Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial

BACKGROUND:Childhood asthma is common in Cape Town, a province of South Africa, but is underdiagnosed by general practitioners. Medications are often prescribed inappropriately, and care is episodic. The objective of this study is to assess the impact of educational outreach to general practitioners on asthma symptoms of children in their practice. METHODS: This is a cluster randomised trial with general practices as the unit of intervention, randomisation, and analysis. The setting is Mitchells Plain (population 300,000), a dormitory town near Cape Town. Solo general practitioners, without nurse support, operate from storefront practices. Caregiver-reported symptom data were collected for 318 eligible children (2 to 17 years) with moderate to severe asthma, who were attending general practitioners in Mitchells Plain. One year post-intervention follow-up data were collected for 271 (85%) of these children in all 43 practices.Practices randomised to intervention (21) received two 30-minute educational outreach visits by a trained pharmacist who left materials describing key interventions to improve asthma care. Intervention and control practices received the national childhood asthma guideline. Asthma severity was measured in a parent-completed survey administered through schools using a symptom frequency and severity scale. We compared intervention and control group children on the change in score from pre-to one-year post-intervention. RESULTS: Symptom scores declined an additional 0.84 points in the intervention vs. control group (on a nine-point scale. p = 0.03). For every 12 children with asthma exposed to a doctor allocated to the intervention, one extra child will have substantially reduced symptoms. CONCLUSION: Educational outreach was accepted by general practitioners and was effective. It could be applied to other health care quality problems in this setting

Primary Cutaneous Melanoma-Management in 2024

Background: Maximizing survival for patients with primary cutaneous melanomas (melanomas) depends on an early diagnosis and appropriate management. Several new drugs have been shown to improve survival in high-risk melanoma patients. Despite well-documented guidelines, many patients do not receive optimal management, particularly when considering patient age. Objective: to provide an update on melanoma management from the time of the decision to biopsy a suspicious skin lesion. Methods: We reviewed melanoma-management research published between 2018 and 2023 and identified where such findings impact and update the management of confirmed melanomas. Pubmed, Google Scholar, Ovid and Cochrane Library were used as search tools. Results: We identified 81 publications since 2017 that have changed melanoma management; 11 in 2018, 12 in 2019, 10 in 2020, 12 in 2021, 17 in 2022 and 18 in 2023. Discussion: Delayed or inaccurate diagnosis is more likely to occur when a partial shave or punch biopsy is used to obtain the histopathology. Wherever feasible, a local excision with a narrow margin should be the biopsy method of choice for a suspected melanoma. The Breslow thickness of the melanoma remains the single most important predictor of outcome, followed by patient age and then ulceration. The BAUSSS biomarker, (Breslow thickness, Age, Ulceration, Subtype, Sex and Site) provides a more accurate method of determining mortality risk than older currently employed approaches, including sentinel lymph node biopsy. Patients with metastatic melanomas and/or nodal disease should be considered for adjuvant drug therapy (ADT). Further, high-risk melanoma patients are increasingly considered for ADT, even without disease spread. Invasive melanomas less than 1 mm thick are usually managed with a radial excision margin of 10 mms of normal skin. If the thickness is 1 to 2 mm, select a radial margin of 10 to 20 mm. When the Breslow thickness is over 2 mm, a 20 mm clinical margin is usually undertaken. In situ melanomas are usually managed with a 5 to 10 mm margin or Mohs margin control surgery. Such wide excisions around a given melanoma is the only surgery that can be regarded as therapeutic and required. Patients who have had one melanoma are at increased risk of another melanoma. Ideal ongoing management includes regular lifelong skin checks. Total body photography should be considered if the patient has many naevi, especially when atypical/dysplastic naevi are identified. Targeted approaches to improve occupational or lifestyle exposure to ultraviolet light are important. Management also needs to include the consideration of vitamin D supplementary therapy

The Prevalence of Sexually Transmitted Infections in Papua New Guinea: A Systematic Review and Meta-Analysis

Patellofemoral osteoarthritis (PF OA) is more prevalent than previously thought and contributes to patient's suffering from knee OA. Synthesis of prevalence data can provide estimates of the burden of PF OA

Cutaneous lesions of the nose

Skin diseases on the nose are seen in a variety of medical disciplines. Dermatologists, otorhinolaryngologists, general practitioners and general plastic and dermatologic surgeons are regularly consulted regarding cutaneous lesions on the nose. This article is the second part of a review series dealing with cutaneous lesions on the head and face, which are frequently seen in daily practice by a dermatologic surgeon. In this review, we focus on those skin diseases on the nose where surgery or laser therapy is considered a possible treatment option or that can be surgically evaluated

Jellyfish stings

Jellyfish are members of the phylum Cnidaria, which consists of five classes: Cubozoa (box jellyfish), Hydrozoa (Portuguese manof-war), Schyphozoa (true jellyfish), Staurozoa (staromedusans),and Anthozoans (corals). They are found in every ocean and some fresh water, from the surface to the depths of the seas. They often consist of a bell shaped body, ranging from 1 millimeter to over 2 meters in diameter, with tentacles up to 30 meters in length. Many have complex life cycles, usually with both a sexual and an asexual stage, often with a sessile polyp stage and a motile medusal stage. Jellyfish envenomings can occur during recreational and commercial pursuits, both in the water and when encountering living or dead animals on the shore. Jellyfish sting their prey using nematocysts, stinging structures located in specialized cells called cnidocytes. Contact with a jellyfish tentacle can trigger millions of nematocysts to pierce the skin and inject venom. Those providing care to sting victims should avoid being stung by adherent tentacles on the victim; however, the risk of the carer being envenomed is minimal. The severity of jellyfish stings depends on the species of jellyfish involved, its age and geographic location, the location of the nematocysts involved (bell or tentacle) and factors such as patient age and general health, amount of skin involved, and number of nematocysts triggered. Understanding the complexity of jellyfish venom is still in its infancy. Most jellyfish stings are self-limiting, causing localized pain and skin lesions. However, symptoms can range from local discomfort, to severe pain, through to cardiovascular collapse and death. Immediate management of jellyfish stings occurs at the beach with first aid and resuscitation, and then if needed in hospital. Immediate cutaneous reactions include wheals, blisters, and angioedema. Dermatologists are most likely to become involved later to manage the delayed sequelae of jellyfish stings. In this chapter we will discuss the most important type of jellyfish stings, the different symptoms and management of these stings, as well as strategies for prevention of jellyfish stings

Jellyfish stings

Jellyfish are members of the phylum Cnidaria, which consists of five classes: Cubozoa (box jellyfish), Hydrozoa (Portuguese manof-war), Schyphozoa (true jellyfish), Staurozoa (staromedusans),and Anthozoans (corals). They are found in every ocean and some fresh water, from the surface to the depths of the seas. They often consist of a bell shaped body, ranging from 1 millimeter to over 2 meters in diameter, with tentacles up to 30 meters in length. Many have complex life cycles, usually with both a sexual and an asexual stage, often with a sessile polyp stage and a motile medusal stage. Jellyfish envenomings can occur during recreational and commercial pursuits, both in the water and when encountering living or dead animals on the shore. Jellyfish sting their prey using nematocysts, stinging structures located in specialized cells called cnidocytes. Contact with a jellyfish tentacle can trigger millions of nematocysts to pierce the skin and inject venom. Those providing care to sting victims should avoid being stung by adherent tentacles on the victim; however, the risk of the carer being envenomed is minimal. The severity of jellyfish stings depends on the species of jellyfish involved, its age and geographic location, the location of the nematocysts involved (bell or tentacle) and factors such as patient age and general health, amount of skin involved, and number of nematocysts triggered. Understanding the complexity of jellyfish venom is still in its infancy. Most jellyfish stings are self-limiting, causing localized pain and skin lesions. However, symptoms can range from local discomfort, to severe pain, through to cardiovascular collapse and death. Immediate management of jellyfish stings occurs at the beach with first aid and resuscitation, and then if needed in hospital. Immediate cutaneous reactions include wheals, blisters, and angioedema. Dermatologists are most likely to become involved later to manage the delayed sequelae of jellyfish stings. In this chapter we will discuss the most important type of jellyfish stings, the different symptoms and management of these stings, as well as strategies for prevention of jellyfish stings

Applied Clinical Epidemiology in General Practice

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