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The mechanisms for neurological complications of COVID-19, the disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), are not yet well understood. We present a critically ill man with a COVID-19-associated hemorrhagic encephalopathy. SARS-CoV-2 RNA was not detected in cerebrospinal fluid (CSF) or blood. CSF analyses suggested dysregulation of pro-inflammatory cytokine pathways, particularly tumor necrosis factor-α and interleukin-6, consistent with a cytokine release syndrome. The patient gradually recovered with supportive care and neurological rehabilitation. Awareness of this clinical entity may facilitate the identification of patients with a potentially remediable cause of encephalopathy in COVID-19.

P hysician attire is a modifiable factor that has been demonstrated to influence the patient-physician relationship. [1][2][3][4][5][6] However, patient-physician interactions in the intensive care unit (ICU) differ from other health care settings. Patients admitted to the ICU typically do not have a preexisting long-term relationship with their ICU physician, and therefore trust needs to be established over a short time frame. 7 The severity of patient illness frequently results in the active participation of family as surrogate decision makers, complicating the patient-physician relationship. The high acuity of the ICU makes for a wide range of attires worn, from scrubs to suits. We therefore conducted a survey in 3 ICUs to examine ICU patient family perceptions and preferences for physician attire.Methods. We performed a cross-sectional survey of family members of consecutive patients admitted to 3 medicalsurgical ICUs (Calgary, Alberta, Canada) during the period November 1, 2010, to October 31, 2011, to assess self-expressed preference for physician attire. Participants were asked to rate the importance of 10 physicianrelated factors (age, sex, race, neat grooming, facial piercings, visible tattoos, professional dress, white coat, visible name tag, and overall first impression) using a 5-point Likert scale and to select the best physician from photograph panels of 4 physicians (eAppendix; http://www .jamainternalmed.com). Photograph panels were generated from a stratified random of 32 photographs of 8 physician models to ensure that each panel contained a photograph of each study attire (traditional white coat, scrubs, suit, and casual attire), 2 male and 2 female models, and 1 model of each visible race (white, black, Indian, and Asian). Binomial confidence intervals were computed for observed categorical responses and compared using 2 tests. All analyses were performed with SAS version 9.2 (SAS Institute Inc) statistical software. The study was approved by the Conjoint Health Research Ethics Board.

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Our review identified outcome-based assessment as the predominant measure used to report effectiveness of clinical ethics consultation consultations. In particular, clinical ethics consultation decreased ICU length of stay and increased family and healthcare provider satisfaction. However, using outcome measures as the primary endpoint may not reflect the original intent of the clinical ethics consultation service. Based on our review, we propose a list of process measures that may better capture the key domains of a quality clinical ethics consultation.