What Can COVID-19 Teach Us about Using AI in Pandemics?

The COVID-19 pandemic put significant strain on societies and their resources, with the healthcare system and workers being particularly affected. Artificial Intelligence (AI) offers the unique possibility of improving the response to a pandemic as it emerges and evolves. Here, we utilize the WHO framework of a pandemic evolution to analyze the various AI applications. Specifically, we analyzed AI from the perspective of all five domains of the WHO pandemic response. To effectively review the current scattered literature, we organized a sample of relevant literature from various professional and popular resources. The article concludes with a consideration of AI\u27s weaknesses as key factors affecting AI in future pandemic preparedness and response

Comprehensive User Engagement Sites (CUES): Is This a Viable Option for the Opioid Epidemic in Philadelphia?

INTRODUCTION: Opioid drug abuse has become an increasing concern throughout the United States, especially within the Philadelphia region. In 2017, the number of deaths by drug overdose were four times that of deaths by homicide. In addition, a total of 935 cases of secondary conditions due to needle sharing such as HIV and HCV occurred during the past year. The opioid epidemic has caused a public health emergency and any measures that could decrease the morbidity and mortality associated with opioid abuse are vital. A current proposal to combat this issue in Philadelphia is the implementation of a Comprehensive User Engagement Site (CUES); a site intended to offer medical resources and assistance for opioid users. This study analyzed the clinical, ethical, and economic considerations associated with a potential CUES site in Philadelphia. METHODS: A review of the literature was conducted using PubMed, EMBASE, and various public data sources. Search keywords included the history and efficacy of safe injection facilities (SIFs), their implementation to Philadelphia, and other related terms. Semi-structured discussion sessions were also conducted among members of the Institute of Clinical Bioethics at Saint Joseph’s University, resident physicians at Mercy Health System, and PCOM medical students. Topics of discussion included the risks, benefits, and ethics involved in initiating a CUES in Philadelphia, with research regarding past SIFs being uses as a comparative model. RESULTS: The impact of a CUES in Philadelphia has been estimated to avert 3-48 cases of HIV infections annually, 15-213 cases of HCV infections annually, and between 24-76 deaths. In addition, the site is estimated to reduce costs due to skin infection by $1.5-1.9 Million annually, costs due to overdose deaths by upwards of$75 Million annually, as well as costs related to ambulance and hospital visits by $123,000 and$300,000 per averted case respectively. Ethical analysis revealed that safe injection is ethically permissible given the primary intent is to limit the user’s exposure to harm. DISCUSSION: The implementation of a CUES in Philadelphia may be an effective tool to address opioid crisis. It would reduce healthcare costs through prevention of drug-related sequelae, offer treatment and resources for people seeking to overcome their opioid dependence, and act as an educational opportunity for future healthcare professionals by promoting student engagement with marginalized populations

Outcomes After Transcatheter Aortic Valve Implantation in Patients Excluded From Clinical Trials

Background: The use of transcatheter aortic valve implantation (TAVI) in patients with aortic valve disease excluded from clinical trials has increased with no large-scale data on its safety. Objectives: The purpose of this study was to assess the trend of utilization and adjusted outcomes of TAVI in clinical trials excluded (CTE) vs clinical trials included TAVI (CTI-TAVI) patients. Methods: We used the National Readmission Database (2015-2019) to identify 15 CTE-TAVI conditions. A propensity score-matched analysis was used to calculate the adjusted odds ratio (aOR) of net adverse clinical events (composite of mortality, stroke, and major bleeding) in patients undergoing CTE-TAVI vs CTI-TAVI. Results: Among the 223,238 patients undergoing TAVI, CTE-TAVI was used in 41,408 patients (18.5%). The yearly trend showed a steep increase in CTE-TAVI utilization (P = 0.026). At index admission, the adjusted odds of net adverse clinical events (aOR: 1.83, 95% CI: 1.73-1.95) and its components, including mortality (aOR: 2.94, 95% CI: 2.66-3.24), stroke (aOR: 1.20, 95% CI: 1.07-1.34), and major bleeding (aOR: 1.49, 95% CI: 1.36-1.63) were significantly higher in CTE-TAVI compared with CTI-TAVI. Among the individual contraindications to clinical trial enrollment in the CTE-TAVI, patients with bicuspid aortic valve, leukopenia, and peptic ulcer disease appeared to have similar outcomes compared with CTI-TAVI, while patients with end-stage renal disease, bioprosthetic aortic valves, and coagulopathy had a higher readmission rate at 30 and 180 days. Conclusions: CTE-TAVI utilization has increased significantly over the 4-year study period. Patients undergoing CTE-TAVI have a higher likelihood of mortality, stroke, and bleeding than those undergoing CTI-TAVI

An Anti-CD3 Antibody, Teplizumab, in Relatives at Risk for Type 1 Diabetes.

BackgroundType 1 diabetes is a chronic autoimmune disease that leads to destruction of insulin-producing beta cells and dependence on exogenous insulin for survival. Some interventions have delayed the loss of insulin production in patients with type 1 diabetes, but interventions that might affect clinical progression before diagnosis are needed.MethodsWe conducted a phase 2, randomized, placebo-controlled, double-blind trial of teplizumab (an Fc receptor-nonbinding anti-CD3 monoclonal antibody) involving relatives of patients with type 1 diabetes who did not have diabetes but were at high risk for development of clinical disease. Patients were randomly assigned to a single 14-day course of teplizumab or placebo, and follow-up for progression to clinical type 1 diabetes was performed with the use of oral glucose-tolerance tests at 6-month intervals.ResultsA total of 76 participants (55 [72%] of whom were ≤18 years of age) underwent randomization - 44 to the teplizumab group and 32 to the placebo group. The median time to the diagnosis of type 1 diabetes was 48.4 months in the teplizumab group and 24.4 months in the placebo group; the disease was diagnosed in 19 (43%) of the participants who received teplizumab and in 23 (72%) of those who received placebo. The hazard ratio for the diagnosis of type 1 diabetes (teplizumab vs. placebo) was 0.41 (95% confidence interval, 0.22 to 0.78; P = 0.006 by adjusted Cox proportional-hazards model). The annualized rates of diagnosis of diabetes were 14.9% per year in the teplizumab group and 35.9% per year in the placebo group. There were expected adverse events of rash and transient lymphopenia. KLRG1+TIGIT+CD8+ T cells were more common in the teplizumab group than in the placebo group. Among the participants who were HLA-DR3-negative, HLA-DR4-positive, or anti-zinc transporter 8 antibody-negative, fewer participants in the teplizumab group than in the placebo group had diabetes diagnosed.ConclusionsTeplizumab delayed progression to clinical type 1 diabetes in high-risk participants. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT01030861.)

Self-Assessment of Preparedness among Critical Care Trainees Transitioning from Fellowship to Practice

This study evaluated the subjective assessment of preparedness needs of critical care trainees and recent graduates between 2013 and 2014. A questionnaire was developed and validated by the subcommittee of the In-Training Section of Society of Critical Care Medicine (SCCM). The survey was deployed twice between December 2013 and January 2014 via email to any trainee or individual graduated from a critical care fellowship within the previous three years. Six percent (180) of all individuals completed the survey, and 67% of respondents had recently interviewed for a job. Northeast was the preferred location for a job (47%), and academia was favored over private practice (80% vs. 15%). Of the respondents that secured an interview, 55% felt prepared for the interview, 67% felt prepared to build an adequate job portfolio, 33% received formal guidance from their mentor/training program. 89% of total respondents agreed it is important to participate in a formal training course in job search, portfolio development, and interviewing process. The preferred sources of training were equally distributed between their home institution, webinars, and SCCM. There is an ongoing need in education regarding the transition period from fellowship to practice

Content analysis of locum tenens recruitment emails for anesthesiologists

Abstract Background Locum tenens continues to be an increasingly utilized employment option among healthcare organizations to cope with short-term provider vacancies. There exist no studies that explore the job characteristics of such assignments. The purpose of this study was to characterize the clinical responsibilities and compensation of anesthesiology locum tenens positions through content analysis of recruitment emails. Through this data, anesthesiologists interested in locum tenens will be better equipped to evaluate the merit of potential opportunities. Methods The study was conducted using a compiled database of unsolicited emails received by one of the authors. A total of 241 emails containing 794 assignments were included during the period of 1/09/17 to 1/26/18 (383 days in total). The information was extracted using a standardized template and was entered into a database. Additional validation of the content was done using a data mining tool. Results Most of the job opportunities originated from five staffing agencies. A total of 37, 25, and 17% of the assignments were allocated to hospitals, ambulatory surgical centers, and trauma centers respectively. The mean caseload for the assignments was between 8.5 and 11.1 cases per day. The mean daily work shift was 9.1 hours, and the average duration of the assignment was one week. The most frequently requested cases included general (74%), orthopedics (54%), and OB/GYN (51%). However, information regarding training qualifications and licensing was not routinely provided. Only 13.1% of assignments specified a system of medical documentation with paper charting being the most common. The mean hourly rate for locum anesthesiologists in our sample was $186.19, significantly higher than the national average of$127.88. Around 28% of staffing agencies covered the licensing expenses of specialists while 23% covered the expense of travels and 20% covered accommodation costs. Conclusions Descriptions for locum tenens positions follow common anesthesiology practices and feature superior compensation to national estimates. However, vital information is often omitted from recruitment emails, and practice settings are highly variable. Anesthesiologists are urged to fully investigate opportunities before accepting based on recruitment emails. Managers should require more details to be provided in job offers

Global Brain Drain: How Can the Maslow Theory of Motivation Improve Our Understanding of Physician Migration?

The migration of physicians from low-resource to high-resource settings is a prevalent global phenomenon that is insufficiently understood. Most low-income countries are severely understaffed with physicians, and the emigration of the already limited number of physicians to other countries can significantly reduce access to healthcare in the source country. Despite a growing interest in global capacity building in these countries by academic and non-governmental organizations in high-income countries, efforts to stem physician migration have been mostly unsuccessful. The authors reviewed the current literature for the motivational factors leading to physician migration in the context of Maslow’s hierarchy of human needs. Our study found that financial safety needs were major drivers of physician emigration. However, factors related to self-actualization such as the desire for professional development through training opportunities and research, were also major contributors. These findings highlight the multifactorial nature of physician motivations to emigrate from low-resource countries. Maslow’s Theory of Motivation may provide a useful framework for future studies evaluating the concerns of physicians in low-income countries and as a guide to incentivize retention

A Longitudinal Survey of Participation in Medical Elective Rotations in Developing Nations by US-based Anesthesiology Residents

International electives are a growing interest among residents in all training programs. Personal observations of anesthesia volunteers’ experiences overseas have been published, but descriptive studies regarding the effects of an international humanitarian assignment are lacking. Health Volunteers Overseas (HVO) is a private, non-governmental volunteer organization. It has long-term programs in developing countries aimed at improving education of local anesthesia providers. Clinical and didactic teaching is provided by volunteers, including residents, during a 2 to 4-week period. The aim of this study was to gather information on the effect of a volunteer assignment on personal and professional development of resident volunteers. It is designed as a longitudinal survey (pre- and post- assignment) of a cohort of anesthesia resident volunteers participating in HVO-sponsored teaching programs abroad. The survey contains 12 questions designed to have residents report their comfort and experience level with specific teaching techniques. Residents were also asked basic demographic data and professional goals. Due to small sample, only basic descriptive statistics were utilized; the study was not successfully powered to determine the significance of these findings. Forty-one residents were sent the survey and 33 completed it (n=33). Out of our sample of anesthesia residents, 26.85% were planning to go to academics, 19.51% private practice while 9.7% were undecided. After the HVO assignment, their career choices predictably narrowed down: 37.1% academia, 34.3% private practice, 5.7% were still undecided, 11.4% planned public health career. The vast majority of strongly agreed that “they plan to make participation in volunteer assignment abroad their career” before involvement in the volunteer assignment (88%). After the assignment, this enthusiasm was somewhat dampened since only 60% still strongly agreed with this statement. In summary, anesthesia residents doing an international elective reported their experience as meaningful and professionally rewarding. Despite a slight decrease in the magnitude of enthusiasm, the vast majority of participants remained committed to volunteer service throughout their careers following the experience. Furthermore, by self-report, the assignment increased residents’ confidence in teaching and positively impacted their professional focus