A novel cohorting and isolation strategy for suspected COVID-19 cases during a pandemic.

BACKGROUND: The COVID-19 pandemic presents a significant infection prevention and control challenge. The admission of large numbers of patients with suspected COVID-19 disease risks overwhelming the capacity to protect other patients from exposure. The delay between clinical suspicion and confirmatory testing adds to the complexity of the problem. METHODS: We implemented a triage tool aimed at minimizing hospital-acquired COVID-19 particularly in patients at risk of severe disease. Patients were allocated to triage categories defined by likelihood of COVID-19 and risk of a poor outcome. Category A (low-likelihood; high-risk), B (high-likelihood; high-risk), C (high-likelihood; low-risk) and D (low-likelihood; low-risk). This determined the order of priority for isolation in single-occupancy rooms with Category A the highest. Patients in other groups were cohorted when isolation capacity was limited with additional interventions to reduce transmission. RESULTS: Ninety-three patients were evaluated with 79 (85%) receiving a COVID-19 diagnosis during their admission. Of those without a COVID-19 diagnosis: 10 were initially triaged to Category A; 0 to B; 1 to C and 4 to D. All high-risk patients requiring isolation were, therefore, admitted to single-occupancy rooms and protected from exposure. Twenty-eight (30%) suspected COVID-19 patients were evaluated to be low risk (groups C and D) and eligible for cohorting. No symptomatic hospital-acquired infections were detected in the cohorted patients. DISCUSSION: Application of a clinical triage tool to guide isolation and cohorting decisions may reduce the risk of hospital-acquired transmission of COVID-19 especially to individuals at the greatest of risk of severe disease.

SU-E-I-67: Multi-Shot RESOLVE Compared to Single-Shot EPI Diffusion- Weighted MR Imaging Acquisition Scheme.

PURPOSE: The purpose of this project was to configure the parameters for optimal comparison of image quality differences between the prototype imaging technique, read-out-segmented EPI multi-shot (RESOLVE) and the clinically used single-shot EPI (SS-EPI) MRI sequence for Diffusion Weighted Imaging (DWI) in a saline phantom, followed by a normal rat brain. METHODS: Saline phantom (4.2 × 4.2 cm2 ) and a rat brain were imaged on the 1.5T ESPREE (Siemens, Germany) MRI magnet using a wrist coil. Both the SS-EPI and RESOLVE DWI were optimized with equal imaging parameters such as slice thickness/slice gap = 3.0/0 mm, field of view = 210 mm, phase resolution = 100%, and diffusion b values = 0, 600 s/mm2 while other parameters were given similar settings such as the base resolution, which had to be interpolated for the SS-EPI to 96i to match the RESOLVE as it was unable to be set at 192. Image quality was compared in terms of signal intensity, distortion, % ghosting and Apparent Diffusion Co-efficient (ADC) measurements from each sequence. RESULTS: A marked enhancement of overall image quality with superior detail was observed in each of the scans from the RESOLVE sequence when compared to the SS-EPI. Comparing the efficiency of both sequences in terms of image quality, RESOLVE demonstrated a better stable image with minimal distortion and ghosting. The phantom dimensions obtained from RESOLVE images matched the actual dimensions perfectly. RESOLVE images had signal intensities significantly higher than (2.4×) the SS-EPI images (p=0.0008) and ∼0.6 % times less ghosting compared to SS-EPI (p=0.82) which also exhibited distortion with reduced phantom dimensions (4.05 × 3.28 cm) from original. The ADC values computed were almost identical to be (p=0.32) from SS-EPI (2.21mm2 /sec) and RESOLVE (2.19mm2 /sec). CONCLUSIONS: The RESOLVE sequence has significantly superior image quality compared to SS-EPI at 1.5 T with reasonable scan times. DWI with RESLOVE acquisition scheme can be highly beneficial in obtaining distortion free images in routine clinical studies to characterize tumors and other pathological mechanisms with much greater detail than the current clinically used SS-EPI.

Perceptions of blindness related to smoking: a hospital-based cross-sectional study.

AIMS: Smoking is associated with several serious eye diseases. Awareness of smoking and blindness, and its potential to act, as a stimulus to assist stopping smoking has not been investigated. METHODS: A cross-sectional survey using a structured interview of adult patients attending district general hospital ophthalmology, general surgery, and orthopaedic clinics. The interview investigated the awareness and fear of blindness for three established smoking-related diseases, and a distractor condition (deafness), and the likelihood that smokers would quit on developing early signs of each condition. RESULTS: Response was 89.1% (358/402). In all, 183 (51.1%) of responders were male and 175 (48.9%) female. Only 9.5% of patients believed that smoking was definitely or probably a cause of blindness, compared with 92.2% for lung cancer, 87.6% for heart disease, and 70.6% for stroke. Patients ranked their fear of each of the five conditions, scoring five for the most feared and one for the least feared. Patients were significantly (P<0.01) less fearful of blindness (mean score 2.80) than lung cancer (3.89), heart disease (3.58), and stroke (3.35). About one-half of smokers stated that they would definitely or probably quit smoking if they developed early signs of blindness or the three established smoking-related conditions, with no significant differences in proportions for these four conditions. CONCLUSION: The findings suggest that awareness of the risk of blindness from smoking is low, but that the fear of blindness is as compelling a motivation to quit as fear of lung cancer, heart disease, and stroke. The link between smoking and eye disease should be publicised to help reduce smoking prevalence.

Peritoneal dialysis: a temporizing means for hemodialysis patients with subdural hematomas.

Subdural hematoma has a higher mortality rate with hemodialysis patients than the normal population. One reason for this is the coagulation abnormalities of hemodialyzed patients. One case of a successfully treated subdural hematoma in a chronic peritoneal dialysis patient is presented. Changing the mode of dialysis from hemodialysis to peritoneal dialysis in a patient suspected of having a subdural hematoma may be beneficial in improving overally survival.