A Comprehensive Review of Non-Surgical Treatments for Hypertrophic and Keloid Scars in Skin of Color.

Hypertrophic and keloid scars are fibroproliferative growths resulting from aberrant wound healing. Individuals with Fitzpatrick skin types (FSTs) IV-VI are particularly predisposed to hypertrophic and keloid scarring, yet specific guidelines for these populations are still lacking within the literature. Therefore, this comprehensive review provides a list of various treatments and considerations for hypertrophic and keloid scarring in patients with skin of color. We constructed a comprehensive PubMed search term and performed quadruple-blinded screening on all resulting studies to achieve this objective. Our findings demonstrate 1) the lack of efficacious treatments for raised scars within this population and 2) the need to empirically investigate individualized and multimodal therapeutic options for those with skin of color.

Preferences and Perspectives of Black Male Barbershop Patrons on Receiving Health Care in Nontraditional Settings.

Introduction: Non-Hispanic Black men experience a disproportionate rate of morbidity and mortality from hypertension, cardiovascular disease, and other chronic conditions in the United States. Studies have demonstrated the efficacy of community-based health outreach in settings not traditionally utilized for health care. Understanding how potential future participants view health care services in nontraditional settings is a necessary step to ascertain the success of these interventions in the real world. Our study objective was to explore the preferences of Black male barbershop patrons regarding health care-provided services in these nontraditional settings. Methods: We recruited patrons of a Black-owned barbershop in the San Francisco Bay Area. Study participants were asked to complete a survey assessing individual attitudes and preferences toward the idea of receiving health care services in traditional and nontraditional settings. Results: Among non-Hispanic Black males (n=17), 81% agreed or strongly agreed that they would prefer to receive health care in traditional clinics. Receiving care at the pharmacy (56% agreed or strongly agreed) and the patient's own home (53% agreed or strongly agreed) were the next most preferred locations. A minority of participants agreed or strongly agreed that they preferred to receive health care in nontraditional settings: 47% for barbershops, 19% for churches, and 6% for grocery stores. Discussion: Participants expressed preference for traditional over nontraditional settings, despite listing barriers that may be addressed, in part, by nontraditional settings. One potential reason for this is simply a lack of familiarity. Establishing and normalizing nontraditional clinical settings may allow for enhanced acceptance within Black communities, ultimately increasing health care access.

Beyond the Surface: A Deeper Look at the Psychosocial Impacts of Acne Scarring.

Post-acne scarring is a common consequence of acne vulgaris with no universal cure. Although there have been many recent advances to address acne scars physically, there is still a lack of research that investigates their psychosocial impacts. Our comprehensive PubMed search presents an overview of existing information to highlight known sources of mental distress caused by post-acne scarring, both related to and independent of the psychosocial detriments caused early on by active acne. The literature indicates that acne scarring is a distinct condition from acne vulgaris and therefore requires a comprehensive clinical approach unique from those available for active acne.

Randomized trial protocol for remote monitoring for equity in advancing the control of hypertension in safety net systems (REACH-SNS) study.

BACKGROUND: Self-measured blood pressure monitoring (SMBP) is essential to effective management of hypertension. This study aims to evaluate effectiveness and implementation of SMBP that leverages: cellular-enabled home BP monitors without a need for Wi-Fi or Bluetooth; simple communication modalities such as text messaging to support patient engagement; and integration into existing team-based workflows in safety-net clinics. METHODS: This study will be conducted with patients in San Francisco who are treated within a network of safety-net clinics. English and Spanish-speaking patients with diagnosed hypertension will be eligible for the trial if they have recent BP readings ≥140/90 mmHg and do not have co-morbid conditions that make home BP monitoring more complex to manage. This study will implement a three-arm randomized controlled trial to compare varying levels of implementation support: 1) cellular-enabled BP monitors (with minimal implementation support), 2) cellular-enabled BP monitors with protocol-based implementation support (text reminders for patients; aggregated BP summaries sent to primary care providers), and 3) cellular-enabled BP monitors and pharmacist-led support (pharmacist coaching and independent medication adjustments). RESULTS: For the main analysis, we will use mixed effects linear regression to compare the change in primary outcome of systolic BP. Secondary outcomes include BP control (<140/90 mmHg), medication intensification, patient-reported outcomes, and implementation processes (i.e., engagement with the intervention). DISCUSSION: This study will design and test a digital health intervention for use in marginalized populations treated within safety net settings, evaluating both effectiveness and implementation to advance more equitable health outcomes.

Subcision for Atrophic Acne Scarring: A Comprehensive Review of Surgical Instruments and Combinatorial Treatments.

Subcutaneous incisionless surgery, also known as subcision, is a minimally invasive procedure that is commonly indicated for the treatment of atrophic acne scars. In recent years, many new techniques have been developed to maximize results from this procedure. This review article aims to identify an updated list of instruments and combinatorial treatments available for atrophic acne scar patients undergoing subcision. We constructed a comprehensive PubMed search term and performed triple-blinded screening on all resulting studies for mentions of subcision as indicated by acne scarring. Our results show that there are four main categories of subcision tools that are commonly employed to treat atrophic acne scars: needles, cannulas, wires, and blunt-blade instruments. Usage of these devices varies by scar depth, personal preference, and combinatorial treatment options. Overall, subcision is a particularly effective treatment for atrophic acne scars, and there is vast potential for further innovation with this technique.

Pharmacy Telehealth Services: Perspectives From an Academic Medical Center.

Telehealth allows patients to receive healthcare with the aid of technology by overcoming physical barriers. The Coronavirus Disease 2019 (COVID-19) pandemic created challenges with regards to in person patient care. The use of video visits and telehealth increased in a rapid manner due to the COVID-19 pandemic. The objective of this paper is to describe telehealth services utilized by pharmacists at a large, academic medical center. Pharmacists teaching and clinical services conducted via telehealth and remote methods in the inpatient and outpatient settings are discussed. The tools and platforms utilized for patient care, staff communications, and education are described. Telehealth is likely to remain in many clinical practices even after restrictions due to COVID-19 are removed; however, as we transition, a more sustainable model that includes faculty and staff development is needed. Additionally, clinical outcomes and patient and provider satisfaction for the varying visit types should continue to be examined. Although the switch to telehealth was rapid and unprecedented, it allowed a large academic medical center to continue providing patient care and learning experiences for most clinical pharmacy services.

Evaluation of standard versus reduced dose apixaban for the treatment of venous thromboembolism in patients with severe renal disease (ESRD-VTE).

BACKGROUND: There are no clear dosing recommendations when using apixaban for venous thromboembolism (VTE) treatment in patients with severe or end-stage renal disease; clinical trials excluded patients with a creatinine clearance (CrCl) <25 mL/min or on dialysis. This study compares bleeding rates in patients with severe or end-stage renal disease taking standard versus reduced dose apixaban for VTE treatment. MATERIALS AND METHODS: This was a multicenter, retrospective cohort study using electronic medical records between January 1, 2013, and August 31, 2021. This study included patients 18 years or older who had severe or end-stage renal disease when prescribed apixaban for VTE treatment. Severe or end-stage renal disease was defined as at least one of the following: CrCl <25 mL/min, SCr >2.5 mg/dL, CKD stage 4 or 5, or on dialysis. The primary endpoint was rate of clinically relevant bleeding within six months of starting apixaban. Secondary endpoints were VTE recurrence within six months of starting apixaban, time to clinically relevant bleed, and time to VTE recurrence. RESULTS: A total of 203 patients were included in the final analysis (n = 125 on 5 mg; n = 78 on 2.5 mg). Clinically relevant bleeding rate was significantly higher in the standard dose group (14.4 % vs 3.8 %, p = 0.02). Rates of VTE recurrence appear similar (6.4 % vs 7.7 %, p = 0.21). CONCLUSIONS: A reduced dose of apixaban may be considered when treating VTE in patients with severe or end-stage renal disease.

Visualizing classification of drugs used in psychotic disorders: A 'subway map' representing mechanisms, established classes and informal categories.

Drugs used to treat psychotic disorders ('antipsychotics') have been widely used in psychiatry since the introduction of chlorpromazine in the mid-1950s. The categorization of these drugs evolved in a piecemeal way, relying initially on grouping by chemical structure (e.g. phenothiazines, butyrophenones), then by epoch of introduction (e.g. first generation ('conventional') vs second generation ('atypical')). As psychopharmacological expertise has advanced, it has become possible to quantify affinities for each drug in this class for relevant receptors including dopamine D2, 5HT2A, 5HT2C, histamine H1 and others. However, until the recent emergence of a new generation of agents known collectively as dopamine D2 receptor partial agonists (e.g. aripiprazole, brexpiprazole and cariprazine), there had been little reference in drug classification to specific pharmacological properties. An overview of data on receptor affinities across multiple drugs and receptor types would permit categorization according to binding affinities and putative pharmacological mechanisms. In this paper, we have attempted to construct a 'subway map' of 32 drugs used for treatment of psychotic disorders. This design allows a visualization of both the historical classifications by structure and epoch of introduction, and of the binding affinities for key receptors based on appraisal of scientific literature. The map represents a step towards categorization by mechanism, allowing prescribers and patients to understand which drugs share common biological features and the extent to which drugs may have similarities and differences in their mechanisms. In addition, this approach may encourage more logical groupings of drugs to be used in systematic reviews and meta-analyses.

Improved Patient-Reported Medication Adherence, Patient Satisfaction, and Glycemic Control in a Collaborative Care Pharmacist-Led Diabetes "Tune-Up" Clinic.

Diabetes complications remain a leading cause of death, which may be due to poor glycemic control resulting from medication nonadherence. The relationship between adherence status and HbA1c (glycemic control) has not been well-studied for clinical pharmacist interventions. This study evaluated medication adherence, patient satisfaction, and HbA1c, in a collaborative pharmacist-endocrinologist diabetes clinic over 6 months. Of 127 referred, 83 patients met the inclusion criteria. Mean medication adherence scores, considered "good" at baseline, 1.4 ± 1.2, improved by 0.05 points (p = 0.018), and there was a 26% increase in patients with good adherence. A significant improvement of 0.40 percentage points (95% CI: -0.47, -0.34) was observed in mean HbA1c across the three time points (p < 0.001). Mean total satisfaction scores were high and increased, with mean 91.3 ± 12.2 at baseline, 94.7 ± 9.6 at 3 months, and 95.7 ± 10.8 at 6 months (p = 0.009). A multimodal personalized treatment approach from a pharmacist provider significantly and positively impacted glycemic control regardless of self-reported medication adherence, and patient satisfaction remained high despite changing to a clinical pharmacist provider and increased care intensity.

Effect of Tobacco Cessation on Weight in a Veteran Population.

INTRODUCTION/OBJECTIVES: Weight gain concerns remain a barrier to tobacco cessation. Literature suggests that weight gain can occur after stopping tobacco, but continuing tobacco can have far worse outcomes. Limited information is available regarding weight gain in military personnel. The objective of this study was to evaluate weight change in veterans that stopped tobacco for a minimum of 12 months enrolled in a pharmacist managed telephone tobacco cessation clinic (PMTTCC). METHODS: A retrospective analysis of veterans who had been tobacco-free for 12 months enrolled in a PMTTCC were included in this analysis. Primary outcomes were change in weight (kg) and body mass index (BMI) from baseline. Descriptive data were utilized where appropriate and paired t-tests were utilized for the primary outcomes. RESULTS: Seventy-seven patients were screened and 10 were excluded. Sixty-seven veterans met inclusion criteria and were mostly male (91%, n = 61) and Caucasian (74.6%, n = 50). At 12 months post cessation, the mean weight gain was (1.81 kg ± 6.83, P = .03) and BMI (0.51 ± 2.23 kg/m2, P = .06). CONCLUSIONS: Veterans appeared to have minimal weight gain despite statistical significance and no statistical change with BMI after 12 months of being tobacco-free. Results suggest that the long-term weight gain is minimal, and a comprehensive tobacco cessation program can be helpful to improve weight outcomes.

Noninvasive wearable electroactive pharmaceutical monitoring for personalized therapeutics.

To achieve the mission of personalized medicine, centering on delivering the right drug to the right patient at the right dose, therapeutic drug monitoring solutions are necessary. In that regard, wearable biosensing technologies, capable of tracking drug pharmacokinetics in noninvasively retrievable biofluids (e.g., sweat), play a critical role, because they can be deployed at a large scale to monitor the individuals' drug transcourse profiles (semi)continuously and longitudinally. To this end, voltammetry-based sensing modalities are suitable, as in principle they can detect and quantify electroactive drugs on the basis of the target's redox signature. However, the target's redox signature in complex biofluid matrices can be confounded by the immediate biofouling effects and distorted/buried by the interfering voltammetric responses of endogenous electroactive species. Here, we devise a wearable voltammetric sensor development strategy-centering on engineering the molecule-surface interactions-to simultaneously mitigate biofouling and create an "undistorted potential window" within which the target drug's voltammetric response is dominant and interference is eliminated. To inform its clinical utility, our strategy was adopted to track the temporal profile of circulating acetaminophen (a widely used analgesic and antipyretic) in saliva and sweat, using a surface-modified boron-doped diamond sensing interface (cross-validated with laboratory-based assays, R2 ∼ 0.94). Through integration of the engineered sensing interface within a custom-developed smartwatch, and augmentation with a dedicated analytical framework (for redox peak extraction), we realized a wearable solution to seamlessly render drug readouts with minute-level temporal resolution. Leveraging this solution, we demonstrated the pharmacokinetic correlation and significance of sweat readings.

Manipulating instructions strategically affects reliance on the ventral-lexical reading stream: converging evidence from neuroimaging and reaction time.

Neurobiology of reading research has yet to explore whether reliance on the ventral-lexical stream during word reading can be enhanced by the instructed reading strategy, or whether it is impervious to such strategies. We examined Instructions: name all vs. name words (based on spelling), Word Type: regular words vs. exception words, and Word Frequency (WF) in print (log10 HAL WF) in an experiment while measuring fMRI BOLD and overt naming reaction time (RT) simultaneously. Instructions to name words increased overall reliance on the ventral-lexical stream, as measured by visible BOLD activation and the WF effect on RT, with regular words showing the greatest effects as a function of this reading strategy. Furthermore, the pattern of joint effects of these variables on RT supports the notion of cascaded, not parallel, processing. These results can be accommodated by dual-stream cascaded models of reading, and present a challenge to single-mechanism parallel processing models.

A functional neuroimaging case study of Meares-Irlen syndrome/visual stress (MISViS).

The aim of this study is to evaluate the data from a participant in a reading study who had a diagnosis of Meares-Irlen syndrome/visual stress (MISViS). MISViS is characterised by visual distortions and somatic issues, which are remediated using coloured filters. The authors present a case study providing descriptive neurobiological comparisons of MISViS versus a control group. The study involved eleven English language speakers who participated in behavioural and neuroimaging versions of a language experiment with varied proportions of regular and exception words. Behavioural measures included accuracy and response times. Neuroimaging was conducted using a 1.5T Siemens Sonata MRI. The MISViS participant's data were removed from the overall experiment and analysed as a case study. Impulse response functions (IRFs) and percentage of active voxels were extracted from four regions of interest: BAs 17, 18, 19, and the postcentral gyrus (PG) and two control regions (BA6 and left BA45). The results indicated that significant differences existed between the control group and the MISViS participant for IRF intensity in two regions (BA6 and PG) and percentage of active voxels in four regions (BA17, BA19, PG, and BA6). No significant differences occurred in left BA45 for either variable of interest. No significant differences were found for behavioural measures. In conclusion, our findings offer one of the first neurobiological descriptions of differences in IRF intensity and percentage of active voxels in visual and somatosensory cortex during a language experiment for a participant with MISViS in the absence of migraine compared to controls.

Local conformational flexibility provides a basis for facile polymer formation in human neuroserpin.

Neuroserpin is a regulator of neuronal growth and plasticity. Like other members of the serpin family, neuroserpin undergoes a large conformational change as part of its function. Unlike other serpins such as α(1)-antitrypsin, wild-type neuroserpin will polymerize under near-physiological conditions, and will spontaneously transition to the latent state. To probe the origins of this conformational lability, we have performed hydrogen exchange measurements and molecular-dynamics simulations on human neuroserpin. Hydrogen exchange indicates that neuroserpin has greater flexibility in the breach region and in ß-strand 1C compared with α(1)-antitrypsin. Molecular-dynamics simulations show that the distance between the top of ß-strands 3 and 5A averages 4.6 Å but becomes as large as 7.5 Å in neuroserpin while it remains stable at ∼3.5 Å in α(1)-antitrypsin. Further simulations show that the stabilizing S340A mutation suppresses these fluctuations in neuroserpin. The first principal component calculated from the simulations shows a movement of helix F away from the face of ß-sheet A in neuroserpin while no such movement is evident in α(1)-antitrypsin. The increased mobility of these regions in neuroserpin relative to α(1)-antitrypsin provides a basis for neuroserpin's increased tendency toward the formation of polymers and/or the latent state.

Brain imaging investigation of the neural correlates of observing virtual social interactions.

The ability to gauge social interactions is crucial in the assessment of others' intentions. Factors such as facial expressions and body language affect our decisions in personal and professional life alike (1). These "friend or foe" judgements are often based on first impressions, which in turn may affect our decisions to "approach or avoid". Previous studies investigating the neural correlates of social cognition tended to use static facial stimuli (2). Here, we illustrate an experimental design in which whole-body animated characters were used in conjunction with functional magnetic resonance imaging (fMRI) recordings. Fifteen participants were presented with short movie-clips of guest-host interactions in a business setting, while fMRI data were recorded; at the end of each movie, participants also provided ratings of the host behaviour. This design mimics more closely real-life situations, and hence may contribute to better understanding of the neural mechanisms of social interactions in healthy behaviour, and to gaining insight into possible causes of deficits in social behaviour in such clinical conditions as social anxiety and autism (3).