Office 365: Microsoft Lists as a tool for a secure online second-line/systemic drug database

Pre-COVID our dermatology department had slightly fragmented and unreliable methods of storing the details of patients receiving second-line and systemic medications, such as immunosuppressive agents. Often, this information was held within individual Microsoft Excel worksheets on desktop PCs. At the onset of the COVID-19 pandemic in 2020, rapid access to this information was required to allow high-risk patients and shielding groups to be identified. We spent significant time updating and merging these separate files to form a single document. At that stage, multiuser updates and simultaneous working on a single document was not feasible, and there was often duplication and being 'locked out'. A multirow section of our newly combined document was also inadvertently deleted and could not be recovered. Thankfully, at an early stage of the COVID-19 pandemic, Microsoft 365 was rapidly adopted and rolled out in our health board. The aim was to provide a comprehensive, all-in-one digital workspace, including communications, cloud storage, backup and syncing, and productivity apps to aid working remotely and from home. Our department, in a tertiary teaching hospital, migrated to this software and it rapidly helped facilitate increased digital collaboration between clinical team members. It was recognized that its cloud storage capability would be a useful tool to help centralize and store an online, amendable patient database to record details of current and previous second- line treatments, and important information relating to shielding and COVID-19 risk status. One of the revamped application functions within Office 365 is Microsoft Lists. This offers real-time, online, secure functionality, with the ability to colour-code patients by drug, consultant and COVID-19 risk status. All members of our team have access, including administrative and clinical pharmacy staff, allowing each patient record to be easily accessed and updated. There is an additional functionality to allow email notifications of any updates (e.g. when made to specific patient entries) and even direct notification to associated stakeholders (such as government COVID-19 risk and shielding bodies). This set-up has also provided an ideal platform to allow research and clinical audit activities to be performed, which can be backwards formatted into Microsoft Excel, again for any data interpretation. Removed entries for patients no longer on second-line drugs can be automatically transferred to a linked archive list. In summary, this digital project highlights our departmental experience in using Microsoft Lists as an online, secure, cloud-based portal for patients on second-line medications and to record accurately COVID-19 risk status. It is easy to use, pleasing on the eye and its functionality could be transferrable to other clinical areas, such as in skin cancer or diagnosis logs.

Virtual undergraduate dermatology teaching using headmount camera video

Undergraduate clinical dermatology teaching in our hospital was delivered pre-COVID-19 to fourth-year medical students via an objective structured clinical examination-style circuit education session, with preselected live patients displaying important clinical presentation signs. A combination of posters, quizzes and interactive stations (e.g. topical therapy application and cryotherapy demonstration) were also used. Feedback for this consultant-delivered clinical teaching session was always excellent. However, this format did not lend itself easily to virtual teaching when COVID-19 forced immediate changes to undergraduate teaching delivery. A particular, understandable anxiety specifically reported by students was the loss of 'hands-on' clinical teaching with patients. Despite COVID-19 restrictions, a significant number of our face-toface clinics continued and so to harness these clinical teaching opportunities, both live and recorded patient video interactions were arranged. With local university and health-board approval, we obtained written patient consent to record consultations and used secure portals offered by Microsoft Office 365 to display live videos or recorded consultations using a secure NHS Microsoft Teams group, which allowed storage of these teaching videos within its One Drive application. To mimic a 'hands-on' patient interaction, a head-mount (temporal), wireless, 4 K camera was used to mirror the view of the clinician. For skin lesion consultations, ring lamp and dermoscopy magnification examination could also be included (additional still images could also be added retrospectively to any offline video edit). Full-skin examination and general dermatology findings, such as rash pattern and distribution, were highlighted. Some surgical procedures were also recorded, including local anaesthesia infiltration, skin excisions and curettage, as well as cryotherapy administration and topical therapy application. Despite novice use of this teaching technique, video quality was good and feedback excellent, with students appreciating the efforts made to provide interactive clinical teaching during an unprecedented time. Limited existing literature highlighting the use of such teaching models has mainly come from its application in postgraduate surgical specialty intraoperative teaching. We hope the merits of these techniques can be applied to current undergraduate dermatology teaching methodology. We plan to continue to record further clinical consultations to expand our existing teaching video portfolio and are likely to continue to use this as an adjunct resource in our undergraduate teaching delivery. Depending on student feedback, we may consider future professional video recording methods from our university and medical illustration colleagues.

Symmetrical drug-related intertriginous and flexural exanthema like eruption associated with COVID-19 vaccination.

This is a case of symmetrical drug-related intertriginous and flexural exanthema-like eruption following ChAdOx1 nCoV-19 (AstraZeneca-Oxford) vaccination. Investigations, including repeated skin swabs, ruled out an infectious cause. He was subsequently treated with oral prednisolone, which led to a resolution of his symptoms.

Keeping the lights on: Virtual asynchronous consultations during the COVID-19 pandemic

The COVID-19 pandemic has changed the way we deliver healthcare. During 'lockdown' all but the most urgent face-toface (F2F) consultations stopped. There will be a continuing need for innovation to maintain services, and teledermatology offers the potential to help meet demand, while continuing to maintain social distancing. We report the use of a store-andforward teledermatology platform to facilitate virtual asynchronous consultations. The platform was developed and piloted across two health boards, with initial use focused on return consultations. The restrictions imposed during the pandemic prompted its use on a larger scale, with the addition of a specific proforma for new consultations. Patients are invited to register using a web-based app, and then have a 5-day window to submit information and pictures to an assigned clinician. The clinician then responds within an agreed timeframe, and a PDF of the consultation is sent to the general practitioner automatically. The system can integrate with patientmanagement systems, although at the time of this audit it was only integrated in one of two health boards. During an 11-week period from late March 2020, 405 consultations (new 297;return 108) were completed. In total, 292 consultations involved the assessment of lesions, most referred as suspected cancers. Patients of all ages participated successfully, with 31% over the age of 60 years. Parents of 12 children also successfully participated. Responses to 219 consultations were completed from home by a clinician, highlighting the potential for the system to facilitate remote working. Outcomes from the virtual consultations included further virtual review (16%), F2F review (47%), direct surgery (12%), discharge (22%) and other treatment/investigations (3%). The majority of those needing F2F review were scheduled for routine follow-up, although 29% were booked as urgent to confirm diagnosis, typically where image quality was not sufficient for diagnostic certainty. The average time taken by the clinician was 10 min per consultation vs. 13 min for equivalent F2F. However, these timings were taken without the benefit of full system integration. Patient satisfaction was good, with 82% of respondents reporting ease of use. Forty-two per cent reported that they would normally have had to miss work to attend the clinic. The system also confers environmental benefits with a total of 5758 km of patient travel saved. This pandemic has resulted in a paradigm shift in the way we deliver outpatient care. Virtual asynchronous consultations, within an integrated dermatology service, provide an efficient alternative to some F2F consultations.