Triaging of Respiratory Protective Equipment on the assumed risk of SARS-CoV-2 aerosol exposure in patient-facing healthcare workers delivering secondary care: a rapid review

ABSTRACT BACKGROUND Objectives: "In patient-facing healthcare workers delivering secondary care, what is the evidence behind UK Government PPE Guidance on surgical masks versus respirators for SARS-CoV-2 protection?" METHODS Two independent reviewers searched MEDLINE, Google Scholar and grey literature 11th-30th April 2020. Studies published on any date containing primary data comparing surgical facemasks and respirators specific to SARS-CoV-2, and studies underpinning government PPE guidance, were included. Appraisal was performed using CASP checklists. Results were synthesised by comparison of findings and appraisals. RESULTS In all three laboratory studies of 14 different respirators and 12 surgical facemasks, respirators were significantly more effective than facemasks in protection factors, reduction factors, filter penetrations, and total inspiratory leakages at differing particle sizes, mean inspiratory flows, and breathing rates. Tests included live viruses and inert particles on dummies and humans. In six clinical studies, 6,502 participants, there was no consistent definition of "exposure" to determine the efficacy of RPE. It is difficult to define "safe". The only statistically significant result found continuous use of respirators more effective in clinical respiratory illness compared to targeted use or surgical facemask. CONCLUSIONS There is a paucity of evidence on the comparison of FRSMs and respirators specific to SARS-CoV-2, and poor-quality evidence in other contexts. Indirectness results in extrapolation of non-SARS-CoV-2 specific data to guide UK Government PPE guidance. The appropriateness of this is unknown given the uncertainty over the transmission of SARS-CoV-2. 1. The evidence base for UK Government PPE guidelines is not based on SARS-CoV-2 and requires generalisation from low-quality evidence of other pathogens/particles. 2. There is a paucity of high-quality evidence regarding the efficacy of RPE specific to SARS-CoV-2. 3. HMG's PPE guidelines are underpinned by the assumption of droplet transmission of SARS-CoV-2. Triaging the use of FFP3 respirators might increase the risk of COVID-19 faced by some. FUNDING This review was unfunded and unsponsored.

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Triaging of respiratory protective equipment on the assumed risk of SARS-CoV-2 aerosol exposure in patient-facing healthcare workers delivering secondary care: a rapid review

BMJ Open ◽

10.1136/bmjopen-2020-040321 ◽

2020 ◽

Vol 10 (10) ◽

pp. e040321

Author(s):

Prashanth Ramaraj ◽

Jonathan Super ◽

Ruben Doyle ◽

Christopher Aylwin ◽

Shehan Hettiaratchy

Keyword(s):

Secondary Care ◽

Healthcare Workers ◽

Grey Literature ◽

Respiratory Illness ◽

Rapid Review ◽

Primary Data ◽

Protective Equipment ◽

Eligibility Criteria ◽

Uk Government ◽

Quality Evidence

ObjectivesIn patient-facing healthcare workers delivering secondary care, what is the evidence behind UK Government personal protective equipment (PPE) guidance on surgical masks versus respirators for SARS-CoV-2 protection?DesignTwo independent reviewers performed a rapid review. Appraisal was performed using Critical Appraisal Skills Programme checklists and Grading of Recommendations, Assessment, Development and Evaluations methodology. Results were synthesised by comparison of findings and appraisals.Data sourcesMEDLINE, Google Scholar, UK Government COVID-19 website and grey literature.Eligibility criteriaStudies published on any date containing primary data comparing surgical facemasks and respirators specific to SARS-CoV-2, and studies underpinning UK Government PPE guidance, were included.ResultsOf 30 identified, only 3 laboratory studies of 14 different respirators and 12 surgical facemasks were found. In all three, respirators were significantly more effective than facemasks when comparing protection factors, reduction factors, filter penetrations, total inspiratory leakages at differing particle sizes, mean inspiratory flows and breathing rates. Tests included live viruses and inert particles on dummies and humans. In the six clinical studies (6502 participants) included the only statistically significant result found continuous use of respirators more effective in clinical respiratory illness compared with targeted use or surgical facemasks. There was no consistent definition of ‘exposure’ to determine the efficacy of respiratory protective equipment (RPE). It is difficult to define ‘safe’.ConclusionsThere is a paucity of evidence on the comparison of facemasks and respirators specific to SARS-CoV-2, and poor-quality evidence in other contexts. The use of surrogates results in extrapolation of non-SARS-CoV-2 specific data to guide UK Government PPE guidance. The appropriateness of this is unknown given the uncertainty over the transmission of SARS-CoV-2.This means that the evidence base for UK Government PPE guidelines is not based on SARS-CoV-2 and requires generalisation from low-quality evidence of other pathogens/particles. There is a paucity of high-quality evidence regarding the efficacy of RPE specific to SARS-CoV-2. UK Government PPE guidelines are underpinned by the assumption of droplet transmission of SARS-CoV-2.These factors suggest that the triaging of filtering face piece class 3 respirators might increase the risk of COVID-19 faced by some.

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Mental health and well-being of healthcare workers during the COVID-19 pandemic in the UK: contrasting guidelines with experiences in practice

BJPsych Open ◽

10.1192/bjo.2020.148 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Norha Vera San Juan ◽

David Aceituno ◽

Nehla Djellouli ◽

Kirsi Sumray ◽

Nina Regenold ◽

...

Keyword(s):

Mental Health ◽

Healthcare Workers ◽

Well Being ◽

Evidence Base ◽

Rapid Review ◽

Front Line ◽

Contextual Characteristics ◽

Definition Of ◽

The Uk

Background Substantial evidence has highlighted the importance of considering the mental health of healthcare workers during the COVID-19 pandemic, and several organisations have issued guidelines with recommendations. However, the definition of well-being and the evidence base behind such guidelines remain unclear. Aims The aims of the study are to assess the applicability of well-being guidelines in practice, identify unaddressed healthcare workers’ needs and provide recommendations for supporting front-line staff during the current and future pandemics. Method This paper discusses the findings of a qualitative study based on interviews with front-line healthcare workers in the UK (n = 33), and examines them in relation to a rapid review of well-being guidelines developed in response to the COVID-19 pandemic (n = 14). Results The guidelines placed greater emphasis on individual mental health and psychological support, whereas healthcare workers placed greater emphasis on structural conditions at work, responsibilities outside the hospital and the invaluable support of the community. The well-being support interventions proposed in the guidelines did not always respond to the lived experiences of staff, as some reported not being able to participate in these interventions because of understaffing, exhaustion or clashing schedules. Conclusions Healthcare workers expressed well-being needs that aligned with socio-ecological conceptualisations of well-being related to quality of life. This approach to well-being has been highlighted in literature on support of healthcare workers in previous health emergencies, but it has not been monitored during this pandemic. Well-being guidelines should explore the needs of healthcare workers, and contextual characteristics affecting the implementation of recommendations.

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Healthcare Workers′ Mental Health and Wellbeing During the COVID-19 Pandemic in the UK: Contrasting Guidelines with Experiences in Practice

10.1101/2020.07.21.20156711 ◽

2020 ◽

Author(s):

Norha Vera San Juan ◽

David Aceituno ◽

Nehla Djellouli ◽

Kirsi Sumray ◽

Nina Regenold ◽

...

Keyword(s):

Mental Health ◽

Qualitative Study ◽

Healthcare Workers ◽

Evidence Base ◽

Rapid Review ◽

Frontline Staff ◽

Individual Level ◽

Mental Health Support ◽

Definition Of ◽

The Uk

Background Substantial evidence has highlighted the importance of considering healthcare workers′ (HCW) mental health during the COVID-19 pandemic, and several organisations have issued guidelines with recommendations. However, the definition of wellbeing and the evidence-base behind such guidelines remains unclear. Objectives Assessing the applicability of wellbeing guidelines in practice; identify unaddressed HCWs′ needs; and provide recommendations for supporting frontline staff during the current and future pandemics. Methods and Design This paper discusses the findings of a qualitative study based on interviews with frontline healthcare staff in the UK and examines them in relation to a rapid review of wellbeing guidelines developed in response to the COVID-19 pandemic. Results 14 guidelines were included in the rapid review and 33 interviews with HCWs were conducted in the qualitative study. As a whole, the guidelines placed greater emphasis on wellbeing at an individual level, while HCWs placed greater emphasis on structural conditions at work, such as understaffing and the invaluable support of the community. This in turn had implications for the focus of wellbeing intervention strategies; staff reported an increased availability of formal mental health support, however, understaffing or clashing schedules prevented them from participating in these activities. Conclusion HCWs expressed wellbeing needs which align with social-ecological conceptualisations of wellbeing related to quality of life. This approach to wellbeing has been highlighted in literature about HCWs support in previous health emergencies, yet it has not been monitored during this pandemic. Wellbeing guidelines should explore staff′s needs and contextual characteristics affecting the implementation of recommendations.

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‘Both Sides of the Argument’? A critical review of existing evidence on the illicit trade in tobacco products in Canada

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054687 ◽

2019 ◽

Vol 28 (e2) ◽

pp. e141-e147

Author(s):

Julia Smith ◽

Sheryl Thompson ◽

Kelley Lee

Keyword(s):

Tobacco Industry ◽

Grey Literature ◽

Evidence Base ◽

Complex Problem ◽

Primary Data ◽

Original Research ◽

Tobacco Products ◽

Illicit Trade ◽

Tobacco Control Policies ◽

Transnational Tobacco Companies

IntroductionThe illicit trade in tobacco products (ITTP) is widely recognised as a substantial and complex problem in Canada. However, the independence of available data and quality of analyses remains unknown. Reliable and accurate data on the scale and causes of the problem are needed to inform effective policy responses.MethodsWe searched the scholarly and grey literature using keywords related to ITTP in Canada. We identified 26 studies published in English since 2008 that present original research drawing on primary data. We analysed these studies for their independence from the tobacco industry, methodology, findings and gaps in knowledge.ResultsThe study finds 42% of the literature reviewed has links to the tobacco industry. These studies provide insufficient methodological detail, present higher estimates of the volume of ITTP and attribute the causes to higher rates of tobacco taxation. The classification of all indigenous tobacco sales as illicit, by both industry linked and independent studies, contributes to overestimates and serves the interests of transnational tobacco companies. There is need for independent and comprehensive data on the ITTP in Canada over time, across population groups and geographies.ConclusionWhile there is evidence that the ITTP in Canada is a major and complex issue that requires effective tobacco control policies, there is a limited evidence base on which to develop such responses. This review finds industry-linked studies lack independence, employ biased methodologies and serve tobacco industry interests. Independent studies present more rigorous approaches, but primarily focus on youth and the province of Ontario.

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Systems levers for commissioning primary mental healthcare: a rapid review

Australian Journal of Primary Health ◽

10.1071/py17030 ◽

2018 ◽

Vol 24 (1) ◽

pp. 29 ◽

Cited By ~ 4

Author(s):

Carla Meurk ◽

Meredith Harris ◽

Eryn Wright ◽

Nicola Reavley ◽

Roman Scheurer ◽

...

Keyword(s):

Mental Health ◽

Information Systems ◽

Health Information ◽

Grey Literature ◽

Mental Healthcare ◽

Health Information Systems ◽

Evidence Base ◽

Stepped Care ◽

Rapid Review ◽

Health Networks

Primary Health Networks (PHNs) are a new institution for health systems management in the Australian healthcare system. PHNs will play a key role in mental health reform through planning and commissioning primary mental health services at a regional level, specifically adopting a stepped care approach. Selected PHNs are also trialling a healthcare homes approach. Little is known about the systems levers that could be applied by PHNs to achieve these aims. A rapid review of academic and grey literature published between 2006 and 2016 was undertaken to describe the use of systems levers in commissioning primary care services. Fifty-six documents met the inclusion criteria, including twelve specific to primary mental healthcare. Twenty-six levers were identified. Referral management, contracts and tendering processes, and health information systems were identified as useful levers for implementing stepped care approaches. Location, enrolment, capitation and health information systems were identified as useful in implementing a healthcare homes approach. Other levers were relevant to overall health system functioning. Further work is needed to develop a robust evidence-base for systems levers. PHNs can facilitate this by documenting and evaluating the levers that they deploy, and making their findings available to researchers and other commissioning bodies.

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Measuring frailty in younger populations: a rapid review of evidence

BMJ Open ◽

10.1136/bmjopen-2020-047051 ◽

2021 ◽

Vol 11 (3) ◽

pp. e047051

Author(s):

Gemma F Spiers ◽

Tafadzwa Patience Kunonga ◽

Alex Hall ◽

Fiona Beyer ◽

Elisabeth Boulton ◽

...

Keyword(s):

Patient Outcomes ◽

Predictive Validity ◽

Data Extraction ◽

Grey Literature ◽

Frailty Index ◽

Study Data ◽

Rapid Review ◽

Eligibility Criteria ◽

Adult Age ◽

The Impact

ObjectivesFrailty is typically assessed in older populations. Identifying frailty in adults aged under 60 years may also have value, if it supports the delivery of timely care. We sought to identify how frailty is measured in younger populations, including evidence of the impact on patient outcomes and care.DesignA rapid review of primary studies was conducted.Data sourcesFour databases, three sources of grey literature and reference lists of systematic reviews were searched in March 2020.Eligibility criteriaEligible studies measured frailty in populations aged under 60 years using experimental or observational designs, published after 2000 in English.Data extraction and synthesisRecords were screened against review criteria. Study data were extracted with 20% of records checked for accuracy by a second researcher. Data were synthesised using a narrative approach.ResultsWe identified 268 studies that measured frailty in samples that included people aged under 60 years. Of these, 85 studies reported evidence about measure validity. No measures were identified that were designed and validated to identify frailty exclusively in younger groups. However, in populations that included people aged over and under 60 years, cumulative deficit frailty indices, phenotype measures, the FRAIL Scale, the Liver Frailty Index and the Short Physical Performance Battery all demonstrated predictive validity for mortality and/or hospital admission. Evidence of criterion validity was rare. The extent to which measures possess validity across the younger adult age (18–59 years) spectrum was unclear. There was no evidence about the impact of measuring frailty in younger populations on patient outcomes and care.ConclusionsLimited evidence suggests that frailty measures have predictive validity in younger populations. Further research is needed to clarify the validity of measures across the adult age spectrum, and explore the utility of measuring frailty in younger groups.

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Letter to the editor. Healthcare workers on the edge of sanity due to COVID-19: Rapid review of the results of systematic reviews and meta-analyzes

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2020.11.041 ◽

2021 ◽

Vol 83 ◽

pp. 21-24

Author(s):

Ivan Lozada-Martínez ◽

Maria Bolaño-Romero ◽

Luis Moscote-Salazar ◽

Daniela Torres-Llinas ◽

Amit Agrawal

Keyword(s):

Systematic Reviews ◽

Healthcare Workers ◽

Rapid Review ◽

Letter To The Editor

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Getting It Straight: Accommodating Rectilinear Behavior in Captive Snakes—A Review of Recommendations and Their Evidence Base

Animals ◽

10.3390/ani11051459 ◽

2021 ◽

Vol 11 (5) ◽

pp. 1459

Author(s):

Clifford Warwick ◽

Rachel Grant ◽

Catrina Steedman ◽

Tiffani J. Howell ◽

Phillip C. Arena ◽

...

Keyword(s):

Scientific Evidence ◽

Grey Literature ◽

Evidence Base ◽

Short Term ◽

Absolute Minimum ◽

Scientific Letter ◽

General Welfare ◽

Other Information ◽

Enclosure Size ◽

Current Guidance

Snakes are sentient animals and should be subject to the accepted general welfare principles of other species. However, they are also the only vertebrates commonly housed in conditions that prevent them from adopting rectilinear behavior (ability to fully stretch out). To assess the evidence bases for historical and current guidance on snake spatial considerations, we conducted a literature search and review regarding recommendations consistent with or specifying ≥1 × and <1 × snake length enclosure size. We identified 65 publications referring to snake enclosure sizes, which were separated into three categories: peer-reviewed literature (article or chapter appearing in a peer-reviewed journal or book, n = 31), grey literature (government or other report or scientific letter, n = 18), and opaque literature (non-scientifically indexed reports, care sheets, articles, husbandry books, website or other information for which originating source is not based on scientific evidence or where scientific evidence was not provided, n = 16). We found that recommendations suggesting enclosure sizes shorter than the snakes were based entirely on decades-old ‘rule of thumb’ practices that were unsupported by scientific evidence. In contrast, recommendations suggesting enclosure sizes that allowed snakes to fully stretch utilized scientific evidence and considerations of animal welfare. Providing snakes with enclosures that enable them to fully stretch does not suggest that so doing allows adequate space for all necessary normal and important considerations. However, such enclosures are vital to allow for a limited number of essential welfare-associated behaviors, of which rectilinear posturing is one, making them absolute minimum facilities even for short-term housing.

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What have we learned about COVID-19 volunteering in the UK? A rapid review of the literature

BMC Public Health ◽

10.1186/s12889-021-11390-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Guanlan Mao ◽

Maria Fernandes-Jesus ◽

Evangelos Ntontis ◽

John Drury

Keyword(s):

Community Engagement ◽

Social Trust ◽

Grey Literature ◽

National Level ◽

Community Support ◽

Public Institutions ◽

Rapid Review ◽

Mutual Aid ◽

Review Of The Literature ◽

The Uk

Abstract Background Community engagement and volunteering are essential for the public response to COVID-19. Since March 2020 a large number of people in the UK have been regularly doing unpaid activities to benefit others besides their close relatives. Although most mutual aid groups emerged from local neighbourhoods and communities, official public institutions also fostered community volunteering, namely through the community champions scheme. By considering a broad definition of COVID-19 volunteering, this article describes a systematic review of the literature focused on one broad question: What have we learned about COVID-19 volunteering both at the UK national level and the more local community level? Methods A rapid review of the literature in peer-reviewed databases and grey literature was applied in our search, following the PRISMA principles. The search was conducted from 10 to 16 of October 2020, and sources were included on the basis of having been published between January and October 2020, focusing on COVID-19 and addressing community groups, volunteering groups, volunteers, or community champions in the UK. Results After initial screening, a total of 40 relevant sources were identified. From these, 27 were considered eligible. Findings suggest that food shopping and emotional support were the most common activities, but there were diverse models of organisation and coordination in COVID-19 volunteering. Additionally, community support groups seem to be adjusting their activities and scope of action to current needs and challenges. Volunteers were mostly women, middle-class, highly educated, and working-age people. Social networks and connections, local knowledge, and social trust were key dimensions associated with community organising and volunteering. Furthermore, despite the efforts of a few official public institutions and councils, there has been limited community engagement and collaboration with volunteering groups and other community-based organisations. Conclusions We identified important factors for fostering community engagement and COVID-19 volunteering as well as gaps in the current literature. We suggest that future research should be directed towards deepening knowledge on sustaining community engagement, collaboration and community participation over time, during and beyond this pandemic.

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A scoping review of registry captured indicators for evaluating quality of critical care in ICU

Journal of Intensive Care ◽

10.1186/s40560-021-00556-6 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Issrah Jawad ◽

Sumayyah Rashan ◽

Chathurani Sigera ◽

Jorge Salluh ◽

Arjen M. Dondorp ◽

...

Keyword(s):

Critical Care ◽

Scoping Review ◽

Health Care Quality ◽

Grey Literature ◽

Healthcare Providers ◽

Evidence Base ◽

Patient Reported Outcome ◽

Care Quality ◽

Patient Reported

Abstract Background Excess morbidity and mortality following critical illness is increasingly attributed to potentially avoidable complications occurring as a result of complex ICU management (Berenholtz et al., J Crit Care 17:1-2, 2002; De Vos et al., J Crit Care 22:267-74, 2007; Zimmerman J Crit Care 1:12-5, 2002). Routine measurement of quality indicators (QIs) through an Electronic Health Record (EHR) or registries are increasingly used to benchmark care and evaluate improvement interventions. However, existing indicators of quality for intensive care are derived almost exclusively from relatively narrow subsets of ICU patients from high-income healthcare systems. The aim of this scoping review is to systematically review the literature on QIs for evaluating critical care, identify QIs, map their definitions, evidence base, and describe the variances in measurement, and both the reported advantages and challenges of implementation. Method We searched MEDLINE, EMBASE, CINAHL, and the Cochrane libraries from the earliest available date through to January 2019. To increase the sensitivity of the search, grey literature and reference lists were reviewed. Minimum inclusion criteria were a description of one or more QIs designed to evaluate care for patients in ICU captured through a registry platform or EHR adapted for quality of care surveillance. Results The search identified 4780 citations. Review of abstracts led to retrieval of 276 full-text articles, of which 123 articles were accepted. Fifty-one unique QIs in ICU were classified using the three components of health care quality proposed by the High Quality Health Systems (HQSS) framework. Adverse events including hospital acquired infections (13.7%), hospital processes (54.9%), and outcomes (31.4%) were the most common QIs identified. Patient reported outcome QIs accounted for less than 6%. Barriers to the implementation of QIs were described in 35.7% of articles and divided into operational barriers (51%) and acceptability barriers (49%). Conclusions Despite the complexity and risk associated with ICU care, there are only a small number of operational indicators used. Future selection of QIs would benefit from a stakeholder-driven approach, whereby the values of patients and communities and the priorities for actionable improvement as perceived by healthcare providers are prioritized and include greater focus on measuring discriminable processes of care.

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