A Case of Successful Management of Adult-Onset Linear IgA Bullous Disease With Sulfasalazine During the COVID-19 Pandemic.

Linear IgA bullous disease (LABD) is a rare, acquired, autoimmune, pruritic, and blistering skin condition. Dapsone is a first line treatment option, however, there are limited options if this fails, or if contraindicated. We present a case of successful management of LABD with sulfasalazine. A 46-year-old Caucasian female with LABD was commenced on high dose corticosteroids. She failed to wean, and dapsone was contraindicated due to a history of primary sclerosing cholangitis and risk of hepatitis. Following the failure of mycophenolate mofetil, sulfasalazine was trialed and successfully controlled both this patient’s LABD and ulcerative colitis. There is little literature on the use of sulfasalazine in dermatological conditions. We present sulfasalazine as an option for patients who are unable to use classically used treatments for LABD, or in those who have a dual diagnosis, as in this case, allowing for one agent to manage both conditions. Furthermore, The National Institute for Health and Care Excellence guidance mentions sulfasalazine as one of the few drugs that can be continued during the COVID-19 pandemic, and its use spared this patient from the significant immunosuppression associated with other treatment modalities.J Drugs Dermatol. 2022;21(12): doi:10.36849/JDD.6717.

Opinions and experiences on the provision of care to people with mental illnesses: a qualitative study with Doctor of Pharmacy graduates after a rotation in psychiatry.

BACKGROUND: Pharmacists are vital to optimizing therapy of people with mental illnesses. Limited knowledge, lack of confidence, and mental health-related stigma can lead to pharmacists' reluctance in the provision of pharmaceutical care to this population. Advanced pharmacy practice experiences (APPE) in mental health have been reported as valuable learning opportunities to overcome these challenges. AIM: This study aimed to explore PharmD graduates' perceived preparedness, attitudes, beliefs, and opinions on influencing factors for the provision of pharmaceutical care to people with mental illnesses after completing an APPE rotation in psychiatry. METHOD: All PharmD graduates who had completed a rotation in psychiatry were invited to participate in semi-structured interviews. An interview guide was developed based on a literature review. A total of 11 PharmD graduates agreed to participate in the interviews, which were recorded, transcribed, and analysed inductively using thematic analysis and following a phenomenological approach. RESULTS: Five themes were identified: Prior familiarity to mental health, opinions on the rotation, views on stigma, rotation's areas of improvement, and the positive impact of the rotation on practice. Although participants started the psychiatric rotation with low confidence and a sense of apprehension, they described their experience as unique, eye-opening, and insightful. Familiarity with mental health conditions before the rotation were perceived as a challenge to achieving full confidence in mental health care provision. CONCLUSION: For the most part, the APPE in psychiatry was viewed as a positive opportunity for enhancing the PharmD graduates' insight, knowledge, and skills for pharmaceutical care provision to people with mental illnesses.

Use of the job demands-resource model to understand community pharmacists' burnout during the COVID-19 pandemic.

BACKGROUND: Community pharmacists are one of the most accessible healthcare providers during the COVID-19 pandemic. Whilst playing a vital role in medication supply and patient education, exposure to the pandemic demands and prolonged stressors increase their risk of burnout. OBJECTIVES: Using the Job Demands-Resources model, this study aims to understand the factors that led to community pharmacists' burnout and to identify their coping strategies and perceived recommendations on interventions to mitigate burnout during the COVID-19 pandemic. METHODS: A qualitative phenomenological approach was used with focus groups and interviews of community pharmacists in Qatar who were recruited using purposeful, convenience, and snowballing sampling methods. Interviews were conducted between February and April 2021, were audio-recorded and transcribed verbatim. Using thematic analysis methodology, manual inductive and deductive (based on the model) codes from the interviews were used for synthesis of themes. 11 themes emerged from six focus groups, six dyadic interviews and mini focus groups, and four individual interviews with community pharmacists. RESULTS: The contributing factors to community pharmacists' burnout have been identified as practical job demands, and emotional demands including fear of infection. On the other hand, government and workplace-specific resources, personal characteristics such as resiliency and optimism, as well as the implementation of coping strategies, have reduced their stress and burnout. CONCLUSIONS: The use of the Job Demands-Resources model was appropriate to identify the contributing factors to community pharmacists' burnout during the COVID-19 pandemic. Based on these factors, individual, organizational, and national strategies can be implemented to mitigate burnout in community pharmacists during the pandemic and future emergencies.