AI and ICU Monitoring on the Wake of the COVID-19 Pandemic

The Intensive Care Unit (ICU) is a paradigmatic example of the potential reach of data-centred knowledge discovery. This is because the contemporary ICU heavily depends on medical devices for patient monitoring through electronic data acquisition. This poses a unique opportunity for multivariate data analysis to support evidence-based medicine (EBM), particularly in the form of Artificial Intelligence (AI) approaches. The COVID-19 pandemic has tested the limits of critical care management, often overwhelming ICUs. In this brief chapter, we sketch the role of AI, especially in the form of Machine Learning (ML), at the ICU and discuss what can it offer to address COVID-19 disruption in this environment. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

[Acute Cough in Adult Patients]. / Akuter Husten bei erwachsenen Patient*innen.

Background: Acute cough (< 8 weeks) is a frequent complaint in family practice consultations. The most common cause are respiratory infections. The Guideline "Acute and chronic cough" of the German College of General Practitioners and Family Physicians (DEGAM) was updated in 2021 and contains recommendations for an evidence-based approach for the management of acute cough in primary care. Methods: The guideline has been updated in accordance with the findings of a systematic search of the literature for international guidelines and systematic reviews. All recommendations were developed by an interdisciplinary guideline committee and agreed by formal consensus. Results: History-taking, exclusion of red flags and a physical examination are the basis of diagnostic evaluation. If an acute, uncomplicated bronchitis is likely, no laboratory tests, sputum diagnostics, or chest x-rays should be performed, and antibiotics should not be administered. Evidence based strategies to avoid antibiotic therapy (delayed prescribing, shared decision making, point-of-care-tests) can be used. There is inadequate evidence for the efficacy of antitussive or expectorant drugs against acute cough. The state of the evidence for phytotherapeutic agents is heterogeneous; clinical importance is minimal. COVID-19 should currently be considered in cases of acute respiratory symptoms. If specific symptoms or red flags occur, further diagnoses in the context of acute cough such as community-acquired pneumonia, influenza disease and exacerbations of chronic respiratory diseases (bronchial asthma, COPD) should be taken into consideration. Conclusions: These evidence-based recommendations are intended to reduce the use of antibiotics to treat colds and acute bronchitis, for which they are not indicated. Further clinical trials of symptomatic treatments for cough should be performed in order to extend the evidence base.

"The History of Chinese Medicine Really Is Very Detailed Regarding Pandemics": A Qualitative Analysis of Evidence-Based Practice and the Use of Chinese Herbal Medicine by Licensed Acupuncturists During the COVID-19 Pandemic in the United States.

Objective: The objective of this qualitative study was to understand how licensed acupuncturists determined treatment strategies for patients with symptoms likely related to COVID-19 using Chinese herbal medicine (CHM) and the impact of the pandemic upon their clinical practice. Methods: A qualitative instrument was developed with questions aligned with when participants started treating patients with symptoms likely related to COVID-19 and the availability of information related to the use of CHM for COVID-19. Interviews took place between March 8 and May 28, 2021, and were transcribed verbatim by a professional transcription service. Inductive theme analysis and ATLAS.ti Web software were used to determine themes. Results: Theme saturation was achieved after 14 interviews lasting 11-42 min. Treatment predominantly started before mid-March 2020. Four themes emerged (1) information sources; (2) diagnostic and treatment decision-making; (3) practitioner experience; (4) resources and supplies. Conclusion: Primary sources of information informing treatment strategies came from China through professional networks and were widely disseminated throughout the United States. Scientific studies evaluating the effectiveness of CHM for COVID-19 were generally not deemed useful for informing patient care because treatment had been initiated before they were published and because of limitations associated with the research and the ability to apply it to real world practice.

Treatment of coronavirus disease 2019: Timing determines prognosis

The global epidemic of coronavirus disease 2019 (COVID-19) is still growing. The response to this emerging disease should be considered with the context of its clinical characteristics and pathophysiological mechanisms. Although available therapeutic options are still very limited, current experience has suggested that the choice of clinical strategies should be based upon the disease stage and immune functions of the patients. The present article reviews the clinical characteristics of COVID-19 and current evidence of various treatment approaches. Combined with first-line experience, we summarize the current clinical strategies for COVID-19 management based on disease progress and staging.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.

A practical guide to statistics for general practice

EVIDENCE-BASED MEDICINE is a well-established part of general practice in Australia.1 Understanding research is embedded within the current curriculum of The Royal Australian College of General Practitioners (RACGP), with the ability to discuss 'scientific and statistical information' for clinical decisions listed as a required skillset for general practitioners (GPs).2 In the past few years, the COVID-19 pandemic has further highlighted that interpreting epidemiology and statistics is not only relevant for GP academics, but is also an integral part of clinical care.3 For example, GPs are often the first point of contact for patients asking about the evidence for masks, diagnostic accuracy of COVID-19 tests, vaccine efficacy and effectiveness of new antiviral treatments. In clinical practice, framing a research question, conducting a database search and critical appraisal of the selected paper are key first steps in interpreting and using research evidence.

Use of Telemedicine in Pediatric Services for 4 Representative Clinical Conditions: Scoping Review.

BACKGROUND: Telemedicine is becoming routine in health care. Postpandemic, a universal return to face-to-face consultations may risk a loss of some of the advantages of telemedicine. However, rapid implementation and adoption without robust evaluation of usability, efficacy, and effectiveness could potentially lead to suboptimal health outcomes and downstream challenges to providers. OBJECTIVE: This review assesses telemedicine interventions against international guidance and sufficiency of evidence to support postpandemic utilization in pediatric settings. METHODS: This scoping review was performed following searches on PubMed, Embase, and CINAHL databases on April 15, 2021, and May 31, 2022, and examined studies focused on telemedicine, remote consultation, video call, or remote patient monitoring in children (0-18 years) receiving outpatient care for diabetes, asthma, epilepsy, or renal disease. Exclusion criteria included studies published before 2011 as the technologies used have likely been improved or replaced, studies in adult populations or where it was not possible to disaggregate data for participants younger than 18 years as the focus of the review was on pediatric care, and studies not published in English. Data were extracted by 4 authors, and the data were corroborated by a second reviewer. Studies were examined for feasibility and usability, clinical and process outcomes, and cost-effectiveness. RESULTS: Of the 3158 studies identified, 56 were suitable for final inclusion and analysis. Data on feasibility or usability of interventions (48 studies) were overwhelmingly positive in support of telemedicine interventions, with common themes including convenience, perceived cost savings, and ease of use. However, use in preference to usual care was rarely explored. Clinical and process outcome data (31 studies) were mostly positive. Across all studies, there was limited measurement of standardized clinical outcomes, although these were more commonly reported in asthma (peak flow) and diabetes (glycated hemoglobin [HbA1c]). Implementation science data generally supported cost-effectiveness of telemedicine with a reduction of health care costs. CONCLUSIONS: There is promising evidence supporting telemedicine in pediatric settings. However, there is a lack of evaluation of telemedicine in comparison with usual outpatient care for noninferiority of clinical outcomes, and this review highlights the need for a more standardized approach to evaluation of digital interventions.

Practical Recommendations of Peking Union Medical College Hospital for Assessment and Management of COVID-19 in Primary Care (2023).

Following the recent adjustments to coronavirus disease 2019 (COVID-19) prevention and control policies, an increasing number of medical staffs, especially those in primary care facilities are confront-ed with rapid growth of COVID-19 patients. Peking Union Medical College Hospital (PUMCH) has therefore compiled this recommendation for COVID-19 primary care practices based on a patient-centered perspective and following recommendations from domestic and international guidelines as well as the latest Chinese government policies. Further, PUMCH.s conception and compilation of this recommendation strictly adhere to evidence-based, concise and clinically applicable principles of practice. For the critical clinical questions with insufficient medical evidence, the recommendation offers insights on the basis of experience from PUMCH multi-disciplinary expert team and first-line medics.practices. Emphasizing on screening community residents with higher risk of severe illness, implementing early interventions including pharmaceutical treatment, enhan-cing nutritional support and improving sleep quality, we aim to construct a "Household-Community-Hospital" tertiary defense, with the hope of promoting health and reducing severe cases.Copyright © 2023, Peking Union Medical College Hospital. All rights reserved.

Diagnosis and Clinical Management of COVID-19 Infection in Adults: Operational Recommendations of Peking Union Medical College Hospital (2023).

With the adjustment of China's COVID-19 policies and measures, the treatment of infected patients, especially the severe and critically ill patients, has become the focus of all medical staff at this stage. Since the outbreak of the pandemic, Peking Union Medical College Hospital has accumulated rich experience in this field. Based on the updated international evidence-based knowledge, the multidisciplinary expert group of COVID-19 at Peking Union Medical College Hospital has compiled a set of operational recommendations. Adhering to the evidence-based, concise, and clinically operable principles, these recommendations for diagnosis and treatment integrate the latest research evidence. For clinical issues that lack evidence, certain recommendations are given based on the frontline clinical working experience and expert opinions. The purpose is to enhance medical staff's understanding of COVID-19 infection and its critical illness and improve patient care.Copyright © 2023, Peking Union Medical College Hospital. All rights reserved.

Collaborative comparisons: A pragmatist approach towards designing large-scale, comparative qualitative research

This article draws lessons for organizing and designing large-scale qualitative comparative research in turbulent, rapidly evolving, real-world settings. The challenge to the researcher is that such studies need to meet conflicting requirements of rigor, relevance, and responsiveness. Recognizing that in such settings scientific research cannot be insulated from its environment, the article discusses a pragmatist approach to comparative research design. Using the case of the SolPan project (Solidarity in Times of a Pandemic), a large-scale and longitudinal qualitative comparative study of people's experiences during the Covid pandemic, the article presents basic principles of pragmatist research design, such as problem-orientation, design-in-action, and the use of a plurality of evidence. It then argues that interpretation is at the heart of all comparison, and that large-scale qualitative comparative research combines the detailed contextual richness of interpretive explanation, the systematicity, robustness and transparency of large-N comparative analysis, and the flexibility of emergent design. We describe the design and methodology of SolPan and illustrate this with an empirical example. First, we argue that research design and project organization are continuous and reframe comparative research design as generative organization. Second, we describe the use of computer-assisted qualitative data analysis software to assist in analysing large amounts of interview data. In the final section we describe some of the limitations of this large-scale qualitative comparative research.Copyright © 2022 The Authors

A visual analysis of the current research status of evidence-based social sciences.

Objective To analyze the research status and development trend of evidence-based social sciences, and to explore the synergistic relationship among branches of various fields. Methods A comprehensive search for research related to evidence-based social sciences published between the establishment of the database and September 2022 was conducted on the Web of Science, China Science Citation Database (CSCD), and Chinese Social Sciences Citation Index (CSSCI). The VOSviewer software was used to analyze the author and keywords and to perform the visualization. Results A total of 6 969 papers were included, 195 of which were in Chinese. The first paper, published in 1995, was on evidence-based management. The number of papers published on evidence-based social science research presented a trend of increasing continuously. The country with the most papers published was the United States;the institution outside China with the most papers published was McMaster University;and the institution in China with the most papers published was Sichuan University. The analysis of keywords showed that evidence-based policy, evidence-based practice, evidence-based management, and evidence-based decision-making appeared more frequently;research questions focused on evidence-based health policy development, application of big data in the context of COVID-19, evidence of climate change-induced disease, and real world research. Conclusion All the fields of evidence-based social sciences are closely related to each other in terms of research content and methods, and it presents a multi-level and multi-field crossover with evidence-based medicine. However, evidence-based social sciences in China are still in their infancy. Therefore, it is necessary to improve the methodological system of evidence-based social sciences, enrich the research content of social sciences, speed up the filling of evidence gaps in various fields, and promote the improvement and sustainable development of evidence-based social sciences.Copyright © 2023 West China University of Medical Science. All rights reserved.

Getting the Most Out of the Evidence for Transfusion Medicine and Lessons from the COVID-19 Pandemic

Evidence-based medicine (EBM) has been described by Sackett et al. as ‘the integration of best research evidence with clinical expertise and patient values'. This chapter discusses core elements of EBM with particular reference to clinical research in transfusion medicine, and provides a practical approach to searching for evidence and critical appraisal, with some considerations of different study designs. It also includes a review of how the evidence base for transfusion medicine was collated in response to the COVID-19 pandemic. One important component of EBM is the critical appraisal of the evidence generated from a study. One important aspect of clinical trial appraisal concerns the understanding of chance variation and sample-size calculation. Appraising the evidence base for transfusion medicine is one part of improving practice;another is the effective dissemination of the evidence to clinicians. © 2022 John Wiley and Sons Ltd.

COVID-19 and its influence on gastroenterology and endoscopy.

This article provides a short overview of the impact of the COVID-19 on gastroenterology and endoscopy. The healthcare worker's and scientists' selfless work helped to accumulate in a short period a large amount of information that helped to fight the new infection and its consequences. As clinicians, we need to continually renew information and promptly change clinical practice based on evidence-based medicine principles.Copyright © 2020, Media Sphera Publishing Group. All rights reserved.

Year 2022 in review - Respiratory failure and lung support therapy.

The use of ECMO methods has experienced a significant boom in recent years, mainly due to the SARS-CoV-2 pandemic. Many workplaces that had little or no experience with ECMO currently possess the relevant technology and can use this method in real clinical practice. The prone position (PP) has changed from the original position of rescue intervention to the leading position among the methods that should be considered standard in patients with a severe form of acute respiratory failure. Thus, the combination of pronation and ECMO support has received considerable attention in recent years. This text, although a year in the 2022 review, briefly discusses available evidence-based medicine publications over the past few years devoted to this topic. The use of PP in clinical conditions other than mechanical ventilation (MV), e.g. in conscious patients on non-invasive ventilatory support, is described in the next section of this text. Another topic is the correct setting of MV while using PP and the effect of PP in pregnant patients with COVID-19. Inhalational anesthetics and their use for sedation of patients on UPV are currently among the frequently discussed topics within the optimization of intensive care. Conversely, ventilator-induced dysfunction of the main respiratory muscles, especially the diaphragm, has been a serious topic in critical care for a long time. Next, critically ill patients are at risk of hyperoxemia both as part of MV and ECMO support. The negative impact of this condition is the final topic of the article.Copyright © 2022, Czech Medical Association J.E. Purkyne. All rights reserved.

Year 2022 in review - Paediatric anesthesia and intensive care.

From the Evidence-based medicine (EBM) point-of-view, the year 2022 due to the slowly subsiding world SARS-CoV-2 pan-demic, brought the whole complex of articles, publications, and guidelines once again. The aim of the article Year 2022 in pediatric anesthesia and intensive care is to highlight the important publications that should not be missed due to their impact on daily clinical practice.Copyright © 2022, Czech Medical Association J.E. Purkyne. All rights reserved.

Evidence and experience in management of neonatal COVID-19

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has mutated multiple times since the first report in December 2019 and is still spreading globally. A variant of SARS-CoV-2, Omicron, was prevalent in Shanghai from March to May 2022. Based on published data and the experience in the management of neonatal COVID-19 cases and infants of mothers with COVID-19 during the pandemic in Shanghai, it is suggested that neonates are infected with SARS-CoV-2 mainly through postnatal horizontal transmission, but rarely through vertical transmission. The risk of SARS-CoV-2 infection in infants born to mothers with COVID-19 is low if quarantine measures are appropriately implemented. Even if they are infected, the risk of severe neonatal COVID-19 is low, but long-term neurological prognosis needs to be followed closely. Human milk feeding without contact is advocated for infants of infected mothers. During the COVID-19 pandemic, attention should also be paid to indirect effect on neonatal health due to possible inadequate medical resources. © 2022 Chinese Medical Journals Publishing House Co.Ltd. All rights reserved.

How to recognize a trustworthy clinical practice guideline.

Trustworthy clinical practice guidelines represent a fundamental tool to summarize relevant evidence regarding a set of clinical choices and provide guidance for making optimal clinical decisions. Clinicians must differentiate between guidelines that provide trustworthy evidence guidance and those that do not. We present six questions clinicians should ask when evaluating a guideline's trustworthiness. (1) Are the recommendations clear?; (2) Have the panelists considered all alternatives?; (3) Have the panelists considered all patient-important outcomes?; (4) Is the recommendation based on an up-to-date systematic review?; (5) Is the strength of the recommendation compatible with the certainty of the evidence?; (6) Might conflicts of interest influence the recommendations? If yes, were they managed? Once the conclude they are dealing with a trustworthy guideline, clinicians must gain an understanding of the transparent evidence summary that the guideline will offer, and judge the applicability of trustworthy recommendations to their patients and settings. Consideration of the circumstances and values and preferences of patients will be crucial for all weak or conditional recommendations.

A twisting tale of misinformation: should ivermectin be approved as a treatment for COVID-19 disease?

This editorial examines what has caused the evidence around ivermectin to be so controversial, provides a brief analysis of recently published evidence, and highlights why it is important to learn lessons from ivermectin for future re-purposed drugs.

Association between self-reported evidence-based medicine competencies and prescribing of drugs without scientific evidence against mild COVID-19 among recently graduated physicians in Peru.

Objective: To evaluate the association between self-rated evidence-based medicine (EBM) competencies and the prescription of drugs without scientific evidence against mild COVID-19 (present with any of the signs and symptoms of COVID-19 but who do not have shortness of breath, dyspnea, or abnormal chest imaging) among recently graduated physicians in Peru. Methods: We conducted an analytical cross-sectional study where we evaluated a non-probability sample of recently graduated physicians during June and July 2021 (end of second wave of COVID-19 in Peru). Self-rated EBM competencies were assessed by four domains (formulation of a clinical question, search, analysis, and application) using a Likert scale with scores from zero to four ("Very inadequate" = 0, to "Very Adequate" = 4), it was considered as "Adequate" if the score was three or four. In addition, the variable "General competence on EBM" was rated as "Adequate" if in all domains evaluated it presented an adequate self-rating. For the outcome, drug prescription, we considered the use of ivermectin, azithromycin, other antibiotics, hydroxychloroquine, dexamethasone, and anticoagulants (drugs with no efficacy demonstrated for patients with mild COVID-19). To assess the association, we used Poisson regression models with robust variances and obtaining crude (cPR) and adjusted (aPR) prevalence ratios with their 95% confidence intervals (95%CI). Results: Of a total of 239 physicians included 70.7% prescribed at least one drug without scientific evidence. A total of 51.1% reported adequate ratings in all evaluated domains of EBM. Self-rating the "Clinical Question Formulation" competency as adequate was associated with a lower frequency of prescribing medications for mild COVID-19 (aPR: 0.93; 95% CI: 0.91-0.95). While self-rating as adequate the competency of "Identify possible implications of investigations" was associated with an increase in the prescription of such drugs (aPR: 1.14; 95% CI: 1.09-1.20). Additionally, self-rating all domains as adequate were associated with less prescription (aPR: 0.93; 95% CI: 0.90-0.96). Conclusion: Seven out of ten recently graduated physicians prescribed some type of medication without scientific evidence to treat patients with mild COVID-19. Having adequate self-perceived EBM competencies was associated with a lower frequency of prescribing medications without scientific evidence to manage patients with mild COVID-19.