To determine which early-stage variables best predicted the deterioration of coronavirus disease 2019 (COVID-19) among community-isolated people infected with severe acute respiratory syndrome coronavirus 2 and to test the performance of prediction using only inexpensive-to-measure variables.
Medical records of 3145 people isolated in two Fangcang shelter hospitals (large-scale community isolation centers) from February to March 2020 were accessed. Two complementary methods—machine learning algorithms and competing risk survival analyses—were used to test potential predictors, including age, gender, severity upon admission, symptoms (general symptoms, respiratory symptoms, and gastrointestinal symptoms), computed tomography (CT) signs, and comorbid chronic diseases. All variables were measured upon (or shortly after) admission. The outcome was deterioration versus recovery of COVID-19.
More than a quarter of the 3145 people did not present any symptoms, while one-third ended isolation due to deterioration. Machine learning models identified moderate severity upon admission, old age, and CT ground-glass opacity as the most important predictors of deterioration. Removing CT signs did not degrade the performance of models. Competing risk models identified age ≥ 35 years, male gender, moderate severity upon admission, cough, expectoration, CT patchy opacity, CT consolidation, comorbid diabetes, and comorbid cardiovascular or cerebrovascular diseases as significant predictors of deterioration, while a stuffy or runny nose as a predictor of recovery.
Early-stage prediction of COVID-19 deterioration can be made with inexpensive-to-measure variables, such as demographic characteristics, severity upon admission, observable symptoms, and self-reported comorbid diseases, among asymptomatic people and mildly to moderately symptomatic patients.
The COVID-19 vaccination strategy has been widely used to protect population health worldwide. This study aims to summarize the cost-effectiveness evidence of economic evaluation of COVID-19 vaccination strategies to provide evidence supporting the usage of COVID-19 vaccination, especially where the supply of COVID-19 vaccine is limited.
A systematic literature review was performed by searching both English and Chinese databases, including PubMed, Embase, Science Direct, Web of Science, Medline, Scopus, and CNKI. Articles published from January 1, 2020 to August 1, 2022 (PROSPERO registration number: CRD42022355442).
Of the 1035 papers identified, a total of 28 English studies that met the preset criteria were included. COVID-19 vaccination and booster vaccination were cost-effective or cost-saving regardless of the vaccine type; vaccine efficacy, vaccine price, vaccine supply or prioritization, and vaccination pace were the influential factors of cost-effectiveness among different population groups. When supply is adequate, mass vaccination should be encouraged, while when supply is inadequate, prioritizing the high risk and the elderly is more cost-effective.
COVID-19 vaccination strategies are economically favorable in a wide range of countries and population groups, and further research on suitable strategies for booster COVID-19 vaccination is needed.
Frozen shoulder is a common disorder that can lead to long-lasting impairment in shoulder-related daily activities. Traditional Chinese medicine (TCM) has played an important role in the effort to manage frozen shoulder.
We aimed to develop an evidence-based guideline for treating frozen shoulder with traditional Chinese medicine.
Evidence-based guideline.
We developed this guideline based on internationally recognized and accepted guideline standards. The guideline development group used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to rate the certainty of evidence and the strength of recommendations. The benefits and harms, resources, accessibility, and other factors were fully taken into account, and the GRADE grid method was used to reach consensus on all recommendations.
We established a multidisciplinary guideline development panel. Based on a systematic literature search and a face-to-face meeting, nine clinical questions were identified. Finally, twelve recommendations were reached by consensus, comprehensively considering the balance of benefits and harms, certainty of evidence, costs, clinical feasibility, accessibility, and clinical acceptability.
This guideline panel made twelve recommendations, which covered the use of manual therapy, acupuncture, needle knife, Cheezheng Xiaotong plaster, Gutong plaster, exercise therapy and integrated TCM and Western medicine, such as combined modalities and corticosteroid injections. Most of them were weakly recommended or consensus based. The users of this guideline are most likely to be clinicians and health administrators.
This study aimed to assess the reporting quality and risk of bias of Cochrane individual participant data meta-analyses (IPD-MAs).
We searched the Cochrane Library and identified the Cochrane IPD-MAs. We used the Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data (PRISMA-IPD) assessed the reporting quality of included Cochrane IPD- MAs, and the Risk Of Bias In Systematic reviews (ROBIS) tool was used to assess the risk of bias. We performed stratified and correlation analyses to explore factors affecting the quality.
Forty-six Cochrane IPD-MAs were included in our study. Twenty-six Cochrane IPD-MAs (56.5%) had statistical or epidemiological authors involved, and 31 (67.4%) contained only IPD data. Thirty-five studies (76.1%) did not report whether they used 1-stage or 2-stage methods, and forty (87.0%) did not report the statistical techniques used for missing participant data. We found that the entire compliance reported PRISMA-IPD items of Cochrane IPD-MAs published after 2015 (n = 18; Mean ± SD: 26.61 ± 2.75) was higher than those studies published in 2015 and before (n = 28; Mean ± SD: 22.61 ± 4.73), the difference was statistically significant (p = 0.002). A strong positive correlation was found between the fully reported PRISMA-IPD items and fully accordance ROBIS items (Spearman's: ρ = 0.653, p < 0.001).
The quality of Cochrane IPD-MAs is not high, especially in the reporting of statistical methods. There was room for further improvement in IPD retrieval, IPD integrity and statistical analyses.
Is acupuncture effective in treating knee osteoarthritis (KOA)?
Although increasingly used in the clinical setting, acupuncture is not mentioned or weakly recommended in guidelines for the treatment of KOA.
We suggest acupuncture rather than no treatment in adult KOA (weak recommendation, moderate certainty evidence), and acupuncture combined with nonsteroidal anti-inflammatory drugs (NSAIDs) rather than acupuncture alone when KOA symptoms are severe (weak recommendation, moderate certainty evidence), with duration of acupuncture for 4–8 weeks depending on KOA severity and treatment response (weak recommendation, moderate certainty evidence), and discussing with patients in shared decision-making.
This rapid recommendation was developed following the Making GRADE the Irresistible Choice (MAGIC) methodological framework. First, the clinical specialist identified the topic of recommendation and demand for evidence. Then the independent evidence synthesis group performed a systematic review to summarize available evidence and evaluate the evidence using the GRADE approach. Finally, the clinical specialist group produced recommendations for practice through a consensus procedure.
The linked systematic review and meta-analysis included 9422 KOA patients, 61.1% of whom were women. The median mean age was 61.8 years. Compared with no treatment, acupuncture had beneficial effect on KOA in improving the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score (moderate certainty evidence), and WOMAC pain (very low certainty evidence), WOMAC stiffness (low certainty evidence), and WOMAC function (low certainty evidence) subscale scores. Compared with usual care, acupuncture improved WOMAC stiffness subscale score (moderate certainty evidence). Subgroup analyses showed different effects in the improvement of WOMAC total scores by different durations of acupuncture and whether acupuncture combined with NSAIDs, but no difference between manual acupuncture and electroacupuncture was found.
Compa
The devastating health impact of COVID-19 pandemic in early 2020 shortened the bench-to-clinic process of vaccine development from 10–20 years to ~10 months. The efficacy of such vaccines in preventing disease severity and mortality has been appreciated by both clinicians and end users. However, for infertile couples ready to undergo assisted reproductive technology, there is hesitation about vaccination due to the lack of comprehensive follow-up studies and clinical evidence on its safety during this procedure. Even the recommendations are not consistent between different fertility and obstetric societies. For example, the European Society of Human Reproduction and Embryology published a recommendation of at least a 2-month delay before starting assisted reproductive therapy after vaccination.1 However, the American Society for Reproductive Medicine encourage women who are undergoing assisted reproductive quality to receive vaccination.2
Acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invades target host cells via angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) that are present in the reproductive system, such as the epithelium of the urogenital tract and endometrium. Thus, SARS-CoV-2 infection may affect endometrial regeneration, proliferation and, subsequently, fetal implantation.3 The virus may also infect the placenta resulting in preeclampsia, miscarriage, fetal distress, and preterm birth.4 Vaccination remains the main strategy to reduce SARS-CoV2 transmission and prevent severe symptoms; however, there is a structural similarity between the spike protein of SARS-CoV-2 and human syncytidin-I related to placenta formation,5 which may cause a cross-reaction between the anti-spike protein antibodies produced by the vaccine and human syncytidin-I leading to implantation failure or miscarriage. In China, two inactivated COVID-19 vaccines (CoronaVac (Sinovac Life Sciences) and Sinopharm vaccine (The Beijing Institute of Biological Products)) have been widely used and recognized by WHO, which contain viruses that have lost their ability to infect or replicate but can still induce immune responses. Most studies outside China have focused on mRNA vaccines due to their local availability,6-8 which showed the safety amount infertile patients who require assisted reproductive technology. However, those studies did not include fetal growth, birth outcome and pregnancy complications. In addition, it is unclear whether the same applies to inactivated vaccines for such patients.
The research on the impact of COVID-19 vaccines on pregnancy outcomes in patients undergoing in vitro fertilization/intracytoplasmic sperm injection—embryo transfer (IVF/ICSI-ET) treatment is limited. One single-center study has investigated the effects of CoronaVac and Sinopharm va
Reporting guidelines (RGs) have been developed by researchers, methodologists, and journal editors to enhance the quality and transparency of scientific research reporting1 and to facilitate readers’ assessment of the internal and external validity of the studies. In 2014, a joint editorial2 of 28 rehabilitation journals highlighted the need to use RGs to ensure the quality of reporting rehabilitation research, stating “that simultaneous implementation of this new reporting requirement will send a strong message to all disability and rehabilitation researchers about the need to adhere to the highest standards when performing and disseminating research.”
While there is encouraging evidence that RGs improve reporting quality,3 there are also challenges to implementation and dissemination. Rehabilitation is a growing field with increasing attention to the quality of reporting. However, our previous studies show that in rehabilitation journals authors do not frequently declare the use of RGs,4 and the completeness of reporting of randomized controlled trials5 and systematic reviews6 is suboptimal.
The study protocol and the full version of the survey are available on the OSF Repository.8 We followed the guidance by Gaur et al.9 for the reporting of this manuscript. We conducted a web-based survey among all editorial board members (i.e., editors-in-chief, senior editors, and associate editors) of the 68 journals indexed under the “rehabilitation” category in InCites Journal Citation Report. This study complies with the Code of Ethics for Research involving Human Participants Faculty of Science (BETHCIE), Vrije Universiteit Amsterdam; therefore, a formal ethics review is not required.10 All participants were explicitly informed that participation in the survey was anonymous and voluntary. A copy of informed consent is available in the OSF repository.8 Only the participants that explicitly gave their consent to be acknowledged were mentioned in the acknowledgment section. Further information on ethics and privacy are available in the published protocol.8
Several meetings were held among the study authors, including one editor-in-chief of a rehabilitation journal (RZP) and two members of editorial boards of high-impact rehabilitation journals (RO, AV) to discuss the survey. One investigator (TI) developed a preliminary version, which was then further reviewed and discussed to ensure that the questions adequately met the study aims (confirming face validity). Next, the clarity of the questions with appropriate response items was checked in a pilot test among the study authors (RZP, AV, AC, RO, SS, SG), and any duplications or coinciding themes were removed. The initial questionnaire was r
To promote better reporting quality regarding sham acupuncture in clinical trials for a precise appraisal of the adequacy of the sham acupuncture procedure.
A three-stage online Delphi survey was conducted to a group of experts. Items with higher than 80% consensus from the initial checklist were selected as the final candidates. Further discussion among the working group was convened to preclude potential redundancy among the items.
A total of 23 experts out of 35 (66%) responded to the Delphi process. The final checklist consists of 23 items in six categories: type of sham acupuncture, details of sham acupuncture manipulation, location of sham acupuncture, treatment regimen, practitioner, and protocol and settings.
This paper presents the Acupuncture Controls gUideline for Reporting humAn Trials and Experiments (ACURATE) checklist, an extension of The Consolidated Standards for Reporting of Trials (CONSORT) and to be used along with STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) when sham acupuncture needles are used in the study. This checklist focuses on a clear depiction of sham needling procedures to enhance replicability and enable a precise appraisal. We encourage researchers to use ACURATE in trials and reviews involving sham acupuncture to assist reporting sham acupuncture procedures and the related components.
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