Facilitating human papillomavirus vaccination pathways by extending vaccination competencies to community pharmacists: A cross-sectional survey on the acceptability and expectations among healthcare professionals and parents.

Background: Human papillomavirus (HPV) vaccination coverage rate (VCR) remains low in France (37.4% in girls in 2021). The French health authority recommended in 2022 to extend vaccination competencies to additional healthcare providers (HCPs), including community pharmacists (CPs). Objectives: To understand the acceptability by general practitioners (GPs), CPs and parents of adolescents of extending vaccination competencies and to identify benefits and barriers of new vaccination pathways. Methods: This cross-sectional research used a qualitative and quantitative approach. For the quantitative survey, GPs, CPs and parents of adolescents eligible to HPV vaccination completed an online questionnaire. Participants were asked to imagine themselves in different pathways and evaluate them. Results: A total of 200 GPs, 201 CPs and 800 parents were included. The level of acceptability of extending vaccination competencies to other HCPs was high in CPs (86% rated ≥7/10), but low in GPs (35%) and intermediate in parents (61%). Parents ranked first (44%) a pathway where GPs prescribed while CPs vaccinated because GPs inspire confidence as vaccine prescribers (80%) and parents prefer to be informed on vaccination by them (80%). CPs ranked first (42%) a scenario where they vaccinated after invitation of adolescents from the French National Health Insurance Fund (NHIS). They emphasized the simplicity of this scenario (94%) and the potential increase of VCR (91%), but asked to be more informed on HPV vaccination (77%) and favored television (83%) for communication campaigns. Conclusions: GPs and parents, in contrast with community pharmacists, were only moderately supportive of the extension the vaccination competencies. Confidence in the HCP remains the primary factor for adherence to a vaccination pathway beyond the simplicity of the pathway. Training of CPs, traceability tool, support from authorities and communication campaigns are levers that will support CPs in their new role and contribute to increase parents' acceptability toward CPs.

Interstitial and Granulomatous Lung Disease in Inflammatory Bowel Disease Patients.

BACKGROUND: Interstitial lung [ILD] disease and granulomatous lung disease [GLD] are rare respiratory disorders that have been associated with inflammatory bowel disease [IBD]. Clinical presentation is polymorphic and aetiology is unclear. METHODS: This was an ECCO-CONFER project. Cases of concomitant ILD or GLD and IBD, or drug-induced ILD/GLD, were collected. The criteria for diagnosing ILD and GLD were based on definitions from the American Thoracic Society and the European Respiratory Society and on the discretion of reporting clinician. RESULTS: We identified 31 patients with ILD. The majority had ulcerative colitis [UC] [n = 22]. Drug-related ILD was found in 64% of these patients, 25 patients [80.6%] required hospitalisation, and one required non-invasive ventilation. The causative drug was stopped in all drug-related ILD, and 87% of patients received systemic steroids. At follow-up, 16% of patients had no respiratory symptoms, 16% had partial improvement, 55% had ongoing symptoms, and there were no data in 13%. One patient was referred for lung transplantation, and one death from lung fibrosis was reported. We also identified 22 GLD patients: most had Crohn's disease [CD] [n = 17]. Drug-related GLD was found in 36% of patients and 10 patients [45.4%] required hospitalisation. The causative drug was stopped in all drug-related GLD, and 81% of patients received systemic steroids. Remission of both conditions was achieved in almost all patients. CONCLUSIONS: ILD and GLD, although rare, can cause significant morbidity. In our series, over half of cases were drug-related and therefore focused pharmacovigilance is needed to identify and manage these cases.

Resistance to levothyroxine in a bariatric surgery patient: an indication for liquid formulation?

We report the case of a 49-year-old female patient with hypothyroidism who underwent bariatric surgery and developed severe hypothyroidism despite high doses of oral levothyroxine (L-T4) tablets. Initially, a high-dose L-T4 tablets absorption test was performed to exclude pseudo-malabsorption. In view of a modest increase in serum T4 levels, L-T4 liquid formulation absorption test was performed, and showed faster and more efficient absorption of thyroid hormones. We discuss the issue of distinguishing malabsorption from pseudo-malabsorption, review the literature concerning the benefits of liquid L-T4 in cases of impaired absorption such as bariatric surgery and consider the socio-economic implications of different liquid formulations.