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Article: Review of the Effect of Continuous Use and Limited Reuse of N95 Respirators on Respirator Fit.

Berger, Daniel / Caldwell, Catherine / Zukowski, Monica / Basting, James / Mazur, Lauren / Gopaul, Ravindra

Journal of the International Society for Respiratory Protection

2023 Volume 39, Issue 1, Page(s) 1–25

Abstract: Background: Coronavirus disease 2019 (COVID-19) has led to severe shortages of filtering facepiece respirators (FFRs). As a result, extended use, limited reuse, and FFR decontamination have been utilized to extend the life of single-use FFRs. Although ... ...

Abstract	Background: Coronavirus disease 2019 (COVID-19) has led to severe shortages of filtering facepiece respirators (FFRs). As a result, extended use, limited reuse, and FFR decontamination have been utilized to extend the life of single-use FFRs. Although some studies have raised concerns that reuse could affect the FFR's ability to form a seal, no comprehensive literature review of the effect of extended use or limited reuse on FFR seal exists. Objective: The goal of this review was to assess the effect of extended use and reuse on respirator fit, with and without decontamination. Methods: Searches of PubMed and Medrxiv yielded 24 papers that included assessment of fit after extended use or limited reuse on a human. One additional handpicked paper was added. Results: Studies report a wide variation in the number of donnings and doffings before fit failure between different models of respirators. Additionally, while seal checks lack sufficient sensitivity to reliably detect fit failures, individuals who failed fit testing were often able to pass subsequent tests by re-positioning the respirator. Even with failure, respirators often maintained a substantially higher level of fit than a surgical mask, so they may still provide a level of protection in crisis settings. Conclusion: Based on currently available data, this literature review was unable to establish a consensus regarding the amount of time a respirator can be worn or the number of uses before fit failure will occur. Furthermore, variations in reuses before fit failure between different models of N95 respirators limit the ability to offer a comprehensive recommendation of greater than one reuse or a specific amount of wear time.
Language	English
Publishing date	2023-05-09
Publishing country	United States
Document type	Journal Article
ISSN	0892-6298
ISSN	0892-6298
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Practical Diagnostic Accuracy of Nasopharyngeal Swab Testing for Novel Coronavirus Disease 2019 (COVID-19).

Gopaul, Ravindra / Davis, Joshua / Gangai, Linda / Goetz, Lianna

The western journal of emergency medicine

2020 Volume 21, Issue 6, Page(s) 1–4

Abstract: Introduction: The novel coronavirus (SARS-CoV-2) is the cause of COVID-19, which has had a devastating international impact. Prior reports of testing have reported low sensitivities of nasopharyngeal polymerase chain reaction (PCR), and reports of viral ...

Abstract	Introduction: The novel coronavirus (SARS-CoV-2) is the cause of COVID-19, which has had a devastating international impact. Prior reports of testing have reported low sensitivities of nasopharyngeal polymerase chain reaction (PCR), and reports of viral co-infections have varied from 0-20%. Therefore, we sought to determine the accuracy of nasopharyngeal PCR for COVID-19 and rates of viral co-infection. Methods: We conducted a retrospective chart review of all patients who received viral testing between March 1, 2020-April 28, 2020. Test results of a complete viral pathogen panel and COVID-19 testing were abstracted. We compared patients with more than one COVID-19 test for diagnostic accuracy against the gold standard of chart review. Results: We identified 1950 patients, of whom 1024 were tested for COVID-19. There were 221 repeat tests for COVID-19. Among patients with a repeat test, COVID-19 swabs had a sensitivity of 84.6% (95% confidence interval (CI), 69.5-94.4%) and a specificity of 99.5% (95%CI, 97-100%) compared to a clinical and radiographic criterion reference by chart review. We found viral co-infection rates of 2.3% in patients without COVID-19 and 6.1% in patients with COVID-19. Rates of co-infection appeared to be related to base rates of infection in the community and not a specific property of COVID-19. Conclusion: COVID-19 nasopharyngeal PCR specimens are accurate but have imperfect sensitivity. Repeat testing for high-risk patients should be considered, and presence of an alternative virus should not be used to limit testing for COVID-19 for patients where it would affect treatment or isolation.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; COVID-19/diagnosis ; COVID-19 Testing ; Child ; Child, Preschool ; Coinfection/diagnosis ; Female ; Humans ; Infant ; Male ; Middle Aged ; Nasopharynx/virology ; Polymerase Chain Reaction ; Retrospective Studies ; SARS-CoV-2/genetics ; SARS-CoV-2/isolation & purification ; Sensitivity and Specificity ; Young Adult
Keywords	covid19
Language	English
Publishing date	2020-09-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375700-0
ISSN	1936-9018 ; 1936-9018
ISSN (online)	1936-9018
ISSN	1936-9018
DOI	10.5811/westjem.2020.8.48420
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Evaluation of Provider Assessment of Clinical History When Using the HEART Score.

Gopaul, Ravindra / Waller, Robert A / Kalayanamitra, Ricci / Rucker, Garrett / Foy, Andrew

Open access emergency medicine : OAEM

2022 Volume 14, Page(s) 421–428

Abstract: Objective: The HEART Score is a clinically validated risk stratification tool for patients with chest pain. Using five parameters (History, Electrocardiogram, Age, Risk factors, and Troponin), this instrument categorizes patients as low, moderate, or ... ...

Abstract	Objective: The HEART Score is a clinically validated risk stratification tool for patients with chest pain. Using five parameters (History, Electrocardiogram, Age, Risk factors, and Troponin), this instrument categorizes patients as low, moderate, or high risk for major adverse cardiac events within six weeks after evaluation. Of these parameters, History is the most subjective, as providers independently assign their level of clinical suspicion. Overestimation of history, and ultimately the HEART Score, can result in increased resource utilization, expense, and patient risk. We sought to evaluate bias in provider assessment of history when determining the HEART Score. Methods: Emergency medicine (EM) and Cardiology providers received surveys with one of two versions of clinical vignettes randomized at the question level and were asked to estimate the history component of the HEART Score. Vignettes differed by age, risk factors, sex, and socioeconomic status (SES), but both versions should have received the same score for history. Statistical analysis was then used to assess differences in history assessment between vignettes. Results: Of the 884 responses analyzed, most providers overestimated the historical portion of the HEART Score when assessing risk factors, patient distress, age, and lower SES. Many underestimated history with knowledge of a previous negative stress test. When controlling for specialty, the universal theme was overestimation by EM providers and underestimation by cardiologists. Despite the presence of hypertension, gender differences, and the appearance of mild distress, cardiologists were more likely to correctly estimate history compared to EM providers. SES consideration generally led to an underestimation of history by cardiologists. These findings were all statistically significant. Conclusion: Our study demonstrates that both EM and cardiology providers overestimate history when considering prognosticators that are frequently viewed as concerning. Further education on proper usage of the HEART Score is needed for more appropriate scoring of history and improved resource allocation for hospital systems.
Language	English
Publishing date	2022-08-04
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2520704-0
ISSN	1179-1500
ISSN	1179-1500
DOI	10.2147/OAEM.S371502
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Returns After Discharge From the Emergency Department Observation Unit: Who, What, When, and Why?

Berger, Daniel / King, Steven / Caldwell, Catherine / Soto, Erik F / Chambers, Andrew / Boehmer, Susan / Gopaul, Ravindra

The western journal of emergency medicine

2023 Volume 24, Issue 3, Page(s) 390–395

Abstract: Introduction: The number of emergency department observation units (EDOU) and observation stays has continued to increase. Despite this, there is limited data on the characteristics of patients who return unexpectedly to the ED after EDOU discharge.: ... ...

Abstract	Introduction: The number of emergency department observation units (EDOU) and observation stays has continued to increase. Despite this, there is limited data on the characteristics of patients who return unexpectedly to the ED after EDOU discharge. Methods: We identified the charts of all patients who were admitted to the EDOU of an academic medical center between January 2018-June 2020 and had a return to the ED within 14 days of discharge from the EDOU. Patients were excluded if they were admitted to the hospital from the EDOU, left against medical advice, or died in the EDOU. We manually extracted selected demographic factors, comorbidities, and healthcare utilization data from the charts. Physician reviewers identified return visits thought to be related to the index visit or potentially avoidable. Results: During the study period, there were 176,471 ED visits, 4,179 admissions to the EDOU, and 333 return visits to the ED within 14 days from discharge from the EDOU, representing 9.4% of all patients discharged from the EDOU. We identified a higher rate of return for patients treated for asthma and lower rates of return for patients treated for chest pain or syncope than the overall return rate. Physician reviewers determined that 64.6% of unplanned returns were related to the index visit, and 4.5% were potentially avoidable. Of potentially avoidable visits, 53.3% occurred within 48 hours of discharge, supporting the use of this period as a potential quality metric. While there was no significant difference in the percentage of related return visits between males and females, there was a higher rate of potentially avoidable visits for male patients. Conclusion: This study adds to the limited body of literature on EDOU returns, finding an overall return rate of under 10%, with about two-thirds of returns determined to be related to the index visit and <5% considered to be potentially avoidable.
MeSH term(s)	Female ; Humans ; Male ; Patient Discharge ; Clinical Observation Units ; Length of Stay ; Hospitalization ; Emergency Service, Hospital ; Retrospective Studies
Language	English
Publishing date	2023-05-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375700-0
ISSN	1936-9018 ; 1936-9018
ISSN (online)	1936-9018
ISSN	1936-9018
DOI	10.5811/westjem.59023
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Practical Diagnostic Accuracy of Nasopharyngeal Swab Testing for Novel Coronavirus Disease 2019 (COVID-19)

Ravindra Gopaul / Joshua Davis / Linda Gangai / Lianna Goetz

Western Journal of Emergency Medicine, Vol 21, Iss

2020 Volume 6

Abstract	Introduction: The novel coronavirus (SARS-CoV-2) is the cause of COVID-19, which has had a devastating international impact. Prior reports of testing have reported low sensitivities of nasopharyngeal polymerase chain reaction (PCR), and reports of viral co-infections have varied from 0–20%. Therefore, we sought to determine the accuracy of nasopharyngeal PCR for COVID-19 and rates of viral co-infection. Methods: We conducted a retrospective chart review of all patients who received viral testing between March 1, 2020–April 28, 2020. Test results of a complete viral pathogen panel and COVID-19 testing were abstracted. We compared patients with more than one COVID-19 test for diagnostic accuracy against the gold standard of chart review. Results: We identified 1950 patients, of whom 1024 were tested for COVID-19. There were 221 repeat tests for COVID-19. Among patients with a repeat test, COVID-19 swabs had a sensitivity of 84.6% (95% confidence interval (CI), 69.5–94.4%) and a specificity of 99.5% (95%CI, 97–100%) compared to a clinical and radiographic criterion reference by chart review. We found viral co-infection rates of 2.3% in patients without COVID-19 and 6.1% in patients with COVID-19. Rates of co-infection appeared to be related to base rates of infection in the community and not a specific property of COVID-19. Conclusion: COVID-19 nasopharyngeal PCR specimens are accurate but have imperfect sensitivity. Repeat testing for high-risk patients should be considered, and presence of an alternative virus should not be used to limit testing for COVID-19 for patients where it would affect treatment or isolation.
Keywords	Medicine ; R ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9
Subject code	610
Language	English
Publishing date	2020-09-01T00:00:00Z
Publisher	eScholarship Publishing, University of California
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Returns After Discharge From the Emergency Department Observation Unit

Daniel Berger / Steven King / Catherine Caldwell / Erik F. Soto / Andrew Chambers / Susan Boehmer / Ravindra Gopaul

Western Journal of Emergency Medicine, Vol 24, Iss

Who, What, When, and Why?

2023 Volume 3

Abstract	Introduction: The number of emergency department observation units (EDOU) and observation stays has continued to increase. Despite this, there is limited data on the characteristics of patients who return unexpectedly to the ED after EDOU discharge. Methods: We identified the charts of all patients who were admitted to the EDOU of an academic medical center between January 2018–June 2020 and had a return to the ED within 14 days of discharge from the EDOU. Patients were excluded if they were admitted to the hospital from the EDOU, left against medical advice, or died in the EDOU. We manually extracted selected demographic factors, comorbidities, and healthcare utilization data from the charts. Physician reviewers identified return visits thought to be related to the index visit or potentially avoidable. Results: During the study period, there were 176,471 ED visits, 4,179 admissions to the EDOU, and 333 return visits to the ED within 14 days from discharge from the EDOU, representing 9.4% of all patients discharged from the EDOU. We identified a higher rate of return for patients treated for asthma and lower rates of return for patients treated for chest pain or syncope than the overall return rate. Physician reviewers determined that 64.6% of unplanned returns were related to the index visit, and 4.5% were potentially avoidable. Of potentially avoidable visits, 53.3% occurred within 48 hours of discharge, supporting the use of this period as a potential quality metric. While there was no significant difference in the percentage of related return visits between males and females, there was a higher rate of potentially avoidable visits for male patients. Conclusion: This study adds to the limited body of literature on EDOU returns, finding an overall return rate of under 10%, with about two-thirds of returns determined to be related to the index visit and <5% considered to be potentially avoidable.
Keywords	Medicine ; R ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9
Language	English
Publishing date	2023-05-01T00:00:00Z
Publisher	eScholarship Publishing, University of California
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Adolescent with Stroke-like Symptoms.

Mazzei, Joseph C / Louka, Stephanie / Gopaul, Ravindra / Taylor, Lindsay

Clinical practice and cases in emergency medicine

2018 Volume 2, Issue 2, Page(s) 175–176

Language	English
Publishing date	2018-04-05
Publishing country	United States
Document type	Journal Article
ISSN	2474-252X
ISSN (online)	2474-252X
DOI	10.5811/cpcem.2018.2.36886
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Practical Diagnostic Accuracy of Nasopharyngeal Swab Testing for Novel Coronavirus Disease 2019 (COVID-19)

Gopaul, Ravindra / Davis, Joshua / Gangai, Linda / Goetz, Lianna

West. j. emerg. med. (Online)

Abstract: INTRODUCTION: The novel coronavirus (SARS-CoV-2) is the cause of COVID-19, which has had a devastating international impact. Prior reports of testing have reported low sensitivities of nasopharyngeal polymerase chain reaction (PCR), and reports of viral ... ...

Abstract	INTRODUCTION: The novel coronavirus (SARS-CoV-2) is the cause of COVID-19, which has had a devastating international impact. Prior reports of testing have reported low sensitivities of nasopharyngeal polymerase chain reaction (PCR), and reports of viral co-infections have varied from 0-20%. Therefore, we sought to determine the accuracy of nasopharyngeal PCR for COVID-19 and rates of viral co-infection. METHODS: We conducted a retrospective chart review of all patients who received viral testing between March 1, 2020-April 28, 2020. Test results of a complete viral pathogen panel and COVID-19 testing were abstracted. We compared patients with more than one COVID-19 test for diagnostic accuracy against the gold standard of chart review. RESULTS: We identified 1950 patients, of whom 1024 were tested for COVID-19. There were 221 repeat tests for COVID-19. Among patients with a repeat test, COVID-19 swabs had a sensitivity of 84.6% (95% confidence interval (CI), 69.5-94.4%) and a specificity of 99.5% (95%CI, 97-100%) compared to a clinical and radiographic criterion reference by chart review. We found viral co-infection rates of 2.3% in patients without COVID-19 and 6.1% in patients with COVID-19. Rates of co-infection appeared to be related to base rates of infection in the community and not a specific property of COVID-19. CONCLUSION: COVID-19 nasopharyngeal PCR specimens are accurate but have imperfect sensitivity. Repeat testing for high-risk patients should be considered, and presence of an alternative virus should not be used to limit testing for COVID-19 for patients where it would affect treatment or isolation.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #869240
Database	COVID19

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Article ; Online: Practical Diagnostic Accuracy of Nasopharyngeal Swab Testing for Novel Coronavirus Disease 2019 (COVID-19)

Gopaul, Ravindra / Davis, Joshua / Gangai, Linda / Goetz, Lianna

Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, vol 0, iss 0

2020

Abstract	Introduction: The novel coronavirus (SARS-CoV-2) is the cause of COVID-19, which has had a devastating international impact. Prior reports of testing have reported low sensitivities of nasopharyngeal polymerase chain reaction (PCR), and reports of viral co-infections have varied from 0-20%. Therefore, we sought to determine the accuracy of nasopharyngeal PCR for COVID-19 and rates of viral co-infection.Methods: We conducted a retrospective chart review of all patients who received viral testing between March 1, 2020–April 28, 2020. Test results of a complete viral pathogen panel and COVID-19 testing were abstracted. We compared patients with more than one COVID-19 test for diagnostic accuracy against the gold standard of chart review.Results: We identified 1950 patients, of whom 1024 were tested for COVID-19. There were 221 repeat tests for COVID-19. Among patients with a repeat test, COVID-19 swabs had a sensitivity of 84.6% (95% confidence interval (CI), 69.5-94.4%) and a specificity of 99.5% (95%CI, 97-100%) compared to a clinical and radiographic criterion reference by chart review. We found viral co-infection rates of 2.3% in patients without COVID-19 and 6.1% in patients with COVID-19. Rates of co-infection appeared to be related to base rates of infection in the community and not a specific property of COVID-19.Conclusion: COVID-19 nasopharyngeal PCR specimens are accurate but have imperfect sensitivity. Repeat testing for high-risk patients should be considered, and presence of an alternative virus should not be used to limit testing for COVID-19 for patients where it would affect treatment or isolation.
Keywords	COVID-19 ; coronavirus ; PCR ; diagnostic accuracy ; polymerase chain reaction ; SARS-CoV-2 ; nasopharyngeal ; covid19
Subject code	610
Publishing date	2020-09-28
Publisher	eScholarship, University of California
Publishing country	us
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Ultrasound Use in Resource-limited Settings

Ravindra Gopaul / Gonzalo Bearman / Michael P. Stevens

Journal of Global Radiology, Vol 4, Iss

A Systematic Review

2018 Volume 1

Abstract: Purpose: Over the past decade, ultrasound (US) machines have become smaller, less expensive, more reliable, durable and user-friendly, making ultrasonography an ideal imaging modality in resource-poor settings. We conducted a literature review to examine ...

Abstract	Purpose: Over the past decade, ultrasound (US) machines have become smaller, less expensive, more reliable, durable and user-friendly, making ultrasonography an ideal imaging modality in resource-poor settings. We conducted a literature review to examine the use of ultrasound in resource-limited settings, with emphasis on common applications, barriers to implementation, and impact on clinical decision-making and patient disposition. Methods and Materials: Literature review. We conducted a PubMed and Cochrane Central search on the clinical use of ultrasound in the developing world. Search terms included ultrasonography, developing countries, resource limited, remote setting, poverty, and low income. Articles from 2000 to 2015 that included data on the clinical use of ultrasound in resource limited settings were eligible for inclusion. Data on country of origin, medical specialty, US modality, clinical impact, and potential barriers to implementation were recorded. Results: Fifty-eight articles were eligible for inclusion. Most studies were observational, with Africa as the most common site, accounting for 35 articles. Radiology was the most represented specialty. Cardiac and obstetric were the most commonly utilized ultrasound modalities. Most data on cardiac ultrasound pertained to its role in the diagnosis of rheumatic heart disease. Obstetric ultrasound was primarily used for pregnancy dating and diagnosing fetal abnormalities. Twelve studies examined clinical impact of ultrasound in resource-limited settings and showed that its use dramatically altered differential diagnosis and patient disposition. Common barriers to implementation were the high cost of equipment and maintenance, and lack of skilled personnel and formal training programs. A commonly cited consequence of ultrasound use in resource-poor settings was sex-selective abortions. Conclusion: Ultrasound has widespread clinical applications, particularly as a diagnostic tool in the developing world. Significant barriers exist with respect to access ...
Keywords	ultrasonography ; developing countries ; resource limited ; remote setting ; poverty ; low income ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
Subject code	306
Language	English
Publishing date	2018-12-01T00:00:00Z
Publisher	University of Massachusetts Medical School
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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