Letter to Editor | DOI: https://doi.org/10.31579/2690-8794/064
*Corresponding Author: Juan Martin Lazaro, Intensive Care Unit, Newham University Hospital, London.
Citation: Juan M. Lazaro, Kelly J. and Alamo P. (2021) Clinical decision Support Systems in Critical Care During Covid-19 Clinical Medical Reviews and Reports 3(2); DOI: 10.31579/2690-8794/064
Copyright: © 2021, Juan Martin Lazaro, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 11 February 2021 | Accepted: 15 February 2021 | Published: 22 February 2021
Keywords: Keywords
Abstract
We congratulate Alexander Supady and colleagues for their recent informative work on rationing decisions for COVID-19 patients when resources are scarce [1]. We appreciate the proposal of involving triage committees in the application of rationing. However, we suggest that the clinical needs are somewhat broader than those discussed in this work.
With the first wave of COVID-19 we learnt to optimise care by utilitarian and egalitarian principles of prioritisation, which provided a reasonable method of rationing resources. In the second wave of COVID-19 we have taken a different approach, because more equipment and resources were initially available. Generally, we tried to save more lives, and put aside, at least for a while, utilitarian rationing. However, it was realised that incrementing equipment and resources soon led to a lack of specialised personnel, and would potentially overwhelm the healthcare system in the United Kingdom and globally.
The input of triage committees is timely because it can help address several other significant problems intensivists face beyond the question of who should be admitted to an intensive care unit. These problems include: when is the right moment to withdraw care? Which patients should be palliated? which patients should be escalated to dialysis or inotropes?
Clinical Decision Support (CDS) systems must be developed to increase equity and reduce the burden these decisions place on clinicians - particularly now that it is becoming more widely recognised that taking such decisions has the potential to inflict occupational moral injury on clinicians [2]. The 4C Deterioration Model and the 4C Mortality Score arose during the first wave as potential solutions. More complex tools have emerged, such as the COVID-19 Severity Score, and risk factors in a statistical learning algorithm to predict mortality [3]. However, such tools are still only targeted at the questions of admission to ICU and mortality.
Of course, clinicians need to use their judgement to make decisions that are at all times realistic and impartial [4], but they would benefit greatly from tools to answer the additional pressings questions above. These tools have the potential to help clinicians make clearer decisions based on more rational support than family or system pressures, and to save lives by prioritizing critical care in patients at high risk for adverse outcomes [5]. Traditional tools such as SOFA scoring have become obsolete, showing no accuracy in end of life care decisions in the context of a viral pandemic. There is an urgent need for a COVID-19 disease severity assessment that can assist in critical care in resource allocation for patients at risk for severe disease.
Dear Editorial Team, Clinical Medical Reviews and Reports. My experience with the journal was highly positive. The peer-review process was rigorous, constructive, and completed in a timely manner. The reviewers provided valuable comments that helped improve the quality and clarity of our manuscript. The editorial office was professional, responsive, and supportive throughout all stages of the publication process. Communication was clear and efficient, and any questions were addressed promptly. Overall, I found the journal to maintain high scientific standards and an excellent publication workflow. I would be pleased to consider submitting future work to this journal. Best wishes from, Elena Popa.
It was my pleasure to submit my testimonial concerning the Reviewer Board of our Scientific Journal “Brain and Neurological Disorders”. The Reviewers focused on some modifications and their contribution was helpful. The ladies of our Editorial Office were also supported my efforts. It was my honor to have such a co-operation and I am looking forward for more collaboration.
Dear Grace Pierce, Editorial Coordinator of Journal of Clinical Research and Reports, Thank you for the speedy and efficient peer review process. I appreciate the fact that your peer reviewers do not take months to respond like with some other journals. I would also like to thank the editorial office for responding quickly to my questions. It is an excellent journal. I plan to submit more manuscripts in the future. Best wishes from, Robert W. McGee
Dear Grace Pierce, Editorial Coordinator of Journal of Clinical Research and Reports, Working with you and your team on our recent publication in JCRR has been a truly wonderful and enjoyable experience. The responses were prompt, and the reviewers were patient, constructive, and highly professional. One reviewer in particular gave me the feeling that a professor was carefully reading and commenting on my coursework, which was deeply touching. The entire process was straightforward and hassle‑free, with no tedious online forms to complete. I highly recommend this journal. Best wishes from, DR Aibing Rao, Head of R&D
I Appreciate the Opportunity to Share my Experience with the Journal of Clinical Research and Reports. The peer review process was timely and constructive, and the feedback provided helped improve the quality of our manuscript. The editorial office was professional, responsive, and supportive throughout the process, ensuring smooth communication and efficient handling of the submission. Overall, it was a positive experience collaborating with your team.
Dear Mercy Grace, Editorial Coordinator of Obstetrics Gynecology and Reproductive Sciences, We would like to express our gratitude for your help at all stages of publishing and editing the article. The editors of the magazine answer all the necessary questions and help at every stage. We will definitely continue to cooperate and publish other works in the Obstetrics Gynecology and Reproductive Sciences! Best wishes from, Alla Konstantinovna Politova,
