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1.
Radiotherapy and Oncology ; 170:S906-S907, 2022.
Article in English | EMBASE | ID: covidwho-1967469

ABSTRACT

Purpose or Objective RTQA practice is known to have significant variation amongst institutions worldwide. It is critical to maintaining patient safety, treatment effectiveness and accuracy. However there is no standard practice, with often only target volume delineation reviewed alone and performed retrospectively. Previous studies have highlighted higher rates of changes made in more complex techniques and subsites. This study aims at evaluating our prospective structured peer review process in a proton beam therapy (PBT) centre. Materials and Methods We reviewed the RTQA cases of all patients treated at The Christie Proton Beam Centre since its opening in November 2018 until February 2021. The RTQA process is carried out weekly, is subsite specific and every case has their target volumes and plans reviewed in detail in the presence of consultants, fellows, physicists and dosimetrists. Since the COVID-19 pandemic, the peer review meetings are now virtual. Every peer review has a standardised RTQA form filled. We classified the peer reviews as having major/minor or no change. A major change was one where the target volumes (GTV and/or CTV) were too small or big;dose fractionation was incorrect to that of the prescription treated and any plan that was changed. A minor change was one where there were minor modifications to the target volumes, OARs or non-essential suggestions in relation to the plan that didn’t result in the plan being altered eg. addition of an OAR. Results There was a total of 1,209 peer reviews for 462 patients. 100% of cases had both volumes and plans peer reviewed prospectively. 591 were reviews of target volumes and 618 were plan reviews. In total there were 208 (17%) major changes, 194 (16%) minor and 807 (67%) with no changes. Of the major changes 137 (66%) were target volumes and 71 (34%) plans. Of the minor changes 174 (90%) were target volumes and 20 (10%) plans. There were more major and minor changes in the brain and head & neck subsites possibly due to their complexity. When diagnoses in the brain were categorised (Table 1) and reviewed against changes using a chi-squared test the resulting p-value = 0.027 suggests a significant relationship between type of diagnoses and likely need for change following peer review.(Table Presented) Conclusion Target volume delineation and radiotherapy plans particularly in brain, head & neck as well as other complex subsites require mandatory prospective review as highlighted above. We have shown this to be practically achievable and successful despite challenging times

2.
Radiotherapy and Oncology ; 170:S866, 2022.
Article in English | EMBASE | ID: covidwho-1967466

ABSTRACT

Purpose or Objective SABR has become standard of care for early stage lung cancer where surgery is contraindicated. As a result of the COVID- 19 pandemic access to surgery was limited and demand for SABR as primary treatment has increased. A national program to implement lung SABR in all radiotherapy centres was commissioned and an associated QA program was developed. One of its components was a planning benchmark case to ensure optimal planning of target volumes whilst sparing organs at risk following the SABR Consortium Guidelines. Results of the benefits of the QA process are presented here. Materials and Methods A dual-lesion planning benchmark DICOM dataset was circulated amongst 24 participating centres, including a planning CT and a structure set. Centres had to plan the lesions to 55Gy in 5# and meet dose constraints, coverage and conformity criteria outlined in the Guidelines. All plans were reviewed on Velocity v4.1 (Varian Medical Systems) and PTV coverage, dose distribution, plan conformity and OAR dose constraints were assessed. Prescription Dose Spillage (PDS) was used to define conformity in the high dose area as Body V100(cc)/PTV V100(cc) and Modified Gradient Index (MGI) was defined for conformity in low dose area as Body V50(cc)/PTV V100(cc). The Mann Whitney test was used to evaluate differences in conformity across plans, with statistical significance set at 5%. Results Mean V100% for first submissions for lesions 1 and 2 were 97.26% (S.D. 1.86) and 98.19 % (S.D.1.61), respectively. All mandatory OARs were well within tolerance. The largest variation across centres was plan conformity, which is summarised in Table 1. (Table Presented) Ten plans failed their first attempt and centres were asked to resubmit following detailed feedback. Mean PDS for these plans changed from 1.19 (S.D. 0.09) to 1.13 (S.D. 0.05), although this was not statistically significant (p=0.12). Mean MGI was significantly improved on resubmission, decreasing from 7.08 (S.D. 0.8) to 6.16 (S.D.0.84), (p=0.03). Figure 1 shows increase in consistency and improvement in conformity across centres after resubmission. On completion of the QA process, the final set of accepted plans had improved conformity indices from initial PDS and MGI, however these were not statistically significant (p=0.31 and p=0.13, respectively). (Figure Presented) Conclusion A national QA program for lung SABR is critical for the safe implementation of this technique and to ensure standards are consistently high across multiple centres. The planning benchmark has highlighted differences in plan conformity and technique, in particular for MGI, however feedback within the QA process has allowed for increased consistency across departments through improved quality.

3.
Gastroenterology ; 162(7):S-474, 2022.
Article in English | EMBASE | ID: covidwho-1967313

ABSTRACT

Aims: COVID-19 has exacted a worldwide devastating toll, not only through its direct effects, but also through wide-ranging indirect effects on access to and delivery of healthcare. We conducted a survey to better understand the pandemic's impact in patients with digestive disorders. We also sought to understand the rate of COVID-19 vaccination and barriers to vaccination amongst persons with digestive disorders. Methods: A web-based survey was conducted through the International Foundation for Gastrointestinal Disorders (IFFGD) website. The survey was open, internationally accessible from 8/11/21-11/17/21 and completed via the Alchemer survey tool. There were 57 questions related to demographic variables, classification of GI symptoms/disorders, care delivery and illness experience during the pandemic. Patients were also asked about their vaccination status and opinions toward receiving the vaccine. No compensation was provided. Results: Of the 322 survey responders, 210 reported chronic GI illness and were included in the analysis. Demographics are provided in table 1. Most survey respondents (68%) had disorders of gut-brain interaction (DGBI). Overall, 70% of respondents stated the pandemic impacted their gastroenterological health. Most notably, 40% of respondents reported accessing their provider during the pandemic was somewhat difficult, while 14% found it very difficult. More than half (58%) received less frequent care or access to their provider, and almost 3 in 4 visits (71%) were completed virtually. Virtual care was perceived to be of lesser quality by 38% of respondents. Procedures and/or tests were delayed > 3 months in more than half (54%). Strikingly, nearly a third (30%) reported a decrease in income that made it more difficult to see their provider, purchase a prescription or afford healthy food. In a univariable analysis, non-white participants were more likely to have a loss of income and negative impact on their access to care (p <0.04). While >80% of respondents were vaccinated for COVID-19, one in seven (16%) were unvaccinated. Demographic and disease characteristics of unvaccinated respondents can be found in table 2. Over 80% of the unvaccinated felt well informed about the risks of contracting COVID. Sixty-three percent chose not to be vaccinated because of anxiety about side effects. For unvaccinated respondents, 19% (6/32) were advised by a healthcare professional to not be vaccinated because of their GI illness. Conclusions: This survey shows that the pandemic negatively affected patients with digestive disorder's access to healthcare, disproportionately affecting those who are non-white. Additionally, we identified an important, potentially correctible gap in education surrounding COVID-19 vaccination in those with digestive disorders. (Table Presented) Table 1. Demographic characteristics of survey respondents (n: 210) (Table Presented) Table 2. Demographic characteristics and primary GI conditions of unvaccinated survey respondents (n:32)

4.
Gastroenterology ; 162(7):S-365, 2022.
Article in English | EMBASE | ID: covidwho-1967300

ABSTRACT

Introduction: Gastrointestinal symptomatology in SARS-CoV-2 infection is a common clinical presentation, reported in up to 61% in those affected, being the presence of acute diarrhea one of the most common symptoms, reported in up to 33.7%. There are multiple theories about physiopathological mechanisms of diarrhea associated with SARS-CoV2 infection, but there is not enough evidence to attribute this symptom only to the infection without the influence of host and environment factors. Objective: Determine the associated factors with acute diarrhea in Mexican population with SARS-CoV-2 infection. Methods: A case-control cross-sectional study was performed to analyze the factors associated with acute diarrhea in patients with SARS-CoV-2. This research was carried out during the 2020-2021 in five states of Mexico. An online survey was applied to 784 patients, selected by randomized sampling of whom sociodemographic data, medical history, and symptoms related to SARSCoV- 2 infection were collected. A univariate and multivariate logistic regression analysis was performed applying a χ2 test with 95% confidence intervals to determinate the association of acute diarrhea in SARS-CoV-2 infection with other symptomatology and possible nonhost contributing factors for its presentation. Results: A total of 784 patients were analyzed with a mean age of 29 ± 8 years, predominantly female with 75.4% (591). The most frequently described symptom was fatigue in 75% (588) followed by anosmia and myalgias with 67% (525) and 65.5% (514) respectively. Acute diarrhea was present in 28.6% (321) of our population during the acute phase of SARS-CoV-2 infection. The most used drugs were acetaminophen (79.2%) and azithromycin (29.7%). The multivariate logistic regression analysis showed a statistically significant association between acute diarrhea and the use of macrolides, mainly with clarithromycin with an OR of 2.96 (95% CI of 1.26-6.95, p = 0.001) followed by azithromycin with an OR of 1.47 (95% CI 1.035-2.091, p = 0.031). In this same analysis, there was no significant association of acute diarrhea with the rest of SARS-CoV-2 infection symptoms. Discussion: This study demonstrates the association of acute diarrhea in SARS-CoV-2 infection with the concomitant use of macrolides, without finding any association with described SARS-CoV-2 viral symptoms. According to the previously mentioned, we propose that a proportion of acute diarrhea associated with SARSCoV- 2 infection may be secondary to inappropriate macrolide prescription and not due to the viral disease itself.

5.
Gastroenterology ; 162(7):S-289, 2022.
Article in English | EMBASE | ID: covidwho-1967280

ABSTRACT

Introduction The COVID-19 pandemic has globally impacted public health and the world economy. This has related, in part, to challenges in accessing medical care including procedures, hospitalizations and/or surgeries that would have been otherwise warranted in their disease management. Access to care was affected during the pandemic as most providers were not seeing patients in person, but providing virtual care. Patients' perceptions of their access to care may cause significant stress and anxiety, in a population in which many already have existing mental health conditions. Methods Participants in the populationbased University of Manitoba IBD Research Registry (n=2833) were invited to participate in a survey regarding their experiences with COVID-19, during autumn 2020, just prior to and during the second pandemic wave in Manitoba. The survey included background sociodemographic and disease information (e.g., symptom severity, medication use), COVIDrelated personal and health circumstances and coping. Results There were 1384 respondents (48.9%), of which 46.9% had Crohn's disease, 40.8% had ulcerative colitis, 3.2% had ulcerative proctitis, 2.8% had IBD-U and 2.2% had an ileoanal pouch. The mean age of respondents was 57.8 years, 40.6% were male. Mean duration of disease was 24.8 years. 38.3% said the pandemic was affecting them extremely, or a lot, while 15.6% said not at all or a little. 65.5% and 62.1% of respondents felt they had good access to their non-IBD provider to discuss non-IBD health care issues, and IBD issues, respectively. Only 53% felt they had good access to their gastroenterologist to discuss their IBD. 45.3% of respondents had increased stress about accessing their physician or nurse, while 19.9% had increased stress about accessing their prescription IBD medications. 901 (65.1%) patients were on some form of IBD therapy;12.5% of IBD-medication users adjusted their IBD medications on their own, while 13.8% had a provider adjust their IBD therapy. Conclusion Our survey revealed that over half of respondents did not feel they had good access to their gastroenterologist, or had increased stress associated with accessing care or their IBD medications 9-10 months into the pandemic. Some adjusted their IBD therapies on their own. Perception regarding access to care is integral for patients with IBD, and further research is needed to understand if perceptions regarding limited access to care changed and whether or not care was in fact limited as the pandemic evolved.

6.
Research in Veterinary Science ; 2022.
Article in English | ScienceDirect | ID: covidwho-1967091

ABSTRACT

The high rate of antibiotic resistance constitutes a global threat to the continuous use of these drugs, because of increasing treatment failures. The aim of this study was to survey antibiotic prescription practices of veterinarians and the possible contribution to antimicrobial resistance (AMR) and antimicrobial stewardship (AMS) in Nigeria during the COVID era. This was a cross-sectional study that used a 33-question survey questionnaire administered to registered veterinarians in Nigeria. The study was both online survey and hard copy administered during the annual meeting of the veterinarians from July to October 2021. Descriptive statistics, bivariate analysis using Chi-square test were also done to analyze the results, while a two-tailed P-value of <0.05 at 95% confidence level was considered statistically significant. IBM SPSS Version 26 was used to analyze the data. A total of 172 respondents completed the online and hard copy questionnaire. Majority of the respondents engaged majorly in mixed veterinary practice (72.1%). A total of 53.5% were aware of the country's policy concerning antibiotic prescription, while majority (64.5%) do not do culture and sensitivity before antibiotic prescription. Majority (34.3%) felt that the risk of potential adverse drug reaction could affect their decision when choosing to prescribe an antibiotic to the owner. Majority (51.2%) felt that some antibiotics were over prescribed, while 26.7% opined that all antibiotics were appropriately prescribed. To improve antibiotic use and practice amongst veterinarians in Nigeria, dependence on laboratory services for antibiotic prescription, enforcement of national guidelines and monitoring of antibiotic prescription amongst the veterinarians is essential to curb over-prescription and strengthen antimicrobial stewardship.

7.
BMJ Leader ; 5, 2021.
Article in English | EMBASE | ID: covidwho-1965240

ABSTRACT

The proceedings contain 79 papers. The topics discussed include: the junior doctor shadow board, lessons learned from the corporate sector;workplace wellness: the impact of a series of trainee wellbeing workshops in the north east;the effectiveness of social media during the COVID-19 pandemic in engaging students and clinicians in medical leadership and management topics;use of simulation to develop leadership;quality improvement project on pediatric antibiotic prescription writing;standardizing wellbeing for junior doctors- the wellbeing checklist;the Headstart project - a peer-led introduction to the NHS for international medical graduates;navigating the storm: structuring and supporting junior doctor wellbeing during the covid-19 pandemic;and pelvic osteomyelitis complicating pressure ulcers - prevalence and management evaluation study in a district general hospital in surrey.

8.
American Journal of Public Health ; 112(8):1110-1114, 2022.
Article in English | ProQuest Central | ID: covidwho-1958495

ABSTRACT

GOVERNMENT PATENT USE One way to facilitate public access to high-cost medications is through government patent use.1 Given sovereign immunity-a legal doctrine immunizing the government from being sued without its consent-the federal government and its agents, such as generic drug manufacturers, have the ability to make or use patented inventions without the permission of the patent holder;in other words, protected by sovereign immunity, the federal government could use inventors' US patents without legal consequence (US patent rights do not apply overseas). [...]nonpatent exclusivities generally prohibit the approval of competing products only if they rely on data generated by another manufacturer. [...]the government or any third party could submit full new drug applications with original data.1,2 This strategy would not be able to circumvent Orphan Drug Act exclusivity for rare disease drugs because that act blocks the FDA from approving the "same drug" for the same disease or condition if it is a generic;however, because full trials would be needed, it might be feasible to pursue approval of a chemically distinct but therapeutically identical drug. [...]many agency actions are judicially reviewable under the Administrative Procedure Act (1946, Pub L No. 79-404)-a statute that waives the federal government's sovereign immunity. Fourth, Congress could amend the Federal Food, Drug, and Cosmetic Act (1938, Pub L No. 75-717) and the Public Health Service Act (1944, Pub L No. 78-410) to carve out exceptions to existing nonpatent exclusivities for government use.1,8 Although an exception exists for biologics the Public Health Service prepares when the biologic is unavailable from the license holder,9 this kind of authority could be expanded in terms of both to whom and to what it applies as well as under what conditions.

9.
Natural Product Communications ; 17(7), 2022.
Article in English | EMBASE | ID: covidwho-1956964

ABSTRACT

Objective: The Chinese herbal formula Huo-Xiang-Zheng-Qi (HXZQ) is effective in preventing and treating coronavirus disease 19 (COVID-19) infection;however, its mechanism remains unclear. This study used network pharmacology and molecular docking techniques to investigate the mechanism of action of HXZQ in preventing and treating COVID-19. Methods: The Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) was used to search for the active ingredients and targets of the 10 traditional Chinese medicines (TCMs) of HXZQ prescription (HXZQP). GeneCards, Online Mendelian Inheritance in Man (OMIM), Pharmacogenomics Knowledge Base (PharmGKB), Therapeutic Target Database (TTD), and DrugBank databases were used to screen COVID-19-related genes and intersect them with the targets of HXZQP to obtain the drug efficacy targets. Cytoscape 3.8 software was used to construct the drug-active ingredient–target interaction network of HXZQP and perform protein–protein interaction (PPI) network construction and topology analysis. R software was used to perform Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Finally, AutoDock Vina was utilized for molecular docking of the active ingredients of TCM and drug target proteins. Results: A total of 151 active ingredients and 250 HXZQP targets were identified. Among these, 136 active ingredients and 67 targets of HXZQP were found to be involved in the prevention and treatment of COVID-19. The core proteins identified in the PPI network were MAPK1, MAPK3, MAPK8, MAPK14, STAT3, and PTGS2. Using GO and KEGG pathway enrichment analysis, HXZQP was found to primarily participate in biological processes such as defense response to a virus, cellular response to biotic stimulus, response to lipopolysaccharide, PI3K-Akt signaling pathway, Th17 cell differentiation, HIF-1 signaling pathway, and other signaling pathways closely related to COVID-19. Molecular docking results reflected that the active ingredients of HXZQP have a reliable affinity toward EGFR, MAPK1, MAPK3, MAPK8, and STAT3 proteins. Conclusion: Our study elucidated the main targets and pathways of HXZQP in the prevention and treatment of COVID-19. The study findings provide a basis for further investigation of the pharmacological effects of HXZQP.

10.
Sexually Transmitted Infections ; 98:A74, 2022.
Article in English | EMBASE | ID: covidwho-1956944

ABSTRACT

Introduction Evaluation of effectiveness of new telephone prescribing service introduced during COVID-19 pandemic at two community sexual health centres. Service introduced to reduce infection risk for patients and staff and cater for patients requiring access to medications for common genitourinary conditions and contraception despite restrictions on face to face consultation. Methods 781 patients (age range 16-59 years) audited from two community sexual health centres. Data collected from September - November 2021 medication prescription records included patient age, gender, medication name and type and length of time (days) for prescription to be collected. Standard set to fulfil was >95% of medications collected from both sites and >95% collected within 14 days. Results 97.70% of patients collected medications from both sites. 96.01% collected medication within 14 days from site A and 95.14% collected medication within 14 days from site B. Average time taken to collect medication was 2.5 days. No found correlation between any particular medication type or patient demographic and associated longer collection time. P111 Table 1 Discussion First audit of new telephone prescribing service. Data showed effective service providing patients with medications via remote telephone consultation despite COVID-19 restrictions, with good compliance for collection. Evidence of minimal medication waste within the service. Community sexual health services able to navigate through difficulties of COVID-19 including increased demand with limited face to face consultation availability. Common prescribing services can be done remotely and effectively whilst acting as a tool for infection prevention control. Data indicates this service has multiple benefits for patients and staff so should continue post-pandemic. (Table Presented).

11.
Sexually Transmitted Infections ; 98:A71, 2022.
Article in English | EMBASE | ID: covidwho-1956940

ABSTRACT

Introduction Our service switched routine PrEP consultations to telephone appointments from May2020 due to the Covid- 19 pandemic. We undertook an audit of revised service, on patients first prescribed Emtricitabine/Tenofovir as HIV preexposure prophylaxis (PrEP) in August/September2021. Methods Retrospective review of electronic patient records conducted on first 60 patients attending PrEP start appointment from 02/08/21-22/09/21. Demographics, referral pathway, tests performed, vaccine status and prescription outcome recorded. Results compared to national BHIVA/BASHH and service guidelines. Results 10 patients excluded: 8 on NHS-PrEP already, 2 failed criteria and did not start PrEP. All 50 patients were cis-men who have sex with men, 14% bisexual. Median age 25- 34years (range:16-55+). 93%(26/28) of documented patient ethnicity was white. Self-referrals accounted for 46%(15/33) of documented referral-routes. 25(50%) patients waited ≥2months for appointment. 46 patients prescribed NHS-PrEP met recommended BHIVA/BASHH criteria, 4(8%) failed criteria and to self-source. 36(72%) patients met BHIVA/BASHH guidelines for HIV testing, negative in 4weeks before first appointment(BFA). 73%(24/33) of patients with HIV risk after testing had repeat within 6weeks. In 3months BFA, 45(90%) patients had sexual health screen (SHS) and 26(52%) patients received hepatitis B&C testing. In 4months after, 39%(7/18) repeated hepatitis B, 54%(7/13) hepatitis C tests. 94%(29/31) patients requiring vaccinations agreed to receive. 48(96%) patients had eGFR checked in 6months BFA, no eGFR<60. Discussion Our service ensures patients meet recommended criteria for NHS-PrEP prescription and undertake renal testing and SHS. Vaccines initiated for most patients in need. Proportion of patients receiving baseline hepatitis B&C testing requires improvement. Patient pathways are being reviewed to ensure testing 2-3weeks BFA.

12.
Sexually Transmitted Infections ; 98:A67-A68, 2022.
Article in English | EMBASE | ID: covidwho-1956939

ABSTRACT

Introduction Since the beginning of COVID lockdown, we have provided 28 day PEP packs from sexual health clinics, emergency departments and sexual assault referral centres to minimise number of patient contacts. This study is to look at the provision of PEP since the new initiative. Methods Patients who attended our hospital emergency department, sexual assault referral centre, and sexual health clinics between March 2020 and October 2021 were randomly selected. Retrospective patient records were reviewed and the BHIVA 2015 PEP standards were used. Results 434 patients and 468 PEP prescriptions were included. 384 (88%) were male, in whom 337 (87.8%) were MSM. 166 (38.2%) were from our emergency department. 401 (85.7%) were after sexual exposure, 56 (20.0%) were occupational exposure. 413 (88.2%) prescriptions met criteria for initiation, 43 (9.2%) did not and 3 (0.6%) had insufficient information. 448 (95.7%) had baseline blood tests. 28 (6%) did not attend sexual health clinic for follow up. 255 (54.5%) had repeat HIV test after 8-12 weeks of exposure. 213 (45.5%) did not have repeat test. STI screening was performed in 368 (78%) attendances and 106 infections were identified. Discussion The majority of PEP was prescribed appropriately and baseline testing was performed in most cases. Out study demonstrates the safety of 28-day PEP pack being issued in settings other than sexual health clinics. Post-PEP HIV testing remains poor, which is consistent with other national audits. This highlights the need for focussed work to improve followup attendance.

13.
Sexually Transmitted Infections ; 98:A64, 2022.
Article in English | EMBASE | ID: covidwho-1956936

ABSTRACT

Introduction BHIVA guidelines recommend that those prescribed pre-exposure prophylaxis (PrEP) have 3-monthly HIV testing and appropriate monitoring of renal function. The aim of this audit was to assess if these tests were being reliably completed, despite restricted access to Sexual Health Services during COVID restrictions. Methods Service-users prescribed ongoing PrEP June-August 2021 were identified via the electronic patient record (EPR). Those initiating PrEP were excluded. It was noted whether an HIV test result was recorded at time of prescription (or within 4 weeks), and if renal function was performed as per recommendations. STI diagnoses were noted. Results 82 PrEP-users were included. 31% used postal testing and 69% had tests in clinic. 95% had an HIV test within 4 weeks of PrEP prescription (87% of those using postal kits and 94% of those performing tests in clinic). No one missed renal function testing when required. STI rates were low. Discussion Whilst remote delivery of many services, including PrEP, will be retained beyond COVID restrictions, it is vital that those accessing PrEP also engage with testing and other health promotion activities. This audit has reassuringly demonstrated that those prescribed PrEP during this period had appropriate HIV and renal function follow-up (whether in-person or by post). Most not testing were low-risk due to behaviour change during COVID restrictions. When designing future PrEP delivery, we plan to perform a re-audit (during a period of no restrictions), and learn from the literature and other services how to ensure PrEP-users engage with testing despite a reduction in face-to-face services.

14.
Sexually Transmitted Infections ; 98:A36-A37, 2022.
Article in English | EMBASE | ID: covidwho-1956911

ABSTRACT

During the COVID-19 pandemic sexual health services have adapted swiftly to ensure continued provision of essential services. To protect patients and staff, face-to-face appointments were replaced by remote telephone consultations where possible. We report our experience in a busy sexual health clinic of a novel, remote telemedicine service intended for the assessment of visible genital skin lesions. We carried out a retrospective study evaluating diagnoses and outcomes for patients assessed remotely between 03/2020 & 03/2021,01/2022 & 02/2022. Patients who reported genital lumps,where appropriate, were invited to send images for review. A total of 372 and 53 images were studied for 2020/2021 and 2022 review periods respectively. 289/372 (78%) & 47/ 53 (89%) images were of good quality, patients were able to be managed remotely (n=189, 65%) & (n=35, 74%) with a remote prescription and treatment plan for genital warts. A total of 91 patients required face-to-face review, however, only 75 patients attended in 2020/2021 review, which in 67 cases was due to poor-quality images and in 8 cases due to other service needs. See Tables1&2. While we have received a small number of patients feedback responses, the majority found the service convenient and would use it again. Our findings indicate that telemedicine has allowed us to remotely diagnose and safely manage many patients with genital dermatoses, thereby avoiding 289 and 47 faceto- face appointments for review periods respectively. Its advantages include convenience, accessibility, and patient comfort. Moving forward, telemedicine can be used as an adjunct to the existing sexual health services in the post COVID era. (Table Presented).

15.
BMJ Leader ; 4:A73, 2020.
Article in English | EMBASE | ID: covidwho-1956884

ABSTRACT

Background Several studies have shown that new medical graduates feel unprepared for their role as clinicians. In October 2019 Salisbury District Hospital (SDH) piloted a successful 'hold-the-bleep' simulation day for 5th year Southampton medical students. In March 2020, in response to COVID-19, medical students were given early registration. The majority of FiY1s had not received or missed out on formal bleep training due to graduating early. Methodology Over 2 days 8 FiY1s were issued with a bleep for a half-day period, continuing normal daily tasks whilst being bleeped for phone advice or to assess a simulated patient. 4 clinical stations and 4 phone calls were designed to simulate roles of FY1s with SIM-Man simulating the patients. Immediate feedback was recorded and generic themes discussed at a structured session, discussing what went well or was challenging. Each FiY1 completed a feedback for assessing confidence and wrote a reflective piece. Results Feedback was qualitatively and quantitatively positive. All found the SIM session useful and would recommend it. 7 of 8 candidates had a numerical increase in confidence in managing and prioritising calls. Conclusions and recommendations The stations addressed communication skills, prioritisation, clinical and practical skills, and drug prescribing. The improvement in FiY1s confidence and skills is likely to lead to improved patient outcome and satisfaction. Faculty who role played, reported an improvement in the trainees' performance. These results are similar to those from Liverpool and previous bleep SIM sessions we held at SDH.

16.
BJOG: An International Journal of Obstetrics and Gynaecology ; 129:177, 2022.
Article in English | EMBASE | ID: covidwho-1956665

ABSTRACT

Objectives: To assess whether current Venous Thromboembolism (VTE) guidance in Pregnancy is being adhered to in the antenatal period within South Tyneside and Sunderland NHS Foundation Trust. Design: A retrospective audit of the electronic patient records of the first 100-women to deliver in November 2020. Methods: Community midwives (CMW) booking VTE risk assessment recorded and score validated against information including in midwifery and/or medical booking documentation as well as information from any attendances or admissions during pregnancy. Pharmacy records of low molecular weight heparin (LMWH) prescriptions reviewed and crosscheck against above as well as verified for correctness based on booking weight. Any patient with an incomplete record were excluded. Results: 100% of women with had a VTE risk assessment carried out at booking. These were inaccurate in 22% (20/92) of women with implications for management in 10% (9/92) of women. Only 12% (n = 11) of women had a reassessment of VTE risk recorded at 28-weeks gestation. These were incorrect in 36% (4/11) women with implications for management in 27% (3/11) of women. 13% (12/92) of the total cohort required re-assessment at 28-weeks gestation but only 1-women had an this completed and 8-women had no consideration of VTE, however this only potentially impacted management in 1-women. 8% (7/92) of women were missed and did NOT receive appropriate VTE prophylaxis. 2% (2/92) of women were prescribed LMWH in error based on miscalculated risk assessments. The dose of ALL LMWH prescribed was based on booking weight. Difference were observed in how age and BMI where used in the calculation and re-calculation of VTE score with an observation that Covid-19, and the advent of telephone consultations, has impacted on the ability to accurately weigh patients at booking. Conclusion: VTE remains a leading cause of maternal death in the UK 1 and the accuracy of VTE risk assessments remains an essential tool in prevention. In these data VTE assessments were completed at booking but rarely reviewed at 28-weeks gestation or when the clinical condition changed and scores were often subject to inaccuracies. Since completion of this work changes have been made to documentation including a separate 28-week visit proforma with linked VTE assessment. A re-audit has been planned to assess the impact of these changes.

17.
Journal of Investigative Dermatology ; 142(8):S66, 2022.
Article in English | EMBASE | ID: covidwho-1956221

ABSTRACT

The impact of the COVID-19 pandemic caused dermatology providers to use telemedicine to safely arrange clinic appointments during lockdowns. This study aimed to evaluate the impact of telehealth on antibiotic prescription length. Specifically, we sought to compare antibiotic length prescription for virtual vs. in-person visits before, during, and after COVID-19 shutdowns. A retrospective cohort study was performed using all documented pharmaceutical prescriptions of tetracycline in 2019-2021 prescribed by dermatology providers at a large academic tertiary referral center. Results show an increase in telemedicine visits from 0.75% (2019) to 18.51% (2020), with a decrease to 3.98% in 2021 (p<0.0001). Analysis demonstrates that a tetracycline prescription of over 91 days was given in 37.90% vs. 28.83% of visits for virtual vs. in-person visits respectively (p<0.0001). Interestingly, 52.64% of antibiotic prescriptions written by staff physician dermatologists exceeded 91 days vs. 18.18% for dermatology fellows, 25.74% for resident physicians, and 21.35% for physician-assistants (p<0.001). The demonstrated increase in duration of tetracycline prescription during virtual visits is perhaps indicative of less data available for clinical decision-making, longer wait times between provider appointments during this era of lockdowns, and providers desire to make the visit worthwhile. Future studies should explore factors related to provider decision-making in virtual compared to in-person visits. This research is important in laying a foundation for how virtual visits may play a greater role in dermatologic care as we move towards a post-COVID world.

18.
European Journal of Clinical Pharmacology ; 78:S130, 2022.
Article in English | EMBASE | ID: covidwho-1955961

ABSTRACT

Introduction: Zolpidem and zopiclone are widely used for sleep disorders, yet their abuse and dependence potential has been underestimated. The electronic prescription of zolpidem/zopiclone became mandatory on 17.07.2019 in Greece. Objectives: To investigate descriptive characteristics of zolpidem/ zopiclone prescriptions and the impact of the mandatory electronic prescription mandate. Methods: Anonymized prescriptions of zopiclone (ATC: N05CF01) and/or zolpidem (ATC: NC05CF02) that were executed in pharmacies between 01.10.2018 and 01.10.2021 were obtained from the Greek nationwide prescription database. The database covers almost the entire Greek population and it is administrated by IDIKA of the Greek Ministry of Health. We investigated descriptive characteristics of prescriptions, and calculated themonthly number of prescriptions taking into consideration dates with potential impact, i.e., the date of the mandatory electronic prescription mandate (on 17.07.2019) and the date of the first case of COVID-19 in Greece (on 26.02.2020). Results and Conclusion: During the investigated period of three years, there were 1229842 executed prescriptions of zolpidem (89.4%), zopiclone (10.4%) or both (0.3%), considering 156554 unique patients. The patients weremainly elderly (73.1%were ≥ 65 years old) andwomen (64.5%). The majority of the prescription physicians (69.9%) were general practitioners or internists, followed by 17% psychiatrists or neurologists, 5.3% cardiologists, 4.5% physicians in specialty training, 1% nephrologists and 2.4% of physicians with another specialty. After the mandatory electronic prescription mandate and before COVID- 19 in Greece, i.e., between 08.2019 to 03.2020, there was a notable increase of prescriptions in comparison to the previous period from 10.2018 to 07.2019 (median 37267 vs median 34106;Mann-Whitney U=9, p-value=0.009). After COVID-19, the median monthly number of prescriptions was 36363, yet there were variations ranging from 16963 to 39956. In conclusion, the mandatory electronic prescription system could increase the surveillance of drugs with abuse potential such as zolpidem and zopiclone. Nevertheless, the large number of prescriptions in elderly patients and prescribed by primary care physicians is worrisome and warrants further investigation.

19.
European Journal of Clinical Pharmacology ; 78:S74-S75, 2022.
Article in English | EMBASE | ID: covidwho-1955956

ABSTRACT

Introduction: Low molecular weight heparins are used extensively in anticoagulant therapy, due to their safer profile, in comparison to other anticoagulants. Direct Oral AntiCogulants (DOACs) have been initiated in anticoagulant therapy as a safer treatment choice than coumarin derivatives. Objectives: The aim of this study was to investigate the use of oral and injectable anticoagulants, and especially the place of DOACs in anticoagulant treatment, in a tertiary Hospital of Thessaloniki, Greece. Methods: The data were collected by investigating prescriptions from the Hospital Pharmacy of a tertiary Hospital in Thessaloniki, Greece. Prescriptions of oral and injectable anticoagulants for hospitalized patients were collected during the period from June to September 2021. The consumption of the following oral and injectable anticoagulants was recorded in DDDs: acenocumarol, rivaroxaban, apixaban, dabigatran, heparin, enoxaparin, tinzaparin, bemiparin and fondaparinux. Results: The total amount of anticoagulants used was 53,041 DDDs, of which 97,9% were injectable anticoagulants whereas 2,1% were oral anticoagulants. DOACs represented the 1,8% of the anticoagulants used. The consumption of injectable anticoagulants for the hospitalized patients was 51,936 DDDs, of which 63.5% was enoxaparin, 18.5% was tinzaparin, 6.3% was heparin, 6.1% was bemiparin, and 5.6% was fondaparinux. The consumption of acenocumarol was 176 DDDs and the consumption of DOACs was 929 DDDs, with the percentage of rivaroxaban, apixaban, and dabigatran being 46%, 45% and 9% respectively. Indications with the highest prevalence for patients on enoxaparin was COVID 19, heart failure, stroke, angina pectoris, malignancy. Indications with the highest prevalence for patients on tinzaparin was COVID 19, malignancy, stroke. Indications with the highest prevalence for patients on bemiparin was malignancy, COVID 19, aortic valve disease, stroke. Heart failure, stroke and atrial fibrillation were the indications with highest prevalence in patients on DOACs. Acenocumarol was used mainly for heart failure, stroke and aortic valve stenosis. Conclusion: Injectable anticoagulants, and mainly low molecular weight heparins were the treatment of choice in hospitalized patients. Oral anticoagulants represented only a very small proportion (2,1%) of the anticoagulants used. DOACs have replaced coumarin derivatives, representing the 86% of oral anticoagulants in clinical use. Nevertheless, the percentage of DOACs was very low (1.8%) in the total consumption of anticoagulants, with rivaroxaban and apixaban being the most commonly used DOACs. Injectable anticoagulants, especially enoxaparin, are preferred by the clinicians as a safer choice for managing high risk thrombosis in hospitalized patients. DOACs, Direct Oral AntiCogulants, anticoagulants, NOACs.

20.
European Journal of Clinical Pharmacology ; 78:S14-S15, 2022.
Article in English | EMBASE | ID: covidwho-1955950

ABSTRACT

Introduction: The European Open Platform for Prescribing Education (EurOP2E) aims to improve and harmonize European clinical pharmacology and therapeutics education by facilitating international collaboration and sharing open educational resources. The COVID-19 pandemic has forced teachers to switch to online teaching, highlighting the need for high-quality online teaching materials. Objectives: The goal of this study was to establish the resources needed to sustain prescribing education during the pandemic and thereafter. Methods: A nominal group technique study was conducted with prescribing teachers from several European countries and combined with thematic analysis. Results: In four meetings, 20 teachers from 15 countries ranked 35 teaching materials. Ten themes were identified: prescribing scenarios;interactivity & gamification;re-usable materials;online case discussions;practical aspects of prescribing;teaching the teacher;knowledge multimedia;topical issues;personalized & evidence-based prescribing;and essential formularies. Conclusion: By making teaching materials related to the learning outcomes of CPT, format of teaching and resource and faculty development openly available, EurOP2E will help to make high-quality prescribing education available to all. The role of the platform will range from facilitating collaboration to educating the teachers and/or providing ready-touse teaching materials.

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