Safety and efficacy of an artificial intelligence-enabled decision tool for treatment decisions in neovascular age-related macular degeneration and an exploration of clinical pathway integration and implementation: protocol for a multi-methods validation study.

INTRODUCTION: Neovascular age-related macular degeneration (nAMD) management is one of the largest single-disease contributors to hospital outpatient appointments. Partial automation of nAMD treatment decisions could reduce demands on clinician time. Established artificial intelligence (AI)-enabled retinal imaging analysis tools, could be applied to this use-case, but are not yet validated for it. A primary qualitative investigation of stakeholder perceptions of such an AI-enabled decision tool is also absent. This multi-methods study aims to establish the safety and efficacy of an AI-enabled decision tool for nAMD treatment decisions and understand where on the clinical pathway it could sit and what factors are likely to influence its implementation. METHODS AND ANALYSIS: Single-centre retrospective imaging and clinical data will be collected from nAMD clinic visits at a National Health Service (NHS) teaching hospital ophthalmology service, including judgements of nAMD disease stability or activity made in real-world consultant-led-care. Dataset size will be set by a power calculation using the first 127 randomly sampled eligible clinic visits. An AI-enabled retinal segmentation tool and a rule-based decision tree will independently analyse imaging data to report nAMD stability or activity for each of these clinic visits. Independently, an external reading centre will receive both clinical and imaging data to generate an enhanced reference standard for each clinic visit. The non-inferiority of the relative negative predictive value of AI-enabled reports on disease activity relative to consultant-led-care judgements will then be tested. In parallel, approximately 40 semi-structured interviews will be conducted with key nAMD service stakeholders, including patients. Transcripts will be coded using a theoretical framework and thematic analysis will follow. ETHICS AND DISSEMINATION: NHS Research Ethics Committee and UK Health Research Authority approvals are in place (21/NW/0138). Informed consent is planned for interview participants only. Written and oral dissemination is planned to public, clinical, academic and commercial stakeholders.

Changes in dispensing of medicines proposed for re-purposing in the first year of the COVID-19 pandemic in Australia.

BACKGROUND: Since COVID-19 was first recognised, there has been ever-changing evidence and misinformation around effective use of medicines. Understanding how pandemics impact on medicine use can help policymakers act quickly to prevent harm. We quantified changes in dispensing of common medicines proposed for "re-purposing" due to their perceived benefits as therapeutic or preventive for COVID-19 in Australia. METHODS: We performed an interrupted time series analysis and cross-sectional study using nationwide dispensing claims data (January 2017-November 2020). We focused on six subsidized medicines proposed for re-purposing: hydroxychloroquine, azithromycin, ivermectin, colchicine, corticosteroids, and calcitriol (Vitamin D analog). We quantified changes in monthly dispensing and initiation trends during COVID-19 (March-November 2020) using autoregressive integrated moving average models and compared characteristics of initiators in 2020 and 2019. RESULTS: In March 2020, we observed a 99% (95%CI: 96%-103%) increase in hydroxychloroquine dispensing (approximately 22% attributable to new users), and a 199% increase (95%CI: 184%-213%) in initiation, with an increase in prescribing by general practitioners (42% in 2020 vs 25% in 2019) rather than specialists. These increases subsided following regulatory restrictions on prescribing. There was a small but sustained increase in ivermectin dispensing over multiple months, with an 80% (95%CI 42%-118%) increase in initiation in May 2020 following its first identification as potentially disease-modifying in April. Other than increases in March related to stockpiling, we observed no change in the initiation of calcitriol or colchicine during COVID-19. Dispensing of corticosteroids and azithromycin was lower than expected from April through November 2020. CONCLUSIONS: While most increases in dispensing observed early on during COVID-19 were temporary and appear to be related to stockpiling among existing users, we observed increases in the initiation of hydroxychloroquine and ivermectin and a shift in prescribing patterns which may be related to the media hype around these medicines. A quick response by regulators can help limit inappropriate repurposing to lessen the impact on medicine supply and patient harm.

A look at the C3 and C5 proteins in the Covid‐19

Because of the crucial role played by proteins C3 and C5 in the infection by the SARS-COV-2 virus, new complement system inhibition treatments have emerged as a possible first line of defense against the worst symptoms developed during Covid-19 disease. C3, C5, Complemento, Inhibición, SARS-CoV-2 INTRODUCTION In December 2019, China informed the World Health Organization (WHO) about the spread of a new pathogen in the Chinese city of Wuhan, this pathogen was named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Abd El-Aziz and Stockand, 2020), causing the Covid-19 disease. Once a person is infected with the SARSCoV-2 virus, the spike homotrimer glycoprotein of the virus connects to the integral membrane protein ACE2 of human cells (Lan et al., 2020;Rothan and Byrareddy, 2020), many of these receptors are found in the lung epithelium layer, making them one of the main sites of infection of the SARS-CoV-2 virus (Connors and Levy, 2020). The activation of the complement system is vital to the control of viruses, fungi, bacteria, and other pathogens, this activation triggers the opsonization of the pathogens and the elimination of them (Merle et al., 2015;Sarma and Ward, 2011);the activation is sequential: a catalytic cascade is produced through the generation of complex enzymes and proteins, in one step an enzyme or protein of this cascade can generate many active molecules for the next step in the activation of the complement system (Merle et al., 2015).

Dampak psikologis tenaga kesehatan selama pandemi COVID-19

The Coronavirus Disease 2019 (COVID-19) outbreak that emerged in December 2019 in Wuhan, quickly spread outside of China, so the World Health Organization (WHO) declared an Emergency at the Public Health Emergency of International Concern (PHEIC), causing Psychological Stress on Health workers who handle COVID-19 patients, the purpose of this study is to determine the Psychological Disorders of Health Workers during the COVID-19 pandemic. This study is a literature review by comparing articles, journals or secondary data from previously published literature contained in the medical journal database Science Direct, PubMed and ClinicalKey. Result of the ten articles reviewed, there were 11,611 respondents consisting of 3,070 men, 8,534 women, 4 respondents who did not fill in gender and 1 Genderqueer respondent obtained data on increased psychological pressure from health workers during the COVID-19 pandemic. In conclusion, it found the prevalence of psychological impacts such as stress, anxiety and depression from mild to severe among health workers during the COVID-19 pandemic. These findings will help improve our understanding of the impact or impact of the COVID-19 pandemic on the Psychology of Health Workers. Keywords: Psychological Impacts, Health Workers, the COVID-19 Pandemic Wabah Coronavirus Disease 2019 (COVID-19) yang muncul pada Desember 2019 di Wuhan, dengan cepat menyebar ke luar Tiongkok, sehingga World Health Organization (WHO) mengumumkan Darurat pada Public Health Emergency of International Concern (PHEIC), menyebabkan Tekanan Psikologis pada tenaga Kesehatan yang menangani Pasien COVID-19, tujuan dari penelitian ini untuk mengetahui Gangguan Psikologis pada Tenaga Kesehatan selama Masa pandemi COVID-19. Metode penelitian berupa literature review dengan membandingkan artikel jurnal atau data sekunder dari literatur-literatur yang dipublikasi sebelumnya yang terdapat dalam database jurnal kedokteran Science direct, PubMed dan ClinicalKey. Hasilnya sebanyak sepuluh artikel yang direview terdapat 11.611 responden yang terdiri dari 3.070 laki-laki, 8.534 perempuan, 4 responden tidak mengisi gender dan 1 responden Genderqueer didapatkan data peningkatan tekanan Psikologis dari para tenaga Kesehatan selama masa pandemi COVID-19. Sebagai simpulan, ditemukan prevalensi dampak psikologis seperti stres, kecemasan, dan depresi dari ringan hingga Berat pada Tenaga Kesehatan selama masa pandemi COVID-19. Temuan ini akan membantu meningkatkan pemahaman kita tentang pengaruh atau dampak pandemi COVID-19 pada Psikologis Tenaga Kesehatan. Kata Kunci: Dampak Psikologis, Tenaga Kesehatan, Pandemi COVID-19

Generating Real-World Evidence on the Quality Use, Benefits and Safety of Medicines in Australia: History, Challenges and a Roadmap for the Future.

Australia spends more than $20 billion annually on medicines, delivering significant health benefits for the population. However, inappropriate prescribing and medicine use also result in harm to individuals and populations, and waste of precious health resources. Medication data linked with other routine collections enable evidence generation in pharmacoepidemiology; the science of quantifying the use, effectiveness and safety of medicines in real-world clinical practice. This review details the history of medicines policy and data access in Australia, the strengths of existing data sources, and the infrastructure and governance enabling and impeding evidence generation in the field. Currently, substantial gaps persist with respect to cohesive, contemporary linked data sources supporting quality use of medicines, effectiveness and safety research; exemplified by Australia's limited capacity to contribute to the global effort in real-world studies of vaccine and disease-modifying treatments for COVID-19. We propose a roadmap to bolster the discipline, and population health more broadly, underpinned by a distinct capability governing and streamlining access to linked data assets for accredited researchers. Robust real-world evidence generation requires current data roadblocks to be remedied as a matter of urgency to deliver efficient and equitable health care and improve the health and well-being of all Australians.

Teledermatology in Times of COVID-19 Pandemic

Teledermatology is the need of every dermatologist in the time of COVID-19 pandemic. Teledermatology will help to provide skin care to the patients in the time of pandemic and will also help to prevent the spread of COVID infection.