CMO Update August 17, 2022
I am very pleased to share an update regarding our company-wide Service Excellence and Patient Experience initiative, led by Dr. Dan Pearce (Skin Surgery Center, WS, NC) and Megan Erickson (QDP, Nashville, TN). Last week I was able to participate in our first team huddle, which are named the “Practice Pulse” and I am very excited about how this engages everyone with a common goal. 
Dr. Pearce states:

QualDerm Partners' affiliated practices have a strong reputation for high quality at each touchpoint of the patient’s journey. We share a commitment to providing the best possible patient experience and we should strive for ways to improve the service we provide. Reflecting our core values and mission, we strongly believe a culture of service excellence across all team members enhances the patient experience and fosters pride in one’s work and enhances job satisfaction. Our goal with these team huddles, AKA the "Practice Pulse", is to explore monthly themes integral to excellence in the patient experience. Hopefully these brief sessions will spur meaningful dialogue and reflection, and also highlight the importance of all that we do in providing professional, compassionate and efficient high quality care.
The Practice PULSE:
P lan for excellence
U nited in all we do as a team
L istening to our patients and team
S erving others is what we do
E xcellence with every touch point
Our QualDerm Pilot program sites and champions/leaders deserve our thanks as we test the project in several sites to identify areas for improvement or clarification prior to our company-wide campaign:

North Carolina
  • The Skin Surgery Center Winston-Salem (Stephanie Cortez)
  • Hickory Dermatology at Viewmont (Dr. David Harker) 

  • Blodgett Dermatology (Jackie Caldwell)
  • Advanced Dermatology of North Central Ohio (Heather Conard)

  • Cumberland Skin Surgery and Dermatology Hendersonville (Sara Pesavento)

  • Dermatology of Athens (Alice Harper, Jennifer Smith-Hogan, Christan McDaniel)

  • Bikowski Skin Care Center (Nick Chagnon)
  • Rencic Dermatology (Amanda Ladd)
COVID-19 Update
Last week the CDC updated several of its guidelines regarding COVID-19, which have caused confusion for many in the public. I encourage everyone to read this outstanding summary of the CDC updates and what they mean to an epidemiologist with young children who is navigating the pandemic like all of us.
The primary take-away for me applies to the CDCs recommendation regarding ending isolation after COVID-19 infection after 5 days.

This recommendation is NOT EVIDENCE-BASED as shown in the following study highlighted by Dr. Michael Mina, a prominent expert in epidemiology, infectious disease, immunology and pathology. It is also disputed by many other prominent authoritative experts.

Dr. Mina notes that 94% of COVID-19 patients remain positive and infectious at peak viral load at Day 5 when CDC advises ending isolation and returning to normal work and public activity (while masked):
Furthermore, the FDA issued new guidance recommending Americans take three negative at-home COVID tests over five days before ending isolation to ensure that one is no longer infectious. Others have recommended at least 2 consecutive daily negative rapid-antigen tests before ending isolation. This is particularly important for anyone with exposure to high-risk people, like health care workers.

Our QualDerm policy (shown below) is consistent with this evidence and remains a conservative approach to protect our vulnerable patients and teammates, particularly during this Omicron BA.5 surge with the most highly transmissible and immune evasive variant to date. We continue to track and monitor the evidence and will update our policy as necessary.
Monkeypox Key Points
WHO notes the likelihood of this becoming a true pandemic is remote or very low.

CDC currently reports 11,000 cases in the US, but is rising.
  • Could Monkeypox become a pandemic?
  • While it produces less severe disease than COVID-19, Monkeypox is on a worrying trajectory, said Dr. Hotez.

  • The disease most likely spreads through close, personal contact, although the scientific community is divided on whether it transmits through aerosols. Cases are going up, and reported numbers likely underestimate the extent of prevalence, he said.

  • “Unless we can get our arms around this, and really start to beat it back with vaccinations, it's going to generalize across the U.S. population,” in addition to Europe and Latin America, he said.

It's not the same as chicken pox
  • Chickenpox is a herpes virus, Monkeypox is an orthopox virus, genetically similar to smallpox, although fortunately produces much less severe disease
  • Smallpox kills 1/3 of individuals; two forms of Monkeypox with mortality of 1% and 10%

Spread occurs through direct contact
  • Very close personal contact through skin abrasion or respiratory secretions/droplets
  • Most experts do not believe aerosol transmission is significant (like COVID-19)
  • Clothing, bedding, towels contaminated with Monkeypox virus can be infectious

Virus in not sexually transmitted
  • Current outbreak in US primarily in MSM community (men having sex with men) but not transmitted through bodily fluids; rather face-to-face, intimate contact with lesions
  • Anyone can be infected through close contact with unrecognized lesions

Contact tracing is vital
  • Smallpox was eradicated by ring vaccination; Monkeypox presents same opportunity
  • Infected individual and every contact was traced and all were vaccinated
  • Importance of referring all cases to local or state Health Departments

Children and immunocompromised at higher risk of morbidity and mortality

Smallpox vaccines may help while specific Monkeypox vaccines developed and mass-produced

Two antiviral drugs available for high-risk patients, but no specific treatments approved

The AMA provides the following FAQ information about Monkeypox for physicians:
12.7% or 1 in 8 people who had Covid were considered to develop the condition.

  • There have been reports that Long Covid is less prevalent with Omicron and reduced by vaccination.
  • Likely lower for BA.5 and fully vaccinated, but still very high burden of chronic disease and disability
  • On the good news front, recent report in children with controls suggested that Long Covid in kids is of low prevalence.

There’s only one surefire way to prevent Long Covid: not to get Covid!
Other Health News Update
FDA issues consumer warning to companies over unapproved products to remove moles, skin tags that can cause injuries and scarring
The FDA has issued warnings to three companies for selling unapproved products to remove moles or skin tags. These warning letters were sent to Amazon, Ariella Naturals and Justified Laboratories, which are all said to be in violation of the Federal Food, Drug and Cosmetic Act by selling products that claim to remove moles or skin tags. No over-the-counter medications have FDA approval for that purpose.

Tetracyclines may pose greater hyperpigmentation risk
According to a study presented at the Society for Investigative Dermatology’s recent annual meeting, doxycycline as oral monotherapy for acne is significantly associated with the development of new hyperpigmentation in acne patients, particularly in patients with skin of color (Black, Hispanic and Asian patients).

The researchers suggest that dermatologists may want to lean more toward minocycline when prescribing for patients. Also, they recommend taking a second look at topical formulations of antibiotics as well as counseling patients about sunscreen use, particularly in patients with darker skin.

Finally, I saw this simple but powerful method used by a teacher to survey her students at the end of the year about how she might improve and be more effective. I think it applies to all of us who lead teams and are trying to be more efficient and productive. Soliciting this simple feedback is worth considering.
Thank you and I continue to appreciate all of you who keep doing a wonderful job caring for our patients and teammates through a long and challenging couple years. I have read some encouraging early results about variant-specific, pan-coronavirus and nasal vaccines for this fall/winter that may be more effective at protection.

I also want to plant the seed now that experts predict that this winter may be a higher-than-normal influenza season so you should strongly consider obtaining your flu vaccine when recommended later this fall. More information will be forthcoming and QualDerm has already ordered our influenza vaccine supply so we can offer this to all teammates.

Be well,
Dr. A
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