An international survey of healthcare workers use of personal protective equipment during the early stages of the COVID-19 pandemic

OBJECTIVE

Little is known regarding the specific ways personal protective equipment (PPE) has been used and reused during the coronavirus disease 2019 (COVID-19) pandemic. The objective of this study was to evaluate the patterns of PPE use and the impact of PPE availability on the attitudes and well-being of an international population of healthcare workers.

METHODS

This was an online, cross-sectional survey of healthcare workers. The survey was disseminated internationally using social media, specialty society list-serves, and email augmented by snowball sampling to healthcare workers who provided direct care to patients with suspected or confirmed COVID-19. The survey was conducted between April 13 and May 1, 2020. The primary outcome was self-reported PPE use during aerosol-generating medical procedures. Other outcomes included PPE use during care for respiratory patients in general, PPE reuse, PPE decontamination, and healthcare worker impressions related to their work and the pandemic.

RESULTS

A total of 2227 healthcare workers from 23 countries completed the survey. The N95 was the most common respirator among the 1451 respondents who performed aerosol-generating procedures (n = 1050, 72.3%). Overall, 1783 (80.1%) of providers reported general reuse of PPE, which was similar across US regions but less common in Canada, Italy, and Spain. The most commonly reused item of PPE was the N95 respirator, with the majority of respondents who reused PPE reporting N95 reuse (n = 1157, 64.9%). Of the 1050 individuals who wore an N95 mask while performing an aerosol-generating medical procedure, 756 (72%) reported re-using an N95, and 344 (45.5%) reported reuse for >3 days. Qualitative results identified several common themes, including (1) lack of availability of PPE, (2) fear and anxiety as a result of inadequate PPE, (3) potential exposure to family members, and (4) concerns regarding workload and pay.

CONCLUSIONS

This international survey of healthcare workers found that N95 respirators were commonly used to care for patients with respiratory symptoms with and without aerosol-generating medical procedures. Healthcare workers reported an unprecedented need to reuse PPE that was designed for single-use, specifically the N95 respirator. The reuse of PPE increased the perceived risk for COVID-19 infection and harmed mental health.

Application of the advanced communications technology satellite to teleradiology and real-time compressed ultrasound video telemedicine

The authors have investigated the application of the NASA Advanced Communications Technology Satellite (ACTS) to teleradiology and telemedicine using the Jet Propulsion Laboratory (JPL)-developed ACTS Mobile Terminal (AMT) uplink. In this experiment, bidirectional 128, 256, and 384 kbps satellite links were established between the ACTS/AMT, the ACTS in geosynchronous orbit, and the downlink terrestrial terminal at JPL. A terrestrial Integrated Digital Services Network (ISDN) link was established from JPL to the University of Washington Department of Radiology to complete the bidirectional connection. Ultrasound video imagery was compressed in real-time using video codecs adhering to the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T) Recommendation H.261. A 16 kbps in-band audio channel was used throughout. A five-point Likert scale was used to evaluate the quality of the compressed ultrasound imagery at the three transmission bandwidths (128, 256, and 384 kbps). The central question involved determination of the bandwidth requirements to provide sufficient spatial and contrast resolution for the remote visualization of fine- and low-contrast objects. The 384 kbps bandwidth resulted in only slight tiling artifact and fuzziness owing to the quantizer step size; however, these motion artifacts were rapidly resolved in time at this bandwidth. These experiments have demonstrated that real-time compressed ultrasound video imagery can be transmitted over multiple ISDN line bandwidth links with sufficient temporal, contrast, and spatial resolution for clinical diagnosis of multiple disease and pathology states to provide subspecialty consultation and educational at a distance.

Proptosis as the manifesting sign of Weber-Christian disease

PURPOSE

To identify proptosis as a manifesting sign of Weber-Christian disease (recurrent febrile nodular panniculitis).

METHOD

Case report. A 61-year-old man had signs of right proptosis and orbital inflammation that resolved with oral corticosteroid therapy. Orbital inflammation later recurred with associated cutaneous nodules, myalgia, nausea, and malaise.

RESULTS

Rheumatologic evaluation and subcutaneous nodule biopsy led to the diagnosis of Weber-Christian disease. The patient required systemic immunosuppressive agents to control the disease.

CONCLUSION

This case shows the rare finding of proptosis as the manifesting sign of Weber-Christian disease.

Ambulatory care training standards for continuity of care in osteopathic family medicine

The authors developed statewide standards of excellence for ambulatory care training in an osteopathic medical consortium of family medicine residency programs. A total of 16 osteopathic family medicine residency programs joined with the Michigan State University-College of Osteopathic Medicine to form the Consortium for Osteopathic Graduate Medical Education Training (COGMET) Family Medicine Division. Standards were developed and implemented on a statewide basis for all member residency programs. Initial qualitative evaluations discovered minor as well as more substantive noncompliance after a 6-month trial. Results from longitudinal quantitative evaluations will determine the effectiveness of these standards.

Bilateral parotid swelling associated with chronic obstructive pulmonary disease. A case of pneumoparotid

Acute enlargement of the parotid glands due to air insufflation is well reported under various names, the most appropriate of which is pneumoparotid. We report an unusual example of pneumoparotid, which was difficult to diagnose, that involved background swelling of the parotids because of the respiratory effort of chronic obstructive pulmonary disease and acute exacerbations associated with episodes of coughing.

Monoclonal plasmacytic ulcerative stomatitis. A plasma cell dyscrasia?

We report a case of extramedullary plasmacytoma that appeared in an uncharacteristic manner as an ulcerative stomatitis affecting particularly the tongue and buccal mucosa. The lesions were associated with a transient lichenoid skin rash. The literature is reviewed and comparisons made between this tumor and the related plasma cell dyscrasias of multiple myeloma and monoclonal gammopathy.