scholarly journals Systematic review and meta-analysis comparing ventilatory support in chemical, biological and radiological emergencies

2020 ◽  
Vol 28 ◽  
Author(s):  
Israel Baptista de Souza Borges ◽  
Magali Rezende de Carvalho ◽  
Marcel de Souza Quintana ◽  
Alexandre Barbosa de Oliveira
Keyword(s):  
Personal Protective Equipment ◽  
Health Professionals ◽  
Meta Analysis ◽  
Ventilatory Support ◽  
Orotracheal Intubation ◽  
Protective Equipment ◽  
Laryngeal Masks ◽  
Orotracheal Tube ◽  
The Mean ◽  
Meta Analyses

Objective: to compare the mean development time of the techniques of direct laryngoscopy and insertion of supraglottic devices; and to evaluate the success rate in the first attempt of these techniques, considering health professionals wearing specific personal protective equipment (waterproof overalls; gloves; boots; eye protection; mask). Method: meta-analysis with studies from LILACS, MEDLINE, CINAHL, Cochrane, Scopus and Web of Science. The keywords were the following: personal protective equipment; airway management; intubation; laryngeal masks. Results: in the “reduction of the time of the procedures” outcome, the general analysis of the supraglottic devices in comparison with the orotracheal tube initially presented high heterogeneity of the data (I2= 97%). Subgroup analysis had an impact on reducing heterogeneity among the data. The “laryngeal mask as a guide for orotracheal intubation” subgroup showed moderate heterogeneity (I2= 74%). The “2ndgeneration supraglottic devices” subgroup showed homogeneity (I2= 0%). All the meta-analyses favored supraglottic devices. In the “success in the first attempt” outcome, moderate homogeneity was found (I2= 52%), showing a higher proportion of correct answers for supraglottic devices. Conclusion: in the context of chemical, biological or radiological disaster, the insertion of the supraglottic device proved to be faster and more likely to be successful by health professionals. PROSPERO record (CRD42019136139).

scholarly journals Orotracheal tube versus supraglottic devices in biological, chemical and radiological disasters: meta-analysis in manikin-based studies

2021 ◽  
Vol 74 (5) ◽  
Author(s):  
Israel Baptista de Souza Borges ◽  
Magali Rezende de Carvalho ◽  
Marcel de Souza Quintana ◽  
Dalmo Valério Machado de Lima ◽  
Bruno Leal Barbosa ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Healthcare Providers ◽  
Ventilatory Support ◽  
Orotracheal Intubation ◽  
Supraglottic Airway ◽  
Emergency Setting ◽  
Level Of Evidence ◽  
Orotracheal Tube ◽  
Supraglottic Airway Devices ◽  
Airway Devices

ABSTRACT Objective: To compare the mean time of orotracheal intubation and insertion of supraglottic airway devices, considering healthcare providers wearing waterproof overall, gloves, boots, eye protection and mask at the Chemical, Biological, Radiological and Nuclear context in simulation setting. Methods: Six databases were searched. The selected studies were put in a pool of results using a random-effects meta-analysis, with standardized mean differences and calculation of 95% confidence intervals. Results: Nine observational studies were included. Regarding reducing time to provide ventilatory support, subgroup analyses were made. The emergency setting subgroup: -12.97 [-16.11; -9.83]; I2 = 64%. The surgery setting subgroup: -14.96 [-18.65; -11.27]; I2 = 75%. Another analysis was made by reproductive methodology subgroups. Ophir’s subgroup: -15.70 [-17.04; -14.37]; I2 = 0%. All meta-analyses had orotracheal tube as comparator. Conclusion: Moderate level of evidence was in favor of insertion of supraglottic devices because of fast application.

Recomendações de equipamentos de proteção individual no combate ao COVID-19

2020 ◽  
Vol 10 (31) ◽  
pp. 87-95
Author(s):  
Nicole Maria Miyamoto Bettini ◽  
Fabiana Tomé Ramos ◽  
Priscila Masquetto Vieira de Almeida
Keyword(s):  
World Health Organization ◽  
Personal Protective Equipment ◽  
Health Professionals ◽  
Health Personnel ◽  
Healthcare Professionals ◽  
World Health ◽  
Protective Equipment ◽  
Effective Strategy ◽  
The World ◽  
Health Organization

A Organização Mundial da Saúde - OMS confirmou a circulação internacional do novo Coronavírus em janeiro de 2020, nomeando-o como COVID-19 e, declarando uma pandemia. É de extrema importância que durante a pandemia, os profissionais de saúde tenham acesso e conhecimento sobre o uso correto dos Equipamentos de Proteção Individual (EPIs) e suas indicações, tomando assim, as devidas precauções na prevenção de infecções. O presente estudo buscou identificar a padronização mundial quanto ao uso dos EPIs utilizados no atendimento a pacientes suspeitos e/ou confirmados de COVID-19 no Brasil, EUA, China, Espanha, Itália e demais países europeus. Os guidelines apresentam a padronização quanto ao uso dos EPIs utilizados no atendimento a suspeitos e/ou confirmados de COVID-19, indo ao encontro das recomendações fornecidas pela OMS. Até o momento, o uso de EPIs é sem dúvida a estratégia mais importante e eficaz para proteger os profissionais de saúde durante a assistência ao paciente com COVID-19.Descritores: Infecções por Coronavírus, Equipamento de Proteção Individual, Pessoal de Saúde, Enfermagem. Recommendations for personal protective equipment to combat COVID-19Abstract: The World Health Organization - WHO confirmed the international circulation of the new Coronavirus in January 2020, naming it as COVID-19 and declaring a pandemic. It is extremely important that during the pandemic, health professionals have access and knowledge about the correct use of Personal Protective Equipment (PPE) and its indications, thus taking appropriate precautions to prevent infections. The present study sought to identify the worldwide standardization regarding the use of PPE utilized to take care of suspected and confirmed patients with COVID-19 in Brazil, USA, China, Spain, Italy and other European countries. The guidelines present a standardization regarding the use of PPE utilized to take care of suspected and confirmed with COVID-19, in line with the recommendations provided by WHO. To date, the use of PPE is undoubtedly the most important and effective strategy to protect healthcare professionals during care for patients with COVID-19.Descriptors: Coronavirus Infections, Personal Protective Equipment, Health Personnel, Nursing. Recomendaciones para el equipo de protección personal para combatir COVID-19Resumen: La Organización Mundial de la Salud - La OMS confirmó la circulación internacional del nuevo Coronavirus en enero de 2020, nombrándolo COVID-19 y declarando una pandemia. Es extremadamente importante que durante la pandemia, los profesionales de la salud tengan acceso y conocimiento sobre el uso correcto del Equipo de Protección Personal (EPP) y sus indicaciones, tomando así las precauciones adecuadas para prevenir infecciones. El presente estudio buscó identificar la estandarización mundial con respecto al uso de EPP utilizado para atender a pacientes sospechosos y/o confirmados con COVID-19 en Brasil, Estados Unidos, China, España, Italia y otros países europeos. Las pautas presentan la estandarización con respecto al uso de EPP utilizado para cuidar COVID-19 sospechoso y/o confirmado, de acuerdo con las recomendaciones proporcionadas por la OMS. Hasta la fecha, el uso de EPP es, sin duda, la estrategia más importante y efectiva para proteger a los profesionales de la salud durante la atención de pacientes con COVID-19.Descriptores: Infecciones por Coronavirus, Equipo de Protección Personal, Personal de Salud, Enfermería.

scholarly journals A systematic review of pharmacist-led audit and feedback interventions to influence prescribing behaviour in general practice settings

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i34-i35
Author(s):  
M Carter ◽  
N Abutheraa ◽  
N Ivers ◽  
J Grimshaw ◽  
S Chapman ◽  
...  
Keyword(s):  
General Practice ◽  
Systematic Reviews ◽  
Health Professionals ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Audit And Feedback ◽  
Cochrane Library ◽  
Randomised Trials ◽  
Prescribing Behaviour ◽  
Meta Analyses

Abstract Introduction Audit and Feedback (A&F) involves measuring data about practice, comparing it with clinical guidelines, professional standards or peer performance, and then feeding back the data to individuals/groups of health professionals to encourage change in practice (if required). A 2012 Cochrane review (1) found A&F was effective in changing health professionals’ behaviour and suggested that the person who delivers the A&F intervention influences its effect. Increasingly, pharmacists work in general practice and often have responsibility for medication review and repeat prescriptions. The effectiveness of pharmacist-led A&F in influencing prescribing behaviour is uncertain. Aim This secondary analysis from an ongoing update of the original Cochrane review aims to identify and describe pharmacist-led A&F interventions and evaluate their impact on prescribing behaviour in general practice compared with no intervention. Methods This sub-review is registered with PROSPERO: CRD42020194355 and complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (2). For the updated Cochrane review, the Cochrane Effective Practice and Organization of Care Group searched MEDLINE (1946 to present), EMBASE, CINAHL and Cochrane Library (March 2019) to identify randomised trials featuring A&F interventions. For this sub-review, authors screened titles and abstracts (May 2020) to identify trials involving pharmacist-led A&F interventions in primary care, extracted data, and assessed risk of bias (RoB) in eligible studies. Review results are summarised descriptively. Heterogeneity will be assessed and a random-effects meta-analysis is planned. Publication bias for selected outcomes and the certainty of the body of evidence will be evaluated and presented. Sub-group analyses will be conducted. Results Titles and abstracts of 295 studies identified for inclusion in the Cochrane A&F review update were screened. Eleven studies (all cluster-randomised trials) conducted in 9 countries (Denmark, Italy, Netherlands, Norway, Republic of Ireland, UK, Australia, Malaysia, USA) were identified for inclusion (Figure 1). Six studies had low RoB, two had high risk due to dissimilarities between trial arms at baseline and/or insufficient detail about randomisation, and three studies had unclear RoB. Studies examined the effect of A&F on prescribing for specific conditions (e.g. hypertension), medications (e.g. antibiotics), populations (e.g. patients >70), and prescribing errors (e.g. inappropriate dose). The pharmacist delivering A&F was a colleague of intervention participants in five studies. Pharmacists’ levels of skill and experience varied; seven studies reported details of pharmacist training undertaken for trial purposes. A&F interventions in nine studies demonstrated changes in prescribing, including reductions in errors or inappropriate prescribing according to the study aims and smaller increases in unwanted prescribing compared with the control group. Data analyses are ongoing (results will be available for the conference). Conclusion The preliminary results demonstrate the effectiveness of pharmacist-led A&F interventions in different countries and health systems with influencing prescribing practice to align more closely with guidance. Studies measured different prescribing behaviours; meta-analysis is unlikely to include all 11 studies. Further detailed analysis including feedback format/content/frequency and pharmacist skill level/experience, work-base (external/internal to recipients), will examine the impact of specific features on intervention effectiveness. References 1. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012(6):CD000259. 2. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

Aerosol-generating procedures in home care

2021 ◽  
Vol 26 (2) ◽  
pp. 76-80
Author(s):  
Drew Payne ◽  
Martin Peache
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Personal Protective Equipment ◽  
Health Professionals ◽  
Community Setting ◽  
Protective Equipment ◽  
Clinical Environment ◽  
Clinical Practices ◽  
Clinical Procedures ◽  
Increased Risk ◽  
The Uk

COVID-19 has changed the landscape of healthcare in the UK since the first confirmed case in January 2020. Most of the resources have been directed towards reducing transmission in the hospital and clinical environment, but little is known about what community nurses can do to reduce the risk when they nurse people in their own homes? This article looks at what COVID-19 is, how it is spread and how health professionals are at an increased risk from aerosol-generating procedures (AGPs). There is also a discussion on the benefit of mask usage. It defines what AGPs are, which clinical procedures are AGPs, including ones performed in the community setting, and which identified clinical practices that have been mistaken for AGPs. There is also a discussion on the suitability of performing cardiopulmonary resuscitation (CPR). It also describes how to reduce the risk by the use of full personal protective equipment (PPE) and other strategies when AGPs are performed in a patient's home. It ends with general advice about managing the risk of COVID-19 transmission with patients in their homes.

scholarly journals Decontamination methods of personal protective equipment for repeated utilization in medical/surgical settings

2020 ◽  
Vol 8 (34) ◽  
pp. 27-39
Author(s):  
Abdurrahman Kharbat ◽  
Adin Mizer ◽  
Mimi Zumwalt
Keyword(s):  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Protective Equipment ◽  
Pilot Studies ◽  
Medical Supplies ◽  
Policy Statements ◽  
Repeated Use ◽  
Meta Analyses ◽  
N95 Respirators ◽  
Made In

The COVID-19 pandemic has affected citizens and healthcare workers worldwide due to a number of important factors. The transmission of the SARS CoV-2 microorganism, the pathogen that causes COVID-19 infection, occurs through droplet and aerosol spread due to coughs and sneezes from infected patients. A panicked public began hoarding medical supplies and personal protective equipment (PPE), leaving healthcare workers to care for patients without adequate protection. A literature review was conducted to better understand the options available to hospital and healthcare system administrators as they develop necessary protocols for the conservation and possible reuse of PPE. This review is based upon the peer-reviewed studies of various scientific investigators, biotechnology researchers, governmental agency health officials, including meta-analyses, preliminary/pilot studies, and policy statements. Current findings indicate that extended usage of N95 respirators is practical since there are methods available for the decontamination/repeated use of N95 respirators. In evaluating the efficacy of such methods, the safety of healthcare workers is important in deciding which method to recommend. Available evidence supports the use of the Bioquell Hydrogen Peroxide Vapor (HPV) system for decontaminating N95 respirators. Information on other PPE will also be discussed about more specific items. Informed decisions regarding the policies of hospitals and healthcare systems must be considered, and with the safety of healthcare workers in mind, both factors influenced the recommendations made in this comprehensive review.

scholarly journals Flunarizine as prophylaxis for episodic migraine: a systematic review with meta-analysis

Ból ◽  
2019 ◽  
Vol 20 (1) ◽  
pp. 25-38
Author(s):  
Anker Stubberud ◽  
Nikolai Melseth Flaaen ◽  
Douglas C. McCrory ◽  
Sindre Andre Pedersen ◽  
Mattias Linde
Keyword(s):  
Confidence Interval ◽  
Meta Analysis ◽  
Episodic Migraine ◽  
Pooled Analysis ◽  
Risk Of Bias ◽  
Current Guideline ◽  
Data Synthesis ◽  
Randomized Controlled ◽  
The Mean ◽  
Meta Analyses

Based on few clinical trials, flunarizine is considered a first-line prophylactic treatment for migraine in several guidelines. In this meta-analysis, we examined the pooled evidence for its effectiveness, tolerability, and safety. Prospective randomized controlled trials of flunarizine as a prophylaxis against migraine were identified from a systematic literature search, and risk of bias was assessed for all included studies. Reduction in mean attack frequency was estimated by calculating the mean difference (MD), and a series of secondary outcomes –including adverse events (AEs) – were also analyzed. The database search yielded 879 unique records. Twentyfive studies were included in data synthesis. We scored 31/175 risk of bias items as “high”, with attrition as the most frequent bias. A pooled analysis estimated that flunarizine reduces the headache frequency by 0.4 attacks per 4 weeks compared with placebo (5 trials, 249 participants: MD 20.44; 95% confidence interval 20.61 to 2 0.26). Analysis also revealed that the effectiveness of flunarizine prophylaxis is comparable with that of propranolol (7 trials, 1151 participants, MD 20.08; 95% confidence interval 20.34 to 0.18). Flunarizine also seems to be effective in children. The most frequent AEs were sedation and weight increase. Meta-analyses were robust and homogenous, although several of the included trials potentially suffered from high risk of bias. Unfortunately, reporting of AEs was inconsistent and limited. In conclusion, pooled analysis of data from partially outdated trials shows that 10- mg flunarizine per day is effective and well tolerated in treating episodic migraine – supporting current guideline recommendations.

Meta-Analyses of Predictors of Health Practices in Pregnant Women

2016 ◽  
Vol 40 (3) ◽  
pp. 425-446 ◽  
Author(s):  
Barbara L. Cannella ◽  
Adela Yarcheski ◽  
Noreen E. Mahon
Keyword(s):  
Pregnant Women ◽  
Meta Analysis ◽  
Health Practices ◽  
Inclusion Criteria ◽  
Maternal Fetal Attachment ◽  
Support Employment ◽  
The Mean ◽  
Fetal Attachment ◽  
Meta Analyses ◽  
Doctoral Dissertations

The aims of this study were to identify predictors of health practices of pregnant women in the literature reviewed, to use meta-analysis to ascertain the mean effect size (ES) across studies between each predictor and health practices, and to examine four moderators on each predictor–health practices relationship. Using preferred reporting items for systematic reviews and meta-analyses guidelines for the literature assessed, 32 published studies or doctoral dissertations completed between 1992 and 2015 met the inclusion criteria. Twelve predictors were identified, and each predictor in relation to health practices was subjected to meta-analysis. One predictor (maternal–fetal attachment) of health practices had a large ES, two predictors (depression and stress) had medium ESs, six predictors (income, education, parity, social support, employment, and age) had small ESs, and three predictors (gestational age, marital status, and race) had trivial ESs. Findings are interpreted relative to health practices in pregnant women.

Precautions and Recommendations for Dental Care During the COVID-19 Pandemic

2020 ◽  
Vol 8 (1) ◽  
pp. 37-43
Author(s):  
Téssia Melo ◽  
◽  
Poliana Costa ◽  
Rafaela Medeiros ◽  
Jorge Araújo-Filho ◽  
...  
Keyword(s):  
Public Health ◽  
Clinical Practice ◽  
Dental Care ◽  
Personal Protective Equipment ◽  
Health Professionals ◽  
Public Health Emergency ◽  
Protective Equipment ◽  
International Public Health ◽  
Dental Offices ◽  
Need For Information

The COVID-19 disease pandemic, caused by the new Coronavirus (SARS-COV-2) that originated in Wuhan, China, is an international public health emergency. This disease represents a major challenge for all health professionals, including dentists and their staff. This moment has significantly changed the attendance and routine of dental offices, so there is a great need for information and the development of protocols for the guidance of professionals. This paper aims to systematize the recommendations for dentists’ clinical practice on biosafety and the use of Personal Protective Equipment (PPE), seeking to optimize dental care during the COVID-19 pandemic.

Underutilization of Meta-analysis in Diagnostic Pathology

2015 ◽  
Vol 139 (10) ◽  
pp. 1302-1307 ◽  
Author(s):  
Michael Kinzler ◽  
Lanjing Zhang
Keyword(s):  
Meta Analysis ◽  
Citation Count ◽  
Research Articles ◽  
Published Data ◽  
Original Research ◽  
Diagnostic Pathology ◽  
Review Articles ◽  
The Mean ◽  
Meta Analyses

Context No studies to our knowledge have investigated citations and utilization of meta-analysis in diagnostic pathology (DP). Objective To characterize meta-analyses in DP compared with meta-analyses in medicine. Design We searched PubMed for meta-analyses in 12 major DP journals without specifying years and in 4 major medicine journals in both 2006 and 2011. We compared articles' adjusted citation ratios (ACRs), defined as an article's citation count divided by the mean citations for the meta-analysis, review, and original research articles published in the same journal in the same year. Results Forty-one of 76 DP articles, 74 of 125 medicine articles in 2011, and 52 of 83 medicine articles in 2006 were qualified meta-analyses as identified by PubMed. The ACRs of DP meta-analysis articles were higher than those of original research articles (2.62 ± 2.31 versus 0.92 ± 0.84, P < .001) and similar to those of review articles in 2006 (2.62 ± 2.31 versus 1.95 ± 1.59, P = .50), but they were similar to both in 2011 (1.85 ± 1.39 versus 0.99 ± 1.43, P = .11; 1.85 ± 1.39 versus 1.12 ± 1.43, P = .21, respectively). Diagnostic pathology and medicine meta-analyses had similar ACRs (1.85 ± 1.39 versus 1.57 ± 1.35 in 2011, P = .60; and 2.62 ± 2.31 versus 1.85 ± 1.90 in 2006, P = .50, respectively). However, although DP journals published fewer meta-analyses (0.97% versus 6.66% in 2011 and 0.67% versus 4.40% in 2006, P < .001 for both), they published more meta-analyses using both original and published data than medicine (21.95% versus 1.59%, P < .001). They also published more meta-analyses per year in 2011–2014 than in 2000–2010 (6.4 ± 1.29 versus 1.36 ± 1.03 articles per year, P < .001). Conclusions We found underutilization of meta-analyses in DP, despite their high ACRs and recently increased utilization. More DP meta-analyses are needed.

scholarly journals The Cupola: An Additional Layer of Protection for Providers Working in the Oropharyngeal Region

2021 ◽  
Author(s):  
Alessandro Villa ◽  
Marlene Grenon
Keyword(s):  
Pilot Study ◽  
Personal Protective Equipment ◽  
Airborne Particles ◽  
Protective Equipment ◽  
Additional Layer ◽  
Dental Procedures ◽  
The Mean ◽  
Mechanical Barrier

Abstract ObjectivesTo reduce the spread of the infection, especially during aerosol generating procedures, we invented “The Cupola”, a shield that creates a mechanical barrier around the patient’s head and body. With this pilot study we aimed to assess the effectiveness of an additional layer of protection (The Cupola) developed for providers working in the oropharyngeal region.ResultsThe mean number of 0.3 μm particles with no Cupola was 3777 (SD: ±556), with The Cupola was 2068 (SD: ±1468) and with the Cupola and Drape was 2031 (SD: ±1108) (p<0.015). The mean number of 0.5 μm airborne particles with no Cupola was 65 (SD: ±7), with The Cupola was 29 (SD: ±28) and with the Cupola and Drape was 28 (SD: ±23) (p<0.05). Results showed a significant reduction of aerosols generated during simulated dental procedures when the Cupola was used. The Cupola offers an extra layer of protection in addition to the recommended personal protective equipment.

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