Coevolution of COVID-19 research and China's policies

A comment-driven evidence appraisal approach to promoting research findings into practice when only uncertain evidence is available

BACKGROUND

Comments in PubMed are usually short papers for supporting or refuting claims, or discussing methods and findings in original articles. This study aims to explore whether they can be used as a quick and reliable evidence appraisal instrument for promoting research findings into practice, especially in emergency situations such as COVID-19 in which only missing, incomplete or uncertain evidence is available.

METHODS

Evidence-comment networks (ECNs) were constructed by linking COVID-19-related articles to the commentaries (letters, editorials or brief correspondence) they received. PubTator Central was used to extract entities with a high volume of comments from the titles and abstracts of the articles. Among them, six drugs were selected, and their evidence assertions were analysed by exploring the structural information in the ECNs as well as the sentiment of the comments (positive, negative, neutral). Recommendations in WHO guidelines were used as the gold standard control to validate the consistency, coverage and efficiency of comments in reshaping clinical knowledge claims.

RESULTS

The overall positive/negative sentiments of comments were aligned with recommendations for/against the corresponding treatments in the WHO guidelines. Comment topics covered all significant points of evidence appraisal and beyond. Furthermore, comments may indicate the uncertainty regarding drug use for clinical practice. Half of the critical comments emerged 4.25 months earlier on average than the guideline release.

CONCLUSIONS

Comments have the potential as a support tool for rapid evidence appraisal as they have a selection effect by appraising the benefits, limitations and other clinical practice issues of concern in existing evidence. We suggest as a future direction an appraisal framework based on the comment topics and sentiment orientations to leverage the potential of scientific commentaries supporting evidence appraisal and decision-making.

Regulating the product quality of COVID-19 antigen testing reagents: A tripartite evolutionary game analysis under China's legal framework

Personal purchases of novel coronavirus antigen detection reagents (ADRs) for self-detection have contributed to the optimization of medical resources and containment of the COVID-19 pandemic. The recurring occurrence of false testing results in China has generated concerns regarding the quality of ADRs and the testing mechanism for medical devices. Academic viewpoints and remarks on the sensitivity, application possibilities, and product innovation of ADRs may be found in the extant scientific literature. However, the current research does not explore the microscopic product quality concerns that emerge throughout the production and marketing of ADRs. To explore strategic equilibrium circumstances and behavioral evolution processes, an evolutionary game model was developed to include ADR manufacturers, third-party medical device inspection agencies, and regulatory authorities. The results reveal that the quantity of illegal incentives, the cost of regulation, and the loss of government credibility have a major impact on the decisions of regulatory authorities and determine three potential systemic equilibrium states. To maximize social welfare, ADRs should be incorporated into China's medication price monitoring system in order to manage market prices. To cut regulatory expenses, the government should employ blockchain technology for traceable network regulation of ADR product quality. The government should also protect the people's right to free speech and encourage online reporting of adverse incidents caused by ADRs. The conclusions of this article can provide many developing nations with important insights for regulating the quality of ADR products.

Influence on emergency digit replantation and outcome assessment after COVID-19 virus nucleic acid testing normalization

Objective

The study aims to compare the implementation and prognosis of emergency digit replantation surgery before and after normalized corona virus disease 2019 (COVID-19) nucleic acid testing for patients taking emergency operation and to explore the influence of normalized COVID-19 nucleic acid testing on replantation surgery.

Method

Normalized COVID-19 nucleic acid testing for patients taking emergency operation has been carried out since 1 August 2021 at our hospital, which means each patient who needs emergency surgical treatment has to obtain either positive or negative results of COVID-19 nucleic acid before entering the operating room. This research reviewed and compared the prognosis of the injured extremity that had emergency severed digit replantation between June and September 2021, at the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, and analyzed the impact of normalized COVID-19 nucleic acid testing on the outcome of the replanted fingers of different severity using disability of arm-shoulder-hand (DASH) and hand injury severity scoring (HISS) scoring systems.

Results

A total of 54 cases with 74 severed replanted phalanges were included replanted by the research group between 1 August and 30 September 2021, without any COVID-19 suspected/confirmed case detected. Compared with previous period (1 June to 31 July, 2021), although the interval between emergency visits and emergency replantation did increase significantly after normalized COVID-19 nucleic acid testing [(3.83 ± 0.94) to (1.77 ± 0.67) h, P < 0.05], we observed no significant difference in the improvement rate of the DASH scoring of the disabled upper extremity 3-month postoperatively (P = 0.538) nor in the complication rate (P = 0.344). Moreover, there was no significant difference in the improvement rate of the DASH scoring of the disabled upper extremity 3-month postoperatively in patients with different traumatic severities before and after normalized COVID-19 nucleic acid testing (moderate P = 0.269, severe P = 0.055, major P = 0.149).

Conclusion

Despite the preoperative delay, the policy of COVID-19 nucleic acid testing normalization does not have explicit influence on the short-term outcomes of emergency digit replantation surgery. With this evidence, microsurgeons could pay attention to the patients' anxiety and spend more effort in comforting them during the prolonged preoperative wait. These insights may have implications for other emergency department resource management whenever a social crisis occurs.

The Running Track of Government Responsibility During the Pandemic, Characteristic Analysis of Policy Documents Relevant to the COVID-19 Pandemic Released by Beijing Municipal Government in 2020

Objective: Provide a reference point for the division of labor during the collaboration of multiple departments and the planning for the prevention and control of the Covid-19 epidemic of departments of the Beijing Municipal Government, from the perspective of policy documents. Methods: Policy documents and daily updates on COVID-19 cases published in 2020 are taken from the official website of Beijing Municipal Government and Beijing Municipal Health Commission. The characteristics of the pandemic situation and the content of relevant documents issued by different departments are described in five stages. Results: There were 988 confirmed cases of COVID-19 in Beijing in 2020, and policy analysis covered 444 documents (257 policy documents and 187 explanations of policy). A total of 153 policy documents were directly issued by the Beijing Municipal Government and its 45 subordinate commissions and bureaus, while others were policy forwarding from the central government and its relevant departments, county-level governments of Beijing and other organizations. Most cases and documents emerged during the initial stage of the pandemic (Level-I of the Emergency Response, which is the most serious). It was found that as many as 109 documents published by Beijing Municipal Government during the Level I emergency response period were relevant to economic and social development, 83 documents were related to disease control and medical services, and the rest were in close relation to the production and daily life of the people. Overall, major policy measures taken were relevant to 7 fields: finance, transportation, economic activities, employment people's lives, epidemic prevention and control and medical insurance. Policy implementation objectives were centered on promoting epidemic prevention and control and maintaining the stability of social production and residents' life. However, there are different emphases in different stages of the epidemic. Conclusion: Beijing municipality realized an effective mode of collaboration among multiple departments and organizations in the prevention and control of the COVID-19 epidemic, which was an example of the practice of "Health in All Policies."