Contrasting Virtual and In-Person Family Therapy Teaching

Objectives: Family therapy using reflecting teams (RT) is one key psychotherapy training modality within psychiatry residencies. Historically, RTs have been facilitated in-person. Due to COVID-19 restrictions, the authors created an analogous RT teaching process via Zoom. The purpose of this study was to contrast in-person vs virtual family therapy teaching modalities through learner-reported survey data. Method(s): Learner self-report REDCap survey data were collected after the completion of each seminar. Data were analyzed in cohorts grouped by modality in prepandemic (N = 41) when it was delivered in-person, and during the pandemic (N = 16) when delivered virtually. The statistical analyses were performed using R software (version 4.0.5). Frequencies and proportions were used to describe participant survey responses. For comparison of virtual and in-person groups, proportion tests were used with a p value of <.05. Result(s): In comparing responses from sessions that were in-person to those held virtually, there was evidence of a higher proportion of virtual sessions that were rated as "essential" compared to in-person (p =.001). However, there was evidence of a decline in the level of interest when the authors compared ratings from virtual sessions;that is, the proportion of responses that were rated as "very interesting" decreased from 230/598 (38.5%) to 34/128 (26.6%) (p =.007). There was no evidence of a difference in the proportion who did not attend when comparing virtual and in-person (p =.886). Conclusion(s): The COVID-19 pandemic caused most in-person teaching to be offered virtually. Our learners identified teaching as more essential given the many societal restrictions imposed by the pandemic. In addition, as evidenced by the similar attendance rates pre- and postpandemic, virtual teaching did not appear to influence attendance. Finally, it appears that learners may have found virtual teaching less engaging, as evidenced by the decrease in "very interesting" ratings, which signals a need for increased attention to creative means of engaging learners virtually. FT, REST, P Copyright © 2022

Microwave- and heat-based decontamination of N95 filtering facepiece respirators: a systematic review.

BACKGROUND: In pandemics such as COVID-19, shortages of personal protective equipment are common. One solution may be to decontaminate equipment such as facemasks for reuse. AIM: To collect and synthesize existing information on decontamination of N95 filtering facepiece respirators (FFRs) using microwave and heat-based treatments, with special attention to impacts on mask function (aerosol penetration, airflow resistance), fit, and physical traits. METHODS: A systematic review (PROSPERO CRD42020177036) of literature available from Medline, Embase, Global Health, and other sources was conducted. Records were screened independently by two reviewers, and data was extracted from studies that reported on effects of microwave- or heat-based decontamination on N95 FFR performance, fit, physical traits, and/or reductions in microbial load. FINDINGS: Thirteen studies were included that used dry/moist microwave irradiation, heat, or autoclaving. All treatment types reduced pathogen load by a log10 reduction factor of at least three when applied for sufficient duration (>30 s microwave, >60 min dry heat), with most studies assessing viral pathogens. Mask function (aerosol penetration <5% and airflow resistance <25 mmH2O) was preserved after all treatments except autoclaving. Fit was maintained for most N95 models, though all treatment types caused observable physical damage to at least one model. CONCLUSIONS: Microwave irradiation and heat may be safe and effective viral decontamination options for N95 FFR reuse during critical shortages. The evidence does not support autoclaving or high-heat (>90°C) approaches. Physical degradation may be an issue for certain mask models, and more real-world evidence on fit is needed.

Decontaminating N95 and SN95 masks with ultraviolet germicidal irradiation does not impair mask efficacy and safety.

Inadequate supply of filtering facepiece respirators (FFRs) for healthcare workers during a pandemic such as the novel coronavirus outbreak (SARS-CoV-2) is a serious public health issue. The aim of this study was to synthesize existing data on the effectiveness of ultraviolet germicidal irradiation (UVGI) for N95 FFR decontamination. A systematic review (PROSPERO CRD42020176156) was conducted on UVGI in N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined eligibility and extracted predefined variables. Original research reporting on function, decontamination, or mask fit following UVGI were included. Thirteen studies were identified, comprising 54 UVGI intervention arms and 58 N95 models. FFRs consistently maintained certification standards following UVGI. Aerosol penetration averaged 1.19% (0.70-2.48%) and 1.14% (0.57-2.63%) for control and UVGI arms, respectively. Airflow resistance for the control arms averaged 9.79 mm H2O (7.97-11.70 mm H2O) vs 9.85 mm H2O (8.33-11.44 mm H2O) for UVGI arms. UVGI protocols employing a cumulative dose >20,000 J/m2 resulted in a 2-log reduction in viral load. A >3-log reduction was observed in seven UVGI arms using >40,000 J/m2. Impact of UVGI on fit was evaluated in two studies (16,200; 32,400 J/m2) and no evidence of compromise was found. Our findings suggest that further work in this area (or translation to a clinical setting) should use a cumulative UV-C dose of 40,000 J/m2 or greater, and confirm appropriate mask fit following decontamination.

Efficacy and safety of disinfectants for decontamination of N95 and SN95 filtering facepiece respirators: a systematic review.

BACKGROUND: Decontaminating and reusing filtering facepiece respirators (FFRs) for healthcare workers is a potential solution to address inadequate FFR supply during a global pandemic. AIM: The objective of this review was to synthesize existing data on the effectiveness and safety of using chemical disinfectants to decontaminate N95 FFRs. METHODS: A systematic review was conducted on disinfectants to decontaminate N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined study eligibility and extracted predefined data fields. Original research reporting on N95 FFR function, decontamination, safety, or FFR fit following decontamination with a disinfectant was included. FINDINGS AND CONCLUSION: A single cycle of vaporized hydrogen peroxide (H2O2) successfully removes viral pathogens without affecting airflow resistance or fit, and maintains an initial filter penetration of <5%, with little change in FFR appearance. Residual hydrogen peroxide levels following decontamination were within safe limits. More than one decontamination cycle of vaporized H2O2 may be possible but further information is required on how multiple cycles would affect FFR fit in a real-world setting before the upper limit can be established. Although immersion in liquid H2O2 does not appear to adversely affect FFR function, there is no available data on its ability to remove infectious pathogens from FFRs or its impact on FFR fit. Sodium hypochlorite, ethanol, isopropyl alcohol, and ethylene oxide are not recommended due to safety concerns or negative effects on FFR function.