Personal Protective Equipment Portraits Canada (PPC)-Humanization and surveying mask-wearing nationally.

BACKGROUND: Personal Protective Equipment (PPE) Portraits is a hybridized art and medical intervention that lessens the alienating appearance of PPE through wearable, smiling headshot pictures. During the pandemic, the use of these portraits was expanded, but Canadian initiatives offered portraits only to immediate stakeholders. PPE Portraits Canada (PPC) aimed to provide PPE portraits to any Canadian healthcare institution and surveyed healthcare workers (HCW) regarding these portraits' impact. METHODS: University student volunteers founded PPC via online platforms and coast-to-coast collaborations that allowed any HCW nationwide to request a free portrait via an accessible online form. PPC has gathered feedback from participating HCWs directly via an anonymous and bilingual survey. RESULTS: 70% of HCWs wore their portraits "always" or "usually", 69% of HCWs "definitely would" recommend their portrait, 89.5% of HCWs found that the PPE portraits made a difference in their experiences with patients and 74% found the same for their colleagues. The pre- and post-effect of the portraits, led to a 37.5% greater likelihood that HCWs felt "connected" or "very connected" to patients/residents. For the thematic analysis, 70% or more of the comments were rated as positive, with less than 5% of comments being rated as negative. CONCLUSION: This model's logistical framework can be expanded beyond PPE portraits to other initiatives with limited resources, allowing them to reach and positively impact diverse populations. HCW feedback was predominantly positive. The optimal design and impact of PPE portraits on patients and HCWs should be studied further to improve portrait adoption.

Medicamentos bioterapéuticos: uso de toxinas botulínicas en la era de biosimilares / Biotherapeutic medicines: use of botulinum toxins in the era of biosimilars

Introducción: Las toxinas botulínicas son medicamentos bioterapéuticos con grandes aplicaciones en el campo de la neurología, como la cefalea y los movimientos anormales. Debido a la importancia médica y al incremento de las indicaciones terapéuticas de la toxina botulínica, este artículo pretende hacer claridad acerca de la terminología básica con respecto a la naturaleza de este medicamento, a las diferencias estructurales con medicamentos convencionales y aspectos importantes en relación con su potencia biológica e inmunogenicidad, para así comprender las potenciales diferencias entre las toxinas disponibles y conceptuar en torno a la no intercambiabilidad o sustitución de una toxina por otra. Materiales y métodos: Revisión no sistemática, según lo recomendado en la Escala para la Verificación de los Artículos Revisiones Narrativas (Sanra). Conclusiones: Los medicamentos biológicos no son intercambiables entre sí, aunque demuestren bioequivalencia. No se pueden evaluar como medicamentos genéricos intercambiables porque son biológicos; no existen estudios comparativos cabeza a cabeza; son diferentes, debido al proceso individual de manufactura.

Introduction: Botulinum toxins are biotherapeutic drugs with great applications in the field of neurology such as headache and abnormal movements. Due to the medical importance and the increase in therapeutic indications of botulinum toxin, this article aims to clarify the basic terminology regarding the nature of this drug, the structural differences with conventional drugs and important aspects in relation to its biological potency and immunogenicity in order to understand the potential differences between the available toxins and conceptualize regarding the non-interchangeability or substitution of one toxin for another. Materials and methods: Non-systematic review as recommended in the Scale for the Verification of Narrative Review Articles (SANRA). Conclusions: Biological drugs are not interchangeable with each other, even if they demonstrate bioequi-valence. They cannot be evaluated as interchangeable generic drugs because they are biologics. There are no head-to-head comparative studies. They are different due to the individual manufacturing process.

Five ways to get a grip on organizational logistics, backends, and workflows.

Organizational backends and logistics are often complex and many institutions set-up their workflows based on manual and tedious processes that negatively shape their interactions with stakeholders. Incorporating new technologies can be intimidating. However, a plethora of financially and technically accessible resources that do not require any coding knowledge, can be utilized by institutions to enhance their organizational workflow and stakeholder experience. Guided by our own learning experiences in optimal logistical set-up and user design, we wish to highlight five effective and easily implementable tricks to aid higher institutions and student groups in healthcare to accomplish their administrative duties.

Les backends et la logistique des organisations sont souvent complexes et de nombreuses institutions établissent leurs flux de travail sur la base de processus manuels et fastidieux qui influencent négativement leurs interactions avec les parties prenantes. L'intégration de nouvelles technologies peut être intimidante. Cependant, il existe une pléthore de ressources financièrement et techniquement accessibles, qui ne nécessitent aucune connaissance en codage, que les institutions peuvent utiliser pour améliorer leur flux de travail organisationnel et l'expérience des parties prenantes. Guidés par nos propres expériences d'apprentissage en matière de mise en place d'une logistique optimale et de conception pour l'utilisateur, nous souhaitons mettre en avant cinq astuces efficaces et faciles à mettre en œuvre pour aider les établissements supérieurs et les groupes d'étudiants en soins de santé à accomplir leurs tâches administratives.

Monogenic Causes in the Type 1 Diabetes Genetics Consortium Cohort: Low Genetic Risk for Autoimmunity in Case Selection.

HYPOTHESIS: About 1% of patients clinically diagnosed as type 1 diabetes have non-autoimmune monogenic diabetes. The distinction has important therapeutic implications but, given the low prevalence and high cost of testing, selecting patients to test is important. We tested the hypothesis that low genetic risk for type 1 diabetes can substantially contribute to this selection. METHODS: As proof of principle, we examined by exome sequencing families with 2 or more children, recruited by the Type 1 Diabetes Genetics Consortium (T1DGC) and selected for negativity for 2 autoantibodies and absence of risk human leukocyte antigen haplotypes. RESULTS: We examined 46 families that met the criteria. Of the 17 with an affected parent, 7 (41.2%) had actionable monogenic variants. Of 29 families with no affected parent, 14 (48.3%) had such variants, including 5 with recessive pathogenic variants of WFS1 but no report of other features of Wolfram syndrome. Our approach diagnosed 55.8% of the estimated number of monogenic families in the entire T1DGC cohort, by sequencing only 11.1% of the autoantibody-negative ones. CONCLUSIONS: Our findings justify proceeding to large-scale prospective screening studies using markers of autoimmunity, even in the absence of an affected parent. We also confirm that nonsyndromic WFS1 variants are common among cases of monogenic diabetes misdiagnosed as type 1 diabetes.

Evaluation of a home-based 7-day infection control strategy for healthcare workers following high-risk exposure to severe acute respiratory coronavirus virus 2 (SARS-CoV-2): A cohort study.

OBJECTIVE: Evidence-based infection control strategies are needed for healthcare workers (HCWs) following high-risk exposure to severe acute respiratory coronavirus virus 2 (SARS-CoV-2). In this study, we evaluated the negative predictive value (NPV) of a home-based 7-day infection control strategy. METHODS: HCWs advised by their infection control or occupational health officer to self-isolate due to a high-risk SARS-CoV-2 exposure were enrolled between May and October 2020. The strategy consisted of symptom-triggered nasopharyngeal SARS-CoV-2 RNA testing from day 0 to day 7 after exposure and standardized home-based nasopharyngeal swab and saliva testing on day 7. The NPV of this strategy was calculated for (1) clinical coronavirus disease 2019 (COVID-19) diagnosis from day 8-14 after exposure, and for (2) asymptomatic SARS-CoV-2 detected by standardized nasopharyngeal swab and saliva specimens collected at days 9, 10, and 14 after exposure. Interim results are reported in the context of a second wave threatening this essential workforce. RESULTS: Among 30 HCWs enrolled, the mean age was 31 years (SD, ±9), and 24 (80%) were female. Moreover, 3 were diagnosed with COVID-19 by day 14 after exposure (secondary attack rate, 10.0%), and all cases were detected using the 7-day infection control strategy: the NPV for subsequent clinical COVID-19 or asymptomatic SARS-CoV-2 detection by day 14 was 100.0% (95% CI, 93.1%-100.0%). CONCLUSIONS: Among HCWs with high-risk exposure to SARS-CoV-2, a home-based 7-day infection control strategy may have a high NPV for subsequent COVID-19 and asymptomatic SARS-CoV-2 detection. Ongoing data collection and data sharing are needed to improve the precision of the estimated NPV, and here we report interim results to inform infection control strategies in light of a second wave threatening this essential workforce.

Impacto de la restricción al uso de medicamentos en un hospital de alta complejidad / Impact of the restriction to the use of drugs in a hospital of high complexity

RESUMEN Introducción: La política farmacéutica colombiana estableció la prescripción adecuada de medicamentos como estrategia para contrarrestar el acceso inequitativo a los medicamentos y la deficiente calidad de la atención en salud. Objetivo: establecer restricciones al uso de medicamentos en un hospital de alta complejidad y medir el impacto económico, sin afectar la seguridad en la atención. Materiales y métodos: Cada medicamento se evaluó de acuerdo a la inclusión en el plan de beneficios en salud (PBS), alternativas farmacológicas y uso en urgencias. Posteriormente se clasificaron según restricciones de prescripción: 1) libre prescripción, 2) urgente libre prescripción, 3) no urgente libre prescripción, 4) prescripción restringida y 5) prescripción inhabilitada. Se compararon 12 meses previos restricción con 33 meses posteriores restricción. Resultados: Se incluyeron 1217 medicamentos. 56,5% incluidos en el PBS de libre prescripción, 22,4% no incluidos en el PBS de libre prescripción, 11,6% inhabilitados y 6,0% restringidos. Posterior a la restricción se observó una disminución de al menos 58.274 unidades farmacéuticas y $826.130.680 mensual. El mayor impacto fue para los medicamentos PBS, seguido de no PBS urgentes. Conclusión: Establecer criterios de prescripción, permite disminuir el costo asociado al uso de medicamentos y hacer un uso racional de estos, sin afectar la seguridad.

SUMMARY Introduction: Colombian pharmaceutical policy established the adequate prescription of drugs, as a strategy to counteract the inequitable access to drugs and the deficient quality of health care. Objective: establish restrictions on the use of drugs in a highly complex hospital and measure the economic impact, without affecting the safety of care. Materials and methods: Each drug were evaluated according to the inclusion of the health benefits plan (PBS), use in emergencies and alternatives of use. Then, they were classified according to prescription restrictions: 1) no restriction, 2) urgent and prescription with restriction by specialty, 3) non-urgent and prescription with restriction by specialty, 4) restricted prescription, and 5) prescription forbidden. The comparison between 12 months before restriction and 33 months afterwards. Results: 1217 medications were included. 56.5% included in the PBS of prescription without restriction, 22.4% not included in the PBS of prescription with restriction by specialty, 11.6% forbidden and 6.0% restricted. After the restriction, there was a statistically significant monthly decrease of at least 58,274 pharmaceutical units and USD $275,446. The greatest impact was obtained with PBS drugs, followed by no urgent PBS. Conclusion: The establishment of clear prescribing criteria allows a reduction in the cost associated with the drug's use, as well as a rational use of them, without affecting the patients' safety.