Evidence check
A rapid review outlining the available evidence on a discrete topic or question. Evidence includes grey and peer review literature. View all Evidence Checks by date of publication.
Archive COVID-19 transmission risk on aircraft
Added: 25 Jun 2020
There are few instances of confirmed transmission of COVID-19 on aircraft. 12 in Zhejiang, China, one possible instance in France.(1-3)
- There are few instances of confirmed transmission of COVID-19 on aircraft. 12 in Zhejiang, China, one possible instance in France.(1-3)
- Studies using computational fluid dynamics show a theoretical increased risk of transmission if seated in close proximity to an index case. Evidence from observational studies is inconclusive.(6)
Archive The impact of COVID-19 on clinical education and training
Added: 18 Jun 2020
Updated: 19 Jun 2020
What has been the impact on the mode and content of clinical education*, and what has been trialled and/or recommended to address the impact?
How has the clinical training of postgraduate trainees† been affected?
How has the clinical training of postgraduate trainees† been affected?
- Due to the COVID-19 pandemic, many medical education programs suspended onsite activities such as clinical rotations, clerkships, and in-person lectures and examinations.
- Innovations and changes often relate to virtual distance-learning formats, such as videoconferencing, live streamed ward rounds, pre-recorded lectures, podcasts, and online surveys, and discussion forums.
Archive Hydrotherapy and COVID-19
Added: 17 Jun 2020
Updated: 18 Jun 2020
What evidence is available regarding the safe use of pools for hydrotherapy or aquatic physiotherapy during COVID-19?
Guidance regarding COVID-19 from physiotherapy societies, government and international bodies recommends:(1-5)
Guidance regarding COVID-19 from physiotherapy societies, government and international bodies recommends:(1-5)
- Current guidance from Centers for Disease Control and Prevention (CDC) notes there is no evidence to suggest that COVID-19 can be spread to humans through the use of recreational waters such as swimming pools.(1)
Archive Nosocomial COVID-19 infections
Added: 5 Jun 2020
Is there evidence of transmission of COVID-19 to and from healthcare professionals?
What strategies are available to reduce risk of nosocomial infections of COVID-19?
What strategies are available to reduce risk of nosocomial infections of COVID-19?
- There are documented outbreaks of nosocomial spread of COVID-19, including infections in healthcare workers.
- There are multiple reports of healthcare workers infected with COVID-19, as well as accounts of healthcare workers as a source of infection. However, the direction of transmission can be difficult to determine.
- The Centre for Evidence Based Medicine reported on 15 April 2020 that 13.8% of COVID-19 positive cases in the UK were critical key workers in the National Health Service and other sectors. In China, more than 3,300 healthcare workers were infected (4% of the 81,285 reported infections), while in Spain on the 25 March nearly 6,500 medical personnel were infected, 13.6% of the country’s 47,600 total cases. As of 20 April 2020, there were 112 persons associated with the outbreak in north-west Tasmania, including 72 healthcare workers.
- In Lombardy, over-referral led to significant numbers of unwell people presenting to hospital, with subsequent spread within the facility. Healthcare workers then had a higher risk of exposure and became vectors of onwards transmission.
- Factors identified as contributing to nosocomial spread include: staff continuing to work despite showing symptoms, contact time, workplace activities, shortcomings in infection control practices, incomplete or delayed identification of close contacts of confirmed cases, high levels of staff mobility between different healthcare facilities, transfer of undiagnosed infectious or incubating patients between healthcare facilities.
- Use of personal protective equipment (PPE), staff surveillance, infection prevention, control and monitoring, isolating suspected or confirmed COVID-19 cases, social distancing in hospitals, real-time monitoring of staff, setting up infection control teams, measuring body temperature or testing staff, roster changes and team grouping are strategies described to mitigate the risk of nosocomial infection in healthcare workers.
- Modelling from the Imperial College COVID-19 response team found PCR screening of healthcare workers could reduce transmission of COVID-19 by a further 16-23%, on top of self-isolation based on symptoms, if results were available within 24 hours.
- Healthcare workers are at different risk of infection based on factors such as setting, clinical role and their interactions with others.
- There is a relationship between the stage of the pandemic and risk, e.g. in China most infections among healthcare workers occurred during the early stage of the outbreak, before protective measures were implemented.
Archive Computed tomography use during the COVID-19 pandemic
Added: 4 Jun 2020
What is evidence for the use of computed tomography (CT) in patients with COVID-19?
2. What alternative imaging/diagnostics are being used if CT is not recommended?
2. What alternative imaging/diagnostics are being used if CT is not recommended?
- Articles published early in the pandemic described the use of CT as a primary or adjunct technique for diagnosing COVID-19. More recently, practice has moved away from the use of CT for primary diagnosis due to poor utility and safety concerns.
- Practice varies in the use of CT on patients with COVID-19. According to five large systematic reviews, CT has been used to identify various lung complications, including round-glass opacity, bilateral compromise, unilateral compromise, peripheral distribution, multilobular involvement and consolidation.
- There are no comparative diagnostic imaging studies, no comparative effectiveness research, nor health technology assessments comparing CT with another technique for diagnosing COVID-19.
Archive COVID-19 infectivity and transmission in children
Added: 4 Jun 2020
What is the evidence on the infection rate, infectivity and transmission of COVID-19 in children?
- Publications have generally found a lower attack rate in children compared to adults.
- Prevalence of COVID-19 infection is reported to be lower in children than in adults, however prevalence can be difficult to determine in children as most present with mild or no apparent symptoms.
- There is preliminary evidence that children and young people have lower susceptibility to COVID-19, with a 56% lower odds of being an infected contact compared with adults.
Archive Virtual care and telehealth for specific conditions
Added: 28 May 2020
What is the available evidence about the effective use of telemedicine or virtual care in different clinical areas?
- Telehealth has been shown to improve access to care, is acceptable to patients and clinicians, and available technology can provide high-quality and secure information transfer.
- The application of telehealth spans from the highly technical to the person centred and from time-limited acute encounters to ongoing episodes or series of care.
- Strongest evidence is available for the acute management of ischaemic stroke via telestroke and for monitoring and management of chronic conditions such as diabetes and heart failure.
- Tele-ICU, tele-mental health and tele-rehabilitation have also been associated with positive outcomes.
- Much of the available evidence is of low quality.
Archive Preserving consumer and patient partnership during COVID-19
Added: 28 May 2020
How can we preserve consumer and patient partnership approaches during COVID-19? Specifically, what guidance is available for patient experience and person-centred care in renal care?
- In response to the COVID-19 pandemic, organisations are using initiatives and programs to preserve patient experience and person-centred care. NSW Health is expanding the ‘Patient Experience Program’ to COVID-19 clinics. This initiative involves four key strategies: patient experience officers, information technology, waiting room enhancements and staff support and development. The Point of Care Foundation in the UK has implemented ‘Team Time’, online reflective practice sessions for health professionals to share experiences of their work in health and social care. Patient partnership champions have called for the immediate recognition of families as ‘essential partners in care’ not ‘visitors’ in response to COVID-19 visitor policies. The Beryl Institute further suggests the need to reinstate responsible access and visitation policies that balance clinical and personal needs. Hospitals are using virtual visiting solutions, apps and smart devices to support communication between patients and families. McMaster University and the National Hospice and Palliative Care Organisation have developed patient decision aids to support shared decision making during COVID-19.
- A May 2020 Beryl Institute survey on US patient experience in healthcare found despite lower engagement in healthcare activities in the context of COVID-19, consumers were more positive about overall healthcare quality and their own care experiences compared to the previous survey in January 2020.
- Evidence based guidance on the introduction and use of video consultations during COVID-19 notes that technology can alter the quality of clinical encounters and outcomes. Expert opinion is that video consultation is preferable to telephone as it supports relationship building and allows patients to feel more comfortable.
- Australia’s Health Panel asked 95 panellists about their views and perceptions on the use of telehealth in Australia during March 2020. Only one third (n=32) had ever been offered a telehealth service and the majority found it to be of excellent or good quality. When compared to regular face-to-face consultations, 11 panellists believed it was better than face-to-face, 9 thought it was worse and 8 thought it was more or less the same.
- In renal care during COVID-19, opinion recommends transparency when disclosing information to patients in dialysis units. This includes communicating what patients can and cannot expect from the service during COVID-19.
- Broader evidence base for renal care. o A systematic review found person-centred integrated care may have little effect on mortality or quality of life. o Evidence from a number of studies suggests patient education and shared decision making can help achieve person-centred care for people with chronic kidney diseases. o Expert opinion suggests a collaborative approach, using shared goals rather than prescribed targets, a greater understanding by the individual of their condition and their treatment can lead to better decision-making and a more positive experience of care.
Rapid evidence checks are based on a simplified review method and may not be entirely exhaustive, but aim to provide a balanced assessment of what is already known about a specific problem or issue. This brief has not been peer-reviewed and should not be a substitute for individual clinical judgement, nor is it an endorsed position of NSW Health. Evidence checks are archived a year after the date of publication.