Oral epithelium response of electronic cigarette users to electronic cigarette.

BACKGROUND: Electronic cigarettes are increasing in popularity, but there is only little information on their biologic effects on the oral epithelium, the initial site exposed to electronic cigarette smoke. METHODS: We assessed the oral epithelium response to electronic cigarettes by comparing the histology and RNA transcriptome (mRNA and miRNA) of healthy electronic cigarette vapers to nonsmokers. mRNA was assessed based on: (1) genome-wide; (2) genes previously identified as dysregulated in the oral epithelium of electronic cigarette vapers versus nonsmokers; (3) immune and inflammatory-related genes previously identified as dysregulated in the nasal epithelium of electronic cigarette vapers compared to nonsmokers; (4) genes previously identified as dysregulated in the small airway epithelium of nonsmokers following an acute exposure to electronic cigarette; and (5) genes related to the initial steps of COVID-19 infection. In addition, miRNA was assessed genome-wide. Comparisons were performed using analysis of variance, and Benajmini-Hochberg corrected p < 0.05 was considered significant. RESULTS: The histology of the epithelium, lamina propria and basal layer in electronic cigarette vapers appeared normal. Assessment of mRNA and miRNA, based on all gene lists, did not identify any genes significantly modified in the oral epithelium of electronic cigarette vapers in response to electronic cigarette use. CONCLUSION: An average history of 2 years of vaping results in no detectable histologic or transcriptome abnormalities in the buccal mucosa.

Atypical herpetic ulcerations in COVID-19 positive patients: A report of three cases.

Since the global COVID-19 pandemic, numerous reports have been made regarding oral lesions seen in COVID-19 patients. It remains unclear whether or not these are true manifestations of COVID-19. Here we present 3 patients who were hospitalized for COVID-19 and who developed atypical herpetic ulcerations during their treatment with remdesivir (Veklury) and steroids. In healthy patients, recurrent infection by herpes simplex virus (HSV) presents as lesions only on the lips and the attached oral mucosa. Atypical herpetic ulcerations are seen in immunocompromised patients. They present as large, stellate shaped ulcerations with raised borders and may involve movable mucosa. The 3 cases presented in this report resembled the atypical herpetic ulcerations typically seen in patients with immunosuppression. Through our report, we aimed to introduce the possibility of atypical herpetic ulcers in patients being treated for COVID-19, to allow for their timely diagnosis and to raise awareness of the underlying immunocompromised state.

THE EFFECT OF CONVERTING AN INTEGRATED BEHAVIORAL HEALTH PRACTICE TO TELEHEALTH DURING THE COVID-19 PANDEMIC

STATEMENT OF PROBLEM/QUESTION: When COVID-19 emerged in March 2020, we transitioned to 100% telemedicine visits. We asked: 1. Is our practice providing equitable depression screening and care for patients after transitioning to telemedicine? 2. How might we improve access to care and increase equity for depression in our practice and systemwide? DESCRIPTION OF PROGRAM/INTERVENTION: In March 2019, we integrated mental health services at our academic faculty internal medicine practice consisting of over 5000 patients. We implemented the Collaborative Care model (University Washington, AIMS): 1) to consistently identify patients in primary care with distressing depressive symptoms, and 2) to quickly treat patients with distressing symptoms of depression. We began systematically screening patients for depressive symptom severity and treated using a team-based approach. The team-based approach included psychotherapy, psychiatric consultation, support for psychosocial needs, and online resources. MEASURES OF SUCCESS: We will describe our workflow and program evaluation measures. We explored whether differences in screening and treatment rates occurred based on age, sex and payor status comparing patients screened and treated one year before versus one year after the start of the COVID pandemic as we transitioned to using telemedicine. Patients were defined as “screened” if the Patient Health Questionnaire, 9-item version (PHQ-9) was administered at their physical examination, Annual Wellness Visit, or new patient visit. Patients were defined as“treated” if they enrolled in our mental health program and had more than one visit with the program psychologist. Chi-square tests of independence were conducted to determine associations between time period (Pre COVID vs Pandemic) and equity variables: age (<65 and 65+ years), payor (Medicaid vs. all others), and sex. FINDINGS TO DATE: The number of Annual Wellness, physicals and new patient visits dropped from 2,333 during the pre-COVID period to 1,464 during the pandemic period. The percentage of patients screened for depression using the PHQ-9 at physical examinations initially dropped, then increased dramatically in the Fall of 2020 and has trended back up to pre-COVID rates. Overall, our results may indicate we are offering equitable care. There were no significant differences in screening rates comparing the pre-COVID and pandemic periods stratified by age (p=.24), payor (p=.16) or sex (p=.32);patients who screened positive for depression, stratified by age (p=1.0), payer (p=.15) or sex (p=.22);or for patients who were treated on age (p=.14), payer (p=.51) or sex (p=.39). KEY LESSONS FOR DISSEMINATION: Screening and treatment of depression markedly improved in our primary care ambulatory setting since integrating mental health services. Depression screening after the start of the pandemic nearly ceased but has nearly returned to pre-COVID levels. Screening for depression in the clinic served to improve screening rates, but additional solutions are needed to modernizing telehealth tools for screening for depression.

Pharmacists' Willingness to Provide Coronavirus Disease (COVID-19) Services and the Needs to Support COVID-19 Testing, Management, and Prevention.

The need for increased testing is pivotal in the response to the coronavirus disease (COVID-19) pandemic. Recently, through the Public Readiness and Emergency Preparedness (PREP) Act, pharmacists were given the ability to order and administer COVID-19 tests, giving them a better opportunity to engage in the pandemic response across the nation as well as in Idaho. This survey sought to determine Idaho pharmacists' willingness to provide different COVID-19 related services, assess needed resources to provide such services, and identify and prioritize other unmet community needs. We conducted a nine-question, cross-sectional survey distributed to pharmacists with addresses located in Idaho. All questions in the survey were optional and focused on pharmacist's willingness to provide services, what resources and additional training they would need, difficulty with 90-day prescriptions, and solicited additional feedback using an open-ended question. A total of 229 responses were received, representing all areas of pharmacy practice, with approximately half from community settings. The majority of respondents (70%) were willing to provide COVID-19 testing. Adequate staffing, changes to workflow, and the need for billing and clear reimbursement mechanisms were most frequently cited as barriers to contributing to the COVID-19 response. In summary, we found that pharmacists are very willing to help during this crisis, but their involvement may be better facilitated with the removal of barriers.

Alaska pharmacists: First responders to the pandemic in the last frontier.

BACKGROUND: Pharmacists are among the nation's most accessible and underused health professionals. Within their scope of practice, pharmacists can prescribe and administer vaccines, conduct point-of-care testing, and address drug shortages through therapeutic substitutions. OBJECTIVES: To better use pharmacists as first responders to coronavirus disease 2019 (COVID-19), we conducted a needs and capacity assessment to (1) determine individual commitment to provide COVID-19 testing and management services, (2) identify resources required to provide these services, and (3) help prioritize unmet community needs that could be addressed by pharmacists. METHODS: In March 2020, pharmacists and student pharmacists within the Alaska Pharmacist Association worked to tailor, administer, and evaluate results from a 10-question survey, including demographics (respondent name, ZIP Code, cell phone, and alternate e-mail). The survey was developed on the basis of published COVID-19 guidelines, Centers for Disease Control and Prevention COVID-19 screening and management guidelines, National Association of Boards of Pharmacy guidance, and joint policy recommendation from pharmacy organizations. RESULTS: Pharmacies are located in the areas of greatest COVID-19 need in Alaska. Pharmacists are willing and interested in providing support. Approximately 63% of the pharmacists who completed the survey indicated that they were interested in providing COVID-19 nasal testing, 60% were interested in conducting COVID-19 antibody testing, and 93% were interested in prescribing and administering immunizations for COVID-19, as available. When asked about resources needed to enable pharmacists to prescribe antiviral therapy, 37% of the pharmacists indicated they needed additional education or training, and 39% required access to technology to bill and document provided services. CONCLUSION: The primary barrier to pharmacists augmenting the current COVID-19 response is an inability to cover the costs of providing these health services. Pharmacists in Alaska are ready to meet COVID-19-related clinical needs if public and private insurers and legislators can help address the barriers to service sustainability.