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Radiation Oncology (London, England) Mar 2024Intensity-modulated radiation therapy (IMRT) is considered standard of care for head and neck squamous cell carcinoma (HNSCC). Improved conformity of IMRT and smaller... (Review)
Review
BACKGROUND
Intensity-modulated radiation therapy (IMRT) is considered standard of care for head and neck squamous cell carcinoma (HNSCC). Improved conformity of IMRT and smaller margins, however, have led to concerns of increased rates of marginal failures. We hypothesize that while patterns of failure (PoF) after IMRT for HNSCC have been published before, the quality of patient positioning and image guided radiotherapy (IGRT) have rarely been taken into account, and their importance remains unclear. This work provides a systematic review of the consideration of IGRT in PoF studies after IMRT for HNSCC.
MATERIALS AND METHODS
A systematic literature search according to PRISMA guidelines was performed on PubMed for HNSCC, IMRT and PoF terms and conference abstracts from ESTRO and ASTRO 2020 and 2021 were screened. Studies were included if they related PoF of HNSCC after IMRT to the treated volumes. Data on patient and treatment characteristics, IGRT, treatment adaptation, PoF and correlation of PoF to IGRT was extracted, categorized and analyzed.
RESULTS
One-hundred ten studies were included. The majority (70) did not report any information on IGRT. The remainder reported daily IGRT (18), daily on day 1-3 or 1-5, then weekly (7), at least weekly (12), or other schemes (3). Immobilization was performed with masks (78), non-invasive frames (4), or not reported (28). The most common PoF classification was "in-field/marginal/out-of-field", reported by 76 studies. Only one study correlated PoF in nasopharyngeal cancer patients to IGRT.
CONCLUSION
The impact of IGRT on PoF in HNSCC is severely underreported in existing literature. Only one study correlated PoF to IGRT measures and setup uncertainty. Further, most PoF studies relied on outdated terminology ("in/out-of-field"). A clearly defined and up-to-date PoF terminology is necessary to evaluate PoFs properly, as is systematic and preferably prospective data generation. PoF studies should consistently and comprehensively consider and report on IGRT.
Topics: Humans; Squamous Cell Carcinoma of Head and Neck; Radiotherapy, Intensity-Modulated; Nasopharyngeal Neoplasms; Prospective Studies; Head and Neck Neoplasms
PubMed: 38444011
DOI: 10.1186/s13014-024-02421-w -
The Journal of Hospital Infection May 2024Healthcare-associated infections (HAIs) burden healthcare globally. Amid the SARS-CoV-2 pandemic, intensified infection control measures, such as mask usage and hand... (Review)
Review
BACKGROUND
Healthcare-associated infections (HAIs) burden healthcare globally. Amid the SARS-CoV-2 pandemic, intensified infection control measures, such as mask usage and hand hygiene, were implemented.
AIM
To assess the efficacy of these measures in preventing HAIs among hospitalized patients.
METHODS
Using the PICO framework (Population, Intervention, Comparison, Outcome), the study focused on hospitalized patients and the effectiveness of anti-COVID-19 measures in preventing HAIs. A systematic review of literature published in 2020-2022 was conducted, examining interventions such as mask usage, hand hygiene, and environmental cleaning.
FINDINGS
This systematic review analysed 42 studies: two in 2020, 21 in 2021, and 19 in 2022. Most studies were from high-income countries (28). Most studies (30 out of 42) reported a reduction in HAIs after implementing anti-COVID-19 measures. Gastrointestinal infections and respiratory tract infections showed significant reduction, unlike bloodstream infections and urinary tract infections. Some wards, like cardiology and neurology, experienced reduced HAIs, unlike intensive care units and coronary care units. There was an increase in studies reporting no effect of hygiene measures on HAIs in 2022, eventually indicating a shift in effectiveness over time.
CONCLUSION
Anti-COVID-19 measures have shown selective efficacy in preventing HAIs. The study emphasizes the need for context-specific strategies and increased focus on regions with limited resources. Continued research is essential to refine infection control practices, especially in high-risk settings.
Topics: Humans; COVID-19; Cross Infection; Infection Control; SARS-CoV-2; Hand Hygiene; Masks
PubMed: 38423132
DOI: 10.1016/j.jhin.2024.02.008 -
Journal of Clinical Medicine Feb 2024: Oral midazolam is the most commonly used sedative premedication agent in pediatric patients. While effective, oral midazolam cannot reduce the incidence of emergence... (Review)
Review
Oral Dexmedetomidine Achieves Superior Effects in Mitigating Emergence Agitation and Demonstrates Comparable Sedative Effects to Oral Midazolam for Pediatric Premedication: A Systematic Review and Meta-Analysis of Randomized Controlled Studies.
: Oral midazolam is the most commonly used sedative premedication agent in pediatric patients. While effective, oral midazolam cannot reduce the incidence of emergence agitation. Oral dexmedetomidine may be effective in providing satisfactory sedation and reduce the incidence of emergence agitation, although the results of different randomized controlled trials are conflicting. : This study enrolled randomized controlled trials (RCTs) examining premedication with oral dexmedetomidine versus oral midazolam in pediatric patients undergoing general anesthesia. PubMed, the Cochrane Library, Embase, and the Web of Science database were searched from their inception until June 2023. The outcomes were the incidence of satisfactory preoperative sedation, satisfactory sedation during separation from parents, satisfactory sedation during anesthesia induction using an anesthesia mask, and the incidence of emergence agitation. : A total of 9 RCTs comprising 885 patients were analyzed. Our data revealed comparable effects of dexmedetomidine and midazolam with respect to satisfactory preoperative sedation and a satisfactory incidence of sedation during parental separation and mask acceptance before anesthesia induction. Notably, our data revealed that the rate of emergence agitation was significantly lower in pediatric patients receiving dexmedetomidine ( = 162) than in those receiving midazolam ( = 159) (odds ratio = 0.16; 95% confidence interval: 0.06 to 0.44; < 0.001; = 35%). : Data from this meta-analysis revealed comparable effects for premedication with oral dexmedetomidine or oral midazolam with respect to satisfactory sedation; furthermore, premedication with oral dexmedetomidine more effectively mitigated emergence agitation in pediatric patients receiving general anesthesia compared with oral midazolam.
PubMed: 38398486
DOI: 10.3390/jcm13041174 -
American Journal of Infection Control Jul 2024To evaluate the evidence related to maintaining the integrity and filtration efficiency of N95 and/or PFF2 respirators after decontamination in health care... (Meta-Analysis)
Meta-Analysis
Integrity and filtration efficiency of decontaminated N95/PFF2 masks to protect health care professionals against COVID-19: A systematic literature review and meta-analysis.
BACKGROUND
To evaluate the evidence related to maintaining the integrity and filtration efficiency of N95 and/or PFF2 respirators after decontamination in health care professionals' protection against COVID-19.
METHODS
Systematic review, developed based on the guidelines from Joanna Briggs Institute for syntheses focusing on effectiveness evidence. The protocol was registered on the International Prospective Register of Ongoing Systematic Reviews platform, under the number CRD42022354256. This study report was developed in accordance with the guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Publications between January 2020 and August 2022 were selected of Embase, Medline, CINAHL, Web of Science, Cochrane, SciELO and Virtual Health Library databases. Joanna Briggs critical appraisal tool for nonrandomized experimental tests was used to evaluate the evidence quality.
RESULTS
Seven articles were included in the data extraction and critical evaluation, and 3 in the meta-analysis. Four studies evaluated the integrity by visual inspection and 2 by electron microscopy. There was no association between the number of cycles increase and the reduction in filtration in up to 10 cycles. None study was considered of high methodological quality.
CONCLUSIONS
There is some evidence that integrity and filtration capacity were maintained after decontamination of N95/PFF2 respirators to prevent COVID-19.
Topics: Humans; COVID-19; Decontamination; Filtration; Health Personnel; SARS-CoV-2; N95 Respirators; Masks
PubMed: 38342344
DOI: 10.1016/j.ajic.2024.01.020 -
International Journal of Hygiene and... Apr 2024behaviour change interventions were central in the COVID-19 response and are vital for strengthening pandemic preparedness and resilience. To be effective, interventions...
BACKGROUND
behaviour change interventions were central in the COVID-19 response and are vital for strengthening pandemic preparedness and resilience. To be effective, interventions must target specific behavioural determinants, but determinants are complex and multifaceted and there is a gap in robust, theory driven evidence on which behavioural determinants are most effective at changing mask usage and hand hygiene behaviour.
PURPOSE
to map available evidence on the types of hand hygiene and mask usage behaviour change interventions conducted during the COVID-19 pandemic and assess their effectiveness, feasibility and acceptability.
METHODS
we conducted a systematic review, searching four peer-reviewed databases for terms related to COVID-19, targeted behaviours (hand hygiene and mask usage) and interventions. Eligible studies were those which focused on adults or children in naturalistic, non-experimental settings; reported on an intervention designed to change hand hygiene and or mask usage to reduce COVID-19 transmission; provided clear outcome measures, including through self-report, proxy indicators or observation. Studies were excluded if they were purely qualitative, opinion pieces or based on secondary data alone; focused on health workers; measured intended rather than enacted behaviour; were conducted in laboratory or health care-based settings; involved infants; were published before the 11th of March 2020 (when COVID-19 was declared a pandemic) and published in a language other than English. There were no geographical limits set. Descriptive summaries were produced and the quality of evidence and reporting was evaluated. Studies were divided into three sub-groups according to the behaviour targeted and behaviour change techniques (BCTs) were mapped. Effect estimates were summarised and the relationship between BCTs and effect was explored. Feasibility and acceptability was summarised where reported. Due to the heterogeneity of studies included, meta-analysis could not be conducted.
FINDINGS
sixteen citations met the criteria, with sub-studies (two citations including multiple studies) totalling nineteen eligible studies. The majority were randomised controlled trials which targeted hand hygiene only and were conducted in high income nations, with none conducted in crisis settings. Due to the constraints of the pandemic, many interventions were delivered online. The quality of studies was low, with the majority demonstrating a medium risk of bias (Likert scale: low, medium, high). Whilst acceptability and feasibility was good, both were rarely evaluated. 'Natural consequences' was the most commonly used BCT group. Fourteen of the studies elicited positive or potentially positive effects in at least one intervention arm and/or targeted behaviour. Effective interventions typically targeted multiple individual BCTs, including 'Instruction on how to perform a behaviour', 'Information about health consequences', and group 'Reward and threat', through repeated engagement over a sustained period of time.
CONCLUSION
there is a substantial knowledge gap, particularly in low resource and crisis settings, and available evidence is of low quality. We must address these gaps to enable evidence-based practice and strengthen pandemic preparedness and resilience. Future research should include another systematic review which includes grey literature and different languages, as well as more robust evaluations which use implementation research to explore the impact of multiple BCTs in low resource and crisis settings. Evaluations should include assessments of acceptability, practicability, affordability and equity.
Topics: Child; Infant; Adult; Humans; COVID-19; Pandemics; Hand Hygiene; Costs and Cost Analysis; Health Personnel
PubMed: 38325104
DOI: 10.1016/j.ijheh.2023.114309 -
Anesthesia and Analgesia Feb 2024The effects of oxygenation targets (partial pressure of arterial oxygen [Pao2], arterial oxygen saturation [Sao2]/peripheral oxygen saturation [Spo2], or inspiratory...
BACKGROUND
The effects of oxygenation targets (partial pressure of arterial oxygen [Pao2], arterial oxygen saturation [Sao2]/peripheral oxygen saturation [Spo2], or inspiratory oxygen concentration [Fio2] on clinical outcomes in critically ill patients remains controversial. We reviewed the existing literature to assess the effects of lower and higher oxygenation targets on the mortality rates of critically ill intensive care unit (ICU) patients.
METHODS
MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched from their dates of inception to December 31, 2022, for randomized controlled trials (RCTs) comparing lower and higher oxygenation targets for critically ill patients ≥18 years of age undergoing mechanical ventilation, nasal cannula, oxygen mask, or high-flow oxygen therapy in the ICU. Data extraction was conducted independently, and RoB 2.0 software was used to evaluate the quality of each RCT. A random-effects model was used for the meta-analysis to calculate the relative risk (RR). We used the I2 statistic as a measure of statistical heterogeneity. Certainty of evidence was assessed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines.
RESULTS
We included 12 studies with a total of 7416 patients participating in RCTs. Oxygenation targets were extremely heterogeneous between studies. The meta-analysis found no differences in mortality between lower and higher oxygenation targets for critically ill ICU patients (relative risk [RR], 1.00; 95% confidence interval [CI], 0.93-1.09; moderate certainty). The incidence of serious adverse events (RR, 0.93; 95% CI, 0.85-1.00; high certainty), mechanical ventilation-free days through day 28 (mean difference [MD], -0.05; 95%CI, -1.23 to 1.13; low certainty), the number of patients requiring renal replacement therapy (RRT) (RR, 0.96; 95% CI, 0.84-1.10; low certainty), and ICU length of stay (MD, 1.05; 95% CI, -0.04 to 2.13; very low certainty) also did not differ among patients with lower or higher oxygenation targets.
CONCLUSIONS
Critically ill ICU patients ≥18 years of age managed with lower and higher oxygenation targets did not differ in terms of mortality, RRT need, mechanical ventilation-free days through day 28, or ICU length of stay. However, due to considerable heterogeneity between specific targets in individual studies, no conclusion can be drawn regarding the effect of oxygenation targets on ICU outcomes.
PubMed: 38315626
DOI: 10.1213/ANE.0000000000006859 -
Nature Communications Jan 2024A key goal of pertussis control is to protect infants too young to be vaccinated, the age group most vulnerable to this highly contagious respiratory infection. In the... (Meta-Analysis)
Meta-Analysis
A key goal of pertussis control is to protect infants too young to be vaccinated, the age group most vulnerable to this highly contagious respiratory infection. In the last decade, maternal immunization has been deployed in many countries, successfully reducing pertussis in this age group. Because of immunological blunting, however, this strategy may erode the effectiveness of primary vaccination at later ages. Here, we systematically reviewed the literature on the relative risk (RR) of pertussis after primary immunization of infants born to vaccinated vs. unvaccinated mothers. The four studies identified had ≤6 years of follow-up and large statistical uncertainty (meta-analysis weighted mean RR: 0.71, 95% CI: 0.38-1.32). To interpret this evidence, we designed a new mathematical model with explicit blunting mechanisms and evaluated maternal immunization's short- and long-term impact on pertussis transmission dynamics. We show that transient dynamics can mask blunting for at least a decade after rolling out maternal immunization. Hence, the current epidemiological evidence may be insufficient to rule out modest reductions in the effectiveness of primary vaccination. Irrespective of this potential collateral cost, we predict that maternal immunization will remain effective at protecting unvaccinated newborns, supporting current public health recommendations.
Topics: Infant; Pregnancy; Female; Infant, Newborn; Humans; Whooping Cough; Vaccination; Parturition; Respiratory Tract Infections; Vaccines; Immunization
PubMed: 38297003
DOI: 10.1038/s41467-024-44943-7 -
Acute Medicine 2023To determine factors affecting inpatient sleep and assess the range and effectiveness of non-pharmacological interventions aimed at improving the sleep of patients... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine factors affecting inpatient sleep and assess the range and effectiveness of non-pharmacological interventions aimed at improving the sleep of patients admitted to regular care wards.
METHODS
A systematic literature search was conducted in five scientific databases, including articles published from inception to June 23rd, 2023. Eligible studies evaluated sleep disturbing factors or the effect of non-pharmacological intervention(s). Meta-analyses on intervention studies were conducted using a random effects model. Certainty of evidence was assessed using the GRADE approach.
RESULTS
Out of 591 potentially eligible studies, 229 were included in this review. Sleep disturbers were identified in 153 studies, and 102 studies were eligible for meta-analysis. Common factors contributing to poor sleep included noise, light, care-related interruptions, pain, and anxiety. The meta-analyses revealed large pooled effects in favor of sleep for the use of eye masks and earplugs, headphones and white noise, aromatherapy, massage, muscle relaxation and breathing exercises, and advanced nursing strategies. However, the certainty of the evidence ranged from moderate to very low.
CONCLUSION
Inpatient sleep is often disturbed by patient-related, care-related, and environmental factors. While there are promising non-pharmacological interventions, the overall quality of studies, heterogeneity in study populations, and differences in outcome measures present challenges for drawing definitive conclusions.
Topics: Humans; Inpatients; Hospitals; Hospitalization; Sleep
PubMed: 38284637
DOI: No ID Found -
The Cochrane Database of Systematic... Jan 2024Laryngeal mask airway surfactant administration (S-LMA) has the potential benefit of surfactant administration whilst avoiding endotracheal intubation and ventilation,... (Review)
Review
BACKGROUND
Laryngeal mask airway surfactant administration (S-LMA) has the potential benefit of surfactant administration whilst avoiding endotracheal intubation and ventilation, ventilator-induced lung injury and bronchopulmonary dysplasia (BPD).
OBJECTIVES
To evaluate the benefits and harms of S-LMA either as prophylaxis or treatment (rescue) compared to placebo, no treatment, or intratracheal surfactant administration via an endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) or extubate at standard criteria (S-ETT) or via other less-invasive surfactant administration (LISA) methods on morbidity and mortality in preterm infants with or at risk of respiratory distress syndrome (RDS).
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, CINAHL, and three trial registries in December 2022.
SELECTION CRITERIA
Randomised controlled trials (RCTs), cluster- or quasi-RCTs of S-LMA compared to placebo, no treatment, or other routes of administration (nebulised, pharyngeal instillation of surfactant before the first breath, thin endotracheal catheter surfactant administration or intratracheal surfactant instillation) on morbidity and mortality in preterm infants at risk of RDS. We considered published, unpublished and ongoing trials.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed studies for inclusion and extracted data. We used GRADE to assess the certainty of the evidence.
MAIN RESULTS
We included eight trials (seven new to this update) recruiting 510 newborns. Five trials (333 infants) compared S-LMA with surfactant administration via ETT with InSurE. One trial (48 infants) compared S-LMA with surfactant administration via ETT with S-ETT, and two trials (129 infants) compared S-LMA with no surfactant administration. We found no studies comparing S-LMA with LISA techniques or prophylactic or early S-LMA. S-LMA versus surfactant administration via InSurE S-LMA may have little or no effect on the composite outcome of death or BPD at 36 weeks' postmenstrual age (risk ratio (RR) 1.50, 95% confidence interval (CI) 0.27 to 8.34, I = not applicable (NA) as 1 study had 0 events; risk difference (RD) 0.02, 95% CI -0.07 to 0.10; I = 0%; 2 studies, 110 infants; low-certainty evidence). There may be a reduction in the need for mechanical ventilation at any time (RR 0.53, 95% CI 0.36 to 0.78; I = 27%; RD -0.14, 95% CI -0.22 to -0.06, I = 89%; number needed to treat for an additional beneficial outcome (NNTB) 7, 95% CI 5 to 17; 5 studies, 333 infants; low-certainty evidence). However, this was limited to four studies (236 infants) using analgesia or sedation for the InSurE group. There was little or no difference for air leak during first hospitalisation (RR 1.39, 95% CI 0.65 to 2.98; I = 0%; 5 studies, 333 infants (based on 3 studies as 2 studies had 0 events); low-certainty evidence); BPD among survivors to 36 weeks' PMA (RR 1.28, 95% CI 0.47 to 3.52; I = 0%; 4 studies, 264 infants (based on 3 studies as 1 study had 0 events); low-certainty evidence); or death (all causes) during the first hospitalisation (RR 0.28, 95% CI 0.01 to 6.60; I = NA as 2 studies had 0 events; 3 studies, 203 infants; low-certainty evidence). Neurosensory disability was not reported. Intraventricular haemorrhage ( IVH) grades III and IV were reported among the study groups (1 study, 50 infants). S-LMA versus surfactant administration via S-ETT No study reported death or BPD at 36 weeks' PMA. S-LMA may reduce the use of mechanical ventilation at any time compared with S-ETT (RR 0.47, 95% CI 0.31 to 0.71; RD -0.54, 95% CI -0.74 to -0.34; NNTB 2, 95% CI 2 to 3; 1 study, 48 infants; low-certainty evidence). We are very uncertain whether S-LMA compared with S-ETT reduces air leak during first hospitalisation (RR 2.56, 95% CI 0.11 to 59.75), IVH grade III or IV (RR 2.56, 95% CI 0.11 to 59.75) and death (all causes) during the first hospitalisation (RR 0.17, 95% CI 0.01 to 3.37) (1 study, 48 infants; very low-certainty evidence). No study reported BPD to 36 weeks' PMA or neurosensory disability. S-LMA versus no surfactant administration Rescue surfactant could be used in both groups. There may be little or no difference in death or BPD at 36 weeks (RR 1.65, 95% CI 0.85 to 3.22; I = 58%; RD 0.08, 95% CI -0.03 to 0.19; I = 0%; 2 studies, 129 infants; low-certainty evidence). There was probably a reduction in the need for mechanical ventilation at any time with S-LMA compared with nasal continuous positive airway pressure without surfactant (RR 0.57, 95% CI 0.38 to 0.85; I = 0%; RD -0.24, 95% CI -0.40 to -0.08; I = 0%; NNTB 4, 95% CI 3 to 13; 2 studies, 129 infants; moderate-certainty evidence). There was little or no difference in air leak during first hospitalisation (RR 0.65, 95% CI 0.23 to 1.88; I = 0%; 2 studies, 129 infants; low-certainty evidence) or BPD to 36 weeks' PMA (RR 1.65, 95% CI 0.85 to 3.22; I = 58%; 2 studies, 129 infants; low-certainty evidence). There were no events in either group for death during the first hospitalisation (1 study, 103 infants) or IVH grade III and IV (1 study, 103 infants). No study reported neurosensory disability.
AUTHORS' CONCLUSIONS
In preterm infants less than 36 weeks' PMA, rescue S-LMA may have little or no effect on the composite outcome of death or BPD at 36 weeks' PMA. However, it may reduce the need for mechanical ventilation at any time. This benefit is limited to trials reporting the use of analgesia or sedation in the InSurE and S-ETT groups. There is low- to very-low certainty evidence for no or little difference in neonatal morbidities and mortality. Long-term outcomes are largely unreported. In preterm infants less than 32 weeks' PMA or less than 1500 g, there are insufficient data to support or refute the use of S-LMA in clinical practice. Adequately powered trials are required to determine the effect of S-LMA for prevention or early treatment of RDS in extremely preterm infants. S-LMA use should be limited to clinical trials in this group of infants.
Topics: Infant, Newborn; Infant; Humans; Surface-Active Agents; Laryngeal Masks; Respiratory Distress Syndrome, Newborn; Respiratory Distress Syndrome; Morbidity; Infant, Extremely Premature; Bronchopulmonary Dysplasia; Cerebral Hemorrhage
PubMed: 38270182
DOI: 10.1002/14651858.CD008309.pub3 -
PLOS Global Public Health 2024To make inferences regarding the effectiveness of respiratory interventions and case isolation measures in reducing or preventing the transmission of mpox based on...
OBJECTIVES
To make inferences regarding the effectiveness of respiratory interventions and case isolation measures in reducing or preventing the transmission of mpox based on synthesis of available literature.
METHODS
The WHO Clinical Management and Infection Prevention and Control 2022 guideline and droplet precautions in healthcare facilities and home isolation infection prevention control measures for patients with mpox. We conducted a systematic review that included a broad search of five electronic databases. In a two-stage process, we initially sought only randomized controlled trials and observational comparative studies; when the search failed to yield eligible studies, the subsequent search included all study designs including clinical and environmental sampling studies.
RESULTS
No studies were identified that directly addressed airborne and droplet precautions and home isolation infection prevention control measures. To inform the review questions the review team synthesized route of transmission data in mpox. There were 2366/4309 (54.9%) cases in which investigators identified mpox infection occurring following transmission through direct physical sexual contact. There were no reported mpox cases in which investigators identified inhalation as a single route of transmission. There were 2/4309 cases in which investigators identified fomite as a single route of transmission. Clinical and environmental sampling studies isolated mpox virus in a minority of saliva, oropharangeal swabs, mpox skin lesions, and hospital room air.
CONCLUSIONS
Current findings provide compelling evidence that transmission of mpox occurs through direct physical contact. Because investigators have not reported any cases of transmission via inhalation alone, the impact of airborne and droplet infection prevention control measures in reducing transmission will be minimal. Avoiding physical contact with others, covering mpox lesions and wearing a medical mask is likely to reduce onward mpox transmission; there may be minimal reduction in transmission from additionally physically isolating patients with mild disease at home.
PubMed: 38236835
DOI: 10.1371/journal.pgph.0002731