Introduction: More than 93,000 cases of coronavirus disease have been reported worldwide. We describe the epidemiology, clinical course, and virologic characteristics of the first 12 U.S. patients with COVID-19. Methods:We collected demographic, exposure, and clinical information from 12 patients confirmed by CDC during January 20-February 5, 2020 to have COVID-19. Respiratory, stool, serum, and urine specimens were submitted for SARS-CoV-2 rRT-PCR testing, virus culture, and whole genome sequencing. Results:Among the 12 patients, median age was 53 years (range: 21-68); 8 were male, 10 had traveled to China, and two were contacts of patients in this series. Commonly reported signs and symptoms at illness onset were fever (n=7) and cough (n=8). Seven patients were hospitalized with radiographic evidence of pneumonia and demonstrated clinical or laboratory signs of worsening during the second week of illness. Three were treated with the investigational antiviral remdesivir. All patients had SARS-CoV-2 RNA detected in respiratory specimens, typically for 2-3 weeks after illness onset, with lowest rRT-PCR Ct values often detected in the first week. SARS-CoV-2 RNA was detected after reported symptom resolution in seven patients. SARS-CoV-2 was cultured from respiratory specimens, and SARS-CoV-2 RNA was detected in stool from 7/10 patients. Conclusions:In 12 patients with mild to moderately severe illness, SARS-CoV-2 RNA and viable virus were detected early, and prolonged RNA detection suggests the window for diagnosis is long. Hospitalized patients showed signs of worsening in the second week after illness onset.for use under a CC0 license.

The trial was registered with ClinicalTrials.gov (NCT02593253).

IMPORTANCE Sleep has major consequences for physical and emotional well-being. Hospitalized patients experience frequent iatrogenic sleep interruptions and there is evidence that such interruptions can be safely reduced.OBJECTIVE To determine whether a clinical decision support tool, powered by real-time patient data and a trained prediction algorithm, can help physicians identify clinically stable patients and safely discontinue their overnight vital sign checks. DESIGN, SETTING, AND PARTICIPANTSA randomized clinical trial, with inpatient encounters randomized 1:1 to intervention vs usual care, was conducted from March 11 to November 24, 2019. Participants included physicians serving on the primary team of 1699 patients on the general medical service (not in the intensive care unit) of a tertiary care academic medical center.INTERVENTIONS A clinical decision support notification informed the physician if the patient had a high likelihood of nighttime vital signs within the reference ranges based on a logistic regression model that used real-time patient data as input. The notification provided the physician an opportunity to discontinue measure of nighttime vital signs, dismiss the notification for 1 hour, or dismiss the notification for that day. MAIN OUTCOMES AND MEASURESThe primary outcome was delirium, as determined by bedside nurse assessment of Nursing Delirium Screening Scale scores, a standardized delirium screening tool (delirium diagnosed with score Ն2). Secondary outcomes included mean nighttime vital sign checks. Potential harms included intensive care unit transfers and code blue alarms. All analyses were conducted on the basis of intention-to-treat.RESULTS A total of 1930 inpatient encounters in 1699 patients (intervention encounters: 566 of 966 [59%] men; mean [SD] age, 53 [15] years) were randomized. In the intervention vs control arm, there was a significant decrease in the mean (SD) number of nighttime vital sign checks (0.97 [0.95] vs 1.41 [0.86]; P < .001) with no increase in intensive care unit transfers (49 [5%] vs 47 [5%]; P = .92) or code blue alarms (2 [0.2%] vs 9 [0.9%]; P = .07). The incidence of delirium was not significantly reduced (108 [11%] vs 123 [13%]; P = .32).CONCLUSIONS AND RELEVANCE While this randomized clinical trial found no difference between groups in the primary outcome, delirium incidence, the secondary findings indicate that a real-time prediction algorithm embedded within a clinical decision support tool in the electronic health record can help physicians identify clinically stable patients who can forgo routine vital sign checks, safely giving them greater opportunity to sleep. Other aspects of hospital care that depend on clinical stability, such as level of care or cardiac monitoring, may be amenable to a similar intervention.

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Background: Atrial tachyarrhythmia is common in adults with tetralogy of Fallot (TOF) due to surgical scarring from repairs and atrial enlargement. The maze procedure refers to surgical ablation within the right atrium to disrupt arrhythmogenic circuits and is sometimes performed concomitantly during reoperation on repaired TOF patients. Our study aims to evaluate the effectiveness of maze in TOF patients. Methods: We performed a retrospective chart review that identified 30 TOF patients who underwent a pulmonary valve replacement (PVR) with maze and 38 TOF patients who underwent a PVR without maze from 1994 to 2011 and had at least 2 years of post-surgical follow-up at the Ahmanson/UCLA Adult Congenital Heart Disease Center. Preoperative and postoperative arrhythmia status and management were compared in maze and non-maze groups. Results: Before the procedure, the most common pre-operative arrhythmias in the maze group were a history of atrial fibrillation (AFib)(n=16), atrial flutter (AFL)(n=10), and other supraventricular tachycardia (SVT)(n=6). Isolated right atrial maze was performed in 26 patients, and combined right and left atrial maze-cox procedure was performed in 4 patients. Of the 16 patients in the maze group with pre-op Afib, 6 had recurrent Afib within the first 2 years of follow-up (62.5% relative reduction, p=0.012). Of the 10 patients with pre-op AFL, only 1 had recurrence (90% relative reduction, p=0.012). Of the 6 patients with pre-op SVT, 4 had recurrence (33.3% relative reduction, p=0.727). There was no significant arrhythmia status change in the non-maze group at 2 years. Comparing patients with and without maze, the average cardiopulmonary bypass times were 155 minutes and 97 minutes, respectively (p=0.064), and aortic cross clamp times were 122 minutes and 64 minutes, respectively (p=0.004). On average, patients with maze spent 3.7 more days in the hospital compared to those without maze (p=0.001). Conclusions: Performing a concomitant maze procedure in patients undergoing TOF repair was associated with a moderate improvement in atrial tachyarrhythmia burden over 2 years. TOF patients who had the concomitant maze procedure required longer cardiopulmonary bypass time, aortic cross clamp time, and total hospital stay.