187 research outputs found
Patterns of Clinical Management of Atopic Dermatitis in Infants and Toddlers: A Survey of Three Physician Specialties in the United States
ObjectiveTo describe atopic dermatitis (AD) management patterns in children ā¤36 months old as reported by pediatricians, dermatologists, and allergists in the US.Study designA nationally-representative survey was administered to pediatricians (n = 101), dermatologists (n = 26), and allergists (n = 26). Main outcomes included referrals to health care professionals, suggested/ordered laboratory tests, management approach (dietary, pharmacologic, or combination of both) by age, AD location, and severity.ResultsSignificant differences were observed in referrals to healthcare professionals (P < .001). Pediatricians more frequently referred to dermatologists than allergists in mild (52.4% vs 32.0%) and moderate/severe (60.6% vs 38.1%) cases. Dermatologists referred to allergists less frequently for mild (9.1%) than moderate/severe (40.7%) AD cases. Pediatricians (59%), allergists (61.5%), and dermatologists (26.9%) reported treating at least some of their patients with AD with dietary management (infant formula change) alone (with or without emollients). Soy-based formulas were often used. For mild AD, the most commonly reported first-line pharmacologic treatments included topical emollients, topical corticosteroids, and barrier repair topical therapy/medical devices. Over 80% of physicians used a dietary and pharmacologic combination approach. Dermatologists were most likely to manage AD symptoms with a pharmacologic-only approach. AD lesion location influenced pharmacologic treatment in >80% of physicians.ConclusionsSignificant and distinct differences in AD treatment approach exist among physicians surveyed. Most pediatricians and allergists use formula change as a management strategy in some patients, whereas dermatologists favor a pharmacologic approach. This diversity may result from inadequate evidence for a standard approach. Consistent methods for managing AD are needed
Report from the third international consensus meeting to harmonise core outcome measures for atopic eczema/dermatitis clinical trials (HOME).
This report provides a summary of the third meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in San Diego, CA, U.S.A., 6-7 April 2013 (HOME III). The meeting addressed the four domains that had previously been agreed should be measured in every eczema clinical trial: clinical signs, patient-reported symptoms, long-term control and quality of life. Formal presentations and nominal group techniques were used at this working meeting, attended by 56 voting participants (31 of whom were dermatologists). Significant progress was made on the domain of clinical signs. Without reference to any named scales, it was agreed that the intensity and extent of erythema, excoriation, oedema/papulation and lichenification should be included in the core outcome measure for the scale to have content validity. The group then discussed a systematic review of all scales measuring the clinical signs of eczema and their measurement properties, followed by a consensus vote on which scale to recommend for inclusion in the core outcome set. Research into the remaining three domains was presented, followed by discussions. The symptoms group and quality of life groups need to systematically identify all available tools and rate the quality of the tools. A definition of long-term control is needed before progress can be made towards recommending a core outcome measure
Management of infantile hemangiomas during the COVID pandemic
This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.The COVIDā19 pandemic has caused significant shifts in patient care including a steep decline in ambulatory visits and a marked increase in the use of telemedicine. Infantile hemangiomas (IH) can require urgent evaluation and risk stratification to determine which infants need treatment and which can be managed with continued observation. For those requiring treatment, prompt initiation decreases morbidity and improves longāterm outcomes. The Hemangioma Investigator Group has created consensus recommendations for management of IH via telemedicine. FDA/EMAāapproved monitoring guidelines, clinical practice guidelines, and relevant, upātoādate publications regarding initiation and monitoring of betaāblocker therapy were used to inform the recommendations. Clinical decisionāmaking guidelines about when telehealth is an appropriate alternative to ināoffice visits, including medication initiation, dosage changes, and ongoing evaluation, are included. The importance of communication with caregivers in the context of telemedicine is discussed, and online resources for both hemangioma education and propranolol therapy are provided
The Use of DecisionāAnalytic Models in Atopic Eczema: A Systematic Review and Critical Appraisal
Objective: The objective of this systematic review was to identify and assess the quality of published economic decisionāanalytic models within atopic eczema against best practice guidelines, with the intention of informing future decisionāanalytic models within this condition. Methods: A systematic search of the following online databases was performed: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, NHS Economic Evaluation Database, EconLit, Scopus, Health Technology Assessment, Cost-Effectiveness Analysis Registry and Web of Science. Papers were eligible for inclusion if they described a decisionāanalytic model evaluating both the costs and benefits associated with an intervention or prevention for atopic eczema. Data were extracted using a standardised form by two independent reviewers, whilst quality was assessed using the model-specific Philips criteria. Results: Twenty-four models were identified, evaluating either preventions (n = 12) or interventions (n = 12): 14 reported using a Markov modelling approach, four utilised decision trees and one a discrete event simulation, whilst five did not specify the approach. The majority, 22 studies, reported that the intervention was dominant or cost effective, given the assumptions and analytical perspective taken. Notably, the models tended to be short-term (16 used a time horizon of ā¤1 year), often providing little justification for the limited time horizon chosen. The methodological and reporting quality of the studies was generally weak, with only seven studies fulfilling more than 50% of their applicable Philips criteria. Conclusions: This is the first systematic review of decision models in eczema. Whilst the majority of models reported favourable outcomes in terms of the cost effectiveness of the new intervention, the usefulness of these findings for decision-making is questionable. In particular, there is considerable scope for increasing the range of interventions evaluated, for improving modelling structures and reporting quality
A systematic review of the safety of topical therapies for atopic dermatitis
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75613/1/j.1365-2133.2006.07538.x.pd
āSoftā policing at hot spotsādo police community support officers work? A randomized controlled trial
Hypersensitivity to Pollen of Olea Europea in Patients with Pollen Allergy in Zadar Country, Croatia
Preosjetljivost na pelud masline važan je uzrok peludnih alergija u mediteranskim zemljama. Cilj ovoga rada bio je utvrditi uÄestalost preosjetljivosti na pelud masline meÄu bolesnicima s peludnom alergijom u Zadru i Zadarskoj županiji. Dobivene rezultate usporedili smo s ranijim ispitivanjem preosjetljivosti na pelud masline u Dalmaciji.
Ukupno je obraÄen 671 ispitanik s preosjetljivosti na peludne alergene. Od toga broja 61 % ispitanika bilo je muÅ”kog spola, a 39 % je bilo ženskog spola. Od ukupno ispitanih 53.5 % Äinila su djeca u dobi od 4 do 14 godina, a preostalih 46.5 % bili su odrasli u dobi od 15 do 59 godina života. Svim ispitanicima uzeta je detaljna obiteljska i osobna anamneza, napravljen kliniÄki pregled te uÄinjeno kožno prick-testiranje i enzimatsko-imunoloÅ”ki UniCAP-test za odreÄivanje specifi Änih IgE-protutijela. StatistiÄka obrada podataka
uÄinjena je Ļ2-testom.
Preosjetljivost na pelud masline dokazana je u 8.8 % bolesnika s peludnom alergijom. NajveÄi broj bolesnika s preosjetljivosti na pelud masline boluje od alergijskog rinitisa, 58 % bolesnika. Postoji statistiÄki znaÄajna razlika u broju bolesnika izmeÄu dvije ispitivane sredine, gradske i seoske. Samo 3 % bolesnika
stanovnici su otoka.
Preosjetljivost na pelud masline u naÅ”em ispitivanju najniža je u odnosu na ispitivanja provedena u drugim mediteranskim zemljama. NajÄeÅ”Äe se oÄituje kliniÄkom slikom alergijskog rinitisa, a statistiÄki je znaÄajno ÄeÅ”Äa u gradskoj sredini. Usporedba preosjetljivosti na pelud masline tijekom dvaju ispitivanih razdoblja u naÅ”oj zemlji nije pokazala porast broja bolesnika s preosjetljivosti na pelud masline.Olive pollen is one of the most common respiratory allergens in the Mediterranean countries. The aim of this study was to establish the frequency of hypersensitivity to the pollen of Olea europea in pollen
allergic patients in the County of Zadar. The study included 671 patients with pollen allergy; 61 % were male and 39 % female. 53.5 % were children aged from 4 to 14 years and 46.5 % adolescents and adults from 15 to 59 years. We took their case history, clinically examined them, and tested using the skin prick test and enzymo-immunologic UniCAP test for specifi c IgE antibodies. For statistical analysis we used the chi-square test.
Hypersensitivity to Olea europea pollen was confi rmed in 8.8 % patients with pollen allergy. Among them, the most prevalent symptom was rhinitis (58 %). Most hypersensitive patients were urban residents. Only 3 % patients lived on an island.
Judging by available data, our fi ndings show the lowest hypersensitivity to olive pollen in the Mediterranean.
A comparison with our two earlier studies did not show any fl uctuation in this kind of hypersensitivity
A thin-slice of institutionalised police brutality: a tradition of excessive force in the Chicago Police Department
In the Chicago Police Department, a sustained tradition of tolerating violent conduct has contributed to the fostering of a police culture in which the use of force is celebrated. Evidence suggests that there has been a historical reluctance to take action to discipline officers accused of misconduct ā many of whom are highly decorated veterans of the Chicago Police Department. It is the contention of this article that the long-standing endorsement of excessive force in Chicago policing has compromised officersā ability to thin-slice, a psychological process in which people are able to draw on their experiences and socio-cultural context to make quick decisions under pressure. Instead, officers are instinctively drawn to engage in misconduct as a means to an end, with the confidence that their actions will not attract the sanction of their superiors
Comparison of the Efficacy of AtopalmĀ® Multi-Lamellar Emulsion Cream and PhysiogelĀ® Intensive Cream in Improving Epidermal Permeability Barrier in Sensitive Skin
Neuronal plasticity of the ābraināskin connectionā: stress-triggered up-regulation of neuropeptides in dorsal root ganglia and skin via nerve growth factor-dependent pathways
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