Quality and reliability of YouTube as an educational tool for patients undergoing radiological musculoskeletal intervention

Purpose: With increasing demands and time constraints on physicians, compounded by the telemedicine era of COVID, patients are ill-equipped to make informed decisions regarding their treatments1. Patients are seeking further information on the internet, particularly the audio-visual platform YouTube2. Appropriate patient education is paramount for patients undergoing treatment, particularly intervention, as it provides appropriate expectations and reduces anxiety1. This aim of this study was to objectively evaluate videos on YouTube that related to commonly performed musculoskeletal procedures against validated scoring systems. Methods and Materials: YouTube was utilised to search for common musculoskeletal procedures including "facet joint injection", "knee injection" and "shoulder injection". The first thirty videos returned for each search were assessed for suitability as it was deemed this was likely to encompass a patient search results as average user's will only assess the first 5 search results 3. 90 total videos were identified, and after exclusion 51 were included for analysis by three independent reviewers. Data extracted from the videos included video authorship, year published, number of views and number of 'likes' and 'dislikes'. Videos were scored for quality and reliability using three separate and validated tools for online medical video assessment;Journal of American Medical Association (JAMA) benchmark criteria, the global quality scoring (GQS) and the DISCERN criteria. Result(s): Of the 51 videos analysed, 88% were authored by a medical doctor, and the average number of views were 67,552. The overall video quality and reliability was poor. The mean DISCERN score was 32.78 (<39 = poor). The mean JAMA score was 1.79 (<3 = low quality) and the GQS was 2.39 (<3 = poor). As per DISCERN standards 24.18% of videos were very poor, 46.70% were poor, 26.79% were fair, 2.61% were good, and 0% were excellent. There was no significant difference in quality or reliability across the three video categories. Conclusion(s): YouTube is a popular medium for individuals seeking health related information, however, it provides substandard information for patient education on three commonly performed radiological guided musculoskeletal procedures;failing to meet benchmark criteria. Radiologists and referring physicians should avoid the recommendation of YouTube as an education aid at this time, as it may misinform patients and provide misconceptions with altered expectations.

Evaluating the Relationship between Cycle Threshold Values and Reported COVID-19 Symptoms among Healthcare Workers

Background: SARS-CoV-2 detected by reverse transcription polymerase chain reaction (RT-PCR) can persist for weeks to months in some individuals. Cycle threshold (Ct) values represent the number of cycles needed to amplify viral ribonucleic acid (RNA) to reach a detectable level. As such, Ct values are inversely related to the amount of virus in a sample. As knowledge of SARS-CoV-2 viral dynamics continues to evolve, understanding the relationship between Ct values, type of symptoms, and timing of symptom onset can help determine when infected individuals are most likely to be infectious. Methods: We conducted a retrospective cohort study of 1,027 healthcare workers (HCWs) who tested positive for SARS-CoV-2 by RT-PCR from nasopharyngeal specimens between June 27, 2020, and September 21, 2020. All HCWs were interviewed within 72 hours of their diagnosis for symptom history. Due to multiple PCR platforms being in use in our facility, only 360 HCWs (35%) had Ct values available for analysis. Multivariate linear regression models examined the effect of COVID-19–related symptoms and timing of symptom onset to test on Ct values. Results: The most frequently reported symptoms were congestion (55.6%), cough (50.3%), and headache (46.7%). Other symptoms less commonly reported were fatigue (36.7%), loss of taste or smell (36.4%), fever (35.4%), muscle aches (33.3%), sore throat (27.4%), and diarrhea (26.7%). Symptomatic HCWs (88.3% of sample) had lower Ct values (ORF-1 M = 22.66, SD = 5.17;E-Gene M = 24.34, SD = 6.60) than asymptomatic individuals (ORF-1 M = 25.46, SD = 6.06;E-Gene M = 29.34, SD = 7.96). Of all symptoms measured, only presence of fever, congestion, and muscle aches predicted significantly lower Ct values. Mean Ct values decreased 2 days prior to symptom onset, were lowest the day of symptom onset, then increased in a curvilinear fashion. There were no significant 2-way interactions between symptoms and time of symptom onset to testing. Conclusions: The curvilinear pattern of Ct values over time from symptom onset are consistent with disease progression patterns and support current understanding of infectivity being highest 2 days prior to symptom onset through day 8. Presence of fever, congestion, and muscle aches are significantly correlated with lower Ct values, suggesting that these symptoms are associated with higher viral load. Although Ct values are not without limitations, our findings support the current understanding that presymptomatic and symptomatic individuals, particularly those with fever, congestion, and muscle aches, may pose higher risk of transmission to others.Funding: NoDisclosures: NoneFigure 1.Figure 2.Table 1.

Cholecystitis as a Possible Immunologic Consequence of COVID-19;Case Series from a Large Healthcare System

Background. Gastrointestinal manifestations are commonly seen in COVID-19 disease with up to 50% of patients reporting nausea or diarrhea. Cholecystitis has been described in rare cases related to COVID-19, possibly in consequence of immune activation, but biliary disease from SARS-CoV-2 infection is not well described. We examined a case series of patients with both COVID-19 and cholecystitis at our institution. Methods. We performed a retrospective chart review of all patients with a diagnosis of cholecystitis within 3 months of SARS-CoV-2 infection;looking at clinical, laboratory, and radiographic characteristics of this population. Results. 30 individuals were identified with a diagnosis of cholecystitis within 3 months of diagnosis of SARS-CoV-2 infection. Most patients presenting with cholecystitis were female and obese (see Table 1). 14 individuals were diagnosed with SARSCoV-2 infection during the same presentation as their cholecystitis diagnosis, usually as part of pre-operative screening. Of 16 individuals diagnosed with SARS-CoV-2 prior to their cholecystitis presentation, a mean of 24 and 17 days elapsed between SARS-CoV-2 infection and cholecystitis symptom onset and radiographic diagnosis, respectively (see Figure 1). Most of these patients had mild respiratory disease, with only 9 developing an oxygen requirement, and only 3 requiring mechanical ventilation. While 17 patients were treated surgically for their cholecystitis, this did not appear to impact symptom resolution. Conclusion. Cholecystitis may be an uncommon complication of COVID-19 disease. Cholecystitis may manifest most often 2-4 weeks following SARS-CoV-2 infection. This timing is similar to that in Multisystem Inflammatory Syndrome following SARS-CoV-2 infection and given similarities in timing to we hypothesize that cholecystitis in our patients could be driven by immune activation.

Bamlanivimab and Casirivimab/Imdevimab Treatment Outcomes: Results from a Large Healthcare System's Structured Implementation Experience

Background. Neutralizing antibody therapies targeting SARS-CoV-2 have been released for emergency use authorization by the FDA. Little is published on their real-world experience. In this retrospective study we share the results of our early experience on patient outcomes from use of these neutralizing antibodies within a large healthcare system. Methods. We retrospectively analyzed results of a healthcare system wide program to pro-actively identify and treat COVID-19 patients with neutralizing antibody therapy. Results. The 449 patients identified for SARS-CoV-2 neutralizing antibody therapy during the study period were retrospectively classified as falling in one of the three groups: untreated (199), bamlanivimab (87) and casirivimab/indevimab (125) treated patients (Table 1). Reasons identified patients were not treated most commonly were patient declined (n=74), unable to be contacted (n=36), out of treatment window (n=23), asymptomatic and feeling better (n=21) or did not have transportation (n=9). Bamlanivimab infusion did not reduce emergency room (ER) visits or hospitalization compared to untreated patient within 30-days of follow up (Table 2), and among all patients treated with antibody therapy only treatment with bamlanivimab and non-white race were predictors of need for hospitalization (Table 3). Casirivimab/ indevimab did reduce subsequent ER visits or hospitalization within 30 days post-infusion when compared to the untreated group. However, patients treated with either antibody therapy had lower acuity of COVID-19 disease as reflected in need for intensive care unit (ICU) stay, mechanical ventilation or death (Table 2). Conclusion. Either neutralizing antibody therapy appears to markedly reduce acuity of COVID-19 disease even if patients do progress to requiring hospitalization. However, casirivimab/indevimab therapy also decreased ER visits and hospitalization suggesting better efficacy in our experience.

COVID-19 wastewater based epidemiology: long-term monitoring of 10 WWTP in France reveals the importance of the sampling context.

SARS-CoV-2 wastewater-based epidemiology (WBE) has been advanced as a relevant indicator of distribution of COVID-19 in communities, supporting classical testing and tracing epidemiological approaches. An extensive sampling campaign, including ten municipal wastewater treatment plants, has been conducted in different cities of France over a 20-week period, encompassing the second peak of COVID-19 outbreak in France. A well-recognised ultrafiltration - RNA extraction - RT-qPCR protocol was used and qualified, showing 5.5 +/- 0.5% recovery yield on heat-inactivated SARS-CoV-2. Importantly the whole, solid and liquid, fraction of wastewater was used for virus concentration in this study. Campaign results showed medium- to strong- correlation between SARS-CoV-2 WBE data and COVID-19 prevalence. To go further, statistical relationships between WWTP inlet flow rate and rainfall were studied and taken into account for each WWTP in order to calculate contextualized SARS-CoV-2 loads. This metric presented improved correlation strengths with COVID-19 prevalence for WWTP particularly submitted and sensitive to rain. Such findings highlighted that SARS-CoV-2 WBE data ultimately require to be contextualized for relevant interpretation.

Decontamination interventions for the reuse of surgical mask personal protective equipment: A systematic review

AIMS & OBJECTIVES: Surgical masks are broadly used as personal protective equipment in a pandemic setting, but little is known regarding decontamination interventions to allow for their reuse. This systematic review sought to evaluate and synthesize data from original research evaluating interventions to decontaminate surgical masks. METHODS: The protocol was registered on PROSPERO (CRD42020178290). We searched MEDLINE, Embase, CENTRAL, Global Health, the WHO COVID-19 database, Google Scholar, DisasterLit, and preprint servers from inception to April 8, 2020. Citation screening was conducted independently in duplicate. Outcomes of interest included mask performance (i.e. filtration efficiency, airflow resistance) and germicidal effects following decontamination. RESULTS: Of 1874 unique citations, 33 full-texts were assessed of which 7 studies were included. One study evaluated mask performance with interventions applied after mask use: dry heat (via rice cooker), autoclave, and three chemical agents (70% ethanol, 100% isopropanol, and 0.5% sodium hypochlorite). Six studies evaluated interventions applied prior to mask use to enhance antimicrobial properties and/or mask performance: nanoparticle emulsions, quaternary ammonium agent, N-halamine, salt film, and a fluorochemical repellent. Heterogeneity of interventions evaluated and outcomes assessed precluded quantitative analysis. Mask performance was best preserved with dry heat decontamination. Good germicidal effects were observed in salt-, N-halamine-, and nanoparticle-coated masks. Safety outcomes were infrequently evaluated. CONCLUSIONS: Limited evidence exists on the safety or efficacy of surgical mask decontamination interventions. Studies to date have evaluated interventions and outcomes using heterogenous and non-standardized test conditions, limiting our ability to compare between interventions or draw conclusions on the most efficacious intervention.

Microwave- and heat-based decontamination of N95 filtering facepiece respirators: a systematic review.

BACKGROUND: In pandemics such as COVID-19, shortages of personal protective equipment are common. One solution may be to decontaminate equipment such as facemasks for reuse. AIM: To collect and synthesize existing information on decontamination of N95 filtering facepiece respirators (FFRs) using microwave and heat-based treatments, with special attention to impacts on mask function (aerosol penetration, airflow resistance), fit, and physical traits. METHODS: A systematic review (PROSPERO CRD42020177036) of literature available from Medline, Embase, Global Health, and other sources was conducted. Records were screened independently by two reviewers, and data was extracted from studies that reported on effects of microwave- or heat-based decontamination on N95 FFR performance, fit, physical traits, and/or reductions in microbial load. FINDINGS: Thirteen studies were included that used dry/moist microwave irradiation, heat, or autoclaving. All treatment types reduced pathogen load by a log10 reduction factor of at least three when applied for sufficient duration (>30 s microwave, >60 min dry heat), with most studies assessing viral pathogens. Mask function (aerosol penetration <5% and airflow resistance <25 mmH2O) was preserved after all treatments except autoclaving. Fit was maintained for most N95 models, though all treatment types caused observable physical damage to at least one model. CONCLUSIONS: Microwave irradiation and heat may be safe and effective viral decontamination options for N95 FFR reuse during critical shortages. The evidence does not support autoclaving or high-heat (>90°C) approaches. Physical degradation may be an issue for certain mask models, and more real-world evidence on fit is needed.

Decontaminating N95 and SN95 masks with ultraviolet germicidal irradiation does not impair mask efficacy and safety.

Inadequate supply of filtering facepiece respirators (FFRs) for healthcare workers during a pandemic such as the novel coronavirus outbreak (SARS-CoV-2) is a serious public health issue. The aim of this study was to synthesize existing data on the effectiveness of ultraviolet germicidal irradiation (UVGI) for N95 FFR decontamination. A systematic review (PROSPERO CRD42020176156) was conducted on UVGI in N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined eligibility and extracted predefined variables. Original research reporting on function, decontamination, or mask fit following UVGI were included. Thirteen studies were identified, comprising 54 UVGI intervention arms and 58 N95 models. FFRs consistently maintained certification standards following UVGI. Aerosol penetration averaged 1.19% (0.70-2.48%) and 1.14% (0.57-2.63%) for control and UVGI arms, respectively. Airflow resistance for the control arms averaged 9.79 mm H2O (7.97-11.70 mm H2O) vs 9.85 mm H2O (8.33-11.44 mm H2O) for UVGI arms. UVGI protocols employing a cumulative dose >20,000 J/m2 resulted in a 2-log reduction in viral load. A >3-log reduction was observed in seven UVGI arms using >40,000 J/m2. Impact of UVGI on fit was evaluated in two studies (16,200; 32,400 J/m2) and no evidence of compromise was found. Our findings suggest that further work in this area (or translation to a clinical setting) should use a cumulative UV-C dose of 40,000 J/m2 or greater, and confirm appropriate mask fit following decontamination.

Efficacy and safety of disinfectants for decontamination of N95 and SN95 filtering facepiece respirators: a systematic review.

BACKGROUND: Decontaminating and reusing filtering facepiece respirators (FFRs) for healthcare workers is a potential solution to address inadequate FFR supply during a global pandemic. AIM: The objective of this review was to synthesize existing data on the effectiveness and safety of using chemical disinfectants to decontaminate N95 FFRs. METHODS: A systematic review was conducted on disinfectants to decontaminate N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined study eligibility and extracted predefined data fields. Original research reporting on N95 FFR function, decontamination, safety, or FFR fit following decontamination with a disinfectant was included. FINDINGS AND CONCLUSION: A single cycle of vaporized hydrogen peroxide (H2O2) successfully removes viral pathogens without affecting airflow resistance or fit, and maintains an initial filter penetration of <5%, with little change in FFR appearance. Residual hydrogen peroxide levels following decontamination were within safe limits. More than one decontamination cycle of vaporized H2O2 may be possible but further information is required on how multiple cycles would affect FFR fit in a real-world setting before the upper limit can be established. Although immersion in liquid H2O2 does not appear to adversely affect FFR function, there is no available data on its ability to remove infectious pathogens from FFRs or its impact on FFR fit. Sodium hypochlorite, ethanol, isopropyl alcohol, and ethylene oxide are not recommended due to safety concerns or negative effects on FFR function.

Decontamination interventions for the reuse of surgical mask personal protective equipment: a systematic review.

BACKGROUND: The high demand for personal protective equipment during the novel coronavirus outbreak has prompted the need to develop strategies to conserve supply. Little is known regarding decontamination interventions to allow for surgical mask reuse. AIM: To identify and synthesize data from original research evaluating interventions to decontaminate surgical masks for the purpose of reuse. METHODS: MEDLINE, Embase, CENTRAL, Global Health, the WHO COVID-19 database, Google Scholar, DisasterLit, preprint servers, and prominent journals from inception to April 8th, 2020, were searched for prospective original research on decontamination interventions for surgical masks. Citation screening was conducted independently in duplicate. Study characteristics, interventions, and outcomes were extracted from included studies by two independent reviewers. Outcomes of interest included impact of decontamination interventions on surgical mask performance and germicidal effects. FINDINGS: Seven studies met eligibility criteria: one evaluated the effects of heat and chemical interventions applied after mask use on mask performance, and six evaluated interventions applied prior to mask use to enhance antimicrobial properties and/or mask performance. Mask performance and germicidal effects were evaluated with heterogeneous test conditions. Safety outcomes were infrequently evaluated. Mask performance was best preserved with dry heat decontamination. Good germicidal effects were observed in salt-, N-halamine-, and nanoparticle-coated masks. CONCLUSION: There is limited evidence on the safety or efficacy of surgical mask decontamination. Given the heterogeneous methods used in studies to date, we are unable to draw conclusions on the most efficacious and safe intervention for decontaminating surgical masks.