Critical Appraisal of Early Remdesivir

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Critical Appraisal of Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients

Critical Appraisal of Early Remdesivir

The article intended to determine the effectiveness of remdesivir use in preventing hospitalization among symptomatic, non-hospitalized patients with Covid-19 who are at an increased risk for disease progression. The authors hypothesized that initiating a short course remdesivir treatment early among outpatients would minimize hospitalization and mortality. Results indicate that the treatment modality helped reduce Covid-related hospitalization or mortality, medically attended visits, and adverse events, confirming the hypothesis.4 Conclusively, the drug can be used to treat Covid-19 outpatients to reduce the risk of hospitalization or death, medically attended visits, and adverse events, offering healthcare providers an additional and effective treatment regimen.  (Critical Appraisal of Early Remdesivir)

Best Available Evidence

Evidence-based practice entails providers using the best available evidence to inform practice and clinical decision-making. Studies are of varying levels of evidence and evidence quality, and providers are expected to select the best available evidence to make the most appropriate decisions.2 This article adopts a randomized, double-blind, placebo-controlled trial, which offers the highest level of evidence available regarding remdesivir effectiveness in treating Covid-19 and preventing hospitalization and mortality among outpatients. Randomized double-blind placebo controls (RDBPC) are perceived gold standard of epidemiological scientific research.6 The design provides the strongest possible evidence showing causation. Therefore, providers can adopt the results of this article to inform practice and make clinical decisions when treating Covid-19 outpatients.    (Critical Appraisal of Early Remdesivir)

Clinical Guidelines

Clinical guidelines include recommendations to help optimize care informed by systematic evidence review and an evaluation of alternative care options’ benefits and harms.1 Remdesivir is an alternative treatment regimen in Covid-19 patients and this article offer recommendation for its use supported by gold-standard research methodology and evidence. This study recommends remdesivir use among outpatients and those with moderate-to-severe Covid-19, offering concrete evidence of its effectiveness in reducing hospitalization, mortality, medically intended visits, adverse events, quick recovery, and reduced risk of disease progression. The study also aligns with other trials, including the SIMPLE trial, which indicated that remdesivir helped achieve better clinical status among individuals with moderate Covid-19 and the ACTT-1, which showed remdesivir effectiveness in accelerating recovery and reducing disease progression. (Critical Appraisal of Early Remdesivir)

Clinical Judgment

Healthcare providers adopt evidence-based insights, their experience, and personally-developed knowledge to make clinical judgements. Clinical judgement includes skills and knowledge accumulated over time from experience and evidence-based research knowledge, which contribute to providers’ ability to analyze and synthesize patient data, objective and subjective and recommend or offer evidence-based nursing interventions to enhance patient outcomes.5 This study provides evidence to guide clinical judgement and decision-making when selecting a treatment regimen to treat moderate Covid-19 or Covid-19 in outpatients. The data offers another treatment option for providers treating Covid-19 with supported insights to inform clinical decisions. (Critical Appraisal of Early Remdesivir)

Patient Preferences

Patient preferences inform clinical decisions, implying the selection of clinical interventions depends on the patient’s deliberations, including anticipations regarding treatment or health outcomes.3 Patients prefer a treatment regimen with promising or proven positive health outcomes. These preferences result from clinician advice and patients’ cognition, experience, and reflection.3 The beneficial clinical benefits of remdesivir indicated in this study are likely to influence patient preferences. The data obtained adds another option for treating vulnerable patient populations to prevent Covid-19 progress.4 Patients have a better option in remdesivir, and they can anticipate improved health outcomes. (Critical Appraisal of Early Remdesivir)

References

  1. Bhaumik S. Use of evidence for clinical practice guideline development. Trop Parasitol. 2017;7(2):65-71. doi:10.4103/tp.TP_6_17
  2. Flecha OD, Douglas de Oliveira DW, Marques LS, Gonçalves PF. A commentary on randomized clinical trials: How to produce them with a good level of evidence. Perspect Clin Res. 2016;7(2):75-80. doi:10.4103/2229-3485.179432
  3. Gärtner FR, Portielje JE, Langendam M, et al. Role of patient preferences in clinical practice guidelines: a multiple methods study using guidelines from oncology as a case. BMJ Open. 2019;9(12):e032483. Published 2019 Dec 5. doi:10.1136/bmjopen-2019-032483
  4. Gottlieb RL, Vaca CE, Paredes R, et al. Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients. N Engl J Med. 2022;386(4):305-315. doi:10.1056/NEJMoa2116846
  5. Kinyon K, D’Alton S, Poston K, Navarrete S. Improving Physical Assessment and Clinical Judgment Skills without Increasing Content in a Prelicensure Nursing Health Assessment Course. Nurs Rep. 2021;11(3):600-607. Published 2021 Aug 2. doi:10.3390/nursrep11030057
  6. Misra S. Randomized double blind placebo control studies, the “Gold Standard” in intervention based studies. Indian J Sex Transm Dis AIDS. 2012;33(2):131-134. doi:10.4103/0253-7184.102130 https://pubmed.ncbi.nlm.nih.gov/23188942/
 
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