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  1. Article ; Online: Prospective observational study of gender and ethnicity biases in respiratory protective equipment for healthcare workers in the COVID-19 pandemic

    Paul Robert Greig / Jan Schumacher / Danny J N Wong / Clarissa Y M Carvalho

    BMJ Open, Vol 11, Iss

    2021  Volume 5

    Abstract: Objective To describe success rates of respiratory protective equipment (RPE) fit testing and factors associated with achieving suitable fit.Design Prospective observational study of RPE fit testing according to health and safety, and occupational health ...

    Abstract Objective To describe success rates of respiratory protective equipment (RPE) fit testing and factors associated with achieving suitable fit.Design Prospective observational study of RPE fit testing according to health and safety, and occupational health requirements.Setting A large tertiary referral UK healthcare facility.Population 1443 healthcare workers undergoing quantitative fit testing.Main outcome measures Quantitative fit test success (pass/fail) and the count of tests each participant required before successful fit.Results Healthcare workers were fit tested a median (IQR) 2 (1–3) times before successful fit was obtained. Males were tested a median 1 (1–2) times, while females were tested a median 2 (1–2) times before a successful fit was found. This difference was statistically significant (p<0.001). Modelling each fit test as its own independent trial (n=2359) using multivariable logistic regression, male healthcare workers were significantly more likely to find a well-fitting respirator and achieve a successful fit on first attempt in comparison to females, after adjusting for other factors (adjusted OR=2.07, 95% CI): 1.66 to 2.60, p<0.001). Staff who described their ethnicity as White were also more likely to achieve a successful fit compared with staff who described their ethnicity as Asian (OR=0.47, 95% CI: 0.38 to 0.58, p<0.001), Black (OR=0.54, 95% CI: 0.41 to 0.71, p<0.001), mixed (OR=0.50 95% CI: 0.31 to 0.80, p=0.004) or other (OR=0.53, 95% CI: 0.29 to 0.99, p=0.043).Conclusions Male and White ethnicity healthcare workers are more likely to achieve RPE fit test success. This has broad operational implications to healthcare services with a large female and Black, Asian and minority ethnic group population. Fit testing is imperative in ensuring RPE effectiveness in protecting healthcare workers during the COVID-19 pandemic and beyond.
    Keywords Medicine ; R
    Language English
    Publishing date 2021-06-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: healthcareCOVID

    Justin Kua / Reshma Patel / Eveliina Nurmi / Sarah Tian / Harpreet Gill / Danny J.N. Wong / Calvin Moorley / Dmitri Nepogodiev / Imran Ahmad / Kariem El-Boghdadly

    PeerJ, Vol 9, p e

    a national cross-sectional observational study identifying risk factors for developing suspected or confirmed COVID-19 in UK healthcare workers

    2021  Volume 10891

    Abstract: Objective To establish the prevalence, risk factors and implications of suspected or confirmed coronavirus disease 2019 (COVID-19) infection among healthcare workers in the United Kingdom (UK). Design Cross-sectional observational study. Setting UK-based ...

    Abstract Objective To establish the prevalence, risk factors and implications of suspected or confirmed coronavirus disease 2019 (COVID-19) infection among healthcare workers in the United Kingdom (UK). Design Cross-sectional observational study. Setting UK-based primary and secondary care. Participants Healthcare workers aged ≥18 years working between 1 February and 25 May 2020. Main outcome measures A composite endpoint of laboratory-confirmed diagnosis of SARS-CoV-2, or self-isolation or hospitalisation due to suspected or confirmed COVID-19. Results Of 6,152 eligible responses, the composite endpoint was present in 1,806 (29.4%) healthcare workers, of whom 49 (0.8%) were hospitalised, 459 (7.5%) tested positive for SARS-CoV-2, and 1,776 (28.9%) reported self-isolation. Overall, between 11,870 and 21,158 days of self-isolation were required by the cohort, equalling approximately 71 to 127 working days lost per 1,000 working days. The strongest risk factor associated with the presence of the primary composite endpoint was increasing frequency of contact with suspected or confirmed COVID-19 cases without adequate personal protective equipment (PPE): ‘Never’ (reference), ‘Rarely’ (adjusted odds ratio 1.06, (95% confidence interval: [0.87–1.29])), ‘Sometimes’ (1.7 [1.37–2.10]), ‘Often’ (1.84 [1.28–2.63]), ‘Always’ (2.93, [1.75–5.06]). Additionally, several comorbidities (cancer, respiratory disease, and obesity); working in a ‘doctors’ role; using public transportation for work; regular contact with suspected or confirmed COVID-19 patients; and lack of PPE were also associated with the presence of the primary endpoint. A total of 1,382 (22.5%) healthcare workers reported lacking access to PPE items while having clinical contact with suspected or confirmed COVID-19 cases. Conclusions Suspected or confirmed COVID-19 was more common in healthcare workers than in the general population and is associated with significant workforce implications. Risk factors included inadequate PPE, which was reported by nearly a quarter of ...
    Keywords Coronavirus ; COVID-19 ; SARS-CoV-2 ; Healthcare workers ; Medical workers ; Medicine ; R ; Biology (General) ; QH301-705.5
    Subject code 610 ; 360
    Language English
    Publishing date 2021-02-01T00:00:00Z
    Publisher PeerJ Inc.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Developing and validating subjective and objective risk-assessment measures for predicting mortality after major surgery

    Danny J N Wong / Steve Harris / Arun Sahni / James R Bedford / Laura Cortes / Richard Shawyer / Andrew M Wilson / Helen A Lindsay / Doug Campbell / Scott Popham / Lisa M Barneto / Paul S Myles / SNAP-2: EPICCS collaborators / S Ramani Moonesinghe

    PLoS Medicine, Vol 17, Iss 10, p e

    An international prospective cohort study.

    2020  Volume 1003253

    Abstract: Background Preoperative risk prediction is important for guiding clinical decision-making and resource allocation. Clinicians frequently rely solely on their own clinical judgement for risk prediction rather than objective measures. We aimed to compare ... ...

    Abstract Background Preoperative risk prediction is important for guiding clinical decision-making and resource allocation. Clinicians frequently rely solely on their own clinical judgement for risk prediction rather than objective measures. We aimed to compare the accuracy of freely available objective surgical risk tools with subjective clinical assessment in predicting 30-day mortality. Methods and findings We conducted a prospective observational study in 274 hospitals in the United Kingdom (UK), Australia, and New Zealand. For 1 week in 2017, prospective risk, surgical, and outcome data were collected on all adults aged 18 years and over undergoing surgery requiring at least a 1-night stay in hospital. Recruitment bias was avoided through an ethical waiver to patient consent; a mixture of rural, urban, district, and university hospitals participated. We compared subjective assessment with 3 previously published, open-access objective risk tools for predicting 30-day mortality: the Portsmouth-Physiology and Operative Severity Score for the enUmeration of Mortality (P-POSSUM), Surgical Risk Scale (SRS), and Surgical Outcome Risk Tool (SORT). We then developed a logistic regression model combining subjective assessment and the best objective tool and compared its performance to each constituent method alone. We included 22,631 patients in the study: 52.8% were female, median age was 62 years (interquartile range [IQR] 46 to 73 years), median postoperative length of stay was 3 days (IQR 1 to 6), and inpatient 30-day mortality was 1.4%. Clinicians used subjective assessment alone in 88.7% of cases. All methods overpredicted risk, but visual inspection of plots showed the SORT to have the best calibration. The SORT demonstrated the best discrimination of the objective tools (SORT Area Under Receiver Operating Characteristic curve [AUROC] = 0.90, 95% confidence interval [CI]: 0.88-0.92; P-POSSUM = 0.89, 95% CI 0.88-0.91; SRS = 0.85, 95% CI 0.82-0.87). Subjective assessment demonstrated good discrimination (AUROC = 0.89, 95% CI: 0.86-0.91) that was not different from the SORT (p = 0.309). Combining subjective assessment and the SORT improved discrimination (bootstrap optimism-corrected AUROC = 0.92, 95% CI: 0.90-0.94) and demonstrated continuous Net Reclassification Improvement (NRI = 0.13, 95% CI: 0.06-0.20, p < 0.001) compared with subjective assessment alone. Decision-curve analysis (DCA) confirmed the superiority of the SORT over other previously published models, and the SORT-clinical judgement model again performed best overall. Our study is limited by the low mortality rate, by the lack of blinding in the 'subjective' risk assessments, and because we only compared the performance of clinical risk scores as opposed to other prediction tools such as exercise testing or frailty assessment. Conclusions In this study, we observed that the combination of subjective assessment with a parsimonious risk model improved perioperative risk estimation. This may be of value in helping clinicians allocate finite resources such as critical care and to support patient involvement in clinical decision-making.
    Keywords Medicine ; R
    Subject code 310
    Language English
    Publishing date 2020-10-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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