Effect of Laser and Energy-based Device Therapies to Minimize Surgical Scar Formation: A Systematic Review and Network Meta-analysis.

Utilization of lasers and energy-based devices for surgical scar minimization has been substantially evaluated in placebo-controlled trials. The aim of this study was to compare reported measures of efficacy of lasers and energy-based devices in clinical trials in preventing surgical scar formation in a systematic review and network meta-analyses. Five electronic databases, PubMed, Scopus, Embase, ClinicalTrials.gov, and the Cochrane Library, were searched to retrieve relevant articles. The search was limited to randomized controlled trials that reported on clinical outcomes of surgical scars with treatment initiation no later than 6 months after surgery and a follow-up period of at least 3 months. A total of 18 randomized controlled trials involving 482 participants and 671 postsurgical wounds were included in the network meta-analyses. The results showed that the most efficacious treatments were achieved using low-level laser therapy) (weighted mean difference -3.78; 95% confidence interval (95% CI) -6.32, -1.24) and pulsed dye laser (weighted mean difference -2.46; 95% CI -4.53, -0.38). Nevertheless, low-level laser therapy and pulsed dye laser demonstrated comparable outcomes in surgical scar minimization (weighted mean difference -1.32, 95% CI -3.53, 0.89). The findings of this network meta-analyses suggest that low-level laser therapy and pulsed dye laser are both effective treatments for minimization of scar formation following primary closure of surgical wounds with comparable treatment outcomes.

Learning to PERSEVERE: A pilot study of peer mentor support and caregiver education in Lewy body dementia.

BACKGROUND: Lewy Body Disease (LBD) is the second most common neurodegenerative disorder. Despite high family caregiver strain and adverse patient and caregiver outcomes, few interventions exist for LBD family caregivers. Based on a successful peer mentoring pilot study in advanced Parkinson's Disease, we revised the curriculum of this peer-led educational intervention incorporating LBD caregiver input. OBJECTIVE: We assessed feasibility of a peer mentor-led educational intervention and its impact on LBD family caregivers' knowledge, dementia attitudes, and mastery. METHODS: Using community-based participatory research, we refined a 16-week peer mentoring intervention and recruited caregivers online through national foundations. Experienced LBD caregiver mentors were trained and matched with newer caregiver mentees with whom they spoke weekly for 16 weeks, supported by the intervention curriculum. We measured intervention fidelity biweekly, program satisfaction, and change in LBD knowledge, dementia attitudes, and caregiving mastery before and after the 16-week intervention. RESULTS: Thirty mentor-mentee pairs completed a median of 15 calls (range: 8-19; 424 total calls; median 45 min each). As satisfaction indicators, participants rated 95.3% of calls as useful, and at week 16, all participants indicated they would recommend the intervention to other caregivers. Mentees' knowledge and dementia attitudes improved by 13% (p < 0.05) and 7% (p < 0.001), respectively. Training improved mentors' LBD knowledge by 32% (p < 0.0001) and dementia attitudes by 2.5% (p < 0.001). Neither mentor nor mentee mastery changed significantly (p = 0.36, respectively). CONCLUSIONS: This LBD caregiver-designed and -led intervention was feasible, well-received, and effective in improving knowledge and dementia attitudes in both seasoned and newer caregivers. TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT04649164ClinicalTrials.gov Identifier: NCT04649164; December 2, 2020.

Community-based neuropalliative care.

Community-based palliative care is defined as palliative care delivered outside of the hospital and outpatient clinics. These settings include the home, nursing homes, day programs, volunteer organizations, and support groups. There is strong evidence outside of the neuropalliative context that community-based palliative care can reduce hospital costs and admissions at the end of life. Research that focuses on specialized community-based palliative care for neurologic disease have similar findings, although with significant variability across conditions and geographic locations. Several of these studies have investigated home-based care for neurologic conditions including dementia, Parkinson's disease, multiple sclerosis, brain tumors, and motor neuron disease. Other work has focused on incorporating palliative care models into the treatment of patients with neurologic diseases within nursing home settings. Similar to nonneurologic community-based palliative care, little has been published on patient and caregiver quality-of-life outcomes in such models of care, although the emerging data are generally positive. Future studies should explore how best to provide comprehensive, cost-effective, scalable, and replicable models of community-based neuropalliative care, patient and caregiver outcomes in such models, and how care can be adapted between and within specific patient populations and healthcare systems.

Family Caregiver Comorbidities in Lewy Body Dementia Versus Alzheimer Disease and Associated Disorders.

BACKGROUND: Family caregivers of people living with dementia have high caregiver strain and poor health consequences. Limited research exists on Lewy body dementia (LBD) caregivers and their specific comorbidities. This study aimed to (1) identify the prevalence of self-reported comorbidities among LBD caregivers and (2) contextualize these findings with historical data on caregivers of persons living with Alzheimer disease and associated disorders (ADADs). METHODS: In a national, online survey, LBD family caregivers completed the Self-Administered Comorbidity Questionnaire and we compared these findings with extant literature on ADAD caregiver comorbidities. RESULTS: Among 217 LBD caregivers, 84.3% were female, 39.1% were 64 years old or younger, and 66.8% had >2 years of caregiving experience. Caregivers self-identified as current (83.9%) or former (16.1%) caregivers. The most frequent comorbidities were hypertension (38.2%), depression (35.0%), back pain (34.1%), and arthritis (27.7%). LBD caregivers, particularly younger caregivers, had a higher prevalence of depression compared with ADAD caregivers and older adult populations, and back pain prevalence nearly equivalent to spinal cord injury caregivers. CONCLUSIONS: Our study is the first to illustrate and contextualize specific comorbidities among LBD caregivers. Understanding the causality and impact of these conditions will be critical in designing effective interventions to improve the lives of families affected by LBD.

The impact and feasibility of a brief, virtual, educational intervention for home healthcare professionals on Parkinson's Disease and Related Disorders: pilot study of I SEE PD Home.

BACKGROUND: Individuals with advanced Parkinson's Disease (PD) and Parkinson-related disorders (PRD) are frequently referred for home allied therapies and nursing care, yet home healthcare professionals have limited training in PD/PRD. While recognizing the need for such care, patients and families report home healthcare professionals are unfamiliar with these conditions, which may be driven by neurophobia and may contribute to suboptimal care and early termination of services. We sought to determine the feasibility and effects of a virtual, multimodal educational intervention on PD knowledge, confidence, and empathy among home health professionals. METHODS: Home health nurses, occupational therapists, physical therapists and physical therapy assistants, and speech-language pathologists participated in a daylong, virtual symposium on advanced PD/PRD, combining focused lectures, discipline-specific breakout sessions, immersive virtual reality vignettes, and interactive panels with both patients and families, and movement disorders and home healthcare experts. Participants completed online pre- and post-symposium surveys including: demographics; PD/PRD knowledge (0-10 points possible); empathy (Interpersonal Reactivity Index); and 10-point scales of confidence with and attitudes towards individuals with PD/PRD, respectively. Pre-post intervention changes and effect sizes were evaluated with paired t-tests and Cohen's d. We performed qualitative analyses of post-symposium free-text feedback using a grounded theory approach to identify participants' intentions to change their practice. RESULTS: Participants had a mean improvement of 3.1 points on the PD/PRD knowledge test (p < 0.001, d = 1.97), and improvement in confidence managing individuals with PD/PRD (p = 0.0003, d = .36), and no change in empathy. The interactive, virtual format was rated as effective by 95%. Common themes regarding symposium-motivated practice change included: interdisciplinary collaboration; greater involvement and weighting of the patient and caregiver voice in care plans; attention to visit scheduling in relation to patient function; recognition and practical management of the causes of sudden change in PD/PRD, including infections and orthostatic hypotension. CONCLUSIONS: A virtual, multimodal, brief educational pilot intervention improved PD/PRD-specific knowledge and confidence among home healthcare nurses and allied health professionals. Future studies are necessary to test the short- and long-term effects of this intervention more broadly and to investigate the impact of this education on patient and caregiver outcomes.

Peer Mentoring Program for Informal Caregivers of Homebound Individuals With Advanced Parkinson Disease (Share the Care): Protocol for a Single-Center, Crossover Pilot Study.

BACKGROUND: Homebound individuals with advanced Parkinson disease (PD) require intensive caregiving, the majority of which is provided by informal, family caregivers. PD caregiver strain is an independent risk factor for institutionalization. There are currently no effective interventions to support advanced PD caregivers. Studies in other neurologic disorders, however, have demonstrated the potential for peer mentoring interventions to improve caregiver outcomes. In the context of an ongoing trial of interdisciplinary home visits, we designed and piloted a nested trial of caregiver peer mentoring for informal caregivers of individuals with advanced PD. OBJECTIVE: The aim of this study was to test the feasibility of peer mentoring for caregivers of homebound individuals with advanced PD and to evaluate its effects on anxiety, depression, and caregiver strain. METHODS: This was a single-center, 16-week pilot study of caregiver peer mentoring nested within a year-long controlled trial of interdisciplinary home visits. We recruited 34 experienced former or current family caregivers who completed structured mentor training. Caregivers enrolled in the larger interdisciplinary home visit trial consented to receive 16 weeks of weekly, one-to-one peer mentoring calls with a trained peer mentor. Weekly calls were guided by a curriculum on advanced PD management and caregiver support. Fidelity to and satisfaction with the intervention were gathered via biweekly study diaries. Anxiety, depression, and caregiver strain were measured pre- and postmentoring intervention at home visits 2 and 3. RESULTS: Enrollment and peer-mentor training began in 2018, and 65 caregivers enrolled in the overarching trial. The majority of mentors and mentees were White, female spouses or partners of individuals with PD; mentors had a mean of 8.7 (SD 6.4) years of caregiving experience, and 33 mentors were matched with at least 1 mentee. CONCLUSIONS: This is the first study of caregiver peer mentoring in PD and may establish an adaptable and sustainable model for disease-specific caregiver interventions in PD and other neurodegenerative diseases. TRIAL REGISTRATION: ClinicalTrials.gov NCT03189459; http://clinicaltrials.gov/ct2/show/NCT03189459. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34750.

Treatment of Hyperpigmented Discoid Lupus Erythematosus With Jessner's Peel: A Case Report.

Discoid lupus erythematosus (DLE) is the most common type of chronic cutaneous lupus erythematosus and is categorized by well-demarcated, often hyper or hypopigmented macules or papules that gradually progress into discoid plaques. Lesions are most commonly found above the neck, particularly on the face, scalp, and ears.1.

Identifying and characterizing basal cell carcinomas in persons with albinism.

BACKGROUND: Historically, persons with albinism (PWA) were thought to develop squamous cell carcinoma (SCC) more frequently than basal cell carcinoma (BCC). Recent evidence suggests BCCs in PWA are more common than initially hypothesized. OBJECTIVE: To characterize the presentation of BCC in PWA. METHODS: Fifty-four PWA with lesions suspicious for non-melanoma skin cancer sought care at Tanzanian dermatologic clinics from 2017 to 2019. Demographic and clinical presentation data were recorded. Histologic analysis of each sample was completed. RESULTS: The majority of PWA were female (53.7%), with a mean age of 34.6 ± 14.9 years and a mean duration of disease of 0.70 ± 0.73 years. Physician description of histologically proven BCC included ulceration (41.7%), erythema (16.7%), and scale (16.7%). Lesions were most commonly located on the trunk (47.1%) and face (41.2%). Histologic analysis demonstrated 30.2% of lesions were BCC, 26.4% SCC, and 17% Bowen's disease. LIMITATIONS: Patient population was limited to those visiting clinics, and data were limited by accuracy of the medical record. CONCLUSIONS: Basal cell carcinoma occurs at a higher rate than SCC in our population, suggesting BCC in PWA is underdiagnosed. It is important to recognize BCC early in PWA to avoid large disease burden and high rates of morbidity and mortality.

The role of systemic treatments for skin lightening.

BACKGROUND: Pigmentation of the skin occurs as a result of increased melanin production or deposition due to various reasons including age, hormonal imbalances, endocrine disease, inflammation, and/or exposure to damaging radiation, resulting in dermatologic conditions such as lentigines, melasma, or postinflammatory hyperpigmentation. Although numerous topical therapies exist for skin lightening, they are limited by efficacy and pigmentation recurrence after treatment cessation. New research into systemic therapies for hyperpigmentation has been promising. OBJECTIVE: To summarize the current literature for systemic skin lightening therapies. METHODS: A review of the literature surrounding systemic skin lightening therapies was completed using PubMed (US National Library of Medicine). RESULTS: Multiple systemic therapies for skin lightening exist including oral carotenoids, glutathione, melatonin, Polypodium leucotomos hydrophilic extract, procyanidin, and tranexamic acid. Preliminary data for the treatment of hyperpigmentation are promising, and currently, these oral treatments appear safe. It is not suggested to use intravenous glutathione for skin lightening due to the increased risk of adverse events. CONCLUSION: With the patient population seeking effective systemic treatments for skin pigmentation, it is important for dermatologists to understand the properties, the efficacy, and the adverse events profile of each compound, thus ensuring proper use by patients, and that patients are appropriately counseled regarding treatment expectation and safety.

Scoping Review: Social Determinants of Young Children's Participation in the United States.

Optimal child development is supported by services, policies, a social determinants of health (SDOH) frame, and meaningful participation (as defined by the International Classification of Functioning, Disability, and Health-Children and Youth [ICF-CY]). This scoping review describes the social determinants that may affect the participation of young children aged 0 to 3 years with developmental disabilities (DD) in the United States. Scoping review of studies including U.S. children with DD aged 0 to 3 years, from 2000 to 2016, were used. 5/979 studies met inclusion criteria. Two researchers independently coded studies to align them with both ICF-CY and SDOH. Studies found determinants of participation stemming from the child (e.g., individual) and multiple contexts: immediate, community, and policy. The emergent literature continues to primarily focus on child determinants but suggests participation of young children with DD is affected by social determinants stemming from the community and policy contexts. The literature underrepresents children from racial/ethnic minority backgrounds.

Initial evaluation of the effects of an environmental-focused problem-solving intervention for transition-age young people with developmental disabilities: Project TEAM.

AIM: Project TEAM (Teens making Environment and Activity Modifications) teaches transition-age young people with developmental disabilities, including those with co-occurring intellectual or cognitive disabilities, to identify and resolve environmental barriers to participation. We examined its effects on young people's attainment of participation goals, knowledge, problem-solving, self-determination, and self-efficacy. METHOD: We used a quasi-experimental, repeated measures design (initial, outcome, 6-week follow-up) with two groups: (1) Project TEAM (28 males, 19 females; mean age 17y 6mo); and (2) goal-setting comparison (21 males, 14 females; mean age 17y 6mo). A matched convenience sample was recruited in two US states. Attainment of participation goals and goal attainment scaling (GAS) T scores were compared at outcome. Differences between groups for all other outcomes were analyzed using linear mixed effects models. RESULTS: At outcome, Project TEAM participants demonstrated greater knowledge (estimated mean difference: 1.82; confidence interval [CI]: 0.90, 2.74) and ability to apply knowledge during participation (GAS: t[75]=4.21; CI: 5.21, 14.57) compared to goal-setting. While both groups achieved significant improvements in knowledge, problem-solving, and self-determination, increases in parent reported self-determination remained at 6-week follow-up only for Project TEAM (estimated mean difference: 4.65; CI: 1.32, 7.98). Significantly more Project TEAM participants attained their participation goals by follow-up (Project TEAM=97.6%, goal-setting=77.1%, p=0.009). INTERPRETATION: Both approaches support attainment of participation goals. Although inconclusive, Project TEAM may uniquely support young people with developmental disabilities to act in a self-determined manner and apply an environmental problem-solving approach over time. WHAT THIS PAPER ADDS: Individualized goal-setting, alone or during Project TEAM (Teens making Environment and Activity Modifications) appears to support attainment of participation goals. Project TEAM appears to support young people with developmental disabilities to apply an environmental problem-solving approach to participation barriers. Parents of young people with developmental disabilities report sustained changes in self-determination 6 weeks after Project TEAM.

The use of natural ingredients in innovative Korean cosmeceuticals.

BACKGROUND: The cosmeceutical industry is an ever-growing and in demand market, especially in Asia. Korea has been on the forefront of creating the newest generation and most innovative cosmeceuticals products including ingredients such as snail secretions, starfish powder, botanical extracts, green tea, and red ginseng. Given their increasing prevalence in the cosmeceutical industry, scientists have been conducting investigations into these extracts and their properties. OBJECTIVE: To summarize the current literature surrounding multiple natural ingredients found in Korean cosmeceutical products. METHODS: A review of the literature surrounding natural ingredients found in Korean cosmeceuticals was conducted using PubMed (U.S. National Library of Medicine). RESULTS: Multiple natural extracts have been found to have antiaging, antitumor, and antimelanogenic effects making them useful additives in current cosmeceutical products. CONCLUSION: With the public's increasing awareness of cosmeceutical products, it is important for physicians to understand the properties of these extracts in order to inform patients correctly and ensure patient safety.

Pilot Study Examining the Safety and Efficacy of Calcium Hydroxylapatite Filler With Integral Lidocaine Over a 12-Month Period to Correct Temporal Fossa Volume Loss.

BACKGROUND: Age-related volume loss in the temporal fossae is due to thinning of the epidermis, loss of subcutaneous structural volume, and change in the bony architecture. Temporal concavities are important areas of 3-dimensional volume restoration. The temporal fossae is becoming an increasingly popular area for patients seeking soft tissue augmentation with injectable fillers such as calcium hydroxylapatite with integral lidocaine [CaHA (+)]. OBJECTIVE: This pilot study aims to define the safety, efficacy, technique, and patient-reported outcomes for injectable CaHA (+) to correct volume loss in the temporal fossae over a 12-month period. MATERIALS AND METHODS: This was a single-investigator, nonblinded study involving 20 participants. Participants received filler injection into their temporal fossae, with follow-up evaluations at Day 14, 6 weeks, and 3, 6, 9, and 12 months. RESULTS: CaHA (+) results in statistically significant improvement in temporal fossae appearance lasting up to 12 months. Subjects reported "moderate" global aesthetic improvement over the 12-month period. CONCLUSION: As the cosmetic field continues to advance, it is important for practitioners to have access to research regarding the efficacy and safety of injectables. These results show that CaHA (+) is an effective and safe option to correct temporal fossae volume loss associated with high patient satisfaction.

Recall erythema phenomenon following Er:YAG laser treatment: two case studies and literature review.

Recall erythema is a phenomenon occurring when an area of epidermis treated with laser is later exposed to a trigger, most often sunlight or hot water, causing erythema in the zone of laser treatment after post-treatment erythema has already resolved. Radiation recall dermatitis is a more specific subtype of recall erythema in which an area treated with radiation is subjected to another exposure causing erythema in the area of previous radiation. Cases of recall dermatitis after laser treatment are extremely rare and have only been reported with diode neodymium-doped yttrium aluminum garnet lasers. We report two cases of recall dermatitis following erbium-doped yttrium aluminum garnet resurfacing laser triggered by exposure to either hot water or direct sunlight, and in one case, radioablation of the thyroid gland. We will also provide a brief literature review of recall dermatitis in the setting of laser surgery.

A review of available laser and intense light source home devices: A dermatologist's perspective.

BACKGROUND: Home optical devices are becoming an increasingly popular treatment modality sought out by patients for dermatologic pathologies such as acne, hair removal and anti-aging, as these devices are a low-cost and convenient therapy choice. METHODS: An Internet search using PubMed.gov was completed with search terms, "home device dermatology," "home device acne," "home device hair" or "hair removal," and "home device aging." RESULTS: Currently, there are multiple home optical devices available on the market. These devices have been approved for the treatment of acne, scars, hair removal, and wrinkles using intense pulsed light, light-emitting diode, heat, infrared, low-level light therapy, and laser. Although studies on home devices are limited, current dermatologic literature shows that these devices are promising with significant post-treatment results as well as a high level of safety. CONCLUSIONS: Home optical devices are mostly used without medical practitioner supervision. As home devices usually deliver less energy per session than with professional treatments, it is important that consumers are given realistic expectations of post-treatment outcomes. Patients may use home devices without disclosure to their physician and it is important as healthcare professionals to be aware of the existence of these devices, how to use the devices properly (including what diseases can be treated and which skin types are considered safe for use), as well as any adverse effects that may occur. New research endeavors are being completed to explore the used of home devices for the treatment of chronic inflammatory diseases such as psoriasis.

The Kinetics of Reversible Hyaluronic Acid Filler Injection Treated With Hyaluronidase.

BACKGROUND: Hyaluronidase is an enzyme capable of dissolution of hyaluronic acid (HA). There is a lack of evidence-based research defining time- and concentration-dependent reversal of HA filler using hyaluronidase. OBJECTIVE: To explore the efficacy of different concentrations of hyaluronidase in digesting commercially available HA-based reversible fillers-Belotero Balance (BEL), Juvederm Ultra XC (JUVXC), Juvederm Ultra Plus (JUVX+), Juvederm Voluma XC (JUVV), Restylane-L (RESL), Restylane Silk (RESS), and Perlane/Restylane Lyft (RESLYFT). MATERIALS AND METHODS: This was a blinded randomized study involving 15 participants. Participants received HA filler injection into their back, followed by no secondary injection, or injection with normal saline, 20 or 40 units of hyaluronidase. Using a 5-point palpation scale, the degradation of HA filler was monitored over 14 days. RESULTS: In the authors' study, there is a significant decrease in HA filler degradation using 20 and 40 units of hyaluronidase compared with no secondary injection or normal saline. There is no significant difference in HA filler dissolution when comparing 20 to 40 units of hyaluronidase. CONCLUSION: Lower concentrations of hyaluronidase may be just as effective as higher concentrations to degrade HA filler in situations where the reversal of cutaneous augmentation with HA filler arises.