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Decision tree model for early use of semi-elemental formula versus standard polymeric formula in critically ill Malaysian patients: A cost-effectiveness study

Adam A, Ibrahim NA, Tah PC, Liu XY, Dainelli L, Foo CY

JPEN J Parenter Enteral Nutr, 2023 Nov;47(8):1003-1010.
PMID: 37497593 DOI: 10.1002/jpen.2554

BACKGROUND: Prevention of enteral feeding interruption (EFI) improves clinical outcomes of critically ill intensive care unit (ICU) patients. This leads to shorter ICU stays and thereby lowers healthcare costs. This study compared the cost of early use of semi-elemental formula (SEF) in ICU vs standard polymeric formula (SPF) under the Ministry of Health (MOH) system in Malaysia.
METHODS: A decision tree model was developed based on literature and expert inputs. An epidemiological projection model was then added to the decision tree to calculate the target population size. The budget impact of adapting the different enteral nutrition (EN) formulas was calculated by multiplying the population size with the costs of the formula and ICU length of stay (LOS). A one-way sensitivity analysis (OWSA) was conducted to examine the effect each input parameter has on the calculated output.
RESULTS: Replacing SPF with SEF would lower ICU cost by MYR 1059 (USD 216) per patient. The additional cost of increased LOS due to EFI was MYR 5460 (USD 1114) per patient. If the MOH replaces SPF with SEF for ICU patients with high EFI risk (estimated 7981 patients in 2022), an annual net cost reduction of MYR 8.4 million (USD 1.7 million) could potentially be realized in the MOH system. The cost-reduction finding of replacing SPF with SEF remained unchanged despite the input uncertainties assessed via OWSA.
CONCLUSION: Early use of SEF in ICU patients with high EFI risk could potentially lower the cost of ICU care for the MOH system in Malaysia.
Fulltext Bioinspired Conductive Enhanced Polyurethane Ionic Skin as Reliable Multifunctional Sensors

Zhao B, Yan J, Long F, Qiu W, Meng G, Zeng Z, et al.

Adv Sci (Weinh), 2023 Jul;10(19):e2300857.
PMID: 37092565 DOI: 10.1002/advs.202300857

Ionogels prepared from ionic liquid (IL) have the characteristics of nonevaporation and stable performance relative to traditional hydrogels. However, the conductivities of commonly used ionogels are at very low relative to traditional hydrogels because the large sizes of the cation and anion in an IL impedes ion migration in polymer networks. In this study, ultradurable ionogels with suitable mechanical properties and high conductivities are prepared by impregnating IL into a safe, environmentally friendly water-based polyurethane (WPU) network by mimicking the ion transport channels in the phospholipid bilayer of the cell membrane. The increase in electrical conductivity is attributed to the introduction of carboxylic acid in the hard segment of WPU; this phenomenon regularly arranges hard segment structural domains by hydrogen bonding, forming ionic conduction channels. The conductivities of their ionogels are >28-39 mS cm-1 . These ionogels have adjustable mechanical properties that make the Young's modulus value (0.1-0.6 MPa) similar to that of natural skin. The strain sensor has an ultrahigh sensitivity that ranges from 0.99 to 1.35, with a wide sensing range of 0.1%-200%. The findings are promising for various ionotronics requiring environmental stability and high conductivity characteristics.
Epidemiological characteristics and strategies for prevention and elimination of malaria in Qingdao, Shandong Province, China from 1949 to 2021

Shi LM, Liu SZ, Dou XJ, Liu XY, Feng EQ, Liang JW, et al.

Trop Biomed, 2024 Jun 01;41(2):134-141.
PMID: 39154264 DOI: 10.47665/tb.41.2.001

Malaria is an insect-borne disease transmitted by Anopheles mosquitoes or the importation of Plasmodium-infected blood, posing a serious threat to human health and life safety. This study aims to analyze the incidence of malaria in Qingdao at various stages from 1949 to 2021, to collate the control measures taken at different epidemic stages to assess the effectiveness of malaria control, and to identify a set of malaria control strategies suitable for Qingdao, while providing Chinese experience for other countries or cities in their malaria elimination efforts. A retrospective survey was used to collect information on malaria cases, control measures and prevention and control effects in Qingdao from 1949 to 2021, and to evaluate malaria control strategies and measures in Qingdao. 704 155 cases have been reported from 1949 to 2021, with three epidemic peaks: the incidence rate was 1715.9/100 000 in 1961, 1409.7/100 000 in 1965, and the most severe case occurred in 1972, with an incidence rate of 1635.6/100 000 and a case count exceeding 90 000. Throughout the various stages of malaria epidemics, Qingdao has effectively eliminated indigenous malaria by implementing diverse preventive and control measures. Since the last indigenous case of Plasmodium vivax was reported in 2002, all locally reported cases have been imported, mainly by returning migrant workers from Africa. This study examines a range of malaria prevention and control strategies and interventions that are appropriate for Qingdao. These measures have enabled Qingdao to successfully eliminate malaria and maintain malaria-free status for more than 20 years. These measures can also serve as a reference for similarly situated cities in Africa and Southeast Asia.

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