Evaluating the effect of electronic monitoring and feedback on hand cream use in healthcare workers: Healthy Hands Project

Modelling of patient journey in chronic spontaneous urticaria: Increasing awareness and education by shorten patients' disease journey in Germany

BACKGROUND

Chronic spontaneous urticaria (CSU) is both physically and emotionally stressful, and guideline recommendations are often not optimally implemented in clinical practice. The objective of this study was to provide an overview on the patient journey in CSU and to develop a mathematical model based on solid data.

METHODS

The journey of CSU patients in Germany was traced through literature review and expert meetings that included medical experts, pharmacists and representatives of patient organizations. The current situation's main challenges in the patient journey (education, collaboration and disease management) were discussed in depth. Then, a probabilistic model was developed in a co-creation approach to simulate the impact of three potential improvement strategies: (1) patient education campaign, (2) medical professional education programme and (3) implementation of a disease management programme (DMP).

RESULTS

Chronic spontaneous urticaria patients are severely burdened by delays in diagnosis and optimal medical care. Our simulation indicates that in Germany, it takes on average of 3.8 years for patients to achieve disease control in Germany. Modelling all three optimization strategies resulted in a reduction to 2.5 years until CSU symptom control. On a population level, the proportion of CSU patients with disease control increased from 44.2% to 58.1%.

CONCLUSIONS

In principle, effective CSU medications and a disease-specific guideline are available. However, implementation of recommendations is lagging in practice. The approach of quantitative modelling of the patient journey validates obstacles and shows a clear effect of multiple interventions on the patient journey. The data generated by our simulation can be used to identify strategies for improving patient care. Our approach might helping in understanding and improving the management of patients beyond CSU.

[Prevention and health promotion in dermatology]

The term prevention includes measures that are used to avoid illnesses or damage to health as well as to reduce the risk of illness or to delay its occurrence. Preventive measures can be classified based on various criteria: temporal differentiation (primary, secondary, and tertiary prevention), context (behavioral and relational prevention), and recipient (general and individual prevention). Health promotion is used when appropriate measures are intended to strengthen and increase human health potential and resources. This includes, among other things, measures to develop health-promoting behavior (empowerment) and measures regarding the planning and implementation of health-promoting behavior (participation). One goal of these measures is generally to increase health literacy. This article describes examples of prevention and health promotion measures for occupational skin cancer (counseling approach for individual sun protection for outdoor workers; "individuelle Lichtschutzberatung" [ILB]) as well as occupational hand eczema within the meaning of German occupational disease number 5101 (outpatient and inpatient individual prevention measures). These are supplemented by the example of outpatient age-adapted small group trainings for patients with atopic dermatitis according to the multicenter evaluated concept of AGNES e. V. ("Arbeitsgemeinschaft Neurodermitisschulung") and ARNE ("Arbeitsgemeinschaft Neurodermitisschulung im Erwachsenenalter"). These examples also address aspects of sustainability and digitalization (eHealth, eLearning) in the areas of prevention and health promotion.

[Skin cancer from solar ultraviolet radiation exposure at work]

Due to their professional activities, outdoor workers are exposed to an increased risk of developing occupational skin cancer caused by solar ultraviolet (UV) radiation as defined by occupational disease (OD) number 5103. Since the amendment to the Occupational Diseases Ordinance ("Berufskrankheitenverordnung", BKV) in 2015, squamous cell carcinomas or multiple actinic keratoses of the skin caused by natural UV radiation in outdoor workers in Germany can be recognized as occupational disease in the sense of OD number 5103. The main cause of nonmelanoma skin cancer (NMSC) is solar UV radiation; it is the most relevant occupational carcinogen in terms of the number of exposed workers (i.e., outdoor workers). Circumstances associated with climate change include increased terrestrial UV radiation, an increase in the number of cloudless days and therefore the number of hours of direct sunshine, adverse meteorological effects to the stratospheric ozone layer, and so-called low ozone events and associated more intense UV radiation. In the future, comprehensive considerations will have to be made as to how prevention concepts can be effectively designed to avoid the development of occupational skin cancer in outdoor workers. The treatment of future cases of skin cancer will be a particular challenge due to their high number and only a limited number of dermatologists available. Hopefully, prevention of skin cancer will become even more important in the future.

Occupational Hand Dermatitis

PURPOSE OF REVIEW

Occupational hand dermatitis is a common work-related disorder of the skin. Prevention and management of this disease is critical to improving workers' quality of life and for occupation-specific retention.

RECENT FINDINGS

This is a critical review of the current literature on occupational hand dermatitis. Occupational dermatitis continues to have a high prevalence among workers although the overall incidence may be slowly decreasing. Irritant contact dermatitis due to wet work exposure is the most common cause of occupational hand dermatitis. Healthcare workers, hairdressers, and metal workers are at particularly high risk for this disease. While some prevention programs have been ineffective in mitigating occupational hand dermatitis, other more resource-intensive initiatives may have benefit. Continued research is needed on ways to manage wet work exposures and on scalable, effective prevention programs for occupational hand dermatitis. The spectrum of culprit contact allergens continues to evolve, and vigilance for potential occupation-specific allergens remains important.

Prevention of occupational hand eczema in healthcare workers during the COVID-19 pandemic: a controlled intervention study

BACKGROUND

Occupational hand eczema (HE) is common among healthcare workers (HCWs) and has - in some regions of the world - increased during the COVID-19 pandemic due to related hygiene measures.

OBJECTIVES

To evaluate the efficacy of an intervention for HE prevention in HCWs during the pandemic.

METHODS

A prospective, controlled, unblinded interventional trial was conducted in 302 HCWs. The intervention group (IG) (n = 135) received online-based health education and free access to hand cleansing and hand care products. The control group (CG) (n = 167) did not receive any intervention within the study. At baseline (T0), after three (T1) and six (T2) months, participants completed standardised questionnaires. The Osnabrueck Hand Eczema Severity Index (OHSI) was assessed at T0 and T2.

RESULTS

During the observation period, there were no new HE cases in the IG (n = 115) and 12 cases (8.8%) in the CG (n = 136). OHSI values at T2 were lower in the IG (b = -1.44, P < 0.001). Daily use of emollients was higher at work (b = 1.73, P < 0.001) and at home (b = 1.62, P < 0.001) in the IG at T2.

CONCLUSIONS

The intervention was effective in HE prevention and improving skin care behaviour during the COVID-19 pandemic. This article is protected by copyright. All rights reserved.

Artificial Intelligence, Big Data, and mHealth: The Frontiers of the Prevention of Violence Against Children

Violence against children is a global public health threat of considerable concern. At least half of all children worldwide experience violence every year; globally, the total number of children between the ages of 2 and 17 years who have experienced violence in any given year is one billion. Based on a review of the literature, we argue that there is substantial potential for AI (and associated machine learning and big data), and mHealth approaches to be utilized to prevent and address violence at a large scale. This potential is particularly marked in low- and middle-income countries (LMIC), although whether it could translate into effective solutions at scale remains unclear. We discuss possible entry points for Artificial Intelligence (AI), big data, and mHealth approaches to violence prevention, linking these to the World Health Organization's seven INSPIRE strategies. However, such work should be approached with caution. We highlight clear directions for future work in technology-based and technology-enabled violence prevention. We argue that there is a need for good agent-based models at the level of entire cities where and when violence can occur, where local response systems are. Yet, there is a need to develop common, reliable, and valid population- and individual/family-level data on predictors of violence. These indicators could be integrated into routine health or other information systems and become the basis of Al algorithms for violence prevention and response systems. Further, data on individual help-seeking behavior, risk factors for child maltreatment, and other information which could help us to identify the parameters required to understand what happens to cause, and in response to violence, are needed. To respond to ethical issues engendered by these kinds of interventions, there must be concerted, meaningful efforts to develop participatory and user-led work in the AI space, to ensure that the privacy and profiling concerns outlined above are addressed explicitly going forward. Finally, we make the case that developing AI and other technological infrastructure will require substantial investment, particularly in LMIC.

A behaviour change package to prevent hand dermatitis in nurses working in the National Health Service: results of a cluster randomized controlled trial

BACKGROUND

Occupational hand dermatitis poses a serious risk for nurses.

OBJECTIVES

To evaluate the clinical and cost-effectiveness of a complex intervention in reducing the prevalence of hand dermatitis in nurses METHODS: This was a cluster randomized controlled trial conducted at 35 hospital trusts, health boards or universities in the UK. Participants were (i) first-year student nurses with a history of atopic conditions or (ii) intensive care unit (ICU) nurses. Participants at intervention sites received access to a behavioural change programme plus moisturizing creams. Participants at control sites received usual care. The primary outcome was the change of prevalent dermatitis at follow-up (adjusted for baseline dermatitis) in the intervention vs. the control group. Randomization was blinded to everyone bar the trials unit to ensure allocation concealment. The trial was registered on the ISRCTN registry: ISRCTN53303171.

RESULTS

Fourteen sites were allocated to the intervention arm and 21 to the control arm. In total 2040 (69·5%) nurses consented to participate and were included in the intention-to-treat analysis. The baseline questionnaire was completed by 1727 (84·7%) participants. Overall, 789 (91·6%) ICU nurses and 938 (84·0%) student nurses returned completed questionnaires. Of these, 994 (57·6%) had photographs taken at baseline and follow-up (12-15 months). When adjusted for baseline prevalence of dermatitis and follow-up interval, the odds ratios (95% confidence intervals) for hand dermatitis at follow-up in the intervention group relative to the controls were 0·72 (0·33-1·55) and 0·62 (0·35-1·10) for student and ICU nurses, respectively. No harms were reported.

CONCLUSIONS

There was insufficient evidence to conclude whether our intervention was effective in reducing hand dermatitis in our populations. Linked Comment: Brans. Br J Dermatol 2020; 183:411-412.

Using Implementation Science to Optimize the Uptake of Evidence-Based Medicine into Dermatology Practice

An estimated 17-year lag exists between evidence generation and its integration into routine clinical care. The field of implementation science has emerged to close this gap by applying rigorous methods to systematically study the obstacles and facilitators of the uptake of evidence-based practices. However, implementation science has not gained wide traction in dermatology. In this narrative review, we use literature and expert input to introduce implementation science and key frameworks for implementing interventions and evaluating their uptake. We then highlight opportunities for dermatology-specific interventions at the patient-, provider-, system-, and population-levels, and advocate for the field's expansion into dermatology.

Effectiveness of a skin care programme for the prevention of contact dermatitis in healthcare workers (the Healthy Hands Project): A single-centre, cluster randomized controlled trial

BACKGROUND

Healthcare workers (HCWs) are at risk of developing hand dermatitis (HD). Guidelines recommend moisturizers to prevent HD, but in practice their effectiveness has been poorly investigated.

OBJECTIVES

To assess whether an intervention aimed at improving skin care leads to a reduction in HD severity.

METHODS

In this 1-year randomized controlled trial, 9 wards (285 HCWs) were allocated to an intervention group (IG), and 10 wards (216 HCWs) were allocated to the control group (CG). The intervention included provision of cream dispensers with electronic monitoring of use, regularly communicated to the HCWs. The primary and secondary outcomes were change from baseline in Hand Eczema Severity Index (HECSI) score (ΔHECSI) and change in natural moisturizing factor (NMF) level (ΔNMF).

RESULTS

At 12 months, the rates of loss to follow-up were 41% and 39% in the IG and the CG, respectively. The HECSI score was reduced in the IG by -6.2 points (95%CI: -7.7 to -4.7) and in the CG by -4.2 points (95%CI: -6.0 to -2.4). There was no significant difference in ΔHECSI or ΔNMF between the groups. Relative improvement in the HECSI score was significantly higher in the IG than in the CG (56% vs 44%). In a subgroup of HCWs with mild HD, the IG showed a larger HECSI score decrease than the CG (P < 0.001).

CONCLUSION

Although there was no significant effect on the primary outcomes, the intervention showed overall positive effects on the HECSI score.

Evaluating the effect of electronic monitoring and feedback on hand cream use in healthcare workers: Healthy Hands Project

BACKGROUND

Healthcare workers (HCWs) are at high risk of developing hand dermatitis (HD). Current guidelines on HD prevention recommend the use of emollients; however, in practice, adherence is poor.

OBJECTIVE

To assess whether the provision of creams, electronic monitoring and feedback on cream consumption can improve skin care in HCWs.

METHODS

A cluster randomized controlled trial was conducted on 19 academic hospital wards, including 501 HCWs, for 12 months. The intervention wards (n = 9; 285 HCWs) were provided with hand cream dispensers equipped with an electronic system to monitor use, which was regularly communicated to the HCWs by the use of posters. The process outcomes were self-reported cream consumption in both groups, and electronically measured consumption per ward in the intervention group (IG) vs the control group (CG).

RESULTS

Self-reported cream use at follow-up was significantly higher in the IG than in the CG, before (odds ratio [OR] 2.27; 95%CI: 1.29-3.97; P = 0.004) and during (OR 3.30; 95%CI: 1.80-6.06, P < 0.001) the shift, whereas at baseline there was no difference between the groups. In the IG, electronically measured cream use was, on average, 0.4 events per shift per HCW.

CONCLUSION

The intervention improved hand cream use, and may therefore be considered as a practical strategy to promote skin care in HCWs. Notwithstanding this, the application frequency remained lower than recommended in the present study and current guidelines.