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In the age of 'influencers', social media is exerting an ever-increasing impact in dermatology. More than half the world's population use social media and its popularity continues to grow. However, studies have confirmed that content is not always evidence based. Owing to its accessibility, social media is frequently used as an information resource for patients on managing their own skin condition. The influence that it has on parents and guardians in paediatric dermatology is less well described. A 10-point questionnaire was designed to assess social media use in parents and guardians with regard to their child's skin condition. Data were collected on parent or guardian age, sex, online platforms used and changes in management as a direct result of social media-sourced information. Children's demographics, diagnosis and disease duration were also noted. Questionnaires were anonymously distributed in a general paediatric dermatology outpatient clinic waiting room over 3 months. A chi2-test of independence was used to examine the relationship between social media use and parent or guardian age, sex and child's disease duration. In total, 116 parents and guardians participated in the survey. Average child age was 9.9 years (range 0-18), male-to-female ratio 1 : 1. Diagnoses included eczema (n = 35;30%), naevi or other skin lesions (n = 27;23%), acne (n = 18;15%) and psoriasis (n = 4;3%). Ninety-three (80%) of the dermatoses had a duration of > 1 year. Over 40% (n = 48) of parents and guardians used social media on at least one occasion as an educational resource for their child's skin condition across eight online platforms, most commonly Facebook (n = 21;44%), Google (n = 15;31%) and YouTube (n = 8;16%). There was no significant relationship between social media use and parent or guardian age (P = 0.89), sex (P = 0.10) or disease duration (P = 0.77). Of the 48 social media users, 26 (54%) parents and guardians changed their use of over-the-counter products, and a further 14 (29%) altered use of physician-prescribed treatments as a result of social media-derived information. Our findings suggest that a significant number of parents and guardians use social media to understand their child's dermatosis and some change the management based on it. Following the COVID-19 pandemic, a shift to virtual platforms for human interactions has fuelled the use of social media. With its growing popularity, it is likely that dermatologicalrelated content will also increase and therefore this should be addressed in both adult and paediatric clinics.
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INTRODUCTION: Physicians' wellbeing is a priority to prevent increasing rates of poor mental health and burnout, exacerbated by caregiving during the COVID-19 pandemic. Structured mindfulness courses have been shown to be beneficial, but face-to-face delivery is not always feasible in the context of busy health services. Remotely delivered structured mindfulness courses could enable wider participation, particularly at time when social distancing to prevent infection transmission is necessary. Our objective was to test the feasibility of a remotely delivered structured mindfulness course for hospital doctors during the COVID-19 pandemic. METHODS: This was a feasibility study run at one English hospital between January and March 2021, when COVID-19 admissions were at a high. Interested doctors participated in a 6-session remotely delivered mindfulness course. Sessions lasted 90 min and could be attended on-line or the recording watched at later time. Main outcome measures were data on interest, course attendance and engagement, together with validated psychological outcome measures at baseline and follow-up after course completion. RESULTS: 20 doctors expressed interest to participate and 16 started the course. Of these, 12 completed at least 3 sessions (median = 4); difficulty attending resulted from conflicting clinical commitments and rosters. Twelve participants completed the follow-up survey. They rated the course highly and all perceived it to have been useful, with statistically significant (P < .01) improvements in wellbeing and mindfulness scores. They all stated that they would recommend this course to their colleagues and most (10/12) were interested in follow-up mindfulness sessions. CONCLUSION: Remotely delivered structured mindfulness training for hospital doctors was feasible, but there is a need to address the difficulties that affected attendance in order to optimize accessibility and completion of such programs.
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COVID-19 , Mindfulness , Physicians , Humans , Pandemics , Adaptation, Psychological , HospitalsABSTRACT
Background: Patients with autoimmune infammatory rheumatic diseases are susceptible to infections. This could be attributed to theimmunosuppressive effect of the underlying condition or the use of immunomodulatory medications. According to the Department of Health guidelines inthe UK and the European League Against Rheumatism (EULAR), patients who are immunosuppressed should be vaccinated against infuenza and pneumococcal infection, as well as COVID-19 infection. Objectives: Our aim was to explore the Pneumococcal, Infuenza and COVID-19 vaccination uptake of our patients with different autoimmune infammatory rheu-matological conditions. In addition, to assess the side effects profile and the status of their underlying rheumatological diseases following COVID-19 vaccination. Methods: We undertook a prospective audit of consecutive patients with regards to their vaccination update for infuenza, pneumococcus, and COVID-19, utilizing a standard questionnaire and compared the results to our 2017 data. Results: Some 81% of patients received the infuenza vaccination (compared to 47% in 2017) representing a 172% improvement, p<0.001. Some 53% received the pneumococcus vaccination compared to 28% in 2017, indicating a 185% improvement, p=0.003. With regards to COVID-19 vaccination, 98/101(97%) of eligible patients received at least one dose and 66% received two doses. 47% received Astra Zeneca, 52% Pfzer and 1% unsure. 46% of patients mentioned, no one specifcally discussed the COVID vaccine with them-got information via SMS/from media, However, 37% of patients were informed by GP Doctor/Nurse, 14% from the person giving the vaccine, and 7% from specialist hospital doctor. Safety concerns were indicated by all 3 patients who deferred vaccination. Most side-effects were observed following the frst dose (74 patients) vs. the second dose (13 patients) and were mainly mild (66%), but also moderate (19%) and severe (15%). The sore arm was the commonest side-effect, whilst the majority of side-effects resolved within two days. Crucially, 28% reported a fare of the rheumatological condition following the vaccination. No patients receiving at least one dose were diagnosed with COVID-19 infection subsequently. Conclusion: Vaccination rates for infuenza and pneumococcus have improved substantially since 2017, although the population with rheumatic diseases still has low uptake in pneumococcal vaccination. The COVID-19 vaccination uptake has been extremely high in this cohort.
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Introduction Although Norway had lower infection rates and fewer patients hospitalized during the first year of the covid- 19 pandemic, measures taken to avoid anticipated pressure on health care involved hard priorities of patients and staff. How did doctors experience this situation? We studied doctors' knowledge about, and adherence to, guidelines and regulations on priority setting, and whether the actual priorities were considered reasonable and justifiable. Method 2316 members of a representative panel of doctors practicing in Norway received a questionnaire in December 2020. Data were analysed by descriptive statistics and regression analyses. Results 1617 of 2316 (70%) responded. A majority reported familiarity with the official priority criteria, but not with the particular legislation on priority setting (the Priority Regulation/ Prioriteringsforskriften), or the Directorate of Health's Guidelines for priority setting during the pandemic. 60-74% did not use guidelines for priority setting. 60,5% experienced that some of their patients got lower priority for treatment. Of these, 47% considered this medically indefensible to some/ a large extent. We saw a significant difference between GPs, hospital doctors and private specialists in considering the lower priority indefensible: 42,6% (hospital doctors), and 57,8% (GPs). Regression analysis showed that increased age involved fewer claims of lower priority, controlling for age and workplace, while working in primary care increased the probability of considering the priorities medically indefensible, controlling for age and gender. Discussion If priority setting in clinical practice is to proceed in accordance with priority setting principles and guidelines, doctors' familiarity with them must improve. Apparently, the clinical priority setting in response to the pandemic was considered medically indefensible by many doctors. One interpretation is that doctors have judged that the rationing of care went too far;another is that the society, including politicians, patients, and doctors, find it hard to accept rationing of care for particular patient groups.
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Background: COVID-19 pandemic placed unusual additional burden upon international healthcare systems. This study aims to explore the associations between burnout, alexithymia and defense mechanisms in a group of Italian hospital physicians during the COVID-19 pandemic. Methods: 96 hospital physicians completed self-reported questionnaires through Google Forms platform, including Maslach Burnout Inventory (MBI), Defense Style Questionnaire-40 (DSQ-40), and 20- item Toronto Alexithymia Scale (TAS-20). Results: Emotional Exhaustion (EE) and Depersonalization (DP) burnout dimensions were positively correlated with alexithymia and with immature and neurotic defenses, while negative associations were correlated with a mature defensive style. MBI Personal Accomplishment (PA) was negatively correlated with alexithymia levels but positively correlated with mature defenses. According to regression models, EE levels were predicted by female gender (beta = -0.20;p <.04) and DSQ mature defenses (beta= -.24;p<.02);DP levels were predicted by alexithymia total score (beta= 0.26;p <.04) and DSQ mature defenses (beta= -.20;p<.05);and PA levels were predicted by alexithymia total score (beta = -0.29;p <.02) and DSQ mature defense (beta=.45;p<.001). Conclusions: Consistent with the broader literature, an association between burnout and both alexithymia and defense mechanisms emerged. These findings highlight the importance of reducing occupational-related burden on healthcare workers and of promoting protecting strategies to deal with emergency situations.
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Introduction: Children appear less susceptible to SARS-CoV2 infection comparing to adults;however, the burden of the disease remains unclear particularly among specific groups, including immunocompromised children. Objectives: To assess the impact of COVID-19 in children with chronic rheumatic/autoinflammatory diseases (AIRD) being treated with disease-modifying antirheumatic drugs (DMARDs). Methods: We conducted a telephone survey between May 2020 and May 2021 interviewing the parents of all children with AIRD that attend the Immunology and 2Rheumatology Unit of our center. A hospital physician inquired about AIRD characteristics, current DMAR Ds use and duration, COVID-19 main symptoms, if any, source of transmission and duration. Results: Of all 453 patients with AIRD who were currently on DMARDs, 20 children (4.4%) had tested positive for SARS-CoV2 by polymerase chain reaction of nasopharyngeal specimen, during the study period. Male/Female ratio of patients was 0.8 and the median age was 13 years old (interquartile range 5.3- 15 years). The underlying AIRD was polyarticular juvenile idiopathic arthritis (35%), followed by oligoarticular idiopathic arthritis (25%). In all cases, primary AIRD was in remission at the time of SARS-CoV2 acquisition. Comorbidities were recorded in three patients (15%), including one adolescent with chronic stable course of asthma, one case of Hashimoto thyroiditis and one child with atopic dermatitis. Six out of all patients (30%) were symptomatic, with a mild course of COVID-19. Predominant symptoms were malaise (67%), cough (67%) and fever (50%);sore throat, muscle aches and abdominal aches were also reported in 33% of cases, respectively. No hospitalizations nor flares of the underlying AIRD were recorded. No in-school transmission was documented. All patients successfully recovered after a median of three days, without experiencing any post-COVID-19 conditions, and were followed until having three serial negative molecular tests. Biologic agents were not administered during COVID-19 course, according to The American College of Rheumatology guidance. Tocilizumab and adalimumab were the most prevalent biologic DMARDs (35%) followed by etanercept (15%). None of the patients were on corticosteroids, while seven (35%) were receiving conventional DMARDs concomitantly, mainly methotrexate (86%). The six COVID-19 symptomatic children were receiving adalimumab (3/ 6), tocilizumab (1/6), canacimumab (1/6) and belimumab (1/6). Conclusion: In our small cohort of children with AIRD and DMARDs, SARS-CoV2 infection was relatively mild in all symptomatic cases without triggering any relapse of the primary AIRD. Our results may suggest a potential protective role of DMARDs in the evolution of COVID-19 among children with AIRD, particularly when the AIRD is in remission and there are no significant comorbidities.
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Introduction: Personal protective equipments (PPEs) are like war uniforms in the fight against Corona Pandemic. The limited supply of PPEs warrant their proper use not only to avoid shortage of supplies but also to prevent any infectious spread to healthcare workers. This study aimed at analyzing awareness among non-consultant hospital doctors re proper use of PPEs Method: A questionnaire was devised using local available guidelines published by university Hospital Limerick. The study was done in 2 phases. In 1st phase 100 questionnaires were distributed to non-consultant hospital doctors(NCHDs). Results were analysed and after 1st phase and emails were sent with results and local guidelines and a zoom educational session was organized. In 2nd phase, questionnaire was redistributed in a week's time and results were re analysed to close the loop. Results: 200 NCHDs participated in the study,100 in each phase. Most common age group in two phases was 21-30 yrs. Awareness about PPEs use for Covid 19 increased significantly in 2nd phase across all domains (what is included in PPEs (100% from 91%), Sequence for putting on PPEs (52% to 88% p<0.05), steps for FIT test (57% to 74% p=0.247) and sequence for removing PPEs (47% to 81% p<0.05). Conclusions: Though PPEs donning and doffing sessions were organized by the hospital officially, Awareness about effective use of PPEs among NCHDs further improved after organizing a Zoom educational session and auditing.
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Case report-IntroductionWe describe an acute onset self-limiting seronegative non-destructive symmetrical polyarthritis five weeks after laboratory confirmed COVID-19 infection.Case report-Case descriptionA 37-year-old male hospital doctor of presented to the Early Inflammatory Arthritis clinic with a four-week history of acute onset joint pain, swelling and early morning stiffness in excess of two hours. The symptoms began at the left ankle with Achilles' tendonitis but progressed over the following 72 hours to a symmetrical polyarthritis affecting the wrists, proximal interphalangeal joints, shoulders, elbows, and knees.Approximately five weeks prior to the onset of his joint symptoms he had laboratory confirmed SARS-CoV-2 infection with six days of fever, non-productive cough, and fatigue. He did not require hospitalisation.His past medical history was significant for biopsy proven non-alcoholic fatty liver disease. There was no prior history of inflammatory arthritis and no personal or family history of skin psoriasis, inflammatory bowel disease or uveitis. There was no preceding genitourinary or gastrointestinal upset. His family history was significant for a sister with seronegative rheumatoid arthritis for which she was taking sulfasalazine.Examination revealed a normal BMI, synovitis at the wrists and proximal interphalangeal joints without evidence of joint effusion in the large joints. Blood tests revealed elevations in the ESR (83 mm/hour, reference range 0-10 mm/hour) and CRP (25mg/dL, reference range <5mg/dL). Serology was negative for the rheumatoid factor, anti-CCP antibodies, antinuclear antibodies, and an extractable nuclear antigen panel. Radiographs of the affected joints were unremarkable. Serological testing was positive for anti-SARS-CoV-2 IgG antibodies.He was started on oral Prednisolone 20mg daily and an NSAID with good symptomatic response and normalisation of his ESR (5mm/hour) and CRP (<1mg/dL). The course of prednisolone was tapered over a 6-week period and he is still in steroid free remission with normal inflammatory markers at follow up. The patient was given a diagnosis of a post-viral reactive arthritis which was attributed to the preceding COVID-19 illness.Case report-DiscussionPost infectious inflammatory arthritis has been described with many viral infections including: hepatitis virus, parvovirus B19, enterovirus, rubella, alphavirus (including Chikungunya), flavivirus (including Zika), herpes viruses (including Epstein-Barr virus), varicella, cytomegalovirus and human immunodeficiency virus (HIV). Interestingly, viral arthritis has not been reported in influenza and human coronaviruses (including SARS and MERS). Arthralgia was reported in 14.9% of laboratory confirmed COVID-19 cases in China during the early phases of the pandemic but inflammatory arthritis was not well described.The clinical course of the inflammatory arthritis in this case was self-limiting with enthesitis and synovitis resolving within six weeks of onset with the mainstay of treatment being symptomatic relief in the form of non-steroidal anti-inflammatory drugs and corticosteroids.Patient perspective: When I woke up that Tuesday morning with severe joint pains and stiffness, I knew something was not right. It was not like anything I have felt before in terms of my joints, having had sports injuries in the past. It was to the point where I was even struggling to go from sitting to standing. Without Prednisolone, I feel as if I would not have been able to work and may even have been house bound. I was relieved that this inflammatory arthritis did respond to Prednisolone. After six weeks of taking Prednisolone, the condition seemed to settle.Case report-Key learning pointsA self-limiting episode of inflammatory arthritis may occur following COVID-19 infection.