Query: health and safety protocol during pandemic

title: Commercial airline protocol during COVID 19 pandemic: An experience of Thai Airways International
abstract: Coronavirus disease 2019 (COVID 19) pandemic has affected the aviation industry. Existing protocols have relied on scientifically questionable evidence and might not lead to the optimal balance between public health safety and airlines' financial viability.  To explore the implementation feasibility of Thai Airways International protocol from the perspectives of passengers and aircrews.  An online questionnaire survey of passengers and an in depth interview with aircrews.  Two randomly selected repatriation flights operated by Thai Airways International using Boeing 777 aircraft (TG476 from Sydney and TG492 from Auckland to Bangkok) Participants 377 Thai passengers and 35 aircrews.  The mean age of passengers was 28.14 (95%CI 26.72 to 29.55) years old; 57.03% were female. TG492 passengers were mostly students and significantly younger than that of TG476 (p<0.0001) with comparable flying experience (p 0.1192) The average body temperature was 36.52 (95%CI 36.48 to 36.55) degrees Celsius. Passengers estimated average physical distances of 1.59 (95%CI 1.48 to 1.70) 1.41 (95%CI 1.29 to 1.53) and 1.26 (95%CI 1.12 to 1.41) meters at check in, boarding, and in flight, respectively. Passengers were checked for body temperature during the flight 1.97 (95%CI 1.77 to 2.18) times on average which is significantly more frequent in longer than shorter flight (p<0.0001) Passengers moved around or went to the toilet during the flight 2.00 (95%CI 1.63 to 2.37) and 2.08 (95%CI 1.73 to 2.43) times which are significantly more frequent in longer than shorter flight (p 0.0186 and 0.0049, respectively) The aircrews were satisfied with the protocol and provided several practical suggestions.  The protocol was well received by the passengers and aircrews of the repatriation flights with some suggestions for improvement.

title: Commercial Airline Protocol during Covid 19 Pandemic: An Experience of Thai Airways International
abstract: Coronavirus disease 2019 (COVID 19) pandemic has affected the aviation industry. Existing protocols have relied on scientifically questionable evidence and might not lead to the optimal balance between public health safety and airlines' financial viability.  To explore the implementation feasibility of Thai Airways International protocol from the perspectives of passengers and aircrews.  An online questionnaire survey of passengers and an in depth interview with aircrews.  Two randomly selected repatriation flights operated by Thai Airways International using Boeing 777 aircraft (TG476 from Sydney and TG492 from Auckland to Bangkok) Participants: 377 Thai passengers and 35 aircrews.  The mean age of passengers was 28.14 (95%CI 26.72 to 29.55) years old; 57.03% were female. TG492 passengers were mostly students and significantly younger than that of TG476 (p<0.0001) with comparable flying experience (p=0.1192) The average body temperature was 36.52 (95%CI 36.48 to 36.55) degrees Celsius. Passengers estimated average physical distances of 1.59 (95%CI 1.48 to 1.70) 1.41 (95%CI 1.29 to 1.53) and 1.26 (95%CI 1.12 to 1.41) meters at check in, boarding, and in flight, respectively. Passengers were checked for body temperature during the flight 1.97 (95%CI 1.77 to 2.18) times on average which is significantly more frequent in longer than shorter flight (p<0.0001) Passengers moved around or went to the toilet during the flight 2.00 (95%CI 1.63 to 2.37) and 2.08 (95%CI 1.73 to 2.43) times which are significantly more frequent in longer than shorter flight (p=0.0186 and 0.0049, respectively) The aircrews were satisfied with the protocol and provided several practical suggestions.  The protocol was well received by the passengers and aircrews of the repatriation flights with some suggestions for improvement.

title: The Severity of Traumatic Stress Associated with COVID 19 Pandemic, Perception of Support, Sense of Security, and Sense of Meaning in Life among Nurses: Research Protocol and Preliminary Results from Poland
abstract: The COVID 19 pandemic can not only affect physical health, but also mental health, resulting in sleep problems, depression, and traumatic stress. Our research investigates the level of posttraumatic stress, perceived social support, opinions on positive and negative consequences of the pandemic, sense of security and sense of meaning among nurses in the face of this new and not fully understood global epidemiological phenomenon. For this purpose, computer assisted web interviews were conducted between May 1 and May 15, 2020. Participating nurses completed the following research tools: The Impact Event Scale Revised (IES R) The Multidimensional Scale of Perceived Social Support (MSPSS) The Changes in Outlook Questionnaire (CIOQ) The Safety Experience Questionnaire (SEQ) and The Meaning in Life Questionnaire (MLQ) Three hundred and twenty five nurses of an average age of 39.18 11.16 years and working throughout Poland joined the study. The average overall IES R score in the study group was 1.78 0.65. Among the dimensions of traumatic stress, the highest score was obtained in the "avoidance" dimension was 1.86 0.73. Amongst participating nurses, the highest support rates were provided by significant others (22.58 5.22) Higher average scores were noted among participants in the subscale measuring positive psychological changes (18.56 4.04) The mean MLQ score was 5.33 0.87. A slightly higher result was observed in the subscale "presence" (5.35 1.14) The results of the research implemented during the period of severe psychological pressure associated with the COVID 19 pandemic provided information on symptoms of traumatic stress in the examined group of nurses. Their sense of security has been lowered and accompanied by an intensified reflection on issues concerning security. However, their current sense of meaning in life remains higher than the tendency to searching for it. The surveyed nurses received individual support mostly from significant others (i.e. other than family and friends) They see positive changes resulting from painful experiences related to the COVID 19 pandemic, which can be characterized by adaptation in the form of post traumatic growth.

title: Closing the Psychological Treatment Gap During the COVID 19 Pandemic With a Supportive Text Messaging Program: Protocol for Implementation and Evaluation
abstract: Coronavirus disease (COVID 19) has spread globally with far reaching, significant, and unprecedented impacts on health and everyday life. Threats to mental health, psychological safety, and well being are now emerging, increasing the impact of this virus on world health. Providing support for these challenges is difficult because of the high number of people requiring support in the context of a need to maintain physical distancing. This protocol describes the use of SMS text messaging (Text4Hope) as a convenient, cost effective, and accessible population level mental health intervention. This program is evidence based, with prior research supporting good outcomes and high user satisfaction.  The project goal is to implement a program of daily supportive SMS text messaging (Text4Hope) to reduce distress related to the COVID 19 crisis, initially among Canadians. The prevalence of stress, anxiety, and depressive symptoms; the demographic correlates of the same; and the outcomes of the Text4Hope intervention in mitigating distress will be evaluated.  Self administered anonymous online questionnaires will be used to assess stress (Perceived Stress Scale) anxiety (Generalized Anxiety Disorder 7 scale [GAD 7] and depressive symptoms (Patient Health Questionnaire 9 [PHQ 9] Data will be collected at baseline (onset of SMS text messaging) the program midpoint (6 weeks) and the program endpoint (12 weeks)  Data analysis will include parametric and nonparametric techniques, focusing on primary outcomes (ie, stress, anxiety, and depressive symptoms) and metrics of use, including the number of subscribers and user satisfaction. Given the large size of the data set, machine learning and data mining methods will also be used.  This COVID 19 project will provide key information regarding prevalence rates of stress, anxiety, and depressive symptoms during the pandemic; demographic correlates of distress; and outcome data related to this scalable population level intervention. Information from this study will be valuable for practitioners and useful for informing policy and decision making regarding psychological interventions during the pandemic.

title: Novel 3D printable powered air purifying respirator for emergency use during PPE shortage of the COVID 19 pandemic: a study protocol and device safety analysis
abstract: To design a low cost 3D printable powered air purifying respirator (PAPR) that meets National Institute for Occupational Safety and Health (NIOSH) standard for flow rate and Occupational Safety and Health Administration (OSHA) standard for particle filtration for loose fitting PAPRs and that can be made with a 3D printer and widely available materials.  Detailed description of components, assembly instructions and testing of a novel PAPR design in an academic laboratory following respective protocols. The assembled PAPR must meet NIOSH standards of flow rate, 170 L/min; OSHA fit factor for particle filtration, =250 and maintain positive pressure during regular and deep breathing.  The PAPR design was run through a series of tests: air flow (L/min) particle filtration (quantitative and qualitative) and positive pressure measured inside the helmet (mm Hg)  Flow rate was 443.32 L/min (NIOSH standard: minimum 170 L/min) and overall fit factor for particle filtration was 1362 (OSHA pass level: =500) n=1. The device passed qualitative particle filtration, n=2, and measured peak pressure of 6mm Hg >0 mm Hg indicates positive pressure) in the helmet, n=1.  The Hygieia PAPR is a low cost, easily accessible, just in time 3D printable PAPR design that meets minimum NIOSH and OSHA standards for flow rate and particle filtration for loose fitting PAPR devices to be made and used when industry made designs are unavailable.

title: Endoscopic Skull Base Surgery Protocol From the Frontlines: Transnasal Surgery During the COVID 19 Pandemic
abstract: The coronavirus disease 2019 (COVID 19) pandemic disrupted the standard management paradigms for care of patients with sinus and skull base presentations due to concern for patient and health care provider safety, given the high aerosol generating potential of endonasal procedures.  We reviewed the relevant literature complied from available sources, including PubMed, Google Scholar, and otolaryngology journals providing electronic manuscripts ahead of indexing or publication.  Incorporating available evidence and the projected infection control and resource limitations at our institution, we collectively authored a dynamic set of protocols guiding (1) case stratification, (2) preoperative assessment, (3) operative setup, and (4) postoperative care of patients with sinus or skull base presentations. Due to the rapidly evolving nature of COVID 19 publications, lack of rigorous data, and urgent necessity of standardized protocols, strict inclusion and exclusion criteria were not employed.  As scarce hospital resources are diverted to COVID 19 care and staff are redeployed to forward facing roles, endonasal procedures have largely ceased, leaving patients with ongoing sinonasal and skull base complaints untreated. Skull base teams now weigh the urgency of surgery in this population with the regional availability of resources. Implications for Practice The COVID 19 pandemic will have an enduring and unpredictable impact on hospital operations and surgical skull base practices and will require a dynamic set of management protocols responsive to new evidence and changing resources. In the current resource limited environment, clinicians may utilize these protocols to assist with stratifying patients by acuity, performing preoperative assessment, and guiding peri and postoperative care.

title: A Surgical Protocol to Mitigate the SARS CoV 2 Transmission Using Multifocal Povidone Iodine Applications in Lacrimal Surgeries During Coronavirus Disease 2019 (COVID 19) Pandemic
abstract: The coronavirus disease 2019 (COVID 19) pandemic is a zoonoses caused by the SARS CoV 2 virus and is highly infectious. Presence of the virus in the shedding from the nasopharynx and oropharynx is very high, and there is conflicting evidence of its presence on the ocular surface and in tears. The lacrimal surgery usually involves the surgeon coming in contact with the ocular surface, tears, and nasal tissues. Hence, the virus transmission risk for a lacrimal surgeon is very high among the ophthalmologists. Povidone iodine (PVP I) has been used in varying concentrations for surgical preparation of the skin and mucous membranes for decades. Its safety has been well established even in ophthalmology for infection prophylaxis, where it is used as eyedrops in a concentration of 1% to 5% PVP I is also available as 1% gargles and 0.45% throat spray. PVP I has a broad spectrum of antibacterial and antiviral effects. It has 10. Health AGDo. Coronavirus (COVID 19) information on the use of surgical masks. 2020 resources/publications/coronavirus covid 19 information on theuse of surgical masks. Accessed April 26, 2020. 11. Morley AM, Jazayeri F, Ali S, et al. Factors prompting sneezing in intravenously sedated patients receiving local anesthetic injections to the eyelids. Ophthalmology 2010;117:1032 1036. 12. Hakim KY, Alsaeid MA. Comparative study between the efficacy of fentanyl, antihistamines, and dexmedetomidine in suppressing photic sneeze reflex during peribulbar block. Anesth Essays Res 2019;13:40 43. 13. Tao J, Nunery W, Kresovsky S, et al. Efficacy of fentanyl or alfentanil in suppressing reflex sneezing after propofol sedation and periocular injection.  Plast Reconstr Surg 2008;24:465 467. 14. England PH. Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID 19. 2020 guidance on shielding and protecting people defined on medical grounds as extremely vulnerable. Accessed April 26, 2020. 15. Rheumatology BCo. Important advice to keep you safe from coronavirus. 2020 Accessed April 26, 2020. 16. Little P. Non steroidal anti inflammatory drugs and covid 19. BMJ 2020;368:m1185. 17. Russell B, Moss C, Rigg A, et al. COVID 19 and treatment with NSAIDs and corticosteroids: should we be limiting their use in the clinical setting? Ecancermedicalscience 2020;14:1023. 18. Sahu KK, Mishra AK,   Accessed April 26, 2020. 21. Herrera V, Finkler N, Vincent J. Innovation and transformation in the response to COVID 19: seven areas where clinicians need to lead. NEJM Catalyst 2020;1:1 13.

title: Virtual reality videos for training and protocol dissemination during a pandemic
abstract: Preparations for the COVID 19 pandemic required healthcare teams to practice known skills, such as intubation, with renewed consideration for safety, as well as develop new Standard Operating Procedures (SOPs) for health care delivery. In these conditions, translational simulation based education (SBE) is a well known tool that supports health care teams to improve the system using design thinking methods such as walkthroughs and team based simulation. However, the pandemic has introduced two stressors on translational SBE simultaneously. Firstly, the need for rapid upskilling of front line staff and rapid change to SOPs. Secondly, the need for social or physical distancing at work, such that it quickly became inappropriate for large groups of individuals to practice in situ SBE and debrief together in close proximity. An educational approach that brings the best of translational SBE while minimizing contact and maximizing experiential learning is needed.

title: COVID 19: Closing the Psychological Treatment Gap during the Pandemic, a Protocol for Implementation and Evaluation of Text4Hope (a Supportive Text Message Program)
abstract: Coronavirus disease 2019 (COVID 19) has spread globally with far reaching, significant and unprecedented impacts on health and way of life. Threats to mental health, psychological safety and well being are now emerging, increasing the impact of this virus on world health. Providing support for these challenges is difficult because of very high numbers of people requiring support in the context of a need to maintain physical distancing. This protocol describes use of text messaging (Text4Hope) as a convenient, cost effective, and accessible population level mental health intervention. This program is evidence based, with prior research supporting good outcomes and high user satisfaction.  The project goal is to implement a program of daily supportive text messaging (Text4Hope) to reduce distress related to the COVID 19 crisis initially amongst Canadians. Prevalence of stress, anxiety and depressive symptoms, demographic correlates of the same, and the outcomes of the Text4Hope intervention in mitigating distress will be evaluated.  Self administered, anonymous, online questionnaires will be used to assess stress (Perceived Stress Scale) anxiety (GAD 7) and depressive symptoms (PHQ 9) Data will be collected at baseline (onset of text messaging) at program midpoint (6 weeks) and end (12 weeks)  Data analysis will include parametric and non parametric techniques, focusing on primary outcomes (i.e. stress, anxiety, depressive symptoms) and metrics of use, including number of subscribers and user satisfaction. Given the large size of the data set, machine learning and data mining methods will also be used.  This COVID 19 project will provide key information regarding prevalence rates of stress, anxiety, and depressive symptoms during the pandemic, demographic correlates of distress, and outcome data related to this scalable population level intervention. Information from this study will be valuable for practitioners, as useful for informing policy and decision making regarding psychological interventions during the pandemic.

title: Safety recommendations for dentists and maxillofacial surgeons during COVID 19 pandemic
abstract: Oral health professionals are at high risk of developing COVID 19 infection due to their practice of close proximity to the patients. Patients in daily dental practice can be seen with basic protection protocol. Routine and elective dental procedures should be cancelled during this pandemic situation and could be rescheduled when the situation eases. In practice, as of universal prevention strategy, all patients should be assumed as COVID 19 infected and treated accordingly. Adequate standards of hygiene and protection should be adopted for all patients to avoid potential transmission risks. During the COVID 19 pandemic, it would be crucial to categorize oral and maxillofacial surgery cases into: emergency case, urgent case, intermediate case and low priority cases. While there has been a growing literature suggesting the aspect of critical care associated in treating these patients, ample of evidence indicates how this COVID 19 pandemic will affect surgical practice. Here we highlight the current unfavorable situation due to COVID 19 and offer recommendations for changes to dental and maxillofacial surgical practices.