Avoidance of preferred beta-lactam therapy in patients who report allergy is associated with an increased risk of adverse events. Development of inpatient programs aimed at accurately identifying beta-lactam allergies to safely promote beta-lactam administration among these patients is warranted.

This proof-of-concept study demonstrates that no longer routinely reporting urine culture results from noncatheterized medical and surgical inpatients can greatly reduce unnecessary antimicrobial therapy for asymptomatic bacteriuria without significant additional laboratory workload. Larger studies are needed to confirm the generalizability, safety, and sustainability of this model of care.

Since its publication in 2008, SQUIRE (Standards for Quality Improvement Reporting Excellence) has contributed to the completeness and transparency of reporting of quality improvement work, providing guidance to authors and reviewers of reports on healthcare improvement work. In the interim, enormous growth has occurred in understanding factors that influence the success, and failure, of healthcare improvement efforts. Progress has been particularly strong in three areas: the understanding of the theoretical basis for improvement work; the impact of contextual factors on outcomes; and the development of methodologies for studying improvement work. Consequently, there is now a need to revise the original publication guidelines. To reflect the breadth of knowledge and experience in the field, we solicited input from a wide variety of authors, editors and improvement professionals during the guideline revision process. This Explanation and Elaboration document (E&E) is a companion to the revised SQUIRE guidelines, SQUIRE 2.0. The product of collaboration by an international and interprofessional group of authors, this document provides examples from the published literature, and an explanation of how each reflects the intent of a specific item in SQUIRE. The purpose of the guidelines is to assist authors in writing clearly, precisely and completely about systematic efforts to improve the quality, safety and value of healthcare services. Authors can explore the SQUIRE statement, this E&E and related documents in detail at http://www.squire-statement.org.

No abstract

A 56-year-old man presented to our Emergency Department in Toronto, ON, Canada, with fever and non-productive cough, 1 day after returning from a 3-month visit to Wuhan, China. Given this travel history, the transferring ambulance and receiving hospital personnel used appropriate personal protective equipment. He had a medical history of well controlled hyper tension. On examination, his maximum temperature was 38•6°C, oxygen saturation was 97% on room air, and respiratory rate was 22 breaths per min-without any signs of respiratory distress. Laboratory investigations showed mild thrombocyto penia (113 × 10⁹ per L, normal 150-400), haemoglobin concentration 146 g/L (normal 130-180), white blood cell count 7•4 × 10⁹ per L (normal 4-11), creatinine concentration 81 μmol/L, alanine amino transferase 29 IU/L (normal <40), and lactate concentration 1•1 mmol/L (normal 0•5-2•0). A chest x-ray showed patchy bilateral, peribronchovascular, ill-defined opacities in all lung zones.Considering the clinical presentation of viral pneumonia in a patient with the appropriate epidemiological risk, the patient was admitted as a probable case of 2019 novel coronavirus (2019-nCoV) infection. The public health authority was notified of the case on admission and it traced the contacts. Mid-turbinate swabs were negative for influenza virus A and influenza virus B, parainfluenza virus, respiratory syncytial virus, adenovirus, and human metapneumovirus. Coronavirus was detected in both mid-turbinate and throat swabs by PCR and confirmed as 2019-nCoV by sequencing. 1 day after admission to hospital, the patient developed mild haemoptysis We would like to thank the nursing staff involved in this patient's care, Infection Prevention and Control team members, as well as

Abstract We report diagnosis and management of the first laboratory-confirmed case of coronavirus disease 2019 (COVID-19) hospitalized in Toronto, Canada. No healthcare-associated transmission occurred. In the face of a potential pandemic of COVID-19, we suggest sustainable and scalable control measures developed based on lessons learned from severe acute respiratory syndrome.

Extracellular [K+] can range within 2.5-3.5 mM under normal conditions to 50-80 mM under ischemic and spreading depression events. Sustained exposure to elevated [K+]o has been shown to cause significant neuronal death even under conditions of abundant glucose supply. Astrocytes are well equipped to buffer this initial insult of elevated [K] through extensive gap junctional coupling, Na+/K+ pump activity (with associated glycogen and glycolytic potential), and endfoot siphoning capability. Their abundant energy availability and alkalinizing mechanisms help sustain Na+/K+ ATPase activity under ischemic conditions. Furthermore, passive K+ uptake mechanisms and water flux mediated through aquaporin-4 channels in endfoot processes are important energy-independent mechanisms. Unfortunately, as the length of ischemic episode is prolonged, these mechanisms increase to a point where they begin to have repercussions on other important cellular functions. Alkalinizing mechanisms induce an elevation of [Na+]i, increasing the energy demand of Na+/K+ ATPase and leading to eventual detrimental reversal of the Na+/glutamate- cotransporter and excitotoxic damage. Prolonged ischemia also results in cell swelling and activates volume regulatory processes that release excessive excitatory amino acids, further exacerbating excitotoxic injury. In the days following ischemic injury, reactive astrocytes demonstrate increased cell size and process thickness, leading to improved spatial buffering capacity in regions outside the lesion core where there is better neuronal survival. There is a substantial heterogeneity among reactive astrocytes, with some close to the lesion showing decreased buffering capacity. However, it appears that both Na+/K+ ATPase activity (along with energy production processes) as well as passive K+ uptake mechanisms are upregulated in gliotic tissue outside the lesion to enhance the above-mentioned homeostatic mechanisms.

I n December 2019, an outbreak of acute respiratory illness secondary to a novel coronavirus (SARS-CoV-2) originated in Wuhan, China. As of May 13, 2020, coronavirus disease 2019 (COVID-19) has caused a global pandemic resulting in more than 4 170 000 cases and over 287 000 deaths. 1 This pandemic has placed immense, and in some cases overwhelming, strain on health care systems around the world. Most people with COVID-19 present initially with a mild illness and do not require hospital admission. 2 These patients are generally discharged home to self-isolation as a means of reducing the burden on the health care system and limiting spread of COVID-19 to other, vulnerable patients and staff in hospital. 3 We expected, however, that, owing to self-isolation requirements, there would be no formal method for physician assessments or counselling to occur in outpatients whose tests subsequently return as positive for COVID-19. The aim of our study was to develop and test the feasibility of a virtual care program for physician assessment and follow-up of outpatients with COVID-19 in self-isolation. Methods Design and setting Sunnybrook Health Sciences Centre is a 627-bed academic tertiary care centre located in Toronto, Ontario. Patients who present to our institution with suspected COVID-19 infection and mild symptoms are sent home to self-isolate while test results are pending. Institutional testing criteria for COVID-19 have evolved throughout the pandemic. Early in the pandemic, criteria for testing focused on patients with respiratory symptoms and a compatible history of travel to a high-risk country within the preceding 14 days. With ongoing local