Experiences of community pharmacists in the United Kingdom on the provision of travel health services and associated educational requirements.

BACKGROUND: Travel health services play a critical role in public health. Previously, travel services were provided solely through GPs or private specialist clinics. In recent years, they have been available from community pharmacists in the UK. This study sought to understand the types of travel health services provided by community pharmacists and to establish the educational needs. METHOD: Qualitative interviews and focus groups explored current practices and educational needs in travel medicine. Thematic analysis of transcribed interviews and focus groups was conducted to understand how travel services are provided and the training undertaken by community pharmacists in delivering these services. RESULTS: Nine individual interviews and one focus group of seven additional pharmacists was conducted. Pharmacists considered that they provided a comprehensive service and undertook the necessary training for safe delivery. Pharmacists described a 'vaccine centric' approach to travel services, with aspects, such as management of chronic conditions, fitness/preparedness for travel, prevention and self-management of travel-related conditions considered to be of lower priority. This was reflected in the travel medicine education that they had received and their perception of future requirements. CONCLUSION: Whilst vaccination is a critical aspect of travel health medicine, taking a 'vaccine centric' approach represents a missed opportunity in public health. Future educational opportunities for pharmacists could include training that encourages a broader approach to travel health consultations, to include a co-created, structured, and holistic risk assessment for travellers and recommendations for appropriate prevention and management strategies for travellers prior to, during and after travel.

The U.S. Travel Health Pharmacists' Role in a Post-COVID-19 Pandemic Era.

Background: Many countries have enforced strict regulations on travel since the emergence of the SARS-CoV-2 (COVID-19) pandemic in December 2019. However, with the development of several vaccines and tests to help identify it, international travel has mostly resumed in the United States (US). Community pharmacists have long been highly accessible to the public and are capable of providing travel health services and are in an optimal position to provide COVID-19 patient care services to those who are now starting to travel again. Objectives: (1) To discuss how the COVID-19 pandemic has changed the practice of travel health and pharmacist provided travel health services in the US and (2) to discuss the incorporation COVID-19 prevention measures, as well as telehealth and other technologies, into travel health care services. Methods: A literature review was undertaken utilizing the following search engines and internet websites: PubMed, Google Scholar, Centers for Disease Control Prevention (CDC), World Health Organization (WHO), and the United States Department of Health and Human Services to identify published articles on pharmacist and pharmacy-based travel health services and patient care in the US during the COVID-19 pandemic. Results: The COVID-19 pandemic has changed many country's entry requirements which may now include COVID-19 vaccination, testing, and/or masking requirements in country. Telehealth and other technological advancements may further aid the practice of travel health by increasing patient access to care. Conclusions: Community pharmacists should consider incorporating COVID-19 vaccination and testing services in their travel health practices in order to meet country-specific COVID-19 entry requirements. Further, pharmacists should consider utilizing telehealth and other technologies to increase access to care while further limiting the potential spread and impact of COVID-19.

Serogroup B meningococcal disease in persons previously vaccinated with a serogroup B meningococcal vaccine - United States, 2014-2019.

Since serogroup B meningococcal (MenB) vaccines became available in the United States, six serogroup B meningococcal disease cases have been reported in MenB-4C (n = 4) or MenB-FHbp (n = 2) recipients. Cases were identified and characterized through surveillance and health record review. All five available isolates were characterized using whole genome sequencing; four isolates (from MenB-4C recipients) were further characterized using flow cytometry, MenB-4C-induced serum bactericidal activity (SBA), and genetic Meningococcal Antigen Typing System (gMATS). Three patients were at increased meningococcal disease risk because of an outbreak or underlying medical conditions, and only four of the six patients had completed a full 2-dose MenB series. Isolates were available from 5 patients, and all contained sub-family A FHbp. The four isolates from MenB-4C recipients expressed NhbA but were mismatched for the other MenB-4C vaccine antigens. These four isolates were relatively resistant to MenB-4C-induced SBA, but predicted by gMATS to be covered. Overall, patient risk factors, incomplete vaccine series completion, waning immunity, and strain resistance to SBA likely contributed to disease in these six patients.

Ayahuasca and the traveller: A scoping review of risks and possible benefits.

BACKGROUND: Ayahuasca is a psychotropic drink made from the Amazonian vine Banisteriopsis caapi. Active components include beta-carboline alkaloids and the hallucinogen N-N-dimethyltryptamine (DMT). This review aimed to identify and summarize the literature on the safety and effectiveness of ayahuasca among recreational users. METHOD: A comprehensive literature search was done on November 1, 2019 in the following six databases: PubMed(MEDLINE), Ovid Embase, Ovid International Pharmaceutical Abstracts, LILACS, Scopus, and Web of Science. Articles were included if they were original research published in English, Spanish, or Portuguese, among human participants using oral ayahuasca for neuropsychiatric effects. Chemical or pharmacological analyses, brain imaging studies, and studies examining the use of ayahuasca within a religious context were excluded. RESULTS: 5750 unique titles were identified through the database searches, with an additional 19 titles identified through manual searches. Ultimately, 39 met all the criteria for inclusion. Articles were organized into 4 themes: (1) Case reports and case series; (2) The use of ayahuasca for depression or grief; (3) The use of ayahuasca and other psychiatric or neuropsychological outcomes; and (4) Studies examining ayahuasca use and physiologic outcomes. Ayahuasca use is associated with a risk of both psychiatric and non-psychiatric events including hallucinations, agitation or aggression, vomiting, seizure, and rhabdomyolysis. Five fatalities have been reported in the literature following ayahuasca use. Open-label studies assessing ayahuasca use in depression found favorable results persisting across 21 days. Ayahuasca was also found to influence the MINDSENS scale for mindfulness, with mixed results observed for impact of ayahuasca on cognitive function and creativity, and benefits observed for measures of self-acceptance and overall wellbeing. CONCLUSIONS: To date, evidence on benefits for the management of depression, anxiety, and other mental health disorders is mixed, with some evidence suggesting improvements in mindfulness measures and creativity that are generally short-lived, and multiple case reports suggesting the potential for harm and interactions.

The changing times of Europe's largest remaining commercially harvested population of eel Anguilla anguilla L.

This study quantifies the processes involved in regulating the European eel population of Lough Neagh, a lake in Northern Ireland. The relationship between glass eel input and silver eel output for the 1923-1997 cohorts was best described by a Beverton-Holt stock recruitment model. Glass eel input time series was not complete and was thus derived from the relationship between catches elsewhere in Europe and Lough Neagh, together with the addition of stocked glass eel. Silver eel output was the sum of silver eel escapement, catch and yellow eel catch converted to silver eel equivalents. Natural mortality increased with glass eel density, ranging from 0.017 to 0.142 year-1 . The mean carrying capacity increased from ≈3.25 M silver eels (≈26 kg ha-1 ) for the 1923-1943 cohorts to ≈5.0 M (≈40 kg ha-1 ) for the 1948-1971 cohorts before regressing back to ≈3.25 M. The total silver eel output was highest during the late 1970s/early 1980s at 35-45 kg ha-1  year-1 and lowest during the early years of the 20th century and is currently at 10-15 kg ha-1  year-1 . The findings are discussed in relation to (a) the ecological changes that have occurred within the lough, associated with eutrophication and the introduction of roach (Rutilus rutilus L.), and (b) the decline of the wider European eel stock across its distribution range. The findings from this study have relevance for the wider management of the European eel stock.

Comprehensive Approach to Reduce Surgical Site Infections in Patients Undergoing Neurosurgical Procedures.

Background: Surgical site infections (SSIs) are recognized complications of surgical procedures. Methicillin-resistant Staphylococcus aureus (MRSA) colonization increases the likelihood of developing SSIs. Decolonization of MRSA has been shown to reduce post-operative SSIs, therefore, the aim of this project was to identify and decolonize MRSA carriers and to tailor perioperative antibiotic prophylaxis to protect those at high risk for SSIs better. Methods: In September 2013, a quality improvement process initiative was implemented for pre-operative screening of MRSA nasal carriage for patients undergoing elective neurosurgical procedures. Those identified as colonized received a 10-day decolonization protocol that consisted of: oral doxycycline 100 mg twice daily or oral trimethoprim-sulfamethoxazole (TMP-SMX) DS twice daily; oral rifampin 600 mg daily; daily bathing with chlorhexidine; and twice daily use of mupirocin ointment in each nostril and under the fingernails. In addition to cefazolin (weight-based dosing), vancomycin (weight-based dosing) was recommended for perioperative prophylaxis in known MRSA carriers and patients undergoing surgical procedures involving hardware implantation irrespective of colonization status. We compared the results with our previously documented neurosurgical site infection rates (2012 and 2013 were 3.0 and 2.2%, respectively) Results: From 2014 to 2015, MRSA screening was done for 1,197 patients, of whom 52 (4.3%) were found to be colonized. Surgical site infections occurred in 14 procedures (1.4%) in 2014 and eight (0.8%) procedures in 2015, respectively. Methicillin-resistant Staphylococcus aureus remained responsible for most of these infections. None of the patients who underwent decolonization developed an infection (MRSA or otherwise). Conclusions: The overall rate of neurosurgical site infections can be reduced through a bundled approach of MRSA decolonization and change in perioperative antibiotic prophylaxis to include vancomycin for procedures involving hardware implantation irrespective of MRSA carriage state.

River lamprey present an unusual predation threat to Atlantic salmon smolts in Lough Neagh, Northern Ireland.

A new monitoring programme on the Lough Neagh catchment has documented a high incidence of river lamprey, Lampetra fluviatilis L., predation on Atlantic salmon smolts, Salmo salar L. In total 470 smolts were examined during the 2020 emigration period with 168 fish (36%) exhibiting lamprey scars of which 57 were lightly scarred and 111 were classed as heavily scarred. Lamprey predation was not size selective on Lough Neagh S. salar smolts.

A Case of Drug-induced Linear IgA Bullous Dermatosis.

Linear immunoglobulin A (IgA) bullous dermatosis (LABD) presents as a rare autoimmune disease that can either occur spontaneously or induced by certain drugs, the most common of which is vancomycin. LABD is a subepidermal blistering disease that is diagnosed by detecting linear IgA bands along the basement membrane. We present a case of a 59-year-old man with worsening blistering skin rash who was treated with vancomycin and piperacillin-tazobactam for pneumonia.

Long-term retention of dummy acoustic transmitters in adult brown trout.

A group of 36 1+ age class Salmo trutta were surgically implanted with dummy acoustic tags and monitored for 370 days. In total 13 tags were expelled throughout the experiment with an overall tag loss rate of c. 0.035 tags per day. Fish length was the only explanatory variable which had a significant association with subsequent tag expulsion. The estimated probability of retaining a tag for a year for a fish of length 32 cm was 0.76, 34 cm was 0.60 and 36 cm was 0.38. The long-term tag loss patterns were examined and discussed.

First examination of the Lough Neagh European eel (Anguilla anguilla) population for eel virus European, eel virus European X and Anguillid Herpesvirus-1 infection by employing novel molecular techniques.

Lough Neagh is home to the largest wild-caught European eel (Anguilla anguilla) commercial fishery in the EU, producing 14% of the EU catch and worth £3.2 million to the local economy. Viral infections have been suggested to play a contributory role in the decline of the worldwide eel stock, but previous studies of the Lough Neagh European eel population had not observed either acute or chronic viral signs. Eel virus European (EVE), Eel virus European X (EVEX) and Anguillid herpesvirus-1 (HVA) have been detected throughout Europe and as the Lough Neagh eel fishery is supplemented by re-stocking of eels from France, Spain and the United Kingdom and these viral infections may be asymptomatic, it is vital that the viral pathogen prevalence in the Lough is accurately determined. This study aimed to ascertain the presence of these viruses in the Lough Neagh European eel population by employing novel molecular techniques testing specifically for the presence of EVE, EVEX and HVA. No evidence was found of HVA infection, whereas EVE and EVEX were found, albeit at a very low prevalence.

Impact of Pharmacy Based Travel Medicine with the Evolution of Pharmacy Practice in the UK.

Background: Pharmacy has utilised the changes in legislation since 2000 to increase the range and supply function of services such as travel health to travellers. With the number of travellers leaving the UK and trying new destinations there is an increasing need for more travel health provision. Working models: The models of supply of a travel health service vary according to the size of the corporate body. The large multiples can offer assessment via a specialist nurse or doctor service and then supply through the pharmacy. Others will undertake an onsite risk assessment and supply through the pharmacist. The sole Internet suppliers of medication have been reviewed and the assessment standards questioned following survey and inspection. Education: There is no dedicated pharmacist-training programme in advanced level travel health. As a consequence one academic institution allows pharmacists to train on a multidisciplinary course to obtain an academic membership. With training for travel health not being mandatory for any travel health supply function the concern is raised with standards of care. Future: There is a consultation paper on the removal of travel vaccines from NHS supply due to be decided in the future. If these vaccines are removed then they will provide a greater demand on pharmacy services. Discussion: The starting of a travel health service can be made without any additional training and remains unregulated, giving cause for concern to the supply made to the traveller. Conclusions: Pharmacies in the UK offer a range of options for supplying travel health services; however these need to be with improved mandatory training and supply.

Non-pharmacotherapeutic interventions in travellers diarrhoea (TD).

BACKGROUND: This is a review of some of the non-pharmacotherapeutic interventions in travellers diarrhoea (TD) looking particularly at the role of pre and probiotics, the evidence behind water purification and the impact of advice given and its adherence by travellers. METHOD: A systematic review of the research completed under section using the listed key words and searched using the databases of Google Scholar, Journal of Travel Medicine, QxMD, ReadCube and The Knowledge Network. RESULTS AND CONCLUSIONS: Travellers' diarrhoea and use of pre/probiotics: There is no significant evidence to suggest the benefit of using pre or probiotics to prevent or treat TD. A new second generation of B-GOS prebiotics shows some potential in preventing the incidence and symptoms of TD but lack high levels of graded evidence. Recent reports from the biotics industry suggest that a review of the above issues is being addressed and in the future more robust studies may be completed. The evidence behind water purification and diarrhoeal disease: Evidence suggests there is no direct correlation that water purification has an impact on diarrhoeal disease, although some studies underline the value of water purification. The use of bottled water is questioned as being unreliable due to the inconsistencies of microbiological safety. With new water purification products and methods being introduced a benefit could be found for publishing effectiveness against pathogen groups to improve comparison. Are travellers given good sanitary advice and do they follow it? The advice given to travellers by non-clinical sources is unregulated and not a statutory obligation of a reservation to travel. Within the clinical sector the advice provided and the outcomes of advice provision do not correlate with a reduction in TD as a variance can occur by travellers' changes and behaviours towards the advice given. Following recommended advice and consuming higher risks foods do not correspond directly with levels of reported TD, suggesting attitudes and practices deviate away from this advice when travelling.

Cases of disseminated cryptococcosis in intravenous drug abusers without HIV infection: A new risk factor?

Cryptococcosis is a fungal disease which has been characterized by its identified risk groups. There are many risk factors identified. We present a surprising four cases of disseminated cryptococcosis in intravenous drug abuse (IVDA) patients in a short period of time and in one geographical area, this observation suggest that there may be a new association with IVDA and cryptococosis.

Recruitment collapse and population structure of the European eel shaped by local ocean current dynamics.

Worldwide, exploited marine fish stocks are under threat of collapse [1]. Although the drivers behind such collapses are diverse, it is becoming evident that failure to consider evolutionary processes in fisheries management can have drastic consequences on a species' long-term viability [2]. The European eel (Anguilla anguilla; Linnaeus, 1758) is no exception: not only does the steep decline in recruitment observed in the 1980s [3, 4] remain largely unexplained, the punctual detection of genetic structure also raises questions regarding the existence of a single panmictic population [5-7]. With its extended Transatlantic dispersal, pinpointing the role of ocean dynamics is crucial to understand both the population structure and the widespread decline of this species. Hence, we combined dispersal simulations using a half century of high-resolution ocean model data with population genetics tools. We show that regional atmospherically driven ocean current variations in the Sargasso Sea were the major driver of the onset of the sharp decline in eel recruitment in the beginning of the 1980s. The simulations combined with genotyping of natural coastal eel populations furthermore suggest that unexpected evidence of coastal genetic differentiation is consistent with cryptic female philopatric behavior within the Sargasso Sea. Such results demonstrate the key constraint of the variable oceanic environment on the European eel population.

The European eel quality database: towards a pan-European monitoring of eel quality.

The stocks of the European eel Anguilla anguilla are in decline and there is an increasing awareness that poor health status due to contaminants and/or diseases might be a key element in this decline and might be a hindrance to recovery. Many countries have started compiling data on the health status of eels in their water bodies. Objectives for these monitoring actions are diverse and there is a large amount of information collected by EU member countries. However, this information is widely scattered over Europe in agencies, institutes or universities. As there is a growing need to collect and report on data on the health status of the eel on international level, the Joint EIFAC/ICES Working Group on Eels initiated in September 2007 the set up of an European Eel Quality Database to collect recent data of contaminants and diseases over the distribution area of the eel. This paper describes the aim, the set up and future development of the database in order to give it greater publicity and to call on scientists or managers to submit data on eel health status. The database represents now the first comprehensive pan-European compilation of eel health data, including data from over 10,000 eels from approximately 1,200 sites over 14 countries. Preliminary work has indicated a number of shortcomings and future developments will be needed. Guaranteeing further development of the database, harmonisation of methods, quality assurance, and setting up harmonised eel monitoring strategies over Europe will be a great challenge and will need pan-European cooperative work.

Sexual history: its importance in averting detrimental misdiagnosis and delayed diagnosis.

Two cases where the sexual history proved important in reaching the diagnosis are presented. Case 1 concerns a 37-year-old HIV positive homosexual man, who presented with symptoms of rectal pain associated with bleeding. He was unsuccessfully treated for Crohn disease. A subsequent review of his sexual history led to investigations for venereal infections. A final diagnosis of proctitis secondary to lymphogranuloma venereum was made. The patient was successfully treated with doxycycline and spared an unnecessary colectomy. Case 2 concerns a 22-year-old Caucasian woman under investigation for possible lymphoma. However, the doctor carrying out the biopsy experienced a needle stick injury and the ensuing investigations revealed the patient's HIV positive status and thus the explanation for her hitherto undiagnosed lymphadenopathy. A prior review of her sexual history could have hastened the diagnosis and prevented the need for invasive tests.

A retrospective audit of the management and complications of pelvic inflammatory disease.

Our objective was to examine the management of pelvic inflammatory disease (PID) in Southend Hospital against the British Association for Sexual Health and HIV guidelines. In addition, we reviewed the Genito-Urinary (GU) Medicine and Gynaecology notes for patients who failed treatment for PID in GU medicine. This was to reveal their complications and subsequent management. Thirty of 249 patients diagnosed with PID failed treatment. Chlamydia was found in 30% of these patients, gonorrhoea in 10%, with the rest being categorized into presumed anaerobic/other aetiology. Appropriate antibiotic regimens were used in 96.6% of patients and the 66.7% of contacts who were traced and treated. Eighteen of the 30 patients had a laparoscopy. Findings were: confirmed PID in 5.6%; endometriosis in 27.8%, adhesions with no evidence of PID in 27.8%; and 38% had no abnormalities found. Laparoscopy has an important role in excluding other pathology in patients who have failed to respond to appropriate conservative management.