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MJA RESEARCH SKILLS – De-confounding confounding Part 3: controlling for confounding in statistical analyses

This MJA series – co-edited by HNELHD staff John Attia – aims to make statistics accessible for clinicians. The latest instalment – after a period of limbo – returns to the topic of confounding, offering an alternative method of control.

Part 2: Discusses the emergence of directed acyclic graphs (DAGs) to identify confounding
Part 1: Provides traditional explanations of confounding

Saliva as a candidate for COVID-19 diagnostic testing

The present gold standard for sampling is the nasopharyngeal swab method. However, several recent papers suggested that saliva-based testing is a promising alternative that could simplify and accelerate COVID-19 diagnosis.

Rapid review...
Practical challenges...

Management of post-acute COVID-19 in primary care

Post-acute covid-19 (“long covid”) seems to be a multisystem disease, sometimes occurring after a relatively mild acute illness. Clinical management requires a whole-patient perspective. This article, intended for primary care clinicians, relates to the patient who has a delayed recovery from an episode of covid-19 that was managed in the community or in a standard hospital ward. Broadly, such patients can be divided into those who may have serious sequelae (such as thromboembolic complications) and those with a non-specific clinical picture, often dominated by fatigue and breathlessness.

LISTEN to podcast: ‘What do we know about long covid?’

Living systematic review: comparing effects of drug treatments for COVID-19

A network meta-analysis was performed on data extracted from the US Centers for Disease Control and Prevention COVID-19 Research Articles Downloadable Database. 23 trials were included, in which people with suspected, probable, or confirmed covid-19 were randomised to drug treatment or to standard care or placebo. The certainty of the evidence for most comparisons was very low because of risk of bias and serious imprecision.

Glucocorticoids were the only intervention with evidence for a reduction in death compared with standard care and mechanical ventilation (moderate certainty). Three drugs might reduce symptom duration compared with standard care: hydroxychloroquine (low certainty), remdesivir (moderate certainty), and lopinavir-ritonavir (low certainty). Hydroxychloroquine might increase the risk of adverse events compared with the other interventions, and remdesivir probably does not substantially increase the risk of adverse effects leading to drug discontinuation. No other interventions included enough patients to meaningfully interpret adverse effects leading to drug discontinuation.

The value of this resource is in its ‘living’ status. The review will be updated (for up to two years) to reflect emerging evidence.

READ full article in the BMJ...
VIEW - Infographic (Use Microsoft Edge)...

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