The Debate: What Are Aerosol-Generating Procedures in Dentistry? A Rapid Review.

INTRODUCTION: This article aims to review the current national and international dental guidance produced during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic to identify the level of consensus on aerosol-generating dental procedures (AGDPs). The outcomes intend to encourage increased collaboration with respect to dental guidelines in relation to the SARS-CoV-2 pandemic, as well as to improve decision making and safety for dental patients and staff. METHODS: This rapid review was conducted by 2 authors (MKV and KD), with the support of a third author (SD), to assess current guidelines related to dental AGDPs. This streamlined review approach allowed synthesis of data in an efficient manner in the rapidly evolving environment associated with the SARS-CoV-2 pandemic. RESULTS: The findings identified 1) a lack of consistency in reporting which procedures were deemed an AGDP; 2) that high-speed handpieces, air-water syringes, and mechanical scalers were consistently considered high-risk AGDPs; 3) a lack of consensus on the risk of coronavirus disease 2019 (COVID-19) transmission with the use of slow-speed handpieces; 4) a general agreement, when described, that rubber dam and high-volume evacuation can significantly reduce aerosol production; and 5) a lack of consistency in reporting whether procedures constitute a low, moderate, or high risk of COVID-19 transmission. The findings are discussed in relation to the guidance and future recommendations. CONCLUSION: It is recommended that future published guidance should indicate the risk stratification (low/moderate/high) of each procedure/exposure in a standardized international approach. KNOWLEDGE TRANSFER STATEMENT: The results of this rapid review can be used by clinicians to increase their awareness of international guidance on aerosol-generating procedures in dentistry. It will also encourage those publishing future guidance to provide an internationally standardized, risk-stratified approach to describing aerosol-generating procedures. Currently, it allows clinicians to consider aerosol-generating procedures as a risk spectrum.

Should the food intake of patients admitted to acute hospital services be routinely supplemented? A randomized placebo controlled trial.

BACKGROUND: Many patients admitted to acute hospital services are underweight or harbour vitamin deficiencies. OBJECTIVES: To determine the effect on patient throughput of a policy of routine vitamin supplementation, and of early routine sipfeed supplementation in 'thin' patients (5-10% weight loss or body mass index 18-22). DESIGN: Factorial randomized placebo controlled trial of oral multivitamins from the first day of admission, and, after nutritional screening, of a nutritionally complete sipfeed from the second day in 'thin' patients. SETTING: Acute medical, surgical and orthopaedic hospital services of a London teaching hospital. PARTICIPANTS: 1561 patients admitted as emergencies were included in the vitamin study of which 549 were included in the sipfeed study. MAIN OUTCOME MEASURE: Length of hospital stay (LOS). RESULTS: Offering multivitamins to acute admissions resulted in a mean change (reduction) in LOS of -0.4 days 95% CI (-2-1.2days). The results suggest greater reductions for those discharged after 10 days: mean change=-2.3 days 95% CI (-5.7 to 1.2). Sipfeed supplementation was associated with an increased mean length of stay 2.8 days 95% CI (-0.8-6.3). 18% of acute admissions were classified undernourished on the basis of BMI, MUAC or percent weight loss combined. CONCLUSIONS: No benefit was observed for sipfeed intervention although a small benefit of less than one day is not excluded. Vitamin supplementation may have slight but economically important benefit.