Impact of COVID-19 pandemic on hepatocellular carcinoma ultrasound surveillance volumes at a united states liver transplant center

Purpose: The COVID-19 pandemic led to nationwide postponement of outpatient preventative health services. The purpose of our study was to determine the effect of the COVID-19 pandemic on hepatocellular carcinoma ultrasound (HCC US) surveillance volumes at a liver transplant center. Material(s) and Method(s): This retrospective study examined ultrasound volumes across the first two years of the pandemic (March 1, 2020, to February 28, 2022) compared to a baseline year (March 1, 2019, to February 28, 2020). Monthly and annual surveillance volumes, cumulative number of positive ultrasound examinations, and rate of follow-up CT or MRI on an US-3 observation were compared using paired t-tests. Result(s): A total of 6765 ultrasound examinations for HCC at our institution were performed over the three-year study period: 2507 in the baseline year, 1943 in the first year, and 2345 in the second year, representing a 24% (p = 0.036) and 6% (p = 0.144) decline in volume, respectively, compared to baseline. The first pandemic year had the greatest decline (mean 159/month, range 8-217, versus baseline year mean 209/month, range 182-241/month;p = .0363). The most dramatic reductions were in March, April, and May, in which 111, 8, and 126 surveillance ultrasound examinations were performed, respectively. In the baseline year, 95 (4%) had an US-3 observation (1 cm or larger nodule at ultrasound) and 63 (66%) underwent followup CT or MRI. In the first pandemic year, 64 (3%, p = 0.016) patients had an US-3 observation and 48 (75.00%, p = 0.0584) underwent follow-up CT or MRI. In the second pandemic year, 65 (3%, p = 0.001) patients had an US-3 observation and 48 (74%, p = 0.040) underwent follow-up CT or MRI. Conclusion(s): The significantly decreased surveillance ultrasound volume during the pandemic led to fewer positive surveillance studies and therefore fewer recommendations for follow-up imaging. As frequent surveillance is critical to HCC management, the pandemic is expected to have a significant impact on HCC epidemiology in the future.

Basic needs of the first batch of medical staff in the fever clinic of Peking union medical college hospital during Coronavirus disease 2019 outbreak: A qualitative study.

Objective The objective of this study was to investigate the basic needs of medical staff during the coronavirus disease 2019 pandemic in a fever clinic, so as to provide a reference for the global epidemic medical teams. Methods A semi-structured qualitative interview outline was designed, including: (1) work level: Working hours, working intensity, and safety guarantee in a fever clinic;(2)life level: Diet, sleep, and physical comfort;(3)psychological level: Emotion, pressure, coping style, and interpersonal resources. The basic needs of the first batch of the fever clinic in Peking Union Medical College Hospital was studied by open telephone interviews. Results A total of 37 medical staff were interviewed, including 8 males (21.6%) and 29 females (78.4%). Among them, there were 16 doctors (43.2%), 19 nurses (51.4%), and 2 medical technicians (5.4%). In terms of work settings, the ideal continuous working time was 4-6 hours per shift. There should be pro re nata positions during extremely high workload, and sufficient personal protective equipment was the key to safety. In terms of living conditions, providing meals according to different shifts was important for dietary needs, and sleeping pills were temporarily needed for sleep. In terms of psychological reactions, nervousness and worrying were relatively common. Family and colleagues were important resources of support. Sport could help relieve physical and psychological stress, and psychological support from psychologists was helpful in reducing their negative emotions. Conclusions The basic needs of medical staff should be respected so as to keep the efficacy of their work. We suggest that medical staff can rest after each 4-6 h working shift. Personal protective equipment should be sufficient. Psychological support should be noted in all of them and provided when necessary.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.

VMCTE: Visualization-Based Malware Classification Using Transfer and Ensemble Learning

The Corona Virus Disease 2019 (COVID-19) effect has made telecommuting and remote learning the norm. The growing number of Internet-connected devices provides cyber attackers with more attack vectors. The development of malware by criminals also incorporates a number of sophisticated obfuscation techniques, making it difficult to classify and detect malware using conventional approaches. Therefore, this paper proposes a novel visualization-based malware classification system using transfer and ensemble learning (VMCTE). VMCTE has a strong anti-interference ability. Even if malware uses obfuscation, fuzzing, encryption, and other techniques to evade detection, it can be accurately classified into its corresponding malware family. Unlike traditional dynamic and static analysis techniques, VMCTE does not require either reverse engineering or the aid of domain expert knowledge. The proposed classification system combines three strong deep convolutional neural networks (ResNet50, MobilenetV1, and MobilenetV2) as feature extractors, lessens the dimension of the extracted features using principal component analysis, and employs a support vector machine to establish the classification model. The semantic representations of malware images can be extracted using various convolutional neural network (CNN) architectures, obtaining higher-quality features than traditional methods. Integrating fine-tuned and non-fine-tuned classification models based on transfer learning can greatly enhance the capacity to classify various families of malware. The experimental findings on the Malimg dataset demonstrate that VMCTE can attain 99.64%, 99.64%, 99.66%, and 99.64% accuracy, F1-score, precision, and recall, respectively. © 2023 Tech Science Press. All rights reserved.

Myocardial Injury on CMR in Patients With COVID-19 and Suspected Cardiac Involvement.

BACKGROUND: Myocardial injury in patients with COVID-19 and suspected cardiac involvement is not well understood. OBJECTIVES: The purpose of this study was to characterize myocardial injury in a multicenter cohort of patients with COVID-19 and suspected cardiac involvement referred for cardiac magnetic resonance (CMR). METHODS: This retrospective study consisted of 1,047 patients from 18 international sites with polymerase chain reaction-confirmed COVID-19 infection who underwent CMR. Myocardial injury was characterized as acute myocarditis, nonacute/nonischemic, acute ischemic, and nonacute/ischemic patterns on CMR. RESULTS: In this cohort, 20.9% of patients had nonischemic injury patterns (acute myocarditis: 7.9%; nonacute/nonischemic: 13.0%), and 6.7% of patients had ischemic injury patterns (acute ischemic: 1.9%; nonacute/ischemic: 4.8%). In a univariate analysis, variables associated with acute myocarditis patterns included chest discomfort (OR: 2.00; 95% CI: 1.17-3.40, P = 0.01), abnormal electrocardiogram (ECG) (OR: 1.90; 95% CI: 1.12-3.23; P = 0.02), natriuretic peptide elevation (OR: 2.99; 95% CI: 1.60-5.58; P = 0.0006), and troponin elevation (OR: 4.21; 95% CI: 2.41-7.36; P < 0.0001). Variables associated with acute ischemic patterns included chest discomfort (OR: 3.14; 95% CI: 1.04-9.49; P = 0.04), abnormal ECG (OR: 4.06; 95% CI: 1.10-14.92; P = 0.04), known coronary disease (OR: 33.30; 95% CI: 4.04-274.53; P = 0.001), hospitalization (OR: 4.98; 95% CI: 1.55-16.05; P = 0.007), natriuretic peptide elevation (OR: 4.19; 95% CI: 1.30-13.51; P = 0.02), and troponin elevation (OR: 25.27; 95% CI: 5.55-115.03; P < 0.0001). In a multivariate analysis, troponin elevation was strongly associated with acute myocarditis patterns (OR: 4.98; 95% CI: 1.76-14.05; P = 0.003). CONCLUSIONS: In this multicenter study of patients with COVID-19 with clinical suspicion for cardiac involvement referred for CMR, nonischemic and ischemic patterns were frequent when cardiac symptoms, ECG abnormalities, and cardiac biomarker elevations were present.

Rapid Convergence: The Outcomes of Making PPE During a Healthcare Crisis

The U.S. National Institute of Health (NIH) 3D Print Exchange is a public, open-source repository for 3D printable medical device designs with contributions from clinicians, expert-amateur makers, and people from industry and academia. In response to the COVID-19 pandemic, the NIH formed a collection to foster submissions of low-cost, locally manufacturable personal protective equipment (PPE). We evaluated the 623 submissions in this collection to understand: what makers contributed, how they were made, who made them, and key characteristics of their designs. We found an immediate design convergence to manufacturing-focused remixes of a few initial designs affiliated with NIH partners and major for-profit groups. The NIH worked to review safe, effective designs but was overloaded by manufacturing-focused design adaptations. Our work contributes insights into: the outcomes of distributed, community-based medical making;the features that the community accepted as "safe"making;and how platforms can support regulated maker activities in high-risk domains. © 2023 Copyright held by the owner/author(s).

Spatiotemporal characteristics of ozone and the formation sensitivity over the Fenwei Plain.

High surface ozone (O3) levels affect human and environmental health. The Fenwei Plain (FWP), one of the critical regions for China's "Blue Sky Protection Campaign", has reported severe O3 pollution. This study investigates the spatiotemporal properties and the causes of O3 pollution over the FWP using high-resolution data from the TROPOspheric Monitoring Instrument (TROPOMI) from 2019 to 2021. This study characterizes spatial and temporal variations in O3 concentration by linking O3 columns and surface monitoring using a trained deep forest machine learning model. O3 concentrations in summer were 2-3 times higher than those found in winter due to higher temperatures and greater solar irradiation. The spatial distributions of O3 correlate with the solar radiation showing decreased trends from the northeastern to the southwestern FWP, with the highest O3 values in Shanxi Province and the lowest in Shaanxi Province. For urban areas, croplands and grasslands, the O3 photochemistry in summer is NOx-limited or in the transitional regime, while it is VOC-limited in winter and other seasons. Reducing NOx emissions would be effective for decreasing O3 levels in summer, while VOC reductions are necessary for winter. The annual cycle in vegetated areas included both NOx-limited and transitional regimes, indicating the importance of NOx controls to protect ecosystems. The O3 response to limiting precursors shown here is of importance for optimizing control strategies and is illustrated by emission changes during the 2020 COVID-19 outbreak.

Research on Influence Factors of Prevention and Control Measures on Economy-based on Netlogo Simulation and Big Data Computation

Emergencies have a significant impact on the economy. Thus, effective prevention and control measures can reduce economic losses to the greatest extent. Taking the novel coronavirus outbreak as the starting point, we proposed the SEEIR-E model, an optimization model of the SEIR. The model compares two different prevention and control modes, 'fence mode' and 'free-range mode' Combined with the big data of the epidemic, systematic simulation and analysis were carried out in the Netlogo simulation environment. When environmental factors are the same, the 'fence model' can control the spread of the disease more quickly, and the economic impact is less. At the same time, the impact of various environmental factors on economic recovery was simulated and analyzed. The result provides a basic understanding in economic recovery after the epidemic. © 2022 IEEE.

A dynamic design strategy of epidemic spreading parameters based on data driven

When modeling and fitting various kinds of epidemic outbreaks, the value of parameters has always been an important practical problem for many scholars. In the existing studies, most of the authors select a fixed parameter by referring to the relevant literature or combined with medical experiments. With the help of Euler difference transformation and the characteristics of the solution of linear equations, we innovatively propose a dynamic update strategy of epidemic diffusion parameters based on data-driven in this study in order to overcome the above limitation. The method can help decision-makers to calculate the optimal parameters of epidemic spread by combining the real-time update data. A case study is conducted with the COVID-19 data of Wuhan. The results show that the dynamic parameter update strategy designed in this paper can effectively improve the accuracy of the evolution prediction of epidemic outbreaks, which provides an important decision support for the accurate allocation of government emergency resources. © 2023 Northeast University. All rights reserved.

Influencing factors and clinical significance of liver function damage in patients diagnosed with COVID-19.

Objective: To invetigate the influencing factors and clinical significance of liver function damage (LFD) in patients diagnosed with Corona Virus Disease 2019 (COVID-19). Method(s): The retrospective case-control study was conducted. The clinicopathological data of 51 patients with COVID-19 who were admitted to the Sino-French New City Branch of Tongji Hospital Affiliated to Huazhong University of Science and Technology by the 5th group assisting team from the First Hospital of Jilin University from February 9th to 27th in 2020 were collected. There were 27 males and 24 females, aged from 36 to 86 years, with an average age of 68 years. The treatment modality was according to the diagnostic and therapeutic guideline for COVID-19 (Trial 6th edition) issued by National Health Commission. Observation indicators: (1) clinical data of patients;(2) analysis of liver function index and treatment of LFD;(3) analysis of influencing factors for LFD. Measurement data with normal distribution were represented as Mean+/-SD, and measurement data with skewed distribution were described as M (range). Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. The Logistic regression method was used for univariate analysis. Result(s): (1) Clinical data of patients: of the 51 patients, 21 were classified as ordinary type of COVID-19, 19 as severe type and 11 as critical type. In terms of medical history, 31 patients suffered from more than or equal to one kind of chronic disease, 20 had no history of chronic disease. Thirteen patients had the drinking history and 38 had no drinking history. Seven patients were hepatitis positive and 44 were hepatitis negative. Five patients had septic shock at admission, 5 had systemic inflammatory response syndrome (SIRS), and 41 had neither shock nor SIRS. The body mass index (BMI), time from onset to admission, temperature, heart rate, respiratory rate of the 51 patients were (24+/-3)kg/m2, (13+/-5)days, 36.5 (range, 36.0-38.1 ), 82 times/minutes (range, 50-133 times/minutes), 20 times/minutes (range, 12-40 times/minutes). The white blood cell count, level of creatinine, and level of b-type natriuretic peptide within 24 hours after admission were 6.3x109/L [range, (2.2-21.7)x109/L], 75 mumol/L (range, 44-342 mumol/L), 214 ng/L (range, 5-32 407 ng/L). (2) Analysis of liver function index and treatment of LFD: the level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), direct bilirubin (DBil), indirect bilirubin (IBil), activated partial thromboplastin time (APTT) and prothrombin time (PT) were 31 U/L (range, 7-421 U/L), 29 U/L (range, 15-783 U/L), 36 U/L (range, 13-936 U/L), 76 U/L (range, 41-321 U/L), 4.9 mumol/L (range, 2.6-14.3 mumol/L), 5.8 mumol/L (range, 2.6-23.9 mumol/L), 37.2 s (range, 30.9-77.1 s), 13.9 s (range, 12.5-26.7 s), respectively. The percentages of cases with abnormal ALT, AST, GGT, ALP, DBil, IBil, APTT and PT were 47.1%(24/51), 47.1%(24/51), 35.3%(18/51), 13.7%(7/51), 7.8%(4/51), 2.0%(1/51), 21.6%(11/51), and 19.6%(10/51), respectively. Of the 51 patients, LFD was detected in 10 patients classified as ordinary type, in 9 patients as severe type, and in 10 as critical type, respectively. In the 51 patients, 1 of 22 patients with normal liver function developed respiratory failure and received mechanical ventilation within 24 hours after admission, while 9 of 29 patients with abnormal liver function developed respiratory failure and received mechanical ventilation, showing a significant difference between the two groups (chi2=5.57, P<0.05). (3) Analysis of influencing factors for LFD. Results of univariate analysis showed that clinical classification of COVID-19 as critical type was a related factor for LFD of patients (odds ratio=10.000, 95% confidence interval: 1.050-95.231, P<0.05). Conclusion(s): COVID-19 patients with LFD are more susceptible to develop respiratory failure. The clinical classification of COVID-19 as critic l type is a related factor for LFD of patients.Copyright © 2020 by the Chinese Medical Association.

Nanoformulations targeting immune cells for cancer therapy: mRNA therapeutics

The approved worldwide use of two messenger RNA (mRNA) vaccines (BNT162b2 and mRNA-1273) in late 2020 has proven the remarkable success of mRNA therapeutics together with lipid nanoformulation technology in protecting people against coronaviruses during COVID-19 pandemic. This unprecedented and exciting dual strategy with nanoformulations and mRNA therapeutics in play is believed to be a promising paradigm in targeted cancer immunotherapy in future. Recent advances in nanoformulation technologies play a prominent role in adapting mRNA platform in cancer treatment. In this review, we introduce the biologic principles and advancements of mRNA technology, and chemistry fundamentals of intriguing mRNA delivery nanoformulations. We discuss the latest promising nano-mRNA therapeutics for enhanced cancer immunotherapy by modulation of targeted specific subtypes of immune cells, such as dendritic cells (DCs) at peripheral lymphoid organs for initiating mRNA cancer vaccine-mediated antigen specific immunotherapy, and DCs, natural killer (NK) cells, cytotoxic T cells, or multiple immunosuppressive immune cells at tumor microenvironment (TME) for reversing immune evasion. We highlight the clinical progress of advanced nano-mRNA therapeutics in targeted cancer therapy and provide our perspectives on future directions of this transformative integrated technology toward clinical implementation.

PCR Amplification and Sequencing Analysis of Full-Length Turkey Coronavirus Spike Gene

Turkey coronaviral enteritis caused by turkey coronavirus (TCoV) continues to infect turkey flocks, resulting in significant economic loss. Determining and understanding genetic relationships among different TCoV isolates or strains is important for controlling the disease. Using two-step RT-PCR assays that amplify the full length of TCoV spike (S) gene, TCoV isolates can be sequenced, analyzed, and genotyped. Described in this chapter is the protocol on PCR amplification and sequencing analysis of full-length TCoV S gene. Such protocol is useful in molecular epidemiology for establishing an effective strategy to control the transmission of TCoV among turkey flocks. Copyright © Springer Science+Business Media New York 2016

Modeling and analysis of SEIRS epidemic models using homotopy perturbation method: A special outlook to 2019-nCoV in India

Considering the prevailing situations, the mathematical modeling and dynamics of novel coronavirus (2019-nCoV) particularly in India are studied in this paper. The goal of this work is to create an effective SEIRS model to study about the epidemic. Four different SEIRS models are considered and solved in this paper using an efficient homotopy perturbation method. A clear picture of disease spreading can be obtained from the solutions derived using this method. We parametrized the model by considering the number of infection cases from 1 April 2020 to 30 June 2020. Finally, numerical analysis and graphical representations are provided to interpret the spread of virus. © 2022 World Scientific Publishing Company.

Evaluation of practical experience with medical sewage treatment in medical institutions in China

Objective To evaluate the evidence of the experience with medical sewage treatment procedures in medical institutions in China. Methods Databases including CNKI, WanFang Data, PubMed, Web of Science, and EBSCO were electronically searched to collect studies on the medical sewage treatment process, flow, and specifications in medical institutions in China. We used the quality evaluation system to classify and grade the experiences based on the principles and methods of evidence-based science and performed a descriptive analysis. Results After the SARS pandemic in 2003, China systematically established and standardized the technical criteria of medical sewage treatment and discharge. Moreover, a prevention system for the epidemic using medical sewage was constructed, which guaranteed that the quality of medical sewage treatment and discharge would meet the criteria and protect the citizens, and the technical specifications of medical sewage treatment would progress and increase strictly. At present, medical sewage treatment in medical institutions in China was based on mechanical and biological methods, and disinfection was mainly performed using chlorine and its compounds, ozone, and ultraviolet light. Conclusion The COVID-19 pandemic requires a higher quality of medical sewage treatment and discharge criteria for medical institutions in China. To meet these criteria, all medical institutions in China should check, replace, and update their old facilities;strengthen personnel training and effectively ensure the quality of medical sewage treatment.

Experience of Overseas Research on Electronic Health Literacy and Its Enlightenment to China in Public Health Emergencie

The Internet has become an important carrier of medical information.Good electronic health literacy can enhance the public’s ability to obtain correct medical and health information with the help of electronic resources,which is helpful for the public to use health information to prevent diseases,avoid drug abuse,reduce the waste of medical resources and strengthen the self-management of chronic diseases. The improvement of electronic health literacy is of great value to the healthy development of citizens’ health literacy and healthy behavior.In view of the late start and slow development in the field of electronic health literacy in China,by combing the theoretical and practical research experience of electronic health literacy outside the region and combining with the COVID-19,this paper put forward new thinking on electronic health literacy in China,in order to provide useful reference for improving electronic health iteracy of Chinese citizens,realizing self-care,self-management and disease prevention. © 2022, Editorial department of Chinese Medical Ethics. All rights reserved.

Increasing Use Of ED Chest Pain Triage With Coronary CTA Does Not Devolve Into Low-risk Imaging

Introduction: Coronary CT angiography (CCTA) is a Class I recommendation for patients with acute chest pain. However, as with any Emergency Department (ED) imaging algorithm, there is often a decline in the pre-test probability of coronary artery disease (CAD) over time, producing a preponderance of low-risk patients. Methods: 6121 patients presented to a single ED with acute chest pain and underwent CCTA from 2016 to 2021. These patients were categorized, as normal coronary artery, non-obstructive or obstructive CAD. Obstructive CAD was defined ≥ 50% stenosis. Results: The number of patients triaged with CCTA more than tripled over 6 years: from 418 in 2016 to a 1453 in 2021, even during COVID-19 pandemic (see figure). Despite this, there was no significant change in the prevalence of CAD by CCTA. No significant CAD ranged from 83% to 88% with no significant trend over time. Among patients with no significant CAD, normal coronary study ranged from 46% to 54% and non-obstructive CAD ranged from 12% to 17%. Conclusions: The prevalence of CAD remained constant, despite more than a triple increase in triage CCTA with no regression to low-risk patients. [Formula presented]

Memory-Guided Multi-View Multi-Domain Fake News Detection

The wide spread of fake news is increasingly threatening both individuals and society. Great efforts have been made for automatic fake news detection on a single domain (e.g., politics). However, correlations exist commonly across multiple news domains, and thus it is promising to simultaneously detect fake news of multiple domains. Based on our analysis, we pose two challenges in multi-domain fake news detection: 1) <bold/>domain shift<bold/>, caused by the discrepancy among domains in terms of words, emotions, styles, etc. 2) <bold/>domain labeling incompleteness<bold/>, stemming from the real-world categorization that only outputs one single domain label, regardless of topic diversity of a news piece. In this paper, we propose a Memory-guided Multi-view Multi-domain Fake News Detection Framework (M <inline-formula><tex-math notation="LaTeX">$

Can financial crisis be detected? Laplacian energy measure

How to rapidly and accurately detect the financial crisis is one of the fundamental and challenging problems in the field of financial risk management. This paper aims to develop a novel network characteristic indicator to deal with this issue. Specifically, we select the daily closing price of stocks spanning from 2006 to 2020 in China’s A-share market to establish a series of complex networks, and extract Laplacian energy measure as a new network indicator. By employing the method of seasonal-trend decomposition procedure based on loess, the proposed indicator successfully detects the global financial crisis, the Eurozone debt crisis, the Chinese stock market crash, the Sino-US trade friction and the COVID-19 pandemic. Furthermore, compared with the traditional topological indicators (e.g. global efficiency, average clustering coefficient, characteristic path length and network density), the proposed indicator demonstrates the outstanding characteristics of higher identification accuracy, wider application range and faster response speed. Lastly, the robustness of the Laplacian energy measure in the financial crisis detection is further confirmed in the US, UK, German, French and Spanish stock markets. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

[Time to initial diagnosis of imported malaria and its influencing factors in Jiangsu Province].

OBJECTIVE: To investigate the health-seeking behaviors of imported malaria cases after returning to China, and to investigate the factors affecting the time to initial diagnosis, so as to provide the scientific evidence for early identification of imported malaria cases and prevention of severe cases development and secondary transmission. METHODS: The individual demographic features, and the disease onset and the time to initial diagnosis of imported malaria cases in Jiangsu Province in 2019 were captured from the National Notifiable Disease Report System and the Information Management System for Parasitic Disease Control in China. The characteristics of health-seeking behaviors and epidemiological features of imported malaria cases were descriptively analyzed, and the factors affecting the time to initial diagnosis of imported malaria cases after returning to China were identified using multivariate logistic regression analysis. RESULTS: A total of 244 imported malaria cases were reported in Jiangsu Province in 2019, and the time to initial diagnosis of the cases were 1-12 days, with mean time of (1.53 ± 1.65) days, with median time of one day. The highest number of malaria cases seeking healthcare services were found on the day of developing primary symptoms (76 cases, 31.1%), followed by on the second day (68 cases, 27.9%), on the third day (46 cases, 18.9%), and 54 cases (22.1%) received initial diagnosis 3 days following presence of primary symptoms, including 3 cases with initial diagnosis at more than one week. High proportions of imported malaria cases with a delay in the time to initial diagnosis were seen in migrant workers who returned to China in January (14 cases, 5.7%) and December (13 cases, 5.3%) and those aged between 41 and 50 years (32 cases, 13.1%). Multivariate logistic regression analysis showed relative short time to initial diagnosis among imported malaria cases returning to China on March [odds ratio (OR) = 0.16, P = 0.03, 95% confidence interval (CI): (0.03, 0.85)] and those with a history of overseas malaria parasite infections [OR = 0.36, P = 0.001, 95% CI: (0.19, 0.67)]. CONCLUSIONS: Timely health-seeking behaviors should be improved among imported malaria cases in Jiangsu Province, patients with a history of overseas malaria infections require faster health-seeking activities.

Improving compliance with blood and platelet transfusion thresholds on a tertiary haematology ward

Restrictive transfusion thresholds are accepted as optimal blood management for patients receiving transfusions. 1 Unnecessary blood transfusions result in increased blood product shortages (exacerbated by the COVID-19 pandemic), 2 adverse patient outcomes and significant costs to health systems. 3 To improve transfusion practice, we aimed to minimise inappropriate transfusions through exploring and targeting areas of noncompliance with locally agreed red blood cell (RBC) and platelet transfusion thresholds of 80 g/l and 10∗109/l respectively. We conducted a retrospective multicycle audit over 4 months (Aug 2020, Feb 2021, May 2021 and Jun 2021) for all patients on the Haematology-Oncology ward. Standards were set at 100% compliance with local hospital guidelines. We analysed the number of RBC and platelet transfusions, pre-and post-transfusion haemoglobin and platelet counts, and clinical indications for transfusion. Actions implemented following each cycle composed of departmental meetings, teaching for foundation doctors and trainees, trust guideline updates and creation of a RBC transfusion checklist on our electronic 'EPIC' prescribing system. 4 Percentage compliance for RBC transfusions improved from 89% to 95% following actions implemented per audit cycle. Inappropriate RBC transfusions associated with discharge decreased from 10% to 1% and transfusion of two RBC units without appropriate increment decreased from 10% to 3%. Although percentage compliance of platelet transfusions did not improve from Aug 2020 to Jun 2021, they were consistently higher (97%) compared to RBC transfusions. This may be secondary to differing causes for inappropriate platelet transfusions detected each cycle. Despite inappropriate HLA-platelet use detected in the latest cycle, there are improvements in documentation to justify platelet transfusions outside normal threshold (100% in latest cycle), total number of platelets transfused and transfusion associated with discharge. Our audit has been successful in improving overall transfusion practice on the Haematology-Oncology ward. Ongoing education and re-audit will ensure this is maintained. (Table Presented).