COVID-19 vaccination status and its impact on psoriatic lesions in patients with psoriasis treated with biologics: a single-center cross-sectional study.

Objective To investigate COVID-19 vaccination status and relevant adverse reactions in patients with psoriasis treated with biological agents, and to explore the effect of COVID-19 vaccination on psoriatic lesions. Methods Clinical data were collected from 572 psoriasis patients aged 18-60 years, who were registered in the management system of psoriasis patients treated with biological agents in the University of Hong Kong-Shenzhen Hospital from May 2019 to June 2021. The COVID-19 vaccination status was investigated by telephone interviews, and the vaccination-related information was obtained by fixed healthcare workers during a fixed time period according to a predesigned questionnaire. Measurement data were compared between two groups by using t test, and enumeration data were compared by using chi- square test or Fisher's exact test. Results The COVID-19 vaccination coverage rate was 43.13%226 casesamong the 524 patients who completed the telephone interview, and was significantly lower in the biological agent treatment group30.79%, 105/341than in the traditional drug treatment group66.12%, 121/183;chi2 = 60.60, P < 0.001. The main reason for not being vaccinated was patients' fear of vaccine safety49.66%, 148/298, followed by doctors' not recommending26.51%, 79/298. In the biological agent treatment group after vaccination, the exacerbation of psoriatic lesions was more common in patients receiving prolonged-interval treatment42.86%, 6/14compared with those receiving regular treatment 4.40%, 4/91;Fisher's exact test, P < 0.001. Skin lesions were severely aggravated in two patients after COVID-19 vaccination, who ever experienced allergic reactions and whose skin lesions did not completely subside after the treatment with biological agents. Conclusions The COVID-19 vaccination coverage rate was relatively low in the psoriasis patients treated with biological agents, and no serious adverse reaction was observed after vaccination. Prolonged-interval treatment due to COVID-19 vaccination ran the risk of exacerbation of skin lesions.Copyright © The Author(s) 2023.

Dermatologists' perceptions of using teledermatology to manage hidradenitis suppurativa

The COVID-19 pandemic has led to rapid adoption of teledermatology. Hidradenitis Suppurativa (HS) is a chronic inflammatory condition that requires recurrent clinical evaluation and may be subjected to privacy concerns amongst patients when managed over teledermatology. We assessed dermatologists' perceptions of teledermatology in managing HS. Participants were invited to completed a survey electronically via a secure online platform. The survey was disseminated to members of the Asia Pacific Hidradenitis Suppurativa Foundation and through word of mouth, over February to June 2022. Demographics and survey responses were collated. Associations between demographics and attitudes towards teledermatology for HS were evaluated by multivariable ordered logistic regression. 100 responses were obtained comprising of 76 (81.7%) dermatologists and 17 dermatology trainees (18.3%). Older physicians tended to express sentiments that it was difficult to accurately assess disease severity for HS.There was increased tendency for physicians to perceive difficulty in managing HS compared to AD (assessed as a control cohort) - in terms of photography of sensitive areas (adjusted OR 4.71 (95% confidence interval: 2.44-9.07);p value < 0.001), accurate assessment (adjusted OR 2.66 (95% confidence interval: 1.48-4.79);p value 0.001), privacy issues from examination of private body areas (adjusted OR 2.75 (95% confidence interval 1.36-5.56);p value 0.005). This study, is the first, to our knowledge that assess physician attitudes towards the use of teledermatology in managing HS patients, and compares differential perspectives of its use on HS and AD patients. Physicians' efforts should be focused on streamlining patient selection and optimizing consult environments for patients with HS.Copyright © 2023

Knowledge, Perception, and Reporting Practices of Healthcare Providers about Adverse Events Following the COVID-19 Vaccination in Iraq

Routine vaccination activities, such as detection, reporting, and management of adverse events following immunization (AEFIs), are generally handled by healthcare providers (HCPs). Safe vaccines against severe acute respiratory syndrome coronavirus (SARS-CoV-2) were introduced to control the Coronavirus Disease-19 (COVID-19) pandemic. The study aimed to assess the knowledge, perceptions, and practice of HCPs in Iraq about reporting adverse events following COVID-19 vaccination, and their association with sociodemographic variables. The study was a cross-sectional study that was carried out between August and September 2021 at the COVID-19 vaccination centers in Iraq. This study used an online and paper-based questionnaire, which was distributed among HCPs (physicians and pharmacists) in COVID-19 vaccination centers. A total of 117 pharmacists and physicians responded to the survey. Two-thirds of respondents were pharmacists. The majority of the respondents (49.6%) had fair knowledge levels on AEFIs. The perception of 43% of the participants was very good, whereas the perception of 28%, 23%, and 6% of the participants was fair, good, and poor, respectively. The reporting practice of HCPs was inadequate in 53% of respondents. The number of pharmacists who had good knowledge of AEFIs was significantly higher than that of the physicians. The age group (30-39) years of HCPs was significantly associated with more positive perception towards AEFIs. The number of pharmacists that had good perception was significantly higher than that of the physicians. Furthermore, HCPs aged 30 to 39 years had significantly higher reporting practices than other age groups. The study highlighted that the HCPs working at the COVID-19 vaccination centers have low knowledge of AEFIs. On the other hand, HCPs had more positive perception towards reporting AEFIs. Education programs and reference materials are needed to increase their awareness about AEFIs.Copyright © 2022 University of Baghdad - College of Pharmacy. All rights reserved.

Increase of high flow nasal cannulas use after the pandemic in bronchiolitis: a more severe disease or a changed physician's attitude?

In the 2020-2021 winter season, COVID related measures reduced the incidence of bronchiolitis to a tenth. The aim of this study was to describe the chat-up of hospitalization for bronchiolitis during the latter winter. The primary outcome was the prevalence of high flow nasal cannula (HFNC) that spread over the pre-pandemic decade. We performed a retrospective study at four Italian hospitals collecting data on infants (<1 year) hospitalized for bronchiolitis from September 1st to March 31st. During the last winter, 197 out of 300 patients (66%) received HFNC treatment;5 patients out of 22 (23%) during the pandemic winter(p<0.001);99 out of 259 (38%) and 102 out of 295 (35%) in the latter two pre-pandemic winters (p<0.001). Non-invasive ventilation and continuous positive airway pressure use similarly increased: 68 patients (23%) in the last winter vs 2 (9%) in the pandemic winter;42 (16%) and 36 (12%) in the latter two pre-pandemic winters (p=0.003). Intensive care admission increased to 29% from 22-15% of the pre-pandemic period. HFNC use was extended this winter to 2.8+/- 2.7 days vs 1.7+/- 2.7 and 1.3 +/- 2.2 in the two pre-pandemic SOPswinters respectively (p<0.001). On the opposite, all the other severity indexes such as intubation need, in-hospital length of stay or ICU length of stay did not differ. Therefore a more severe disease course behind the respiratory support choice seem unlikely and we rather recognize a change in paediatrician attitude to less tolerate respiratory distress with an easier step-up in respiratory support leading to an overtreatment starting with a non-evidence-based and maybe non wisely choice of HFNC candidates.

COMPARISON OF PATIENT SATISFATCION SCORES BETWEEN TELEMEDICINE AND IN-PEROSN VISITS AT AN ACADEMIC PRIMARY CARE PRACTICE

BACKGROUND: Telemedicine, in various forms, has existed for over 100 years. Increased bandwidth and emergence of easily accessible video communication over the last 15-20 years has led to video health or “telemedicine” gaining momentum. In the COVID pandemic there was an accelerated uptake of telemedicine at Academic Medical Centers (AMCs). There has been debate over this rapid implementation and the quality of care delivered by video visits. To examine this issue, we looked at our own academic primary care practice patient satisfaction scores to see if people were less satisfied with their interaction with medical providers during video visits versus in person medical visits. METHODS: Mount Sinai Health System uses a private vendor called Q reviews to evaluate patient satisfaction with 24 hours of a health care visit. With-in minutes post-visit patients receive a text-based message to their mobile phone with a link to the review site. A 5-point Likert Scale is used for all questions. We performed a retrospective study to compare the patient experience in a primary care practice at Mount Sinai Beth Israel. RESULTS: We reviewed all patient responses (1821) for in-person or video visits from June 1, 2020 to April 30, 2021. We compared responses for the three questions on the physician role (see table) Overall, patient satisfaction did not differ statistically on these questions. Response rates were similar;1,427/ 7,913 (18%) for in-person visit and 394/2,543 (15%) for telemedicine visits. CONCLUSIONS: We found no statistically significant difference found in patient satisfaction between video visits and in-person visits on the provider specific questions we reviewed. Many worry, about this rapid transition to video visits driven by the COVID-19 pandemic and propose a return to the majority or entirety of health care visits being in person, when possible. Prior to the pandemic new companies were entering the health care market place providing telehealth or video visits and taking patients from traditional office-based practices. Many AMC patients face significant social and financial hurdles to attending in person visits. This retrospective data shows that AMC based practices can and do provide a high level of engagement for patients whose visits are appropriate for a video visit. While this cohort may have had some self-selection biases, as patients could choose which type of visit, they would attend, it does show a proof of concept that we should maintain video visits as an option for patients seen at AMC practices. Future studies should focus on if telemedicine can improve healthcare disparities and which types of cases are not appropriate for telehealth visits.

Health Care–Associated Infections: Best Practices for Prevention

Health care–associated infections (HAIs) are a significant cause of morbidity and mortality in the United States. Common examples include catheter-associated urinary tract infections, central line–associated bloodstream infections, ventilator-associated pneumonia, surgical site infections, and Clostridioides difficile infections. Standardized infection control processes and precautions have been shown to reduce the rate of HAIs, and targeted practices for HAIs have shown further reductions. Patient safety tools have been developed for various HAIs to help guide administrators and are free for public use through the Centers for Disease Control and Prevention STRIVE (States Targeting Reduction in Infections via Engagement) initiative. The Choosing Wisely initiative makes best practice recommendations for physicians to improve quality of care and reduce costs;targeted recommendations were developed to reduce the risk of HAIs. For example, using invasive devices only when indicated and for the shortest time possible reduces the risk of device-related HAIs. The goal of antibiotic stewardship is to reduce C. difficile infections and further development of multidrug-resistant organisms such as vancomycin-resistant Enterococcus and carbapenem-resistant Enterobacteriaceae. Antibiotic stewardship targets physician behaviors such as reviewing antibiotic therapy choices every 48 to 72 hours, reviewing culture results as soon as available, de-escalating antibiotic therapy when appropriate, and documenting the indications for initiating and continuing antibiotic therapy.

Knowledge, attitudes, and perceptions related to telemedicine among young doctors and nursing staff at the King Abdul-Aziz University Hospital Jeddah, KSA.

OBJECTIVE: To investigate the knowledge, perceptions, and attitude of young doctors and nurses at Kind Abdulaziz University Hospital (KAUH) Jeddah, KSA, regarding the effectiveness of telemedicine in dealing with the patients for either follow-up or continuous monitoring of chronic diseases. MATERIAL AND METHODS: This prospective cross-sectional study was carried out on the young doctors and nursing staff at KAUH. An online questionnaire addressing all the required fields, i.e., background essential demography, perceptions, acceptance, and knowledge regarding telemedicine's utility, was sent to the targeted population of health care workers. Completed responses were analyzed statistically as per study objectives. RESULTS: The response rate in our study was 85%. A total of 335 participants responded to our questionnaire. One hundred seventy-one (51.1%) were doctors, whereas one hundred sixty-four (48.9%) were the nursing staff. Among doctors, 50 (29.4%) were recent graduates, whereas, in the nursing side, 77 (46.7%) were the senior nursing students. The knowledge and attitude of the young nursing staff were relatively better than the senior staff taking part in the study and the trends were found statistically significant. CONCLUSION: Our study participants, being young, were enthusiastic, had good knowledge regarding the advantages and limitations of telemedicine in managing the selected groups of patients. Their perception and attitude were quite positive. This is an encouraging trend in the promotion of telemedicine as an established way of managing patients with special requirements in an effective way. The ongoing COVID-19 pandemic has highlighted the importance of telemedicine in emergencies to protect both patients and health care workers by reducing chronic patients' avoidable hospital visits.