The COVID-19 pandemic has sparked unprecedented public health and social measures (PHSM) by national and local governments, including border restrictions, school closures, mandatory facemask use and stay at home orders. Quantifying the effectiveness of these interventions in reducing disease transmission is key to rational policy making in response to the current and future pandemics. In order to estimate the effectiveness of these interventions, detailed descriptions of their timelines, scale and scope are needed. The Health Intervention Tracking for COVID-19 (HIT-COVID) is a curated and standardized global database that catalogues the implementation and relaxation of COVID-19 related PHSM. With a team of over 200 volunteer contributors, we assembled policy timelines for a range of key PHSM aimed at reducing COVID-19 risk for the national and first administrative levels (e.g. provinces and states) globally, including details such as the degree of implementation and targeted populations. We continue to maintain and adapt this database to the changing COVID-19 landscape so it can serve as a resource for researchers and policymakers alike.

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Spur cell hemolytic anemia (SCHA) is a rare, acquired, nonimmune hemolytic anemia of decompensated cirrhosis. Data describing prognostic impact, outcomes of liver transplant, and clinical hematologic characteristics of SCHA are absent or limited. We performed a multicenter, 24-year observational cohort study of patients with SCHA, retrospectively analyzing hepatic and hematologic parameters, independent predictors of mortality, and long-term outcomes of liver transplant. Sixty-nine patients with SCHA met eligibility for inclusion. The median (interquartile range) age was 53 (42-59) years; 46.4% were female, and 11 (15.9%) received liver transplant. Thirty-nine patients (56.5%) were red blood celltransfusion-dependent. All 11 patients undergoing transplant had rapid and complete resolution of SCHA, with improvement in median hematocrit from 22.1% to 34.6% post-transplant (p = .001) and excellent post-transplant outcomes. In multivariable logistic models adjusting for age, sex, etiology of cirrhosis, active/recent variceal bleeding, and Child-Turcotte-Pugh score, transfusion dependence had an odds ratio (OR) for 90-day mortality of 9.14 (95% CI, 2.46-34.00) and reduced pre-transfusion hematocrit had an OR of 4.73 (95% CI, 1.42-15.82) per 6% decrease; increased red cell transfusion requirement, reduced hemoglobin, increased lactate dehydrogenase, and increased indirect bilirubin were also independently predictive of higher 90-day mortality. Model for endstage liver disease (MELD)-Na and Child-Turcotte-Pugh scores consistently significantly underestimated 90-day mortality, with standardized mortality ratios (SMRs) >1 across all scores/classes [MELD-Na 20-29, SMR 2.42 (1.18-4.44); Child-Turcotte-Pugh class B, SMR 4.46 (1.64-9.90)]. In conclusion, SCHA is associated with substantial excess mortality than predicted by MELD-Na or Child-Turcotte-Pugh scores and uniformly resolves with liver transplant, without recurrence. Multiple parameters of hemolytic anemia severity independently predict higher 90-day mortality. | INTRODUCTIONSpur cell hemolytic anemia (SCHA) is a rare, acquired, nonimmune hemolytic anemia occurring in patients with cirrhosis. 1 It is characterized by the presence of spur cells (acanthocytes), abnormal red cells with spiculated projections that decrease the fluidity of the red cell membrane, 2 in the setting of a clinically significant hemolytic anemia.These red cell changes are thought to be driven by abnormalities in hepatic lipid metabolism in patients with cirrhosis, resulting in perturbed red cell membrane lipid cholesterol balance. 3,4 This alteration to the red cell membrane results in reduced membrane fluidity and susceptibility to hemolysis.Data describing the hepatic and hematologic characteristics of SCHA, as well as its prognosis and treatment, are scarce. There are no consensus diagnostic criteria for SCHA, and its prevalence and incidence are unclear. The limited published data suggests that patients with end-stage liver disease and SCHA may have higher model for end-stage liver disease ...

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Background: Acute kidney injury (AKI) is an abrupt decrease in kidney function associated with significant morbidity and mortality. Electronic notifications of AKI have been utilized in hospitalized patients, but their efficacy in the outpatient setting is unclear. Methods: We evaluated the impact of two outpatient interventions: an automated comment on increasing creatinine results (intervention I; 6 months; n=159) along with an email to the provider (intervention II; 3 months; n=105) compared to a control (baseline; 6 months; n=176). A comment was generated if a patient's creatinine increased by >0.5 mg/dL (previous creatinine ≤2.0 mg/dL) or by 50% (previous creatinine >2.0 mg/dL) within 180 days. Process measures included documentation of AKI and clinical actions. Clinical outcomes were defined as recovery from AKI within 7 days, prolonged AKI from 8 to 89 days, progression to CKD within 120 days. Results: Providers were more likely to document AKI in interventions I (p=0.004; OR=2.80) and II (p=0.01; OR=2.66). Providers were also more likely to discontinue nephrotoxins in intervention II (p<0.001; OR= 4.88). The median time to follow-up creatinine trended shorter among patients with AKI documented (21 vs. 42 days; p=0.11). There were no significant differences in clinical outcomes. Conclusions: An automated comment was associated with improved documented recognition of AKI and the additive intervention of an email alert was associated with increased discontinuation of nephrotoxins, but neither improved clinical outcomes. Translation of these findings into improved outcomes may require corresponding standardization of clinical practice protocols for managing AKI.