scholarly journals 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 ◽  
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.

scholarly journals 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

2020 ◽  
Author(s):  
Prashanth Ramaraj ◽  
Jonathan Thomas Super ◽  
Ruben Doyle ◽  
Christopher Aylwin ◽  
Shehan Hettiaratchy
Keyword(s):  
Secondary Care ◽  
Healthcare Workers ◽  
Grey Literature ◽  
Respiratory Illness ◽  
Evidence Base ◽  
Poor Quality ◽  
Rapid Review ◽  
Primary Data ◽  
Uk Government ◽  
Quality Evidence

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.

scholarly journals Measuring frailty in younger populations: a rapid review of evidence

BMJ Open ◽  
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.

scholarly journals Identifying enablers and barriers to referral, uptake and completion of lifestyle modification programmes: a rapid literature review

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045094
Author(s):  
Yvonne Zurynski ◽  
Carolynn Smith ◽  
Joyce Siette ◽  
Bróna Nic Giolla Easpaig ◽  
Mary Simons ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Lifestyle Modification ◽  
Data Extraction ◽  
Empirical Studies ◽  
Grey Literature ◽  
International Health ◽  
Rapid Review ◽  
Eligibility Criteria ◽  
Relevant Evidence ◽  
Literature Reviews

ObjectiveTo identify current, policy-relevant evidence about barriers and enablers associated with referral, uptake and completion of lifestyle modification programmes (LMPs) for secondary prevention of chronic disease in adults.DesignA rapid review, co-designed with policymakers, of peer-reviewed and grey literature using a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework.Data sourcesMedline, Embase, Scopus, PsycINFO and CINAHL were searched for relevant studies and literature reviews. Grey literature was identified through Advanced Google searching and targeted searching of international health departments’ and non-government organisations’ websites.Eligibility criteria for selecting studiesDocuments published 2010–2020, from high-income countries, reporting on programmes that included referral of adults with chronic disease to an LMP by a health professional (HP).Data extraction and synthesisData from grey and peer-reviewed literature were extracted by two different reviewers. Extracted data were inductively coded around emergent themes. Regular meetings of the review group ensured consistency of study selection and synthesis.ResultsTwenty-nine documents were included: 14 grey literature, 11 empirical studies and four literature reviews. Key barriers to HPs referring patients included inadequate HP knowledge about LMPs, perceptions of poor effectiveness of LMPs and perceptions that referral to LMPs was not part of their role. Patient barriers to uptake and completion included poor accessibility and lack of support to engage with the LMPs. Enablers to HP referral included training/education, effective interdisciplinary communication and influential programme advocates. Support to engage with LMPs after HP referral, educational resources for family members and easy accessibility were key enablers to patient engagement with LMPs.ConclusionsFactors related to HPs’ ability and willingness to make referrals are important for the implementation of LMPs, and need to be coupled with support for patients to engage with programmes after referral. These factors should be addressed when implementing LMPs to maximise their impact.

scholarly journals Factors influencing the readiness to tackle the burden of ischaemic heart disease in India: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047464
Author(s):  
Shuvarthi Bhattacharjee ◽  
Nima Yaghmaei ◽  
Cao Tran Le Phuong ◽  
Dinesh Neupane
Keyword(s):  
Systematic Review ◽  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Grey Literature ◽  
Primary Data ◽  
Eligibility Criteria ◽  
Design Data ◽  
Factors Influencing ◽  
Open Government Data ◽  
The Government

IntroductionIschaemic heart disease (IHD) is one of the leading causes of death and disease burden in India affecting all age groups. To reduce the deaths and tackle the burden of existing IHD, the government approach has been mostly through the National Health Policy (2017) and National Programme for Prevention and Control of Diabetes, Cardiovascular diseases and Stroke. This paper offers a protocol for the systematic review of studies exploring the factors influencing service readiness of the public health system of India to tackle the burden of IHD.Methods and analysisElectronic databases of Embase (Ovid), AMED (Ovid), HMIC (Ovid), BNI (ProQuest), CINAHL (EBSCO), EMCARE (Ovid), PsycINFO (ProQuest), MEDLINE/PubMed and Web of Science (Clarivate Analytics) will be searched till 2020 for primary studies. Grey literature will be accessed through OpenGrey, TRIP Medical, WHO database, MoHFW website, Open Government Data (OGD) Platform of India and Google Scholar (between 2010 and 2020). Primary studies meeting the eligibility criteria and grey literature published in English between 2010 and 2020 will be included. Data will be analysed through a conceptual framework, and the primary outcome will constitute both quantitative and qualitative data. The quality of included studies will be assessed based on study design. Data will be managed on the COVIDENCE platform. All authors will be involved in data extraction, quality appraisal, data synthesis and formulation of the final draft.Ethics and disseminationThis study, being a systematic review, does not involve any clinical trial, primary data collection or empirical study involving humans or animals. Therefore, no ethical permissions were sought by reviewers.PROSPERO registration numberCRD42020219490.

scholarly journals Evidence-Based, Cost-Effective Interventions To Suppress The COVID-19 Pandemic: A Systematic Review

2020 ◽  
Author(s):  
Carl-Etienne Juneau ◽  
Tomas Pueyo ◽  
Matt Bell ◽  
Genevieve Gee ◽  
Pablo Collazzo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Healthcare Workers ◽  
Cost Effective ◽  
Hand Washing ◽  
Contact Tracing ◽  
Protective Equipment ◽  
School Closures ◽  
Effective Interventions ◽  
Quality Evidence

ABSTRACTBackgroundIn an unparalleled global response, during the COVID-19 pandemic, 90 countries asked 3.9 billion people to stay home. Yet some countries avoided lockdowns and focused on other strategies, like contact tracing and case isolation. How effective and cost-effective are these strategies? We aimed to provide a comprehensive summary of the evidence on pandemic control, with a focus on cost-effectiveness.MethodsFollowing PRISMA systematic review guidelines, MEDLINE (1946 to April week 2, 2020) and Embase (1974 to April 17, 2020) were searched using a range of terms related to pandemic control. Articles reporting on the effectiveness or cost-effectiveness of at least one intervention were included and grouped into higher-quality evidence (randomized trials) and lower-quality evidence (other study designs).ResultsWe found 1,653 papers; 62 were included. Higher-quality evidence was only available to support the effectiveness of hand washing and face masks. Modelling studies indicated that these measures are highly cost-effective. For other interventions, lower-quality evidence suggested that: (1) the most cost-effective interventions are swift contact tracing and case isolation, surveillance networks, protective equipment for healthcare workers, and early vaccination (when available); (2) home quarantines and stockpiling antivirals are less cost-effective; (3) social distancing measures like workplace and school closures are effective but costly, making them the least cost-effective options; (4) combinations are more cost-effective than single interventions; (5) interventions are more cost-effective when adopted early and for severe viruses like SARS-CoV-2. For H1N1 influenza, contact tracing was estimated to be 4,363 times more cost-effective than school closures ($2,260 vs. $9,860,000 per death prevented).ConclusionsA cautious interpretation of the evidence suggests that for COVID-19: (1) social distancing is effective but costly, especially when adopted late and (2) adopting as early as possible a combination of interventions that includes hand washing, face masks, ample protective equipment for healthcare workers, and swift contact tracing and case isolation is likely to be the most cost-effective strategy.FundingLP holds the Canada Research Chair in Community Approaches and Health Inequalities (CRC 950232541). This funding source had no role in the design, conduct, or reporting of the study.

scholarly journals COVID-19, SARS-CoV-2: Impact on healthcare workers in the pandemic’s initial months: Rapid review

2021 ◽  
Vol 5 (1) ◽  
pp. 1-15
Author(s):  
Rachel Malone
Keyword(s):  
Healthcare Workers ◽  
Well Being ◽  
World Health Organisation ◽  
Skin Lesions ◽  
World Health ◽  
Rapid Review ◽  
Protective Equipment ◽  
Family Balance ◽  
Work Family ◽  
Frontline Healthcare Workers

On March 11, 2020 the World Health Organisation declared the SARS-CoV-2 viral outbreak a pandemic. This rapid review aimed to identify the pandemic's impact on frontline healthcare workers during the viral outbreak's initial months. Database searches December 1, 2019 to August 29, 2020 retrieved 18 relevant studies. Findings showed that healthcare workers internationally were negatively impacted by the pandemic. Compared to non-frontline healthcare workers a significantly greater proportion of frontline healthcare workers experienced: burnout, stress, and stressors regarding: childcare, job interference with work-family balance and difficulty getting off-duty time. Compared to male physicians, a significantly greater proportion of female physicians scored low for psychological well-being. Mean scores for stress were significantly higher among females and young healthcare workers (22 to 35 years).  Mean scores for anxiety were significantly higher for: nurses compared to technicians, healthcare workers reporting extreme lack of protective equipment and those aged > 30 years. The prevalence of depression among frontline healthcare workers across studies in this review ranged from 9% to 51%. The prevalence of sleep issues ranged from 24% to 60% with some reporting nightmares. However, these studies lack homogeneity. Healthcare workers experienced fear of: contracting the virus (89.8%), spreading it to family (91.3%) and fear of an uncontrollable epidemic (86.8%). Over 90% reported skin lesions due to prolonged use of personal protective equipment. Many lost their lives to the SARS-CoV-2 virus. One prominent impact of the SARS-CoV-2 pandemic is the reported loss of healthcare worker's lives and this paper wishes to pay them tribute.

scholarly journals An outbreak caused by the SARS-CoV-2 Delta variant (B.1.617.2) in a secondary care hospital in Finland, May 2021

2021 ◽  
Vol 26 (30) ◽  
Author(s):  
Iivo Hetemäki ◽  
Sohvi Kääriäinen ◽  
Pirjo Alho ◽  
Janne Mikkola ◽  
Carita Savolainen-Kopra ◽  
...  
Keyword(s):  
Primary Care ◽  
Personal Protective Equipment ◽  
Secondary Care ◽  
Healthcare Workers ◽  
Protective Equipment ◽  
Care Hospital ◽  
National Guidelines ◽  
Staff Members ◽  
Care Facilities ◽  
Permanent Staff

An outbreak caused by the SARS-CoV-2 Delta variant (B.1.617.2) spread from one inpatient in a secondary care hospital to three primary care facilities, resulting in 58 infections including 18 deaths in patients and 45 infections in healthcare workers (HCW). Only one of the deceased cases was fully vaccinated. Transmission occurred despite the use of personal protective equipment by the HCW, as advised in national guidelines, and a high two-dose COVID-19 vaccination coverage among permanent staff members in the COVID-19 cohort ward.

scholarly journals Effectiveness of Personal Protective Equipment for Healthcare Workers Caring for Patients with Filovirus Disease: A Rapid Review

PLoS ONE ◽  
2015 ◽  
Vol 10 (10) ◽  
pp. e0140290 ◽  
Author(s):  
Mona Hersi ◽  
Adrienne Stevens ◽  
Pauline Quach ◽  
Candyce Hamel ◽  
Kednapa Thavorn ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Rapid Review ◽  
Protective Equipment

Functionalized photocatalytic nanocoatings for inactivating COVID-19 virus residing on surfaces of public and healthcare facilities

Coronaviruses ◽  
2021 ◽  
Vol 02 ◽  
Author(s):  
Manjunatha Channegowda
Keyword(s):  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Treatment Options ◽  
Large Population ◽  
Respiratory Illness ◽  
Protective Equipment ◽  
New Disease ◽  
Polymeric Surfaces ◽  
Healthcare Facilities ◽  
Novel Coronavirus

: The current ongoing pandemic of COVID-19 caused by the new coronavirus SARS-CoV-2, has affected the large population across the globe by serious respiratory illness and death. Since the medicine for this new disease is yet to discover, the treatment options against pandemic COVID-19 are very limited and unsatisfactory. Further, the hospitals trying to treat the COVID-19 patients are majorly infected by this virus, as it sustain on the surfaces of inanimate objects for days. Therefore, hospitals have become hotspots for novel coronavirus (SARS-CoV-2) infection. Till date millions of healthcare workers are infected in many countries, and several have died too. The non-availability of quality personal protective equipment (PPE) and the more duration of exposure with severe and critical COVID patients, have been a major factor for the infection in millions of healthcare workers. However, developing an effective medicine has remained challenging due to its unpredicted mutation rate. Here, this article proposes functionalized photocatalytic nanocoatings to destroy the COVID-19 virus, which can be applied on the surface of inanimate objects such as paper, cloth, glass, wood, ceramic, metallic, polymeric surfaces etc. With the supporting experimental results, various possible ways of killing the virus and its mechanism is discussed. This article provides new insights for developing nano solutions to address this COVID-19 issue.

Use of Personal Protective Equipment during Surgical Procedures Including Aerosol-Generating Procedures in Reducing the Risk of SARS-CoV-2 Viral Transmission: A Rapid Review

2021 ◽  
Author(s):  
Valentin C. Dones III ◽  
Maria Cristina Z. San Jose ◽  
Howell G. Bayona
Keyword(s):  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Guideline Development ◽  
Policy Decision ◽  
The Philippines ◽  
Rapid Review ◽  
Protective Equipment ◽  
Quality Of Evidence ◽  
Development Tool

Introduction. COVID-19 infection spreads through respiratory droplets, contact, and airborne transmission. During aerosol-generating procedures (AGPs), the risk of spreading SARS-CoV-2 via aerosols is increased significantly. This rapid review determined the association between using personal protective equipment (PPE) during AGPs, including those during surgery, among confirmed or suspected patients with COVID-19 and the risk of infection among healthcare workers. Method. A systematic search of electronic databases MEDLINE, EBSCO, Science Direct, Google Scholar, and Cochrane CENTRAL base was performed last March 21, 2021, using the Boolean combination of keywords for SARS-CoV-2, PPE, and surgery. Two reviewers screened the articles for relevance and extracted the data from the included studies. We critically appraised the included studies using criteria from the Painless Evidence-Based Medicine Evaluation of Articles on Harm. We used RevMan for data pooling, with a 40% heterogeneity cut-off score. GRADEpro guideline development tool determined the quality of evidence of the included studies. Results. Five observational studies investigated the effectiveness of PPE use in reducing SARS-CoV-2 transmission among healthcare workers during any AGPs. The use of N95 masks (OR 0.37 [95% CI 0.21, 0.67], 1 study, n=195), surgical gown (OR 0.59 [95% CI 0.46, 0.77] I2= 0%, 2 studies, n= 941) and gloves (OR 0.42 [95% CI 0.43, 0.55] I2=34%, 3 studies, n=978) versus their non-use significantly reduced the odds of SARS-COV-2 transmission among healthcare workers involved in AGP. Albeit inconclusive due to the very low quality of evidence, using face shields or goggles was not associated with a significant reduction in the odds of SARS-CoV-2 transmission (OR 0.70 [95% CI 0.31, 1.59]) than the non-use of face shields or goggles. The certainty of the overall body of evidence on PPE use in reducing SARS-CoV-2 transmission during AGP procedures was rated very low. In addition, confounders in the assessment could have been using individual PPE with the other standard PPE, compliance of healthcare worker on properly wearing it, and observing other preventive measures. Conclusion. There were lower odds of COVID-19 infection among healthcare workers using appropriate PPE, including N95 respirators, surgical gowns, and gloves during AGPs in suspected or confirmed COVID-19 patients. Several guidelines recommended using enhanced PPE among healthcare workers during surgery despite limited and low-quality evidence. The findings should help in developing recommendations in reducing SARS-CoV-2 transmission in the Philippines. The findings should provide the information needed for healthcare policy decision-making.

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