Extended use or reuse of single-use surgical masks and filtering face-piece respirators during the coronavirus disease 2019 (COVID-19) pandemic: A rapid systematic review.

BACKGROUND: Shortages of personal protective equipment during the coronavirus disease 2019 (COVID-19) pandemic have led to the extended use or reuse of single-use respirators and surgical masks by frontline healthcare workers. The evidence base underpinning such practices warrants examination. OBJECTIVES: To synthesize current guidance and systematic review evidence on extended use, reuse, or reprocessing of single-use surgical masks or filtering face-piece respirators. DATA SOURCES: We used the World Health Organization, the European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention, and Public Health England websites to identify guidance. We used Medline, PubMed, Epistemonikos, Cochrane Database, and preprint servers for systematic reviews. METHODS: Two reviewers conducted screening and data extraction. The quality of included systematic reviews was appraised using AMSTAR-2. Findings were narratively synthesized. RESULTS: In total, 6 guidance documents were identified. Levels of detail and consistency across documents varied. They included 4 high-quality systematic reviews: 3 focused on reprocessing (decontamination) of N95 respirators and 1 focused on reprocessing of surgical masks. Vaporized hydrogen peroxide and ultraviolet germicidal irradiation were highlighted as the most promising reprocessing methods, but evidence on the relative efficacy and safety of different methods was limited. We found no well-established methods for reprocessing respirators at scale. CONCLUSIONS: Evidence on the impact of extended use and reuse of surgical masks and respirators is limited, and gaps and inconsistencies exist in current guidance. Where extended use or reuse is being practiced, healthcare organizations should ensure that policies and systems are in place to ensure these practices are carried out safely and in line with available guidance.

Modification and Validation of an mHealth App Quality Assessment Methodology for International Use: Cross-sectional and eDelphi Studies.

BACKGROUND: Over 325,000 mobile health (mHealth) apps are available to download across various app stores. However, quality assurance in this field of medicine remains relatively undefined. Globally, around 84% of the population have access to mobile broadband networks. Given the potential for mHealth app use in health promotion and disease prevention, their role in patient care worldwide is ever apparent. Quality assurance regulations both nationally and internationally will take time to develop. Frameworks such as the Mobile App Rating Scale and Enlight Suite have demonstrated potential for use in the interim. However, these frameworks require adaptation to be suitable for international use. OBJECTIVE: This study aims to modify the Enlight Suite, a comprehensive app quality assessment methodology, to improve its applicability internationally and to assess the preliminary validity and reliability of this modified tool in practice. METHODS: A two-round Delphi study involving 7 international mHealth experts with varied backgrounds in health, technology, and clinical psychology was conducted to modify the Enlight Suite for international use and to improve its content validity. The Modified Enlight Suite (MES) was then used by 800 health care professionals and health care students in Ireland to assess a COVID-19 tracker app in an online survey. The reliability of the MES was assessed using Cronbach alpha, while the construct validity was evaluated using confirmatory factor analysis. RESULTS: The final version of the MES has 7 sections with 32 evaluating items. Of these items, 5 were novel and based on consensus for inclusion by Delphi panel members. The MES has satisfactory reliability with a Cronbach alpha score of .925. The subscales also demonstrated acceptable internal consistency. Similarly, the confirmatory factor analysis demonstrated a positive and significant factor loading for all 32 items in the MES with a modestly acceptable model fit, thus indicating the construct validity of the MES. CONCLUSIONS: The Enlight Suite was modified to improve its international relevance to app quality assessment by introducing new items relating to cultural appropriateness, accessibility, and readability of mHealth app content. This study indicates both the reliability and validity of the MES for assessing the quality of mHealth apps in a high-income country, with further studies being planned to extrapolate these findings to low- and middle-income countries.

An examination of the dynamics of intergenerational tensions and technological change in the context of post-pandemic recovery

Technological change is a feature of contemporary life encompassing interactivity, collaboration and, above all, real-time content sharing and live streaming. The COVID-19 pandemic has introduced new dynamics in relation to digitisation and technology usage. Within organisations, these changes have been swift and profound, leading to online meetings, events and virtual team management. An explosion of literature has accompanied these changes and their human impacts. However, the generational and intergenerational issues remain under-examined and therefore constitute an important gap. The paper examines the literature on workplace technology, digitalisation and human impacts in relation to the COVID-19, and particularly, through the lens of different generational adoptive patterns. Taking an inductive qualitative approach, the paper's empirical focus is analyses of semi-structured questionnaire data from intergenerational senior executives. The findings showcase alternative understandings of technology in the late-COVID-19 era and of Xer generational (i.e. born 1961-1981) resilience and operational change dynamics. This allows a number of contributions and implications to be developed.

Animal bite wounds and their management in tropical Australia.

OBJECTIVE: To define the microbiologic characteristics of animal bites in tropical Australia and the appropriateness of current Australian antimicrobial guidelines for their management. METHODS: This retrospective audit examined hospitalizations in tropical Australia after an animal bite or animal-associated penetrating injury between 2013 and 2020. The primary outcome was a composite of death, intensive care unit admission, amputation, quaternary center transfer, or unplanned rehospitalization. RESULTS: A wide variety of animals were implicated, but snakes (734/1745, 42%), dogs (508/1745, 29%), and cats (153/1745, 9%) were the most common. Hospital presentation after 24 hours (odds ratio (OR) (95% confidence interval (CI)): 68.67 (42.10-112.01)) and a cat-related injury (OR (95% CI): 22.20 (11.18-44.08)) were independently associated with an increased risk of infection. A pathogen not covered by the relevant antimicrobial regimen recommended in Australian guidelines was identified in only 12/1745 (0.7%) cases. The primary outcome occurred in 107/1745 (6%) and was independently associated with tissue trauma (OR (95% CI): 9.29 (6.05-14.25), p<0.001), established deep infection at presentation (OR (95% CI): 2.95 (1.31-6.61), p=0.009) and hospital presentation after 24 hours (OR (95% CI): 1.77 (1.12-2.79), p=0.01). CONCLUSIONS: A wide variety of animals bite humans in tropical Australia, but empiric antimicrobial regimens recommended in current national guidelines cover almost all the microbiologic isolates from the resulting wounds.

Wastewater treatment plant operators report high capacity to support wastewater surveillance for COVID-19 across New York State, USA.

Wastewater surveillance for infectious disease expanded greatly during the COVID-19 pandemic. As a collaboration between sanitation engineers and scientists, the most cost-effective deployment of wastewater surveillance routinely tests wastewater samples from wastewater treatment plants. To evaluate the capacity of treatment plants of different sizes and characteristics to participate in surveillance efforts, we developed and distributed a survey to New York State municipal treatment plant supervisors in the summer and fall of 2021. The goal of the survey was to assess the knowledge, capacity, and attitudes toward wastewater surveillance as a public health tool. Our objectives were to: (1) determine what treatment plant operators know about wastewater surveillance for public health; (2) assess how plant operators feel about the affordability and benefits of wastewater surveillance; and (3) determine how frequently plant personnel can take and ship samples using existing resources. Results show that 62% of respondents report capacity to take grab samples twice weekly. Knowledge about wastewater surveillance was mixed with most supervisors knowing that COVID-19 can be tracked via wastewater but having less knowledge about surveillance for other public health issues such as opioids. We found that attitudes toward wastewater testing for public health were directly associated with differences in self-reported capacity of the plant to take samples. Further, findings suggest a diverse capacity for sampling across sewer systems with larger treatment plants reporting greater capacity for more frequent sampling. Findings provide guidance for outreach activities as well as important insight into treatment plant sampling capacity as it is connected to internal factors such as size and resource availability. These may help public health departments understand the limitations and ability of wastewater surveillance for public health benefit.

Performance and impact of disposable and reusable respirators for healthcare workers during pandemic respiratory disease: a rapid evidence review.

OBJECTIVES: To synthesise evidence concerning the range of filtering respirators suitable for patient care and guide the selection and use of different respirator types. DESIGN: Comparative analysis of international standards for respirators and rapid review of their performance and impact in healthcare. DATA SOURCES: Websites of international standards organisations, Medline and Embase, hand-searching of references and citations. STUDY SELECTION: Studies of healthcare workers (including students) using disposable or reusable respirators with a range of designs. We examined respirator performance, clinician adherence and performance, comfort and impact, and perceptions of use. RESULTS: We included standards from eight authorities across Europe, North and South America, Asia and Australasia and 39 research studies. There were four main findings. First, international standards for respirators apply across workplace settings and are broadly comparable across jurisdictions. Second, effective and safe respirator use depends on proper fitting and fit testing. Third, all respirator types carry a burden to the user of discomfort and interference with communication which may limit their safe use over long periods; studies suggest that they have little impact on specific clinical skills in the short term but there is limited evidence on the impact of prolonged wearing. Finally, some clinical activities, particularly chest compressions, reduce the performance of filtering facepiece respirators. CONCLUSION: A wide range of respirator types and models is available for use in patient care during respiratory pandemics. Careful consideration of performance and impact of respirators is needed to maximise protection of healthcare workers and minimise disruption to care.

Maintaining the fight for equality through and beyond COVID-19: a focus on the build back better report and ambidextrous leadership

PurposeThe purpose of this paper is to explore the Diversity Project’s Build Back Better report, which considers leadership practice while maintaining the fight for equality through and beyond COVID-19, through the lens of ambidextrous leadership.Design/methodology/approachThe authors succinctly present findings from the Build Back Better report that explores an industry response of investment and savings practitioners to managing diversity and inclusion through and beyond COVID-19. Ambidextrous leadership is applied to the discussion to offer greater theoretical discussion and practical consideration for HR leaders and their strategic approaches to the subject at hand.FindingsThe Build Back Better report offers numerous recommendations for leadership practice within these unprecedented times. An ambidextrous leadership approach can assist in supporting many of the recommendations, as they are complex and potentially paradoxical.Originality/valueThe Build Back Better report offers a practitioner’s immediate response to supporting business leaders shape their strategies as national lockdown periods ease while also ensuring the fight for equality is not lost within the COVID-19 crisis.

Highlight from this issue

Correspondence to Dr Simon Smith, Emergency Department, Oxford University Hospitals NHS Trust, Oxford OX4 1SZ, UK;Simon.Smith@ouh.nhs.uk This edition of the Emergency Medicine Journal has ‘something for everyone’ (as always), and at least one article that will be of interest to everyone (I think). The Editors Choice this month is a paper looking at the likely cervical spine imaging in a Paediatric population, when using three different clinical decision rules (CDRs) (Philips et al). Other articles of interest The problem of pre-hospital ‘missed stroke’ is considered in the systematic review by Jones et al, and reading this paper reveals the challenges faced by clinicians ‘in the field’.

Highlights from this issue

The International Federation of Emergency Medicine (IFEM) have produced a Quality Framework, and in the article by Hansen et al, the authors provide a summary of this document. There are also papers describing some novel processes adopted during the COVID-19 pandemic;including Chua et al on staff rostering challenges and solutions, Noble et al on the deployment of bespoke care areas for COVID patients (‘Accelerated Care Units’), and a letter describing the experience in Iran of screening processes to reduce referral to health services (including EDs). [...]the description of an increase in methanol toxicity (ingestion for disinfection) highlights the problem of misuse of alcohols during COVID.

A Global Perspective on the Influence of the COVID-19 Pandemic on Freshwater Fish Biodiversity

The COVID-19 global pandemic and resulting effects on the economy and society (e.g., sheltering-in-place, alterations in transportation, changes in consumer behaviour, loss of employment) have yielded some benefits and risks to biodiversity. Here, we considered the ways the COVID-19 pandemic has influenced (or may influence) freshwater fish biodiversity (e.g., richness, abundance). In many cases, we could only consider potential impacts using documented examples (often from the media) of likely changes, because anecdotal observations are still emerging and data-driven studies are yet to be completed or even undertaken. We evaluated the potential for the pandemic to either mitigate or amplify widely acknowledged, pre-existing threats to freshwater fish biodiversity (i.e., invasive species, pollution, fragmentation, flow alteration, habitat loss and alteration, climate change, exploitation). Indeed, we identified examples spanning the extremes of positive and negative outcomes for almost all known threats. We also considered the pandemic’s impact on freshwater fisheries demand, assessment, research, compliance monitoring, and management interventions (e.g., restoration), with disruptions being experienced in all domains. Importantly, we provide a forward-looking synthesis that considers the potential mechanisms and pathways by which the consequences of the pandemic may positively and negatively impact freshwater fishes over the longer term. We conclude with a candid assessment of the current management and policy responses and the extent to which they ensure freshwater fish populations and biodiversity are conserved for human and aquatic ecosystem benefits in perpetuity.

Highlights from this issue

Sethi et al have used a ‘before and after’ study design to retrospectively assess the effect on Emergency Department Clinical Quality Indicators of hospital-wide interventions to improve patient flow through the hospital (the ‘Reader’s choice’ for this month). [...]Man et al studied the long waiting times for Emergency Medical Services (EMS), due to delayed handover from ambulance to the Emergency Department (referred to as ‘ambulance ramping’). [...]the simple ‘AEI’ communication tool described is one that I find elegant, effective and have adopted into my practice.

COVID-19 pandemic impacts on global inland fisheries.

The COVID-19 pandemic has led to environmental recovery in some ecosystems from a global "anthropause," yet such evidence for natural resources with extraction or production value (e.g., fisheries) is limited. This brief report provides a data-driven global snapshot of expert-perceived impacts of COVID-19 on inland fisheries. We distributed an online survey assessing perceptions of inland fishery pressures in June and July 2020 to basin-level inland fishery experts (i.e., identified by the Food and Agriculture Organization of the United Nations across the global North and South); 437 respondents from 79 countries addressed 93 unique hydrological basins, accounting for 82.1% of global inland fish catch. Based on the responses analyzed against extrinsic fish catch and human development index data, pandemic impacts on inland fisheries 1) add gradation to the largely positive environmental narrative of the global pandemic and 2) identify that basins of higher provisioning value are perceived to experience greater fishery pressures but may have limited compensatory capacity to mitigate COVID-19 impacts along with negative pressures already present.

Classification of aerosol-generating procedures: a rapid systematic review.

In the context of covid-19, aerosol generating procedures have been highlighted as requiring a higher grade of personal protective equipment. We investigated how official guidance documents and academic publications have classified procedures in terms of whether or not they are aerosol-generating. We performed a rapid systematic review using preferred reporting items for systematic reviews and meta-analyses standards. Guidelines, policy documents and academic papers published in english or french offering guidance on aerosol-generating procedures were eligible. We systematically searched two medical databases (medline, cochrane central) and one public search engine (google) in march and april 2020. Data on how each procedure was classified by each source were extracted. We determined the level of agreement across different guidelines for each procedure group, in terms of its classification as aerosol generating, possibly aerosol-generating, or nonaerosol-generating. 128 documents met our inclusion criteria; they contained 1248 mentions of procedures that we categorised into 39 procedure groups. Procedures classified as aerosol-generating or possibly aerosol-generating by ≥90% of documents included autopsy, surgery/postmortem procedures with high-speed devices, intubation and extubation procedures, bronchoscopy, sputum induction, manual ventilation, airway suctioning, cardiopulmonary resuscitation, tracheostomy and tracheostomy procedures, non-invasive ventilation, high-flow oxygen therapy, breaking closed ventilation systems, nebulised or aerosol therapy, and high frequency oscillatory ventilation. Disagreements existed between sources on some procedure groups, including oral and dental procedures, upper gastrointestinal endoscopy, thoracic surgery and procedures, and nasopharyngeal and oropharyngeal swabbing. There is sufficient evidence of agreement across different international guidelines to classify certain procedure groups as aerosol generating. However, some clinically relevant procedures received surprisingly little mention in our source documents. To reduce dissent on the remainder, we recommend that (a) clinicians define procedures more clearly and specifically, breaking them down into their constituent components where possible; (b) researchers undertake further studies of aerosolisation during these procedures; and (c) guideline-making and policy-making bodies address a wider range of procedures.

The Challenge of COVID-19: The Biological Characteristics and Outcomes in a Series of 130 Breast Cancer Patients Operated on During the Pandemic.

Background: The worldwide outbreak of the 2019 novel coronavirus disease (COVID-19) emerged in Wuhan, China close to the end of 2019. We analyse the clinical characteristics and management outcomes of a small group of patients who have been treated in the early stage of the COVID-19 disease, and discuss the impact of the pandemic on the service delivered to breast cancer patients. Material Methods: We analysed a cohort of 130 breast cancer patients who underwent elective surgical procedures during the early period of COVID-19. The patients were operated on in the period from March 16th, 2020 to May 18th, 2020. Results: All the patients were female, with an age range of 33-88 years, with a median age of 57.6 years. Most of the cases were admitted as a day case surgery after passing through a preoperative screening pathway, which was developed gradually. Patients were contacted by phone after their surgery to ensure that they have had no symptoms and were reviewed in person two weeks after the procedure with histology results. Only one patient developed COVID-19 symptoms after surgery and recovered. Conclusions: Early and careful implementation of modified practice policies during emerging situation of viral pandemics will reduce the risk of perioperative complications, reduce the risk of patient to staff to patient transmission and minimize the negative impact of COVID-19 on breast cancer management.

Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements.

INTRODUCTION: With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities. METHODS: In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns. RESULTS: Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate. CONCLUSION: Slum residents' ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered.