Summary of your 'study carrel' ============================== This is a summary of your Distant Reader 'study carrel'. The Distant Reader harvested & cached your content into a collection/corpus. It then applied sets of natural language processing and text mining against the collection. The results of this process was reduced to a database file -- a 'study carrel'. The study carrel can then be queried, thus bringing light specific characteristics for your collection. These characteristics can help you summarize the collection as well as enumerate things you might want to investigate more closely. This report is a terse narrative report, and when processing is complete you will be linked to a more complete narrative report. Eric Lease Morgan Number of items in the collection; 'How big is my corpus?' ---------------------------------------------------------- 41 Average length of all items measured in words; "More or less, how big is each item?" ------------------------------------------------------------------------------------ 1682 Average readability score of all items (0 = difficult; 100 = easy) ------------------------------------------------------------------ 48 Top 50 statistically significant keywords; "What is my collection about?" ------------------------------------------------------------------------- 10 COVID-19 5 patient 4 care 3 mask 3 SARS 3 PPE 3 ICU 2 health 2 N95 2 China 1 technology 1 shield 1 research 1 povidone 1 plastic 1 iodine 1 intubation 1 infection 1 figure 1 environment 1 drape 1 decontamination 1 datum 1 covid-19 1 consent 1 clinical 1 York 1 TOF 1 SGA 1 OBICU 1 IQR 1 HMH 1 FFR 1 EHR 1 Clauss 1 CPR 1 Ang-2 Top 50 lemmatized nouns; "What is discussed?" --------------------------------------------- 473 patient 327 care 221 health 174 % 156 mask 153 risk 146 pandemic 126 time 124 use 123 anesthesia 118 respirator 111 infection 108 disease 106 coronavirus 105 case 100 study 97 research 95 surgery 93 system 92 procedure 91 datum 84 virus 84 intubation 84 hospital 76 decontamination 71 worker 70 consent 70 admission 69 transmission 69 resource 69 day 68 delivery 68 author 67 trial 66 method 65 setting 64 airway 62 face 60 ventilation 60 room 59 syndrome 59 model 59 management 58 equipment 56 level 55 information 54 number 51 protection 49 woman 49 figure Top 50 proper nouns; "What are the names of persons or places?" -------------------------------------------------------------- 285 COVID-19 160 ICU 147 SARS 110 CoV-2 105 N95 69 PPE 66 FFR 55 Health 52 Coronavirus 51 China 48 Disease 43 et 42 al 42 OBICU 42 Anesth 42 Analg 38 sha 38 DOI 32 New 32 Care 31 United 30 nan 30 Anesthesia 29 US 26 CoV 26 C 25 York 24 Wuhan 24 States 24 ARDS 23 Pandemic 23 Editor 23 Ang-2 22 M 22 CDC 20 mg 20 National 19 World 19 HP 18 Society 18 RNA 17 March 16 UVGI 16 TOF 16 EHR 16 Control 15 Organization 15 II 14 • 14 Research Top 50 personal pronouns nouns; "To whom are things referred?" ------------------------------------------------------------- 181 we 148 it 54 they 19 us 17 them 12 i 9 one 6 themselves 5 itself 5 he 1 yourself 1 ourselves 1 me Top 50 lemmatized verbs; "What do things do?" --------------------------------------------- 1628 be 380 have 145 use 118 include 104 require 102 provide 74 report 63 do 60 increase 57 need 54 recommend 52 base 48 remain 44 reduce 44 follow 40 associate 39 suggest 38 protect 38 consider 36 perform 36 make 34 allow 33 develop 32 infect 32 give 32 ensure 32 cause 31 find 31 filter 31 decrease 31 become 30 prevent 29 test 29 create 28 describe 27 minimize 27 lead 27 compare 25 work 25 limit 24 show 24 relate 24 receive 24 involve 24 covid-19 23 spread 23 offer 23 manage 23 improve 23 identify Top 50 lemmatized adjectives and adverbs; "How are things described?" --------------------------------------------------------------------- 183 not 133 respiratory 124 clinical 106 covid-19 99 more 98 high 92 also 89 available 83 surgical 79 medical 77 severe 76 such 73 other 71 acute 66 critical 64 however 62 well 62 patient 61 most 58 low 53 elective 52 viral 52 current 51 many 50 effective 49 only 47 protective 45 new 43 large 41 first 40 intensive 39 likely 39 as 38 human 37 potential 37 novel 36 multiple 34 same 34 personal 34 mechanical 33 rapid 33 neuraxial 33 general 33 even 32 obstetric 31 therefore 31 important 31 early 30 specific 30 several Top 50 lemmatized superlative adjectives; "How are things described to the extreme?" ------------------------------------------------------------------------- 23 most 19 good 9 least 8 high 7 large 7 Most 5 great 2 bad 2 N95s 1 simple 1 short 1 safe 1 long 1 late 1 early 1 deadly Top 50 lemmatized superlative adverbs; "How do things do to the extreme?" ------------------------------------------------------------------------ 38 most 4 least 2 well Top 50 Internet domains; "What Webbed places are alluded to in this corpus?" ---------------------------------------------------------------------------- 7 links.lww.com 1 www.asahq.org 1 links.lww 1 links 1 data.lacity.org 1 bit Top 50 URLs; "What is hyperlinked from this corpus?" ---------------------------------------------------- 3 http://links.lww.com/AA/D222 2 http://links.lww.com/ 1 http://www.asahq.org/in-the-spotlight/coronavirus-covid-19-information/caesar 1 http://links.lww.com/AA/D93 1 http://links.lww.com/AA/D105 1 http://links.lww 1 http://links 1 http://data.lacity.org/ 1 http://bit Top 50 email addresses; "Who are you gonna call?" ------------------------------------------------- Top 50 positive assertions; "What sentences are in the shape of noun-verb-noun?" ------------------------------------------------------------------------------- 7 n95 filtering facepiece 3 patients required mechanical 3 virus was later 2 masks are not 2 masks are unavailable 1 % developed acute 1 % developed septic 1 % had acute 1 % had ards 1 % had respiratory 1 % had thrombocytopenia 1 % is likely 1 % required continuous 1 % requiring postoperative 1 % requiring ventilation 1 anesthesia has not 1 anesthesia is safe 1 anesthesia is unique 1 care are validly 1 care using medical 1 case report emergency 1 case report surgical 1 cases are patients 1 cov-2 has rarely 1 cov-2 is efficiently 1 cov-2 is lower 1 cov-2 is now 1 cov-2 is undetectable 1 cov-2 requiring intubation 1 cov-2 was subsequently 1 covid-19 are respiratory 1 covid-19 are significantly 1 covid-19 associated sars 1 covid-19 have high 1 covid-19 included fever 1 covid-19 is acute 1 covid-19 is already 1 covid-19 is only 1 covid-19 is staggering 1 covid-19 is still 1 covid-19 is suitable 1 covid-19 was thus 1 data are generally 1 data do not 1 data reduces barriers 1 data suggest mixed 1 data suggesting requirement 1 decontamination is scarce 1 decontamination using standard 1 disease is quite Top 50 negative assertions; "What sentences are in the shape of noun-verb-no|not-noun?" --------------------------------------------------------------------------------------- 1 infection include not only 1 masks are not necessary 1 patients are not only 1 systems are not interoperable 1 time is not as A rudimentary bibliography -------------------------- id = cord-305066-g042y51w author = Abd-Elsayed, Alaa title = Utility of Substandard Face Mask Options for Health Care Workers During the COVID-19 Pandemic date = 2020-04-20 keywords = N95; mask summary = [4] [5] [6] The US Centers for Disease Control and Prevention (CDC) has suggested that the use of substandard optionsincluding surgical masks, cloth masks, and extended use or reuse of respirators-can be considered, with exercised caution. In this commentary, we attempt to characterize the utility of and provide considerations for the use of these substandard face mask options by HCWs during the COVID-19 pandemic. MacIntyre et al 12 previously reported that the adherent use of surgical face masks or respirators was superior to not using either form of protection in preventing adults from contracting influenza in affected households. Such findings collectively suggest that the adherent use of even suboptimal face masks, along with recommended hand washing practices, may provide meaningful decrement in the risk of contracting respiratory viral illnesses. HCWs, especially those in more impoverished areas of the world, are faced with using substandard options such as surgical face masks, cloth masks, and even extended use or reuse of respirators. doi = 10.1213/ane.0000000000004841 id = cord-287553-yev5i6hu author = Babazade, Rovnat title = Additional Barrier to Protect Healthcare Workers During Intubation date = 2020-04-27 keywords = figure summary = We describe a novel barrier method made from an easily accessible, cheap, and disposable transparent plastic sheet (120 × 100 cm; Figure A) with a crosscut that is marked with a red sticker on the transparent sheet (1.5 × 1.5 cm; Figure A) that is positioned at the mouth. In our simulation, the anesthesiologist covered the head of an airway mannequin with this sheet before preoxygenation with a facemask that is connected to the artificial manual breathing unit through crosscut ( Figure B ). After induction of anesthesia, vocal cords are visualized either by a direct or video laryngoscope under the sheet ( Figure C) , and the endotracheal tube is passed through a marked crosscut in the sheet ( Figure D) . A novel barrier method: "aerosol cover." A, Disposable transparent plastic sheet (120 × 100 cm) with a crosscut (1.5 × 1.5 cm). D, Endotracheal tube is passed through a marked crosscut. doi = 10.1213/ane.0000000000004904 id = cord-257729-s0vo7dlk author = Bauer, Melissa title = Obstetric Anesthesia During the Coronavirus Disease 2019 Pandemic date = 2020-04-20 keywords = SARS; covid-19; infection; patient summary = T he management of obstetric patients infected with Coronavirus Disease 2019 (COVID19) due to human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires quite unique considerations-from caring for critically ill pregnant and postpartum women to protecting health care workers from exposure during the delivery hospitalization (health care providers, personnel, family members, and beyond). 4 An additional manifestation noted among patients with COVID-19 infection is the sudden loss (or reduction) of the sense of smell and taste, which is currently recommended by the American Academy of Otolaryngology-Head With increasing numbers of Coronavirus Disease 2019 (COVID 19) cases due to efficient human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States, preparation for the unpredictable setting of labor and delivery is paramount. doi = 10.1213/ane.0000000000004856 id = cord-280794-k591vqji author = Bauer, Melissa E. title = Neuraxial Procedures in COVID-19–Positive Parturients: A Review of Current Reports date = 2020-04-20 keywords = patient summary = Because anesthesiologists must take into account the risk of meningitis or encephalitis associated with neuraxial procedures in the setting of untreated viremia, we reviewed publications reporting outcomes in COVID-19-positive pregnant women in the current pandemic in an attempt to address this concern. In general, the risk of causing meningitis or encephalitis is extremely low with neuraxial procedures, even in infected patients. Before performing a neuraxial procedure in these patients, it would be advisable to review a recent platelet count given that one-third of patients with COVID-19 infection have been reported to have thrombocytopenia compared with 7%-12% of patients during pregnancy alone. 7 In pregnant women, a platelet count of 70,000 × 10 6 /L has a low risk for spinal epidural hematoma, and lower levels should be considered in cases such as these with a high risk for respiratory compromise with general anesthesia. doi = 10.1213/ane.0000000000004831 id = cord-345610-rx1zmajl author = Boggs, Steven D. title = Calculate the COVID-19 Equation With the People’s Energy as Key Variable date = 2020-04-22 keywords = COVID-19 summary = title: Calculate the COVID-19 Equation With the People''s Energy as Key Variable Besides "joint efforts from people all around the world," 2 it appears to be absolute key that leaders attend to the psychological and emotional well-being of our clinicians in addition to the physical well-being of our staffs "to protect health care workers better, to save more lives." 2 Necessary protective measures interfere with the camaraderie that each of us tries to create at work. While literally getting-in-touch is a caring physician''s "first language," 3 the interactions with our patients now through masks and with PPE create barriers which are new to them and to us. 6 We must calculate the COVID-19 equation with the people''s energy as key variable in mind! Staffing with disease-based epidemiologic indices may reduce shortage of intensive care unit staff during the COVID-19 pandemic doi = 10.1213/ane.0000000000004892 id = cord-350521-jfd5gd2p author = Bong, Choon-Looi title = The COVID-19 Pandemic: Effects on Low- and Middle-Income Countries date = 2020-04-20 keywords = COVID-19; China; care; health summary = Coronavirus Disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, health care workers, health systems, and economies. -William Butler Yeats, The Second Coming A s news of a novel viral illness in China emerged in January 2020 1 and until the day when the Director General of the World Health Organization (WHO) declared a pandemic, 2 those who live and work in low-and middle-income countries (LMICs) held their collective breath. 6 Countries have closed their borders, enforced strict social isolation and quarantine procedures, and increased testing Coronavirus Disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, health care workers, health systems, and economies. This will further reduce resources available for health care, not just in managing COVID-19 patients, but also for those with many other major medical conditions. doi = 10.1213/ane.0000000000004846 id = cord-258071-amkfz940 author = Brown, Sarah title = Barrier System for Airway Management of COVID-19 Patients date = 2020-04-22 keywords = drape summary = To the Editor A irway management of patients with Coronavirus Disease 2019 (COVID-19) poses significant risk to involved staff because of the aerosolizing nature of airway interventions. When selecting such a barrier device, one should consider the importance of access to the airway, containment of aerosolization, time required to set up the device for patient use, and patient tolerance of the device. Some barrier devices, while superior at containing aerosolization, unfortunately restrict the laryngoscopist''s hand movements and would require abandoning a laryngoscopy attempt to remove the barrier if it proved too cumbersome. After intubation is performed and endotracheal tube secured, the clear plastic drape can be tucked into the drawstring bag, which now contains the contaminated airway space for the duration of the case. The patient could be later extubated under the clear drape, and the drape can then be removed and placed in the drawstring bag along with disposable airway equipment such as the suction catheter and stylet. doi = 10.1213/ane.0000000000004876 id = cord-343904-fjtt3f2e author = Brull, Sorin J. title = Clarifications on Technologies to Optimize Care of Severe COVID-19 Patients date = 2020-07-14 keywords = TOF summary = To the Editor W e read with great interest the article by Dr Rubulotta et al 1 and we congratulate the authors for their timely information with regard to strategies and technologies designed to optimize care of patients with severe coronavirus disease (COVID-19). The problem with this statement is that the authors argue that if intubation fails, then neuromuscular block can be reversed quickly by administering sugammadex 16 mg/kg. The authors also suggest, in the event of an anaphylactic reaction to rocuronium, that sugammadex may abort or reverse this process. 2 It also has been shown that subjective (tactile) evaluation of the TOF count is vastly different based on the muscle assessed: qualitative (subjective) evaluation of TOF responses at the eye muscles, for instance, resulted in a >5-fold higher risk of residual paralysis than those patients in whom the hand (adductor pollicis) muscles were assessed subjectively. doi = 10.1213/ane.0000000000005120 id = cord-265233-v5sq5epy author = Cassorla, Lydia title = Decontamination and Reuse of N95 Filtering Facepiece Respirators: Where Do We Stand? date = 2020-10-15 keywords = FFR; N95; SARS; decontamination summary = P ersistent shortages of filtering facepiece respirators (FFR) to protect health care workers (HCW) 1 during the current coronavirus disease 2019 (COVID-19) pandemic 2,3 has driven interest in decontamination and reuse. 8 While FFR are not superior to surgical masks for protection of HCW from seasonal flu, [9] [10] [11] [12] [13] [14] retrospective studies showed increased protection from severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1). [28] [29] [30] [31] [32] [33] [34] In 2006, the Institute of Medicine, now the National Academy of Medicine, convened a "Committee on the Development of Reusable Facemasks for Use during an Influenza Pandemic." Highlighting unpreparedness, 2 reports recommended "expeditious research and policy action" to develop personal protective equipment (PPE) designed to withstand decontamination, evidence-based performance standards, and improved coordination among regulatory agencies. Best available evidence supports moist heat, low T autoclave, MWGS, and HP-based decontamination as effective methods for SARS-CoV-2 without causing significant damage to FFR for 2-5 cycles. doi = 10.1213/ane.0000000000005254 id = cord-291137-09a3tblt author = Chow, Jonathan H. title = Angiotensin II for the Treatment of COVID-19–Related Vasodilatory Shock date = 2020-04-20 keywords = Ang-2 summary = ; Ang-1 = angiotensin I; Ang-2 = angiotensin II; APACHE = Acute Physiology and Chronic Health Evaluation; ARDS = acute respiratory distress syndrome; AT 1 = angiotensin type 1; AT 2 = angiotensin type 2; ATHOS-3 = Angiotensin II for the Treatment of High Output Shock; CI = confidence interval; COVID-19 = coronavirus disease 2019; ECMO = extracorporeal membrane oxygenation; EDHF = endotheliumderived hyperpolarizing factor; ICU = intensive care unit; MAS = mitochondrial assembly protein; NO = nitric oxide; RAAS = renin-angiotensin-aldosterone system; RRT = renal replacement therapy; SARS = severe acute respiratory syndrome C oronavirus disease 2019 (COVID-19) first appeared in Wuhan, China, in early December 2019. 1 In the subgroup of patients admitted to the intensive care unit (ICU), required mechanical ventilation, or died from the disease, 11.9% required continuous renal replacement therapy (RRT), 13.4% developed septic shock, and 40.3% developed acute respiratory distress syndrome (ARDS). doi = 10.1213/ane.0000000000004825 id = cord-336423-rs4bma9b author = Endersby, Ryan Vincent William title = Barrier Devices for Reducing Aerosol and Droplet Transmission in Coronavirus Disease 2019 Patients: Advantages, Disadvantages, and Alternative Solutions date = 2020-05-12 keywords = patient summary = 4 These articles describe barrier devices for potentially reducing aerosol and droplet transmission in Coronavirus Disease 2019 (COVID-19) patients. Brown et al 1 and Babazade et al 4 describe the use of plastic drapes, whereas Lai and Chang 2 and Tsai 3 describe rigid box designs. 2, 3 In addition, the rigid design forces assistants to stand far off to the side of the patient, which limits help with airway management and does not offer them the same protection provided to the laryngoscopist. Without the hood, Glo-Germ could be identified on the laryngoscopist''s hands, entire arms, gown, neck, face, eye protection, mask, and more extended spread around the operating room. We believe our hood maintains the advantages of the barrier design with it offering adequate space around a patient''s head and neck for both the laryngoscopist and assistant to provide effective airway management from preoxygenation to extubation. doi = 10.1213/ane.0000000000004953 id = cord-342642-qzoowc97 author = García-Méndez, Nayely title = Anesthesiologists and the High Risk of Exposure to COVID-19 date = 2020-05-04 keywords = PPE summary = key: cord-342642-qzoowc97 title: Anesthesiologists and the High Risk of Exposure to COVID-19 cord_uid: qzoowc97 (1) PPE are all the set of elements and devices, that are specifically designed to protect the HCP against accidents and illnesses that could be caused by agents during the performance of their daily basis activities as well as in the emergency care; and (2) the occupational risk related to the exposure of the HCP must be identified and analyzed. The JCI has been calling for action at all government levels to address the shortage and protect those who work heroically to care for infected patients with COVID-19. We can confirm that in Mexico, there have been "hospital outbreaks" with 329 HCPs who have been infected with COVID-19 throughout the country. Prevención y control de infección en enfermedades respiratorias agudas con tendencia epidémica y pandémica durante la atención sanitaria Pautas. Available at: www.paho.org/es/documentos/ prevencion-control-infeccion-enfermedades-respiratoriasagudas-con-tendencia-epidemica Anesthesiologists and the High Risk of Exposure to COVID-19 doi = 10.1213/ane.0000000000004919 id = cord-345136-zcd00lcw author = Kapp, Christopher M. title = The Use of Analgesia and Sedation in Mechanically Ventilated Patients With COVID-19 ARDS date = 2020-07-14 keywords = IQR summary = From day 2 to 7, when most patients remained intubated, the median daily dose of oral morphine equivalents was 775 mg (interquartile range [IQR], 648.4-899.7 mg) and for oral midazolam equivalents was 270.9 mg (IQR, 201.3-304.4 mg). Of the patients who underwent neuromuscular blockade, the median daily dose of opiates (in oral morphine equivalents) and benzodiazepines (in oral midazolam equivalents) was 937.2 mg (IQR, 667.7-1683 mg) and 224.7 mg (IQR, 56.56-610 mg), respectively. For patients who did not receive neuromuscular blockade, the median daily dosage of opiates (in oral morphine equivalents) and benzodiazepines (in oral midazolam equivalents) was 623.8 mg (IQR, 176.3-726.9 mg) and 135 mg (IQR, 40.63-203.8 mg), respectively. The median and interquartile range of daily opiate (mg oral morphine equivalents) and benzodiazepine use (mg oral midazolam equivalents) is shown per day of mechanical ventilation at JHH. doi = 10.1213/ane.0000000000005131 id = cord-274819-xp5q9f0r author = Lai, Yu Yung title = A Carton-Made Protective Shield for Suspicious/Confirmed COVID-19 Intubation and Extubation During Surgery date = 2020-04-20 keywords = shield summary = title: A Carton-Made Protective Shield for Suspicious/Confirmed COVID-19 Intubation and Extubation During Surgery A barrier enclosure has recently been proven to effectively minimize the spread of patients'' droplets and aerosols during intubation. 2 However, in the scenario of suspicious/confirmed COVID-19 patients who need to undergo emergency surgery, extubation and emergence cough after general anesthesia are another potential source of transmission, and might contaminate the operating room. Here we proposed a simple, carton-made, protective shield that provides an effective reduction of transmission of droplets and aerosols during both intubation and extubation. After the A Carton-Made Protective Shield for Suspicious/Confirmed COVID-19 Intubation and Extubation During Surgery shield interrupts operation, it should be discarded and a new one prepared for extubation. When extubation of suspicious/confirmed COVID-19 after general anesthesia is needed, the adjunct protective shield may help minimize droplet and aerosol transmission and reduce operating room contamination. doi = 10.1213/ane.0000000000004869 id = cord-296725-ecy0rie9 author = Landau, Ruth title = Lessons Learned From First COVID-19 Cases in the United States date = 2020-04-20 keywords = COVID-19 summary = The simultaneous surge of cases compounded by a critical shortage of protective personnel equipment (PPE), including N95 masks and high-efficiency particulate air (HEPA) filters to avoid contaminating anesthesia machines, has added to the challenge that anesthesiologists are facing today on labor and delivery units across the United States. Current recommendations include airborne protection for all aerosolizing procedures such as endotracheal intubation during general anesthesia. As per current recommendations, for this patient who was neither tested nor symptomatic for COVID-19, the anesthesia team did not use any PPE (besides surgical masks and gloves) nor was a HEPA filter placed between the endotracheal tube and the anesthesia machine. Our case emphasizes that in labor and delivery units managing parturients from communities with a high prevalence of COVID-19 infection, in the absence of universal testing before cesarean delivery, all patients, even those initially asymptomatic on admission, should be treated as PUI when inducing general anesthesia. doi = 10.1213/ane.0000000000004840 id = cord-302112-l74s05s0 author = Laosuwan, Prok title = Acrylic Box Versus Plastic Sheet Covering on Droplet Dispersal During Extubation in COVID-19 Patients date = 2020-05-12 keywords = plastic summary = title: Acrylic Box Versus Plastic Sheet Covering on Droplet Dispersal During Extubation in COVID-19 Patients 1 There are some suggestions from around the world proposing the placement of large transparent plastic sheets over patients'' faces to limit the contamination area. 2, 3 Therefore, we compared the effectiveness and spreading patterns of acrylic boxes and plastic sheets as protective barriers compared to noncoverage technique under fluorescent condition. We demonstrated the differences of overall droplet dispersion between 3 acrylic box models (3.3%-19.0%), plastic sheet (2.8%), and noncoverage technique (26.3%) during tracheal extubation. The plastic sheet caused contamination both on the chest and abdomen of anesthesia personnel. The height of the box might take part in the contamination area as the droplet dispersion may rebound to the surroundings after striking the top. The droplet spreading patterns of panels (A), (B), (C), transparent plastic sheet (D), and noncoverage technique (E). doi = 10.1213/ane.0000000000004937 id = cord-254266-6ca2d79d author = Loftus, Randy W. title = In Response: "Perioperative COVID-19 Defense: An Evidence-Based Approach for Optimization of Infection Control and Operating Room Management" date = 2020-04-20 keywords = iodine; povidone summary = [3] [4] [5] We evaluated the impact of an evidence-based, multifaceted approach on perioperative Staphylococcus aureus transmission and surgical-site infections (SSIs) in a randomized clinical trial. 7 Povidone-iodine has rapid and effective virucidal activity against the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and Modified Vaccinia Virus Ankara (MVA) with at least a 4 log 10 (99.99%) inactivation of both pathogens within 15 seconds. While chlorhexidine gluconate is less effective than povidone-iodine, 8 it has activity against enveloped viruses on skin and in the oral cavity (0.12%) with viral inactivation in as little as 30 seconds. 7, 8, 11, 12, 15 In conclusion, the evidence shows a favorable risk/benefit profile for our recommendation of patient decolonization with nasal povidone and oral chlorhexidine rinse to help mitigate the perioperative spread of COVID-19. doi = 10.1213/ane.0000000000004854 id = cord-327388-26ot3cuy author = Lu, Amy title = The Tipping Point of Medical Technology: Implications for the Postpandemic Era date = 2020-06-16 keywords = COVID-19; care; technology summary = Whereas classic infectioncontrol and public health measures were used during the severe acute respiratory syndrome (SARS) epidemic in 2003, COVID-19 provides the opportunity to explore the potential of new digital technologies, including big data analytics, artificial intelligence, blockchain technology, and the Internet of Things. 1 Among the many available digital technologies, O''Reilly-Shah et al 2 in this issue of Anesthesia & Analgesia address not only the potential benefits but also the barriers to adopting health informatics for patient care during the COVID-19 pandemic. This includes expanding our roles in telehealth platforms and remote monitoring and surveillance in the inpatient and outpatient settings, thereby adding significant value to the continuum of care through perioperative medicine. In the inevitable post-COVID pandemic era, what is the anesthesiologist''s role in technology as our health care systems and other major stakeholders define the "new normal?" Is this our opportunity to take a legitimate seat at the table of state and national discussions on value-based care and population health management strategies using our understanding of the continuum of care from the preoperative phase through the postdischarge phase? doi = 10.1213/ane.0000000000005040 id = cord-337572-kx5hihnr author = Ludwig, Stephan title = Coronaviruses and SARS-CoV-2: A Brief Overview date = 2020-04-20 keywords = COVID-19; China; SARS summary = The virus was later denominated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and defined as the causal agent of Coronavirus Disease 2019 . Here we provide a short background on coronaviruses and their origin, and we describe in more detail the novel SARS-CoV-2 and the efforts thus far to identify effective therapies against COVID-19. The virus was later denominated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and defined as the causal agent of Coronavirus Disease 2019 (COVID-19). The virus was later denominated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and defined as the causal agent of Coronavirus Disease 2019 (COVID-19). 19 SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 At the end of December 2019, China reported the increasing occurrence of pneumonia in the city of Wuhan, Hubei province. Identification of a novel coronavirus in patients with severe acute respiratory syndrome doi = 10.1213/ane.0000000000004845 id = cord-273884-dm73zgt8 author = Ludwin, Kobi title = Cardiopulmonary Resuscitation in the Prone Position: A Good Option for Patients With COVID-19 date = 2020-06-16 keywords = CPR summary = To the Editor P rone positioning of intubated patients suffering from pneumonia improves ventilation-perfusion matching, recruits collapsed alveoli, provides a more uniform distribution of tidal volume through improved chest wall mechanics, and may decrease mortality in more severely hypoxemic patients. 2 Immediate initiation of cardiopulmonary resuscitation (CPR), including chest compressions, are crucial but challenging when the patient is prone. Performance of CPR in the prone position is uncommon, but there are several reports of CPR in patients in the prone position having spine surgery (Supplemental Digital Content, Table 1 , http://links. A reasonable question is whether a prone patient with cardiac arrest be turned supine before initiating CPR or remain in the prone position. Kwon et al 3 reported that the largest left ventricular cross-sectional area is 0-2 vertebral segments below the inferior angle of the scapula in at least 86% of patients in patients positioned prone. Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: a retrospective study doi = 10.1213/ane.0000000000005049 id = cord-293473-32jx8j5g author = Maier, Cheryl L. title = Falsely Low Fibrinogen Levels in COVID-19 Patients on Direct Thrombin Inhibitors date = 2020-05-12 keywords = Clauss summary = When present in the patient sample, DTIs inhibit the thrombin in the Clauss reagent, prolonging the time to clot formation, and thus underestimating the fibrinogen concentration. Viscoelastic testing represents an alternative to the Clauss method for following fibrinogen levels in the setting of DTIs. The platelet-fibrinogen interactions assessed by maximum amplitude on thromboelastography (TEG) (Haemonetics, Boston, MA) or maximum clot formation on rotational thromboelastometry (ROTEM) (Instrumentation Laboratories) are relatively unaffected by the presence of DTIs. 6 In the example provided in the Figure, a ROTEM was obtained following the reported severe drop in fibrinogen on day 4 and resulted in the following notable parameters: EXTEM clotting time of 477 seconds (normal range 43-82 seconds) and FIBTEM maximum clot firmness of 39 mm (normal range 7-24 mm). The graph demonstrates an example of the magnitude of which an argatroban infusion can have upon the measurement of fibrinogen levels determined by the Clauss assay. doi = 10.1213/ane.0000000000004949 id = cord-289806-6ihptx6n author = Martinez, Rebecca title = Critical Obstetric Patients During the Coronavirus Disease 2019 Pandemic: Operationalizing an Obstetric Intensive Care Unit date = 2020-10-07 keywords = OBICU; care; patient summary = The pandemic brought near-complete cessation of nonurgent hospital activities with the rapid expansion of critical care services, with the notable exception of the labor and delivery unit (LDU), which continued to have a full complement of patients presenting for obstetric care. By the time the obstetric ICU (OBICU) was fully operational (end of March), the volume demand was mildly curtailed by some patients electing to leave NYC; however, interinstitutional transfers for maternal or fetal indications provided steady demands for care, with fluctuations occurring week by week. However, a key difference is that the critical care attendings (ICU oversight) are not ultimately responsible for patient care decisions and provide ad hoc consultations if deemed needed by the obstetric anesthesia attending. Daily online lectures by the Internal Medicine or Anesthesia departments review critical care topics that are both general in nature and specific to SARS-CoV-2 infection; these lectures while targeted at residents were available to all members of the OBICU team. doi = 10.1213/ane.0000000000005253 id = cord-012459-tge08va0 author = Matthews, Laura J. title = Airway Alert Bracelets: Enhancing Safety in the Coronavirus Disease 2019 Era date = 2020-08-18 keywords = patient summary = We have designed a medical alert bracelet, similar to a hospital name band, that is placed on any patient where nonstandard equipment (anything other than iView video laryngoscope [Intersurgical, Wokingham, England] plus bougie) was needed to secure the airway or where the person intubating experienced difficulty. They then remain on the patient''s wrist for the duration of their ICU stay and provide a visual alert of their difficult airway, regardless of the bed space or even hospital if they are transferred for ongoing care (Figure) . The presence of this bracelet on a patient prompts a review of the electronic intubation notes before undertaking any procedure where the airway could be "at risk," and appropriate measures to be put in place-for example, a senior anesthetist with the relevant equipment present when airway alert patients are proned or deproned. Airway Alert Bracelets: Enhancing Safety in the Coronavirus Disease 2019 Era Figure. doi = 10.1213/ane.0000000000005165 id = cord-317602-ftcs7fvq author = O’Reilly-Shah, Vikas N. title = The COVID-19 Pandemic Highlights Shortcomings in US Health Care Informatics Infrastructure: A Call to Action date = 2020-05-12 keywords = COVID-19; EHR; datum; health summary = Although it appears that there is general consensus on the use of the Substitutable Medical Apps, Reusable Technologies on Fast Healthcare Interoperability Resources (SMART on FHIR) standard developed by the nonprofit Health Level Seven International (HL7) for the interchange of data, the standard is not specific enough to ensure, and regulators have failed to require, that different vendors implement the specification in compatible ways. To briefly recap, if hospitals across the country were able to observe and interpret data being gathered at other institutions in real time and to contribute their own data to the shared repository, the health care system could be learning about and improving its care of COVID-19 patients continuously and collaboratively, based on the sum total of available information rather than incrementally in silos. The public has a pressing interest in ensuring that data standards (eg, OMOP, FHIR) are rapidly developed, adopted by appropriate international standards organizations (eg, HL7), and implemented by EHR vendors in a manner that facilitates interoperability for individual patient care, public health, and research purposes. doi = 10.1213/ane.0000000000004945 id = cord-273737-t6j3leec author = Poeran, Jashvant title = Cancellation of Elective Surgery and Intensive Care Unit Capacity in New York State: A Retrospective Cohort Analysis date = 2020-06-30 keywords = ICU; York summary = BACKGROUND: In response to the coronavirus disease 2019 (COVID-19) pandemic, New York State ordered the suspension of all elective surgeries to increase intensive care unit (ICU) bed capacity. Descriptions of ICU utilization and mechanical ventilation were stratified by admission type (elective surgery, emergent/urgent/trauma surgery, and medical admissions) and by geographic location (New York metropolitan region versus the rest of New York State). In NYC, 221,970 patients required an ICU stay with mechanical ventilation (Table 3) ; 12,726 of those patients were admitted after elective surgery (12,726/221,970 = 5.7%), versus emergent/urgent/trauma surgery (n = 75,334) and medical reasons (n=133,910). While suspending elective surgeries clearly increases hospital (non-ICU) bed capacity, our analysis suggests a limited impact on ICU resource allocation, especially in the context of the much larger share of ICU admissions due to emergent/urgent/trauma surgery and medical etiologies. doi = 10.1213/ane.0000000000005083 id = cord-336973-z8mwzmf6 author = Rubulotta, Francesca title = In Response date = 2020-07-14 keywords = ICU summary = In Response W e thank esteemed colleagues Drs Brull and Kopman, 1 both well-known experts in the field of neuromuscular monitoring and blockade for their interest in our article and their comments. 2 The creation of dedicated anesthesia intubation teams during the COVID-19 crisis as well as the increasing engagement of anesthesiologists in the ICU setting led us to believe that presenting basic principles of neuromuscular monitoring could be of interest for all readers. NMB monitoring is not standard of care in the ICU, despite the infusion of NMBAs is common for adult with severe ARDS or during proning maneuvers. The COVID-19 pandemic peak has significantly increased the workload in most ICUs and the frequency of TOF monitoring has been compromised at times. We do not recommend the corrugator supercilii as the monitoring site of choice but wanted to point out that it best reflects NMB or neuromuscular transmission at the diaphragm or larynx, anatomic areas of particular interest for ICU physicians. doi = 10.1213/ane.0000000000005121 id = cord-254861-lpzx878m author = Saggese, Nicholas P. title = An Interim Solution to the Decreased Availability of Respirators Against COVID-19 date = 2020-04-22 keywords = mask summary = To the Editor W e read the recent article titled, "Utility of Substandard Facemask Options for Health Care Workers during the COVID-19 Pandemic" by Abd-Elsayed and Karru 1 with great interest. The respirator is comprised of an anesthesia mask, inline ventilator filter, or high-efficiency particulate air (HEPA) filter and elastic straps ( Figure A) . 3 Also, a case report from Singapore demonstrated 41 health care workers (HCWs) who came in contact with COVID-19 patients during aerosolizing procedures. Alternatively, the authors of this letter used 2 tourniquets fashioned together instead of rubber bands to create a better seal ( Figure C) . After using this technique and performing a user seal An Interim Solution to the Decreased Availability of Respirators Against COVID-19 Figure. Solutions to the shortage of N95 respirators are crucial for protecting health care workers from contracting the virus and becoming a vector of transmission to others. Utility of substandard face mask options for health care workers during the COVID-19 pandemic doi = 10.1213/ane.0000000000004879 id = cord-310104-1c7q9m06 author = Sasangohar, Farzan title = Provider Burnout and Fatigue During the COVID-19 Pandemic: Lessons Learned From a High-Volume Intensive Care Unit date = 2020-04-20 keywords = COVID-19; HMH; PPE; care summary = T he novel Coronavirus Disease 2019 (COVID19) pandemic has resulted in an overall surge in new cases of depression and anxiety and an exacerbation of existing mental health issues, with a particular emotional and physical toll on health care workers. In this article, we share the lessons learned collectively by an interdisciplinary team of ICU leadership and collaborating scientists at the Center for Outcomes Research at HMH about the experience of occupational fatigue and burnout of intensive care personnel as a result of responding to the COVID-19 pandemic. Several factors may have exacerbated occupational fatigue and burnout in ICUs. Given our overarching roles across various facets of the health care system and our first-hand experiences with the response, the "lessons learned" documented here provide a holistic overview of major system-level problems exposed by the pandemic. doi = 10.1213/ane.0000000000004866 id = cord-324388-onc441uw author = Siddiqui, Urooj title = Same-Day Consent for Regional Anesthesia Clinical Research Trials: It’s About Time date = 2020-08-12 keywords = clinical; consent; research summary = Notwithstanding the low-risk nature of participation in most regional anesthesia clinical trials, subject recruitment on the same day as surgery is often prohibited by local research ethics boards (REB) due to their concerns regarding patient autonomy and perceptions of patient vulnerability immediately before surgery that could impact the voluntary nature and the rigor of the informed consent process. doi = 10.1213/ane.0000000000005196 id = cord-343865-wbd0hqqc author = Singh, Ajay title = Real-Time Remote Surveillance of Doffing During COVID-19 Pandemic: Enhancing Safety of Health Care Workers date = 2020-05-12 keywords = PPE summary = Worldwide a significant number of health care workers (HCWs) have been infected till to date with Asia-Pacific region reporting 35 deaths and over 4000 quarantined cases, as on April 3, 2020. Effective use of PPE by HCWs is an integral part of COVID-19 prevention in the health care setting. Two-way audio-visual communication system with closed circuit television (CCTV) cameras in the doffing area has the potential to ensure HCW safety from the offsite location through a trained observer, qualified to guide round the clock (Figure) . He will communicate, visually inspect, protect, and guide HCWs through the protocols of doffing PPE. Rational use of personal protective equipment (PPE) for coronavirus disease (COVID-19): interim guidance Use of personal protective equipment among health care personnel: results of clinical observations and simulations Alternative doffing strategies of personal protective equipment to prevent self-contamination in the health care setting doi = 10.1213/ane.0000000000004940 id = cord-288569-sitxa2ul author = Smereka, Jacek title = Role of Mask/Respirator Protection Against SARS-CoV-2 date = 2020-04-20 keywords = mask summary = 1 There are currently many types of masks/respirators available, ranging from simple surgical masks designed to protect wearers from microorganism transmission and fit loosely to the user''s face, through N95 masks used to prevent users from inhaling small airborne particles. Surgical masks are designed to protect against droplets or particles with a diameter of >100 μm, whereas severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is essentially spherical, albeit slightly pleomorphic, with a diameter of 60-140 nm and 100 times smaller than the pore diameter. Long et al 5 conclude in their meta-analysis that the use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory-confirmed influenza. Wang et al 1 indicated that 10 of 213 medical professionals with no mask were infected by COVID-19 as compared with 0 of 278 wearing N95 respirators. 6 To conclude, the use of protective masks can and should be the first protection against SARS-CoV-2 transmission to medical personnel. doi = 10.1213/ane.0000000000004873 id = cord-011656-zln7zmn9 author = Subedi, Asish title = Medical Ethics Versus Healthcare Workers’ Rights: Fight-or-Flee Response date = 2020-06-16 keywords = COVID-19 summary = To the Editor I read with great interest an article by Bong 1 on coronavirus disease 2019 (COVID-19) impact on low-and middle-income countries (LMICs). This article deals with the several health care problems faced in LMICs, and the authors have provided solutions to overcome it. 2 This report highlights the importance of psychological well-being of health care workers involved during the COVID-19 tsunami. To overcome the mental stress, the government should provide social securities and incentives to health care workers, and moral support to reassure how important we are to the country and the sacrifices we are doing at this crisis. 1 While, at this moment, when the rich countries are struggling to get the PPEs for their own health care workers, we will only have a handful of these PPEs by the time it reaches our place. Intensive care units in the context of COVID-19 in Nepal: current status and need of the hour doi = 10.1213/ane.0000000000005060 id = cord-282026-839jc5wp author = Tsui, Ban C. H. title = Coronavirus Disease 2019: Epidemiological Factors During Aerosol-Generating Medical Procedures date = 2020-06-16 keywords = COVID-19; environment summary = 3 During AGMPs, PPE (including N95 respirators, powered air purifying respirators [PAPRs], face shields, gowns, and gloves) remains the major environment-host IF protecting HCWs. For AGMPs, such as intubation, video laryngoscopy provides slightly more distance between the infected patient and the HCW when compared to direct laryngoscopy, but the HCW still remains at high exposure risk. In fact, the Anesthesia Patient Safety Foundation (APSF) and the American Society of Anesthesiologists (ASA) recommend decontamination of the OR after care of COVID patients and "entry should be delayed until sufficient time has elapsed for enough air changes to remove aerosolized infectious particles." 3 Safety practices used by other occupations exposed to hazardous particulates provide a great resource for alternative agent-environment IFs for HCWs performing AGMPs. Local exhaust ventilation hoods near the contamination source provide effective control of dust and fumes generated in industries utilizing woodworking and soldering. doi = 10.1213/ane.0000000000005063 id = cord-347500-sigm6tos author = Vetter, Thomas R. title = The Response of the Anesthesia & Analgesia Community to Coronavirus Disease 2019 date = 2020-04-27 keywords = COVID-19 summary = In February 2020, SARS-CoV-2 was subsequently defined by the World Health Organization (WHO) as the causative agent of the emerging zoonotic coronavirus disease 2019 (COVID-19). As presciently described in 3 articles in the July/ August 2005 issue of the journal Foreign Affairs, the recent emergence of a novel viral strain like SARS-CoV-2 and the ensuing COVID-19 global pandemic were by all accounts biologically, historically, culturally, and politically inevitable. 2-4 COVID-19 is only the most recent of a litany of so-called "emerging infectious diseases" that have opportunistically infected humans for centuries and likely for millennia. For severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), applying an R 0 value of 2.5, this equates to a herd immunity threshold of 60%. Emerging infectious diseases and pandemic potential: status quo and reducing risk of global spread doi = 10.1213/ane.0000000000004905 id = cord-253281-95ubt4k1 author = Wilson, Lauren A. title = Return to Normal: Prioritizing Elective Surgeries With Low Resource Utilization date = 2020-05-04 keywords = ICU summary = We therefore evaluated intensive care unit (ICU) utilization and mechanical ventilation following common elective surgical procedures to (1) determine which procedures are the least resource intensive and (2) which patient populations are less likely to require postoperative ICU admission or ventilation. Multivariable logistic regression models measured the association between patient age/comorbidity burden as measured by Charlson-Deyo index, 3 and the outcomes of ICU admission and ventilation, to validate the perception that younger and healthier patients are less likely to require these resources. Of the 15 elective surgeries evaluated, cardiac procedures were the most resource intensive with 83.9% of patients admitted to the ICU and 27.9% requiring ventilation, followed by abdominal procedures that had an average ICU admission rate of 20.3%. In almost all procedure cohorts, younger patients with a low comorbidity burden were less likely to require ICU admission and/or ventilation. doi = 10.1213/ane.0000000000004930 id = cord-295495-leyasj3d author = Wong, Patrick title = Supraglottic Airway–Guided Intubation During the COVID-19 Pandemic: A Closed Technique date = 2020-05-12 keywords = SGA summary = 2, 3 We propose a potential "closed set up" version of SAGFBI, which uses an ultrasound probe cover, to form a closed system to minimize aerosol contamination. Approximately 10 cm proximal to the distal end of the probe cover, a small slit is created and the patient-end of a filter is inserted. The distal end of the probe cover is pulled over the entrance of the Auragain ventilation port and taped to form an airtight seal (Figure, panel B) . Second, intubation remains "closed" throughout, that is, from insertion of the bronchoscope into the SGA and the patient''s airway until attachment of the anesthetic circuit to the tracheal tube, unlike other intubation techniques. Airtight seals are made by taping the proximal end of the probe cover and plait and taping the filter inserted near the distal end. doi = 10.1213/ane.0000000000004951 id = cord-263087-fhn4m2zc author = Yang, Yao-Lin title = Adaptation to the Plastic Barrier Sheet to Facilitate Intubation During the COVID-19 Pandemic date = 2020-05-04 keywords = intubation summary = To the Editor W e read with interest the recent article by Brown et al, 1 titled "Barrier System for Airway Management of COVID-19 Patients" which described the use of a plastic drape attached to a plastic bag as a protective measure during endotracheal intubation and extubation. A transparent dressing should not be utilized with videolaryngoscopy as the film''s adhesive nature may interfere with the maneuvering of laryngoscope or endotracheal tube, but a dressing can be placed Adaptation to the Plastic Barrier Sheet to Facilitate Intubation During the COVID-19 Pandemic Figure. Although we have been carefully removing the drape after successful intubation, we feel that Brown et al 1 and other authors make an excellent point that the sheet can be left in place for the duration of surgery, and the patient can be subsequently extubated under the drape, shielding anesthesia providers and other operating room personnel when the endotracheal tube is removed. doi = 10.1213/ane.0000000000004923