The Potential of Instagram to Reduce Stigmatization of People with Psoriasis: A Randomized Controlled Pilot Study.

Psoriasis is a stigmatized skin disease. This randomized controlled trial aimed to evaluate an Instagram based stigma-reduction intervention targeting daily Instagram users aged 18 to 49 years without psoriasis. After stratification for baseline characteristics (t0), stigmatization of psoriasis was assessed using a questionnaire and a photo-rating task immediately before (t1) and after (t2) the intervention and two weeks post-intervention (t3). Data from 54 participants, recruited in a university setting and via Instagram, were analysed. For 10 min between t1 and t2, the intervention group (n = 26) and the control group (n = 28) scrolled through two different Instagram accounts. Psoriasis-sensitizing content was displayed to the intervention group while beauty-glorifying posts were shown to the control group. Results indicated significantly less Disease-related Misconceptions in the intervention group in comparison to the control group at t2 (U = 145.50, Z = -3.79, p < 0.001) and at t3 (U = 177.00, Z = -3.25, p = 0.003). Moreover, the intervention group showed a significant reduction over time in Stereotype Endorsement (F(2, 50) = 13.40, p < 0.001, partial η² = 0.35) and Disease-related Misconceptions (χ2(2) = 12.64, p = 0.002). These findings suggest that addressing psoriasis on Instagram has the potential to effectively reduce the related stigmatization. Further studies are necessary to assess the impact of social media on stigmatization concerning psoriasis in more depth.

Happiness Behind the Scenes: Associations between Heuristic Happiness and Related Dimensions in Skin Diseases.

Positive health approaches, such as happiness, are largely unexplored in medicine, including dermatology. Taking into consideration the various happiness measures, the aims of this cross-sectional study were to assess this concept using a 1-item heuristic happiness question and its related dimensions (Satisfaction with Life, Positive and Negative Affect, Quality of Life, and Compound Psychological Capital) in outpatients with different skin diseases between December 2019 and June 2020, and to examine the link between these dimensions. Overall, 414 dermatological patients were included: 67 with psoriasis, 84 atopic eczema, 10 mastocytosis, 19 nummular eczema, 84 malignant melanoma and 150 keratinocyte carcinoma. Comparing the skin diseases, differences were observed for heuristic happiness, Positive Affect, and some domains of Quality of Life and Compound Psychological Capital. Analysing the relationship between heuristic happiness and other happiness measures, the data revealed moderate to strong correlations (r = 0.30-0.46, p< 0.001) and variations in the understanding of happiness between the skin diseases. Overall, the most important facet of happiness was Hope as a domain of Compound Psychological Capital. This study emphasizes the individual definition of heuristic happiness in patients with skin diseases. A 1-item heuristic approach may be a simple and practical method to assess the complexity and individuality of happiness.

Automatic body part identification in real-world clinical dermatological images using machine learning.

BACKGROUND: Dermatological conditions are prevalent across all population sub-groups. The affected body part is of importance to their diagnosis, therapy, and research. The automatic identification of body parts in dermatological clinical pictures could therefore improve clinical care by providing additional information for clinical decision-making algorithms, discovering hard-to-treat areas, and research by identifying new patterns of disease. PATIENTS AND METHODS: In this study, we used 6,219 labelled dermatological images from our clinical database, which were used to train and validate a convolutional neural network. As a use case, qualitative heatmaps for the body part distribution in common dermatological conditions was generated using this system. RESULTS: The algorithm reached a mean balanced accuracy of 89% (range 74.8%-96.5%). Non-melanoma skin cancer photos were mostly of the face and torso, while hotspots of eczema and psoriasis image distribution included the torso, legs, and hands. CONCLUSIONS: The accuracy of this system is comparable to the best to-date published algorithms for image classification challenges, suggesting this algorithm could boost diagnosis, therapy, and research of dermatological conditions.

"The chameleon among diseases" - an explorative view of sarcoidosis and identification of the consequences for affected patients and relatives using qualitative interviews.

INTRODUCTION: Sarcoidosis is a multisystemic disease, with the lungs being the main site of manifestation. Although the exact etiology remains unclear, both genetic and environmental factors are being discussed. Diagnostic evaluation is challenging, and the management of chronic patients and assessment of their needs proves difficult, especially in the absence of targeted therapy. Studies on sarcoidosis patients have shown that quality of life is limited even after clinically measurable parameters have resolved. The question remains how patients and their relatives perceive medical care and the diagnostic process and how these affect their well-being. METHODS: Qualitative, semi-structured interviews were conducted with patients and their relatives between September 2019 and February 2020. Interviews were recorded, transcribed verbatim, and analyzed using qualitative content analysis. Deductive hypotheses were then formed based on categories according to personal aspects, symptoms, diagnostic, daily life activity, therapy, psychological aspects and wishes. RESULTS: Fourteen patients and five relatives were included. Most patients reported subacute symptoms before the first organ-related episode. A high degree of personal initiative was required from the majority of respondents in both the diagnostic and subsequent therapeutic processes. In addition, respondents reported so-called "doctor-hopping", a lack of specialists or contacts, and a lack of medical support. The Internet and self-help groups played a fundamental role for patients and relatives in exchanging information with other affected persons and to compensate for an existing information deficit. CONCLUSION: The results provide new insights into patients' and relatives' perceptions of the sarcoidosis diagnosis and treatment process. Identification of barriers such as a lack of physicians and an information deficit highlights potential targets for strategies to optimize sarcoidosis management.

Cormatrix® for vessel reconstruction in paediatric cardiac surgery-a word of caution.

OBJECTIVES: The aim of this retrospective study was to determine if Cormatrix® (CM) represents a safe alternative to conventional patch materials used in congenital heart surgery. METHODS: A total of 57 paediatric patients who underwent cardiac surgery using an Extracellular Matrix Bioscaffold (CM) were categorized into 4 groups according to the patch implant location. Patch-related complications and reintervention rates were analysed. A subgroup of 18 patients was subsequently compared to a matched group of 36 patients who underwent similar surgical procedures with autologous pericardium as patch material. RESULTS: No patient died during hospitalization. There were 2 late deaths, not related to the implanted CM patch. Fourteen (66.7%) out of 21 patients with arterial patch plasty developed progressive vessel/right ventricular outflow tract stenosis or aneurysm. All 3 patients with a valved CM conduit developed haemodynamically relevant valve stenosis or regurgitation. A total of 18 (31.5%) patients needed reintervention and 12 (21.1%) related to CM. Four (7%) patients needed surgical treatment with operative removal of the stenosis. Redo valve replacement was performed on 2 (3.5%) patients. Six (10.5%) patients required an interventional cardiology procedure at a median interval of 5 months from surgery. The subgroup analysis revealed a significantly lower patch-related reintervention rate in patients treated with autologous pericardium when compared to CM (P = 0.006). CONCLUSIONS: CM is safe for atrial and ventricular defect closure. The use of CM for arterial vessel reconstruction is associated with higher reintervention rates when compared to autologous pericardium.

Evaluation of the clinical use of the ETN PROtect® in non-union therapy.

INTRODUCTION: Non-union of a long bone fracture remains a challenge in orthopaedic and trauma surgery. In the current study, we sought to determine the clinical effectiveness of tibial non-union treatment utilizing an antibiotic-coated intramedullary nail (Expert Tibia Nail (ETN) PROtect®) regarding prevention and treatment of infection and the clinical outcome. PATIENTS AND METHODS: 36 patients suffering from tibial non-unions that were treated with the ETN PROtect® in the course of non-union treatment between February 2010 and March 2015 were included in this clinical observational study. Clinical and radiological examinations were performed preoperatively as well as 4, 6 and 12 weeks and 6 and 12 months postoperatively as part of a standardized follow-up program. Data regarding perioperative complications, weight-bearing capacity, radiological signs of consolidation and subjective health status were assessed at each time point. Laboratory parameters such as C-reactive protein (CRP) and leukocyte count were collected preoperatively in order to assess the patients' risk profile for infection. RESULTS: Patients had an average of 6.2 previous surgeries and 22 patients (61.1%) had a positive bacterial culture from intraoperatively removed tissue during the first operative treatment. 29 patients (80.6%) achieved full weight-bearing after an average of 7.7 months, furthermore 80.6% of patients achieved osseous consolidation. 3 deep infections occurred, including one amputation. Subjective health status increase based on the SF-12 questionnaire during our follow-up program. CONCLUSION: The results from the current study indicate that the use of the ETN PROtect® in the applied non-union therapy has a high clinical effectiveness regarding osseous consolidation and time to weight bearing. In addition, the use of gentamicin-coated nails in the treatment of tibial non-unions might contribute to both successful treatment of the underlying infection and prevention of perioperative infection. The gentamicin-coated nail may serve as a beneficial adjunct treatment in the applied non-union therapy in addition to all established techniques in the treatment of infected non-unions.