Epidemiological models and COVID-19: a comparative view

Epidemiological models have played a central role in the COVID-19 pandemic, particularly when urgent decisions were required and available evidence was sparse. They have been used to predict the evolution of the disease and to inform policy-making. In this paper, we address two kinds of epidemiological models widely used in the pandemic, namely, compartmental models and agent-based models. After describing their essentials-some real examples are invoked-we discuss their main strengths and weaknesses. Then, on the basis of this analysis, we make a comparison between their respective merits concerning three different goals: prediction, explanation, and intervention. We argue that there are general considerations which could favour any of those sorts of models for obtaining the aforementioned goals. We conclude, however, that preference for particular models must be grounded case-by-case since additional contextual factors, as the peculiarities of the target population and the aims and expectations of policy-makers, cannot be overlooked.

Progress in evidence-based medicine: a quarter century on

In response to limitations in the understanding and use of published evidence, evidence-based medicine (EBM) began as a movement in the early 1990s. EBM's initial focus was on educating clinicians in the understanding and use of published literature to optimise clinical care, including the science of systematic reviews. EBM progressed to recognise limitations of evidence alone, and has increasingly stressed the need to combine critical appraisal of the evidence with patient's values and preferences through shared decision making. In another progress, EBM incorporated and further developed the science of producing trustworthy clinical practice guidelines pioneered by investigators in the 1980s. EBM's enduring contributions to clinical medicine include placing the practice of medicine on a solid scientific basis, the development of more sophisticated hierarchies of evidence, the recognition of the crucial role of patient values and preferences in clinical decision making, and the development of the methodology for generating trustworthy recommendations.

An evidence assessment tool for ecosystem services and conservation studies

Reliability of scientific findings is important, especially if they directly impact decision making, such as in environmental management. In the 1990s, assessments of reliability in the medical field resulted in the development of evidence-based practice. Ten years later, evidence-based practice was translated into conservation, but so far no guidelines exist on how to assess the evidence of individual studies. Assessing the evidence of individual studies is essential to appropriately identify and synthesize the confidence in research findings. We develop a tool to assess the strength of evidence of ecosystem services and conservation studies. This tool consists of (1) a hierarchy of evidence, based on the experimental design of studies and (2) a critical-appraisal checklist that identifies the quality of research implementation. The application is illustrated with 13 examples and we suggest further steps to move towards more evidence-based environmental management.

A novel Internet-based blended learning programme providing core competency in clinical research

RATIONALE, AIMS AND OBJECTIVES

We developed a novel Internet-based blended learning programme that allows busy health care professionals to attain core competency in clinical research. This study details the educational strategies and learning outcomes of the programme.

METHOD

This study was conducted at Kyoto University and seven satellite campuses from September 2009 to March 2010. A total of 176 health care professionals who had never attempted to attain core competency in clinical research were enrolled. The participants were supplied with a novel programme comprising the following four strategies: online live lectures at seven satellite campuses, short examinations after each lecture, an Internet-based feedback system and an end-of-course examination. We assessed the proportion of attendance at the lectures as the main outcome. In addition, we evaluated interaction via the feedback system and scores for end-of-course examination.

RESULTS

Of the 176 participants, 134 (76%) reported working more than 40 hours per week. The mean proportion of attendance over all 23 lectures was 82%. A total of 156 (89%) participants attended more than 60% of all lectures and were eligible for the end-of-course examination. A total of the participants accessed the feedback system 3564 times and asked 284 questions. No statistically significant differences were noted in the end-of-course scores among medical doctors, pharmacists, registered nurses and other occupations.

CONCLUSIONS

We developed an Internet-based blended learning programme providing core competency in clinical research. Most busy health care professionals completed the programme successfully. In addition, the participants could attain the core competency effectively, regardless of their occupation.

Why critically ill patients are protein deprived

Critical illness dramatically increases muscle proteolysis and more than doubles the dietary protein requirement. Yet surprisingly, most critically ill patients receive less than half the recommended amount of protein during their stay in a modern intensive care unit. What could explain the wide gap between the recommendations in clinical care guidelines and actual clinical practice? We suggest that an important aspect of the problem is the failure of guidelines to explain the pathophysiology of protein-energy malnutrition and the ways critical illness modifies protein metabolism. The difficulty created by the lack of a framework for reasoning about appropriate protein provision in critical illness is compounded by the many ambiguous and often contradictory ways the word malnutrition is used in the critical care literature. Failing to elucidate these matters, the recommendations for protein provision in the guidelines are incoherent, unconvincing, and easy to ignore.

Heat stimulation on the skin for medical treatment: can it be controlled?

OBJECTIVES

It has become increasingly important for evidence-based medicine to have a proper control for randomized-controlled trials. However, appropriately controlling manual therapies such as moxibustion has proved challenging. Our team designed a novel device based on sensory illusion, and tested its feasibility.

DESIGN AND RESULTS

A sham moxibustion device was constructed to allow participants to feel moxibustion treatment without actually stimulating the corresponding acupoint. The device consisted of two pieces of aluminum, each shaped like a horseshoe, so that the center of the device would not touch the skin. Participants perceived two heat stimuli as one when the distances of two heat sources were within 15 mm on the forearm. The thermal stimulation of the sham device was adjusted to the lowest possible temperature, but enough to elicit a heat sensation (39°C), while that of verum was set at around 44°C. The subject blinding, tested in 30 healthy volunteers, was successful. With the exception of 1 subject, subjects in the sham group described the sensation as a warm solid circle, unable to differentiate between two-pieced sham moxibustion and verum moxibustion.

CONCLUSIONS

This preliminary study indicates that this device may serve as an appropriate control for clinical studies of moxibustion, but more research is clearly needed. A validated sham moxibustion device based on sensory illusion may contribute in expanding knowledge of somatosensory studies.