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Cizmic A, Eichel VM, Weidner NM, Wise PA, Müller F, Rompen IF, Bartenschlager R, Schnitzler P, Nickel F, Müller-Stich BP. Viral load of SARS-CoV-2 in surgical smoke in minimally invasive and open surgery: a single-center prospective clinical trial. Sci Rep 2023; 13:20299. [PMID: 37985848 PMCID: PMC10662446 DOI: 10.1038/s41598-023-47058-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
At the beginning of the COVID-19 pandemic, it was assumed that SARS-CoV-2 could be transmitted through surgical smoke generated by electrocauterization. Minimally invasive surgery (MIS) was targeted due to potentially higher concentrations of the SARS-CoV-2 particles in the pneumoperitoneum. Some surgical societies even recommended open surgery instead of MIS to prevent the potential spread of SARS-CoV-2 from the pneumoperitoneum. This study aimed to detect SARS-CoV-2 in surgical smoke during open and MIS. Patients with SARS-CoV-2 infection who underwent open surgery or MIS at Heidelberg University Hospital were included in the study. A control group of patients without SARS-CoV-2 infection undergoing MIS or open surgery was included for comparison. The trial was approved by the Ethics Committee of Heidelberg University Medical School (S-098/2021). The following samples were collected: nasopharyngeal and intraabdominal swabs, blood, urine, surgical smoke, and air samples from the operating room. An SKC BioSampler was used to sample the surgical smoke from the pneumoperitoneum during MIS and the approximate surgical field during open surgery in 15 ml of sterilized phosphate-buffered saline. An RT-PCR test was performed on all collected samples to detect SARS-CoV-2 viral particles. Twelve patients with proven SARS-CoV-2 infection underwent open abdominal surgery. Two SARS-CoV-2-positive patients underwent an MIS procedure. The control group included 24 patients: 12 underwent open surgery and 12 MIS. One intraabdominal swab in a patient with SARS-CoV-2 infection was positive for SARS-CoV-2. However, during both open surgery and MIS, none of the surgical smoke samples showed any detectable viral particles of SARS-CoV-2. The air samples collected at the end of the surgical procedure showed no viral particles of SARS-CoV-2. Major complications (CD ≥ IIIa) were more often observed in SARS-CoV-2 positive patients (10 vs. 4, p = 0.001). This study showed no detectable viral particles of SARS-CoV-2 in surgical smoke sampled during MIS and open surgery. Thus, the discussed risk of transmission of SARS-CoV-2 via surgical smoke could not be confirmed in the present study.
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Affiliation(s)
- Amila Cizmic
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vanessa M Eichel
- Department of Infectious Diseases, Section Infection Control University Hospital Heidelberg, Heidelberg, Germany
| | - Niklas M Weidner
- Department of Infectious Diseases, Virology, Heidelberg University, Heidelberg, Germany
- Department of Infectious Diseases, Medical Microbiology and Hygiene, University Hospital Heidelberg, Heidelberg, Germany
| | - Philipp A Wise
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Müller
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ingmar F Rompen
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul Schnitzler
- Department of Infectious Diseases, Virology, Heidelberg University, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Beat P Müller-Stich
- Department of Digestive Surgery, University Digestive Healthcare Center Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland.
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Wu CC, Chen WL, Tseng CW, Su YC, Chen HL, Lin CL, Hung TY. Continuous aerosol monitoring and comparison of aerosol exposure based on smoke dispersion distance and concentrations during oxygenation therapy. Sci Rep 2023; 13:15910. [PMID: 37741874 PMCID: PMC10517922 DOI: 10.1038/s41598-023-42909-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023] Open
Abstract
This study evaluated the aerosol exposure risks while using common noninvasive oxygenation devices. A simulated mannequin was designed to breathe at a minute ventilation of 20 L/min and used the following oxygen-therapy devices: nasal cannula oxygenation (NCO) at 4 and 15 L/min, nonrebreathing mask (NRM) at 15 L/min, simple mask at 6 L/min, combination of NCO at 15 L/min and NRM at 15 L/min, high-flow nasal cannula (HFNC) at 50 L/min, and flush rate NRM. Two-dimension of the dispersion distance and the aerosol concentrations were measured at head, trunk, and foot around the mannequin for over 10 min. HFNC and flush-rate NRM yielded the longest dispersion distance and highest aerosol concentrations over the three sites of the mannequin than the other oxygenation devices and should use with caution. For flow rates of < 15 L/min, oxygenation devices with mask-like effects, such as NRM or NCO with NRM, decreased aerosol dispersion more effectively than NCO alone or a simple mask. In the upright position, the foot area exhibited the highest aerosol concentration regardless of the oxygenation device than the head-trunk areas of the mannequin. Healthcare workers should be alert even at the foot side of the patient while administering oxygenation therapy.
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Affiliation(s)
- Chih-Chieh Wu
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan
| | - Wei-Lun Chen
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan
| | - Cheng-Wei Tseng
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan
| | - Yung-Cheng Su
- School of Medicine, Tzu Chi University, Hualien County, Hualien, Taiwan
- Department of Emergency, Ditmanson Medical Foundation, Chiayi Christian Hospital, Chiayi County, Chiayi, Taiwan
| | - Hsin-Ling Chen
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan
| | - Chun-Lung Lin
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan
| | - Tzu-Yao Hung
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan.
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
- CrazyatLAB (Critical Airway Training Laboratory), Taipei, Taiwan.
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Hung TY, Wen CS, Yu SH, Chen YC, Chen HL, Chen WL, Wu CC, Su YC, Lin CL, Hu SC, Lin T. A comparative analysis of aerosol exposure and prevention strategies in bystander, pre-hospital, and inpatient cardiopulmonary resuscitation using simulation manikins. Sci Rep 2023; 13:12552. [PMID: 37532861 PMCID: PMC10397338 DOI: 10.1038/s41598-023-39726-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/30/2023] [Indexed: 08/04/2023] Open
Abstract
To evaluate aerosol exposure risk and prevention strategies during bystander, pre-hospital, and inpatient cardiopulmonary resuscitation (CPR). This study compared hands-only CPR, CPR with a surgical or N95 mask, and CPR with a non-rebreather mask at 15 L/min. 30:2 compression-ventilation ratio CPR was tested with face-mask ventilation (FMV), FMV with a high efficiency particulate air (HEPA) filter; supraglottic airway (SGA), SGA with a surgical mask, SGA with a HEPA filter, or SGA with both. Continuous CPR was tested with an endotracheal tube (ET), ET with a surgical mask, a HEPA filter, or both. Aerosol concentration at the head, trunk, and feet of the mannequin were measured to evaluate exposure to CPR personnel. Hands-only CPR with a surgical or N95 face mask coverings and ET tube ventilation CPR with filters showed the lowest aerosol exposure among all study groups, including CPR with NRM oxygenation, FMV, and SGA ventilation. NRM had a mask effect and reduced aerosol exposure at the head, trunk, and feet of the mannequin. FMV with filters during 30:2 CPR reduced aerosol exposure at the head and trunk, but increased at the feet of the mannequin. A tightly-sealed SGA when used with a HEPA filter, reduced aerosol exposure by 21.00-63.14% compared with a loose-fitting one. Hands-only CPR with a proper fit surgical or N95 face mask coverings is as safe as ET tube ventilation CPR with filters, compared with CPR with NRM, FMV, and SGA. FMV or tight-sealed SGA ventilation with filters prolonged the duration to achieve estimated infective dose of SARS-CoV-2 2.4-2.5 times longer than hands-on CPR only. However, a loose-fitting SGA is not protective at all to chest compressor or health workers standing at the foot side of the victim, so should be used with caution even when using with HEPA filters.
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Affiliation(s)
- Tzu-Yao Hung
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- CrazyatLAB (Critical Airway Training Laboratory), Taipei City, Taiwan
| | - Chung-Shiung Wen
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei City, Taiwan
| | - Sheng-Han Yu
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei City, Taiwan
| | - Yi-Chang Chen
- Department of Energy and Refrigerating Air-Conditioning Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Hsin-Ling Chen
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei City, Taiwan
| | - Wei-Lun Chen
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei City, Taiwan
| | - Chih-Chieh Wu
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei City, Taiwan
| | - Yung-Cheng Su
- School of Medicine, Tzu Chi University, Hualien County, Taiwan.
- Department of Emergency Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, No.539, Zhongxiao Rd., East Dist., Chiayi City, 600566, Taiwan.
| | - Chun-Lung Lin
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei City, Taiwan
| | - Shih-Cheng Hu
- Department of Energy and Refrigerating Air-Conditioning Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Tee Lin
- Department of Energy and Refrigerating Air-Conditioning Engineering, National Taipei University of Technology, Taipei, Taiwan
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Telehealth Management of Dysphagia in Adults: A Survey of Speech Language Pathologists' Experiences and Perceptions. Dysphagia 2022:10.1007/s00455-022-10544-z. [PMID: 36515730 PMCID: PMC9749630 DOI: 10.1007/s00455-022-10544-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022]
Abstract
The goal of this study was to explore telehealth use for dysphagia management in response to COVID-19 to understand variables associated with clinician confidence and perceived effectiveness of this service delivery model and determine clinician-perceived benefits and challenges of managing dysphagia via telehealth. Speech-language pathologists (SLPs, n = 235) completed a web-based survey, providing information on demographics, telehealth use during the pandemic, and perspectives on current and future tele-management of dysphagia. Analyses included descriptive statistics to examine usage patterns; logistic regression to determine which variables were associated with telehealth use, clinician confidence, and perceived-effectiveness; and conventional content analysis to analyze responses to open-ended questions. Results revealed a sharp increase in the tele-management of dysphagia during the pandemic. Years of experience with dysphagia management (p = .031) and pre-pandemic use of telehealth (p < .001) were significantly associated with current use patterns. Working in the outpatient setting was associated with greater clinician confidence (p = .003) and perceived effectiveness (p = .007), and use of guidelines (p = .042) was also associated with greater clinician confidence. Key challenges identified included inadequate technological infrastructure, inadequate patient digital literacy, and reimbursement restrictions. Key benefits were treatment continuity, improving access to care, and time savings. The majority (67%) of respondents reported that they would use telehealth in the future. These findings demonstrate SLPs' abilities and desire to expand their practice patterns to include telehealth for dysphagia management. Therefore, clinician training and more research on best practices for assessment and treatment of dysphagia via telehealth is warranted to refine models of care for dysphagia tele-management.
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Saccente-Kennedy B, Archer J, Symons HE, Watson NA, Orton CM, Browne WJ, Harrison J, Calder JD, Shah PL, Costello D, Reid JP, Bzdek BR, Epstein R. Quantification of Respirable Aerosol Particles from Speech and Language Therapy Exercises. J Voice 2022:S0892-1997(22)00207-7. [PMID: 36031505 DOI: 10.1016/j.jvoice.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Voice assessment and treatment involve the manipulation of all the subsystems of voice production, and may lead to production of respirable aerosol particles that pose a greater risk of potential viral transmission via inhalation of respirable pathogens (eg, SARS-CoV-2) than quiet breathing or conversational speech. OBJECTIVE To characterise the production of respirable aerosol particles during a selection of voice assessment therapy tasks. METHODS We recruited 23 healthy adult participants (12 males, 11 females), 11 of whom were speech-language pathologists specialising in voice disorders. We used an aerodynamic and an optical particle sizer to measure the number concentration and particle size distributions of respirable aerosols generated during a variety of voice assessment and therapy tasks. The measurements were carried out in a laminar flow operating theatre, with a near-zero background aerosol concentration, allowing us to quantify the number concentration and size distributions of respirable aerosol particles produced from assessment/therapy tasks studied. RESULTS Aerosol number concentrations generated while performing assessment/therapy tasks were log-normally distributed among individuals with no significant differences between professionals (speech-language pathologists) and non-professionals or between males and females. Activities produced up to 32 times the aerosol number concentration of breathing and 24 times that of speech at 70-80 dBA. In terms of aerosol mass, activities produced up to 163 times the mass concentration of breathing and up to 36 times the mass concentration of speech. Voicing was a significant factor in aerosol production; aerosol number/mass concentrations generated during the voiced activities were 1.1-5 times higher than their unvoiced counterpart activities. Additionally, voiced activities produced bigger respirable aerosol particles than their unvoiced variants except the trills. Humming generated higher aerosol concentrations than sustained /a/, fricatives, speaking (70-80 dBA), and breathing. Oscillatory semi-occluded vocal tract exercises (SOVTEs) generated higher aerosol number/mass concentrations than the activities without oscillation. Water resistance therapy (WRT) generated the most aerosol of all activities, ∼10 times higher than speaking at 70-80 dBA and >30 times higher than breathing. CONCLUSIONS All activities generated more aerosol than breathing, although a sizeable minority were no different to speaking. Larger number concentrations and larger particle sizes appear to be generated by activities with higher suspected airflows, with the greatest involving intraoral pressure oscillation and/or an oscillating oral articulation (WRT or trilling).
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Affiliation(s)
- Brian Saccente-Kennedy
- Department of Speech and Language Therapy (ENT), Royal National Ear, Nose and Throat and Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Justice Archer
- School of Chemistry, University of Bristol, Bristol, United Kingdom
| | - Henry E Symons
- School of Chemistry, University of Bristol, Bristol, United Kingdom
| | - Natalie A Watson
- Department of Ear, Nose and Throat Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Christopher M Orton
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom; Department of Respiratory Medicine, Chelsea & Westminster Hospital, London, United Kingdom; National Heart and Lung Institute, Guy Scadding Building, Imperial College London, London, United Kingdom
| | - William J Browne
- School of Education, University of Bristol, Bristol, United Kingdom
| | - Joshua Harrison
- School of Chemistry, University of Bristol, Bristol, United Kingdom
| | - James D Calder
- Department of Bioengineering, Imperial College London, United Kingdom; Fortius Clinic, London, United Kingdom
| | - Pallav L Shah
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom; Department of Respiratory Medicine, Chelsea & Westminster Hospital, London, United Kingdom; National Heart and Lung Institute, Guy Scadding Building, Imperial College London, London, United Kingdom
| | - Declan Costello
- Ear, Nose and Throat Department, Wexham Park Hospital, Slough, United Kingdom
| | - Jonathan P Reid
- School of Chemistry, University of Bristol, Bristol, United Kingdom
| | - Bryan R Bzdek
- School of Chemistry, University of Bristol, Bristol, United Kingdom.
| | - Ruth Epstein
- Department of Speech and Language Therapy (ENT), Royal National Ear, Nose and Throat and Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
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Hunt N, Masiewicz S, Herbert L, Bassin B, Brent C, Haas NL, Tiba MH, Lillemoen J, Lowell MJ, Lott I, Basinger M, Smith G, Ward KR. Novel Negative Pressure Procedural Tent Reduces Aerosolized Particles in a Simulated Prehospital Setting. Prehosp Disaster Med 2022; 37:383-389. [PMID: 35379372 PMCID: PMC9118043 DOI: 10.1017/s1049023x22000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/28/2021] [Accepted: 01/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has challenged the ability of Emergency Medical Services (EMS) providers to maintain personal safety during the treatment and transport of patients potentially infected. Increased rates of COVID-19 infection in EMS providers after patient care exposure, and notably after performing aerosol-generating procedures (AGPs), have been reported. With an already strained workforce seeing rising call volumes and increased risk for AGP-requiring patient presentations, development of novel devices for the protection of EMS providers is of great importance.Based on the concept of a negative pressure room, the AerosolVE BioDome is designed to encapsulate the patient and contain aerosolized infectious particles produced during AGPs, making the cabin of an EMS vehicle safer for providers. The objective of this study was to determine the efficacy and safety of the tent in mitigating simulated infectious particle spread in varied EMS transport platforms during AGP utilization. METHODS Fifteen healthy volunteers were enrolled and distributed amongst three EMS vehicles: a ground ambulance, an aeromedical-configured helicopter, and an aeromedical-configured jet. Sodium chloride particles were used to simulate infectious particles and particle counts were obtained in numerous locations close to the tent and around the patient compartment. Counts near the tent were compared to ambient air with and without use of AGPs (non-rebreather mask, continuous positive airway pressure [CPAP] mask, and high-flow nasal cannula [HFNC]). RESULTS For all transport platforms, with the tent fan off, the particle generator alone, and with all AGPs produced particle counts inside the tent significantly higher than ambient particle counts (P <.0001). With the tent fan powered on, particle counts near the tent, where EMS providers are expected to be located, showed no significant elevation compared to baseline ambient particle counts during the use of the particle generator alone or with use of any of the AGPs across all transport platforms. CONCLUSION Development of devices to improve safety for EMS providers to allow for use of all available therapies to treat patients while reducing risk of communicable respiratory disease transmission is of paramount importance. The AerosolVE BioDome demonstrated efficacy in creating a negative pressure environment and workspace around the patient and provided significant filtration of simulated respiratory droplets, thus making the confined space of transport vehicles potentially safer for EMS personnel.
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Affiliation(s)
- Nathaniel Hunt
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MichiganUSA
- Michigan Center for Integrative Research in Critical Care, Ann Arbor, MichiganUSA
| | - Spencer Masiewicz
- Department of Emergency Medicine, Northeast Georgia Medical Center, Gainesville, Georgia USA
| | - Logan Herbert
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MichiganUSA
| | - Benjamin Bassin
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MichiganUSA
- Michigan Center for Integrative Research in Critical Care, Ann Arbor, MichiganUSA
- Division of Critical Care, Department of Emergency Medicine, University of Michigan, Ann Arbor, MichiganUSA
| | - Christine Brent
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MichiganUSA
- Michigan Center for Integrative Research in Critical Care, Ann Arbor, MichiganUSA
- Division of Critical Care, Department of Emergency Medicine, University of Michigan, Ann Arbor, MichiganUSA
| | - Nathan L. Haas
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MichiganUSA
- Michigan Center for Integrative Research in Critical Care, Ann Arbor, MichiganUSA
- Division of Critical Care, Department of Emergency Medicine, University of Michigan, Ann Arbor, MichiganUSA
| | - Mohamad Hakam Tiba
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MichiganUSA
- Michigan Center for Integrative Research in Critical Care, Ann Arbor, MichiganUSA
| | - Jon Lillemoen
- University of Michigan Environment, Health and Safety, Ann Arbor, MichiganUSA
| | - Mark J. Lowell
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MichiganUSA
- Michigan Center for Integrative Research in Critical Care, Ann Arbor, MichiganUSA
| | - Isabel Lott
- University of Michigan Medical School, Ann Arbor, MichiganUSA
| | - Matthew Basinger
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MichiganUSA
| | - Graham Smith
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MichiganUSA
- Michigan Center for Integrative Research in Critical Care, Ann Arbor, MichiganUSA
| | - Kevin R. Ward
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MichiganUSA
- Michigan Center for Integrative Research in Critical Care, Ann Arbor, MichiganUSA
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The Aerosol-Generating Effect Among Noninvasive Positive Pressure Ventilation, High-Flow Nasal Cannula, Nonrebreather Mask, Nasal Cannula, and Ventilator-Assisted Preoxygenation. Ann Emerg Med 2022; 80:22-34. [DOI: 10.1016/j.annemergmed.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 11/23/2022]
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Rasheed Z, Alhomaidan H, Shariq A, Alkhowailed M, Alqossayir F, Rasheed N, Alkhamiss A, Alghsham R, Hershan A, Alharbi S, Alsagaby S, Alduraibi S, Alharbi SH, Al Abdulmonem W. An Updated Analysis on the Risk Factors Associated with COVID-19 Transmission. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The coronavirus disease 2019 (COVID-19) is a global public health disaster and knowledge of its associated risk factors provides protection/slowdown against its transmission.
AIM: This study was undertaken to investigate all major risk factors associated with transmission of the COVID-19 infection.
METHODS: The data on the risk associated factors for the COVID-19 transmission were collected from the Texas Medical Association, Center for Disease Prevention and Control, World Health Organization, and Health and Safety Executive. The collected data were combined, analyzed, and presented as percentage mean ± SD.
RESULTS: The collective data showed that among games such as playing football and basketball are highly risky followed by swimming in public pool and playing at the beach. Whereas, playing golf and tennis are not risky (p < 0.05). Moreover, the carryout food from the restaurants is much safer as compared with eating at buffet, in restaurants (p < 0.01). The data on social gathering showed that religious places, sports stadium, music concert, cinema halls, amusement parks, attending funerals, and wedding showed a higher risk of spreading COVID-19. The data on general outing showed that going to gymnasium, traveling by bus or plane, and visiting in salon are highly risky (p < 0.01) for COVID-19 infection. Moreover, hugging, shaking hands, and kissing are also highly risky for the COVID-19 infection.
CONCLUSIONS: This study provides the collective information on the risk factors associated with the COVID-19 transmission. The findings can contribute to the concerned authorities to formulate the preventive measures to limit spread of the COVID-19 infection.
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Novel Negative Pressure Helmet Reduces Aerosolized Particles in a Simulated Prehospital Setting. Prehosp Disaster Med 2022; 37:33-38. [DOI: 10.1017/s1049023x22000103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract
Background/Objective:
The coronavirus disease 2019 (COVID-19) pandemic has created challenges in maintaining the safety of prehospital providers caring for patients. Reports have shown increased rates of Emergency Medical Services (EMS) provider infection with COVID-19 after patient care exposure, especially while utilizing aerosol-generating procedures (AGPs). Given the increased risk and rising call volumes for AGP-necessitating complaints, development of novel devices for the protection of EMS clinicians is of great importance.
Drawn from the concept of the powered air purifying respirator (PAPR), the AerosolVE helmet creates a personal negative pressure space to contain aerosolized infectious particles produced by patients, making the cabin of an EMS vehicle safer for providers. The helmet was developed initially for use in hospitals and could be of significant use in the prehospital setting. The objective of this study was to determine the efficacy and safety of the helmet in mitigating simulated infectious particle spread in varied EMS transport platforms during AGP utilization.
Methods:
Fifteen healthy volunteers were enrolled and distributed amongst three EMS vehicles: a ground ambulance, a medical helicopter, and a medical jet. Sodium chloride particles were used to simulate infectious particles, and particle counts were obtained in numerous locations close to the helmet and around the patient compartment. Counts near the helmet were compared to ambient air with and without use of AGPs (non-rebreather mask [NRB], continuous positive airway pressure mask [CPAP], and high-flow nasal cannula [HFNC]).
Results:
Without the helmet fan on, the particle generator alone and with all AGPs produced particle counts inside the helmet significantly higher than ambient particle counts. With the fan on, there was no significant difference in particle counts around the helmet compared to baseline ambient particle counts. Particle counts at the filter exit averaged less than one despite markedly higher particle counts inside the helmet.
Conclusion:
Given the risk to EMS providers by communicable respiratory diseases, development of devices to improve safety while still enabling use of respiratory therapies is of paramount importance. The AerosolVE helmet demonstrated efficacy in creating a negative pressure environment and provided significant filtration of simulated respiratory droplets, thus making the confined space of transport vehicles potentially safer for EMS personnel.
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Ong T, Van Citters AD, Dowd C, Fullmer J, List R, Pai SA, Ren CL, Scalia P, Solomon GM, Sawicki GS. Remote monitoring in telehealth care delivery across the U.S. cystic fibrosis care network. J Cyst Fibros 2021; 20 Suppl 3:57-63. [PMID: 34930544 DOI: 10.1016/j.jcf.2021.08.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) programs and people with CF (PwCF) employed various monitoring methods for virtual care during the COVID-19 pandemic. This paper characterizes experiences with remote monitoring across the U.S. CF community. METHODS The CF Foundation (CFF) sponsored distribution of home spirometers (April 2020 to May 2021), surveys to PwCF and CF programs (July to September 2020), and a second program survey (April to May 2021). We used mixed methods to explore access, use, and perspectives regarding the use of remote monitoring in future care. RESULTS By October 2020, 13,345 spirometers had been distributed, and 19,271 spirometers by May 2021. Programs (n=286) estimated proportions of PwCF with home devices increased over seven months: spirometers (30% to 70%), scales (50% to 70%), oximeters (5% to 10%) with higher estimates in adult programs for spirometers and oximeters. PwCF (n=378) had access to scales (89%), followed by oximeters (48%) and spirometers (47%), often using scales and oximeters weekly, and spirometers monthly. Over both surveys, some programs had no method to collect respiratory specimens for cultures associated with telehealth visits (47%, n=132; 41%, n=118). Most programs (81%) had a process for phlebotomy associated with a telehealth visit, primarily through off-site labs. Both PwCF and programs felt future care should advance remote monitoring and recommended improvements for access, training, and data collection systems. CONCLUSIONS PwCF and programs experienced unprecedented access to remote monitoring and raised its importance for future care. Improvements to current systems may leverage these shared experiences to augment future care models.
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Affiliation(s)
- Thida Ong
- Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, Seattle, WA, United States.
| | - Aricca D Van Citters
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | | | - Jason Fullmer
- DCMG Pediatric Pulmonology & Sleep Medicine, Dell Children's Medical Group, Austin, TX, United States
| | - Rhonda List
- Division of Pulmonary and Critical Care, University of Virginia, Charlottesville, VA, United States
| | - Shine-Ann Pai
- Marnie Paul Specialty Care Center, Dell Children's Medical Center of Central Texas, Austin, TX, United States
| | - Clement L Ren
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Peter Scalia
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - George M Solomon
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gregory S Sawicki
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, United States
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11
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Barani S, Jahan N, Karuppiah M, Chaudhuri S, Raju M, Ponnaiah M, Rajaraman S, Vaidhyalingam V, Ganeshkumar P, Kumar Cp G, Muthappan S, Murugesan J, Srinivasan M, Krishnan U, John Varghese A. Epidemiology of hospital-based COVID- 19 cluster in a tertiary care cancer hospital, Chennai, India 2020. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 12:100889. [PMID: 34754984 PMCID: PMC8566092 DOI: 10.1016/j.cegh.2021.100889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/05/2021] [Accepted: 10/26/2021] [Indexed: 10/29/2022] Open
Abstract
Objectives To identify risk factors associated with Coronavirus disease 2019 (COVID-19) in a Tertiary care cancer hospital-based cluster and recommend control measures. Methods We conducted tracing and confirmation among hospital and community contacts. We telephonically interviewed and abstracted information from hospital records and registers. We described the cluster by time, place and person. We conducted unmatched case-control study to compare risk factors and computed Odds Ratio (OR) and 95% confidence interval. Results We confirmed COVID-19 in 21 of 1478 tested (1.4%). Secondary attack (%) of COVID-19 among 824 contacts was higher among in-patients of block A (18), household contacts (3.4), housekeeping staff (3.3) and nurses (1.7). The cluster started on April 22 with two successive peaks five days apart and lasted until May 8. Being male, patients aged >33 years [OR = 30·7; 95% CI = 3·6 to 264], having hypertension [OR = 4·3; 95% CI = 1·1 to 16·7] or diabetes [OR = 3·8; 95% CI = 1·0 to 14·1] were associated with COVID-19. Mask compliance was poor (20%) among hospital workers. Discussion We recommended screening of all patients for diabetes and hypertension and isolation/testing of anyone with influenza-like illness for preventing COVID-19 clusters in hospital settings.
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Affiliation(s)
- Suganya Barani
- Hospital Cluster Investigation Team: ICMR-National Institute of Epidemiology, Chennai, India
| | - Nuzrath Jahan
- Hospital Cluster Investigation Team: ICMR-National Institute of Epidemiology, Chennai, India
| | - Mathan Karuppiah
- Hospital Cluster Investigation Team: ICMR-National Institute of Epidemiology, Chennai, India
| | - Sirshendu Chaudhuri
- Hospital Cluster Investigation Team: ICMR-National Institute of Epidemiology, Chennai, India
| | - Mohankumar Raju
- Hospital Cluster Investigation Team: ICMR-National Institute of Epidemiology, Chennai, India
| | - Manickam Ponnaiah
- Hospital Cluster Investigation Team: ICMR-National Institute of Epidemiology, Chennai, India
| | | | | | - Parasuraman Ganeshkumar
- Hospital Cluster Investigation Team: ICMR-National Institute of Epidemiology, Chennai, India
| | - Girish Kumar Cp
- Hospital Cluster Investigation Team: ICMR-National Institute of Epidemiology, Chennai, India
| | - Sendhilkumar Muthappan
- Hospital Cluster Investigation Team: ICMR-National Institute of Epidemiology, Chennai, India
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12
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Abstract
Health care-acquired viral respiratory infections are common and cause increased patient morbidity and mortality. Although the threat of viral respiratory infection has been underscored by the coronavirus disease 2019 (COVID-19) pandemic, respiratory viruses have a significant impact in health care settings even under normal circumstances. Studies report decreased nosocomial transmission when aggressive infection control measures are implemented, with more success noted when using a multicomponent approach. Influenza vaccination of health care personnel furthers decrease rates of transmission; thus, mandatory vaccination is becoming more common. This article discusses the epidemiology, transmission, and control of health care-associated respiratory viral infections.
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Affiliation(s)
- Joshua G Petrie
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Thomas R Talbot
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, 1161 21st Avenue South, A-2200 MCN, Nashville, TN 37232, USA.
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13
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Baclig MO. Biosafety in the Time of Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic: The Philippine Experience. APPLIED BIOSAFETY 2021; 26:S10-S15. [DOI: 10.1089/apb.20.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Michael O. Baclig
- Research and Biotechnology Group, Center for Basic Science Research, St. Luke's Medical Center, Quezon City, Philippines
- St. Luke's Medical Center College of Medicine-WHQM, Quezon City, Philippines
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14
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Is It Possible to Have Home E-Monitoring of Pulmonary Function in Our Patients with Duchenne Muscular Dystrophy in the COVID-19 Pandemic?-A One Center Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178967. [PMID: 34501557 PMCID: PMC8430665 DOI: 10.3390/ijerph18178967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
Background: Duchenne muscular dystrophy (DMD) is the most common, progressive, irreversible muscular dystrophy. Pulmonary function is crucial for duration of life in this disease. Currently, the European Respiratory Society is focused on digital health, seeking innovations that will be realistic for digital respiratory medicine to support professionals and patients during the COVID-19 pandemic. Aims: The aim of this study was to investigate whether it is possible to monitor pulmonary function at home using an individual electronic spirometry system in boys with Duchenne muscular dystrophy. Materials and methods: In this observational, prospective study, conducted from March 2021 to June 2021, twenty boys with DMD (aged 8–16) were enrolled. The patients were recruited from the Rare Disease Centre, University Clinical Centre, of Gdańsk, Poland. Medical history and anthropometric data were collected, and spirometry (Jaeger, Germany) was performed in all patients at the start of the study. Each patient received an electronic individual spirometer (AioCare) and was asked to perform spirometry on their own every day, morning and evening, at home for a period of 4 weeks. The number of measurements, correctness of performing measurements, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow (PEF) were evaluated. Results: Finally, 14 out of 20 boys enrolled in the study with a mean age of 12.5 years (7 non-ambulatory) applied and received a home spirometer (AioCare). A total of 283 measurements were performed by all patients at home for 4 weeks. Half of the patients were able to perform measurements correctly. There were no significant differences between mean values of FVC, FE1, PEF between home and hospital spirometry (p > 0.05) expect PEF pv% (p < 0.00046). Patients with higher FEV1 (p = 0.0387) and lower BMI (p = 0.0494) were more likely to take home spirometer measurements. The mean general satisfaction rating of home-spirometry was 4.33/5 (SD 0.78), the mean intelligibility rating was 4.83/5 (SD 0.58). Reasons for irregular measurements were: forgetting (43%), lack of motivation (29%), difficulty (14%), lack of time (14%). Conclusion: Home electronic monitoring of pulmonary function in patients with DMD is possible to implement in daily routines at home. This protocol should be introduced as early as possible in patients 7–8 years old with good, preserved lung function. Patients accept this form of medical care but require more education about the benefits of e-monitoring. There is a need to implement a system to remind patients of the use of electronic medical devices at home, e.g., via SMS (short message service).
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15
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Drake S, Wang R, Healy L, Roberts SA, Murray CS, Simpson A, Fowler SJ. Diagnosing Asthma With and Without Aerosol-Generating Procedures. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:4243-4251.e7. [PMID: 34303020 DOI: 10.1016/j.jaip.2021.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Asthma diagnostic guidelines require procedures with aerosol-generating potential (aerosol-generating procedures [AGPs]) to guide decision making. Restricted access to AGPs poses significant challenges in primary care and resource-poor countries, further amplified during the coronavirus disease 2019 pandemic. OBJECTIVE To establish an approach to asthma diagnosis that does not require AGPs. METHOD Symptomatic yet untreated (beyond as-required bronchodilator use) adults with clinician-suspected asthma and maximum 10 pack year smoking history were recruited. Clinical history, physical examination, spirometry with bronchodilator reversibility, home peak flow monitoring, and bronchial challenges were performed, and fractional exhaled nitric oxide and serum eosinophils measured. Tests were then repeated following treatment with inhaled corticosteroids before an asthma diagnosis was confirmed or refuted by an expert panel. RESULTS A total of 65 adults (mean age, 34.8 ± 12.2 years) were recruited. Five were excluded as "unclassifiable," because of borderline results or missing data. Of the remainder, 36 were diagnosed with asthma and 24 were not. Using data from non-AGPs only (wheeze on auscultation and blood eosinophilia) and home peak flow variability, a "rule-in" diagnostic model provided comparable discriminative ability to the application of established guidelines. Clinical suspicion of asthma together with at least 1 positive non-AGP test result provided a sensitivity of 55%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 60%. Application of this model reduced the need for spirometry-based tests by one-third. CONCLUSIONS The proposed diagnostic algorithm may be clinically useful in "ruling-in" asthma in adults when access to AGPs is limited. This algorithm is not suitable for those with low clinical probability, with a significant smoking history, or where alternative diagnoses are more likely. This pragmatic approach to asthma diagnosis merits prospective validation.
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Affiliation(s)
- Sarah Drake
- Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Infection, Immunity & Respiratory Medicine, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Unit and Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Ran Wang
- Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Infection, Immunity & Respiratory Medicine, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Unit and Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Laura Healy
- Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Infection, Immunity & Respiratory Medicine, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Unit and Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Stephen A Roberts
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Clare S Murray
- Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Infection, Immunity & Respiratory Medicine, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Unit and Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Angela Simpson
- Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Infection, Immunity & Respiratory Medicine, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Unit and Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Stephen J Fowler
- Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Infection, Immunity & Respiratory Medicine, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Unit and Manchester University NHS Foundation Trust, Manchester, United Kingdom.
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Moschovis PP, Yonker LM, Shah J, Singh D, Demokritou P, Kinane TB. Aerosol transmission of SARS-CoV-2 by children and adults during the COVID-19 pandemic. Pediatr Pulmonol 2021; 56:1389-1394. [PMID: 33624927 PMCID: PMC8014227 DOI: 10.1002/ppul.25330] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/13/2021] [Accepted: 02/09/2021] [Indexed: 12/23/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be transmitted via respiratory droplets, aerosols, and to a lesser extent, fomites. Defining the factors driving infectivity and transmission is critical for infection control and containment of this pandemic. We outline the major methods of transmission of SARS-CoV-2, focusing on aerosol transmission. We review principles of aerosol science and discuss their implications for mitigating the spread of SARS-CoV-2 among children and adults.
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Affiliation(s)
- Peter P Moschovis
- Division of Pediatric Pulmonary Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lael M Yonker
- Division of Pediatric Pulmonary Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jhill Shah
- Division of Pediatric Pulmonary Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Dilpreet Singh
- Center for Nanotechnology and Nanotoxicology, Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Philip Demokritou
- Center for Nanotechnology and Nanotoxicology, Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - T Bernard Kinane
- Division of Pediatric Pulmonary Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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17
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Chacon AM, Nguyen DD, McCabe P, Madill C. Aerosol-generating behaviours in speech pathology clinical practice: A systematic literature review. PLoS One 2021; 16:e0250308. [PMID: 33909654 PMCID: PMC8081183 DOI: 10.1371/journal.pone.0250308] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/04/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the evidence of aerosol generation across tasks involved in voice and speech assessment and intervention, to inform better management and to reduce transmission risk of such diseases as COVID-19 in healthcare settings and the wider community. DESIGN Systematic literature review. DATA SOURCES AND ELIGIBILITY Medline, Embase, Scopus, Web of Science, CINAHL, PubMed Central and grey literature through ProQuest, The Centre for Evidence-Based Medicine, COVID-Evidence and speech pathology national bodies were searched up until August 13th, 2020 for articles examining the aerosol-generating activities in clinical voice and speech assessment and intervention within speech pathology. RESULTS Of the 8288 results found, 39 studies were included for data extraction and analysis. Included articles were classified into one of three categories: research studies, review articles or clinical guidelines. Data extraction followed appropriate protocols depending on the classification of each article (e.g. PRISMA for review articles). Articles were assessed for risk of bias and certainty of evidence using the GRADE system. Six behaviours were identified as aerosol generating. These were classified into three categories: vegetative acts (coughing, breathing), verbal communication activities of daily living (speaking, loud voicing), and performance-based tasks (singing, sustained phonation). Certainty of evidence ranged from very low to moderate with variation in research design and variables. CONCLUSIONS This body of literature helped to both identify and categorise the aerosol-generating behaviours involved in speech pathology clinical practice and confirm the low level of evidence throughout the speech pathology literature pertaining to aerosol generation. As many aerosol-generating behaviours are common human behaviours, these findings can be applied across healthcare and community settings. SYSTEMATIC REVIEW REGISTRATION Registration number CRD42020186902 with PROSPERO International Prospective Register for Systematic Reviews.
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Affiliation(s)
- Antonia Margarita Chacon
- Discipline of Speech Pathology, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
- Doctor Liang Voice Program, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Duy Duong Nguyen
- Discipline of Speech Pathology, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
- Doctor Liang Voice Program, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Patricia McCabe
- Discipline of Speech Pathology, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Catherine Madill
- Discipline of Speech Pathology, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
- Doctor Liang Voice Program, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
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18
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Hung TY, Chen WL, Su YC, Wu CC, Chueh TY, Chen HL, Hu SC, Lin T. Comparing the effectiveness of negative-pressure barrier devices in providing air clearance to prevent aerosol transmission. PLoS One 2021; 16:e0250213. [PMID: 33882091 PMCID: PMC8059829 DOI: 10.1371/journal.pone.0250213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/01/2021] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To investigate the effectiveness of aerosol clearance using an aerosol box, aerosol bag, wall suction, and a high-efficiency particulate air (HEPA) filter evacuator to prevent aerosol transmission. METHODS The flow field was visualized using three protective device settings (an aerosol box, and an aerosol bag with and without sealed working channels) and four suction settings (no suction, wall suction, and a HEPA filter evacuator at flow rates of 415 liters per minute [LPM] and 530 LPM). All 12 subgroups were compared with a no intervention group. The primary outcome, aerosol concentration, was measured at the head, trunk, and foot of a mannequin. RESULTS The mean aerosol concentration was reduced at the head (p < 0.001) but increased at the feet (p = 0.005) with an aerosol box compared with no intervention. Non-sealed aerosol bags increased exposure at the head and trunk (both, p < 0.001). Sealed aerosol bags reduced aerosol concentration at the head, trunk, and foot of the mannequin (p < 0.001). A sealed aerosol bag alone, with wall suction, or with a HEPA filter evacuator reduced the aerosol concentration at the head by 7.15%, 36.61%, and 84.70%, respectively (99.9% confidence interval [CI]: -4.51-18.81, 27.48-45.73, and 78.99-90.40); trunk by 70.95%, 73.99%, and 91.59%, respectively (99.9% CI: 59.83-82.07, 52.64-95.33, and 87.51-95.66); and feet by 69.16%, 75.57%, and 92.30%, respectively (99.9% CI: 63.18-75.15, 69.76-81.37, and 88.18-96.42), compared with an aerosol box alone. CONCLUSIONS As aerosols spread, an airtight container with sealed working channels is effective when combined with suction devices.
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Affiliation(s)
- Tzu-Yao Hung
- Department of Emergency Medicine, Zhong-Xing branch, Taipei City Hospital, Taipei City, Taiwan
- Faculty of Medicine, National Yang-Ming Chiao Tung University, Tainan City, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
- CrazyatLAB (Critical Airway Training Laboratory), Taipei City, Taiwan
| | - Wei-Lun Chen
- Department of Emergency Medicine, Zhong-Xing branch, Taipei City Hospital, Taipei City, Taiwan
| | - Yung-Cheng Su
- School of Medicine, Tzu Chi University, Hualien County, Taiwan
- Department of Emergency, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan
| | - Chih-Chieh Wu
- Department of Emergency Medicine, Zhong-Xing branch, Taipei City Hospital, Taipei City, Taiwan
| | - Tzu-Yao Chueh
- Department of Energy and Refrigerating Air-conditioning Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Hsin-Ling Chen
- Department of Emergency Medicine, Zhong-Xing branch, Taipei City Hospital, Taipei City, Taiwan
| | - Shih-Cheng Hu
- Department of Energy and Refrigerating Air-conditioning Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Tee Lin
- Department of Energy and Refrigerating Air-conditioning Engineering, National Taipei University of Technology, Taipei, Taiwan
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19
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Borders JC, Sevitz JS, Malandraki JB, Malandraki GA, Troche MS. Objective and Subjective Clinical Swallowing Outcomes via Telehealth: Reliability in Outpatient Clinical Practice. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:598-608. [PMID: 33555954 DOI: 10.1044/2020_ajslp-20-00234] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The COVID-19 pandemic has drastically increased the use of telehealth. Prior studies of telehealth clinical swallowing evaluations provide positive evidence for telemanagement of swallowing. However, the reliability of these measures in clinical practice, as opposed to well-controlled research conditions, remains unknown. This study aimed to investigate the reliability of outcome measures derived from clinical swallowing tele-evaluations in real-world clinical practice (e.g., variability in devices and Internet connectivity, lack of in-person clinician assistance, or remote patient/caregiver training). Method Seven raters asynchronously judged clinical swallowing tele-evaluations of 12 movement disorders patients. Outcomes included the Timed Water Swallow Test (TWST), Test of Masticating and Swallowing Solids (TOMASS), and common observations of oral intake. Statistical analyses were performed to examine inter- and intrarater reliability, as well as qualitative analyses exploring patient and clinician-specific factors impacting reliability. Results Forty-four trials were included for reliability analyses. All rater dyads demonstrated "good" to "excellent" interrater reliability for measures of the TWST (intraclass correlation coefficients [ICCs] ≥ .93) and observations of oral intake (≥ 77% agreement). The majority of TOMASS outcomes demonstrated "good" to "excellent" interrater reliability (ICCs ≥ .84), with the exception of the number of bites (ICCs = .43-.99) and swallows (ICCs = .21-.85). Immediate and delayed intrarater reliability were "excellent" for most raters across all tasks, ranging between ICCs of .63 and 1.00. Exploratory factors potentially impacting reliability included infrequent instances of suboptimal video quality, reduced camera stability, camera distance, and obstruction of the patient's mouth during tasks. Conclusions Subjective observations of oral intake and objective measures taken from the TWST and the TOMASS can be reliably measured via telehealth in clinical practice. Our results provide support for the feasibility and reliability of telehealth for outpatient clinical swallowing evaluations during COVID-19 and beyond. Supplemental Material https://doi.org/10.23641/asha.13661378.
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Affiliation(s)
- James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Jordanna S Sevitz
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Jaime Bauer Malandraki
- Purdue I-EaT Swallowing Research Lab, Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Georgia A Malandraki
- Purdue I-EaT Swallowing Research Lab, Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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20
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Pearson K, Mayer-Hamblett N, Goss CH, Retsch-Bogart GZ, VanDalfsen JM, Burks P, Rosenbluth D, Clancy JP, Hoffman A, Nichols DP. The impact of SARS-CoV-2 on the cystic fibrosis foundation therapeutics development network. J Cyst Fibros 2021; 20:195-197. [PMID: 33349583 PMCID: PMC7834129 DOI: 10.1016/j.jcf.2020.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 11/17/2022]
Abstract
The Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) global pandemic significantly impacted CF clinical research within the Cystic Fibrosis Foundation Therapeutics Development Network (CFF TDN). A Research Electronic Data Capture (REDCap) survey was developed and sent to network sites to monitor and understand the impact on research teams, ongoing and anticipated clinical research, and specific clinical and research procedures. Key findings indicated an early impact on participant enrollment, research team stability, and procedures such as spirometry and sputum induction. These trends steadily improved over the months as research activities began to recover across the TDN. While SARS-CoV-2 created a significant challenge it also highlights new opportunities to expand CF research with greater focus on data collection outside of research centers and increased access for remote participation.
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Affiliation(s)
- Kelsie Pearson
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Hospital, Seattle, WA, United States.
| | - Nicole Mayer-Hamblett
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Hospital, Seattle, WA, United States; Department of Pediatrics, University of Washington, Seattle, WA, United States; Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Christopher H Goss
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Hospital, Seattle, WA, United States; Department of Medicine, University of Washington, Seattle, WA, United States
| | - George Z Retsch-Bogart
- Division of Pediatric Pulmonology, University of North Carolina, Chapel Hill, NC, United States
| | - Jill M VanDalfsen
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Hospital, Seattle, WA, United States
| | | | - Daniel Rosenbluth
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, Missouri, United States
| | | | - Amy Hoffman
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Hospital, Seattle, WA, United States
| | - David P Nichols
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Hospital, Seattle, WA, United States; Department of Pediatrics, University of Washington, Seattle, WA, United States
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21
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Lee Y, Jang JH, Park HS. Management of allergic patients during severe acute respiratory syndrome coronavirus-2 pandemic. ALLERGY ASTHMA & RESPIRATORY DISEASE 2021. [DOI: 10.4168/aard.2021.9.3.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Youngsoo Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Hyuk Jang
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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22
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Hendeles L, Prabhakaran S. Nationwide Shortage of Albuterol Inhalers and Off-Label Use in COVID-19 Patients. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2020; 33:216-219. [PMID: 35921564 PMCID: PMC9353992 DOI: 10.1089/ped.2020.1300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/03/2020] [Indexed: 06/15/2023]
Abstract
The surge in COVID-19 cases during the 2020 Spring led to a nationwide shortage of albuterol inhalers. As a new surge has begun, shortages may make it difficult for patients with obstructive lung disease, including children with asthma, to obtain refills. Since there is no evidence that albuterol relieves symptoms in COVID-19 patients with respiratory symptoms not caused by bronchospasm, it is reasonable for clinicians to not prescribe it for COVID-19 patients unless they also have asthma or chronic obstructive pulmonary disease.
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Affiliation(s)
- Leslie Hendeles
- College of Pharmacy and University of Florida, Gainesville, Florida, USA
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
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