68 research outputs found
From Student to Physician: Determining Which Lifestyle Behaviors May Be Risk Factors for Burnout at a South Florida Medical School
Background: Compared to other professions, physicians have significantly higher rates of burnout and poor lifestyle behaviors, including inadequate sleep, poor diet, limited exercise, and lack of supportive social relationships. Among physicians in training, burnout and increasingly poor lifestyle behaviors can begin as early as the preclinical years of medical school.
Methods: A cross-sectional survey composed of questions from standardized surveys measuring diet (Yaroch’s FVS), exercise (NPAQ-S), sleep (NHANES), stress management (HRQOL), social support (BRFSS), substance use (AUDIT-QF, WHO), and burnout (Mini-Z) was conducted on a South Florida medical school in May 2021. One hundred forty-four students fully completed the survey for a response rate of 16%. Descriptive analysis was performed via SPSS to determine the effects of these lifestyle factors on the likelihood of student burnout.
Results: In this sample of medical students, over half (61%) experienced burnout per the Single Item Burnout Measure. Independently, lack of sleep (p<0.02) and decreased social support (p<0.001) were lifestyle factors positively associated with increased risk of burnout. Furthermore, students who experienced burnout reported more poor mental health days and decreased life satisfaction (p<0.001).
Conclusion: Over half of the medical students experienced burnout. Lack of sleep and lack of social support were significantly associated with increased risk of burnout. In addition, burned-out students showed significantly increased levels of poor mental health and decreased life satisfaction. These findings help us identify specific lifestyle factors that institutions could use to further combat medical student burnout
Interventions for hyperhidrosis in secondary care : a systematic review and value-of-information analysis
Background: Hyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable. Objective: To establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care. Methods: A systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only. Results and conclusions: Fifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life. Limitations: The evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla. Future work: Based on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses
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Could the use of personal care oils in black women contribute to recent findings of an increased risk of breast cancer in this population?
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Optimizing patient care with "natural" products: treatment of hyperpigmentation
Patients with skin of color suffer from different cutaneous issues when compared with skin of light complexion, and therefore management of the former must be representative of these variations. The most common pigmentary complaints in patients with skin of color are post-inflammatory hyperpigmentation, melasma and sun-induced hyperpigmentation. Often, patients with darker skin will turn to naturally occurring ingredients over synthetic analogues both to satisfy cultural preferences and to limit potential adverse effects that have been tied to synthetics. Science-based natural products can offer an attractive adjunct to conventional therapies that treat melasma, post-inflammatory hyperpigmentaion, and other dyschromias. Increasing data on the biological effects and the efficacy of natural therapies support the use of these complementary therapies in treating hyperpigmentation
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Aluminum chloride hexahydrate in a salicylic acid gel base: a case series of combination therapy with botulinum toxin type A for moderate to severe hyperhidrosis
Hyperhidrosis is a common condition that has a tremendous impact on the quality of life of patients. For moderate to severe hyperhidrosis, topical aluminum chloride hexahydrate (AC), iontophoresis, and botulinum toxin type A injections are first-line therapies. Botulinum toxin type A has been a useful addition to the hyperhidrosis armamentarium and typically is utilized when topical therapy or iontophoresis have failed. Although highly effective for most patients, there remains a subset of patients who do not completely respond to botulinum toxin type A injections. For these patients, combination therapy with AC can greatly improve patient response. We present a case series of 10 patients with hyperhidrosis and a history of partial response to botulinum toxin type A monotherapy. With the addition of AC 15% in a salicylic acid 2% gel base, 5 patients achieved 75% to 100% reduction in sweating and 5 patients achieved 100% reduction in sweating. Aluminum chloride hexahydrate in a salicylic acid gel base offers a novel and effective topical therapy in combination with botulinum toxin type A for patients with moderate to severe hyperhidrosis
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Inflammaging in Dermatology: A New Frontier for Research
As humans age, our ability to manage certain types of inflammation is reduced. As a result, we experience chronic, low-grade inflammation, which has been termed "inflammaging". This type of low-level inflammation is driven by a progressive increase in pro- inflammatory systemic cytokines over time. Inflammaging is thought to contribute to many age-related chronic diseases including cardiovascular disease, diabetes, Alzheimer's disease, and even certain cancers. Recent studies suggest that the human microbiome may play a critical role in inflammaging. As the largest organ of the body and home to a significant portion of the human microbiome, the skin may play a unique role in inflammaging. In this review article, we present common dermatological diseases through the lens of inflammaging, look at how our skin may play a role in reducing inflammaging, and highlight the need for further focused research in this area. J Drugs Dermatol. 2021;20(2):144-149. doi:10.36849/JDD.5481
Skin Tightening
Skin tightening describes the treatment of skin laxity via radiofrequency (RF), ultrasound, or light-based devices. Skin laxity on the face is manifested by progressive loss of skin elasticity, loosening of the connective tissue framework, and deepening of skin folds. This results in prominence of submandibular and submental tissues. Genetic factors (chronological aging) and extrinsic factors (ultraviolet radiation) both contribute to skin laxity. There are many RF, ultrasound, and light-based devices directed at treating skin laxity. All of these devices target and heat the dermis to induce collagen contraction. Heating of the dermis causes collagen denaturation and immediate collagen contraction in addition to long-term collagen remodeling. Via RF, light, or ultrasound, these skin tightening devices deliver heat to the dermis to create new collagen and induce skin tightening. This chapter will provide an overview of the various skin tightening devices
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