Assessment of attitude and hesitancy toward vaccine against COVID-19 in a Pakistani population: A mix methods survey.

Objective: The objective of this study was to assess the attitude and hesitancy toward vaccine against COVID-19 in a Pakistani Population. Materials and methods: A mix-method, prospective study was conducted and adults (aged ≥18 years) residing in Pakistan were invited to participate. The questionnaire was prepared, hosted in Google Forms and circulated through electronic platforms and was also available to be done in in-person. Data was compiled from 15th September to 30th November 2020. Results: The response rate was 80%. A total of 1003 participants were included in the final analysis. Of them, 75% completed survey questionnaire online, while remaining 25% responded in-person. The mean age of the participants was 29.62 ± 10.47 years. The majority of participants were females; 60.9% (n = 611). 57.02% (n = 572) of the participants were employed at the time of survey. Overall, 70.68% (n = 709) of the participants had previous experience of vaccines such as the flu vaccine Only 4.9% (n = 49) participants thought that they will be seriously ill from COVID-19 within six months and 39% (n = 392) participants were confident that they will get COVID-19. A total of 71.29% of the participants reported they would consider getting vaccinated once available. There was statistical association between gender and getting vaccinated (P < 0.001). Conclusion: This study demonstrated that majority of the participants showed positive attitude toward considering COVID-19 vaccine. However awareness with informed knowledge of efficacy, possible adverse effects and cost would be of added great value to increase the real response of Pakistani population toward COVID-19 vaccination.

Objetivo: El objetivo de este estudio fue evaluar la actitud y la renuencia hacia la vacuna frente a la COVID-19 en una población paquistaní. Materiales y métodos: Se realizó un estudio prospectivo de método mixto, invitándose a participar a personas adultas (edad ≥18 años) residentes en Paquistán. Se preparó el cuestionario, que se alojó en Google Forms y se hizo circular a través de plataformas electrónicas, pudiendo realizarse también de manera personal. Los datos se recopilaron desde el 15 de septiembre al 30 de noviembre de 2020. Resultados: La tasa de respuesta fue del 80%. El análisis final incluyó un total de 1.003 participantes, de los cuales el 75% completó el cuestionario-encuesta online, mientras que el 25% respondió en persona. La edad media de los participantes fue de 29,62 ± 10,47 años. La mayoría de los participantes eran mujeres: el 60,9% (n = 611). El 57,02% (n = 572) de los participantes tenía empleo en el momento de la encuesta. En general, el 70,68% (n = 709) de los participantes tenía experiencia previa sobre vacunas tales como la vacuna frente a la gripe. Solo el 4,9% (n = 49) de los participantes pensaba que padecerían la COVID-19 de forma grave en el plazo de seis meses, y el 39% (n = 392) de los participantes estaba seguro de que se contagiaría de dicha enfermedad. El 71,29% de los participantes reportó que consideraría recibir la vacuna una vez que se dispusiera de la misma. Existió una asociación estadística entre el sexo y el ser vacunado (P< 0,001). Conclusión: Este estudio demostró que la mayoría de los participantes mostró una actitud positiva hacia la consideración de la vacuna frente a la COVID-19. Sin embargo, la concienciación sobre el conocimiento informado de la vacuna, los posibles efectos adversos y el coste supondrían un gran valor añadido al incremento de la respuesta real de la población paquistaní hacia la vacuna frente a la COVID-19.

Duplicate Prescriptions of Inhaled Medications for Obstructive Lung Diseases.

INTRODUCTION: Inhalative treatments with metered dose aerosols and dry powder inhalers are the backbone of the pharmacotherapy for asthma and COPD. In the last decade many new and generic inhalative bronchodilators were launched at the German market, both monotherapies and fixed dose double bronchodilator (LABA/LAMA, beta adrenergic and antimuscarinic) or LABA and inhaled corticosteroid (ICS) and triple (LABA/LAMA/ICS) combinations. According to two surveys in 2015 among respiratory physicians we expected a high proportion of patients receiving duplicate prescriptions, e. g. a fixed dose new LABA/LAMA combination in addition to an existing ICS/LABA fixed dose combination. METHODOLOGY: We searched the database of a large mail order pharmacy (DocMorris) to identify duplicate prescriptions of inhalative drugs for a patient by the same or by two or more different physicians during a 3 months period. RESULTS: Unexpectedly, we found as little as around 1 % duplicate prescriptions for the same patient. Duplicate prescriptions involving combination products were found to be much more common than duplicate prescriptions of different mono-products. Irrespective the low percentage number of all prescriptions we saw in just one large mail order pharmacy several thousands of erroneous prescriptions. CONCLUSION: At least in the setting of this mail order pharmacy duplicate (i. e. contraindicated and potentially dangerous) prescriptions are relatively rare. Prescribers and pharmacists should be aware of the issue of duplicates - especially when prescribing or filling prescriptions with combination products.

Muscle regeneration following repair of the rotator cuff.

AIMS: The aim of this study was to analyse human muscle tissue before and after rotator cuff repair to look for evidence of regeneration, and to characterise the changes seen in the type of muscle fibre. PATIENTS AND METHODS: Patients were assessed pre-operatively and one year post-operatively using the Oxford Shoulder Score (OSS) and MRI. The cross-sectional area and distribution of the type of muscle fibre were assessed on biopsies, which were taken at surgery and one year post-operatively. Paired samples from eight patients were analysed. There were three men and five women with a mean age of 63 years (50 to 73). RESULTS: All but one patient showed improvement in OSS (p = 0.004). The mean increase in the cross-sectional area of the muscle was 1220 µm2 (-801 to 3712; p = 0.03). There was a reduction of type 2a fibres (p = 0.02). A clear relationship could not be seen between the MRI findings and the histological appearances. CONCLUSION: This is the first study to provide evidence that atrophy of the supraspinatus muscle is reversible. Changes in the types of fibre are discussed. MRI assessment of muscle atrophy may not be fully representative of myofibre atrophy. Cite this article: Bone Joint J 2016;98-B:1389-94.

Does arthroscopic subacromial decompression improve quality of life.

INTRODUCTION: There has been a significant rise in the volume of subacromial decompression surgery performed in the UK. This study aimed to determine whether arthroscopic subacromial decompression improves health related quality of life in a cost effective manner. METHODS: Patients undergoing arthroscopic subacromial decompression surgery for impingement were enrolled between 2012 and 2014. The Oxford shoulder score and the EQ-5D™ instruments were completed prior to and following surgery. A cost-utility analysis was performed. RESULTS: Eighty-three patients were eligible for the study with a mean follow-up duration of 15 months (range: 4-27 months). The mean Oxford shoulder score improved by 13 points (95% confidence interval [CI]: 11-15 points). The mean health utility gain extrapolated from the EQ-5D™ questionnaire improved by 0.23 (95% CI: 0.16-0.30), translating to a minimum cost per QALY of £5,683. CONCLUSIONS: Subacromial decompression leads to significant improvement in function and quality of life in a cost effective manner. This provides justification for its ongoing practice by appropriately trained shoulder surgeons in correctly selected patients.

Patient-reported complications after elective joint replacement surgery: are they correct?

Using general practitioner records and hospital notes and through direct telephone conversation with patients, we investigated the accuracy of nine patient-reported complications gathered from a self-completed questionnaire after elective joint replacement surgery of the hip and knee. A total of 402 post-discharge complications were reported after 8546 elective operations that were undertaken within a three-year period. These were reported by 136 men and 240 women with a mean age of 71.8 years (34 to 93). A total of 319 reported complications (79.4%; 95% confidence interval 75.4 to 83.3) were confirmed to be correct. High rates of correct reporting were demonstrated for infection (94.5%) and the need for further surgery (100%), whereas the rates of reporting deep-vein thrombosis (DVT), pulmonary embolism, myocardial infarction and stroke were lower (75% to 84.2%). Dislocation, peri-prosthetic fractures and nerve palsy had modest rates of correct reporting (36% to 57.1%). More patients who had knee surgery delivered incorrect reports of dislocation (p = 0.001) and DVT (p = 0.013). Despite these variations, it appears that post-operative complications may form part of a larger patient-reported outcome programme after elective joint replacement surgery.

Factors affecting wound ooze in total knee replacement.

INTRODUCTION: Wound ooze is common following total knee arthroplasty (TKA) and persistent wound infection is a risk factor for infection, and increased length and cost of hospitalisation. PATIENTS AND METHODS: We undertook a prospective study to assess the effect of tourniquet time, peri-articular local anaesthesia and surgical approach on wound oozing after TKA. RESULTS: The medial parapatellar approach was used in 59 patients (77%) and subvastus in 18 patients (23%). Peri-articular local anaesthesia (0.25% Bupivacaine with 1:1,000,000 adrenalin) was used in 34 patients (44%). The mean tourniquet time was 83 min (range, 38-125 min). We found a significant association between cessation of oozing and peri-articular local anaesthesia (P = 0.003), length of the tourniquet time (P = 0.03) and the subvastus approach (P = 0.01). CONCLUSIONS: Peri-articular local anaesthesia, the subvastus approach and shorter tourniquet time were all associated with less wound oozing after total knee arthroplasty.

Atypical cutaneous leishmaniasis resembling eczema on the foot.

Cutaneous leishmaniasis (CL) typically presents as ulcerated or crusted nodules and plaques. Eczematous morphology of CL lesions is unusual. We report a case of CL that presented as a large eczematous plaque with no clinically obvious primary lesion.

[In-patient asthma education and self-management training in clinical practice--a national survey in Germany]. / Zur Praxis der stationären Asthmaschulung in der Bundesrepublik Deutschland - eine bundesweite Bestandsaufnahme.

BACKGROUND: According to international guidelines patient education is a key component of modern asthma-management. Especially in rehabilitation, patient training is considered essential for long-term treatment success. Based on growing empirical evidence for clinical efficacy of asthma self-management training, standardized education programs as well as guidelines and recommendations for quality management in health care practice have been developed. AIM: Due to the lack of evidence [empirical data] on compliance to these recommendations we conducted a nation-wide survey including in-patient pneumological clinics in Germany. METHODS: Exploiting address registers of national asthma organizations (i. e. Deutsche Atemwegsliga) we identified 75 clinics that offer education programs on a regular basis, 65 of which participated in this study (drop-out-rate: 12 %). These institutions were asked to complete a questionnaire in order to assess various aspects of their education practice. RESULTS: Although 91 % of clinics reported to adhere to guidelines and recommendations for patient education, merely 50 % supplied standardized and evaluated education and self-management training programs. A rather small proportion (19 %) was found to fully adhere to protocol (maximum treatment integrity, no mixing of different education schemes). Furthermore, substantial variance between clinics was observed in actual performance of asthma education, the major indicators being: indication criteria and eligibility of patients; education contents; group size, duration and frequency of sessions; extent and intensity; didactical methods; number and qualification of trainers; measures of quality management, and settings. Accordingly, a consistent standard of patient education in rehabilitation practice has not yet been achieved. CONCLUSION: While substantial advances in the proposition of patient education and self-management trainings in in-patient health care remain unquestioned, there are some deficits in actually performing such programs in clinical practice. Results also show that another question needs to be addressed: qualifying trainers. Less than half of trainers participating in this study reported to have absolved a train-the-trainer-course.