Cost Determinants of Continuum-Care Episodes for Hip Fracture.

Many factors affect the healthcare costs and outcomes in patients with hip fracture (HF). Through the construction of a Continuum-Care Episode (CCE), we investigated the costs of CCEs for HF and their determinants. We used data extracted from administrative databases of 5094 consecutive elderly patients hospitalized in 2017 in Emilia Romagna, Italy, to evaluate the overall costs of the CCE. We calculated the acute and post-acute costs from the date of the hospital admission to the end of the CCE. The determinants of costs by type of surgical intervention (total hip replacement, partial hip replacement, open reduction, and internal fixation) were investigated using generalized linear regression models. Regardless of the type of surgical intervention, hospital bed-based rehabilitation in public or private healthcare facilities either followed by rehabilitation in a community hospital/temporary nursing home beds or not were the strongest determinants of costs, while rehabilitation in intermediate care facilities alone was associated with lower costs. CCE's cost and its variability is mainly related to the rehabilitation setting. Cost-wise, intermediate care resulted to be an appropriate setting for providing post-acute rehabilitation for HF, representing the one associated with lower overall costs. Intermediate care organizational setting should be privileged when planning integrated care HF pathways.

Using altmetrics for detecting impactful research in quasi-zero-day time-windows: the case of COVID-19.

On December 31st 2019, the World Health Organization China Country Office was informed of cases of pneumonia of unknown etiology detected in Wuhan City. The cause of the syndrome was a new type of coronavirus isolated on January 7th 2020 and named Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2). SARS-CoV-2 is the cause of the coronavirus disease 2019 (COVID-19). Since January 2020 an ever increasing number of scientific works related to the new pathogen have appeared in literature. Identifying relevant research outcomes at very early stages is challenging. In this work we use COVID-19 as a use-case for investigating: (1) which tools and frameworks are mostly used for early scholarly communication; (2) to what extent altmetrics can be used to identify potential impactful research in tight (i.e. quasi-zero-day) time-windows. A literature review with rigorous eligibility criteria is performed for gathering a sample composed of scientific papers about SARS-CoV-2/COVID-19 appeared in literature in the tight time-window ranging from January 15th 2020 to February 24th 2020. This sample is used for building a knowledge graph that represents the knowledge about papers and indicators formally. This knowledge graph feeds a data analysis process which is applied for experimenting with altmetrics as impact indicators. We find moderate correlation among traditional citation count, citations on social media, and mentions on news and blogs. Additionally, correlation coefficients are not inflated by indicators associated with zero values, which are quite common at very early stages after an article has been published. This suggests there is a common intended meaning of the citational acts associated with aforementioned indicators. Then, we define a method, i.e. the Comprehensive Impact Score (CIS), that harmonises different indicators for providing a multi-dimensional impact indicator. CIS shows promising results as a tool for selecting relevant papers even in a tight time-window. Our results foster the development of automated frameworks aimed at helping the scientific community in identifying relevant work even in case of limited literature and observation time.

Frauds in scientific research and how to possibly overcome them.

Frauds and misconduct have been common in the history of science. Recent events connected to the COVID-19 pandemic have highlighted how the risks and consequences of this are no longer acceptable. Two papers, addressing the treatment of COVID-19, have been published in two of the most prestigious medical journals; the authors declared to have analysed electronic health records from a private corporation, which apparently collected data of tens of thousands of patients, coming from hundreds of hospitals. Both papers have been retracted a few weeks later. When such events happen, the confidence of the population in scientific research is likely to be weakened. This paper highlights how the current system endangers the reliability of scientific research, and the very foundations of the trust system on which modern healthcare is based. Having shed light on the dangers of a system without appropriate monitoring, the proposed analysis suggests to strengthen the existing journal policies and improve the research process using new technologies supporting control activities by public authorities. Among these solutions, we mention the promising aspects of the blockchain technology which seems a promising solution to avoid the repetition of the mistakes linked to the recent and past history of research.

Adoption of Digital Technologies in Health Care During the COVID-19 Pandemic: Systematic Review of Early Scientific Literature.

BACKGROUND: The COVID-19 pandemic is favoring digital transitions in many industries and in society as a whole. Health care organizations have responded to the first phase of the pandemic by rapidly adopting digital solutions and advanced technology tools. OBJECTIVE: The aim of this review is to describe the digital solutions that have been reported in the early scientific literature to mitigate the impact of COVID-19 on individuals and health systems. METHODS: We conducted a systematic review of early COVID-19-related literature (from January 1 to April 30, 2020) by searching MEDLINE and medRxiv with appropriate terms to find relevant literature on the use of digital technologies in response to the pandemic. We extracted study characteristics such as the paper title, journal, and publication date, and we categorized the retrieved papers by the type of technology and patient needs addressed. We built a scoring rubric by cross-classifying the patient needs with the type of technology. We also extracted information and classified each technology reported by the selected articles according to health care system target, grade of innovation, and scalability to other geographical areas. RESULTS: The search identified 269 articles, of which 124 full-text articles were assessed and included in the review after screening. Most of the selected articles addressed the use of digital technologies for diagnosis, surveillance, and prevention. We report that most of these digital solutions and innovative technologies have been proposed for the diagnosis of COVID-19. In particular, within the reviewed articles, we identified numerous suggestions on the use of artificial intelligence (AI)-powered tools for the diagnosis and screening of COVID-19. Digital technologies are also useful for prevention and surveillance measures, such as contact-tracing apps and monitoring of internet searches and social media usage. Fewer scientific contributions address the use of digital technologies for lifestyle empowerment or patient engagement. CONCLUSIONS: In the field of diagnosis, digital solutions that integrate with traditional methods, such as AI-based diagnostic algorithms based both on imaging and clinical data, appear to be promising. For surveillance, digital apps have already proven their effectiveness; however, problems related to privacy and usability remain. For other patient needs, several solutions have been proposed, such as telemedicine or telehealth tools. These tools have long been available, but this historical moment may actually be favoring their definitive large-scale adoption. It is worth taking advantage of the impetus provided by the crisis; it is also important to keep track of the digital solutions currently being proposed to implement best practices and models of care in future and to adopt at least some of the solutions proposed in the scientific literature, especially in national health systems, which have proved to be particularly resistant to the digital transition in recent years.

The association between ABO blood group and SARS-CoV-2 infection: A meta-analysis.

At present, existing evidence about the association between SARS-CoV-2 infection and ABO blood group polymorphism is preliminary and controversial. In this meta-analysis we investigate this association and determine SARS-CoV-2 positive individuals' odds of having a specific blood group compared to controls. We performed a systematic search on MEDLINE and LitCovid databases for studies published through July 15, 2020. Seven studies met inclusion criteria for meta-analysis, including a total of 13 subgroups of populations (7503 SARS-CoV-2 positive cases and 2962160 controls). We analysed the odds of having each blood group among SARS-CoV-2 positive patients compared with controls. Random-effects models were used to obtain the overall pooled odds ratio (OR). Subgroup and sensitivity analyses were performed in order to explore the source of heterogeneity and results consistency. The results of our meta-analysis indicate that SARS-CoV-2 positive individuals are more likely to have blood group A (pooled OR 1.23, 95%CI: 1.09-1.40) and less likely to have blood group O (pooled OR = 0.77, 95%CI: 0.67-0.88). Further studies are needed to investigate the mechanisms at the basis of this association, which may affect the kinetics of the pandemic according to the blood group distribution within the population.