Crisis plans facilitated by patient advocates are better than those drawn up by clinicians: results from an RCT.

This study compared quality aspects of crisis plans made with the help of a patient advocate (PACP) with those of plans made with the patient's clinician (clinician crisis plan, CCP). Patients were randomized into PACP and CCP conditions. The quality of crisis plan checklist was used to compare quality aspects of PACP and CCP crisis plans. The quality scores were significantly higher in the PACP group than in the CCP group (Cohen's d = 0.78 for the quality checklist total score). Patient advocates may be important to the successful development of crisis plans.

Mechanochemical endovenous ablation of small saphenous vein insufficiency using the ClariVein(®) device: one-year results of a prospective series.

OBJECTIVE: This study evaluated the feasibility, safety and 1-year results of mechanochemical endovenous ablation (MOCA™) of small saphenous vein (SSV) insufficiency. DESIGN: Prospective cohort study. MATERIALS AND METHODS: Fifty consecutive patients were treated for primary SSV insufficiency with MOCA™ using the ClariVein(®) device and polidocanol. Initial technical success, complications, patient satisfaction and visual analogue scale (VAS) pain score were assessed. Anatomic and clinical success was assessed at 6 weeks and at 1 year. RESULTS: Initial technical success of MOCA™ was 100%. At the 6-week assessment, all treated veins were occluded. The 1-year follow-up duplex showed anatomic success in 94% (95% confidence interval, 0.87-1). Venous clinical severity score (VCSS) decreased significantly from 3.0 (interquartile range (IQR) 2-5) before treatment to 1.0 (IQR 1-3, P < 0.001) at 6 weeks and to 1.0 (IQR 1-2, P < 0.001) at 1 year. Median procedural VAS score for pain was 2 (IQR 2-4). No major complications were observed, especially no nerve injury. CONCLUSIONS: MOCA™ is a safe, feasible and efficacious technique for treatment of SSV insufficiency. One-year follow-up shows a 94% anatomic success rate and no major complications.

Mobile telephone delivered contingency management for encouraging adherence to supervised methadone consumption: feasibility study for an RCT of clinical and cost-effectiveness (TIES).

BACKGROUND: Prescription methadone or buprenorphine enables people with opioid use disorder to stop heroin use safely while avoiding withdrawal. To ensure methadone is taken as prescribed and to prevent diversion onto the illicit market, people starting methadone take their daily dose under a pharmacist's supervision. Many patients miss their daily methadone dose risking withdrawal, craving for heroin and overdose due to loss of heroin tolerance. Contingency management (CM) can improve medication adherence, but remote delivery using technology may be resource-light and cost-effective. We developed an innovative way to deliver CM by mobile telephone. Software monitors patients' attendance and supervised methadone consumption through an internet self-login at the pharmacy and sends reinforcing text messages to patients' mobile telephones. A linked system sends medication adherence reports to prescribers and provides early warning alerts of missed doses. A pre-paid debit card system provides financial incentives. METHODS: A cluster randomised controlled trial design was used to test the feasibility of conducting a future trial of mobile telephone CM to encourage adherence to supervised methadone in community pharmacies. Each cluster (drug service/3 allied pharmacies) was randomly allocated to provide patient's presenting for a new episode of opiate agonist treatment (OAT) with either (a) mobile telephone text message CM, (b) mobile telephone text message reminders, or (c) no text messages. We assessed acceptability of the interventions, recruitment, and follow-up procedures. RESULTS: Four drug clinics were approached and three recruited. Thirty-three pharmacists were approached and 9 recruited. Over 3 months, 173 individuals were screened and 10 enrolled. Few patients presented for OAT and high numbers were excluded due to receiving buprenorphine or not attending participating pharmacies. There was 96% consistency in recording medication adherence by self-login vs. pharmacy records. In focus groups, CM participants were positive about using self-login, the text messages, and debit card. Prescribers found weekly reporting, time saving, and allowed closer monitoring of patients. Pharmacists reported that the tablet device was easy to host. CONCLUSION: Mobile telephone CM worked well, but a planned future trial will use modified eligibility criteria (existing OAT patients who regularly miss their methadone/buprenorphine doses) and increase the number of participating pharmacies. TRIAL REGISTRATION: The trial is retrospectively registered, ISRCTN 58958179 .

[Diagnostic image (381). A man with painful, red spots on one foot]. / Diagnose in beeld (381). Een man met pijnlijke, rode vlekken op de voet.

A 49-year-old Turkish man with classic Kaposi sarcoma on his right foot, was successfully treated by irradiation.

[Diagnostic image (368). A child with a facial swelling after a dog bite]. / Diagnose in beeld (368). Een kind met een zwelling in het gelaat na een hondenbeet.

A 4-year-old boy suffered multiple facial dog bites. In the scar of one of these, on the left lower eyelid, a granuloma teleangiectaticum developed. Within a few days, spontaneous regression occurred. One year later, the defect had disappeared completely.

[Mucocutaneous manifestations of amyloidosis]. / Mucocutane manifestaties van amyloyïdose.

Amyloidosis is the collective term for a group ofuncommon metabolic disorders in which insoluble amyloid protein-fibres are deposited in tissues and organs. Mucocutaneous manifestations are frequently found in this disease. The different types ofamyloidosis are divided into a systemic and a non-systemic group. Systemic amyloidosis is characterised by amyloid deposits in several organs. In the most frequent type, amyloid light chain (AL) systemic amyloidosis, the skin is involved in 29-40% of the cases. These mucocutaneous manifestations are sometimes the first clue to the discovery of systemic involvement. The non-systemic group comprises primarily localised amyloid deposits in skin and mucosa. The treatment of localised mucocutaneous amyloidosis is aimed at the local changes themselves. The mucocutaneous manifestations due to systemic amyloidosis may improve when it is possible to treat the underlying disease successfully.

[Skin diseases of the face; an overview for dental practitioners]. / Huidafwijkingen in het aangezicht. Een overzicht voor tandartsen.

Dental practitioners are supposed to have some knowledge of skin diseases, particularly those occurring in the face. They should encourage a patient to see his physician or a dermatologist for further evaluation and possible treatment. Diseases of the skin can be classified in various ways. In this overview, diseases are classified as infectious diseases, inflammatory diseases, autoimmune diseases, benign neoplasms, premalignant lesions, and malignant lesions. In the Dutch health care system, family doctors play an important role and, until recently, they have been the obvious persons to whom a patient with a detected skin disease was referred by dental practitioners. The general practitioner then determined whether a referral to a dermatologist was indicated. However, because of changes in the health care system it has become possible for a dentist to refer patients directly to a dermatologist in case of the presence of a skin disease.