Evidence map›Paper›PMID 33597140›Full record

ArticleBMJ open2021

Countermeasures against COVID-19: how to navigate medical practice through a nascent, evolving evidence base - a European multicentre mixed methods study.

Fabian Eibensteiner, Valentin Ritschl, Tanja Stamm, Asil Cetin, Claus Peter Schmitt, Gema Ariceta, Sevcan Bakkaloglu, Augustina Jankauskiene, Günter Klaus, Fabio Paglialonga and 10 more

Abstract readMulticenter Study
In one paragraph

Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Fabian EibensteinerDivision of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.ORCID 0000-0001-5012-3082
Valentin RitschlSection for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
Tanja StammSection for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria.ORCID 0000-0003-3073-7284
Asil CetinResearch Platform Data Science, University of Vienna, Vienna, Austria.
Claus Peter SchmittPediatric Nephrology, Center for Child and Adolescent Medicine, Heidelberg University, Heidelberg, Germany.
Gema AricetaDepartment of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain.
Sevcan BakkalogluDivision of Pediatric Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey.
Augustina JankauskienePediatric Center, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.
Günter KlausDepartment of Pediatric Nephrology, KfH Children's Kidney Center, Marburg, Germany.
Fabio PaglialongaPediatric Nephrology, Dialysis and Transplant Unit, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy.
Alberto EdefontiPediatric Nephrology, Dialysis and Transplant Unit, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy.
Bruno RanchinDepartment of Pediatric Nephrology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France.
Rukshana ShroffRenal Unit, UCL Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health, London, UK.
Constantinos J StefanidisDepartment of Pediatric Nephrology, Mitera Children's Hospital, Athens, Greece.
Johan VandewalleDepartment of Pediatric Nephrology, Utoped, Universitair Ziekenhuis Gent, Ghent, Belgium.
Enrico VerrinaDialysis Unit, Department of Pediatrics, IRCCS Giannina Gaslini, Genoa, Italy.
Karel VondrakDepartment of Pediatric Nephrology, University Hospital Motol, Prague, Czech Republic.
Aleksandra ZurowskaDepartment of Pediatric Nephrology, Medical University of Gdansk, Gdansk, Poland.
Seth L AlperDivision of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Christoph AufrichtDivision of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria christoph.aufricht@meduniwien.ac.at.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesIn a previously published Delphi exercise the European Pediatric Dialysis Working Group (EPDWG) reported widely variable counteractive responses to COVID-19 during the first week of statutory public curfews in 12 European countries with case loads of 4-680 infected patients per million. To better understand these wide variations, we assessed different factors affecting countermeasure implementation rates and applied the capability, opportunity, motivation model of behaviour to describe their determinants.

designWe undertook this international mixed methods study of increased depth and breadth to obtain more complete data and to better understand the resulting complex evidence.

settingThis study was conducted in 14 paediatric nephrology centres across 12 European countries during the COVID-19 pandemic.

participantsThe 14 participants were paediatric nephrologists and EPDWG members from 12 European centres.

main outcome measures52 countermeasures clustered into eight response domains (access control, patient testing, personnel testing, personal protective equipment policy, patient cohorting, personnel cohorting, suspension of routine care, remote work) were categorised by implementation status, drivers (expert opinion, hospital regulations) and resource dependency. Governmental strictness and media attitude were independently assessed for each country and correlated with relevant countermeasure implementation factors.

resultsImplementation rates varied widely among response domains (median 49.5%, range 20%-71%) and centres (median 46%, range 31%-62%). Case loads were insufficient to explain response rate variability. Increasing case loads resulted in shifts from expert opinion-based to hospital regulation-based decisions to implement additional countermeasures despite increased resource dependency. Higher governmental strictness and positive media attitude towards countermeasure implementation were associated with higher implementation rates.

conclusionsCOVID-19 countermeasure implementation by paediatric tertiary care centres did not reflect case loads but rather reflected heterogeneity of local rules and of perceived resources. These data highlight the need of ongoing reassessment of current practices, facilitating rapid change in 'institutional behavior' in response to emerging evidence of countermeasure efficacy.

Indexed as

PandemicsChildCOVID-19Delivery of Health CareEuropeHumansInfection ControlNephrologyPediatricsRenal DialysisCOVID-19health policyhealth & safetynephrologypaediatricsqualitative research

Identifiers

PMID33597140
PMCPMC7893209

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.