Aerosol-generating Procedures Research Articles

Pattern of pediatric emergency dental care during COVID-19 pandemic in Saudi Arabia

ObjectiveAt the beginning of the COVID-19 pandemic, it was recommended to provide emergency dental care and avoid aerosol-generating procedures (AGPs) when possible. This study aimed to determine how Saudi Arabian pediatric patients utilized emergency dental services at the national level at the beginning of the COVID-19 pandemic and what situations required an AGP. MethodsData was collected from all Ministry of Health dental facilities in Saudi Arabia between March and May 2020. All pediatric dental patients who received emergency dental care during the COVID-19 lockdown were included in this study. ResultsThe majority of the 1,544 pediatric dental patients who received emergency dental care during this period received treatment for caries (77.9 %). AGPs were predominant in the treatment of urgent dental conditions (51.5 %). About 64 % of cases with pulpal inflammation and 52.4 % with abscesses underwent an AGP. ConclusionEmergency and urgent dental conditions were the main reason for seeking dental care during the pandemic (75.8 %), while only 24.2 % of cases were considered non-urgent. Despite the recommendations, AGPs were required for some urgent conditions to relieve the associated pain, and this comprised 46.8 % of dental treatment provided.

COVID-19 deaths in dental occupations and other healthcare occupations among U.S. decedents in 2020.

Early studies during the COVID-19 pandemic suggested dental occupations were among the highest risk for exposure to SARs-CoV-2 because of multiple factors increasing exposure, including close proximity to unmasked patients and performance of aerosol-generating procedures. However, to date, few studies have investigated COVID-19 deaths in United States dental occupations, and compared COVID-19 deaths among healthcare occupations. We analyzed 2020 mortality data collected by the National Center for Health Statistics' National Vital Statistics System. Multivariable logistic regression was used to generate odds ratios (ORs) and 95% confidence intervals for COVID-19 as the underlying cause of death in relation to occupation in working-age decedents (≤65 years), after adjusting for age, sex, race/ethnicity, education, and medical conditions associated with severe COVID-19. Dental occupations did not have significantly higher risk for COVID-19 death when compared to all other occupations combined. Among healthcare occupations with frequent, direct patient- or client interactions, LPNs and LVNs, and speech and language pathologists had significantly elevated adjusted ORs for COVID-19 death when compared to dentists, dental hygienists, or dental assistants. Similarly, nurse practitioners had significantly higher ORs for COVID-19 mortality than dentists or dental hygienists, and approached significance when compared to dental assistants. Conversely, massage therapists and other health diagnosing and treating practitioners had significantly lower adjusted ORs for COVID-19 death compared with dental occupations. Our study highlights potential differences in work-related transmission of SARs-CoV-2 and subsequent COVID-19 deaths in healthcare occupations, and furthers a previously limited understanding of COVID-19 deaths in healthcare occupations in 2020, before COVID-19 vaccine availability. Our results indicate that dental occupations were not among the highest, nor lowest risk, healthcare occupations for COVID-19 deaths in 2020, despite their known risks of direct exposure.

Factors associated with correction of personal protective equipment nonadherence in a multidisciplinary emergency department setting: A retrospective video review

Despite local and national recommendations, health care provider adherence to personal protective equipment (PPE) varied during the COVID-19 pandemic. Previous studies have identified factors influencing initial PPE adherence but did not address factors influencing behaviors leading to correction after initial nonadherence. We conducted a retrospective video review of 18 pediatric resuscitations involving aerosol-generating procedures from March 2020 to December 2022 to identify factors associated with nonadherence correction. We quantified adherent and nonadherent providers, instances of PPE nonadherence, and time to correction. We also analyzed correction behaviors, including provider actions and correction locations. Among 434 providers, 362 (83%) were nonadherent with at least 1 PPE. Only 186 of 1,832 instances of nonadherence were corrected, primarily upon room entry and during patient care. Correction time varied by PPE type and nonadherence level (incomplete vs absent). Most corrections were self-initiated, with few reminders from other providers. Potential barriers to correction include a lack of social pressure and external reminders. Solutions include optimizing PPE availability, providing real-time feedback, and educating on double gloving. Most providers were nonadherent to PPE requirements during high-risk infection transmission events. The low correction rate suggests challenges in promoting collective responsibility and maintaining protective behaviors during medical emergencies.

Characterization and assessment of exposure risks of healthcare personnel during the COVID-19 pandemic.

Healthcare personnel have the right to decent, healthy, and safe working conditions during COVID-19. Despite our best efforts to safeguard them against SARS-CoV-2 infection, a substantially large number of healthcare personnel fell ill and succumbed to COVID-19. This study aimed to characterize the SARS-CoV-2 exposures among healthcare personnel and determine the risk level of those events, thereby identifying and focusing on the key areas that influence workplace safety. A pre-tested questionnaire was used to collect data from healthcare personnel on the type of exposure, place, and use of preventive measures, along with demographic and occupational data. Exposure events were categorized into low, moderate, and high-risk by using a risk categorization protocol. Doctors were primarily found to be involved in the aerosol-generating procedure, which had 94 times higher odds (95% CI: 43.9926-201.17) for high-risk exposures than other activities. In contrast, nurses were more likely to experience close-contact exposures (OR: 2.77, 95% CI: 1.44-5.33). Both critical care units and operation theaters were identified to have higher odds (OR: 2.34, 95% CI: 1.33-4.23 and OR: 2.31; 95% CI: 0.99-5.42, respectively) than the wards for high-risk exposures. Use of personal protective equipment was poor, with breaches reported in 10.2% of all exposure events. The lacunae in practice were addressed by repeated training and counseling and by ensuring the adequacy of resources in required areas. The assessment was beneficial for safeguarding healthcare personnel and assuring a safer workplace during the early phase of the COVID-19 pandemic.

Impact of nebulization versus metered-dose inhaler utilization on viral particle dispersion in patients with COVID-19.

Conflicting guidance exists regarding the characterization of nebulization as an aerosol-generating procedure and subsequent risk of transmission of SARS-CoV-2 to healthcare workers. This study sought to address whether SARS-CoV-2 viral load distribution was impacted by bronchodilator delivery via nebulizer versus metered-dose inhaler (MDI). Adults infected with COVID-19 were enrolled and received a single dose of albuterol sulfate nebulized solution (2.5mg/3mL via breath-actuated nebulizer with filtered mouthpiece) or albuterol sulfate hydrofluoroalkane inhalation aerosol (90µg/actuation; two puffs via MDI with spacer) in a randomized crossover sequence. Air and surfaces were sampled at predefined locations within patients' hospital rooms to assess SARS-CoV-2 dispersion over three periods (baseline, MDI, and nebulizer). Eleven patients received crossover therapy. Six patients had detectable SARS-CoV-2 RNA during one treatment period (n = 3 each for MDI and nebulizer) and one during both treatment periods. No viral RNA was found in the rooms of four (36.4%) patients. Overall, few environmental samples (17/397; 4.3%) contained detectable viral RNA, with no meaningful differences in positivity rate across periods; RNA genome copy numbers were low in positive samples. No correlation between dispersion and patient clinical status or environmental parameters was observed. In this first prospective trial evaluating viral load distribution following use of nebulizer versus MDI in hospitalized patients with COVID-19, low environmental contamination was found regardless of administration method. Findings support the use of either device when needed to treat patients with COVID-19.

Aerosol generation during pediatric otolaryngological procedures

ObjectivesTo assess the extent of staff exposure to aerosol generation in common pediatric otorhinolaryngological procedures (tonsillotomies, adenoidectomies, and tympanostomies) and determine the surgical phases responsible for most aerosol generation in these procedures. MethodsAerosol generation was measured during 35 pediatric otolaryngological procedures using an Optical Particle Sizer that measures aerosol concentrations for particle sizes between 0.3 and 10.0 μm. The different phases of and instruments used in each procedure were logged. Operating room background aerosol levels and coughing were used as references. ResultsTotal aerosol concentrations were significantly higher during tonsillotomies and adenoidectomies when compared to tympanostomies (p = 0.011 and p = 0.042) and to empty room background aerosol concentrations (p = 0.0057 and p < 0.001). Aerosol concentration during tonsillotomies did not differ from coughing, which is considered as standard for high-risk aerosol procedures. During tympanostomies, aerosol concentrations were even lower than during perioperative concentrations. No statistically significant difference in aerosol generation comparing suction, electrocautery, cold instruments, and paracentesis was found. ConclusionAccording to the results of this study, tympanostomies are low-risk aerosol-generating procedures. On the other hand, pediatric tonsillotomies produced aerosols comparable to coughing, pointing to them being significantly aerosol-producing procedures and viral transmission is theoretically possible intraoperatively.

Potential effects of aerosol generation and transmission during bedside endoscope cleaning.

Airborne transmission is among the most frequent types of nosocomial infection. Recent years have witnessed frequent outbreaks of airborne diseases, such as severe acute respiratory syndrome (SARS) in 2002, Middle East respiratory syndrome (MERS) in 2012, and coronavirus disease 2019 (COVID-19), with the latter being on the rampage since the end of 2019 and bringing the effect of aerosols on health back to the fore (Gralton et al., 2011; Wang et al., 2021). An increasing number of studies have shown that certain highly transmissible pathogens can maintain long-term stability and efficiently spread through aerosols (Leung, 2021; Lv et al., 2021). As reported previously, influenza viruses that can spread efficiently through aerosols remain stable for a longer period compared to those that cannot. The World Health Organization (WHO) has stated that aerosol-generating procedures (AGPs) play an important role in aerosol transmission in hospitals (Calderwood et al., 2021). AGPs, referring to medical procedures that produce aerosols, including dental procedures, endotracheal intubation, sputum aspiration, and laparoscopic surgeries, have been reported to be significantly associated with an increased risk of nosocomial infection among medical personnel (Hamilton, 2021).

The psychological impact of coronavirus disease 2019 pandemic on parents’ knowledge, attitudes, and children’s anxiety during pediatric dental practice

Abstract Purpose This study’s goal was to assess the impact of the coronavirus disease 2019 (COVID-19) outbreak on parent’s knowledge, attitude, and children’s anxiety during dental treatment. Patients and methods A structured questionnaire was applied to a sample of 400 parents of children aged from 8 to 15 years and from different socioeconomic backgrounds. The children’s dental anxiety level was assessed using the Facial image scale. The accompanied parent’s and dentist’s dental anxiety level was also evaluated using a Likert scale, 1–6. Results In total, 71.5% of parents answered that their children could be infected with COVID-19 during dental treatments and that they were concerned about their children receiving such treatment due to the outbreak. When asked about the transmission of COVID-19, 90% of participants believed it was due to aerosol-generating procedures during dental treatment. Conclusion The COVID-19 pandemic has had an impact on parental attitudes about dental care and oral health management.

Comparing the Ease of Endotracheal Intubation with and without an Intubation Box in COVID-19 Patients

Background: Endotracheal intubation is a potentially high-risk aerosol-generating procedure. So, an intubation box (I-Box) is designed for personal protection during intubation. This study aimed to compare the outcomes of endotracheal intubation with and without an I-box in COVID-19 patients. Methods: In this study, 60 COVID-19 patients (30 patients in each group) with and without I-box groups were included. outcomes of intubation including duration of intubation, first-pass success intubation, suitable visibility of airways, restriction of movement in the neck, the need to surface maneuvering of the airway, and the number of attempts for successful intubation were compared between the two groups. Results: The time of intubation was significantly longer in the I-box group (15.27±2.6 seconds) than without the I-box group (8.37±1.3 seconds) (p&lt;0.001). All patients (100%) were intubated in the first attempt in the without I-box group while the rate of first-pass success intubation was 50% in the I-box group (p &lt;0.001). The visibility of the airway was significantly better in the without I-box group than the I-box group (without I-box: 23 patients (76.7%), I-box: 15 patients (50%), p= 0.032). The frequency of need to optimizing maneuver of the airway was in without and with I-box was 23.3% and 50% respectively (p=0.032). Conclusion: However, the I-box as a physical barrier can protect healthcare workers but its use increased the time to intubation and the number of attempts for successful intubation and reduced the rate of first-pass success intubation and visibility.

Using inductive machine learning to identify risk factors for healthcare workers to get infected with highly contagious viruses (based on COVID-19 model)

Epidemic and pandemic spread of highly contagious viruses (SARS-CoV, influenza A virus, Ebola virus, MERS-CoV, and SARS-CoV-2) has been a trend observed in the first two decades of the 21st century. The predominant impact made by the biological occupational factor on healthcare workers determines their high occupational risk of infection, a severe disease course and a fatal outcome. Epidemiological data mining based on machine learning algorithms is successfully used in epidemiological practice to identify factors (predictors) contributing to infection in various risk populations. In this study, the database generated from a survey of 1312 healthcare workers was analyzed intelligently. A total of 6912 machine learning models were implemented. SARS-CoV-2 infection was found to be facilitated by providing medical care to a COVID-19 patient, using a full set of PPE after direct contact with a COVID-19 patient, direct contact with items in the external (hospital) environment, vaccination against COVID-19 after direct contact with a COVID-19 patient, acting as nursing staff (cleaners) and being present during aerosol-generating procedures. The study identified four groups of predictors determining SARS-CoV-2 infection in healthcare workers: contact with a COVID-19 patient and environmental items, PPE quality and complexity, occupational affiliation of healthcare workers and their BMI values. One predictor was found in 56.2 % of healthcare workers; two, in 19.2 %; three, in 16.4 %; four, in 5.5 %; and five predictors, in 2.7 %. Thus, epidemiological data mining is a modern stage in epidemiological analysis. The use of machine learning methods allows for multifactorial assessment of SARS-CoV-2 infection risks in healthcare workers and enables identifying and reliably estimating the most significant predictors. Intelligent data analysis has flexible architecture, which allows adjusting the model under study and supplementing new data to the existing database, detecting changes in an epidemiological situation and accomplishing relevant preventive and anti-epidemic activities.

Использование индуктивного типа машинного обучения для выявления факторов риска инфицирования медицинских работников высоко-контагиозными вирусами (на модели COVID-19)

Epidemic and pandemic spread of highly contagious viruses (SARS-CoV, influenza A virus, Ebola virus, MERS-CoV, and SARS-CoV-2) has been a trend observed in the first two decades of the 21st century. The predominant impact made by the biological occupational factor on healthcare workers determines their high occupational risk of infection, a severe disease course and a fatal outcome. Epidemiological data mining based on machine learning algorithms is successfully used in epidemiological practice to identify factors (predictors) contributing to infection in various risk populations. In this study, the database generated from a survey of 1312 healthcare workers was analyzed intelligently. A total of 6912 machine learning models were implemented. SARS-CoV-2 infection was found to be facilitated by providing medical care to a COVID-19 patient, using a full set of PPE after direct contact with a COVID-19 patient, direct contact with items in the external (hospital) environment, vaccination against COVID-19 after direct contact with a COVID-19 patient, acting as nursing staff (cleaners) and being present during aerosol-generating procedures. The study identified four groups of predictors determining SARS-CoV-2 infection in healthcare workers: contact with a COVID-19 patient and environmental items, PPE quality and complexity, occupational affiliation of healthcare workers and their BMI values. One predictor was found in 56.2 % of healthcare workers; two, in 19.2 %; three, in 16.4 %; four, in 5.5 %; and five predictors, in 2.7 %. Thus, epidemiological data mining is a modern stage in epidemiological analysis. The use of machine learning methods allows for multifactorial assessment of SARS-CoV-2 infection risks in healthcare workers and enables identifying and reliably estimating the most significant predictors. Intelligent data analysis has flexible architecture, which allows adjusting the model under study and supplementing new data to the existing database, detecting changes in an epidemiological situation and accomplishing relevant preventive and anti-epidemic activities.

Infection Prevention Strategies for Otorhinolaryngology and Head-and-Neck Surgery During the COVID-19 Pandemic: A Systematic Review

Background: The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has significantly impacted global healthcare systems, necessitating stringent infection control measures to safeguard patients and healthcare workers. Otorhinolaryngology and head-and-neck surgery, due to their close proximity to the respiratory tract and frequent aerosol-generating procedures, face elevated risks of COVID-19 transmission. Understanding infection control measures in these specialties is paramount to optimize safety protocols and mitigate transmission risks. Aim: The review aims to examine infection control measures in otorhinolaryngology and head-and-neck surgery during the COVID-19 pandemic, addressing specific risks, effectiveness of safety measures, adaptations to evolving knowledge, implementation challenges, and future directions for research and policy. Review Summary: A systematic literature search was conducted from December 2019 to present, focusing on infection control practices in these specialties during the pandemic. Studies addressing infection control measures, risks, and adaptations in otorhinolaryngology and head-and-neck surgery were included. Key findings were synthesized qualitatively, emphasizing trends, common themes, and discrepancies in data. Future Implications: Insights from the review provide actionable guidance for optimizing infection control measures in otorhinolaryngology and head-and-neck surgery, enhancing safety for patients and healthcare providers during current and future pandemics. Areas for future research include ongoing surveillance, adaptation of protocols, and development of innovative safety strategies. Clinical Policy and Development: Recommendations include comprehensive use of personal protective equipment, modifications to patient handling and surgical procedures, telemedicine integration, and adherence to strict infection control protocols. These measures aim to minimize COVID-19 transmission risks while maintaining essential healthcare services. Keywords: COVID-19, Otorhinolaryngology, Head-And-Neck Surgery, Infection Control, Aerosol-Generating Procedures

Chapare virus infection and current perspectives on dentistry.

This narrative review addresses relevant points about Chapare virus (CHAV) entry in oral cells, CHAV transmission, and preventive strategies in dental clinical settings. It is critical in dentistry due to the frequent presence of gingival hemorrhage occurred in CHAV-infected patients. Studies related to CHAV were searched in MEDLINE/PubMed, Scopus, EMBASE, and Web-of-Science databases without language restriction or year of publication. Recently, the PAHO/WHO and CDC indicate a presence of human-to-human transmission of CHAV associated with direct contact with saliva, blood, or urine, and also through droplets or aerosols created in healthcare procedures. CHAV was detected in human oropharyngeal saliva and gingival bleeding was confirmed in all cases of CHAV hemorrhagic fever, including evidence of nosocomial CHAV transmission in healthcare workers. We revisited the human transferrin receptor 1 (TfR1) expression in oral, nasal, and salivary glands tissues, as well as, we firstly identified the critical residues in the pre-glycoprotein (GP) complex of CHAV that interacts with human TfR1 using cutting-edge in silico bioinformatics platforms associated with molecular dynamic analysis. In this multidisciplinary view, we also point out critical elements to provide perspectives on the preventive strategies for dentists and frontline healthcare workers against CHAV, and in the implementation of salivary diagnostic platforms for virus detection, which can be critical to an urgent plan to prevent human-to-human transmission based on current evidence. The preventive strategies in dental clinical settings are pivotal due to the aerosol-generating procedures in dentistry with infected patients or suspected cases of CHAV infection.

Pediatric Plastic Surgery in the COVID-19 Era.

The COVID-19 pandemic has forced the healthcare system to adopt novel strategies to treat patients. Pediatric plastic surgeons are uniquely exposed to high rates of infections during examinations and surgeries via aerosol-generating procedures, in part because of the predilection of viral particles for the nasal cavities and pharynx. Telemedicine has emerged as a useful virtual medium for encouraging prolonged patient follow-up while maintaining physical distance. It has proven beneficial in mitigating infection risks while decreasing the financial burden on patients, their families, and healthcare teams. New trends driven by the pandemic added multiple elements to the patient-physician relationship and have left a lasting impact on the field of pediatric plastic surgery in clinical guidelines, surgical care, and patient outcomes. Lessons learned help inform pediatric plastic surgeons on how to reduce future viral infection risk and lead a more appropriately efficient surgical team depending on early triage.

Healthcare Provider N95 Respirator Contamination Worn Behind Face Shields With SARS-CoV-2 During Routine Clinical Care of Patients With COVID-19.

N95 respirator contamination with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during clinical care of patients with coronavirus disease 2019 is poorly understood. We performed a prospective observational study on healthcare provider's (HCP's) N95 respirators' and face shields' SARS-CoV-2 contamination during aerosol-generating procedures on SARS-CoV-2-positive patients housed in a COVID-19-specific unit. Medical masks worn on top of HCP's N95 respirators, and under face shields, during study aerosol-generating procedures were used as surrogates to detect contamination to avoid waste. Thirty-three HCPs were studied, and a total of 33 mask and 27 face shields were sampled. Masks were cut into 9 pieces and face shields were sampled twice, front and back, to determine locality of contamination; however, no positive samples were identified using standard polymerase chain reaction techniques with a CT value up to 40. All 9 mask piece samples were then pooled, as were face shield samples, using centrifugal concentration with polyethersulfone membranes. Once pooled and concentrated, overall, 9 (15%) samples were positive via real-time polymerase chain reaction: 5 from masks (15.2%) and 4 from face shields (14.8%).

Tracheostomy in Critically Ill Covid 19 Patients: A Review of Outcome

The novel human coronavirus disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which can result in serious respiratory illness requiring endotracheal intubation, mechanical ventilation, and tracheostomy. Resources on the indication, ideal timing and outcomes for tracheostomy in COVID-19 patients are still limited. Tracheostomy is an aerosol generating procedure with risk of transmission of airborne disease to healthcare workers (HCWs)1. However, tracheostomy aids in ventilation liberation2 for mechanical ventilated patient in general but resources on overall outcome for tracheostomy in COVID-19 patients are not well reported. Thus, a trained surgeon, adequate safety equipment and measures are essential to reduce timing of exposure through this aerosol-generating procedures and reduce risk of complications.

Improving compliance with personal protective equipment among anaesthetists through behaviour-changing interventions during the coronavirus disease 2019(COVID-19) pandemic.

Since 2020, the coronavirus disease 2019 (COVID-19) pandemic has seen many changes in our daily infection prevention behaviours so as to reduce healthcare-associated transmission of COVID-19 in patients and healthcare workers. In the early phases of the COVID-19 pandemic of 2020, there was much emphasis on compliant personal protective equipment utilization in the operating theatres (OTs) for COVID-19-positive patients. However, during this period, there was a lack of international validated protocols on the appropriate handling and subsequent storage of personal protective equipment in the context of aerosol-generating procedures in OTs for asymptomatic antigen rapid test (ART)-negative patients. Given the potential for transmission even with a negative ART due to the incubation period, our team developed a checklist of eye protection (e.g. goggles/face shield) and N95 mask handling and storage in non-isolation OTs for these patients. We sought to improve the compliance of best practices from 20% to 80% amongst junior anaesthetists in Singapore General Hospital so as to prevent infection transmission and cross-contamination in the OT through education and behaviour-changing interventions. This quality improvement project took place over 19 weeks from June to October 2020 by our team of anaesthetists and nurse clinicians in the non-isolation OT setting. To analyse the problem, we performed a root cause analysis to understand attitudes and beliefs driving their behaviour. The top 80% of cited root causes for non-compliance then guided prioritization of resources for subsequent behaviour-changing interventions. Using the comprehensive infection control checklist, we conducted several plan-do-study-act cycles while implementing this new checklist amongst junior anaesthetists. A total of 227 assessments of junior anaesthetists were made in the care of asymptomatic ART-negative patients. Compliance with correctly handling goggles post-intubation started out as 33.3% in Week 1, which improved to 78.5% by Week 19. Compliance with goggle storage and face shield disposal started out at 13.6% in Week 1 and increased to 78.6% by Week 19. We attributed this improvement to education and behaviour-changing interventions. This quality improvement project focusing on improving compliance with personal protective equipment utilization during the COVID-19 pandemic in the management of asymptomatic ART-negative patients in non-isolation OTs demonstrated the importance of interventions of education, persuasion, modelling, and training in effecting and sustaining organizational behaviour change in physicians and other healthcare personnel.

Remotely supervised spirometry versus laboratory-based spirometry during the COVID-19 pandemic: a retrospective analysis

BackgroundThe COVID-19 pandemic has constrained access to spirometry, and the inherent risk of infectious transmission during aerosol-generating procedures has necessitated the rapid development of Remotely Supervised Spirometry (RSS). This innovative approach enables patients to perform spirometry tests at home, using a mobile connected spirometer, all under the real-time supervision of a technician through an online audio or video call.MethodsIn this retrospective study, we examined the quality of RSS in comparison to conventional Laboratory-based Spirometry (LS), using the same device and technician. Our sample included 242 patients, with 129 undergoing RSS and 113 participating in LS. The RSS group comprised 51 females (39.5%) with a median age of 37 years (range: 13–76 years). The LS group included 63 females (55.8%) with a median age of 36 years (range: 12–80 years).ResultsWhen comparing the RSS group to the LS group, the percentage of accurate Forced Expiratory Volume in one second (FEV1) measurements was 78% (n = 101) vs. 86% (n = 97), p = 0.177; for Forced Vital Capacity (FVC) it was 77% (n = 99) vs. 82% (n = 93), p = 0.365; and for both FEV1 and FVC, it was 75% (n = 97) vs. 81% (n = 92), p = 0.312, respectively.ConclusionsOur findings demonstrate no significant difference in the quality of spirometry testing between RSS and LS, a result that held true across all age groups, including patients aged over 65 years. The principal advantages of remote spirometry include improved access to pulmonary function tests, reduced infectious risk to curtail disease spread, and enhanced convenience for patients.

Variation in response to the coronavirus disease 2019 (COVID-19) at US dental school clinics.

Although the threat of coronavirus disease 2019 (COVID-19) was the same at different US dental schools, the response wasn't. There is no study that documents the variation in mitigation strategies, COVID-19 transmission, and clinical educational changes at US Dental schools during the ongoing pandemic that began in 2020 in the US. The current study was approved as exempt research (project number HUM00199261). Our survey of Associate Dean's of Clinical Operations was individually emailed in July 2021. There were no reminders and descriptive statistics were calculated using Microsoft Excel. We received 46 completed surveys from the 68 sent out. Note that 65.2% of respondents reported requiring N95 masks for aerosol-generating procedures. Note that 38.9% of respondents said they required student partnering as chairside dental assistants for aerosol-generating procedures. Note that 37.7% of respondents began using alternate cubicles. A total of 6.52% of schools reported a transmission of the severe acute respiratory syndrome coronavirus 2 virus from patient to provider. There were no reported transmissions from provider to patient or from patient to patient. In our study, we found a lot of similarities between the approach taken by Dental School Clinics across the US to mitigate the risks of COVID-19, however, we also observed many differences.

Critical Evaluation of Global Infection Prevention and Control Guidelines for Dentistry Published during the First 2 Years of the COVID-19 Pandemic.

The outbreak of the coronavirus disease (COVID-19) encouraged immediate actions by governments and healthcare associations across the world to flatten the curve and prevent health systems from being overburdened. As dentistry comprises aerosol-generating procedures (AGPs), which could increase the risk of infection, various guidelines were issued for dental services which focused on infection prevention and control (IPC) measures for COVID-19. This systematic review focuses on dental IPC guidelines, with the aim of comparing these guidelines against a gold standard. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist was employed. Predefined inclusion and exclusion criteria were constructed. Information sources comprised Google Scholar, PubMed, and a manual search from December 2019 to December 2021. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was used. Consensus scoring was applied for all guidelines. A total 61 guidelines were included in the review. The UK national guideline was used as a gold standard as it ranked the highest AGREE score (75 out of 84) and thus was established for comparison with each of the included guidelines. Overall, 40% of the included guidelines had a high consensus score in relation to the UK national guideline. This systematic review highlighted the variability in content and quality of advice given by different organizations in response to the COVID-19 pandemic in their efforts to reduce SARS-CoV-2 transmission in dentistry. Establishing a single worldwide fast-acting dental organization would ensure that high-quality standardized guidance is available, to enhance health equality and worldwide dental clinical standards.