Medical and Surgical Education Challenges and Innovations in the COVID-19 Era: A Systematic Review.

The aim of this systematic review was to identify the challenges imposed on medical and surgical education by the COVID-19 pandemic, and the proposed innovations enabling the continuation of medical student and resident training. A systematic review on the MEDLINE and EMBASE databases was performed on April 18th, 2020, and yielded 1288 articles. Sixty-one of the included manuscripts were synthesized in a qualitative description focused on two major axes, "challenges" and "innovative solutions", and two minor axes, "mental health" and "medical students in the frontlines". Shortage of personal protective equipment, suspension of clinical clerkships and observerships and reduction in elective surgical cases unavoidably affect medical and surgical education. Interesting solutions involving the use of virtual learning, videoconferencing, social media and telemedicine could effectively tackle the sudden cease in medical education. Furthermore, trainee's mental health should be safeguarded, and medical students can be involved in the COVID-19 clinical treatment if needed.

The Effect of Coronavirus (COVID-19) on Breast Cancer Teamwork: A Multicentric Survey.

BACKGROUND/AIM: Despite the large amount of clinical data available of Coronavirus-19 (COVID-19), not many studies have been conducted about the psychological toll on Health Care Workers (HCWs). PATIENTS AND METHODS: In this multicentric descriptive study, surveys were distributed among 4 different Breast Cancer Centers (BCC). BCCs were distinguished according to COVID-19 tertiary care hospital (COVID/No-COVID) and district prevalence (DP) (High vs. Low). DASS-21 score, PSS score and demographic data (age, sex, work) were evaluated. RESULTS: A total of 51 HCWs were analyzed in the study. Age, work and sex did not demonstrate statistically significant values. Statistically significant distribution was found between DASS-21-stress score and COVID/No-COVID (p=0.043). No difference was found in the remaining DASS-21 and PSS scores, dividing the HCWs according to COVID-19-hospital and DP. CONCLUSION: Working in a COVID-19-hospital represents a factor that negatively affects psychosocial well-being. However, DP seems not to affect the psychosocial well-being of BCC HCWs. During the outbreak, psychological support for low risk HCWs should be provided regardless DP.

Cabinas sanitizantes para la desinfección de grupos de personas / Sanitizing cabins for the disinfection of groups of people

INTRODUCCIÓN: En el contexto de la pandemia por SARS-CoV-2 se vienen desarrollando estrategias con el fin de reducir la transmisión del virus causante, tales como distanciamiento físico, protección personal, lavado de manos, uso de desinfectantes tales como alcohol 70° y aislamiento social mediante cuarentenas. Con la posibilidad del término de la cuarentena, se ha generado un interés en la aplicación de medidas de utilidad para la prevención del contagio del COVID 19, muchas de las cuales no han sido revisadas y reguladas por las autoridades de salud, entre ellas, el uso de dispositivos tipo cabina, cámara, túnel o arco de aspersión para la aplicación de desinfectantes sobre las personas que transitan por el interior o a través de estos. Se pretende reducir la potencial contaminación infecciosa viral que esté presente sobre la superficie de la ropa de la persona que ingresa al lugar. De acuerdo a lo divulgado por medios de comunicación, y lo reportado por algunos fabricantes, se han estado utilizando para la aspersión sobre personas, diferentes productos cuyo uso autorizado es la desinfección de superficies, equipos, dispositivos. Las cabinas sanitizantes son estructuras modulares de desinfección utilizadas para grandes y continuos flujos de personas. El objetivo es obtener una desinfección de la superficie de las personas que ingresan a sitios confinados, o donde se compartirá con varias personas más, a fin de reducir los contagios, en particular de SARS-COV-2. OBJETIVO: Evaluar la evidencia sobre Cabinas, duchas o túneles sanitizantes saber: Evidencia de eficacia para eliminar el SARS-COV-2 y evidencia de seguridad para la población. METODOLOGÍA: Se realizó una ETS Ultrarrápida en forma colaborativa entre los miembros de Redarets y colaboradores externos. Todos los participantes suscribieron su declaración de conflictos de interés. Las preguntas que se busca responder son las siguientes.¿Qué tipo de cabinas sanitizantes existen en Argentina?¿Cuáles son las diferencias de las cabinas sanitizantes en términos de componentes , tales como tiempo de exposición, tipo de desinfectante? ¿Cuál es la eficacia de las cabinas sanitizantes, para reducir la carga viral de superficies externas de las personas? ¿Cuál es la seguridad de las cabinas sanitizantes para las personas expuestas? RESULTADOS: Se identificaron al menos 6 productos comercializados por diferentes empresas en el país. La mayoría de ellas son transportables, y funcionan a base de ácido hipocloroso, salvo dos que usan adicionalmente ozono y radiación U.V. Así mismo, la ANMAT informó recientemente que las "cabinas sanitizantes o túneles de desinfección", no se encuentran autorizadas por esta Administración Nacional. Las cabinas difieren en sus especificaciones técnicas (detectores, temperatura, equipamiento); desinfectantes usados y tiempo de exposición del mismo. En cuanto a la eficacia de las cabinas sanitizantes, para reducir la carga viral de superficies externas solamente es eficaz a nivel superficial, ya que, de encontrarse presente, el SARS-CoV2, permanecerá en las mucosas y aerosoles de la persona contagiada (sintomático o asintomático), haciendo que a pesar de haberse rociado, sea contagioso, sin considerar los riesgos para la salud. En cuanto a la seguridad para la personas expuestas, los usuarios circulan sin recibir información clara y objetiva al respecto del producto que le aplican o los potenciales riesgos, ni cumplir un protocolo específico, por lo cual, algunos pasan muy rápidamente y otros no. Es infrecuente el uso de protección ocular y algunos entran con ropa que no cubre sus brazos y piernas, haciendo que el producto entre en contacto directo con la piel. La sensación de humedad en la cara, puede hacer que la persona se toque la cara y se refriegue los ojos facilitando la inoculación de partículas virales que pueden estar presentes en sus manos generando un potencial ingreso de agentes patógenos al organismo, generando irritación ocular o en la piel. CONCLUSIONES Y RECOMENDACIONES: La ausencia de estudios y evidencia suficiente que permitan documentar la eficacia y seguridad de la aspersión directa de desinfectantes sobre las personas, es suficiente y contundente para dejar de exponer de forma innecesaria a la población a una diversidad de productos químicos cuyo fabricante no ha probado y desarrollado para ser aplicados sobre las personas, recomendándose no utilizar cabinas, túneles, arcos y demás sistemas de aspersión o nebulización de desinfectantes, como estrategia de desinfección de personas, en el contexto de la emergencia por COVID -19.

Skin cancer protective behaviors among welders of west of Iran: Importance of access to protective equipment.

BACKGROUND: Welders are normally at risk of skin cancer due to continuous contact with natural ultraviolet rays and welding radiation. Protective behaviors against the radiations are the most fundamental measures taken to prevent skin cancer in these individuals. AIMS: This research aimed to evaluate the factors affecting the protective behaviors in welders. PATIENTS/METHODS: In this cross-sectional research, participants were selected by the census method, and the research tool was a reliable and valid questionnaire filled by 154 welders in Yasuj, Iran. Data analysis was performed in SPSS version 16 using ANOVA, Pearson's correlation coefficient, and independent t test. RESULTS: The highest age frequency was related to the age-group of 36-45 years, and the highest frequency of work experience was less than 10 years. In terms of the level of education, most welders had a diploma or a higher degree. In addition, most behaviors reported included using gloves, whereas the least applied method was using sunscreen cream, the most important cause of which was the high cost of the cream. In this regard, the Pearson's correlation coefficient demonstrated a negative association between skin cancer and job difficulty. In addition, performing of protective behaviors decreased in the target group by aging. CONCLUSION: Given the unfavorable mean skin cancer protective behaviors in the welders, it is recommended that interventions, such as planned education, access to protective tools, and periodic skin examinations by a physician, be carried out to promote the health of these individuals and facilitate performing protective behaviors.

Reported fire safety and first-aid amenities in Airbnb venues in 16 American cities.

Airbnb helps hosts rent all or part of their home to guests as an alternative to traditional hospitality settings. Airbnb venues are not uniformly regulated across the USA. This study quantified the reported prevalence of fire safety and first-aid amenities in Airbnb venues in the USA. The sample includes 120 691 venues in 16 US cities. Proportions of host-reported smoke and carbon monoxide (CO) detectors, fire extinguishers and first-aid kits were calculated. The proportion of venues that reportedly contained amenities are as follows: smoke detectors 80% (n=96 087), CO detectors 57.5% (n=69 346), fire extinguishers 42% (n=50 884) and first-aid kits 36% (n=43 497). Among this sample of Airbnb venues, safety deficiencies were noted. While most venues had smoke alarms, approximately 1/2 had CO alarms and less than 1/2 reported having a fire extinguishers or first-aid kits. Local and state governments or Airbnb must implement regulations compliant with current National Fire Protection Association fire safety standards.

An effective way to utilize daycare organizations to distribute home safety equipment.

BACKGROUND: Safety equipment installed in the home can reduce pediatric injuries. The purpose of this study was to compare the proper use of home safety equipment installed by an injury prevention specialist to equipment installed by a family after distribution at a daycare. METHODS: A prospective study involving two daycare organizations from a high-risk community was performed. Both groups consisted of families with children 4 to 24 months old who received a packet containing: cabinet and drawer latches, carbon monoxide (CO) detector, magnetic phone list, and five other items. After consent was obtained, both groups completed a prescreen survey to determine current equipment use. The self-installation group (SI) from one daycare received home safety equipment and education for self-installation of the equipment. The professional installation group (PI) from a comparable daycare received the same equipment and education; however, equipment was installed for them. Assessments of equipment usage and maintenance were performed at follow-up home visits 6 to 9 months after equipment disbursement. Frequencies and χ analysis were used for comparisons. RESULTS: Seventy-nine SI families and 81 PI families were enrolled. There was no difference in home equipment use between the groups prior to interventions with CO detectors (11.4% vs. 12.3%), cabinet locks (2.5% vs. 11.1%), drawer locks (0% vs. 2.5%), or posted emergency numbers (24.1% vs. 19.8%). Follow-up home visits occurred in 71 SI families (87.7%) and 75 PI families (92.6%). In both groups, there was a significantly increased use of CO detectors (73.2% vs. 89.3%, p = 0.02), cabinet locks (38.0% vs. 78.7%, p < 0.001), and drawer locks (22.5% vs. 62.7%, p < 0.001); posted emergency number increased in both groups, but the difference was not significant (78.9% vs. 89.3%, p = 0.11). CONCLUSION: When provided with home safety equipment, it is used much of the time; however, equipment installed by a professional resulted in higher use than if self-installed. For some equipment, distribution of products in daycare settings may be just as effective as if professionally installed.

Scarcity of protective items against HIV and other bloodborne infections in 13 low- and middle-income countries.

OBJECTIVE: To assess protection of surgical healthcare workers against HIV and other bloodborne infections in low- and middle-income countries (LMICs). METHODS: Literature review based on recent studies assessing baseline surgical capacity in LMICs using the WHO Situational Analysis of Access to Emergency and Essential Surgical Care, the Surgeons OverSeas (SOS) Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) survey and the Harvard Humanitarian Initiative survey tools. The availability of protective eyewear, sterile gloves and sterilisers was assessed. RESULTS: Thirteen individual country studies with relevant data were identified documenting items from 399 hospitals. The countries included Afghanistan, Bolivia, Gambia, Ghana, Liberia, Mongolia, Nigeria, Sierra Leone, Solomon Islands, Somalia, Sri Lanka, Tanzania and Zambia. Overall, only 29% (79/270) of hospitals always had eye protection. Sterilisers were only available at 64% (244/383) of facilities. Sterile gloves were the most available item, available at 75% of facilities (256/340). CONCLUSION: Surgical healthcare worker protection for bloodborne infections continues to be deficient in LMICs. Improved documentation of these items should be incorporated into future surgical capacity studies. Policy makers and clinicians should work together to secure resources and interventions that will protect this vital workforce.

Scarcity of healthcare worker protection in eight low- and middle-income countries: surgery and the risk of HIV and other bloodborne pathogens.

OBJECTIVE: In view of the substantial incidence of bloodborne diseases and risk to surgical healthcare workers in low- and middle-income countries (LMICs), we evaluated the availability of eye protection, aprons, sterile gloves, sterilizers and suction pumps. METHODS: Review of studies using the WHO Tool for the Situational Analysis of Access to Emergency and Essential Surgical Care. RESULTS: Eight papers documented data from 164 hospitals: Afghanistan (17), Gambia (18), Ghana (17), Liberia (16), Mongolia (44), Sierra Leone (12), Solomon Islands (9) and Sri Lanka (31). No country had a 100% supply of any item. Eye protection was available in only one hospital in Sri Lanka (4%) and most abundant in Liberia (56%). The availability of sterile gloves ranged from 24% in Afghanistan to 94% in Ghana. CONCLUSION: Substantial deficiencies of basic protective supplies exist in low- and middle-income countries.

Nurses' use of hazardous drug-handling precautions and awareness of national safety guidelines.

PURPOSE/OBJECTIVES: To determine patterns of personal protective equipment (PPE) used by oncology nurses while handling hazardous drugs (HDs) and to assess knowledge of the 2004 National Institute for Occupational Safety and Health (NIOSH) Alert and its effect on precaution use. DESIGN: Descriptive, correlational. SETTING: The Oncology Nursing Society 31st Annual Congress in Boston, MA, in 2006. SAMPLE: 330 nurses who prepared and/or administered chemotherapy. METHODS: Nurses described HD safe-handling precaution use by self-report survey. MAIN RESEARCH VARIABLES: The availability and use of biologic safety cabinets and PPE. FINDINGS: Respondents were well educated (57% had a bachelor's degree or more), experienced (X = 19, SD = 10.2 years in nursing and X = 12, SD = 7.9 years in oncology), and certified (70%; majority OCN®). Forty-seven percent of respondents were aware of the NIOSH Alert. Thirty-five percent of all participants and 93% of nurses in private practice settings reported preparing chemotherapy. Glove use (95%-100%) was higher than that reported in earlier studies, and gown use for drug preparation (65%), drug administration (50%), and handling excretions (23%) have remained unchanged. Double-gloving was rare (11%-18%). Nurses in private practices were less likely to have chemotherapy-designated PPE available, use PPE, and use spill kits for HD spills. CONCLUSIONS: Nurses have adopted glove use for HD handling; however, gown use remains comparatively low. Chemotherapy-designated PPE is not always provided by employers. Nurses lack awareness of current safety guidelines. IMPLICATIONS FOR NURSING: Nurses must know about the risks of HD exposure and ways to reduce exposure. Employers must provide appropriate PPE and encourage its use. Alternative methods of disseminating safety recommendations are needed.

Influência da exposição a material biológico na adesão aouso de equipamentos de proteção individual / Influence of exposure to biological material in the adhesion to theuse of personal protective equipment / Influencia de la exposición a material biológico en la adhesión al usode equipos de protección individual

A exposição a material biológico é uma das principais inquietações de gestores e profissionais da área desegurança ocupacional, pois pode trazer consequências sérias para o trabalhador. Este trabalho teve comoobjetivo avaliar se a exposição a material biológico é um fator determinante para a adesão ao uso doequipamento de proteção individual por parte dos trabalhadores de enfermagem. O estudo é descritivo deabordagem qualitativa e foi realizado em um hospital-escola de grande porte no município de Goiânia-GO/Brasil,no ano de 2008. A coleta de dados foi realizada por meio de grupo focal. Ao analisar os discursos dos grupospercebeu-se que acidentes com material biológico não foram determinantes para a adesão ao equipamento deproteção, variando de adesão permanente até a não adesão. Observou-se que a experiência desta exposiçãoinfluencia em maior ou menor escala na mudança de comportamento para a adesão ao equipamento deproteção. Contudo, esse comportamento é individual e sofre influências de outros fatores, como ausência ouinadequação do equipamento de proteção individual, sobrecarga de trabalho, pressa e situações de emergência.A implementação de educação permanente com discussão de situações de risco vivenciadas pelostrabalhadores expostos será necessária para a adesão e uso consciente dos equipamentos de proteção.

Exposure to biological material is one of the main concerns of managers and professionals in occupational safetyand can have serious consequences for the worker. The purpose of this study was to evaluate whether exposureto biological material is a determining factor for the acceptance of protective equipment from the part of nursingpersonnel. It is a descriptive study with a qualitative approach carried out in 2008 in a large university hospital ofGoiânia (Brazil). Data was collected through focus groups. When analyzing the discourse of the groups it wasnoticed that the accident with biological material was not a determinant of adhesion to protective equipment,ranging from continued adhesion to no compliance of use. It was observed that the experience of this exposureinfluences to a greater or lesser extent in changing behavior for adhesion to the use of protective equipment.However this behavior is individual and is influenced by other factors such as absence or inadequacy of protectiveequipment, work overload, pressure and emergency situations. The implementation of continuing education withdiscussion of risk situations experienced by exposed workers will be required for adhesion and conscious use ofpersonal protective equipment.

La exposición a material biológico es una de las principales preocupaciones de los gestores y profesionales delárea de seguridad ocupacional, pues puede traer consecuencias graves para el trabajador. Este estudio tuvocomo objetivo evaluar si la exposición a material biológico es un factor determinante para la adhesión al uso deequipos de protección individual por parte de los trabajadores de enfermería. El estudio es descriptivo, con unenfoque cualitativo, realizado en un gran hospital de enseñanza en el municipio de Goiânia-GO/Brasil en 2008.Los datos fueron recolectados a través de grupos focales. Al analizar los discursos de los grupos de percibió queaccidentes con material biológico no fueron determinantes para la adhesión a los equipos de protección, que vandesde la adhesión permanente a la no adhesión. Se observó que la experiencia de esta exposición influye enmayor o menor medida en el cambio de comportamiento para la adhesión a los equipos de protección. Sinembargo, esta conducta es individual y está influida por otros factores, como la ausencia o inadecuación deequipos de protección individual, sobrecarga de trabajo, prisa y situaciones de emergencia. La aplicación de laeducación continua con la discusión de situaciones de riesgo que sufren los trabajadores expuestos será necesaria para la adhesión y el uso de conciencia de los equipos de protección.

The effect of education and home safety equipment on childhood thermal injury prevention: meta-analysis and meta-regression.

OBJECTIVE: To evaluate whether home safety education and safety equipment provision increases thermal injury prevention practices or reduces thermal injury rates and whether the effect of interventions differs by social group. METHODS: Systematic review and meta-analysis using individual participant data (IPD) evaluating home safety education with or without provision of free or discounted safety equipment provided to children or young people aged 0-19 years. MAIN OUTCOME MEASURES: possession of functional smoke alarm, fitted fireguard and fire extinguisher; keeping hot drinks or food and keeping matches or lighters out of reach; having a safe hot water temperature and rate of medically attended thermal injuries. RESULTS: Home safety interventions were effective in increasing the proportion of families with a functional smoke alarm (odds ratio (OR) 1.83, 95% CI 1.22 to 2.74) and with a safe hot tap water temperature (OR 1.35, 95% CI 1.01 to 1.80). There was some evidence they increased possession of fitted fireguards (OR 1.39, 95% CI 1.00 to 1.94), but there was a lack of evidence that interventions reduced medically attended thermal injury rates (incident rate ratio (IRR) 1.12, 95% CI 0.81 to 1.56). There was no consistent evidence that the effectiveness of interventions varied by social group. CONCLUSIONS: Home safety education, especially with the provision of safety equipment, is effective in increasing some thermal injury prevention practices, but there is insufficient evidence to show whether this also reduces injury rates.

Universal precautions and surgery in Sierra Leone: the unprotected workforce.

BACKGROUND: Surgical patients and healthcare workers in sub-Saharan Africa are at an increased risk of contracting HIV. Sierra Leone is one of the poorest countries in the world and has a documented HIV prevalence rate of 2%. Because surgeons and other healthcare staff in sub-Saharan Africa are at risk for HIV exposure from their patients, an assessment of protective supplies and equipment was considered essential. METHODS: A Society of International Humanitarian Surgeons team in cooperation with the Sierra Leonean Ministry of Health and Sanitation undertook a survey of HIV-protective supplies and equipment at government hospitals in Sierra Leone. The presence of eye protection, sterile gloves, aprons, functioning suction machines, and sharps containers was recorded and compared with a local mission hospital and a local private hospital. RESULTS: Only 20% of government hospitals in Sierra Leone have adequate stores of sterile gloves or eye protection. Suction pumps and aprons are available in only 30-40% of facilities, respectively, and only half have functioning sterilizers and sharps containers. The mission and private hospitals were fully stocked. CONCLUSIONS: Although surgical healthcare workers are at risk for exposure to HIV, resources for their protection at government hospitals in Sierra Leone are severely lacking. The Society of International Humanitarian Surgeons is developing a program to provide protective supplies and equipment to hospitals in Sierra Leone, but additional efforts by other organizations working to decrease the spread of HIV are essential.

Chemotherapy-handling practices of outpatient and office-based oncology nurses.

PURPOSE/OBJECTIVES: To determine the current patterns of use of personal protective equipment among oncology nurses while handling antineoplastic chemotherapeutic agents in outpatient and office-based settings. DESIGN: Descriptive-correlational, mailed survey. SETTING: National survey of oncology nurses. SAMPLE: 500 randomly selected members of the Oncology Nursing Society who identified their work settings as office, clinic, or outpatient private practice; 263 responded for an overall response rate of 53%. METHODS: Mailed, self-report survey based on the current Occupational Safety and Health Administration's (OSHA's) guidelines for the handling of hazardous drugs. MAIN RESEARCH VARIABLE: Chemotherapy-handling practices. FINDINGS: More than 94% of participants reported usually wearing gloves during chemotherapy handling; 55% reported using laboratory coats as protective garments. Usual use of face and respiratory protection was less than 6%. Chemotherapy was reported to be prepared in laminar air flow hoods in 99% of work settings. Only 46% of sites reportedly provided any type of medical monitoring. CONCLUSION: Use and availability of personal protective equipment when handling chemotherapy have increased, but medical monitoring of exposed employees still is neither widely practiced nor consistent with OSHA guidelines. IMPLICATIONS FOR NURSING: Safety concerns and potential adverse health effects associated with the occupational handling of chemotherapeutic agents have been reported. Historically, nurses' adherence to chemotherapy-handling guidelines has been poor. Results suggest that adherence is increasing; however, research is lacking regarding nurses' level of knowledge of and specific barriers to safe handling of chemotherapy.

Avaliaçäo dos equipamentos de radiodiagnóstico da cidade do Recife / Evaluation of radiodiagnostic equipment of the Recife city

Um estudo preliminar das condições de funcionamento dos equipamentos de raios-X que operam nas clínicas e hospitais de Recife é apresentado neste trabalho. Os resultados mostraram que 78,2 por cento dos equipamentos testados apresentam coincidência de 1 a 2 por cento entre o campo luminoso e o feixe de radiação. Com relação à exatidão do valor da kV e do tempo de irradiação, os resultados indicaram que 84,6 por cento dos equipamentos analisados apresentam uma divergência maior que 10 por cento entre o tempo real de irradiação e o valor prefixado no painel e que 46,2 por cento paresentam variações maiores que 10 por cento com relação ao potencial do tubo.

This k paper reports the preliminary results of a survey aiming to determine the working conditions of x-ray units operating in hospitais and clinics in the city of Recife, Pernambuco. The results show that the discrepancy between the light field and the x-ray field stayed in the 1 to 2% interval in 78.2% of the equipments tested . The results show also that there is only a fair accuracy regarding kilovoltage and inadiation time. The discrepancy between the preset time and the "true" irradiation time was higher than 10% in 84.6% of the cases. The discrepancy between the preset and the applied kilovoltage, on the other hand, was higher than 10% in 46.2% of the inspected units.

Sunglasses: are they necessary in Christchurch?

Concern over potential eye injury from sunlight prompted this study to see if the levels of sunlight in Christchurch posed a particular risk to our population's eyes, whether the populace was aware of any risk and whether effective sunglasses were freely available to the public. While there has been a 4% to 9% increase in UV radiation since 1969 due to global ozone depletion, no firm evidence was found that focal ozone depletion was a particular problem in New Zealand. Christchurch residents were poorly informed about the ocular hazards of sunlight. A questionnaire completed by 200 adults disclosed 32% were unaware of the particular danger of UV light and only 3% knew that snow blindness, eclipse burns and cataracts could all be caused by sunlight. Fifty-four sunglasses were analysed for labelling and for transmission characteristics of their lenses. The standard of labelling of the sunglasses was poor with only 53% making reference to UV transmission characteristics and only three pairs stating that they adhered to the New Zealand Sunglass Standard. Attention is drawn to the need to improve public awareness of the potential for eye injury from sunlight and to improve the standard of labelling of sunglasses.