In the context of covid-19, aerosol generating procedures have been highlighted as requiring a higher grade of personal protective equipment. We investigated how official guidance documents and academic publications have classified procedures in terms of whether or not they are aerosol-generating. We performed a rapid systematic review using preferred reporting items for systematic reviews and meta-analyses standards. Guidelines, policy documents and academic papers published in english or french offering guidance on aerosol-generating procedures were eligible. We systematically searched two medical databases (medline, cochrane central) and one public search engine (google) in march and april 2020. Data on how each procedure was classified by each source were extracted. We determined the level of agreement across different guidelines for each procedure group, in terms of its classification as aerosol generating, possibly aerosol-generating, or nonaerosol-generating. 128 documents met our inclusion criteria; they contained 1248 mentions of procedures that we categorised into 39 procedure groups. Procedures classified as aerosol-generating or possibly aerosol-generating by ≥90% of documents included autopsy, surgery/postmortem procedures with high-speed devices, intubation and extubation procedures, bronchoscopy, sputum induction, manual ventilation, airway suctioning, cardiopulmonary resuscitation, tracheostomy and tracheostomy procedures, non-invasive ventilation, high-flow oxygen therapy, breaking closed ventilation systems, nebulised or aerosol therapy, and high frequency oscillatory ventilation. Disagreements existed between sources on some procedure groups, including oral and dental procedures, upper gastrointestinal endoscopy, thoracic surgery and procedures, and nasopharyngeal and oropharyngeal swabbing. There is sufficient evidence of agreement across different international guidelines to classify certain procedure groups as aerosol generating. However, some clinically relevant procedures received surprisingly little mention in our source documents. To reduce dissent on the remainder, we recommend that (a) clinicians define procedures more clearly and specifically, breaking them down into their constituent components where possible; (b) researchers undertake further studies of aerosolisation during these procedures; and (c) guideline-making and policy-making bodies address a wider range of procedures.
Résumé Objectives: We aimed to evaluate the effects of cannabis on workplace safety outcomes and road traffic collisions (using operation of a motor vehicle as a proxy for other safety-sensitive tasks) via a systematic literature review and meta-analysis. Methods: We searched MEDLINE and the reference lists of relevant articles. We extracted data on cannabis testing (requiring testing in a biological matrix for inclusion), characteristics of the participant groups, and measures of effect. Our main analysis included all eligible studies, a sensitivity analysis considered results from peer-reviewed publications only. Results: Of the 864 deduplicated hits identified by our search, 11 studies investigating road traffic collisions met our eligibility criteria and were included; there were no eligible studies on other workplace safety outcomes. We found that the presence of cannabis resulted in an increased risk estimate for road traffic collisions, with an odds ratio of 2.49 (95% confidence interval 1.68–3.71, P < 0.00001, n = 49,870). When considering peer-reviewed publications only, the odds ratio for road traffic collisions with cannabis was 2.84 (95% confidence interval 1.71–4.71, P < 0.0001, n = 38,947). Conclusions: Based on the risk increase for road traffic collisions seen in our analysis, the use of cannabis is deemed inadvisable for persons performing safety-sensitive work. Until definitive evidence on the duration of effect becomes available, we recommend restricting safety-sensitive duties for at least 24 hours after using cannabis, or for longer if there is concern about ongoing impairment. Objectifs: Nous avions pour objectif d’évaluer les effets du cannabis sur les résultats de sécurité sur les lieus de travail et sur les accidents de la route (utilisation d’un véhicule automobile comme substitut pour d’autres tâches liées à la sécurité) via une revue systématique de la littérature et une méta-analyse. Méthodes: Nous avons effectué une recherche dans MEDLINE et les listes de référence des articles pertinents. Nous avons recueilli des données sur les tests de cannabis (nécessitant des tests dans une matrice biologique pour inclusion), les caractéristiques des groupes de participants et l’évaluation de l’effet. Notre analyse principale incluait toutes les études éligibles, une analyse de discernement prenant en compte uniquement les résultats de publications revues par des pairs. Résultats: Sur les 864 réponses dédoublées identifiées par notre recherche, 11 études portant sur des collisions de la route satisfaisaient nos critères d’éligibilité et ont été incluses; il n’y a pas eu d’études admissibles sur d’autres résultats en matière de sécurité au travail. Nous avons constaté que la présence de cannabis augmentait l’estimation du risque de collision avec un ratio de probabilité (odds ratio OR) de 2,49 (intervalle de confiance à 95% (IC) de 1,68 à 3,71, p < 0,00001, n = 49870). En considérant uniquement les publications revues par les pairs, le OR pour les collisions incluant le cannabis sur la route était de 2,84 (IC 95%: 1,71 à 4,71, p < 0,0001, n = 38947). Conclusions: Sur la base de l’augmentation du risque de collision sur la route constaté dans notre analyse, l’usage du cannabis est jugé déconseillé aux personnes exécutant des travaux critiques pour la sécurité. En attendant que des preuves définitives de la durée de l’effet deviennent disponibles, nous recommandons de limiter les tâches liées à la sécurité pendant au moins 24 heures après avoir consommé du cannabis, ou plus longtemps s’il existe une préoccupation au sujet de l’incapacité.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.