management was assessed as a composite measure of changes in the use of: (i) AD symptomatic medications, (ii) other dementia-relevant medications, (iii) diagnostic procedures, and (iv) referrals or counselling. Results: Of the 142 participants, 66% were determined to have CSF biomarker profiles on the AD continuum. Overall change in management was observed in 89% of patients, with the greatest changes by category being: diagnostic procedures > referrals and counselling > AD symptomatic medications > other dementia-relevant medications. Conclusions: The use of AD CSF biomarker testing increases diagnostic confidence and aids in medical decision-making. Notably, the addition of biomarker testing leads to a reduction in the use of other diagnostic procedures, helps optimize pharmacotherapy and results in increased physician-patient/family member counselling.
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