Assessment and burden of pain symptoms in psoriasis: experiences of patients and physicians

Cilj: Psorijaza je kronična upalna kožna bolest čije manifestacije, osim zahvaćanja kože, uključuju i druge neugodne simptome kao što je bol. Novija istraživanja su istaknula kako je bol povezana s psorijazom do sada nedovoljno istražena stoga je cilj istraživanja provedenih u okviru ove doktorske disertacije bio sažeti dostupne dokaze o boli u psorijazi te istražiti opterećenje simptomom boli u psorijazi kroz iskustva pacijenata i liječnika. Metode: Sustavnim pretražnim pregledom (engl. systematic scoping review) učinjena je sinteza dokaza literature pretraživanjem baza podataka od datuma njihova osnivanja. Zatim su analizirana sva klinička ispitivanja o intervencijama za liječenje psorijaze registrirana na ClinicalTrials.gov i učestalost ishoda povezanih s boli u tim registracijama. Također su provedena dva kvalitativna istraživanja metodom polustrukturiranih intervjua na pacijentima s psorijazom i dermatolozima iz Hrvatske. Podaci iz kvalitativnih istraživanja analizirani su primjenom interpretativne deskriptivne i tematske analize primjenom 4-stupanjske metode za sustavno sažimanje teksta. Rezultati: Pretražni pregled literature pokazao je kako je bol istraživana uglavnom u kontekstu psorijatičnog artitisa te je spomenuta u zaključku svega 21% članka. Analiza registracija kliničkih pokusa pokazala je kako je samo 0,6% planiranih kliničkih istraživanja imalo bol kao primarni ishod, a 6,5% kao sekundarni ishod. Većina bolesnika s psorijazom naglasila je narušavanje kvalitete života zbog prisutnosti boli kao i važnost uzimanja u obzir boli tijekom procjene i liječenja njihove bolesti. Dermatolozi su ukazali na potrebu naglašavanja važnosti boli povezane s psorijazom u kliničkoj praksi te važnosti razmatranja boli tijekom procjene i liječenja ovih bolesnika. Zaključak: Rezultati ovih istraživanja trebali bi ukazati na važno mjesto simptoma boli kod pacijenata s psorijazom. Simptom boli u psorijazi valja redovito uzimati u obzir pri procjeni i liječenju kao i u budućim istraživanjima.Objective: Psoriasis is a chronic inflammatory skin disease whose manifestations, in addition to skin involvement, include other unpleasant symptoms such as pain. Recent research has highlighted that the pain associated with psoriasis has so far been insufficiently studied. Therefore, the aim of the studies conducted within this doctoral thesis was to summarize the available evidence on this topic, to analyze outcomes related to pain used in registered clinical trials and to investigate the burden of pain symptoms in psoriasis through the experiences of patients and dermatologists. Methods: A systematic scoping review was used for mapping the literature on psoriasis and pain. In a meta-research study we analyzed all clinical trials of psoriasis interventions registered at ClinicalTrials.gov and the frequency of pain-related outcomes. We also conducted two qualitative studies based on semi-structured interviews with patients with psoriasis and dermatologists from Croatia. Data from qualitative studies were analyzed using interpretive descriptive and thematic analysis using a 4-step method for systematic text summarization. Results: A search of the literature showed that the majority of studies addressed pain in psoriatic arthritis and pain was mentioned in the conclusion of only 21% of the articles. The second study found that only 0.6% of registered clinical trial protocols had pain as a primary outcome and 6.5% as a secondary outcome. Most patients with psoriasis emphasized the impairment of quality of life due to the presence of pain, as well as the importance of taking pain into account during the assessment and treatment of their disease. Dermatologists indicated the need to emphasize the importance of pain associated with psoriasis in clinical practice and the importance of considering pain during the assessment and treatment of these patients. Conclusion: The results of these studies shoud indicate the important place of pain symptoms in patients with psoriasis. Pain in psoriasis should be considered more often in patient assessment and treatment as well as in future research

Assessment and burden of pain symptoms in psoriasis: experiences of patients and physicians

Cilj: Psorijaza je kronična upalna kožna bolest čije manifestacije, osim zahvaćanja kože, uključuju i druge neugodne simptome kao što je bol. Novija istraživanja su istaknula kako je bol povezana s psorijazom do sada nedovoljno istražena stoga je cilj istraživanja provedenih u okviru ove doktorske disertacije bio sažeti dostupne dokaze o boli u psorijazi te istražiti opterećenje simptomom boli u psorijazi kroz iskustva pacijenata i liječnika. Metode: Sustavnim pretražnim pregledom (engl. systematic scoping review) učinjena je sinteza dokaza literature pretraživanjem baza podataka od datuma njihova osnivanja. Zatim su analizirana sva klinička ispitivanja o intervencijama za liječenje psorijaze registrirana na ClinicalTrials.gov i učestalost ishoda povezanih s boli u tim registracijama. Također su provedena dva kvalitativna istraživanja metodom polustrukturiranih intervjua na pacijentima s psorijazom i dermatolozima iz Hrvatske. Podaci iz kvalitativnih istraživanja analizirani su primjenom interpretativne deskriptivne i tematske analize primjenom 4-stupanjske metode za sustavno sažimanje teksta. Rezultati: Pretražni pregled literature pokazao je kako je bol istraživana uglavnom u kontekstu psorijatičnog artitisa te je spomenuta u zaključku svega 21% članka. Analiza registracija kliničkih pokusa pokazala je kako je samo 0,6% planiranih kliničkih istraživanja imalo bol kao primarni ishod, a 6,5% kao sekundarni ishod. Većina bolesnika s psorijazom naglasila je narušavanje kvalitete života zbog prisutnosti boli kao i važnost uzimanja u obzir boli tijekom procjene i liječenja njihove bolesti. Dermatolozi su ukazali na potrebu naglašavanja važnosti boli povezane s psorijazom u kliničkoj praksi te važnosti razmatranja boli tijekom procjene i liječenja ovih bolesnika. Zaključak: Rezultati ovih istraživanja trebali bi ukazati na važno mjesto simptoma boli kod pacijenata s psorijazom. Simptom boli u psorijazi valja redovito uzimati u obzir pri procjeni i liječenju kao i u budućim istraživanjima.Objective: Psoriasis is a chronic inflammatory skin disease whose manifestations, in addition to skin involvement, include other unpleasant symptoms such as pain. Recent research has highlighted that the pain associated with psoriasis has so far been insufficiently studied. Therefore, the aim of the studies conducted within this doctoral thesis was to summarize the available evidence on this topic, to analyze outcomes related to pain used in registered clinical trials and to investigate the burden of pain symptoms in psoriasis through the experiences of patients and dermatologists. Methods: A systematic scoping review was used for mapping the literature on psoriasis and pain. In a meta-research study we analyzed all clinical trials of psoriasis interventions registered at ClinicalTrials.gov and the frequency of pain-related outcomes. We also conducted two qualitative studies based on semi-structured interviews with patients with psoriasis and dermatologists from Croatia. Data from qualitative studies were analyzed using interpretive descriptive and thematic analysis using a 4-step method for systematic text summarization. Results: A search of the literature showed that the majority of studies addressed pain in psoriatic arthritis and pain was mentioned in the conclusion of only 21% of the articles. The second study found that only 0.6% of registered clinical trial protocols had pain as a primary outcome and 6.5% as a secondary outcome. Most patients with psoriasis emphasized the impairment of quality of life due to the presence of pain, as well as the importance of taking pain into account during the assessment and treatment of their disease. Dermatologists indicated the need to emphasize the importance of pain associated with psoriasis in clinical practice and the importance of considering pain during the assessment and treatment of these patients. Conclusion: The results of these studies shoud indicate the important place of pain symptoms in patients with psoriasis. Pain in psoriasis should be considered more often in patient assessment and treatment as well as in future research

Dermatologist-like explainable AI enhances trust and confidence in diagnosing melanoma

Abstract Artificial intelligence (AI) systems have been shown to help dermatologists diagnose melanoma more accurately, however they lack transparency, hindering user acceptance. Explainable AI (XAI) methods can help to increase transparency, yet often lack precise, domain-specific explanations. Moreover, the impact of XAI methods on dermatologists’ decisions has not yet been evaluated. Building upon previous research, we introduce an XAI system that provides precise and domain-specific explanations alongside its differential diagnoses of melanomas and nevi. Through a three-phase study, we assess its impact on dermatologists’ diagnostic accuracy, diagnostic confidence, and trust in the XAI-support. Our results show strong alignment between XAI and dermatologist explanations. We also show that dermatologists’ confidence in their diagnoses, and their trust in the support system significantly increase with XAI compared to conventional AI. This study highlights dermatologists’ willingness to adopt such XAI systems, promoting future use in the clinic