The effect of mandatory post-call relief on sleep and wellness in ophthalmology residents.

BACKGROUND: Multiple duty hour reforms have been implemented to optimize resident wellness through increasing opportunities for sleep recovery, but few studies have recorded objectively measured sleep or shown direct sleep and wellness benefits from such interventions. This study seeks to determine whether mandatory post-call relief policies with a partial night float system improved resident sleep, activity, and burnout among ophthalmology residents taking home call. METHODS: We conducted a two group cohort study of ophthalmology residents at the University Washington comparing post graduate year-2 (PGY-2) resident sleep, activity, and burnout between the optional post-call relief group from July 1, 2017 to June 30, 2019 to the mandatory post-call relief group from July 1, 2019 to June 30, 2021. RESULTS: Of twenty total residents participating in the survey portion, 18 residents participated in the sleep and activity tracking portion of the study, 9 in in the optional post-call relief cohort, and 9 in the mandatory post-call relief cohort. The mandatory post-call relief group recorded longer total sleep on call than the optional post-call relief group (p < 0.001). There was no difference in overnight sleep recorded on call (median 3.4 h), but residents recorded more time napping in the mandatory post-call relief cohort (p < 0.001). There was no significant difference between cohorts in amount of sleep while not on call. Residents in the mandatory post-call relief cohort recorded higher average daily steps, higher exercise time, and lower sedentary time than residents in the optional post-call relief cohort (p < 0.001). They also recorded lower median emotional exhaustion on the Maslach Burnout Inventory and lower stress in the Depression and Anxiety Stress Scale in the mandatory post-call relief cohort (p = 0.008). CONCLUSIONS: Implementation of mandatory post-call relief policies with a partial night-float system among PGY-2 residents was associated with more post-call naps with more overall physical activity, lower emotional exhaustion scores, and lower stress scores, despite no changes to overnight sleep on call or total sleep. Although sample size limits interpretation of data, implementation of mandatory post call relief could be considered to improve post-call sleep in programs with home call.

Irreversible Bilateral Cicatricial Keratoconjunctivitis after Dupilumab Therapy.

This report highlights a case of irreversible bilateral cicatricial keratoconjunctivitis related to dupilumab therapy for the treatment of severe atopic dermatitis (AD). After 38 years of AD, the patient began dupilumab therapy and achieved disease control. Two years into treatment, his ophthalmic examination was significant for bilateral cicatricial keratoconjunctivitis with severe foreshortening of the inferior conjunctival fornices, symblepharon, and ankyloblepharon, which persisted even after topical steroid eye drops and discontinuation of dupilumab. Treating dermatologists should be aware of this potential irreversible adverse effect, and we recommend that patients are monitored for ocular complications while on dupilumab therapy.

Association of Public Health Measures During the COVID-19 Pandemic With the Incidence of Infectious Conjunctivitis.

Importance: Infectious conjunctivitis is highly transmissible and a public health concern. While mitigation strategies have been successful on a local level, population-wide decreases in spread are rare. Objective: To evaluate whether internet search interest and emergency department visits for infectious conjunctivitis were associated with public health interventions adopted during the COVID-19 pandemic. Design, Setting, and Participants: Internet search data from the US and emergency department data from a single academic center in the US were used in this study. Publicly available smartphone mobility data were temporally aligned to quantify social distancing. Internet search term trends for nonallergic conjunctivitis, corneal abrasions, and posterior vitreous detachments were obtained. Additionally, all patients who presented to a single emergency department from February 2015 to February 2021 were included in a review. Physician notes for emergency department visits at a single academic center with the same diagnoses were extracted. Causal inference was performed using a bayesian structural time-series model. Data were compared from before and after April 2020, when the US Centers for Disease Control and Prevention recommended members of the public wear masks, stay at least 6 feet from others who did not reside in the same home, avoid crowds, and quarantine if experiencing flulike symptoms or exposure to persons with COVID-19 symptoms. Exposures: Symptoms of or interest in conjunctivitis in the context of the COVID-19 pandemic. Main Outcome and Measures: The hypothesis was that there would be a decrease in internet search interest and emergency department visits for infectious conjunctivitis after the adaptation of public health measures targeted to curb COVID-19. Results: A total of 1156 emergency department encounters with a diagnosis of conjunctivitis were noted from January 2015 to February 2021. Emergency department encounters for nonallergic conjunctivitis decreased by 37.3% (95% CI, -12.9% to -60.6%; P < .001). In contrast, encounters for corneal abrasion (1.1% [95% CI, -29.3% to 29.1%]; P = .47) and posterior vitreous detachments (7.9% [95% CI, -46.9% to 66.6%]; P = .39) remained stable after adjusting for total emergency department encounters. Search interest in conjunctivitis decreased by 34.2% (95% CI, -30.6% to -37.6%; P < .001) after widespread implementation of public health interventions to mitigate COVID-19. Conclusions and Relevance: Public health interventions, such as social distancing, increased emphasis on hygiene, and travel restrictions during the COVID-19 pandemic, were associated with decreased search interest in nonallergic conjunctivitis and conjunctivitis-associated emergency department encounters. Mobility data may provide novel metrics of social distancing. These data provide evidence of a sustained population-wide decrease in infectious conjunctivitis.

Granulocyte-macrophage colony stimulating factor: an adjuvant for cancer vaccines.

Granulocyte-macrophage colony stimulating factor (GM-CSF) enhances immune responses by inducing the proliferation, maturation, and migration of dendritic cells, and the expansion and differentiation of B and T lymphocytes. There is significant data in pre-clinical animal models demonstrating the adjuvant effects of GM-CSF in a variety of cancer vaccine approaches, including cellular vaccines, viral vaccines, peptide and protein vaccines, and DNA vaccines. GM-CSF is an attractive vaccine adjuvant because of its immune modulation effects and low toxicity profile. The results in animal models have been confirmed in pilot clinical trials and several clinical trials are currently ongoing.