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Journal of the European Academy of... Jul 2024In recent years, new approaches for optimal patient management of cancer have focused on patient-centered care, with integration of tumour-directed treatment and... (Review)
Review
In recent years, new approaches for optimal patient management of cancer have focused on patient-centered care, with integration of tumour-directed treatment and patient-directed supportive and palliative care throughout the disease journey from prevention through screening, diagnosis, treatment, and follow-up. In 2022, at the International Forum of Dermatology (IFD), a scientific session was entirely dedicated to highlight recent developments on patient-centered approaches in skin cancer. An international panel of different groups of participants involved in a patient's journey on the management of skin cancer presented and discussed challenges and barriers that persist in the field of skin cancer prevention and care pathways. Although primary prevention remains a crucial step in the prevention of melanoma, the different surveys performed during the last 20 years demonstrate that the use of sunscreen increases very slowly. Secondary prevention that includes skin screening and diagnostic measures may benefit from the development of digital tools. To improve adherence, patients need accurate, reliable information about their disease and the treatment options, and this type of content that can also be made available on digital tools. Shared decision-making is a hallmark of a patient-centered approach and requires health care providers who can communicate well to patients and their families, underscoring the pivotal role of health care professionals all through the patient journey. Health care providers have a crucial role in supporting patients through their journey in skin cancer. They will benefit from mobile apps and technologies that have been developed recently to address challenges in skin cancer prevention, detection and care, including those that are primarily directed to the patient. However, more peer-reviewed studies are needed as well as regulations to ensure that apps are accurate, reliable, and up to date.
Topics: Humans; Patient-Centered Care; Skin Neoplasms; Decision Making, Shared; Melanoma; Sunscreening Agents
PubMed: 38923012
DOI: 10.1111/jdv.19573 -
International Journal of Dermatology Jun 2024
Variation in the clinical presentation of atopic dermatitis in adults across self-identified racial categories: a single-center, cross-sectional study in an academic tertiary care center.
PubMed: 38922892
DOI: 10.1111/ijd.17299 -
Journal of Cosmetic Dermatology Jul 2024Specialized aesthetic skincare treatments are an important part of helping reduce facial signs of aging.
BACKGROUND
Specialized aesthetic skincare treatments are an important part of helping reduce facial signs of aging.
AIMS
This article highlights real-world experience with a Macrocystis pyrifera ferment-containing skincare regimen comprising a cleansing foam, a serum, and a moisturizer with anti-aging, anti-inflammatory, anti-erythema, and healing properties for facial skin condition improvement.
PATIENTS/METHODS
The real-world case (RWC) series presented highlights and the expert panel's clinical experience with the M. pyrifera ferment-containing skincare regimen used for 12 weeks to improve facial skin conditions. The panelists convened a meeting to discuss and select RWCs from their practice using the M. pyrifera ferment-containing skincare regimen.
RESULTS
The RWC series showed that erythema and inflamed, easily irritated skin bother patients, even when it is mild. Reducing inflammation, erythema, and visible signs of facial aging and improving skin health contributed to patient satisfaction.
CONCLUSION
The M. pyrifera ferment-containing skincare regimen comprising a cleansing foam, a serum, and a moisturizer is effective in decreasing the visible effects of inflammation and signs of aging while promoting healing by enhancing barrier resilience and recovery.
Topics: Humans; Rejuvenation; Skin Aging; Female; Middle Aged; Skin Care; Face; Patient Satisfaction; Adult; Erythema; Aged; Male; Treatment Outcome
PubMed: 38922798
DOI: 10.1111/jocd.16420 -
International Journal of Dermatology Jun 2024Scabies, caused by the Sarcoptes scabiei var hominis mite burrowing into the skin, is a highly contagious disease characterized by intense nocturnal itching. Its global... (Review)
Review
Scabies, caused by the Sarcoptes scabiei var hominis mite burrowing into the skin, is a highly contagious disease characterized by intense nocturnal itching. Its global impact is considerable, affecting more than 200 million individuals annually and posing significant challenges to healthcare systems worldwide. Transmission occurs primarily through direct skin-to-skin contact, contributing to its widespread prevalence and emergence as a substantial public health concern affecting large populations. This review presents consensus-based clinical practice guidelines for diagnosing and managing scabies, developed through the fuzzy Delphi method by dermatology, parasitology, pediatrics, pharmacology, and public health experts. The presence of burrows containing adult female mites, their eggs, and excreta is the diagnostic hallmark of scabies. Definitive diagnosis typically involves direct microscopic examination of skin scrapings obtained from these burrows, although dermoscopy has become a diagnostic tool in clinical practice. Treatment modalities encompass topical agents, such as permethrin, balsam of Peru, precipitated sulfur, and benzyl benzoate. In cases where topical therapy proves inadequate or in instances of crusted scabies, oral ivermectin is recommended as a systemic treatment option. This comprehensive approach addresses the diagnostic and therapeutic challenges associated with scabies, optimizing patient care, and management outcomes.
PubMed: 38922701
DOI: 10.1111/ijd.17327 -
JAMA Surgery Jun 2024According to the Centers for Disease Control and Prevention and governing bodies within the American College of Surgeons, the administration of antibiotics as...
IMPORTANCE
According to the Centers for Disease Control and Prevention and governing bodies within the American College of Surgeons, the administration of antibiotics as prophylaxis against infection prior to a planned elective procedure is, with rare exception, routinely recommended. The goal of "getting to zero" infections remains a high priority for policymakers, practitioners, and certainly for patients.
OBSERVATIONS
Despite the many advances in surgical technique, skin decontamination, sterile procedure, and enhanced recovery programs, surgical site infections continue to adversely affect procedures as diverse as dental implant surgery, joint arthroplasty, and major abdominal surgery. Although surgical site infection rates are at historically low levels, progress has stalled in recent reporting periods and such infections remain disabling, costly, and occasionally lethal. Stakeholders in the field, including surgeons, infectious diseases specialists, and industry, advocate for strategies emphasizing greater levels of intraoperative sterility or broader-spectrum antibiotic coverage as the most appropriate path forward.
CONCLUSIONS AND RELEVANCE
The current emphasis on ever-increasing levels of intraoperative sterility and extended-spectrum antibiotic use are not sustainable long-term solutions. Continuing to escalate these approaches may contribute to unintended consequences including antimicrobial resistance. Principles of antimicrobial stewardship and microbiome sciences can be applied to inform a more effective and sustainable approach to infection prevention in the field of surgery.
PubMed: 38922606
DOI: 10.1001/jamasurg.2024.0429 -
JAMA Dermatology Jun 2024Access to timely dermatologic care remains a challenge, especially for patients with new skin lesions. Assessing the efficiency of new triage pathways may assist in...
IMPORTANCE
Access to timely dermatologic care remains a challenge, especially for patients with new skin lesions. Assessing the efficiency of new triage pathways may assist in better resource allocation and shorter time to care.
OBJECTIVE
To evaluate whether a rule-based triage system was associated with better skin cancer risk stratification of patients and reduced wait times.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective quality improvement cohort study of patients referred to Stanford University dermatology clinics was conducted between November 2017 and January 2023. A rules-based triage system based on a priori-determined high-risk lesion characteristics was implemented.
EXPOSURES
Referral reasons and risk factors of patients provided by their primary care physicians.
MAIN OUTCOMES AND MEASURES
Biopsy results of patients (diagnosis of any skin cancer and melanoma) at their visit or within 6 months after the visit. Regression models were used to assess the association between risk factors at referral and (1) biopsy outcomes and (2) time to first visit, adjusting for sociodemographic factors.
RESULTS
Among 37 478 patients (mean [SD] age, 54 (18) years; 21 292 women [57%]), the rates of aggregate biopsy, malignant biopsy specimens, and melanoma were comparable across patients seen after (n = 12 302) and before (n = 25 176) the implementation of the new triage pathway. Patients seen through the lesion pathway had a higher risk of having malignant biopsy results (adjusted risk ratio [aRR], 1.6; 95% CI, 1.4-1.9) and melanoma (aRR, 2.0; 95% CI, 1.2-3.2) than those not seen through the pathway. Lesions that were concerning to referring clinicians for skin cancer were associated with an increased risk of skin cancer (all skin cancer: aRR, 2.8; 95% CI, 2.2-3.5; melanoma: aRR, 2.02; 95% CI, 1.1-3.7). Patients in the 3 high-risk lesion groups were seen faster in the new triage pathway (mean reduction, 26 days; 95% CI, 18-34 days).
CONCLUSIONS AND RELEVANCE
In this study, a new automated, rules-based referral pathway was implemented that expedited care for patients with high-risk skin cancer. This reform may have contributed to improving patient stratification, reducing the time from referral to first encounter, and maintaining accuracy in identifying malignant lesions. The findings highlight the potential to optimize clinical resource allocation by better risk stratification of referred patients.
PubMed: 38922597
DOI: 10.1001/jamadermatol.2024.1832 -
Journal of Fungi (Basel, Switzerland) May 2024The skin mycobiota plays a significant role in infection risk, pathogen transmission, and personalized medicine approaches in intensive care settings. This prospective...
The skin mycobiota plays a significant role in infection risk, pathogen transmission, and personalized medicine approaches in intensive care settings. This prospective multicenter study aimed to enhance our understanding of intensive care units' (ICUs') colonization dynamics, identify modifiable risk factors, and assess their impact on survival risk. Specimens were taken from 675, 203, and 110 patients at the admission (D1), 5th (D5), and 8th (D8) days of ICU stay, respectively. The patient's demographic and clinical data were collected. isolates were identified by conventional culture-based microbiology combined with molecular approaches. Overall, colonization was 184/675 (27.3%), 87/203 (42.8%), and 58/110 (52.7%) on D1, D5, and D8, respectively. colonization dynamics were significantly associated with ICU type (odds ratio (OR) = 2.03, 95% CI 1.22-3.39, = 0.007), respiratory infection (OR = 1.74, 95% CI 1.17-2.58, = 0.006), hemodialysis (OR = 2.19, 95% CI 1.17-4.10, = 0.014), COVID-19 (OR = 0.37, 95% CI 0.14-0.99, = 0.048), and with a poor 3-month outcome ( = 0.008). Skin spp. colonization can be an early warning tool to generate valuable insights into the epidemiology, risk factors, and survival rates of critically ill patients, and should be considered for epidemiological surveillance.
PubMed: 38921364
DOI: 10.3390/jof10060378 -
Healthcare (Basel, Switzerland) Jun 2024The prevalence of dermatological conditions in primary care, coupled with challenges such as dermatologist shortages and rising consultation costs, highlights the need... (Review)
Review
The prevalence of dermatological conditions in primary care, coupled with challenges such as dermatologist shortages and rising consultation costs, highlights the need for innovative solutions. Artificial intelligence (AI) holds promise for improving the diagnostic analysis of skin lesion images, potentially enhancing patient care in primary settings. This systematic review following PRISMA guidelines examined primary studies (2012-2022) assessing AI algorithms' diagnostic accuracy for skin diseases in primary care. Studies were screened for eligibility based on their availability in the English language and exclusion criteria, with risk of bias evaluated using QUADAS-2. PubMed, Scopus, and Web of Science were searched. Fifteen studies (2019-2022), primarily from Europe and the USA, focusing on diagnostic accuracy were included. Sensitivity ranged from 58% to 96.1%, with accuracies varying from 0.41 to 0.93. AI applications encompassed triage and diagnostic support across diverse skin conditions in primary care settings, involving both patients and primary care professionals. While AI demonstrates potential for enhancing the accuracy of skin disease diagnostics in primary care, further research is imperative to address study heterogeneity and ensure algorithm reliability across diverse populations. Future investigations should prioritise robust dataset development and consider representative patient samples. Overall, AI may improve dermatological diagnosis in primary care, but careful consideration of algorithm limitations and implementation strategies is required.
PubMed: 38921305
DOI: 10.3390/healthcare12121192 -
Current Issues in Molecular Biology May 2024Skin aging is an unavoidable natural phenomenon caused by intrinsic and extrinsic factors. In modern society, the pursuit of a wrinkle-free and aesthetically appealing...
Skin aging is an unavoidable natural phenomenon caused by intrinsic and extrinsic factors. In modern society, the pursuit of a wrinkle-free and aesthetically appealing face has gained considerable prominence. Numerous studies have aimed at mitigating the appearance of facial wrinkles. Antiaging research focused on regulating the function of mitochondria, the main reactive oxygen species-generating organelles, has been extensively conducted. In this study, we investigated the correlation between facial wrinkles and the expression of , considering the association of this gene with mitochondrial function, to identify its potential as a target for exploring antiaging cosmetic materials. We elucidated the role of in the skin and identified five bioactive materials that modulated its expression. The effectiveness of these materials was verified through in vitro experiments on human dermal fibroblasts. We prepared cosmetic formulations incorporating the five materials and confirmed their ability to enhance dermal collagen in three-dimensional skin models and reduce facial wrinkles under the eyes and nasolabial fold areas in human subjects. The study findings have significant implications for developing novel antiaging cosmetic formulations by reinforcing mitochondrial functions.
PubMed: 38920974
DOI: 10.3390/cimb46060302 -
Journal of Anaesthesiology, Clinical... 2024To compare ultra-sonographic dimensions of acoustic target window of the spine in the participants at four different sitting positions namely cross leg sitting (CLP),...
BACKGROUND AND AIMS
To compare ultra-sonographic dimensions of acoustic target window of the spine in the participants at four different sitting positions namely cross leg sitting (CLP), hamstring stretch (HSP), classical sitting (CSP) and riders sitting position (RSP). The primary objective of this study was to measure the neuraxial acoustic target window (defined as interlaminar distance between L3-L4 lamina). The secondary objective was to compare ultra-sonographic measurements of the depth of ligamentum flavum from the skin, and to compare the diameter of intrathecal space and comfort score in the four different sitting positions.
MATERIAL AND METHODS
This study is a prospective observational study. Eighty participants were included and positioned in four different sitting positions to perform an ultra-sonographic scan and measure various parameters of the acoustic neuraxial window. The interlaminar distance, the distance of skin from the ligamentum flavum, and the diameter of the spinal canal or intrathecal space was measured in the L3-L4 intervertebral space in different positions.
RESULTS
The mean value of interlaminar distance among four sitting positions was ranging from 1.40 cm to 1.44 cm ( value 0.725.) The distance of ligamentum flavum from skin and diameter of intrathecal space was also comparable in all the groups. The comfort score in CSP was significantly better when compared to other groups with a median score of 4 ( value < 0.001).
CONCLUSIONS
There is no statistically significant difference in interlaminar distance in various sitting positions. All four positions are equally effective and can be used as an alternative to spinal/epidural intervention, but the CSP came out to be the most comfortable and more emphasis should be given to the comfort as it increases the chance of success rate of the procedure.
PubMed: 38919435
DOI: 10.4103/joacp.joacp_450_22