A comparative bibliometric analysis of Omicron and Delta variants during the COVID-19 pandemic.

BACKGROUND: To compare the research hotspots of infections with the Delta and Omicron variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the coronavirus disease 2019 (COVID-19) pandemic and to identify future research trends. METHODS: Studies about Delta and Omicron variant infections published over the last 3 years were retrieved from the Web of Science (WoS) database. A comparative bibliometric analysis was conducted through machine learning and visualization tools, including VOSviewer, Bibliographic Item Co-Occurrence Matrix Builder, and Graphical Clustering Toolkit. Research hotspots and trends in the field were analyzed, and the contributions and collaborations of countries, institutions, and authors were documented. A cross-sectional analysis of the relevant studies registered at ClinicalTrials.gov was also performed to clarify the direction of future research. RESULTS: A total of 1,787 articles distributed in 107 countries and 374 publications from 77 countries focused on the Delta and Omicron variants were included in our bibliometric analysis. The top five productive countries in both variants were the USA, China, the UK, India, and Germany. In 5,999 and 1,107 keywords identified from articles on the Delta and Omicron, the top two frequent keywords were the same: "COVID-19" (occurrence: 713, total link strength: 1,525 in Delta; occurrence: 137, total link strength: 354 in Omicron), followed by "SARS-CoV-2" (occurrence: 553, total link strength: 1,478 in Delta; occurrences 132, total link strength: 395 in Omicron). Five theme clusters from articles on Delta variant were identified: transmission, molecular structure, activation mode, epidemiology, and co-infection. While other three theme clusters were recognized for the Omicron variant: vaccine, human immune response, and infection control. Meanwhile, 21 interventional studies had been registered up to April 2022, most of which aimed to evaluate the immunogenicity and safety of different kinds of vaccines in various populations. CONCLUSIONS: Publications and clinical trials related to COVID-19 increased annually. As the first comparative bibliometric analysis for Delta and Omicron variants, we noticed that the relevant research trends have shifted from vaccine development to infection control and management of complications. The ongoing clinical studies will verify the safety and efficacy of promising drugs.

A bibliometric analysis of the application of artificial intelligence to advance individualized diagnosis and treatment of critical illness.

Background: Artificial intelligence (AI) has been extensively applied in the individualized diagnosis and treatment of critical illness, and numerous studies have been published on this topic. Therefore, a bibliometric analysis of these publications should be performed to provide a direction of hot topics and future research trends. Methods: A bibliometric analysis was performed on the research articles to identify the hot topics and any unsolved issues regarding the use of AI in individualized diagnosis and treatment of critical illness. Articles published from January 2011 to December 2021 were retrieved from the Web of Science (WOS) core collection database for bibliometric analysis, and a cross-sectional analysis of the relevant studies that had been registered at ClinicalTrials.gov was also conducted. Results: The number of articles published showed an annually increasing trend, with a worldwide geographic distribution over the past decade. Ultimately, 427 research articles were included in the bibliometric analysis. The relevant articles were divided into four separate clusters that focused on AI application aspects, prediction model establishment, coronavirus disease 2019 (COVID-19) treatment and outcome assessments, respectively. "Machine learning" was the most frequent keyword (147 occurrences, 165 links, and 395 total link strengths) followed by "risk", "models", and "mortality". With 205 articles, the United States of America (USA) had interacted the most with other countries (20 links, and 94 total link strength), while the domestic research institutes in China had infrequently collaborated with others. Approximately 130 trials focusing on the application of AI in the intensive care unit (ICU) and emergency department (ED) had been registered at ClinicalTrial.gov, and most of them (n=71, 54.6%) were interventional. The main research objectives of these trials were to provide decision making assistance and establish prediction models. However, only 3.8% (5 trials) of them had reached exact conclusions which favored the application of AI. Conclusions: The application of AI has raised great interest in critical illness and has mainly been focused on decision making assistance and prediction model establishment. Cooperation between agencies engaged in AI research needs to be strengthened. An increasing number of trials have been registered at ClinicalTrial.gov, and the results of them are promising. Keywords: Bibliometric analysis; artificial intelligence (AI); individualized diagnosis; critical care medicine; emergency department (ED).

Reduction in antimicrobial use associated with a multifaceted antimicrobial stewardship programme in a tertiary teaching hospital in Shanghai: a segmented regression analysis.

BACKGROUND: Rational use of antibiotics received great attention in China, therefore the multifaceted antimicrobial stewardship (MAMS) is urgently required in hospital management. We conducted this study to assess the impact of a MAMS programme on antimicrobial use in a tertiary teaching hospital in Shanghai. METHODS: This retrospective observational study was conducted at a tertiary teaching hospital in Shanghai. The MAMS programme involved multifaceted interventions consisting of a quality premium with financial incentives, antibiotic restriction, audit and feedback, and education. Data were extracted from the electronic medical records of inpatients to analyse monthly and annual antibiotic consumption and the percentage of antibiotic prescriptions during 2017-2020. Segmented regression analysis of the interrupted time series was used to contrast antimicrobial use during 2019-2020, with non-MAMS data from the 2017-2018 period as the historical control. RESULTS: With MAMS implementation, antibiotic consumption decreased from 63.3 (59.3, 67.2) defined daily doses (DDDs) per 100 patient-days (PD) to 43.3 (39.0, 49.8) DDDs/100 PD (P<0.001), and the percentage of antibiotic prescriptions decreased from 44.8% (44.1%, 45.4%) to 43.3% (42.2%, 44.3%) (P<0.001). Segmented regression models suggested a reduction in antibiotic consumption (coefficient = -12.537, P<0.001) and indicated a downward trend in the percentage of antibiotic prescriptions (coefficient =-0.165, P=0.049). Neither antibiotic consumption nor the percentage of antibiotic prescriptions was influenced by the coronavirus disease 2019 (COVID-19) pandemic. CONCLUSIONS: This study suggests that MAMS plays an important role in reducing antibiotic use and is not affected by special circumstances such as the COVID-19 pandemic. This novel intervention, consisting of a quality premium and multidisciplinary cooperation, should be prioritized by policy and decision makers, where rational management of antimicrobial use is urgently needed.

Efficacy and safety of current therapeutic options for COVID-19 - lessons to be learnt from SARS and MERS epidemic: A systematic review and meta-analysis.

The rapidly progressing of coronavirus disease 2019 (COVID-19) pandemic has become a global concern. This meta-analysis aimed at evaluating the efficacy and safety of current option of therapies for severe acute respiratory syndrome (SARS), Middle Eastern respiratory syndrome (MERS) besides COVID-19, in an attempt to identify promising therapy for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients. We searched PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and WANFANG DATA for randomized controlled trials (RCTs), prospective cohort, and retrospective cohort studies that evaluated therapies (hydroxychloroquine, lopinavir/ritonavir-based therapy, and ribavirin-based therapy, etc.) for SARS, MERS, and COVID-19. The primary outcomes were mortality, virological eradication and clinical improvement, and secondary outcomes were improvement of symptoms and chest radiography results, incidence of acute respiratory disease syndrome (ARDS), utilization of mechanical ventilation, and adverse events (AEs). Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random-effects models, and the quality of evidence was appraised using GRADEpro. Eighteen articles (5 RCTs, 2 prospective cohort studies, and 11 retrospective cohort studies) involving 4,941 patients were included. Compared with control treatment, anti-coronary virus interventions significantly reduced mortality (RR 0.65, 95% CI 0.44-0.96; I2 = 81.3%), remarkably ameliorate clinical improvement (RR 1.52, 95% CI 1.05-2.19) and radiographical improvement (RR 1.62, 95% CI 1.11-2.36, I2 = 11.0 %), without manifesting clear effect on virological eradication, incidence of ARDS, intubation, and AEs. Subgroup analyses demonstrated that the combination of ribavirin and corticosteroids remarkably decreased mortality (RR 0.43, 95% CI 0.27-0.68). The lopinavir/ritonavir-based combination showed superior virological eradication and radiographical improvement with reduced rate of ARDS. Likewise, hydroxychloroquine improved radiographical result. For safety, ribavirin could induce more bradycardia, anemia and transaminitis. Meanwhile, hydroxychloroquine could increase AEs rate especially diarrhea. Overall, the quality of evidence on most outcomes were very low. In conclusion, although we could not draw a clear conclusion for the recommendation of potential therapies for COVID-19 considering the very low quality of evidence and wide heterogeneity of interventions and indications, our results may help clinicians to comprehensively understand the advantages and drawbacks of each anti-coronavirus agents on efficacy and safety profiles. Lopinavir/ritonavir combinations might observe better virological eradication capability than other anti-coronavirus agents. Conversely, ribavirin might cause more safety concerns especially bradycardia. Thus, large RCTs objectively assessing the efficacy of antiviral therapies for SARS-CoV-2 infections should be conducted with high priority.

Current therapeutic options for coronavirus disease 2019 (COVID-19)-lessons learned from severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) therapy: a systematic review protocol.

BACKGROUND: Coronavirus disease 2019 (COVID-19), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, first manifested in December 2019, and spread rapidly worldwide. Facing this lethal disease, there is an urgent need to develop potent therapies against SARS-CoV-2 infection. SARS-CoV-2 phylogenetically and symptomatically resembles SARS-CoV and Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Numerous agents have been utilised during the severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) epidemics, which may show some benefit against SARS-CoV-2. METHODS: MEDLINE, EMBASE, Cochrane Library, CBM Disc, China National Knowledge Infrastructure, Wanfang Data, and the China Science and Technology Journal Database will be searched. Manual searches will be conducted by searching pre-printing websites, clinical trial registers, and screening the reference lists of inclusive studies. The screening of all citations and the selection of inclusive articles will be conducted by two reviewers. Randomised controlled trials (RCTs) and controlled cohort studies reporting antiviral therapies, including ribavirin, remdesivir, lopinavir/ritonavir, arbidol, chloroquine, hydroxychloroquine, and interferon, for SARS, MERS, and COVID-19 will be included. The primary outcomes will be mortality, incidence of acute respiratory distress syndrome, and utilisation of mechanical ventilation and intensive care unit admission. The secondary outcomes will be improvement in symptoms and chest radiography results, virus clearance, changes in blood test results, and serum tests. The quality of the retrieved RCTs and observational studies will be appraised according to the Cochrane risk of bias tool and the Newcastle-Ottawa Scale, respectively. If feasible, we will perform a fixed- or random-effects meta-analysis. DISCUSSION: This systematic review and meta-analysis will summarise all the available evidence for the efficacy and safety of current therapeutic options in SARS-CoV, MERS-CoV, or SARS-CoV-2-infected patients. The findings of this study may inform subsequent antiviral interventions for patients with COVID-19. STUDY REGISTRATION: The protocol of this study has been submitted to the PROSPERO platform (https://www.crd.york.ac.uk/PROSPERO/), and the registration number is CRD42020168639.