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Communique

Weekly Communique # 34

03 December, 2020

WEEK IN REVIEW

Updates to the living guideline

New recommendations published this week cover:

  • Dutasteride
  • Oestrogen-containing therapies (including menopause hormone therapies (MHT) and contraceptives).
    These recommendations were developed by the Primary and Chronic Care Panel and the Pregnancy and Perinatal Care Panel with support from members of the Expert Advisory Group with specialist expertise in haematology, women’s heath, reproductive health and family planning.

Further details about these recommendations are below.

Taskforce living guidelines receive NHMRC approval

The Taskforce has received approval from the National Health and Medical Research Council (NHMRC) for version 20.0 of the Australian guidelines for the clinical care of people with COVID-19, under Section 14A of the NHMRC Act 1992. In approving the guideline recommendations, NHMRC considers that they meet the NHMRC standard for clinical practice guidelines.

NHMRC is satisfied that the guideline recommendations are systematically derived, based on the identification and synthesis of the best available scientific evidence, and developed for health professionals practising in an Australian health care setting.

The approval process for living guidelines is iterative and incorporates a 30-day period during which new or updated guideline recommendations are open for public consultation prior to approval. Details regarding which recommendations have been approved by NHMRC are maintained in the Introduction section of the guideline. Version 28 of the guidelines will be submitted for approval next week.

The NHMRC has been a key driver of both excellence and innovation among Australian guideline developers for many years, approving the world’s first living stroke guidelines in 2017. We thank Gerraint Duggan and his team in the Clinical Guidelines and Research Translation Branch at NHMRC for their support and throughout the approval process.

Acknowledging the work of the Taskforce Consumer Panel 

The Consumer Panel held their last meeting for 2020 this week. The Panel has played a tremendously important role in providing strategic consumer advice to help shape the guidelines, identifying clinical questions to be addressed, prioritisation of questions and contributions to the development of individual recommendations.

We thank Co-Chairs Dr Rebecca Randall and Dr Eleanor Horton for their leadership, together with Project Officer Sue Whicker, and gratefully acknowledge the contribution of all members of the panel:

  • Richard Brightwell
  • Lynda Condon
  • Amrita Deshpande
  • Adam Ehm
  • Monica Ferrie
  • Joanne Muller
  • Lara Pullin
  • Elizabeth Robinson
  • Adele Witt

The Consumer Panel is co-convened with our Community Partner, the Consumers Health Forum of Australia.

IPC Panel announced

The Taskforce this week announced the membership of its new expert panel for infection prevention and control (IPC), which will be jointly chaired by the Infection Control Expert Group (ICEG).

The formation of the panel addresses calls from the clinical sector to strengthen capacity for emerging evidence and frontline clinical experience to inform national IPC guidance for healthcare workers.

The panel, which was selected from a highly accomplished field of more than 60 applicants, will be co-chaired by Dr Phillipa Hore (Taskforce nominee) and Professor John Ferguson (ICEG nominee). The 17-member panel draws on some of Australia’s foremost experts in evidence-based clinical practice, infection prevention and control, occupation and environmental health, occupational hygiene and clinical engineering.

The IPC Panel convened for the first time on Wednesday and will meet weekly herein.

IPC Panel Members:

  • Professor John Ferguson (Co-Chair, ICEG Nominee)
  • Dr Phillipa Hore (Co-Chair, Taskforce nominee)
  • Dr Penny Burns (Expertise in Primary care)
  • Ms Kate Cole (Expertise in Occupational Hygiene)
  • Ms Kathy Dempsey (Expertise in IPC)
  • Melanie Dicks (Expertise in Care of Older People)
  • Bridget Ferguson (Expertise in Women’s Health)
  • Associate Professor Deborah Friedman (Expertise in Infectious Diseases and IPC)
  • Dr Briony Hazelton (Expertise in Paediatric and Adolescent Health)
  • Nicole King (Expertise in Operative/Perioperative Care)
  • Associate Professor Sally McCarthy (Expertise in Emergency Care)
  • Associate Professor Steve McGloughlin (Expertise in Critical care)
  • Professor Brett Mitchell (Expertise in IPC)
  • Professor Malcolm Sim AM (Expertise in Occupational and Environmental Medicine)
  • Dr Andrew Stewardson (Expertise in Infectious Diseases and IPC)
  • Mr Barry Tam (Expertise in Clinical Engineering)
  • To be announced (Experience in providing COVID-19 nursing care)

 

LAST CHANCE TO HELP SHAPE THE GUIDELINES

We are calling on Australian healthcare practitioners to participate in a brief 5-minute survey to help us understand how the guidelines and flowcharts developed by the Taskforce are being used, and how we can improve the value of the guidance we publish.

Feedback is vital to improving the ongoing impact of the guidelines. We would very much appreciate your insights and encourage you to distribute through your clinical networks.

The survey will be open until 11:59pm this Sunday, December 6.

 

QUICK STATISTICS

COVID-19 research pipeline

  • 32,543 studies published or registered in Cochrane COVID-19 Study Register, 1,111 added this week
  • 2,176 randomised controlled trials registered (data from Covid-nma site), 60 added this week
  • 2,660 systematic reviews registered in PROSPERO, 44 added this week
  • 135 randomised controlled trials published (data from Covid-nma site), 6 added this week

 

LIVING GUIDELINES

Australian guidelines for the clinical care of people with COVID-19: Version 30.0

NEW RECOMMENDATIONS

  • Dutasteride

Do not use dutasteride for the treatment of COVID-19 outside of randomised trials with appropriate ethical approval.

  • Menopausal hormone therapy in women with mild or moderate COVID-19

Consider stopping oral menopausal hormone therapy (MHT), also known as hormone replacement therapy (HRT), in women with mild or moderate COVID-19.

Before restarting oral MHT, review the indication for this. If MHT is continued, consider using a transdermal preparation.

  • Menopausal hormone therapy in women with severe or critical COVID-19

Stop oral menopausal hormone therapy (MHT) in women with severe or critical COVID-19.

Before restarting oral MHT, review the indication for this and consider transitioning to a transdermal preparation.

  • Oestrogen-containing contraception in women with mild or moderate COVID-19

In women with mild or moderate COVID-19, manage oestrogen-containing contraception as per usual care.

  • Oestrogen-containing contraception in women with severe or critical COVID-19

In women who are receiving care in hospital for severe or critical COVID-19 and who are taking oestrogen-containing contraception, manage these medications as per usual care.

In women who stop or suspend contraception when they have severe or critical COVID-19, restart contraception at the time of
discharge.

The Taskforce is continually monitoring research to update recommendations weekly as new evidence accumulates.

 

CLINICAL FLOWCHARTS

10 clinical flowcharts have been developed by the Taskforce to cover:

  • Assessment for suspected COVID-19
  • Management of adults with mild COVID-19 UPDATED
  • Management of adults with moderate to severe COVID-19 UPDATED
  • Management of adults with severe to critical COVID-19 UPDATED
  • Respiratory support for adults with severe to critical COVID-19 UPDATED
  • Management of people with COVID-19 who are older and living with frailty and/or cognitive impairment
  • Management of people with COVID-19 who are receiving palliative care
  • Preparedness for CPR during the COVID-19 pandemic UPDATED
  • CPR for adults with COVID-19 in healthcare settings UPDATED
  • Basic life support for adults in the community during the pandemic UPDATED

Changes to flowcharts this week include:

  • Only in research’ medications updated to include dutesteride
  • Updated remark in respiratory management of the deteriorating patient recommendation

 

EVIDENCE UNDER REVIEW

We are currently reviewing evidence to develop recommendations and flowcharts to guide practice in areas including:

  • Human umbilical cord mesenchymal stem cells UPDATE
  • Ivermectin plus doxycycline  UPDATE
  • Peginterferon Lambda-1a UPDATE
  • Post-exposure hydroxychloroquine prophylaxis UPDATE
  • Sofosbuvir-daclatasvir UPDATE
  • Care of people with post-acute UPDATE

 

NEWS & EVENTS

ANZ Guideline Network
Last week’s ANZ Guidelines International Network webinar First nations-led guideline development – supporting prevention and management COVID-19 in primary healthcare is now available to view. Speakers include our Guidelines Leadership Group member Dr Jason Agostino, Medical advisor to NACCHO.

FIGO webinar
Watch the International Federation of Gynaecology and Obstetrics recent webinar COVID-19 in Australian and New Zealand – a tale of two countries featuring our Pregnancy and Perinatal Care Panellists – Dr Vijay Roach, Dr Clare Whitehead, A/Prof Joshua Vogel and Jackie Kitschke.

NEW TOPICS AND QUESTIONS

It is a core mission of the Taskforce to engage with frontline clinicians to rapidly identify and address priority clinical questions.

Each week we collect suggestions for new clinical questions or topics for consideration by the Taskforce. A document that lists all of the suggested questions, topics and new patient groups that we have received to date is available here.

Please encourage your clinical colleagues to provide their insights via the website.

Topics