Intraoral human herpes viruses detectable by PCR in majority of patients.

OBJECTIVES: To identify factors which influence the intraoral prevalence of human herpes viruses (HHVs) using mucosal swabs, saliva samples and qPCR analysis. METHODOLOGY: In this cross-sectional observational study, matched saliva and oral swabs were collected from a total of 115 subjects: 70 immunocompetent subjects with no mucosal abnormalities, 22 with mucosal abnormalities and 23 therapeutically immunocompromised individuals. Extracted DNA was analysed by multiplex qPCR for detection and quantification of HHVs 1-6. RESULTS: At least one human herpes virus was detected in 77.1% of immunocompetent individuals with no mucosal abnormalities, with EBV the most commonly detected at 61.4%. HHV-6 was detected in 17.1%, HSV-1 in 4.3% and CMV in 1.1%. Detection was higher in saliva than in oral swabs. There was no detection of HSV-2 or VZV. Neither presence of oral mucosal abnormality nor therapeutic immunocompromise was related to increased detection of human herpes virus. CONCLUSION: Commensal detection rates of EBV are high, and caution in clinical correlation of positive detection is warranted. Commensal CMV rates are low, and detection is likely to be clinically relevant. This study presents a comprehensive commensal detection rate of HHVs 1-6 by qPCR in saliva and swabs.

The association of mycophenolate mofetil and human herpes virus infection.

Purpose: Mycophenolate mofetil (MMF) is a steroid-sparing immunosuppressant used extensively to treat both common and rare dermatological conditions. Its lymphocyte specificity makes it a favorable therapeutic option particularly for patients who cannot tolerate alternative immunosuppressants. However, the side effect profile of MMF has not been extensively evaluated. This review presents current evidence regarding increased risk of human herpesvirus infection (HHV) with MMF therapy.Methods: The electronic database Medline (OVID) was searched on January 2018 for relevant English-language articles regarding the evaluation of incidence/prevalence of HHV infection in patients taking MMF, identifying 24 studies.Results: The majority of available studies were conducted on solid organ transplant recipients receiving complex immunosuppressive treatment including the MMF. Cytomegalovirus is the most well studied of the HHV. A positive association with cytomegaloviruses was found with MMF when compared to alternative immunosuppressants and studies to date suggest dose-dependent effect.Conclusion: MMF is a commonly used steroid-sparing agent used to treat dermatological conditions. This review highlights that MMF is positively associated with cytomegalovirus infection. The presented studies were heterogeneous in study design and detection method, with the majority completed on renal transplant patients. Further studies are needed to shed light on the association of MMF with HHV.

Baseline patients' characteristics as predictors for therapeutic survival and response in patients with psoriasis on biological treatments.

BACKGROUND/OBJECTIVES: Biological agents provide a relatively safe and promising long-term therapeutic option for patients with moderate to severe psoriasis in whom conventional treatment has failed. However, these agents are not effective in all patients. We aimed to examine the association of baseline patients' characteristics with the short-term efficacy and the long-term survival of biological therapies in patients with moderate to severe psoriasis. METHODS: We performed a retrospective observational study of all patients who received biological treatment for psoriasis at the Royal Melbourne Hospital (N = 146). We extracted data on the patients' characteristics and medical history. The outcomes we measured included a 75% reduction in psoriasis area and severity index (PASI) score at 12 and 24 weeks, the total duration of drug survival and dermatology life quality index (DLQI) scores. We used regression modelling to assess the association between each baseline patient's characteristic and outcome measures. RESULTS: An increase in baseline body mass index was associated with a reduced likelihood of achieving PASI75 at 12 and 24 weeks (P = 0.014) and also correlated with reduced long-term therapeutic survival (P = 0.03). High rates of treatment termination were noted in patients with greater baseline DLQI (P = 0.038). CONCLUSION: Greater body mass index at the initiation of biological treatment for psoriasis may contribute to its decreased short-term efficacy. Similarly, a high body mass index or DLQI at baseline was associated with a relatively short duration of biological treatment retention.

Improving patient safety: The impact of an outpatients' electronic handover system in a tertiary dermatology department.

BACKGROUND/OBJECTIVES: Electronic medical records (EMR) can improve quality healthcare, patient safety and streamline workflow to improve efficiency of a department. Despite the known benefits and difficulties of EMR systems, there is limited data on the impact and definable effectiveness it can have within a dermatology unit. We present an outpatients' EMR known as an electronic handover system (EHS) from its inception, delivery and audit of its use in evaluating the true impact. METHODS: An audit of the EHS was conducted from 1 March to 31 August 2014. Quantitative data evaluating the type of jobs entered and completed, overdue tasks, patient workload and phone consultations were conducted. Qualitative data was assessed via a pilot survey assessing users' perspectives of the EHS evaluating communication, clinician-patient relationship and administrative tasks. RESULTS: Altogether 754 jobs were entered for 411 dermatology outpatients using the EHS. Most tasks concerned following up bloods and swabs (38%) or biopsies (36%). Overall, 51 jobs were not completed by the specified due dates and 188 phone consultations were performed. Compared with pre-EHS data, clinic review patients fell by 16%, with a modest increase (2%) in the number of new patients seen. The survey results show that most respondents believed that EHS improved communication, did not affect the clinician-patient relationship and they were more confident in their practice knowing there was a recording system for follow up. CONCLUSION: The dermatology EHS has provided a reliable system for following up all outpatient results. The potential benefits range from clinical, organisational and health research, which, from our experience, demonstrates improved patient follow-up care.

Overdose in young people using heroin: associations with mental health, prescription drug use and personal circumstances.

OBJECTIVE: To identify patterns of mental health, prescription drug use and personal circumstances associated with heroin overdose in young people. DESIGN: Linkage of data on use of Pharmaceutical Benefits Scheme (PBS) prescription drugs with data from a self-report questionnaire. SETTING: Inner metropolitan Melbourne, Australia. SUBJECTS: 163 young people, 15-30 years, using heroin. MAIN OUTCOME MEASURES: Personal circumstances, mental health (as measured by various scales), and PBS-listed prescription drug use. RESULTS: Young people using heroin reported high rates of feelings of hopelessness, depression, antisocial behaviour, self-harm and diagnosed mental illness. A prior history of overdose was associated with previous mental illness, which in turn was associated with being female, having poor social support, being dissatisfied with relationships, and living alone or in temporary accommodation. While feelings of hopelessness and antisocial behaviour were strongly associated with overdose history, the number of PBS prescription drugs used had a very strong relationship with overdose, particularly benzodiazepines, other opioids, tricyclic antidepressants and tranquillisers. CONCLUSIONS: Further research to explore causal relationships between prescription drugs and heroin overdose is warranted. Improved data linkage to PBS records for general practitioners may facilitate safer prescribing practices.

Seeking drugs or seeking help? Escalating "doctor shopping" by young heroin users before fatal overdose.

OBJECTIVE: To identify prescription drug-seeking behaviour patterns among young people who subsequently died of heroin-related overdose. DESIGN: Linkage of Medicare and Pharmaceutical Benefits Scheme and Coroner's Court records from Victoria. SUBJECTS: Two hundred and two 15-24-year-olds who died of heroin-related overdose between 6 January 1994 and 6 October 1999. MAIN OUTCOME MEASURES: Patterns of use of medical services and prescription drugs listed on the Pharmaceutical Benefits Scheme in the years before death, and use of all drugs just before death. RESULTS: Polydrug use was reported in 90% of toxicology reports, and prescription drugs were present in 80% of subjects. Subjects accessed medical services six times more frequently than the general population aged 14-24 years, and more than half of all prescribed drugs were those prone to misuse, such as benzodiazepines and opioid analgesics. A pattern of increasing drug-seeking behaviour in the years before death was identified, with doctor-visitation rates, number of different doctors seen and rates of prescriptions peaking in the year before death. CONCLUSIONS: An apparent increase in "doctor shopping" in the years before heroin-related death may reflect the increasing misuse of prescription drugs, but also an increasing need for help. Identification of a pattern of escalating doctor shopping could be an opportunity for intervention, and potentially, reduction in mortality.

Association of benzodiazepine injection with the prescription of temazepam capsules.

Temazepam capsules have become a popular choice for benzodiazepine injection by injecting drug users, and serious vascular and tissue damage leading to ulcers and gangrene can result. We compared the self-reported benzodiazepine injecting behaviour of 91 heroin users with their Pharmaceutical Benefits Schedule (PBS) records for the preceding 5 years. We found that individuals prescribed PBS temazepam capsules were more likely to report injecting benzodiazepines than individuals who had either not been prescribed PBS temazepam capsules or had been prescribed PBS temazepam tablets. These results provide empirical support for the argument to limit the prescription and supply of temazepam capsules in Australia.

A Graduate Certificate and Master in General Practice Psychiatry by distance education--1998-2001.

BACKGROUND: The General Practice Psychiatry Program is a collaborative initiative between two universities and two professional colleges. Since 1998 it has offered general practitioners a one year part time Graduate Certificate, and a two year Master of General Practice Psychiatry. The learning is by distance education and multimode, including text packages sent out, tapes, teleconferences and two annual residential weekends with role plays and didactic teaching. OBJECTIVE: To describe the development of a Graduate Certificate and Master in General Practice Psychiatry. DISCUSSION: The program has been well supported with 141 general practitioners enrolling in the Graduate Certificate and 48 in the Masters during 1998-2001. General practitioners have been enrolling from around Australia, with rural, female and more experienced GPs predominating.