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1.
Clin Exp Dermatol ; 2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38757196

RESUMO

BACKGROUND: Digital papillary adenocarcinoma (DPA), formerly known as aggressive DPA, is a rare adnexal cancer of sweat gland differentiation with metastatic potential. DPA epidemiology and patient outcome data are a prerequisite to develop diagnostic and therapeutic guidance, which is lacking for this rare cancer. OBJECTIVES: To report the incidence, patient demographics and treatment of patients with DPA in England from 1 January 2013 to 31 December 2020 using national cancer registry data. METHODS: DPA diagnoses in England during 2013-2020 were identified from the National Cancer Registration Dataset using morphology and behaviour codes. These were registered from routinely collected pathology reports and cancer outcomes and services datasets. The 2013 European age-standardised incidence rates (EASRs) were calculated. RESULTS: In total, 36 DPA (7 in females and 29 in males) were diagnosed. The median age at diagnosis for the cohort was 54 years (interquartile range 46-64). The most frequently affected sites were upper limbs (81%). All patients in the cohort received surgical excisions. The European age-standardised incidence rate (EASRs) was 0.10 [95% confidence interval (CI) 0.07-0.14] per 1,000,000 person-years (PY)]. CONCLUSION: This study reports the incidence and variation of DPA in England between 2013 and 2020. DPA was more common in older men and predominantly affected the upper limbs. This supports the need to develop a national policy for the reporting and management of DPA as well as clinical guideline development.

2.
Artigo em Inglês | MEDLINE | ID: mdl-38994876

RESUMO

BACKGROUND: Artificial intelligence (AI) tools have the potential to revolutionize many facets of medicine and medical sciences research. Numerous AI tools have been developed and are in continuous states of iterative improvement in their functionality. OBJECTIVES: This study aimed to assess the performance of three AI tools: The Literature, Microsoft's Copilot and Google's Gemini in performing literature reviews on a range of dermatology topics. METHODS: Each tool was asked to write a literature review on five topics. The topics chosen have recently had peer-reviewed systematic reviews published. The outputs of each took were graded on their evidence and analysis, conclusions and references on a 5-point Likert scale by three dermatologists who are working in clinical practice, have completed the UK dermatology postgraduate training examination and are partaking in continued professional development. RESULTS: Across all five topics chosen, the literature reviews written by Gemini scored the highest. The mean score for Gemini for each review was 10.53, significantly higher than the mean scores achieved by The Literature (7.73) and Copilot (7.4) (p < 0.001). CONCLUSIONS: This paper shows that AI-generated literature reviews can provide real-time summaries of medical literature across a range of dermatology topics, but limitations to their comprehensiveness and accuracy are apparent.

3.
Clin Exp Dermatol ; 48(1): 1-4, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36669187

RESUMO

The International Organization for Standardization ISO 14000 family of standards and the European Commission Eco-Management and Auditing Scheme are examples of voluntary environmental management systems (EMS). EMS provides a framework to facilitate organizations to incorporate environmental considerations into their governance and operations to improve the use of resources and waste management practices. Organizations with EMS accreditation reported operational efficiency improvements and cost savings. This review article describes EMS and discusses their relevance to the dermatology sustainability.


Assuntos
Conservação dos Recursos Naturais , Dermatologia , Humanos , Acreditação , Padrões de Referência
4.
Clin Exp Dermatol ; 48(6): 585-590, 2023 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-36785521

RESUMO

Skin surgery ranges from small biopsies to Mohs micrographic surgery and excisions necessitating complex skin flap design or grafting. For all dermatology doctors in training there is a need to acquire competence to perform skin surgery safely, in an appropriate timeframe and with minimal complication rates. There exist a range of different methods, with varying reliance upon advancing technology, to teach skin surgery and to refine surgical skills before procedures are performed on patients. We searched PubMed, MEDLINE and SCOPUS databases to identify all papers relevant to postgraduate dermatology skin surgery teaching and training published in the past 10 years in English (see Appendix S1 in the Supporting Information for our search strategy). This yielded 440 results, for which all abstracts were screened. Manuscripts related to aesthetic surgery training, such as robotic hair transplantation training are excluded.


Assuntos
Procedimentos Cirúrgicos Dermatológicos , Neoplasias Cutâneas , Humanos , Retalhos Cirúrgicos/cirurgia , Cirurgia de Mohs/efeitos adversos , Transplante de Pele , Neoplasias Cutâneas/cirurgia
5.
Clin Exp Dermatol ; 48(9): 1024-1029, 2023 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-37192414

RESUMO

BACKGROUND: There is a lack of national guidance specifying how skin surgery, including Mohs micrographic surgery (MMS), should be conducted, leading to a degree of heterogeneity in the set-up of skin surgery services and how skin surgeries are performed. OBJECTIVES: To provide the first UK-wide cross-sectional study reporting real-world data on the set-up and waste management practices of skin surgery, including MMS. METHODS: A UK-wide service evaluation study was conducted between 1 March 2022 and 30 June 2022 using a standardized data collection pro forma. Twelve participating sites from England, Northern Ireland, Scotland and Wales provided data from 115 skin surgery lists involving 495 patients and 547 skin surgery procedures between 1 March 2022 and 30 June 2022. RESULTS: Mean total weight of nonsharps skin surgery waste was 0.52 kg per procedure (0.39 kg clinical waste, 0.05 kg general waste and 0.08 kg recycling waste). Data from a single site using disposable surgical instruments reported a mean of only 0.25 kg of sharps waste per procedure. The recycling rate ranged between 0% and 44% across the cohort with a mean recycling rate of 16%. CONCLUSIONS: We advocate that staff transition to the British Society of Dermatological Surgery 2022 sustainability guidance, which made wide-ranging recommendations to facilitate staff to transition to sustainable practices in skin surgery.


Assuntos
Neoplasias Cutâneas , Gerenciamento de Resíduos , Humanos , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Estudos Transversais , Procedimentos Cirúrgicos Dermatológicos , Escócia
12.
Skin Health Dis ; 4(3): e373, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38846682

RESUMO

A prospective controlled pilot study on the feasibility of utilization of a probiotic mixture for management of acute exacerbation of atopic dermatitis (AD). Patients were allocated to either standard of care (SOC) therapy with tapering dose of steroids or a probiotic mixture over 3 weeks. After the 3-week intervention, patients on steroids achieved significantly higher clinical response rates and significantly deeper response as measured by the change in SCORAD score. No gut microbiome changes could be appreciated in either group after the treatment period. We could conclude that probiotics cannot replace SOC therapy for the management of acute exacerbation of AD.

13.
Pathology ; 55(6): 772-784, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37573161

RESUMO

Keratoacanthoma (KA) is widely considered a benign, usually self-resolving, neoplasm distinct from cutaneous squamous cell carcinoma (cSCC), while some consider KA to be indistinguishable from cSCC. Published studies indicate utility for p16, p53, Ki-67 immunostaining and elastic van Gieson (EVG) in the assessment of KA and cSCC. We compared clinical features and staining patterns for p16, p53, Ki-67 and EVG in fully excised KA, cSCC with KA-like features (cSCC-KAL) and other cSCC (cSCC-OTHER). Significant differences between KA, cSCC-KAL and cSCC-OTHER were found for head and neck location (20%, 86%, 84%), and duration <5 months (95%, 63%, 36%). KA shows both a mosaic pattern for p16 (>25-90% of neoplasm area) and peripheral graded pattern for p53 (up to 50% moderate and strong nuclear staining) in 92% compared with 0% of cSCC-KAL and 0% of cSCC-OTHER. In contrast, a highly aberrant pattern (usually null) for one or both p16 and p53, was present in 0% of KA, 83.8% of cSCC-KAL and 90.9% of cSCC-OTHER. Abnormal distribution of Ki-67 beyond the peripheral 1-3 cells was uncommon in KA (4.2%) and common in cSCC-KAL (67.6%) and cSCC-OTHER (88.4%). Moderate to striking entrapment of elastic and collagen fibres was present in the majority of KA (84%), cSCC-KAL (81%) and cSCC-OTHER (65%). KA are clinically distinct neoplasms typically of short duration occurring preferentially outside the head and neck and generally lacking aberrations of p16, p53 and Ki-67, compared with cSCC that have high rates of aberrant or highly aberrant p16, p53 and Ki-67, but EVG lacked specificity.


Assuntos
Carcinoma de Células Escamosas , Ceratoacantoma , Neoplasias Cutâneas , Humanos , Ceratoacantoma/diagnóstico , Ceratoacantoma/patologia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Antígeno Ki-67 , Proteína Supressora de Tumor p53 , Imuno-Histoquímica , Coloração e Rotulagem
14.
BMC Fam Pract ; 11: 62, 2010 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-20807441

RESUMO

BACKGROUND: Melanoma incidence in the UK has doubled over two decades, yet there is conflicting evidence about factors which prompt or delay patients seeking advice. AIM: To explore patient understanding of pigmented skin lesions (moles) and skin cancer, and factors which influence seeking help in primary care. METHOD: Semi-structured interviews with forty MoleMate Trial participants, analysed using the theoretical framework of the Safer-Andersen model of Total Patient Delay. RESULTS: Patient understanding and awareness was influenced by personal, family and friends' experiences of moles, skin cancer and other cancers, knowledge of risk factors, and the lay media. The route to consulting was complex and often iterative. For lesions that people could see, detecting and appraising change was influenced by comparisons with a normal mole on themselves, a family member, friend or image. Inferring illness came about with recognition of changes (particularly size) as serious, and associated 'internal' symptoms such as pain. For lesions that people could not see, family, friends and health professionals detected and appraised changes. Deciding to seek help was often prompted by another person or triggered by rapid or multiple changes in a mole. Three of four people subsequently diagnosed with melanoma did not seek help; instead, their GP opportunistically noticed the lesion. CONCLUSIONS: Changing moles are often perceived as trivial and not signifying possible skin cancer. This study contributes to current national strategies to improve patient awareness and earlier diagnosis of cancer by highlighting factors that can trigger or act as barriers to seeking help.(ISRCTN79932379).


Assuntos
Atitude Frente a Saúde , Melanoma/diagnóstico , Melanoma/psicologia , Nevo/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Atenção Primária à Saúde/métodos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Detecção Precoce de Câncer , Feminino , Educação em Saúde/métodos , Humanos , Entrevistas como Assunto/métodos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Modelos Psicológicos , Nevo/patologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pesquisa Qualitativa , Encaminhamento e Consulta , Fatores de Risco , Neoplasias Cutâneas/patologia , Inquéritos e Questionários
15.
Clin Teach ; 15(2): 109-113, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28436204

RESUMO

BACKGROUND: This study explored the experiences of graduate-entry medicine degree programme students who were disabled on the disclosure of their disability and the challenging disability issues they encountered during their degree programme. METHODS: Eight student volunteers with a disability from the University of Warwick graduate-entry medicine degree programme took part in this study. Audio recordings of their semi-structured interviews were transcribed verbatim and analysed thematically. FINDINGS: Contributory factors to a reluctance or delay in disclosing disability to the medical school included confidentiality concerns, the potential impact of disclosure on their medical school application outcome and not perceiving their disability had an impact on their ability to function. They disclosed their disability for a range of professional and practical considerations. One participant was investigated and diagnosed with dyslexia following failure in a medical school examination. Disabled medical students encountered challenging issues such as having concerns about their future fitness to practice and employability, repeated disclosure of disability, confidentiality, abuse and difficulties in organising reasonable adjustments. Disabled medical students encounter challenging issues DISCUSSION: Medical school staff should keep an open mind about undiagnosed disability as a potential contributory factor to graduate students' academic underperformance. Participants expressed concerns about the management of their disability information that could potentially be addressed through regular dialogue between the students with a disability and medical school representatives, to define who, when and how other staff members could have access to the students' disability information. Despite the challenges students with a disability encountered during their degree programme, they viewed themselves as individuals who were in a good position to empathise with patients and understand their needs.


Assuntos
Fracasso Acadêmico , Educação de Pós-Graduação em Medicina , Deficiências da Aprendizagem , Estudantes de Medicina/psicologia , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , Revelação da Verdade
17.
Clin Teach ; 13(3): 219-22, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26033358

RESUMO

BACKGROUND: This study explored graduate-entry medical students' experiences of health-advice requests from their family and friends. METHODS: This was a descriptive thematic analysis study involving a convenience sample of medical students from the University of Warwick 4-year MB ChB graduate-entry medicine programme. Each participating student attended a one-to-one semi-structured interview. Audio recordings of the interviews were transcribed verbatim and analysed thematically. Data saturation of the main themes was achieved following 14 interviews. FINDINGS: Of the 14 students, eight (57%) were males and six (43%) were females. Students were asked to advise on a range of human and veterinary health issues. They were prepared to offer advice on health issues that they felt competent to manage: for example, first-aid scenarios that a 'reasonable layperson' or a first-aider would be able to help with. The nature of health advice given by students became increasingly complex as they progressed through their degree programme; however, they generally refrained from giving advice on complex health issues and chose to refer the individual to seek help from competent professionals instead. DISCUSSION: Previous research highlighted inappropriate advice could delay individuals seeking help from competent professionals, resulting in adverse clinical outcomes; however, we recommend that students should not be discouraged to act as good Samaritans. Instead, educators could help them to explore the professionalism and ethical issues raised by these requests, and the practical ways of handling these requests sensitively through discussion of case scenarios with acceptable and inappropriate behaviours. This study explored graduate-entry medical students' experiences of health-advice requests from their family and friends.


Assuntos
Família , Amigos , Conhecimentos, Atitudes e Prática em Saúde , Estudantes de Medicina/psicologia , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Papel do Médico
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