Alerts in Clinical Decision Support Systems (CDSS): A Bibliometric Review and Content Analysis.

A clinical decision support system (CDSS) informs or generates medical recommendations for healthcare practitioners. An alert is the most common way for a CDSS to interact with practitioners. Research about alerts in CDSS has proliferated over the past ten years. The research trend is ongoing with new emerging terms and focus. Bibliometric analysis is ideal for researchers to understand the research trend and future directions. Influential articles, institutes, countries, authors, and commonly used keywords were analyzed to grasp a comprehensive view on our topic, alerts in CDSS. Articles published between 2011 and 2021 were extracted from the Web of Science database. There were 728 articles included for bibliometric analysis, among which 24 papers were selected for content analysis. Our analysis shows that the research direction has shifted from patient safety to system utility, implying the importance of alert usability to be clinically impactful. Finally, we conclude with future research directions such as the optimization of alert mechanisms and comprehensiveness to enhance alert appropriateness and to reduce alert fatigue.

Social media sentiment analysis to monitor the performance of vaccination coverage during the early phase of the national COVID-19 vaccine rollout.

BACKGROUND AND OBJECTIVE: Social media sentiment analysis based on Twitter data can facilitate real-time monitoring of COVID-19 vaccine-related concerns. Thus, the governments can adopt proactive measures to address misinformation and inappropriate behaviors surrounding the COVID-19 vaccine, threatening the success of the national vaccination campaign. This study aims to identify the correlation between COVID-19 vaccine sentiments expressed on Twitter and COVID-19 vaccination coverage, case increase, and case fatality rate in Indonesia. METHODS: We retrieved COVID-19 vaccine-related tweets collected from Indonesian Twitter users between October 15, 2020, to April 12, 2021, using Drone Emprit Academic (DEA) platform. We collected the daily trend of COVID-19 vaccine coverage and the rate of case increase and case fatality from the Ministry of Health (MoH) official website and the KawalCOVID19 database, respectively. We identified the public sentiments, emotions, word usage, and trend of all filtered tweets 90 days before and after the national vaccination rollout in Indonesia. RESULTS: Using a total of 555,892 COVID-19 vaccine-related tweets, we observed the negative sentiments outnumbered positive sentiments for 59 days (65.50%), with the predominant emotion of anticipation among 90 days of the beginning of the study period. However, after the vaccination rollout, the positive sentiments outnumbered negative sentiments for 56 days (62.20%) with the growth of trust emotion, which is consistent with the positive appeals of the recent news about COVID-19 vaccine safety and the government's proactive risk communication. In addition, there was a statistically significant trend of vaccination sentiment scores, which strongly correlated with the increase of vaccination coverage (r = 0.71, P<.0001 both first and second doses) and the decreasing of case increase rate (r = -0.70, P<.0001) and case fatality rate (r = -0.74, P<.0001). CONCLUSIONS: Our results highlight the utility of social media sentiment analysis as government communication strategies to build public trust, affecting individual willingness to get vaccinated. This finding will be useful for countries to identify and develop strategies for speed up the vaccination rate by monitoring the dynamic netizens' reactions and expression in social media, especially Twitter, using sentiment analysis.

Social Media Data Analytics for Outbreak Risk Communication: Public Attention on the "New Normal" During the COVID-19 Pandemic in Indonesia.

BACKGROUND: After two months of implementing a partial lockdown, the Indonesian government had announced the "New Normal" policy to prevent a further economic crash in the country. This policy received many critics, as Indonesia still experiencing a fluctuated number of infected cases. Understanding public perception through effective risk communication can assist the government in relaying an appropriate message to improve people's compliance and to avoid further disease spread. OBJECTIVE: This study observed how risk communication using social media platforms like Twitter could be adopted to measure public attention on COVID-19 related issues "New Normal". METHOD: From May 21 to June 18, 2020, we archived all tweets related to COVID-19 containing keywords: "#NewNormal", and "New Normal" using Drone Emprit Academy (DEA) engine. DEA search API collected all requested tweets and described the cumulative tweets for trend analysis, word segmentation, and word frequency. We further analyzed the public perception using sentiment analysis and identified the predominant tweets using emotion analysis. RESULT: We collected 284,216 tweets from 137,057 active users. From the trend analysis, we observed three stages of the changing trend of the public's attention on the "New Normal". Results from the sentiment analysis indicate that more than half of the population (52%) had a "positive" sentiment towards the "New Normal" issues while only 41% of them had a "negative" perception. Our study also demonstrated the public's sentiment trend has gradually shifted from "negative" to "positive" due to the influence of both the government actions and the spread of the disease. A more detailed analysis of the emotion analysis showed that the majority of the public emotions (77.6%) relied on the emotion of "trust", "anticipation", and "joy". Meanwhile, people were also surprised (8.62%) that the Indonesian government progressed to the "New Normal" concept despite a fluctuating number of cases. CONCLUSION: Our findings offer an opportunity for the government to use Twitter in the process of quick decision-making and policy evaluation during uncertain times in response to the COVID-19 pandemic.

Application of Artificial Intelligence for Screening COVID-19 Patients Using Digital Images: Meta-analysis.

BACKGROUND: The COVID-19 outbreak has spread rapidly and hospitals are overwhelmed with COVID-19 patients. While analysis of nasal and throat swabs from patients is the main way to detect COVID-19, analyzing chest images could offer an alternative method to hospitals, where health care personnel and testing kits are scarce. Deep learning (DL), in particular, has shown impressive levels of performance when analyzing medical images, including those related to COVID-19 pneumonia. OBJECTIVE: The goal of this study was to perform a systematic review with a meta-analysis of relevant studies to quantify the performance of DL algorithms in the automatic stratification of COVID-19 patients using chest images. METHODS: A search strategy for use in PubMed, Scopus, Google Scholar, and Web of Science was developed, where we searched for articles published between January 1 and April 25, 2020. We used the key terms "COVID-19," or "coronavirus," or "SARS-CoV-2," or "novel corona," or "2019-ncov," and "deep learning," or "artificial intelligence," or "automatic detection." Two authors independently extracted data on study characteristics, methods, risk of bias, and outcomes. Any disagreement between them was resolved by consensus. RESULTS: A total of 16 studies were included in the meta-analysis, which included 5896 chest images from COVID-19 patients. The pooled sensitivity and specificity of the DL models in detecting COVID-19 were 0.95 (95% CI 0.94-0.95) and 0.96 (95% CI 0.96-0.97), respectively, with an area under the receiver operating characteristic curve of 0.98. The positive likelihood, negative likelihood, and diagnostic odds ratio were 19.02 (95% CI 12.83-28.19), 0.06 (95% CI 0.04-0.10), and 368.07 (95% CI 162.30-834.75), respectively. The pooled sensitivity and specificity for distinguishing other types of pneumonia from COVID-19 were 0.93 (95% CI 0.92-0.94) and 0.95 (95% CI 0.94-0.95), respectively. The performance of radiologists in detecting COVID-19 was lower than that of the DL models; however, the performance of junior radiologists was improved when they used DL-based prediction tools. CONCLUSIONS: Our study findings show that DL models have immense potential in accurately stratifying COVID-19 patients and in correctly differentiating them from patients with other types of pneumonia and normal patients. Implementation of DL-based tools can assist radiologists in correctly and quickly detecting COVID-19 and, consequently, in combating the COVID-19 pandemic.

Obesity and Mortality Among Patients Diagnosed With COVID-19: A Systematic Review and Meta-Analysis.

Coronavirus disease 2019 (COVID-19) has already raised serious concern globally as the number of confirmed or suspected cases have increased rapidly. Epidemiological studies reported that obesity is associated with a higher rate of mortality in patients with COVID-19. Yet, to our knowledge, there is no comprehensive systematic review and meta-analysis to assess the effects of obesity and mortality among patients with COVID-19. We, therefore, aimed to evaluate the effect of obesity, associated comorbidities, and other factors on the risk of death due to COVID-19. We did a systematic search on PubMed, EMBASE, Google Scholar, Web of Science, and Scopus between January 1, 2020, and August 30, 2020. We followed Cochrane Guidelines to find relevant articles, and two reviewers extracted data from retrieved articles. Disagreement during those stages was resolved by discussion with the main investigator. The random-effects model was used to calculate effect sizes. We included 17 articles with a total of 543,399 patients. Obesity was significantly associated with an increased risk of mortality among patients with COVID-19 (RRadjust: 1.42 (95%CI: 1.24-1.63, p < 0.001). The pooled risk ratio for class I, class II, and class III obesity were 1.27 (95%CI: 1.05-1.54, p = 0.01), 1.56 (95%CI: 1.11-2.19, p < 0.01), and 1.92 (95%CI: 1.50-2.47, p < 0.001), respectively). In subgroup analysis, the pooled risk ratio for the patients with stroke, CPOD, CKD, and diabetes were 1.80 (95%CI: 0.89-3.64, p = 0.10), 1.57 (95%CI: 1.57-1.91, p < 0.001), 1.34 (95%CI: 1.18-1.52, p < 0.001), and 1.19 (1.07-1.32, p = 0.001), respectively. However, patients with obesity who were more than 65 years had a higher risk of mortality (RR: 2.54; 95%CI: 1.62-3.67, p < 0.001). Our study showed that obesity was associated with an increased risk of death from COVID-19, particularly in patients aged more than 65 years. Physicians should aware of these risk factors when dealing with patients with COVID-19 and take early treatment intervention to reduce the mortality of COVID-19 patients.

Clinical Characteristics and Neonatal Outcomes of Pregnant Patients With COVID-19: A Systematic Review.

Background and Objective: Coronavirus disease 2019 (COVID-19) characterized by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created serious concerns about its potential adverse effects. There are limited data on clinical, radiological, and neonatal outcomes of pregnant women with COVID-19 pneumonia. This study aimed to assess clinical manifestations and neonatal outcomes of pregnant women with COVID-19. Methods: We conducted a systematic article search of PubMed, EMBASE, Scopus, Google Scholar, and Web of Science for studies that discussed pregnant patients with confirmed COVID-19 between January 1, 2020, and April 20, 2020, with no restriction on language. Articles were independently evaluated by two expert authors. We included all retrospective studies that reported the clinical features and outcomes of pregnant patients with COVID-19. Results: Forty-seven articles were assessed for eligibility; 13 articles met the inclusion criteria for the systematic review. Data is reported for 235 pregnant women with COVID-19. The age range of patients was 25-40 years, and the gestational age ranged from 8 to 40 weeks plus 6 days. Clinical characteristics were fever [138/235 (58.72%)], cough [111/235 (47.23%)], and sore throat [21/235 (8.93%)]. One hundred fifty six out of 235 (66.38%) pregnant women had cesarean section, and 79 (33.62%) had a vaginal delivery. All the patients showed lung abnormalities in CT scan images, and none of the patients died. Neutrophil cell count, C-reactive protein (CRP) concentration, ALT, and AST were increased but lymphocyte count and albumin levels were decreased. Amniotic fluid, neonatal throat swab, and breastmilk samples were taken to test for SARS-CoV-2 but all found negativ results. Recent published evidence showed the possibility of vertical transmission up to 30%, and neonatal death up to 2.5%. Pre-eclampsia, fetal distress, PROM, pre-mature delivery were the major complications of pregnant women with COVID-19. Conclusions: Our study findings show that the clinical, laboratory and radiological characteristics of pregnant women with COVID-19 were similar to those of the general populations. The possibility of vertical transmission cannot be ignored but C-section should not be routinely recommended anymore according to latest evidences and, in any case, decisions should be taken after proper discussion with the family. Future studies are needed to confirm or refute these findings with a larger number of sample sizes and a long-term follow-up period.