A type-2 fuzzy rule-based model for diagnosis of COVID-19

In this study, a type-2 fuzzy logic-based decision support system comprising clinical examination and blood test results that health professionals can use in addition to existing methods in the diagnosis of COVID-19 has been developed. The developed system consists of three fuzzy units. The first fuzzy unit produces COVID-19 positivity as a percentage according to the respiratory rate, loss of smell, and body temperature values, and the second fuzzy unit according to the C-reactive protein, lymphocyte, and D-dimer values obtained as a result of the blood tests. In the third fuzzy unit, the COVID-19 positivity risks according to the clinical examination and blood analysis results, which are the outputs of the first and second fuzzy units, are evaluated together and the result is obtained. As a result of the evaluation of the trials with 60 different scenarios by physicians, it has been revealed that the system can detect COVID-19 risk with 86.6% accuracy. © 2023 TÜBÍTAK.

RBTM: Prediction of COVID-19 from Random Blood Test with Machine Learning Algorithms

Recently, the ongoing global pandemic of novel coronavirus infection had a devastating impact worldwide. We develop an efficient classification model that effectively produces the predictive values of infected patients with suspicious symptoms and epidemiological history to defeat this. The research aims to use the Traditional technique to compare clinical blood tests of positive and negative cases. The diagnostic Machine Learning model incorporates 551random blood samples with the following parameters of the patient's demographic features, Platelet, Hemoglobin, Lymphocyte, Neutrophil, Leukocyte (WBC), Turbidimetric, Troponin-I of COVID positive and negative cases. The prediction model can achieve the classification report of Accuracy, Precision, Recall, and F1 score values. In this analysis, considering seven different algorithms for the prediction and the observation's estimation, the data is 5-fold cross-validated. Finally, investigational outcomes attain accurate predictions. Logistic Regression predicted 0.83% of accuracy. The Receiver Operator Characteristic (ROC) metrics for Logistic Regression, the Precision was 0.78%, Recall was 0.85%, and F1-score was 0.82%, Specificity was 0.58%, and Sensitivity was 0.41%. © 2022 IEEE.

Clinical Characteristics and Blood Test Results in COVID-19 Patients

Objective. An outbreak of pneumonia named COVID-19 caused by a novel coronavirus in Wuhan is rapidly spreading worldwide. The objective of the present study was to clarify further the clinical characteristics and blood parameters in COVID-19 patients. Materials and Methods. Twenty-three suspected patients and 64 patients with laboratory-confirmed SARS-Cov-2 infection were admitted to a designated hospital. Epidemiological, clinical, laboratory, and treatment data were collected and analyzed. Results. Of the 64 patients studied, 47 (73.4%) had been exposed to a confirmed source of COVID-19 transmission. On admission, the most common symptoms were fever (75%) and cough (76.6%). Twenty-eight (43.8%) COVID-19 patients showed leukopenia, 10 (15.6%) showed lymphopenia, 47 (73.4%) and 41 (64.1%) had elevated high-sensitivity C-reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR), respectively, and 30 (46.9%) had increased fibrinogen concentration. After the treatment, the counts of white blood cells and platelets, and the level of prealbumin increased significantly, while aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and hsCRP decreased. COVID-19 patients with the hospital stay longer than 12 days had higher body mass index (BMI) and increased levels of AST, LDH, fibrinogen, hsCRP, and ESR. Conclusions. Results of blood tests have potential clinical value in COVID-19 patients.Copyright © 2020 by the Association of Clinical Scientists, Inc.

Implementing Mailed Colorectal Cancer Fecal Screening Tests in Real-World Primary Care Settings: Promising Implementation Practices and Opportunities for Improvement.

Colorectal cancer (CRC) screening reduces morbidity and mortality, but screening rates in the USA remain suboptimal. The Colorectal Cancer Control Program (CRCCP) was established in 2009 to increase screening among groups disproportionately affected. The CRCCP utilizes implementation science to support health system change as a strategy to reduce disparities in CRC screening by directing resources to primary care clinics to implement evidence-based interventions (EBIs) proven to increase CRC screening. As COVID-19 continues to impede in-person healthcare visits and compel the unpredictable redirection of clinic priorities, understanding clinics' adoption and implementation of EBIs into routine care is crucial. Mailed fecal testing is an evidence-based screening approach that offers an alternative to in-person screening tests and represents a promising approach to reduce CRC screening disparities. However, little is known about how mailed fecal testing is implemented in real-world settings. In this retrospective, cross-sectional analysis, we assessed practices around mailed fecal testing implementation in 185 clinics across 62 US health systems. We sought to (1) determine whether clinics that do and do not implement mailed fecal testing differ with respect to characteristics (e.g., type, location, and proportion of uninsured patients) and (2) identify implementation practices among clinics that offer mailed fecal testing. Our findings revealed that over half (58%) of clinics implemented mailed fecal testing. These clinics were more likely to have a CRC screening policy than clinics that did not implement mailed fecal testing (p = 0.007) and to serve a larger patient population (p = 0.004), but less likely to have a large proportion of uninsured patients (p = 0.01). Clinics that implemented mailed fecal testing offered it in combination with EBIs, including patient reminders (92%), provider reminders (94%), and other activities to reduce structural barriers (95%). However, fewer clinics reported having the leadership support (58%) or funding stability (29%) to sustain mailed fecal testing. Mailed fecal testing was widely implemented alongside other EBIs in primary care clinics participating in the CRCCP, but multiple opportunities for enhancing its implementation exist. These include increasing the proportion of community health centers/federally qualified health centers offering mailed screening; increasing the proportion that provide pre-paid return mail supplies with the screening kit; increasing the proportion of clinics monitoring both screening kit distribution and return; ensuring patients with abnormal tests can obtain colonoscopy; and increasing sustainability planning and support.

Supply and quality of colonoscopy according to the characteristics of gastroenterologists in the French population-based colorectal-cancer screening program.

BACKGROUND: Since its complete roll-out in 2009, the French colorectal cancer screening program (CRCSP) experienced 3 major constraints [use of a less efficient Guaiac-test (gFOBT), stopping the supply of Fecal-Immunochemical-Test kits (FIT), and suspension of the program due to the coronavirus disease 2019 (COVID-19)] affecting its effectiveness. AIM: To describe the impact of the constraints in terms of changes in the quality of screening-colonoscopy (Quali-Colo). METHODS: This retrospective cohort study included screening-colonoscopies performed by gastroenterologists between Jan-2010 and Dec-2020 in people aged 50-74 living in Ile-de-France (France). The changes in Quali-colo (Proportion of colonoscopies performed beyond 7 mo (Colo_7 mo), Frequency of serious adverse events (SAE) and Colonoscopy detection rate) were described in a cohort of Gastroenterologists who performed at least one colonoscopy over each of the four periods defined according to the chronology of the constraints [gFOBT: Normal progress of the CRCSP using gFOBT (2010-2014); FIT: Normal progress of the CRCSP using FIT (2015-2018); STOP-FIT: Year (2019) during which the CRCSP experienced the cessation of the supply of test kits; COVID: Program suspension due to the COVID-19 health crisis (2020)]. The link between each dependent variable (Colo_7 mo; SAE occurrence, neoplasm detection rate) and the predictive factors was analyzed in a two-level multivariate hierarchical model. RESULTS: The 533 gastroenterologists (cohort) achieved 21509 screening colonoscopies over gFOBT period, 38352 over FIT, 7342 over STOP-FIT and 7995 over COVID period. The frequency of SAE did not change between periods (gFOBT: 0.3%; FIT: 0.3%; STOP-FIT: 0.3%; and COVID: 0.2%; P = 0.10). The risk of Colo_7 mo doubled between FIT [adjusted odds ratio (aOR): 1.2 (1.1; 1.2)] and STOP-FIT [aOR: 2.4 (2.1; 2.6)]; then, decreased by 40% between STOP-FIT and COVID [aOR: 2.0 (1.8; 2.2)]. Regardless of the period, this Colo_7 mo's risk was twice as high for screening colonoscopy performed in a public hospital [aOR: 2.1 (1.3; 3.6)] compared to screening-colonoscopy performed in a private clinic. The neoplasm detection, which increased by 60% between gFOBT and FIT [aOR: 1.6 (1.5; 1.7)], decreased by 40% between FIT and COVID [aOR: 1.1 (1.0; 1.3)]. CONCLUSION: The constraints likely affected the time-to-colonoscopy as well as the colonoscopy detection rate without impacting the SAE's occurrence, highlighting the need for a respectable reference time-to-colonoscopy in CRCSP.

2022 AAFP/EveryCat Feline Infectious Peritonitis Diagnosis Guidelines.

CLINICAL IMPORTANCE: Feline infectious peritonitis (FIP) is one of the most important infectious diseases and causes of death in cats; young cats less than 2 years of age are especially vulnerable. FIP is caused by a feline coronavirus (FCoV). It has been estimated that around 0.3% to 1.4% of feline deaths at veterinary institutions are caused by FIP. SCOPE: This document has been developed by a Task Force of experts in feline clinical medicine as the 2022 AAFP/EveryCat Feline Infectious Peritonitis Diagnosis Guidelines to provide veterinarians with essential information to aid their ability to recognize cats presenting with FIP. TESTING AND INTERPRETATION: Nearly every small animal veterinary practitioner will see cases. FIP can be challenging to diagnose owing to the lack of pathognomonic clinical signs or laboratory changes, especially when no effusion is present. A good understanding of each diagnostic test's sensitivity, specificity, predictive value, likelihood ratio and diagnostic accuracy is important when building a case for FIP. Before proceeding with any diagnostic test or commercial laboratory profile, the clinician should be able to answer the questions of 'why this test?' and 'what do the results mean?' Ultimately, the approach to diagnosing FIP must be tailored to the specific presentation of the individual cat. RELEVANCE: Given that the disease is fatal when untreated, the ability to obtain a correct diagnosis is critical. The clinician must consider the individual patient's history, signalment and comprehensive physical examination findings when selecting diagnostic tests and sample types in order to build the index of suspicion 'brick by brick'. Research has demonstrated efficacy of new antivirals in FIP treatment, but these products are not legally available in many countries at this time. The Task Force encourages veterinarians to review the literature and stay informed on clinical trials and new drug approvals.

Challenges of Machine Learning for Covid-19 Diagnosis based on Blood Tests

Machine learning for Covid-19 diagnosis from blood tests is a topical problem. Many studies of this problem are mainly devoted to comparing various algorithms' efficiency. However, the first and often the most critical part of machine learning is the preparation of a relevant and correct dataset of the required size for developing the generalization models. This study demonstrates the lack of the models' generalization performance based on some publicly available datasets. That leads to the futility of such models in practice even if they were developed using the best algorithms and achieved high metrics. Therefore, another dataset is proposed. Its features are discussed. This dataset splits into training and testing sets by stratification due to an imbalanced data structure. Machine learning models of the problem by various algorithms are developed based on the proposed dataset. The modelling results on the testing set have demonstrated that the best models - Gradient Boosting Classifier with fixing imbalance methods SMOTE and ADASYN, TensorFlow and Gene Expression Programming - handle negative Covid-19 diagnosis well enough since they have high precision and high recall. However, mixed signals have been obtained for a positive Covid-19 diagnosis. TensorFlow and Gene Expression Programming models have high precision and relatively low recall for positive Covid-19 diagnosing. It means these models can't detect Covid-19 well enough but are highly reliable when they do. Gradient Boosting Classifier models do not have enough high precision and recall for positive Covid-19 diagnosing. New challenges of machine learning for Covid-19 diagnosis based on blood tests are found for future work. © 2022 IEEE.

Evaluation of effective features in the diagnosis of Covid-19 infection from routine blood tests with multilayer perceptron neural network: A cross-sectional study.

Background and Aim: Coronavirus is an infectious disease that is now known as an epidemic, early and accurate diagnosis helps the patient receive more care. The aim of this study is to investigate Covid-19 using blood tests and multilayer perceptron neural network and affective factors in improving and preventing Covid-19. Methods: This cross-sectional study was performed on 200 patients referred to Sina Hospital, Tehran, Iran, who were confirmed cases of Covid-19 by computerized tomography-scan analysis between 2 March 2020 to 5 April 2020. After verification of lung involvement, blood sampling was done to separate the sera for C-reactive protein (CRP), magnesium (Mg), lymphocyte percentage, and vitamin D analysis in healthy and unhealthy people. Blood samples from healthy and sick people were applied to the multilayer perceptron network for 70% of the data for training and 30% for testing. Result: By examining the features, it was found that in patients with Covid-19, there was a significant relationship between increased CRP and decreased lymphocyte levels, and increased Mg (p < 0.01). In these patients, the amount of CRP and Mg in women and the number of lymphocytes and vitamin D in men were significantly higher (p < 0.01). Conclusion: The important advantage of using a multilayer perceptron neural network is to speed up the diagnosis and treatment.

The Use of the Faecal Immunochemical Test during the Covid-19 Pandemic to Triage Urgent Colorectal Cancer Referrals

Aim: During the first wave of the Covid19 pandemic in 2020, elective GI endoscopy services were abbreviated for fear of viral transmission. However, primary care continued to refer patients on the NG12 pathway. Serendipitously, a national study suggested that a new Faecal Immunochemical Test might be helpful in triaging patients with colorectal alarm symptoms. Method(s): A single centre observational study of patients referred using NG12 referral criteria between March and August [pb1] 2020. Patients were triaged to the urgent cancer pathway if FIT >= 10 mg/ml and investigated using latest NHS England guidance. Demographic data, method of investigations, cancer and polyp detection rates were compared to those observed in a cohort of patients who had been referred in the previous six months prior when FIT was not used as the triage tool (September 2019 to February 2020) when Covid 19 was not prevalent. Result(s): A total of 1192 patients with a median age of 70 years (IQ range 58-79) of which 53.9% were male, were referred using NG12 guidelines during the pandemic period compared with 1592 patients with a median age of 72 years (IQ range 59.5-91) of which 49.2% were male, in the prior six months. Colorectal cancer was detected in 45 patients, (3.2%) compared with 38 patients (2.8%) in the pre pandemic period (NS). There were two patients who turned out to have CRC despite a negative FIT. After the introduction of FIT as a triage tool, there was a significant reduction in the use of endoscopy (n = 463, 42.3% vs. n = 1186, 74.5%, P = 0.035) with a significant increase in CT scanning (n = 677, 61.2% vs. n = 750, 47.1%, P = 0.035). Conclusion(s): The use of FIT in NG12 patients triaged during the first wave of the Covid 19 pandemic reduced endoscopy but not CT scanning and did not compromise CRC detection rates. The use of FIT triage for endoscopic investigation is a safe method that aids in reducing the burden on services greatly. A negative FIT test does not absolutely exclude CRC.

Improving the Accuracy of Rapid Antigen Tests for Covid-19 using Data Mining and Blood Test

PCR tests are known to give the most accurate results, but are not suitable for mass testing. This article suggests the use of data extraction to diagnose Covid-19. For this purpose, data from rapid antigen tests, external signs of infection and general blood count are processed. The result is that the reliability of antigen tests increases from 50% to over 72%. The future development of the system is to generate a hypothesis about the likelihood of complex application of Covid-19. PCR tests are known to give the most accurate results, but are not suitable for mass testing. © 2022 IEEE.

Comparative Hemogram Analysis of Smoking Patients with COVID-19 and Acute Coronary Syndrome

The objective: to define hemogram parameters in smokers with COVID-19 and acute coronary syndrome when they are admitted to hospital. Subjects and Methods. 62 male smokers hospitalized due to acute coronary syndrome (ACS) were enrolled into a case-control study. Group 1 (n = 31) had ASC and COVID-19, Group 2 (n = 31) had ACS and no COVID-19. The groups were adjusted by age, body mass index and the date of hospitalisation. According to the current routing procedures, from September to December 2020, the subjects were referred to different hospitals in Sverdlovsk Region depending on COVID-19 status. Inpatient medical records were used to collect the data. Blood parameters were examined by Mindray BC-5150 (China) automatic hematological analyzer performing complete clinical blood count and differentiating 5 leukocyte subpopulations. Statistical processing was performed using Statistica 13.0. The significance of differences was taken at p < 0.05. Results. Smoking men with COVID-19 and ACS unlike those GOVID-19 negative had a lower level of diastolic blood pressure, significantly more often were diagnosed with low degrees of hypertension, higher BPD with the same frequency of detection and functional characteristics of chronic heart failure and chronic obstructive pulmonary disease. The hemogram showed a lower level of the number of leukocytes, the percentage of neutrophils, erythrocytes, hemoglobin, hematocrit, the average concentration of hemoglobin in the erythrocyte;a higher level of monocytes, erythrocyte sedimentation rate, and average platelet volume. The above changes can be associated with spesific features of the COVID-19 course. © 2022 New Terra Publishing House. All rights reserved.

Towards Automated Multiclass Severity Prediction Approach for COVID-19 Infections Based on Combinations of Clinical Data

The recent dramatic expansion of the COVID-19 outbreak is placing enormous strain on human society as a whole. Numerous biomarkers are being investigated in an effort to track the condition of the patient. This could interfere with signs of many other illnesses, making it more difficult for a specialist to diagnose or predict the severity level of the case. As a result, the focus of this research was on the development of a multiclass prediction system capable of dealing with three severity cases (severe, moderate, and mild). The lymphocyte to CRP ratio (C-reactive protein blood test) and SpO2 (blood oxygen saturation level) indicators were ranked and used as prediction system attributes. A machine learning model based on SVMs is created. A total of 78 COVID-19 patients were recruited from the Azizia primary health care sector/Wasit Health Directorate/Ministry of Health to form different combinations of COVID-19 clinical dataset. The outcomes demonstrate that the proposed approach had an average accuracy of 82%. The established prediction system allows for the early identification of three severity cases, which reduces deaths. © 2022 Ahmed M. Dinar et al.

Study of Ensemble Learners to identify the COVID-19 positive patients

SARS-CoV-2 coronavirus has already attracted substantial attention of the scientific community. Medical Science had never faced a tougher challenge than this pandemic. The rapid spread of the virus has caused a monumental increase in hospital admissions and deaths resulting in availability of data for analysis. Moreover, the disease has now become asymptomatic in most cases yet could be fatal for co-morbid patients. Patients on arrival to hospitals, whatever the case may be, are generally advised to opt for economically reasonable routine blood tests and certain aspects of this blood testing can assist us in determining if a patient is infected with coronavirus or not, at a very early stage. We can utilize ensemble classifiers (i.e., conglomerate of advanced and improved ensemble of learning algorithms) to distinguish between infected and non-infected individuals and rule out the scope of further spreading. In this paper, we have done a comparative study of the diverse ensemble learning techniques that are implemented over different patient's blood test reports and can presage if a patient is infected with coronavirus. © 2022 IEEE.

Alleviating the click fatigue on clinicians to improve referrals for colorectal cancer screening

Background: The impact of clinician burnout on patient care is pervasive across medical delivery systems. The effects are also felt in preventive care where cancer screening efforts rely on clinician referrals through the electronic medical records (EMRs). Though designed to support healthcare, EMRs are a significant source of clinician burnout given the number of clicks or navigation time needed to refer a patient. This is a barrier to Patient Navigation (PN) when ordered tests do not materialize into screenings or when clinicians order labs/imaging and the pending orders are not created. This causes frustration for all clinical staff involved, delays the workflow processes, and leads to missed opportunities for PN. We implemented an 'order set' intervention to reduce the click burden linked to colorectal cancer (CRC) screening referral among clinicians in South Georgia. Methods: The 'order set' intervention was developed to facilitate PN for a Colorectal Cancer Control Program (CRCCP) aimed at implementing Evidence- Based Interventions to increase CRC screening rates in Georgia. The 'order set' was designed to address workflow issues by consolidating steps associated with CRC screening. This reduced typing input and the need to click between multiple windows within the EMR while making a referral to PN. The intervention was piloted in the Albany Area Primary Health Care (AAPHC) system after modifications were made to the EMR and clinician workflows. The monthly CRC screening rates continue to be generated and tracked post-implementation. Results: The use of the 'order set' reduced the click burden from 78 to 7 inputs and clinician EMR interaction time from 110 seconds to 29 seconds. Providers from 4/7 clinics have adopted the 'order sets' when making referrals for CRC screening. Two clinics provided post-implementation screening data. The pre-implementation screening rates for one clinic were comparable (August = 59.3%, September = 57.6%) to post-implementation (October = 56.3%, November = 56.6%, December = 57.2%), while the second clinic showed some increase (August = 58.6%, September = 60%) vs. (October = 61%, November = 62.1%, December = 62.8%). Conclusions: The 'order sets' intervention reduced the time clinicians spent creating referrals for CRC screening, including fecal immunochemical tests (FIT) and colonoscopies. Additional follow-up and rollout to clinics participating in the program is underway to evaluate further the impact of the order sets on CRC screening outcome and process measures, including qualitative interviews with clinicians. There is significant potential in the application of order sets to various workflow processes to aid in preventative health efforts. Challenges linked to the COVID-19 pandemic and staff turnover affected acquisition of patient referral data.

Risk-stratified FIT for urgent colonoscopy in Lynch syndrome: A clinical service throughout the COVID-19 pandemic

Background: Lynch syndrome (LS) is an inherited disorder characterized by pathogenic variants within mismatch repair genes resulting in an increased risk of colorectal cancer (CRC). In England, the fecal immunochemical test for Haemoglobin (FIT) is currently used in non-LS symptomatic and screening populations to guide subsequent colonoscopy. Herein, we report results from a national emergency clinical service implemented during the COVID-19 pandemic which used FIT to prioritize colonoscopy in LS patients while endoscopy services were limited. Methods: Regional genetic and endoscopy services across England were invited to participate. Patient eligibility was determined by 1) Diagnosis of Lynch Syndrome 2) Planned colonoscopic surveillance between 1 March 2020 and 31 March 2021. Requests for FIT testing from participating NHS Trusts were sent to the NHS Bowel Cancer Screening South of England Hub's Research Laboratory in Surrey. The Hub sent patients a FIT kit (OC-Sensor? (Eiken, Japan)), instructions for use, a questionnaire, and a pre-paid return envelope. Lab reports with feecal haemoglobin (f-Hb) results were returned electronically for clinical action. LS patients were risk-stratified for colonoscopy based upon the following f-Hb thresholds: (1) f-Hb ≥10mg of Haemoglobin (Hb)/g (mg/g) faeces: triaged for colonoscopy via an urgent two-week wait (2WW) pathway, (2) f-Hb ≤10mg/g: schedule patients for colonoscopy within 6-12 weeks, where local endoscopy service availability permits. Results: Fifteen centers across England participated in the clinical service from 9th June 2020 to 31st March 2021. An uptake rate of 64% was observed from this cohort (375/588 invites), though 21 cases were removed from analysis due to repeat FITs, insufficient sample, missing clinical data, or FIT completed after colonoscopy. Of the remaining 354 patients analyzed, 269 patients (76%) had a f-Hb of <6mg/g. 6% (n=23) of patients had a f-Hb that was at or between greater than the limit of detection of the assay (≥6mg/g) yet below 10mg/g.18% (n=62) had FIT results of ≥10mg/g and met criteria for urgent colonoscopy triage via the 2WW pathway. Of the 62 urgently triaged patients, 22 had detectable adenomas, 6 had advanced adenomas (AAs), and 4 were diagnosed with CRC (table). Conclusions: The utility of FIT during the pandemic has demonstrated clinical value for LS patients requiring CRC surveillance. Further longitudinal investigation on the efficacy of FIT in people with LS is warranted and will be examined as part of the multi-center prospective research study “FIT for Lynch Syndrome” (ISRCTN15740250) which is presently recruiting patients in the UK.

Haematological Traits in Symptomatic and Asymptomatic COVID-19 Positive Patients for Predicting Severity and Hospitalization.

Objective: The present investigation aims on the clinical attributes and haematological parameters between symptomatic (COVID-19 ICU) and asymptomatic (COVID-19 homes isolation) patients as predisposing sign for COVID-19 related mortality. Materials and Methods: A retrospective cohort research was conducted of admitted patients to ICU, who were suffering from severe COVID-19 in Aseer Central Hospital, Abha, Kingdom of Saudi Arabia (KSA) from July 2020 until September 2020. The study included individuals with COVID -19 and ICU admission as symptomatic group and others who are COVID-19 positives with quarantine as asymptomatic group. Epidemiological, clinical and haematological laboratory data were retrospectively collected, analysed with control subjects. Results: Of the 38 ICU patients studied, the most common symptoms were fever and respiratory distress (100%), cough (86.8%). Majority were of Saudi origin (78.9%). Eighteen (47.4%) COVID-19 ICU patients showed leukocytosis, 6 (15.8%) had severe thrombocytopenia (with most having thrombocytopenia), 18 (47.4%) were anaemic. A significant correlation was observed between the WBC, RBC, Hb, platelets, neutrophil and lymphocyte count between ICU inmates compared with quarantine (p < 0.001) and RBC, Hb, neutrophil and lymphocyte count with control groups (p < 0.001). Conclusion: From the observations it is evident that, the blood tests have potential clinical value in predicting COVID-19 progression. Further, patient characteristics including age, leukocyte count, RBC, platelets and differential leukocyte counts may be significant predictors for monitoring the progression of the critical illness observed in SARS-COV-2 patients. Also, treatment procedures can be re-defined further to reduce COVID-19 mortalities in more critically ill COVID-19 individuals.

FAECAL IMMUNOCHEMICAL TEST CHARACTERISTICS IN A 2 WEEK REFERRAL PATHWAY: A RELIABLE GATEKEEPER

Introduction Faecal Immunochemical testing (FIT) has become an important part of colorectal cancer referral pathways over the last few years. Implementation has been expediated by the Covid pandemic. FIT is increasingly used in primary care in conjunction with high risk symptoms and anaemia to direct referral for further investigation. This investigates the outcomes of patients referred to a large NHS Trust on a lower GI two week wait pathway and compares outcomes in those with and without an initial FIT test. Methods A total of 363 patients were from 1st to 28th February 2021, with information and result gathered from clinic letters and Trust IT systems. The FIT test result was recorded where it had been performed. Positive predictive value (PPV) and negative predictive value (NPV) were calculated to asses FIT performance and outcomes were stratified by FIT positivity. Results The majority of patients referred (275 of 363 patients or 75.54%) underwent FIT as part of their lower GI pathway referral. More than half had a positive FIT result of 10 7ug/ ml or greater (176/275, 64%). 14 out of 275 patients (5.09%) were found to have colorectal cancer. The overall PPV of FIT was 7.8%. PPV was higher in those with FIT >400 (38.5%). The PPV in those with FIT 10-49 was relatively low at 6.5% (5/91). Among 99 patients with negative FIT, 2 patients (2.0%) were found to have colorectal cancer, giving FIT a high NPV of 98.88%. Both patients presented with symptoms including weight loss (but no anaemia) and were diagnosed on CT imaging. Both had extensive metastatic disease at diagnosis. In the group who had not undergone FIT testing, 7 out of 88 (8.0%) were found to have cancer. Conclusions The majority of the patients referred had FIT initially, although continuous improvement is still needed to achieve the aim of all patients undergoing FIT prior to referral. The considerably higher PPV of FIT >400 compared to 10-49 demonstrates how the FIT value can be used to prioritise appropriate investigations and urgency to those with the highest diagnostic yield. As part of a lower GI pathway, there were two FIT negative cancers but these were both picked up on CT scans due to the associated presence of weight loss at presentation. This should reassure referrers that FIT negative patients without anaemia or weight loss do not need urgent referral.

ROLE OF FIT AND CT ABDOMEN-PELVIS IN PRIORITISING DIAGNOSTIC COLONOSCOPY FOR COLORECTAL CANCER

Introduction COVID-19 has resulted in many new challenges for healthcare services. Colonoscopy, which is the gold standard investigation for diagnosis of colorectal cancer (CRC), has been significantly impacted with cessation of services during peak corona virus outbreaks with significant backlog. Several strategies have been proposed to address this. One of the main approaches is to risk stratify patients using a quantitative faecal immunochemical test (qFIT) alone or in combination with CT scan. Our study assessed the adherence of Bedford Hospital NHS Foundation Trust in performing both qFIT and CTAP with Iv contrast prior to colonoscopy referral. This study also evaluated the sensitivity of qFIT and CTAP both individually and in combination of missing a cancer when used as a triage service for prioritisation of colonoscopy. Methodology Data was collected retrospectively from all colonoscopies performed in Bedford hospital, from June to August 2020, totalling 470 patients. Results Average patient age was 59.9 years, with an age range of 19 to 90 years old. 55% were males and 45% were females. 45% (210) patients had a FIT performed pre colonoscopy. 129 patients had positive FIT. Overall, 35% (164) of patients underwent CTAP prior to colonoscopy. 125 patients underwent both FIT and CTAP prior to colonoscopy. Individually, FIT had a positive predictive value (PPV) and negative predictive value (NPV) of 6.2% and 98.7% with respect to diagnosing CRC. CTAP had a PPV and NPV of 42.9% and 100%. Performing FIT and CTAP in combination had a PPV and NPV of 28.6% and 100% respectively. Conclusion Sensitivity of single qFIT is low and can miss cancers if used alone. Therefore, it should not be utilised as a single test for triage in community for prioritising colonoscopy in symptomatic patients. The risk of missing a cancer can be reduced by CTAP with Iv contrast as an add on test with negative predictive value of 100%.

IMPROVING COLORECTAL CANCER SCREENING IN A SAFETY NET CLINIC THROUGH A RETURN- BY-MAIL FECAL IMMUNOCHEMICAL TEST PROGRAM

STATEMENT OF PROBLEM/QUESTION: Can establishing a return-bymail fecal immunochemical test (FIT) program increase the colorectal cancer screening rate in a safety net primary care clinic? DESCRIPTION OF PROGRAM/INTERVENTION: Colorectal cancer (CRC) screening rates are typically lower in safety net health systems. This trend has been exacerbated by the COVID-19 pandemic, which has limited access to colonoscopy for screening. There is evidence that FITs are costeffective and mailed FIT programs can increase screening rates for vulnerable patients. We implemented a return-by-mail FIT program in the adult primary care clinic of New York City Health + Hospitals/Bellevue, a public safety net hospital. We evaluated adults aged 50-75 who were not up to date with CRC screening. All patients due for CRC screening were only offered FIT as a screening modality. We implemented a partial mailed FIT program, in which FIT tests picked up in clinic could be returned by mail directly to the lab. Prior to our intervention, patients were required to return FITs to the clinic in person. MEASURES OF SUCCESS: We evaluated FIT completion rates within our clinic 30 days before and after the introduction of return-by-mail FIT kits in July 2021. We also evaluated our clinic's pre- and post-intervention performance relative to other clinics within the New York City Health + Hospitals system using claims data. Additionally, we randomly surveyed patients who received a FIT and did not complete it in the period prior to our intervention to assess reasons for incompletion. FINDINGS TO DATE: A total of 5,153 and 5,180 patients aged 50-75 were seen in clinic 30 days before and 30 days after the implementation of a mailed FIT program. 571 patients were provided a return-in-person FIT kit 30 days prior to our intervention. Of these patients, 289 (50.6%) completed a FIT. By contrast, 781 patients were provided a return- by-mail FIT kit 30 days following our intervention. Of these patients, 464 (59.4%) completed a FIT (p < 0.01). Additionally, the proportion of patients who completed annual CRC screening prior to our intervention was lower in our clinic (48.2%) compared to the average across the New York City public hospital system (51.4%) according to managed care Medicaid claims data (MetroPlus, June 2021). Four months following our intervention, our clinic's year-to-date CRC screening rate exceeded the average system-wide rate (59.3% vs. 57.6%, November 2021). We also called 45 patients who were provided a FIT test prior to our intervention and did not complete it. 12 patients were reached, and 2 of these patients cited difficulty dropping off the test as the primary barrier to FIT completion (16.7%). KEY LESSONS FOR DISSEMINATION: By implementing a return-bymail FIT program, we were able to increase our clinic's CRC screening rate by 8.8%. Our data are similar to previous programs implementing mailed FIT programs in safety net patient populations. Future aims are to implement a mail-to-patient FIT program in addition to our initial return-by-mail program.