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Tsukada K, Yasui Y, Miyata S, Fuyumuro J, Kikuchi T, Mizuno T, Nakayama S, Kawano H, Miyamoto W. Effectiveness of Virtual Reality Training in Teaching Personal Protective Equipment Skills: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2355358. [PMID: 38353953 PMCID: PMC10867681 DOI: 10.1001/jamanetworkopen.2023.55358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/12/2023] [Indexed: 02/16/2024] Open
Abstract
Importance Training on the proper use of personal protective equipment (PPE) is critical for infection prevention among health care workers. Traditional methods, such as face-to-face and video-based training, can strain resources and present challenges. Objective To determine the effectiveness of 360° virtual reality (VR) training for PPE donning and doffing compared with face-to-face and video training in enhancing the PPE use skills of prospective health care practitioners. Design, Setting, and Participants A blinded, prospective, and randomized noninferiority clinical trial was conducted from August to December 2021 at Teikyo University School of Medicine in Tokyo, Japan, with a mixed population of medical students. Participants were second- to fourth-year medicine, medical technology, or pharmacy students aged 20 years or older with no prior PPE training. Participants were randomized into 1 of 3 training groups (VR, face-to-face, or video) based on their enrollment order. An intention-to-treat analysis was conducted. Intervention A 30-minute lecture on PPE procedures was delivered to all participants before the training. After the lecture, the VR group trained with an immersive 360° VR tool, the face-to-face group trained with actual PPE, and the video group trained by watching video footage on a computer and a projector. After 3 days, a standardized practical skills test was administered. Main Outcomes and Measures The primary outcome was the mean score on a 20-point practical skills test, and the secondary outcome was the percentage of correct execution. Results A total of 91 participants were recruited and randomized into 3 groups: VR (n = 30), face-to-face (n = 30), and video (n = 31) training. After excluding 1 participant due to illness, 90 participants (mean [SD] age, 24.2 [3.15] years; 54 males [60.0%]) completed the assessment. The mean (SD) scores were 17.70 (2.10) points for the VR group, 17.57 (2.45) points for the face-to-face group, and 15.87 (2.90) points for the video group. The VR group demonstrated no significant difference in performance from the face-to-face group. However, the VR group had significantly higher effectiveness than the video group (17.70 vs 15.87 points; P = .02). Conclusions and Relevance Results of this trial indicate that VR training was as effective as face-to-face training in enhancing PPE donning and doffing skills and was superior to video training. The findings suggest that VR training is a viable resource-conserving training option. Trial Registration Japan Registry of Clinical Trials Identifier: jRCT103021029.
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Affiliation(s)
- Keisuke Tsukada
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Kaga Itabashi-ku, Tokyo, Japan
| | - Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Kaga Itabashi-ku, Tokyo, Japan
| | - Satoshi Miyata
- Teikyo University Graduate School of Public Health, Kaga Itabashi-ku, Tokyo, Japan
| | - Junko Fuyumuro
- Department of Infection Control, Teikyo University Hospital, Kaga Itabashi-ku, Tokyo, Japan
| | - Tomomi Kikuchi
- Department of Infection Control, Teikyo University Hospital, Kaga Itabashi-ku, Tokyo, Japan
| | | | - Satoshi Nakayama
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Kaga Itabashi-ku, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Kaga Itabashi-ku, Tokyo, Japan
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Kaga Itabashi-ku, Tokyo, Japan
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Wan Q, Han L, Yang X, Yu S, Zheng X. Dental professionals' use of personal protective equipment during COVID-19: a cross-sectional study in China. Front Public Health 2023; 11:1183580. [PMID: 37465172 PMCID: PMC10350493 DOI: 10.3389/fpubh.2023.1183580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
Background Appropriate use of personal protective equipment (PPE) could significantly reduce the risk of viral transmission and infection. This study aimed to assess the use of PPE among dentists during the COVID-19 pandemic in China, explore its influencing factors, and provide some practical recommendations. Methods An online cross-sectional survey was conducted among 384 Chinese dentists in September 2022. The questionnaire comprised a series of questions about demographic characteristics, compliance with proper PPE use, personal barriers to use, and exposure risk estimation. Results Of the 384 respondents, 57.3% had unacceptable compliance with the proper use of PPE during COVID-19. Medical surgical mask is the most common for dental professionals to wear (93.8%), followed by goggles or face shield (63.8%), and isolation gown (53.1%). Unexpectedly, only 63.3% of respondents always change masks with guidelines. The condition for changing goggles/face shields and isolation gowns is even worse (45.6 and 37.0%, respectively). Visual barriers, physical discomfort, complex procedures, and heavy workload were the most common personal barriers to use. According to the results of Chi-square test and correlation analysis, PPE use compliance was associated with age, years of practice, medical institution type, and exposure risk estimation. Conclusion Chinese dental professionals need to improve their compliance with the proper use of PPE, especially those in the 31-40 age group, with 11-15 experience years and working in private dental clinics. Increasing compliance with PPE may be achieved by addressing personal barriers to use, human resource shortages, and perceptions of exposure risk.
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Affiliation(s)
- Qinjie Wan
- School of Energy and Environment, Southeast University, Nanjing, Jiangsu, China
| | - Lei Han
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xin Yang
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Shaoling Yu
- Department of Pediatric Dentistry, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xiaohong Zheng
- School of Energy and Environment, Southeast University, Nanjing, Jiangsu, China
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Liu E, Smyth RL, Li Q, Qaseem A, Florez ID, Mathew JL, Amer YS, Estill J, Lu Q, Fu Z, Lu X, Chan ESY, Schwarze J, Wong GWK, Fukuoka T, Ahn HS, Lee MS, Nurdiati D, Cao B, Tu W, Qian Y, Zhao S, Dong X, Luo X, Chen Z, Li G, Zhang X, Zhao X, Xu H, Xu F, Shi Y, Zhao R, Zhao Y, Lei J, Zheng X, Wang M, Yang S, Feng X, Wu L, He Z, Liu S, Wang Q, Song Y, Luo Z, Zhou Q, Guyatt G, Chen Y, Li Q. Guidelines for the prevention and management of children and adolescents with COVID-19. Eur J Pediatr 2022; 181:4019-4037. [PMID: 36109390 PMCID: PMC9483317 DOI: 10.1007/s00431-022-04615-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/26/2022] [Accepted: 09/04/2022] [Indexed: 12/15/2022]
Abstract
Children are the future of the world, but their health and future are facing great uncertainty because of the coronavirus disease 2019 (COVID-19) pandemic. In order to improve the management of children with COVID-19, an international, multidisciplinary panel of experts developed a rapid advice guideline at the beginning of the outbreak of COVID-19 in 2020. After publishing the first version of the rapid advice guideline, the panel has updated the guideline by including additional stakeholders in the panel and a comprehensive search of the latest evidence. All recommendations were supported by systematic reviews and graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Expert judgment was used to develop good practice statements supplementary to the graded evidence-based recommendations. The updated guideline comprises nine recommendations and one good practice statement. It focuses on the key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin (IVIG) for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health. CONCLUSION This updated evidence-based guideline intends to provide clinicians, pediatricians, patients and other stakeholders with evidence-based recommendations for the prevention and management of COVID-19 in children and adolescents. Larger studies with longer follow-up to determine the effectiveness and safety of systemic glucocorticoids, IVIG, noninvasive ventilation, and the vaccines for COVID-19 in children and adolescents are encouraged. WHAT IS KNOWN • Several clinical practice guidelines for children with COVID-19 have been developed, but only few of them have been recently updated. • We developed an evidence-based guideline at the beginning of the COVID-19 outbreak and have now updated it based on the results of a comprehensive search of the latest evidence. WHAT IS NEW • The updated guideline provides key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health.
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Affiliation(s)
- Enmei Liu
- Department of Respiratory Medicine Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Rosalind Louise Smyth
- UCL Great Ormond St Institute of Child Health, London, UK
- Great Ormond Street Hospital, London, UK
| | - Qinyuan Li
- Department of Respiratory Medicine Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Amir Qaseem
- Clinical Policy and Center for Evidence Reviews, American College of Physicians, Philadelphia, USA
| | - Ivan D. Florez
- School of Rehabilitation Science, McMaster University, Hamilton, ON Canada
- Department of Pediatrics, University of Antioquia, Medellin, Antioquia Colombia
- Pediatric Intensive Care Unit, Clinica Las Americas, Medellin, Colombia
| | - Joseph L. Mathew
- Advanced Pediatrics Centre, PGIMER Chandigarh, Chandigarh, India
| | - Yasser Sami Amer
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Clinical Practice Guidelines & Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Pediatrics Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Quan Lu
- Shanghai Children’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Zhou Fu
- Department of Respiratory Medicine Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaoxia Lu
- Department of Respiratory Medicine, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Edwin Shih-Yen Chan
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-National University of Singapore Medical School, Singapore, Singapore
- Singapore Clinical Research Institute, Singapore, Singapore
| | - Jürgen Schwarze
- Children’s Research Network and Department of Child Life and Health, Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | - Gary Wing-Kin Wong
- Department of Pediatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Toshio Fukuoka
- Emergency and Critical Care Center, the Department of General Medicine, Department of Research and Medical Education at Kurashiki Central Hospital, Kurashiki, Japan
- Advisory Committee in Cochrane Japan, Tokyo, Japan
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, Korea University, Seoul, South Korea
- Korea Cochrane Centre, Seoul, South Korea
- Institute for Evidence-Based Medicine, Korea University College of Medicine, Seoul, South Korea
- Korea University School of Medicine, Seoul, South Korea
| | - Myeong Soo Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
- Korean Convergence Medicine, University of Science and Technology, Daejeon, South Korea
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Detty Nurdiati
- Cochrane Indonesia, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
- Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China
| | - Wenwei Tu
- Department of Pediatrics & Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Yuan Qian
- Capital Institute of Pediatrics, Beijing, China
| | | | - Xiaoyan Dong
- Shanghai Children’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Xiaoping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhimin Chen
- Department of Pulmonology, Children’s Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Guobao Li
- National Clinical Research Center for Infectious Disease, Shenzhen, China
- Shenzhen Third People’s Hospital, Shenzhen, China
| | - Xiaobo Zhang
- Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Xiaodong Zhao
- Department of Pediatric Research Institute, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Hongmei Xu
- Department of Infection Diseases Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Feng Xu
- Department of Critical Care Medicine Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yuan Shi
- Department of Neonatology Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ruiqiu Zhao
- Department of Infection Diseases Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yao Zhao
- National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Junqiang Lei
- Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Xianlan Zheng
- Department of Nursing, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Mengshu Wang
- Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Shu Yang
- Chengdu University of TCM, Chengdu, China
| | - Xixi Feng
- Chengdu Medical College, Chengdu, China
| | - Liqun Wu
- Shenzhen Health Development Research Center, Shenzhen, China
| | - Zhihui He
- Chongqing Ninth People’s Hospital, Chongqing, China
| | - Shihui Liu
- Beijing Jishuitan Hospital, Beijing, China
| | - Qi Wang
- Department of Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, Canada
- McMaster Health Forum, McMaster University, Hamilton, Canada
| | - Yang Song
- Iberoamerican Cochrane Centre-Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Zhengxiu Luo
- Department of Respiratory Medicine Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qi Zhou
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, Canada
| | - Yaolong Chen
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Institute of Health Data Science, Lanzhou University, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
- Lanzhou University GRADE Centre, Lanzhou, China
| | - Qiu Li
- Department of Nephrology Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Meneguin S, Pollo CF, Melchiades EP, Ramos MSM, de Morais JF, de Oliveira C. Scale of Adherence to Good Hospital Practices for COVID-19: Psychometric Properties. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912025. [PMID: 36231328 PMCID: PMC9566148 DOI: 10.3390/ijerph191912025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 06/01/2023]
Abstract
To avoid hospital transmission, all COVID-19 prevention measures should be followed. This study aimed to evaluate the psychometric properties of a novel scale developed to assess adherence to good practices for COVID-19 in the hospital setting. A methodological cross-sectional study was conducted at a public hospital in the state of São Paulo, Brazil, with 307 healthcare providers. Data were collected using a questionnaire addressing sociodemographic/occupational data and the Adherence to Standard Precautions for COVID-19 scale. Cronbach's alpha coefficients and the intraclass correlation coefficients were used to measure internal consistency and temporal stability (test-retest analysis), respectively. Concurrent validity was evaluated using Spearman's correlation coefficients between the scores of the overall scale and its domains. Factorial structure was evaluated using exploratory factor analysis and goodness-of-fit of the model was tested using confirmatory factor analysis. Cronbach's alpha coefficients for the scale and its domains were higher than 0.7, except the psychosocial domain (0.61). All intraclass correlation coefficients were higher than 0.7. Strong correlations were found between the total score and the personal (0.84) and organizational (0.90) domains of the scale and a good correlation was found with the psychosocial domain (0.66). The fit of the multidimensional model was satisfactory for all parameters and the three-dimensional structure of the scale was confirmed by the fit of the factor loadings. The novel scale is a valid and reliable instrument for assessing adherence to good hospital practices for COVID-19.
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Affiliation(s)
- Silmara Meneguin
- Department of Nursing, Botucatu Medical School, Paulista State University, Botucatu 18618-687, SP, Brazil
| | - Camila Fernandes Pollo
- Department of Nursing, Botucatu Medical School, Paulista State University, Botucatu 18618-687, SP, Brazil
| | - Ediana Preisler Melchiades
- Department of Nursing, Botucatu Medical School, Paulista State University, Botucatu 18618-687, SP, Brazil
| | | | - José Fausto de Morais
- Faculty of Mathematics, Federal University of Uberlândia, Uberlândia 38400-902, MG, Brazil
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, University College London, London WC1E 6BT, UK
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Zhao M, Zhao J, Yan J, Gao X. The Evaluation of Physiological Index Changes and Safety Work of Female Medical Staff With Different Medical Protection Standards in the Ward of COVID-19. Front Med (Lausanne) 2022; 9:906140. [PMID: 35814785 PMCID: PMC9256920 DOI: 10.3389/fmed.2022.906140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Effective personal protective equipment (PPE) contribute to the prevention of COVID-19 infection. However, it is necessary to evaluate the potential risk of different medical protections in the isolation ward of COVID-19. Objectives We aimed to explore the dynamics in physiological indexes of medical staff under primary and secondary PPE in the isolation ward of COVID-19 and provide the scientific basis for determining the safe work strategy. Materials and Methods In this study, 30 female nurses were selected to simulate medical work under the primary or secondary PPE, respectively. The oral temperature, axillary temperature, heart rate, respiratory rate, blood oxygen saturation, and blood pressure were measured and recorded every 20 min. The subjective adverse symptoms were recorded every 30 min. The blood glucose and weight of the individuals were measured and recorded before and after the trial. Results The results indicated that the median trial persistence time in the participants with moderate-intensity work wearing the secondary PPE (70.0 min) was much lower than that with moderate-intensity work wearing the primary PPE (180 min) and with light-intensity work wearing the primary PPE (110 min; p < 0.05). Importantly, the heart rate, oral/axillary temperature, and respiratory rate of physiological indexes of the participants under moderate-intensity work wearing the secondary PPE increased significantly faster than the primary PPE (p < 0.001), while blood oxygen saturation decreased significantly faster than the primary PPE (p < 0.001). In addition, the proportions of subjective adverse symptoms (such as dry mouth, dizziness, palpitations, and anhelation) were much higher than primary PPE (p < 0.001). The average sweat volume and blood glucose consumption of participants under moderate-intensity work wearing primary PPE were higher than secondary PPE (p < 0.001). Conclusion The combination of an exacerbated workload and secondary PPE worn by COVID-19 healthcare workers increases the change in physiological indicators, and in some cases the adverse symptoms, which can affect and even suspend their medical work. For any medical institution, there is room for improvement in terms of bioethics of a "Job Well Done" to reduce the risks of medical activities under secondary PPE.
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Affiliation(s)
- Min Zhao
- Department of Internal Medicine, Fuzhou Pulmonary Hospital of Fujian, Fuzhou, China
| | - Jianhui Zhao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Junbing Yan
- Department of Internal Medicine, Fuzhou Pulmonary Hospital of Fujian, Fuzhou, China
| | - Xiaoye Gao
- Department of Internal Medicine, Fuzhou Pulmonary Hospital of Fujian, Fuzhou, China
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Symvoulakis EK, Karageorgiou I, Linardakis M, Papagiannis D, Hatzoglou C, Symeonidis A, Rachiotis G. Knowledge, Attitudes, and Practices of Primary Care Physicians towards COVID-19 in Greece: A Cross-Sectional Study. Healthcare (Basel) 2022; 10:healthcare10030545. [PMID: 35327023 PMCID: PMC8953255 DOI: 10.3390/healthcare10030545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 02/06/2023] Open
Abstract
The aim of this study was to investigate the knowledge, attitudes, and practices of primary care physicians and residents towards the COVID-19 pandemic in Greece. A cross-sectional questionnaire-based study was conducted in Greece during March 2021. The population frame for the study was a list of currently practicing primary care physicians and residents who were registered within one of the main associations of general/family medicine in Greece. Hierarchical multiple logistic regression analysis was performed for practices at higher levels (vs. lower) in relation to knowledge, attitudes, and general characteristics of participants. Overall, 194 participants completed the survey (e-response rate: 38.4%). In total, 94% of participants were familiar with official recommendations regarding SARS-CoV-2, and 88.7% were vaccinated against SARS-CoV-2 or promptly intended to be. Physicians working in the private sector had a higher average practices score when compared to physicians working in the public sector (87.6 vs. 81.9, p < 0.05). Higher levels of attitudes predicted greater odds for higher levels of practices (odds ratio = 4.18, p < 0.05). Despite the relatively high COVID-19 vaccination rate of physicians, several participants were unvaccinated due to a then unscheduled first dose appointment. Attitudes were the only determinant for more proper practices towards the prevention of COVID-19.
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Affiliation(s)
- Emmanouil K. Symvoulakis
- Clinic of Social and Family Medicine, Department of Social Medicine, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece;
- Correspondence:
| | | | - Manolis Linardakis
- Clinic of Social and Family Medicine, Department of Social Medicine, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece;
| | - Dimitrios Papagiannis
- Public Health & Vaccines Lab., Department of Nursing, School of Health Sciences, University of Thessaly, 41110 Larisa, Greece;
| | - Chrissi Hatzoglou
- Department of Physiology, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece;
| | - Aristotelis Symeonidis
- Bioinformatics and Human Electrophysiology Laboratory, Department of Informatics, Ionian University, 49100 Corfu, Greece;
| | - Georgios Rachiotis
- Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece;
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Risk of Dehydration Due to Sweating While Wearing Personal 2 Protective Equipment in COVID-19 Clinical Care: A Pilot Study. Healthcare (Basel) 2022; 10:healthcare10020267. [PMID: 35206881 PMCID: PMC8871557 DOI: 10.3390/healthcare10020267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: The objectives of this study were (a) to determine the physical impact of the personal protective equipment (PPE) used in COVID-19 care, specifically the impact on the hydration state of the temperature and the comfort of the healthcare workers who use it, and (b) to show the high-fidelity simulated environment as an appropriate place to test the experimental designs to be developed in real environments for COVID-19. Background: All healthcare staff use full PPE in the care of COVID-19 patients. There are problems, such as excessive sweating, which have not been quantified thus far. Methods: A descriptive pilot design was used in a simulated high-fidelity setting. There was paired activity, with mild–moderate physical activity, between 45 and 60 min continuously, with the COVID-19 PPE. Sixteen intensive care nurses were selected. The before–after differential of weight, thirst, weight use of the PPE, body temperature, thermal body image, general and facial warmth sensation, and perspiration sensation were measured. Results: All subjects lost weight in the form of sweat with both PPEs during the simulation scenario, with a mean of 200 g (0.28% of initial weight), and increased thirst sensation. Body thermal image increased by 0.54 °C in people using the full COVID-19 PPE. Conclusions: The use of PPE in the management of critically ill COVID-19 patients generates weight loss related to excessive sweating. The weight loss shown in this pilot test is far from the clinical limits of dehydration. The use of ventilated PPE, such as PAPR, reduce the body temperature and heat sensation experienced by the users of it; at the same time, it improves the comfort of those who wear it. The simulated environment is a suitable place to develop the piloting of applicable research methodologies in future studies in a real environment.
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Kiiza P, Mullin SI, Teo K, Goodman L, Perez A, Pinto R, Thompson K, Piquette D, Hall T, Bah EI, Christian M, Hajek JJ, Kao R, Lamontagne F, Marshall JC, Mishra S, Murthy S, Vanderschuren A, Fowler RA, Adhikari NKJ. Establishing Healthcare Worker Performance and Safety in Providing Critical Care for Patients in a Simulated Ebola Treatment Unit: Non-Randomized Pilot Study. Viruses 2021; 13:v13112205. [PMID: 34835011 PMCID: PMC8622862 DOI: 10.3390/v13112205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Improving the provision of supportive care for patients with Ebola is an important quality improvement initiative. We designed a simulated Ebola Treatment Unit (ETU) to assess performance and safety of healthcare workers (HCWs) performing tasks wearing personal protective equipment (PPE) in hot (35 °C, 60% relative humidity) or thermo-neutral (20 °C, 20% relative humidity) conditions. In this pilot phase to determine the feasibility of study procedures, HCWs in PPE were non-randomly allocated to hot or thermo-neutral conditions to perform peripheral intravenous (PIV) and midline catheter (MLC) insertion and endotracheal intubation (ETI) on mannequins. Eighteen HCWs (13 physicians, 4 nurses, 1 nurse practitioner; 2 with prior ETU experience; 10 in hot conditions) spent 69 (10) (mean (SD)) minutes in the simulated ETU. Mean (SD) task completion times were 16 (6) min for PIV insertion; 33 (5) min for MLC insertion; and 16 (8) min for ETI. Satisfactory task completion was numerically higher for physicians vs. nurses. Participants’ blood pressure was similar, but heart rate was higher (p = 0.0005) post-simulation vs. baseline. Participants had a median (range) of 2.0 (0.0–10.0) minor PPE breaches, 2.0 (0.0–6.0) near-miss incidents, and 2.0 (0.0–6.0) health symptoms and concerns. There were eight health-assessment triggers in five participants, of whom four were in hot conditions. We terminated the simulation of two participants in hot conditions due to thermal discomfort. In summary, study tasks were suitable for physician participants, but they require redesign to match nurses’ expertise for the subsequent randomized phase of the study. One-quarter of participants had a health-assessment trigger. This research model may be useful in future training and research regarding clinical care for patients with highly infectious pathogens in austere settings.
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Affiliation(s)
- Peter Kiiza
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (P.K.); (A.P.); (R.P.)
| | - Sarah I. Mullin
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, ON M1C 1A4, Canada;
| | - Koren Teo
- Canadian Forces Health Services Group (CFHS), Toronto, ON M3K 0A1, Canada;
| | - Len Goodman
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON M3K 2C9, Canada;
| | - Adic Perez
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (P.K.); (A.P.); (R.P.)
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (P.K.); (A.P.); (R.P.)
| | - Kelly Thompson
- The George Institute for Global Health, University of New South Wales, Newtown, NSW 2042, Australia;
| | - Dominique Piquette
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON M4N 3M5, Canada;
| | - Trevor Hall
- Healthcare Insurance Reciprocal of Canada and Interactive Media Lab., University of Toronto, Toronto, ON M2N 6K8, Canada;
| | - Elhadj I. Bah
- Infectious Diseases Department, Donka National Hospital, Conakry, Guinea;
| | | | - Jan J. Hajek
- Division of Infectious Diseases, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
| | - Raymond Kao
- Division of Critical Care Medicine, Western University, London, ON N6A 5W9, Canada;
| | - François Lamontagne
- Department of Medicine, Université de Sherbrooke, and Centre de recherche du CHU de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada;
| | - John C. Marshall
- Departments of Surgery and Critical Care, St. Michael’s Hospital, Department of Surgery, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON M5B 1W8, Canada;
| | - Sharmistha Mishra
- Li Ka Shing Knowledge Institute, Department of Medicine, Division of Infectious Diseases, St. Michael’s Hospital and University of Toronto, Institute of Health Policy, Management and Evaluation and Institute of Medical Science, University of Toronto, Toronto, ON M5B 1W8, Canada;
| | - Srinivas Murthy
- Department of Paediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada;
| | - Abel Vanderschuren
- Division of Intensive Care, Université Laval-CHU de Québec, Québec, QC G1J 1Z4, Canada;
| | - Robert A. Fowler
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M4N 3M5, Canada
- Correspondence: (R.A.F.); (N.K.J.A.)
| | - Neill K. J. Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M4N 3M5, Canada
- Correspondence: (R.A.F.); (N.K.J.A.)
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9
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Temsah MH, Alrabiaah A, Al-Eyadhy A, Al-Sohime F, Al Huzaimi A, Alamro N, Alhasan K, Upadhye V, Jamal A, Aljamaan F, Alhaboob A, Arabi YM, Lazarovici M, Somily AM, Boker AM. COVID-19 Critical Care Simulations: An International Cross-Sectional Survey. Front Public Health 2021; 9:700769. [PMID: 34631644 PMCID: PMC8500233 DOI: 10.3389/fpubh.2021.700769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To describe the utility and patterns of COVID-19 simulation scenarios across different international healthcare centers. Methods: This is a cross-sectional, international survey for multiple simulation centers team members, including team-leaders and healthcare workers (HCWs), based on each center's debriefing reports from 30 countries in all WHO regions. The main outcome measures were the COVID-19 simulations characteristics, facilitators, obstacles, and challenges encountered during the simulation sessions. Results: Invitation was sent to 343 simulation team leaders and multidisciplinary HCWs who responded; 121 completed the survey. The frequency of simulation sessions was monthly (27.1%), weekly (24.8%), twice weekly (19.8%), or daily (21.5%). Regarding the themes of the simulation sessions, they were COVID-19 patient arrival to ER (69.4%), COVID-19 patient intubation due to respiratory failure (66.1%), COVID-19 patient requiring CPR (53.7%), COVID-19 transport inside the hospital (53.7%), COVID-19 elective intubation in OR (37.2%), or Delivery of COVID-19 mother and neonatal care (19%). Among participants, 55.6% reported the team's full engagement in the simulation sessions. The average session length was 30-60 min. The debriefing process was conducted by the ICU facilitator in (51%) of the sessions followed by simulation staff in 41% of the sessions. A total of 80% reported significant improvement in clinical preparedness after simulation sessions, and 70% were satisfied with the COVID-19 sessions. Most perceived issues reported were related to infection control measures, followed by team dynamics, logistics, and patient transport issues. Conclusion: Simulation centers team leaders and HCWs reported positive feedback on COVID-19 simulation sessions with multidisciplinary personnel involvement. These drills are a valuable tool for rehearsing safe dynamics on the frontline of COVID-19. More research on COVID-19 simulation outcomes is warranted; to explore variable factors for each country and healthcare system.
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Affiliation(s)
- Mohamad-Hani Temsah
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulkarim Alrabiaah
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Infectious Disease Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ayman Al-Eyadhy
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Fahad Al-Sohime
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Clinical Skills & Simulation Center, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al Huzaimi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Pediatric Cardiology, Department of Cardiac Sciences, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
- Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Nurah Alamro
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Khalid Alhasan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Nephrology Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Vaibhavi Upadhye
- Clinical Lead in Simulation, Dr. Indumati Amodkar Simulation Center, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Amr Jamal
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
- Evidence-Based Health Care & Knowledge Translation Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Fadi Aljamaan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Critical Care Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ali Alhaboob
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yaseen M. Arabi
- National Guard Health Affairs, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Marc Lazarovici
- Ludwig-Maximilians-University, Munich University Hospital, Munich, Germany
| | - Ali M. Somily
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pathology and Laboratory Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz M. Boker
- Anesthesia and Critical Care Department, King Abdulaziz University Hospital, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Clinical Skills and Simulation Centre, King Abdulaziz University, Jeddah, Saudi Arabia
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10
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Fuchs A, Lanzi D, Beilstein CM, Riva T, Urman RD, Luedi MM, Braun M. Clinical recommendations for in-hospital airway management during aerosol-transmitting procedures in the setting of a viral pandemic. Best Pract Res Clin Anaesthesiol 2021; 35:333-349. [PMID: 34511223 PMCID: PMC7723398 DOI: 10.1016/j.bpa.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/03/2020] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can lead to severe pneumonia and multiorgan failure. While most of the infected patients develop no or only mild symptoms, some need respiratory support or even invasive ventilation. The exact route of transmission is currently under investigation. While droplet exposure and direct contact seem to be the most significant ways of transmitting the disease, aerosol transmission appears to be possible under circumstances favored by high viral load. Despite the use of personal protective equipment (PPE), this situation potentially puts healthcare workers at risk of infection, especially if they are involved in airway management. Various recommendations and international guidelines aim to protect healthcare workers, although evidence-based research confirming the benefits of these approaches is still scarce. In this article, we summarize the current literature and recommendations for airway management of COVID-19 patients.
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Affiliation(s)
- Alexander Fuchs
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Daniele Lanzi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Christian M Beilstein
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Matthias Braun
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
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11
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Knowledge, Behaviors, and Perceptions of Risk of COVID-19 Among Brazilian Nursing Students: A Cross-sectional Study. Nurse Educ 2021; 46:E158-E163. [PMID: 34482344 PMCID: PMC8579890 DOI: 10.1097/nne.0000000000001109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Supplemental digital content is available in the text. Background The COVID-19 pandemic presented important challenges for the education of nursing students to provide health care with competence, quality, and safety. Objectives The purpose was to analyze knowledge, behavior, and perception of risk regarding COVID-19 and associated factors. Methods A cross-sectional study was conducted among 2637 Brazilian undergraduate nursing students using a self-reported online survey. Results Students' knowledge about COVID-19 in general was considered inadequate. Students had limited knowledge about preventive measures in the hospital environment and recommendations for aerosol precautions. More than 90% of graduates adopted recommended prevention measures, and 86.1% perceived themselves to be at a greater risk of acquired SARS-CoV-2 during clinical practice. Conclusions The results show the need to rethink undergraduate nursing education regarding the prevention and control of infectious diseases, including the most appropriate strategies for COVID-19 prevention measures.
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12
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Induri SNR, Chun YC, Chun JC, Fleisher KE, Glickman RS, Xu F, Ioannidou E, Li X, Saxena D. Protective Measures against COVID-19: Dental Practice and Infection Control. Healthcare (Basel) 2021; 9:679. [PMID: 34200036 PMCID: PMC8230244 DOI: 10.3390/healthcare9060679] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 12/15/2022] Open
Abstract
The onset of the Coronavirus 2019 (COVID-19) pandemic has challenged the worldwide healthcare sector, including dentistry. The highly infectious nature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and risk of transmission through aerosol generating procedures has profoundly impacted the delivery of dental care services globally. As dental practices with renewed infection control strategies and preventive measures are re-opening in the "new normal" period, it is the responsibility of healthcare professionals to constantly analyze new data and limit the spread of COVID-19 in dental care settings. In the light of new variants of SARS-CoV-2 rapidly emerging in different geographic locations, there is an urgent need to comply more than ever with the rigorous public health measures to mitigate COVID-19 transmission. The aim of this article is to provide dental clinicians with essential information regarding the spread of SARS-CoV-2 virus and protective measures against COVID-19 transmission in dental facilities. We complied and provided guidance and standard protocols recommended by credible national and international organizations. This review will serve as an aid to navigating through this unprecedented time with ease. Here we reviewed the available literature recommended for the best current practices that must be taken for a dental office to function safely and successfully.
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Affiliation(s)
- Sri Nitya Reddy Induri
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY 10010, USA; (S.N.R.I.); (Y.C.C.); (F.X.); (X.L.)
| | - Yunah Caroline Chun
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY 10010, USA; (S.N.R.I.); (Y.C.C.); (F.X.); (X.L.)
| | | | - Kenneth E. Fleisher
- Department of Oral and Maxillofacial Surgery, College of Dentistry, New York University, New York, NY 10010, USA; (K.E.F.); (R.S.G.)
| | - Robert S. Glickman
- Department of Oral and Maxillofacial Surgery, College of Dentistry, New York University, New York, NY 10010, USA; (K.E.F.); (R.S.G.)
| | - Fangxi Xu
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY 10010, USA; (S.N.R.I.); (Y.C.C.); (F.X.); (X.L.)
| | - Efthimia Ioannidou
- Division of Periodontology, School of Dental Medicine, UCONN Health, Farmington, CT 06030, USA;
| | - Xin Li
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY 10010, USA; (S.N.R.I.); (Y.C.C.); (F.X.); (X.L.)
| | - Deepak Saxena
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY 10010, USA; (S.N.R.I.); (Y.C.C.); (F.X.); (X.L.)
- Department of Surgery, School of Medicine, New York University, New York, NY 10016, USA
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13
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Trancossi M, Carli C, Cannistraro G, Pascoa J, Sharma S. Could thermodynamics and heat and mass transfer research produce a fundamental step advance toward and significant reduction of SARS-COV-2 spread? INTERNATIONAL JOURNAL OF HEAT AND MASS TRANSFER 2021; 170:120983. [PMID: 33495658 PMCID: PMC7816940 DOI: 10.1016/j.ijheatmasstransfer.2021.120983] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/10/2021] [Indexed: 05/09/2023]
Abstract
We are living an extraordinary season of uncertainty and danger, which is caused by SARS-Cov-2 infection and consequent COVID-19 infection. This preliminary study comes from both a mix of entrepreneurial experience and scientific research. It is aimed by the exigency to reach a new and more effective analysis of the risks on the filed and to reduce them inside a necessary cooperation process which may regard both research and some of the economic activities which are damaged by passive protection measures such as indiscriminate lockdowns. This global emergency requires specific efforts by any discipline that regards specific problems which need to be solved urgently. The characteristic airborne diffusion patterns of COVID-19 shows that the airborne presence of viruses depends on multiple factors which include the dimension of microdroplets emitted by a contagious person, the atmospheric temperature and humidity, the presence of atmospheric particulate and pollution, which may act as a transport vehicle for the virus. The pandemic diffusion shows a particular correlation with the air quality and levels of atmospheric pollution. Specific problems need to solved to understand better the virus, its reliability, diffusion, replication, how it attacks the persons and the conditions, which drives to both positive and deadly evolution of the illness. Most of these problems may benefit from the contribution from both heat and mass transfer and the unsteady thermodynamics of living systems which evolves according to constructal law. After the bibliographic research on the virus, emissive and spread modes, and consequent today adopted protection, a detailed analysis of the contributions which may be assessed by research in thermodynamics, heat and mass transfer, technical and chemical physics. Some possible areas of research have been identified and discussed to start an effective mobilization which may support the effort of the research toward a significant reduction of the impacts of the pandemic infection and the economic risks of new generalized lockdowns.
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Affiliation(s)
- Michele Trancossi
- IIS Galvani, Milano, Italy
- Universidade da Beira Interior, Covilha, Portugal
| | | | | | - Jose Pascoa
- Universidade da Beira Interior, Covilha, Portugal
| | - Shivesh Sharma
- Ethical Property Management Italia srl, Parma 43125, Italy
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14
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Mariani A, Capurso G, Marasco G, Bertani H, Crinò SF, Magarotto A, Tringali A, Pasquale L, Arcidiacono PG, Zagari RM. Factors associated with risk of COVID-19 contagion for endoscopy healthcare workers: A survey from the Italian society of digestive endoscopy. Dig Liver Dis 2021; 53:534-539. [PMID: 33785281 PMCID: PMC7980179 DOI: 10.1016/j.dld.2021.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The present study was aimed to assess the risk of SARS-CoV-2 infection and associated factors among HCWs in endoscopy centers in Italy. METHODS All members of the Italian Society of Digestive Endoscopy (SIED) were invited to participate to a questionnaire-based survey during the first months of the COVID-19 outbreak in Italy. RESULTS 314/1306 (24%) SIED members accounting for 201/502 (40%) endoscopic centers completed the survey. Personal Protection Equipment (PPE) were available in most centers, but filtering face-piece masks (FFP2 or FFP3) and negative pressure room were not in 10.9 and 75.1%. Training courses on PPE use were provided in 57.2% of centers only; there was at least one positive HCW in 17.4% of centers globally, 107/3308 (3.2%) HCWs were diagnosed with COVID-19 with similar rates of physicians (2.9%), nurses (3.5%) and other health operators (3.5%). Involvement in a COVID-19 care team (OR: 4.96) and the lack of training courses for PPE, (OR: 2.65) were associated with increased risk. CONCLUSIONS The risk of COVID-19 among endoscopy HCWs was not negligible and was associated with work in a COVID-19 care team and lack of education on proper PPE use. These data deserve attention during the subsequent waves.
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Affiliation(s)
- Alberto Mariani
- Pancreatobiliary and EUS Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita e Salute University of Milan, Via Olgettina 60, Milan 20132, Italy
| | - Gabriele Capurso
- Pancreatobiliary and EUS Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita e Salute University of Milan, Via Olgettina 60, Milan 20132, Italy.
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Helga Bertani
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliera-Universitaria Policlinico di Modena, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona, Italy
| | - Andrea Magarotto
- Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luigi Pasquale
- Gastroenterology Unit, S. O. Frangipane Hospital of A. Irpino, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary and EUS Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita e Salute University of Milan, Via Olgettina 60, Milan 20132, Italy
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15
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Matsevych OY, Koto MZ, Balabyeki M. The Use of Modified Snorkel Masks as Personal Protective Equipment During Aerosol-Generating Procedures: COVID-19 Necessity. Surg Innov 2021; 28:628-633. [PMID: 33830809 DOI: 10.1177/15533506211003528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The available personal protective equipment (PPE) is insufficient to provide adequate protection during high-risk aerosol-generating procedures, and their shortage was reported. The full-face snorkel masks were modified to be used as PPE. However, little is known about their use in medical practice. Methods: The available masks were assessed and compared in terms of safety, comfort, visual acuity, and communication with team members during the aerosol-generating surgical and endoscopic procedures. The masks were compared with a standard option (full-face shield and N95 mask). The score was assigned to each domain to compare the masks. The aim of the study was to assess the modified full-face snorkel masks as PPE during surgical and endoscopic aerosol-generating procedures. Results: Four modified snorkel masks were assessed and compared with the standard option. All masks provided a good seal, comfort, vision, and protection. Communication was the biggest problem and improved after modification. Suggestions for the mask's selection and on further improvements were made. Conclusion: The modified snorkel masks seem a good alternative to the standard PPE during aerosol-generating procedures. However, additional improvements are still needed. More studies are required to prove the benefits of the modified snorkel masks over the standard PPE.
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Affiliation(s)
- Oleh Y Matsevych
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Netcare Montana Hospital, Pretoria, South Africa
| | - Modise Z Koto
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Moses Balabyeki
- Department of Surgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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16
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Terheggen U, Heiring C, Kjellberg M, Hegardt F, Kneyber M, Gente M, Roehr CC, Jourdain G, Tissieres P, Ramnarayan P, Breindahl M, van den Berg J. European consensus recommendations for neonatal and paediatric retrievals of positive or suspected COVID-19 patients. Pediatr Res 2021; 89:1094-1100. [PMID: 32634819 DOI: 10.1038/s41390-020-1050-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The 2020 novel coronavirus (SARS-Cov-2) pandemic necessitates tailored recommendations addressing specific procedures for neonatal and paediatric transport of suspected or positive COVID-19 patients. The aim of this consensus statement is to define guidelines for safe clinical care for children needing inter-facility transport while making sure that the clinical teams involved are sufficiently protected from SARS-CoV-2. METHODS A taskforce, composed of members of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Transport section and the European Society for Paediatric Research (ESPR), reviewed the published literature and used a rapid, two-step modified Delphi process to formulate recommendations regarding safety and clinical management during transport of COVID-19 patients. RESULTS The joint taskforce consisted of a panel of 12 experts who reached an agreement on a set of 17 recommendations specifying pertinent aspects on neonatal and paediatric COVID-19 patient transport. These included: case definition, personal protective equipment, airway management, equipment and strategies for invasive and non-invasive ventilation, special considerations for incubator and open stretcher transports, parents on transport and decontamination of transport vehicles. CONCLUSIONS Our consensus recommendations aim to define current best-practice and should help guide transport teams dealing with infants and children with COVID-19 to work safely and effectively. IMPACT We present European consensus recommendations on pertinent measures for transporting infants and children in times of the coronavirus (SARS-Cov-2 /COVID-19) pandemic. A panel of experts reviewed the evidence around transporting infants and children with proven or suspected COVID-19. Specific guidance on aspects of personal protective equipment, airway management and considerations for incubator and open stretcher transports is presented. Based on scant evidence, best-practice recommendations for neonatal and paediatric transport teams are presented, aiming for the protection of teams and patients. We highlight gaps in knowledge and areas of future research.
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Affiliation(s)
- Ulrich Terheggen
- Department of Critical Care, Paediatric and Cardiac Intensive Care Unit, Al Jalila Children's Hospital, Dubai, United Arab Emirates.
| | - Christian Heiring
- Department of Neonatal and Paediatric Intensive Care, Rigshospitalet, the National University Hospital in Denmark, Copenhagen, Denmark
| | - Mattias Kjellberg
- Department of Neonatal Intensive Care, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Fredrik Hegardt
- Department of Pediatrics, Neonatal Intensive Care Unit, Umeå University Hospital, Umeå, Sweden
| | - Martin Kneyber
- Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, University, Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Critical Care, Anaesthesiology, Peri-Operative & Emergency Medicine (CAPE), University of Groningen, Groningen, The Netherlands
| | - Maurizio Gente
- Maternal Infant Department, Policlinico Umberto I, Sapienza University of Roma, Roma, Italy
| | - Charles C Roehr
- National Perinatal Epidemiology Unit Clinical Trials Unit, Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK.,Newborn Services, Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Gilles Jourdain
- Division of Pediatrics, Neonatal Critical Care and Transportation, Medical Center "A.Béclère", Paris Saclay University Hospitals, APHP, Paris, France
| | - Pierre Tissieres
- Pediatric Intensive Care Unit, Bicêtre University Hospital, AP-HP, Paris Saclay University, Le Kremlin-Bicêtre, France.,Integrative Biology of the Cell, CNRS, CEA, Paris South University, Paris Saclay University, Gif-sur-Yvette, France
| | - Padmanabhan Ramnarayan
- Children's Acute Transport Service (CATS), Great Ormond Street Hospital, London, UK.,Paediatric Intensive Care Unit, St Mary's Hospital, London, UK
| | - Morten Breindahl
- Department of Neonatal and Paediatric Intensive Care, Rigshospitalet, the National University Hospital in Denmark, Copenhagen, Denmark
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17
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LoGiudice JA, Bartos S. Experiences of Nurses During the COVID-19 Pandemic: A Mixed-Methods Study. AACN Adv Crit Care 2021; 32:14-26. [PMID: 33450763 DOI: 10.4037/aacnacc2021816] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The first wave of coronavirus disease 2019 was a global event for which nurses had limited time to prepare before receiving an influx of high-acuity patients and navigating new plans of care. OBJECTIVES To understand nurses' lived experiences during the COVID-19 outbreak and to examine their resiliency. METHODS A convergent mixed methods design was applied in this study. For the quantitative portion, resiliency was measured by using the Brief Resilience Coping Scale. Colaizzi's phenomenological method was used for qualitative analysis. RESULTS A total of 43 nurses participated in the study. The mean score on the Brief Resilience Coping Scale was 14.4. From 21 robust narratives, Colaizzi's qualitative method yielded 5 themes to describe the experience of being a nurse during the pandemic. CONCLUSIONS Understanding the lived experience provides a unique lens through which to view nursing during a global pandemic, and it serves as a starting point to ensure future safeguards are in place to protect nurses' well-being.
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Affiliation(s)
- Jenna A LoGiudice
- Jenna A. LoGiudice is Associate Professor and Director of the Midwifery Program, Egan School of Nursing and Health Studies, Fairfield University, 1073 North Benson Rd, Fairfield, CT 06824 ; and per diem Certified Nurse Midwife, Yale New Haven Hospital, New Haven, Connecticut
| | - Susan Bartos
- Susan Bartos is Assistant Professor, Egan School of Nursing and Health Studies, Fairfield University, Fairfield, Connecticut; and per diem Registered Nurse, Surgical ICU, Bridgeport Hospital, Bridgeport, Connecticut, which was converted to a COVID ICU during the pandemic
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18
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Wong ELY, Ho KF, Dong D, Cheung AWL, Yau PSY, Chan EYY, Yeoh EK, Chien WT, Chen FY, Poon S, Zhang Q, Wong SYS. Compliance with Standard Precautions and Its Relationship with Views on Infection Control and Prevention Policy among Healthcare Workers during COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073420. [PMID: 33806138 PMCID: PMC8038100 DOI: 10.3390/ijerph18073420] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 12/20/2022]
Abstract
Background: Standard precautions prevent the spread of infections in healthcare settings. Incompliance with infection control guidelines of healthcare workers (HCWs) may increase their risk of exposure to infectious disease, especially under pandemics. The purpose of this study was to assess the level of compliance with the infection prevention and control practices among HCWs in different healthcare settings and its relationship with their views on workplace infection control measures during the COVID-19 pandemic. Methods: Nurses in Hong Kong were invited to respond to a cross-sectional online survey, in which their views on workplace infection and prevention policy, compliance with standard precautions and self-reported health during pandemics were collected. Results: The respondents were dissatisfied with workplace infection and prevention policy in terms of comprehensiveness (62%), clarity (64%), timeliness (63%), and transparency (60%). For the protective behavior, the respondents did not fully comply with the standard precautions when they were involved in medical care. Their compliance was relatively low when having proper patient handling (54%) and performing invasive procedures (46%). A multivariate analysis model proved that the level of compliance of the standard precautions was positively associated with the satisfaction on infection control and prevention policy among high risk group (0.020; 95% CI: 0.005–0.036), while older respondents had higher level of compliance among the inpatient and outpatient groups (coefficient range: 0.065–0.076). The higher level of compliance was also significantly associated with working in designated team and having chronic condition of the respondents among high-risk and inpatient groups. Conclusions: Standard precautions are the most important elements to reduce cross-transmission among HCWs and patients while the satisfaction on infection control and prevention policy would increase the compliance among the high-risk group. An overall suboptimal compliance and poor views on the infection prevention and control guidelines is a warning signal to healthcare system especially during pandemics.
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Affiliation(s)
- Eliza Lai-Yi Wong
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (D.D.); (A.W.-L.C.); (P.S.-Y.Y.); (E.-K.Y.)
- Correspondence: ; Tel.: +852-2252-8772
| | - Kin-Fai Ho
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.-F.H.); (E.Y.-Y.C.); (S.Y.-S.W.)
| | - Dong Dong
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (D.D.); (A.W.-L.C.); (P.S.-Y.Y.); (E.-K.Y.)
| | - Annie Wai-Ling Cheung
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (D.D.); (A.W.-L.C.); (P.S.-Y.Y.); (E.-K.Y.)
| | - Peter Sen-Yung Yau
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (D.D.); (A.W.-L.C.); (P.S.-Y.Y.); (E.-K.Y.)
| | - Emily Ying-Yang Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.-F.H.); (E.Y.-Y.C.); (S.Y.-S.W.)
| | - Eng-Kiong Yeoh
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (D.D.); (A.W.-L.C.); (P.S.-Y.Y.); (E.-K.Y.)
| | - Wai-Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
| | - Frank Youhua Chen
- Department of Management Sciences, College of Business, City University of Hong Kong, Hong Kong, China;
| | - Simon Poon
- School of Computer Science, Faculty of Engineering, The University of Sydney, Hong Kong, China;
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, China;
| | - Samuel Yeung-Shan Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.-F.H.); (E.Y.-Y.C.); (S.Y.-S.W.)
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19
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Nasa P, Azoulay E, Khanna AK, Jain R, Gupta S, Javeri Y, Juneja D, Rangappa P, Sundararajan K, Alhazzani W, Antonelli M, Arabi YM, Bakker J, Brochard LJ, Deane AM, Du B, Einav S, Esteban A, Gajic O, Galvagno SM, Guérin C, Jaber S, Khilnani GC, Koh Y, Lascarrou JB, Machado FR, Malbrain MLNG, Mancebo J, McCurdy MT, McGrath BA, Mehta S, Mekontso-Dessap A, Mer M, Nurok M, Park PK, Pelosi P, Peter JV, Phua J, Pilcher DV, Piquilloud L, Schellongowski P, Schultz MJ, Shankar-Hari M, Singh S, Sorbello M, Tiruvoipati R, Udy AA, Welte T, Myatra SN. Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method. Crit Care 2021; 25:106. [PMID: 33726819 PMCID: PMC7962430 DOI: 10.1186/s13054-021-03491-y] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. METHODS Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square (χ2) test (p < 0·05 was considered as unstable). RESULTS Agreement was achieved for 27 (73%) management strategies which were then used to develop expert clinical practice statements. Experts agreed that COVID-19-related acute respiratory distress syndrome (ARDS) is clinically similar to other forms of ARDS. The Delphi process yielded strong suggestions for use of systemic corticosteroids for critical COVID-19; awake self-proning to improve oxygenation and high flow nasal oxygen to potentially reduce tracheal intubation; non-invasive ventilation for patients with mixed hypoxemic-hypercapnic respiratory failure; tracheal intubation for poor mentation, hemodynamic instability or severe hypoxemia; closed suction systems; lung protective ventilation; prone ventilation (for 16-24 h per day) to improve oxygenation; neuromuscular blocking agents for patient-ventilator dyssynchrony; avoiding delay in extubation for the risk of reintubation; and similar timing of tracheostomy as in non-COVID-19 patients. There was no agreement on positive end expiratory pressure titration or the choice of personal protective equipment. CONCLUSION Using a Delphi method, an agreement among experts was reached for 27 statements from which 20 expert clinical practice statements were derived on the respiratory management of C-ARF, addressing important decisions for patient management in areas where evidence is either absent or limited. TRIAL REGISTRATION The study was registered with Clinical trials.gov Identifier: NCT04534569.
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Affiliation(s)
- Prashant Nasa
- Critical Care Medicine, NMC Speciality Hospital, Dubai, United Arab Emirates
| | - Elie Azoulay
- Saint-Louis teaching hospital - APHP - and University of Paris, Paris, France
| | - Ashish K Khanna
- Wake Forest University School of Medicine, Winston-Salem, NC and Outcomes Research Consortium , Cleveland, USA
| | - Ravi Jain
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Sachin Gupta
- Narayana Super Speciality Hospital, Gurugram, India
| | - Yash Javeri
- Regency Super Speciality Hospital, Lucknow, India
| | | | | | | | | | | | - Yaseen M Arabi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Jan Bakker
- New York University School of Medicine and Columbia University College of Physicians & Surgeons, New York, USA
- Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Laurent J Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, and University of Toronto, Toronto, Canada
| | - Adam M Deane
- Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia
| | - Bin Du
- Peking Union Medical College Hospital, Peking, China
| | - Sharon Einav
- The Shaare Zedek Medical Center, Jerusalem, Israel
| | - Andrés Esteban
- Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | | | | | - Claude Guérin
- University de Lyon, Lyon, France
- Institut Mondor de Recherches Biomédicales, Medecine Intensive Réanimation Hôpital Edouard Herriot Lyon, and Medecine Intensive Réanimation Hôpital Edouard Herriot Lyon, Créteil, France
| | - Samir Jaber
- Montpellier University Hospital, Montpellier, France
- Hôpital Saint-Éloi, CHU de Montpellier, Phy Med Exp, Université de Montpellier, Montpellier, France
| | | | - Younsuck Koh
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | | | - Manu L N G Malbrain
- International Fluid Academy, Lovenjoel, Belgium
- Faculty of Engineering, Department of Electronics and Informatics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | | | - Brendan A McGrath
- Manchester University NHS Foundation Trust, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Academic Health Sciences Centre, Manchester, UK
| | - Sangeeta Mehta
- Sinai Health and the University of Toronto, Toronto, Canada
| | - Armand Mekontso-Dessap
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Service de Medicine Intensive Réanimation, and Univ Paris Est Créteil, CARMAS, Créteil, France
| | - Mervyn Mer
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael Nurok
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, USA
| | | | - Paolo Pelosi
- San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences , Genoa, Italy
- Department of Surgical Sciences and Integrated Sciences, University of Genoa , Genoa, Italy
| | | | - Jason Phua
- Alexandra Hospital and National University Hospital, Singapore, Singapore
| | | | - Lise Piquilloud
- Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | | | - Marcus J Schultz
- Amsterdam University Medical Center, Amsterdam, The Netherlands
- Mahidol University, Bangkok, Thailand
- University of Oxford, Oxford, UK
| | - Manu Shankar-Hari
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Suveer Singh
- Royal Brompton Hospital and Chelsea and Westminster Hospital, Imperial College, London, UK
| | | | | | | | - Tobias Welte
- Department of Respiratory Medicine, German Centre of Lung Research, Hannover, Germany
| | - Sheila N Myatra
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, India.
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20
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Nasa P, Azoulay E, Khanna AK, Jain R, Gupta S, Javeri Y, Juneja D, Rangappa P, Sundararajan K, Alhazzani W, Antonelli M, Arabi YM, Bakker J, Brochard LJ, Deane AM, Du B, Einav S, Esteban A, Gajic O, Galvagno SM, Guérin C, Jaber S, Khilnani GC, Koh Y, Lascarrou JB, Machado FR, Malbrain MLNG, Mancebo J, McCurdy MT, McGrath BA, Mehta S, Mekontso-Dessap A, Mer M, Nurok M, Park PK, Pelosi P, Peter JV, Phua J, Pilcher DV, Piquilloud L, Schellongowski P, Schultz MJ, Shankar-Hari M, Singh S, Sorbello M, Tiruvoipati R, Udy AA, Welte T, Myatra SN. Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method. CRITICAL CARE (LONDON, ENGLAND) 2021. [PMID: 33726819 DOI: 10.1186/s13054-021-03491-y.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. METHODS Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square (χ2) test (p < 0·05 was considered as unstable). RESULTS Agreement was achieved for 27 (73%) management strategies which were then used to develop expert clinical practice statements. Experts agreed that COVID-19-related acute respiratory distress syndrome (ARDS) is clinically similar to other forms of ARDS. The Delphi process yielded strong suggestions for use of systemic corticosteroids for critical COVID-19; awake self-proning to improve oxygenation and high flow nasal oxygen to potentially reduce tracheal intubation; non-invasive ventilation for patients with mixed hypoxemic-hypercapnic respiratory failure; tracheal intubation for poor mentation, hemodynamic instability or severe hypoxemia; closed suction systems; lung protective ventilation; prone ventilation (for 16-24 h per day) to improve oxygenation; neuromuscular blocking agents for patient-ventilator dyssynchrony; avoiding delay in extubation for the risk of reintubation; and similar timing of tracheostomy as in non-COVID-19 patients. There was no agreement on positive end expiratory pressure titration or the choice of personal protective equipment. CONCLUSION Using a Delphi method, an agreement among experts was reached for 27 statements from which 20 expert clinical practice statements were derived on the respiratory management of C-ARF, addressing important decisions for patient management in areas where evidence is either absent or limited. TRIAL REGISTRATION The study was registered with Clinical trials.gov Identifier: NCT04534569.
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Affiliation(s)
- Prashant Nasa
- Critical Care Medicine, NMC Speciality Hospital, Dubai, United Arab Emirates
| | - Elie Azoulay
- Saint-Louis teaching hospital - APHP - and University of Paris, Paris, France
| | - Ashish K Khanna
- Wake Forest University School of Medicine, Winston-Salem, NC and Outcomes Research Consortium , Cleveland, USA
| | - Ravi Jain
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Sachin Gupta
- Narayana Super Speciality Hospital, Gurugram, India
| | - Yash Javeri
- Regency Super Speciality Hospital, Lucknow, India
| | | | | | | | | | | | - Yaseen M Arabi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Jan Bakker
- New York University School of Medicine and Columbia University College of Physicians & Surgeons, New York, USA.,Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Laurent J Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, and University of Toronto, Toronto, Canada
| | - Adam M Deane
- Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia
| | - Bin Du
- Peking Union Medical College Hospital, Peking, China
| | - Sharon Einav
- The Shaare Zedek Medical Center, Jerusalem, Israel
| | - Andrés Esteban
- Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | | | | | - Claude Guérin
- University de Lyon, Lyon, France.,Institut Mondor de Recherches Biomédicales, Medecine Intensive Réanimation Hôpital Edouard Herriot Lyon, and Medecine Intensive Réanimation Hôpital Edouard Herriot Lyon, Créteil, France
| | - Samir Jaber
- Montpellier University Hospital, Montpellier, France.,Hôpital Saint-Éloi, CHU de Montpellier, Phy Med Exp, Université de Montpellier, Montpellier, France
| | | | - Younsuck Koh
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | | | - Manu L N G Malbrain
- International Fluid Academy, Lovenjoel, Belgium.,Faculty of Engineering, Department of Electronics and Informatics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | | | - Brendan A McGrath
- Manchester University NHS Foundation Trust, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Academic Health Sciences Centre, Manchester, UK
| | - Sangeeta Mehta
- Sinai Health and the University of Toronto, Toronto, Canada
| | - Armand Mekontso-Dessap
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Service de Medicine Intensive Réanimation, and Univ Paris Est Créteil, CARMAS, Créteil, France
| | - Mervyn Mer
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael Nurok
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, USA
| | | | - Paolo Pelosi
- San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences , Genoa, Italy.,Department of Surgical Sciences and Integrated Sciences, University of Genoa , Genoa, Italy
| | | | - Jason Phua
- Alexandra Hospital and National University Hospital, Singapore, Singapore
| | | | - Lise Piquilloud
- Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | | | - Marcus J Schultz
- Amsterdam University Medical Center, Amsterdam, The Netherlands.,Mahidol University, Bangkok, Thailand.,University of Oxford, Oxford, UK
| | - Manu Shankar-Hari
- Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - Suveer Singh
- Royal Brompton Hospital and Chelsea and Westminster Hospital, Imperial College, London, UK
| | | | | | | | - Tobias Welte
- Department of Respiratory Medicine, German Centre of Lung Research, Hannover, Germany
| | - Sheila N Myatra
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, India.
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21
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Moreno-Casbas MT. Factors related to SARS-CoV-2 infection in healthcare professionals in Spain. The SANICOVI project. ENFERMERIA CLINICA 2020; 30:360-370. [PMID: 32571661 PMCID: PMC7247504 DOI: 10.1016/j.enfcli.2020.05.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/21/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To describe the factors related to the situation of SARS-CoV-2 transmission identified by health professionals in Spain and to propose prevention strategies. METHOD Cross-sectional descriptive study. The population were healthcare professionals working in institutions caring for COVID-19 patients and also confirmed cases of SARS-CoV-2 infection. A questionnaire with sociodemographic, occupational and epidemiological variables was used. Descriptive and bivariate analysis was performed according to the nature of the variables. RESULTS A total of 2.230 questionnaires were analysed on a potential population of 41,239 (5.47%). The diagnosis was made based on a suspicious case (63.4%) and a probable case (12.3%). A study of contacts was carried out at 50.3%. The perception about the availability of protective measures as «always/frequently» were: FPP1 mask 57.3%, gloves 89.5%, soap 95% and hydroalcoholic solution 91.5%. In PPE, FPP2, FPP3 mask, goggles and disposable gowns at around 50%. The availability of protective measures, by field of work, presented significant differences. The average number of patients attended related to the performance of hand hygiene at moment4 and the perception of performing it correctly at moments4 and5. CONCLUSIONS Preliminary data are presented, with variability in the response rate by Autonomous Region. Healthcare professionals infected by SARS-CoV-2 identified the management of the chain of infection transmission, the use and adequacy of protective equipment, as well as the effectiveness of handwashing as factors related to the transmission of the virus among professionals.
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Affiliation(s)
- María Teresa Moreno-Casbas
- Unidad de Investigación en Cuidados y Servicios de Salud del Instituto de Salud Carlos III (Investén-isciii), Madrid, España; Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, España.
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22
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Marshall S, Duryea M, Huang G, Kadioglu O, Mah J, Palomo JM, Rossouw E, Stappert D, Stewart K, Tufekci E. COVID-19: What do we know? Am J Orthod Dentofacial Orthop 2020; 158:e53-e62. [PMID: 33131568 PMCID: PMC7505627 DOI: 10.1016/j.ajodo.2020.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/01/2020] [Accepted: 08/01/2020] [Indexed: 12/14/2022]
Abstract
•Evidence regarding the provision of orthodontic care during the COVID-19 pandemic is examined.
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Affiliation(s)
- Steve Marshall
- Department of Orthodontics, University of Iowa College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa.
| | | | - Greg Huang
- Department of Orthodontics, University of Washington School of Dentistry, University of Washington, Seattle, Wash
| | - Onur Kadioglu
- Division of Graduate Orthodontics, Oklahoma University College of Dentistry, Oklahoma University, Oklahoma City, Okla
| | - James Mah
- Department of Orthodontics, University of Nevada Las Vegas School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, Nev
| | - Juan Martin Palomo
- Department of Orthodontics, Case Western Reserve University School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Emile Rossouw
- Division of Orthodontics, Eastman Institute for Oral Health, University of Rochester School of Medicine and Dentistry, University of Rochester, Rochester, NY
| | - Dina Stappert
- Division of Orthodontics, University of Maryland School of Dentistry, University of Maryland, Baltimore, MD
| | - Kelton Stewart
- Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, Indiana University, Indianapolis, Ind
| | - Eser Tufekci
- Department of Orthodontics, Virginia Commonwealth University School of Dentistry, Virginia Commonwealth University, Richmond, Va
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23
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Moreno-Casbas MT. Factors related to SARS-CoV-2 infection in healthcare professionals in Spain. The SANICOVI project. ENFERMERÍA CLÍNICA (ENGLISH EDITION) 2020. [PMCID: PMC7425715 DOI: 10.1016/j.enfcle.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective To describe the factors related to the situation of SARS-CoV-2 transmission identified by health professionals in Spain and to propose prevention strategies. Method Cross-sectional descriptive study. The population were healthcare professionals working in institutions caring for COVID-19 patients and also confirmed cases of SARS-CoV-2 infection. A questionnaire with sociodemographic, occupational and epidemiological variables was used. Descriptive and bivariate analysis was performed according to the nature of the variables. Results Twenty-two hundred and thirty questionnaires were analysed on a potential population of 41,239 (5.47%). The diagnosis was made based on a suspicious case (63.4%) and a probable case (12.3%). A study of contacts was carried out at 50.3%. The perception about the availability of protective measures as "always/frequently" were: FPP1 mask 57.3%, gloves 89.5%, soap 95% and hydroalcoholic solution 91.5%. In PPE, FPP2, FPP3 mask, goggles and disposable gowns at around 50%. The availability of protective measures, by field of work, presented significant differences. The average number of patients attended related to the performance of hand hygiene at moment 4 and the perception of performing it correctly at moments 4 and 5. Conclusions Preliminary data are presented, with variability in the response rate by Autonomous Region. Healthcare professionals infected by SARS-CoV-2 identified the management of the chain of infection transmission, the use and adequacy of protective equipment, as well as the effectiveness of handwashing as factors related to the transmission of the virus among professionals.
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Bajwa SJS, Kurdi M, Malhotra N. Combating the COVID-19 battle with personal protective equipment (PPE) armamentarium. J Anaesthesiol Clin Pharmacol 2020; 36:S133-S136. [PMID: 33100663 PMCID: PMC7573982 DOI: 10.4103/joacp.joacp_324_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India
| | - Madhuri Kurdi
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Naveen Malhotra
- Anaesthesiology and In Charge Pain Management Centre, Pt BDS PGIMS Rohtak, Haryana, India
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Olry de Labry-Lima A, Bermúdez-Tamayo C, Martinez-Olmos J, Martin-Ruiz E. The use of masks to protect against respiratory infections: an umbrella review. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30262-7. [PMID: 33097294 PMCID: PMC7575638 DOI: 10.1016/j.eimc.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The global health emergency caused by the current COVID-19 pandemic is resulting in a huge challenge at all levels. The use of masks may reduce the spread of the infection by minimising the excretion of Flügge droplets. The objective of this study was to compile the evidence available on the use of masks in relation to respiratory infections. METHODOLOGY An umbrella review (review of systematic reviews) was conducted. Two reviewers independently carried out the screening process, data extraction and data analysis. Discrepancies were resolved with a third reviewer, and the assessment of the risk of bias of the studies was carried out using the AMSTAR 2 tool. The Rayyan QCRI program was used for the screening process. RESULTS A total of eight systematic reviews were included. The studies analysed the use of masks in the general population, in long-term care facilities, in hospitals and at mass gatherings, and compared the effectiveness thereof in preventing infection. The results of this review revealed that the use of masks is associated with a protective effect against respiratory infections in healthcare facilities, in long-term care facilities and at mass gatherings. CONCLUSIONS In light of the results, it seems reasonable to recommend the use of masks to the general population, but this use should be accompanied by a training programme to improve compliance, as not using them properly may increase the risk of infection.
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Affiliation(s)
- Antonio Olry de Labry-Lima
- Escuela Andaluza de Salud Pública (EASP), Granada, España; Instituto de Investigación Biosanitaria ibs. Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, España; CIBER en Epidemiología y Salud Pública (CIBERESP), España.
| | - Clara Bermúdez-Tamayo
- Escuela Andaluza de Salud Pública (EASP), Granada, España; Instituto de Investigación Biosanitaria ibs. Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, España; CIBER en Epidemiología y Salud Pública (CIBERESP), España
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Batista RCS, Arruda CVB, Cassimiro M, Gominho L, Moura AC, Albuquerque DS, Romeiro K. The Role of the Dental Surgeon in Controlling the Dissemination of COVID-19: A Literature Review. ScientificWorldJournal 2020; 2020:7945309. [PMID: 33029109 PMCID: PMC7532361 DOI: 10.1155/2020/7945309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/11/2020] [Accepted: 09/18/2020] [Indexed: 01/08/2023] Open
Abstract
As early as December 2019 in the province of Hubei, China, contamination of patients with pneumonia of an unknown etiology occurred. These patients presented with symptoms such as coughing, sore throat, malaise, diarrhea, high fever, and dyspnea. This emerging disease was named COVID-19 due to being part of the group of coronaviruses (CoVs) belonging to the subfamily Orthocoronavirinae, in the Coronaviridae family and in the Nidovirales order. COVID-19 is most commonly transmitted through speech, coughing, sneezing, and salivary sputum. Because dental professionals work closely with the oral cavity, it is imperative that infection prevention controls are strictly adhered to. It is important that the dental profession treats patients while also limiting the possible contamination through the production of aerosol in the dental environment. Furthermore, the dental professional also has a key role in raising awareness and guidance amongst the population concerning COVID-19 related biosafety measures. This literature review aims to inform dental professionals about the COVID-19 pandemic and to present the implications of the virus to the dentist. Dental professionals are considered to be at high risk for contracting SARS-CoV-2.
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Affiliation(s)
- Régida C. S. Batista
- Dental School, Centro Universitário Facol (UNIFACOL), 85, 55612-650 Vitória de Santo Antão, PE, Brazil
| | - Caio V. B. Arruda
- Dental School, Centro Universitário Facol (UNIFACOL), 85, 55612-650 Vitória de Santo Antão, PE, Brazil
| | - Marcely Cassimiro
- Department of Dentistry, Dental College of Pernambuco, Universidade de Pernambuco (UPE), 1650, 54753-901 Tabatinga, PE, Brazil
| | - Luciana Gominho
- Department of Restorative Dentistry, Universidade Federal da Paraíba (UFPB), s/n, Cidade Universitária, 58051-900 João Pessoa, PB, Brazil
| | - Antônio Carlos Moura
- Department of Oral Medicine, Real Hospital Português de Beneficência em Pernambuco, 4760-Paissandu, 52010-075 Recife, PE, Brazil
| | - Diana S. Albuquerque
- Department of Dentistry, Dental College of Pernambuco, Universidade de Pernambuco (UPE), 1650, 54753-901 Tabatinga, PE, Brazil
| | - Kaline Romeiro
- Department of Oral Medicine, Real Hospital Português de Beneficência em Pernambuco, 4760-Paissandu, 52010-075 Recife, PE, Brazil
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In reply: Personal protective equipment during the COVID-19 pandemic (Letters #1 and #2). Can J Anaesth 2020; 67:1651-1652. [PMID: 32783174 PMCID: PMC7419111 DOI: 10.1007/s12630-020-01786-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 11/03/2022] Open
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Beam EL, Herstein JJ, Kupzyk KA, Gibbs SG. A simulation approach to measure critical safety behaviors when evaluating training methods for respirator education in healthcare workers. Am J Infect Control 2020; 48:869-874. [PMID: 32407827 PMCID: PMC7214345 DOI: 10.1016/j.ajic.2020.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 12/01/2022]
Abstract
N95 respirators are a common tool in healthcare for airborne isolation and pandemic response. Simulation can be used to train healthcare workers. Reflective practice may be a training intervention to improve N95 respirator use compared to video alone.
Background The N95 respirator is the most common safety tool used in hospitals to protect health care workers (HCW) from inhaling airborne particles. Focusing on HCW behavior related to respirator use is an effective route to improve HCW safety and respiratory health. Methods Participants were asked to perform the donning and doffing of an N95 respirator to camera. Then they were randomized to a video alone or a reflective practice intervention. After the intervention they repeated the donning and doffing to camera. A critical safety behavior scoring tool (CSBST) was developed to compare the performance of the participants over time at pretest, post-test and 1 month later for follow-up. Results The reflective practice intervention group was found to have significantly higher scores on the CSBST at post-test and follow-up than the video alone group. In the reflective practice intervention group, the participants perceived they were better at performing the N95 donning and doffing than the experts scored them. Conclusions The CSBST is a tool to measure the performance of HCWs on a specific targeted safety behaviors. The addition of a reflective practice intervention may result in a measurable and sustained improvement in the safety behaviors demonstrated when using the N95 respirator.
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Technics to put on and remove personal protective equipment before surgical or obstetrical procedure in suspected or infected COVID-19 patients (with video). J Gynecol Obstet Hum Reprod 2020; 49:101859. [PMID: 32652303 PMCID: PMC7345405 DOI: 10.1016/j.jogoh.2020.101859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 12/17/2022]
Abstract
Coronavirus pandemic is widely changing our professional daily practice and preventive measures must be taken and taught. Before any planned gynaecological or obstetric surgery, specific technics to put on and safely remove personal protective equipment should be implemented in order to avoid any contamination for both patients and healthcare workers.
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Aziz S, Arabi YM, Alhazzani W, Evans L, Citerio G, Fischkoff K, Salluh J, Meyfroidt G, Alshamsi F, Oczkowski S, Azoulay E, Price A, Burry L, Dzierba A, Benintende A, Morgan J, Grasselli G, Rhodes A, Møller MH, Chu L, Schwedhelm S, Lowe JJ, Bin D, Christian MD. Managing ICU surge during the COVID-19 crisis: rapid guidelines. Intensive Care Med 2020; 46:1303-1325. [PMID: 32514598 PMCID: PMC7276667 DOI: 10.1007/s00134-020-06092-5] [Citation(s) in RCA: 234] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
Given the rapidly changing nature of COVID-19, clinicians and policy makers require urgent review and summary of the literature, and synthesis of evidence-based guidelines to inform practice. The WHO advocates for rapid reviews in these circumstances. The purpose of this rapid guideline is to provide recommendations on the organizational management of intensive care units caring for patients with COVID-19 including: planning a crisis surge response; crisis surge response strategies; triage, supporting families, and staff.
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Affiliation(s)
- Shadman Aziz
- London's Air Ambulance, Royal London Hospital, Barts NHS Health Trust, Whitechapel Rd, Whitechapel, London, E1 1FR, England, UK
| | - Yaseen M Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Waleed Alhazzani
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, Master University, Ontario, Canada
| | - Laura Evans
- Department of Pulmonary and Critical Care Medicine, University of Washington, Seattle, USA
| | | | | | - Jorge Salluh
- Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
| | | | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Abu Dhabi, UAE
| | - Simon Oczkowski
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, Master University, Ontario, Canada
| | - Elie Azoulay
- Assistance publique - Hôpitaux de Paris, Paris, France
| | - Amy Price
- Anaesthesia and Informatics Lab, Stanford University, Stanford, USA
| | - Lisa Burry
- Sinai Health System, University of Toronto, Toronto, Canada
| | - Amy Dzierba
- New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA
| | | | | | - Giacomo Grasselli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Andrew Rhodes
- St Georges Hospitals NHS Foundation Trust, London, UK
| | - Morten H Møller
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Larry Chu
- Anaesthesia and Informatics Lab, Stanford University, Stanford, USA
| | | | - John J Lowe
- Department of Environmental and Occupational Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Du Bin
- Peking Union Medical College Hospital, Beijing, China
| | - Michael D Christian
- London's Air Ambulance, Royal London Hospital, Barts NHS Health Trust, Whitechapel Rd, Whitechapel, London, E1 1FR, England, UK.
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Yao W, Wang T, Jiang B, Gao F, Wang L, Zheng H, Xiao W, Yao S, Mei W, Chen X, Luo A, Sun L, Cook T, Behringer E, Huitink JM, Wong DT, Lane-Fall M, McNarry AF, McGuire B, Higgs A, Shah A, Patel A, Zuo M, Ma W, Xue Z, Zhang LM, Li W, Wang Y, Hagberg C, O'Sullivan EP, Fleisher LA, Wei H. Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations. Br J Anaesth 2020. [PMID: 32312571 DOI: 10.1016/j.bja.2020.03.026)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan, China, a panel of international airway management experts discussed the results and formulated consensus recommendations for the management of tracheal intubation in COVID-19 patients. Of 202 COVID-19 patients undergoing emergency tracheal intubation, most were males (n=136; 67.3%) and aged 65 yr or more (n=128; 63.4%). Most patients (n=152; 75.2%) were hypoxaemic (Sao2 <90%) before intubation. Personal protective equipment was worn by all intubating healthcare workers. Rapid sequence induction (RSI) or modified RSI was used with an intubation success rate of 89.1% on the first attempt and 100% overall. Hypoxaemia (Sao2 <90%) was common during intubation (n=148; 73.3%). Hypotension (arterial pressure <90/60 mm Hg) occurred in 36 (17.8%) patients during and 45 (22.3%) after intubation with cardiac arrest in four (2.0%). Pneumothorax occurred in 12 (5.9%) patients and death within 24 h in 21 (10.4%). Up to 14 days post-procedure, there was no evidence of cross infection in the anaesthesiologists who intubated the COVID-19 patients. Based on clinical information and expert recommendation, we propose detailed planning, strategy, and methods for tracheal intubation in COVID-19 patients.
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Affiliation(s)
- Wenlong Yao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tingting Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bailin Jiang
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA; Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Feng Gao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongbo Zheng
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weimin Xiao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shanglong Yao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Mei
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Ailin Luo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Liang Sun
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA; Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Tim Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - Elizabeth Behringer
- Division of Cardiovascular Surgery and Critical Care, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - David T Wong
- Department of Anaesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Meghan Lane-Fall
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Barry McGuire
- Department of Anaesthesia, Ninewells Hospital, Dundee, UK
| | - Andrew Higgs
- Department of Anaesthesia and Intensive Care Medicine, Warrington and Halton Hospitals, Warrington, UK
| | - Amit Shah
- Department of Anesthesiology, Kailash Cancer Hospital and Research Center, Muni Seva Ashram, Goraj, India
| | - Anil Patel
- Department of Anaesthesiology, Royal National Throat, Nose and Ear Hospital, London, UK
| | - Mingzhang Zuo
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Wuhua Ma
- Department of Anesthesiology, First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Zhanggang Xue
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li-Ming Zhang
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center (UPMC) and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Wenxian Li
- Department of Anesthesiology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Yong Wang
- Department of Anesthesiology, First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Carin Hagberg
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ellen P O'Sullivan
- Department of Anaesthesia and Intensive Care Medicine, St James's Hospital, Dublin, Ireland
| | - Lee A Fleisher
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | - Huafeng Wei
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
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Yao W, Wang T, Jiang B, Gao F, Wang L, Zheng H, Xiao W, Yao S, Mei W, Chen X, Luo A, Sun L, Cook T, Behringer E, Huitink JM, Wong DT, Lane-Fall M, McNarry AF, McGuire B, Higgs A, Shah A, Patel A, Zuo M, Ma W, Xue Z, Zhang LM, Li W, Wang Y, Hagberg C, O'Sullivan EP, Fleisher LA, Wei H. Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations. Br J Anaesth 2020; 125:e28-e37. [PMID: 32312571 PMCID: PMC7151238 DOI: 10.1016/j.bja.2020.03.026] [Citation(s) in RCA: 216] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 02/07/2023] Open
Abstract
Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan, China, a panel of international airway management experts discussed the results and formulated consensus recommendations for the management of tracheal intubation in COVID-19 patients. Of 202 COVID-19 patients undergoing emergency tracheal intubation, most were males (n=136; 67.3%) and aged 65 yr or more (n=128; 63.4%). Most patients (n=152; 75.2%) were hypoxaemic (Sao2 <90%) before intubation. Personal protective equipment was worn by all intubating healthcare workers. Rapid sequence induction (RSI) or modified RSI was used with an intubation success rate of 89.1% on the first attempt and 100% overall. Hypoxaemia (Sao2 <90%) was common during intubation (n=148; 73.3%). Hypotension (arterial pressure <90/60 mm Hg) occurred in 36 (17.8%) patients during and 45 (22.3%) after intubation with cardiac arrest in four (2.0%). Pneumothorax occurred in 12 (5.9%) patients and death within 24 h in 21 (10.4%). Up to 14 days post-procedure, there was no evidence of cross infection in the anaesthesiologists who intubated the COVID-19 patients. Based on clinical information and expert recommendation, we propose detailed planning, strategy, and methods for tracheal intubation in COVID-19 patients.
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Affiliation(s)
- Wenlong Yao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tingting Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bailin Jiang
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA; Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Feng Gao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongbo Zheng
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weimin Xiao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shanglong Yao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Mei
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Ailin Luo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Liang Sun
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA; Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Tim Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - Elizabeth Behringer
- Division of Cardiovascular Surgery and Critical Care, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - David T Wong
- Department of Anaesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Meghan Lane-Fall
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Barry McGuire
- Department of Anaesthesia, Ninewells Hospital, Dundee, UK
| | - Andrew Higgs
- Department of Anaesthesia and Intensive Care Medicine, Warrington and Halton Hospitals, Warrington, UK
| | - Amit Shah
- Department of Anesthesiology, Kailash Cancer Hospital and Research Center, Muni Seva Ashram, Goraj, India
| | - Anil Patel
- Department of Anaesthesiology, Royal National Throat, Nose and Ear Hospital, London, UK
| | - Mingzhang Zuo
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Wuhua Ma
- Department of Anesthesiology, First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Zhanggang Xue
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li-Ming Zhang
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center (UPMC) and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Wenxian Li
- Department of Anesthesiology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Yong Wang
- Department of Anesthesiology, First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Carin Hagberg
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ellen P O'Sullivan
- Department of Anaesthesia and Intensive Care Medicine, St James's Hospital, Dublin, Ireland
| | - Lee A Fleisher
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | - Huafeng Wei
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
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Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020; 395:1973-1987. [PMID: 32497510 PMCID: PMC7263814 DOI: 10.1016/s0140-6736(20)31142-9] [Citation(s) in RCA: 2286] [Impact Index Per Article: 571.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. METHODS We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. FINDINGS Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] -10·2%, 95% CI -11·5 to -7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; pinteraction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD -14·3%, -15·9 to -10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12-16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD -10·6%, 95% CI -12·5 to -7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings. INTERPRETATION The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance. FUNDING World Health Organization.
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Affiliation(s)
- Derek K Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
| | - Elie A Akl
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Stephanie Duda
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Karla Solo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Sally Yaacoub
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Michael G DeGroote Cochrane Canada and GRADE Centres, Hamilton, ON, Canada.
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Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020. [PMID: 32497510 DOI: 10.1016/s0140-6736(20)31142-31149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. METHODS We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. FINDINGS Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] -10·2%, 95% CI -11·5 to -7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; pinteraction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD -14·3%, -15·9 to -10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12-16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD -10·6%, 95% CI -12·5 to -7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings. INTERPRETATION The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance. FUNDING World Health Organization.
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Affiliation(s)
- Derek K Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
| | - Elie A Akl
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Stephanie Duda
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Karla Solo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Sally Yaacoub
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Michael G DeGroote Cochrane Canada and GRADE Centres, Hamilton, ON, Canada.
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Marín-Gabriel JC, Santiago ERD. AEG-SEED position paper for the resumption of endoscopic activity after the peak phase of the COVID-19 pandemic. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:389-407. [PMID: 32561216 PMCID: PMC7250749 DOI: 10.1016/j.gastrohep.2020.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 12/13/2022]
Abstract
Introducción La pandemia por COVID-19 ha conllevado la suspensión de la actividad programada en la mayoría de las Unidades de Endoscopia de nuestro medio. El objetivo del presente documento es facilitar el reinicio de la actividad endoscópica electiva de forma eficiente y segura. Material y métodos Se formuló una serie de preguntas consideradas de relevancia clínica y logística. Para la elaboración de las respuestas, se realizó una búsqueda bibliográfica estructurada en las principales bases de datos y se revisaron las recomendaciones de las principales instituciones de Salud Pública y de endoscopia digestiva. Las recomendaciones finales se consensuaron por vía telemática. Resultados Se han elaborado un total de 33 recomendaciones. Los principales aspectos que se discuten son: 1) la reevaluación y priorización de la indicación; 2) la restructuración de espacios, agendas y del personal sanitario; 3) el cribado de la infección, y 4) las medidas de higiene y los equipos de protección individual. Conclusión La AEG y la SEED recomiendan reiniciar la actividad endoscópica de forma escalonada, segura, adaptada a los recursos locales y a la situación epidemiológica de la infección por SARS-CoV-2.
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Affiliation(s)
- José Carlos Marín-Gabriel
- Servicio de Medicina del Aparato Digestivo, Unidad de Endoscopias, Consulta de Alto Riesgo, Hospital Universitario 12 de Octubre, Instituto de Investigación «i+12», Madrid, España.
| | - Enrique Rodríguez de Santiago
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, España
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Feldman O, Meir M, Shavit D, Idelman R, Shavit I. Exposure to a Surrogate Measure of Contamination From Simulated Patients by Emergency Department Personnel Wearing Personal Protective Equipment. JAMA 2020; 323:2091-2093. [PMID: 32338711 PMCID: PMC7186917 DOI: 10.1001/jama.2020.6633] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study uses an atomizer and fluorescent markers to simulate contamination of uncovered skin and hair of health care workers wearing personal protective equipment after intubating patient manikins under emergency conditions.
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Affiliation(s)
- Oren Feldman
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
| | - Michal Meir
- Pediatric Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Danielle Shavit
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ravit Idelman
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
| | - Itai Shavit
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
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Cianetti S, Pagano S, Nardone M, Lombardo G. Model for Taking Care of Patients with Early Childhood Caries during the SARS-Cov-2 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3751. [PMID: 32466392 PMCID: PMC7312964 DOI: 10.3390/ijerph17113751] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/21/2020] [Accepted: 05/24/2020] [Indexed: 12/19/2022]
Abstract
Pending the availability of vaccines to contain the SARS-CoV-2 pandemic, the current solution is "social distancing" with a reduction of dental treatments to those assessed as urgent and emergency cases. These treatments also involve Early Childhood Caries (ECC) due to the fact that this disease affects preschool children (a vulnerable population) and, in addition, shows a propensity to evolve into more serious complications (dental pain, infections). A narrative review was carried out to support a protocol for treating ECC with efficacious and safe (in terms of SARS-CoV-2 transmission) procedures. Protocol involves criteria for patients' selection remotely (telemedicine), and well-detailed criteria/equipment and hygiene procedures to combat against SARS-CoV-2 transmission. Moreover, the protocol proposes innovative caries treatments, named Minimally Invasive Treatments (MITs), well known in pedodontics for their high level of children's acceptance during dental care. MITs allow for caries removal (particularly in primary teeth) without any high-speed rotating instrument cooled with nebulized air-water spray (with high risk of virus environmental diffusion), usually adopted during traditional treatments. For evaluating MITs effectiveness in caries management, only Systematic Review and Randomized Controlled Trials (RCTs) were included in our study, without any risk of bias assessment. The indications proposed in this protocol could support clinicians for the temporary management of ECC until the SARS-CoV-2 pandemic ends.
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Affiliation(s)
- Stefano Cianetti
- Biomedical Sciences, Unit of Paediatric Dentistry, University of Perugia, 06100 Perugia, Italy; (S.C.); (G.L.)
| | - Stefano Pagano
- Biomedical Sciences, Unit of Paediatric Dentistry, University of Perugia, 06100 Perugia, Italy; (S.C.); (G.L.)
| | - Michele Nardone
- Azienda Socio-Sanitaria Territoriale, Melegnano e della Martesana, 20070 Milano, Regione Lombardia, Italy;
| | - Guido Lombardo
- Biomedical Sciences, Unit of Paediatric Dentistry, University of Perugia, 06100 Perugia, Italy; (S.C.); (G.L.)
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Bredmose PP, Diczbalis M, Butterfield E, Habig K, Pearce A, Osbakk SA, Voipio V, Rudolph M, Maddock A, O'Neill J. Decision support tool and suggestions for the development of guidelines for the helicopter transport of patients with COVID-19. Scand J Trauma Resusc Emerg Med 2020; 28:43. [PMID: 32450877 PMCID: PMC7247287 DOI: 10.1186/s13049-020-00736-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/07/2020] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus SARS-CoV2 emerged in December 2019 and is now pandemic. Initial analysis suggests that 5% of infected patients will require critical care, and that respiratory failure requiring intubation is associated with high mortality. Sick patients are geographically dispersed: most patients will remain in situ until they are in need of critical care. Additionally, there are likely to be patients who require retrieval for other reasons but who are co-incidentally infected with SARS-CoV-2 or shedding virus. The COVID-19 pandemic therefore poses a challenge to critical care retrieval systems, which often depend on small teams of specialists who live and work together closely. The infection or quarantining of a small absolute number of these staff could catastrophically compromise service delivery. Avoiding occupational exposure to COVID-19, and thereby ensuring service continuity, is the primary objective of aeromedical retrieval services during the pandemic. In this discussion paper we collaborated with helicopter emergency medical services(HEMS) worldwide to identify risks in retrieving COVID-19 patients, and develop strategies to mitigate these. Simulation involving the whole aeromedical retrieval team ensures that safety concerns can be addressed during the development of a standard operating procedure. Some services tested personal protective equipment and protocols in the aeromedical environment with simulation. We also incorporated experiences, standard operating procedures and approaches across several HEMS services internationally. As a result of this collaboration, we outline an approach to the safe aeromedical retrieval of a COVID-19 patient, and describe how this framework can be used to develop a local standard operating procedure.
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Affiliation(s)
- Per P Bredmose
- LifeFlight Retrieval Medicine, PO box 15166, City East, QLD, 4002, Australia. .,Air Ambulance Department, Oslo University Hospital, Oslo, Norway. .,Norwegian Air Ambulance Foundation, Oslo, Norway.
| | - Monica Diczbalis
- LifeFlight Retrieval Medicine, PO box 15166, City East, QLD, 4002, Australia
| | - Emma Butterfield
- LifeFlight Retrieval Medicine, PO box 15166, City East, QLD, 4002, Australia
| | - Karel Habig
- NSW Ambulance Aeromedical Sydney HEMS, Sydney, Australia
| | - Andrew Pearce
- MedSTAR Emergency Medical Retrieval, Adelaide, Australia
| | - Svein Are Osbakk
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Ville Voipio
- Centre for pre-hospital emergency care, Oulu University Hospital, Oulu, Finland
| | | | - Alistair Maddock
- Emergency Medical Retrieval Service, ScotSTAR, Paisley, Scotland
| | - John O'Neill
- LifeFlight Retrieval Medicine, PO box 15166, City East, QLD, 4002, Australia.,Department of Emergency Medicine, Cairns Hospital, 165 The Esplanade, Cairns, QLD, Australia
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Thomas JP, Srinivasan A, Wickramarachchi CS, Dhesi PK, Hung YM, Kamath AV. Evaluating the national PPE guidance for NHS healthcare workers during the COVID-19 pandemic. Clin Med (Lond) 2020; 20:242-247. [PMID: 32357976 PMCID: PMC7354042 DOI: 10.7861/clinmed.2020-0143] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Tragically, many of the infections and deaths recorded in the global coronavirus disease 2019 (COVID-19) pandemic have occurred in healthcare workers. Some have attributed this to inadequate provision of personal protective equipment (PPE). In the UK, several organisations have voiced their concerns that the national PPE guidance issued by Public Health England is inadequate. Despite recent revisions to these guidelines, concerns remain that they offer insufficient protection to frontline NHS healthcare workers. In this report, we evaluate whether these concerns are merited, through critical appraisal of the available evidence, review of international PPE guidance, and consideration of the ethical implications.
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Affiliation(s)
- John P Thomas
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | | | - Yat Ma Hung
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Ajay V Kamath
- Norfolk and Norwich University Hospital, Norwich, UK
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Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2020; 5:CD011621. [PMID: 32412096 PMCID: PMC8785899 DOI: 10.1002/14651858.cd011621.pub5] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In epidemics of highly infectious diseases, such as Ebola, severe acute respiratory syndrome (SARS), or coronavirus (COVID-19), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Personal protective equipment (PPE) can reduce the risk by covering exposed body parts. It is unclear which type of PPE protects best, what is the best way to put PPE on (i.e. donning) or to remove PPE (i.e. doffing), and how to train HCWs to use PPE as instructed. OBJECTIVES To evaluate which type of full-body PPE and which method of donning or doffing PPE have the least risk of contamination or infection for HCW, and which training methods increase compliance with PPE protocols. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL to 20 March 2020. SELECTION CRITERIA We included all controlled studies that evaluated the effect of full-body PPE used by HCW exposed to highly infectious diseases, on the risk of infection, contamination, or noncompliance with protocols. We also included studies that compared the effect of various ways of donning or doffing PPE, and the effects of training on the same outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed the risk of bias in included trials. We conducted random-effects meta-analyses were appropriate. MAIN RESULTS Earlier versions of this review were published in 2016 and 2019. In this update, we included 24 studies with 2278 participants, of which 14 were randomised controlled trials (RCT), one was a quasi-RCT and nine had a non-randomised design. Eight studies compared types of PPE. Six studies evaluated adapted PPE. Eight studies compared donning and doffing processes and three studies evaluated types of training. Eighteen studies used simulated exposure with fluorescent markers or harmless microbes. In simulation studies, median contamination rates were 25% for the intervention and 67% for the control groups. Evidence for all outcomes is of very low certainty unless otherwise stated because it is based on one or two studies, the indirectness of the evidence in simulation studies and because of risk of bias. Types of PPE The use of a powered, air-purifying respirator with coverall may protect against the risk of contamination better than a N95 mask and gown (risk ratio (RR) 0.27, 95% confidence interval (CI) 0.17 to 0.43) but was more difficult to don (non-compliance: RR 7.5, 95% CI 1.81 to 31.1). In one RCT (59 participants) coveralls were more difficult to doff than isolation gowns (very low-certainty evidence). Gowns may protect better against contamination than aprons (small patches: mean difference (MD) -10.28, 95% CI -14.77 to -5.79). PPE made of more breathable material may lead to a similar number of spots on the trunk (MD 1.60, 95% CI -0.15 to 3.35) compared to more water-repellent material but may have greater user satisfaction (MD -0.46, 95% CI -0.84 to -0.08, scale of 1 to 5). According to three studies that tested more recently introduced full-body PPE ensembles, there may be no difference in contamination. Modified PPE versus standard PPE The following modifications to PPE design may lead to less contamination compared to standard PPE: sealed gown and glove combination (RR 0.27, 95% CI 0.09 to 0.78), a better fitting gown around the neck, wrists and hands (RR 0.08, 95% CI 0.01 to 0.55), a better cover of the gown-wrist interface (RR 0.45, 95% CI 0.26 to 0.78, low-certainty evidence), added tabs to grab to facilitate doffing of masks (RR 0.33, 95% CI 0.14 to 0.80) or gloves (RR 0.22, 95% CI 0.15 to 0.31). Donning and doffing Using Centers for Disease Control and Prevention (CDC) recommendations for doffing may lead to less contamination compared to no guidance (small patches: MD -5.44, 95% CI -7.43 to -3.45). One-step removal of gloves and gown may lead to less bacterial contamination (RR 0.20, 95% CI 0.05 to 0.77) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28) than separate removal. Double-gloving may lead to less viral or bacterial contamination compared to single gloving (RR 0.34, 95% CI 0.17 to 0.66) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28). Additional spoken instruction may lead to fewer errors in doffing (MD -0.9, 95% CI -1.4 to -0.4) and to fewer contamination spots (MD -5, 95% CI -8.08 to -1.92). Extra sanitation of gloves before doffing with quaternary ammonium or bleach may decrease contamination, but not alcohol-based hand rub. Training The use of additional computer simulation may lead to fewer errors in doffing (MD -1.2, 95% CI -1.6 to -0.7). A video lecture on donning PPE may lead to better skills scores (MD 30.70, 95% CI 20.14 to 41.26) than a traditional lecture. Face-to-face instruction may reduce noncompliance with doffing guidance more (odds ratio 0.45, 95% CI 0.21 to 0.98) than providing folders or videos only. AUTHORS' CONCLUSIONS We found low- to very low-certainty evidence that covering more parts of the body leads to better protection but usually comes at the cost of more difficult donning or doffing and less user comfort. More breathable types of PPE may lead to similar contamination but may have greater user satisfaction. Modifications to PPE design, such as tabs to grab, may decrease the risk of contamination. For donning and doffing procedures, following CDC doffing guidance, a one-step glove and gown removal, double-gloving, spoken instructions during doffing, and using glove disinfection may reduce contamination and increase compliance. Face-to-face training in PPE use may reduce errors more than folder-based training. We still need RCTs of training with long-term follow-up. We need simulation studies with more participants to find out which combinations of PPE and which doffing procedure protects best. Consensus on simulation of exposure and assessment of outcome is urgently needed. We also need more real-life evidence. Therefore, the use of PPE of HCW exposed to highly infectious diseases should be registered and the HCW should be prospectively followed for their risk of infection.
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Affiliation(s)
- Jos H Verbeek
- Cochrane Work Review Group, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Blair Rajamaki
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Sharea Ijaz
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Bronagh Blackwood
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Christina Tikka
- Finnish Institute of Occupational Health, TYÖTERVEYSLAITOS, Finland
| | | | - F Selcen Kilinc Balci
- National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Pittsburgh, PA, USA
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Zhang JC, Cram P, Adisesh A. Controversies in Respiratory Protective Equipment Selection and Use During COVID-19. J Hosp Med 2020; 15:292-294. [PMID: 32379033 PMCID: PMC7205002 DOI: 10.12788/jhm.3437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Joyce C Zhang
- Division of Occupational Medicine, Department of Medicine, University of Toronto, Toronto,
Canada
- Division of Occupational Medicine, St. Michael’s Hospital, Toronto,
Canada
- Corresponding Author: Joyce C Zhang, BSc Pharm, MD, MPH; ; Twitter: @drjoycezhang
| | - Peter Cram
- Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto,
Canada
| | - Anil Adisesh
- Division of Occupational Medicine, Department of Medicine, University of Toronto, Toronto,
Canada
- Division of Occupational Medicine, St. Michael’s Hospital, Toronto,
Canada
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Almadi MA, Aljebreen AM, Azzam N, Alammar N, Aljahdli ES, Alsohaibani FI, Alkhiari R, Almasoud AO, Al Beshir MS, Alshankiti S, Alharbi AW, Alkhathami M, Batwa F. COVID-19 and endoscopy services in intermediately affected countries: a position statement from the saudi gastroenterology association. Saudi J Gastroenterol 2020; 26:240-248. [PMID: 32351243 PMCID: PMC7739996 DOI: 10.4103/sjg.sjg_161_20] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
With the global pandemic due to coronavirus disease 2019 (COVID-19), there has been a significant strain on healthcare facilities. The infectivity rate, as well as the rate of healthcare workers who have fallen ill to the disease, has raised concerns globally on the proper management of patients as well as the role of safe healthcare provision utilizing personal protective equipment (PPE). Furthermore, the limited supply of PPEs has mandated rationing their use to achieve maximum utility and preservation. Multiple gastroenterology associations have issued guidance and statements that would help healthcare providers in navigating these unprecedented and difficult times, and the Saudi Gastroenterology Association has provided this statement in an effort to bring the most up to date information for the management of endoscopy units in terms of resources, manpower planning, scheduling, as well as infection control policies and leadership.
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Affiliation(s)
- Majid A. Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia,Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Québec, Canada,Address for correspondence: Dr. Majid A. Almadi, Division of Gastroenterology, King Khalid University Hospital, King Saud University, P.O. Box 2925 (59), Riyadh 11461, . E-mail:
| | - Abdulrahman M. Aljebreen
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Nahla Azzam
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Nuha Alammar
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Emad S. Aljahdli
- Gastroenterology Division, Department of Internal Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fahad I. Alsohaibani
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Resheed Alkhiari
- Department of Medicine, Qassim University, Buraydah, Saudi Arabia
| | | | - Mohammad S. Al Beshir
- Division of Gastroenterology, Department of Medicine, King Fahd Specialist Hospital, Dammam, Saudi Arabia
| | - Suliman Alshankiti
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad W. Alharbi
- Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammed Alkhathami
- Internal Medicine Department, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Faisal Batwa
- King Saud Bin Abdul-Aziz University of Health Sciences, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
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Personal protective equipment (PPE) for both anesthesiologists and other airway managers: principles and practice during the COVID-19 pandemic. Can J Anaesth 2020; 67:1005-1015. [PMID: 32329014 PMCID: PMC7178924 DOI: 10.1007/s12630-020-01673-w] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/09/2020] [Accepted: 04/12/2020] [Indexed: 01/25/2023] Open
Abstract
Healthcare providers are facing a coronavirus disease pandemic. This pandemic may last for many months, stressing the Canadian healthcare system in a way that has not previously been seen. Keeping healthcare providers safe, healthy, and available to work throughout this pandemic is critical. The consistent use of appropriate personal protective equipment (PPE) will help assure its availability and healthcare provider safety. The purpose of this communique is to give both anesthesiologists and other front-line healthcare providers a framework from which to understand the principles and practices surrounding PPE decision-making. We propose three types of PPE including: 1) PPE for droplet and contact precautions, 2) PPE for general airborne, droplet, and contact precautions, and 3) PPE for those performing or assisting with high-risk aerosol-generating medical procedures.
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Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2020; 4:CD011621. [PMID: 32293717 PMCID: PMC7158881 DOI: 10.1002/14651858.cd011621.pub4] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND In epidemics of highly infectious diseases, such as Ebola, severe acute respiratory syndrome (SARS), or coronavirus (COVID-19), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Personal protective equipment (PPE) can reduce the risk by covering exposed body parts. It is unclear which type of PPE protects best, what is the best way to put PPE on (i.e. donning) or to remove PPE (i.e. doffing), and how to train HCWs to use PPE as instructed. OBJECTIVES To evaluate which type of full-body PPE and which method of donning or doffing PPE have the least risk of contamination or infection for HCW, and which training methods increase compliance with PPE protocols. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL to 20 March 2020. SELECTION CRITERIA We included all controlled studies that evaluated the effect of full-body PPE used by HCW exposed to highly infectious diseases, on the risk of infection, contamination, or noncompliance with protocols. We also included studies that compared the effect of various ways of donning or doffing PPE, and the effects of training on the same outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed the risk of bias in included trials. We conducted random-effects meta-analyses were appropriate. MAIN RESULTS Earlier versions of this review were published in 2016 and 2019. In this update, we included 24 studies with 2278 participants, of which 14 were randomised controlled trials (RCT), one was a quasi-RCT and nine had a non-randomised design. Eight studies compared types of PPE. Six studies evaluated adapted PPE. Eight studies compared donning and doffing processes and three studies evaluated types of training. Eighteen studies used simulated exposure with fluorescent markers or harmless microbes. In simulation studies, median contamination rates were 25% for the intervention and 67% for the control groups. Evidence for all outcomes is of very low certainty unless otherwise stated because it is based on one or two studies, the indirectness of the evidence in simulation studies and because of risk of bias. Types of PPE The use of a powered, air-purifying respirator with coverall may protect against the risk of contamination better than a N95 mask and gown (risk ratio (RR) 0.27, 95% confidence interval (CI) 0.17 to 0.43) but was more difficult to don (non-compliance: RR 7.5, 95% CI 1.81 to 31.1). In one RCT (59 participants), people with a long gown had less contamination than those with a coverall, and coveralls were more difficult to doff (low-certainty evidence). Gowns may protect better against contamination than aprons (small patches: mean difference (MD) -10.28, 95% CI -14.77 to -5.79). PPE made of more breathable material may lead to a similar number of spots on the trunk (MD 1.60, 95% CI -0.15 to 3.35) compared to more water-repellent material but may have greater user satisfaction (MD -0.46, 95% CI -0.84 to -0.08, scale of 1 to 5). Modified PPE versus standard PPE The following modifications to PPE design may lead to less contamination compared to standard PPE: sealed gown and glove combination (RR 0.27, 95% CI 0.09 to 0.78), a better fitting gown around the neck, wrists and hands (RR 0.08, 95% CI 0.01 to 0.55), a better cover of the gown-wrist interface (RR 0.45, 95% CI 0.26 to 0.78, low-certainty evidence), added tabs to grab to facilitate doffing of masks (RR 0.33, 95% CI 0.14 to 0.80) or gloves (RR 0.22, 95% CI 0.15 to 0.31). Donning and doffing Using Centers for Disease Control and Prevention (CDC) recommendations for doffing may lead to less contamination compared to no guidance (small patches: MD -5.44, 95% CI -7.43 to -3.45). One-step removal of gloves and gown may lead to less bacterial contamination (RR 0.20, 95% CI 0.05 to 0.77) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28) than separate removal. Double-gloving may lead to less viral or bacterial contamination compared to single gloving (RR 0.34, 95% CI 0.17 to 0.66) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28). Additional spoken instruction may lead to fewer errors in doffing (MD -0.9, 95% CI -1.4 to -0.4) and to fewer contamination spots (MD -5, 95% CI -8.08 to -1.92). Extra sanitation of gloves before doffing with quaternary ammonium or bleach may decrease contamination, but not alcohol-based hand rub. Training The use of additional computer simulation may lead to fewer errors in doffing (MD -1.2, 95% CI -1.6 to -0.7). A video lecture on donning PPE may lead to better skills scores (MD 30.70, 95% CI 20.14 to 41.26) than a traditional lecture. Face-to-face instruction may reduce noncompliance with doffing guidance more (odds ratio 0.45, 95% CI 0.21 to 0.98) than providing folders or videos only. AUTHORS' CONCLUSIONS We found low- to very low-certainty evidence that covering more parts of the body leads to better protection but usually comes at the cost of more difficult donning or doffing and less user comfort, and may therefore even lead to more contamination. More breathable types of PPE may lead to similar contamination but may have greater user satisfaction. Modifications to PPE design, such as tabs to grab, may decrease the risk of contamination. For donning and doffing procedures, following CDC doffing guidance, a one-step glove and gown removal, double-gloving, spoken instructions during doffing, and using glove disinfection may reduce contamination and increase compliance. Face-to-face training in PPE use may reduce errors more than folder-based training. We still need RCTs of training with long-term follow-up. We need simulation studies with more participants to find out which combinations of PPE and which doffing procedure protects best. Consensus on simulation of exposure and assessment of outcome is urgently needed. We also need more real-life evidence. Therefore, the use of PPE of HCW exposed to highly infectious diseases should be registered and the HCW should be prospectively followed for their risk of infection.
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Affiliation(s)
- Jos H Verbeek
- Academic Medical Center, University of Amsterdam, Cochrane Work Review Group, Amsterdam, Netherlands, 1105AZ
| | - Blair Rajamaki
- University of Eastern Finland, School of Pharmacy, Kuopio, Finland
| | - Sharea Ijaz
- University of Bristol, Population Health Sciences, Bristol Medical School, Bristol, UK, BS1 2NT
| | | | | | - Bronagh Blackwood
- Queen's University Belfast, Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Wellcome-Wolfson Building, 97 Lisburn Road, Belfast, Northern Ireland, UK, BT9 7LB
| | - Christina Tikka
- Finnish Institute of Occupational Health, TYÖTERVEYSLAITOS, Finland, FI-70032
| | - Jani H Ruotsalainen
- Finnish Medicines Agency, Assessment of Pharmacotherapies, Microkatu 1, Kuopio, Finland, FI-70210
| | - F Selcen Kilinc Balci
- Centers for Disease Control and Prevention (CDC), National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH), 626 Cochrans Mill Road, Pittsburgh, PA, USA, 15236
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Baldock TE, Bolam SM, Gao R, Zhu MF, Rosenfeldt MPJ, Young SW, Munro JT, Monk AP. Infection prevention measures for orthopaedic departments during the COVID-2019 pandemic: a review of current evidence. Bone Jt Open 2020; 1:74-79. [PMID: 33215110 PMCID: PMC7659659 DOI: 10.1302/2633-1462.14.bjo-2020-0018.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIM The coronavirus disease 2019 (COVID-19) pandemic presents significant challenges to healthcare systems globally. Orthopaedic surgeons are at risk of contracting COVID-19 due to their close contact with patients in both outpatient and theatre environments. The aim of this review was to perform a literature review, including articles of other coronaviruses, to formulate guidelines for orthopaedic healthcare staff. METHODS A search of Medline, EMBASE, the Cochrane Library, World Health Organization (WHO), and Centers for Disease Control and Prevention (CDC) databases was performed encompassing a variety of terms including 'coronavirus', 'covid-19', 'orthopaedic', 'personal protective environment' and 'PPE'. Online database searches identified 354 articles. Articles were included if they studied any of the other coronaviruses or if the basic science could potentially applied to COVID-19 (i.e. use of an inactivated virus with a similar diameter to COVID-19). Two reviewers independently identified and screened articles based on the titles and abstracts. 274 were subsequently excluded, with 80 full-text articles retrieved and assessed for eligibility. Of these, 66 were excluded as they compared personal protection equipment to no personal protection equipment or referred to prevention measures in the context of bacterial infections. RESULTS There is a paucity of high quality evidence surrounding COVID-19. This review collates evidence from previous coronavirus outbreaks to put forward recommendations for orthopaedic surgeons during the COVID-19 pandemic. The key findings have been summarized and interpreted for application to the orthopaedic operative setting. CONCLUSION For COVID-19 positive patients, minimum suggested PPE includes N95 respirator, goggles, face shield, gown, double gloves, and surgical balaclava.Space suits not advised.Be trained in the correct technique of donning and doffing PPE.Use negative pressure theatres if available.Minimize aerosolization and its effects (smoke evacuation and no pulse lavage).Minimize further unnecessary patient-staff contact (dissolvable sutures, clear dressings, split casts).
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Affiliation(s)
- Thomas E. Baldock
- Department of Orthopaedics, Auckland City Hospital, Grafton, New Zealand
| | - Scott M. Bolam
- Department of Orthopaedics, Auckland City Hospital, Grafton, New Zealand
- University of Auckland, Auckland, New Zealand
| | - Ryan Gao
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
| | - Mark F. Zhu
- Department of Orthopaedics, Middlemore Hospital, Auckland, New Zealand
| | | | - Simon W. Young
- University of Auckland, Auckland, New Zealand
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
| | - Jacob T. Munro
- University of Auckland, Auckland, New Zealand
- Department of Orthopaedics, Auckland City Hospital, Auckland, New Zealand
| | - A. Paul Monk
- University of Auckland, Auckland, New Zealand
- Department of Orthopaedics, Auckland City Hospital, Auckland, New Zealand
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