ABSTRACT
Several studies suggest that patients with psoriasis have a higher incidence of neoplasms, especially of the skin, which could be associated with the use of therapies to treat psoriasis. Furthermore, the evidence available on the safety profile of some treatments in this context, and the management of these patients is scarce, which is why clinical practice guidelines with recommendations on the management of psoriasis in cancer patients are ambiguous. This study provides recommendations on the management and use of the therapies currently available for these patients. They are the result of a Delphi consensus reached by 45 dermatologists of the Spanish Academy of Dermatology and Venereology Psoriasis Working Group, whose goal is to help specialists in the field in their decision-making processes.
ABSTRACT
An asymmetric dual-grating gate bilayer graphene-based field effect transistor (ADGG-GFET) with an integrated bowtie antenna was fabricated and its response as a Terahertz (THz) detector was experimentally investigated. The device was cooled down to 4.5 K, and excited at different frequencies (0.15, 0.3 and 0.6 THz) using a THz solid-state source. The integration of the bowtie antenna allowed to obtain a substantial increase in the photocurrent response (up to 8 nA) of the device at the three studied frequencies as compared to similar transistors lacking the integrated antenna (1 nA). The photocurrent increase was observed for all the studied values of the bias voltage applied to both the top and back gates. Besides the action of the antenna that helps the coupling of THz radiation to the transistor channel, the observed enhancement by nearly one order of magnitude of the photoresponse is also related to the modulation of the hole and electron concentration profiles inside the transistor channel by the bias voltages imposed to the top and back gates. The creation of local n and p regions leads to the formation of homojuctions (np, pn or pp+) along the channel that strongly affects the overall photoresponse of the detector. Additionally, the bias of both back and top gates could induce an opening of the gap of the bilayer graphene channel that would also contribute to the photocurrent.
ABSTRACT
La definición de indicadores de calidad es una estrategia clave para garantizar la calidad de la asistencia sanitaria y su homogenización. Así, el proyecto CUDERMA surge como una iniciativa de la AEDV para definir indicadores de calidad con los que certificar unidades de distintos campos de interés en la dermatología, de los que se seleccionaron psoriasis y dermatooncología de forma inicial. El objetivo de este trabajo fue consensuar los aspectos a evaluar por los indicadores en la certificación de las unidades de psoriasis. Para ello se siguió un proceso estructurado que contempló la revisión bibliográfica de indicadores, la elaboración de un set preliminar revisado por un grupo de expertos multidisciplinar y el consenso Delphi. Un panel de 39 dermatólogos evaluó los indicadores, y los clasificó como «básicos» o «de excelencia». Finalmente se consensuaron 67 indicadores que serán estandarizados para diseñar la norma con la que certificar las unidades de psoriasis (AU)
Defining quality indicators is a key strategy for ensuring the quality and standardization of health care. The CUDERMA project, an initiative of the Spanish Academy of Dermatology and Venerology (AEDV), was undertaken to define quality indicators for the certification of specialized units in dermatology; the first 2 areas selected were psoriasis and dermato-oncology. The aim of this study was to reach a consensus on what should be assessed by the indicators used to certify psoriasis units. The structured process used to do this comprised a literature review to identify potential indicators, the selection of an initial set of indicators to be evaluated by a multidisciplinary group of experts and, finally, a Delphi consensus study. A panel of 39 dermatologists evaluated the selected indicators and classified them as either essential or of excellence. Consensus was finally reached on 67 indicators, which will be standardized and used to develop the certification standard for psoriasis units (AU)
Subject(s)
Humans , Quality of Health Care , Total Quality Management , Dermatology/standards , Psoriasis/therapy , Delphi TechniqueABSTRACT
Defining quality indicators is a key strategy for ensuring the quality and standardization of health care. The CUDERMA project, an initiative of the Spanish Academy of Dermatology and Venerology (AEDV), was undertaken to define quality indicators for the certification of specialized units in dermatology; the first 2 areas selected were psoriasis and dermato-oncology. The aim of this study was to reach a consensus on what should be assessed by the indicators used to certify psoriasis units. The structured process used to do this comprised a literature review to identify potential indicators, the selection of an initial set of indicators to be evaluated by a multidisciplinary group of experts and, finally, a Delphi consensus study. A panel of 39 dermatologists evaluated the selected indicators and classified them as either essential or of excellence. Consensus was finally reached on 67 indicators, which will be standardized and used to develop the certification standard for psoriasis units (AU)
La definición de indicadores de calidad es una estrategia clave para garantizar la calidad de la asistencia sanitaria y su homogenización. Así, el proyecto CUDERMA surge como una iniciativa de la AEDV para definir indicadores de calidad con los que certificar unidades de distintos campos de interés en la dermatología, de los que se seleccionaron psoriasis y dermatooncología de forma inicial. El objetivo de este trabajo fue consensuar los aspectos a evaluar por los indicadores en la certificación de las unidades de psoriasis. Para ello se siguió un proceso estructurado que contempló la revisión bibliográfica de indicadores, la elaboración de un set preliminar revisado por un grupo de expertos multidisciplinar y el consenso Delphi. Un panel de 39 dermatólogos evaluó los indicadores, y los clasificó como «básicos» o «de excelencia». Finalmente se consensuaron 67 indicadores que serán estandarizados para diseñar la norma con la que certificar las unidades de psoriasis (AU)
Subject(s)
Humans , Quality of Health Care , Total Quality Management , Dermatology/standards , Psoriasis/therapy , Delphi TechniqueABSTRACT
Defining quality indicators is a key strategy for ensuring the quality and standardization of health care. The CUDERMA project, an initiative of the Spanish Academy of Dermatology and Venerology (AEDV), was undertaken to define quality indicators for the certification of specialized units in dermatology; the first 2 areas selected were psoriasis and dermato-oncology. The aim of this study was to reach a consensus on what should be assessed by the indicators used to certify psoriasis units. The structured process used to do this comprised a literature review to identify potential indicators, the selection of an initial set of indicators to be evaluated by a multidisciplinary group of experts and, finally, a Delphi consensus study. A panel of 39 dermatologists evaluated the selected indicators and classified them as either "essential" or "of excellence". Consensus was finally reached on 67 indicators, which will be standardized and used to develop the certification standard for psoriasis units.
Subject(s)
Psoriasis , Quality Indicators, Health Care , Humans , Delphi Technique , Psoriasis/therapyABSTRACT
No disponible
Subject(s)
Humans , Biosimilar Pharmaceuticals/administration & dosage , Psoriasis/drug therapy , Biological Products/therapeutic use , Dermatologic Agents/therapeutic use , Treatment Outcome , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Health Systems/standards , Evidence-Based Practice/methods , Antibodies, Monoclonal/therapeutic useSubject(s)
Drug Approval , Psoriasis/drug therapy , Humans , Product Surveillance, Postmarketing , SpainABSTRACT
We report on a novel implementation of the cryo-etching method, which enabled us to fabricate low-roughness hBN-encapsulated graphene nanoconstrictions with unprecedented control of the structure edges; the typical edge roughness is on the order of a few nanometers. We characterized the system by atomic force microscopy and used the measured parameters of the edge geometry in numerical simulations of the system conductance, which agree quantitatively with our low temperature transport measurements. The quality of our devices is confirmed by the observation of well defined quantized 2e2/h conductance steps at zero magnetic field. To the best of our knowledge, such an observation reports the clearest conductance quantization in physically etched graphene nanoconstrictions. The fabrication of such high quality systems and the scalability of the cryo-etching method opens a novel promising possibility of producing more complex truly-ballistic devices based on graphene.
ABSTRACT
BACKGROUND: Treatment persistence is becoming a useful measure to evaluate long-term effectiveness and safety of biological therapies in real-world settings. OBJECTIVE: The main objective of this study was to explore the scientific opinion of a panel of dermatologists and hospital pharmacists to reach a consensus about the impact, causes, and best strategies and interventions that might be associated with improved drug persistence in patients with psoriasis in Spain. METHODS: This research was conducted using a modified Delphi method organized in two rounds and involving a panel of 90 dermatologists and 34 hospital pharmacists. A questionnaire of 70 items was developed. The items proposed to reach a consensus included topics such as definitions and measures in the treatment of psoriasis, analysis of treatment persistence, factors that may influence treatment persistence, impact of treatment persistence and economic cost of treatment. RESULTS: Dermatologists reached a consensus on 77.1% of the items proposed, and hospital pharmacists reached a consensus on 71.4%. Both groups agreed that it is important to use standardized measures in the evaluation of treatment maintenance over time. Dermatologists agreed that treatment survival, persistence and retention are synonymous, but hospital pharmacists considered only treatment persistence as a valid term. In addition, panelists agreed that drug persistence is an indicator of success in the treatment of psoriasis that may be influenced by a drug's effectiveness and safety profile, as well as by patient satisfaction. They agreed that the different causes of treatment discontinuation should be considered in Kaplan-Meier analysis of treatment persistence. Moreover, treatment persistence was agreed to decrease the cost of therapy. CONCLUSION: This Delphi consensus highlights the different perspectives of dermatologists and hospital pharmacists regarding the interpretation of treatment persistence, and the challenge of harmonizing the results obtained.
Subject(s)
Biological Products/therapeutic use , Dermatologic Agents/therapeutic use , Dermatologists , Medication Adherence , Pharmacists , Psoriasis/drug therapy , Biological Products/adverse effects , Biological Products/economics , Consensus , Delphi Technique , Dermatologic Agents/adverse effects , Dermatologic Agents/economics , Humans , Kaplan-Meier Estimate , Patient Satisfaction , Psoriasis/economics , Severity of Illness Index , Spain , Terminology as Topic , Treatment OutcomeABSTRACT
BACKGROUND: Ixekizumab (anti-IL17A) is effective as treatment for moderate-to-severe plaque psoriasis, but real-life data on effectiveness and safety are currently very limited. OBJECTIVE: To evaluate the efficacy and safety of ixekizumab in a cohort of real-life plaque psoriasis patients. METHODS: Retrospective chart review of 100 patients with moderate-to-severe plaque psoriasis treated with ixekizumab at seven Spanish dermatological centres. RESULTS: According to the as observed analysis, the percentage of patients achieving a 75% and 90% of reduction from the baseline score of Psoriasis Area and Severity Index (PASI) was 87.5%-50.0% at week 12-16; 88.3%-58.4% at week 24 and 82.9%-58.5% at week 52, respectively. The mean ± standard deviation (SD) score of PASI at baseline was 12.9 ± 9.2, and it declined rapidly after ixekizumab administration to 1.9 ± 4.0 (P < 0.001) at week 12-16 and was maintained at 1.7 ± 4.1 and 1.8 ± 2.9 at week 24 and 52, respectively. Ixekizumab response was not affected by clinical variables like body mass index, disease duration or the presence of psoriatic arthritis. However, the bio-naive group showed significantly higher PASI 75 response rate at week 12-16 compared to patients previously exposed to biologic agents (P = 0.037). Twenty-six (26%) patients experienced adverse events (AEs) during the follow-up period, being most of them of mild-to-moderate intensity. The most common AE was local reaction at the site of injection (14/26; 53.8%). At the end of the observational period, 15 (15%) patients discontinued ixekizumab treatment due to limited clinical improvement (n = 11), adverse events (n = 3) or lost to follow-up (n = 1) within a mean ± SD time of 6.0 ± 3.9 months. CONCLUSION: The present study illustrates the initial experience with ixekizumab in real-world clinical practice confirming its usefulness and safety in the management of plaque psoriasis patients.
Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Dermatologic Agents/therapeutic use , Psoriasis/drug therapy , Adult , Antibodies, Monoclonal, Humanized/adverse effects , Biological Products/therapeutic use , Dermatologic Agents/adverse effects , Female , Humans , Injection Site Reaction/etiology , Male , Middle Aged , Retreatment , Retrospective Studies , Severity of Illness IndexABSTRACT
INTRODUCCIÓN: El Psoriasis Area Severity Index (PASI) es la escala de medida más utilizada para la valoración de la gravedad de la psoriasis y la toma de decisión para la indicación de tratamiento. Atendiendo a su valor se han diferenciado 2 grupos de pacientes: psoriasis leve y moderada-grave. OBJETIVO: Elaborar una propuesta para la definición y caracterización de la psoriasis moderada mediante el PASI y el DLQI. Material y métodos Un grupo de 6 dermatólogos con experiencia en tratar psoriasis planteó la revisión crítica de la literatura y discusión de casos clínicos para elaborar una propuesta. RESULTADOS: 1) PASI, DLQI y BSA son, en orden de prioridad, los parámetros a emplear en la práctica clínica para la clasificación de la psoriasis leve, moderada y grave; 2) la evaluación de la gravedad debe incluir la evaluación e interpretación conjunta del PASI y del DLQI; y 3) la evaluación del PASI y del DLQI debería tener igual relevancia a la hora de determinar la gravedad de la psoriasis. Conforme a esto, se definieron los siguientes criterios de caracterización de psoriasis: a) leve: PASI<7 y DLQI<7; b) moderada: PASI 7-15 y DLQI 5-15 (grave en caso de localizaciones de difícil acceso para tratamientos o que supongan impacto psicosocial importante); y c) grave: PASI>15, independientemente de la puntuación DLQI. CONCLUSIONES: Una mejor caracterización de los pacientes en función de su gravedad permitirá una mejora del balance de riesgos y beneficios en el que se fundamente la toma de decisiones terapéuticas
INTRODUCTION: The Psoriasis Area Severity Index (PASI) is the most widely used scale for assessing the severity of psoriasis and for therapeutic decision making. On the basis of the PASI score, patients have been stratified into 2 groups: mild disease and moderate-to-severe disease. OBJECTIVE: To draft a proposal for the definition and characterization of moderate psoriasis based on PASI and Dermatology Life Quality Index (DLQI) scores. MATERIAL AND METHODS: A group of 6 dermatologists with experience in the treatment of psoriasis undertook a critical review of the literature and a discussion of cases to draft a proposal. RESULTS: In order of priority, PASI, DLQI, and body surface area (BSA) are the parameters to be used in daily practice to classify psoriasis as mild, moderate, or severe. Severity should be assessed on the basis of a combined evaluation and interpretation of the PASI and DLQI. And 3, PASI and DLQI should carry equal weight in the determination of disease severity. On this basis, psoriasis severity was defined using the following criteria: mild, PASI<7 and DLQI<7; moderate, PASI=7-15 and DLQI=5-15 (classified as severe when difficult-to-treat sites are affected or when there is a significant psychosocial impact); severe, PASI >15, independently of the DLQI score. CONCLUSIONS: A more precise classification of psoriasis according to disease severity will improve the risk-benefit assessment essential to therapeutic decision making in these patients
Subject(s)
Humans , Psoriasis/classification , Severity of Illness Index , Reproducibility of Results , Quality of Life , Sickness Impact Profile , Decision Support TechniquesABSTRACT
INTRODUCTION: The Psoriasis Area Severity Index (PASI) is the most widely used scale for assessing the severity of psoriasis and for therapeutic decision making. On the basis of the PASI score, patients have been stratified into 2 groups: mild disease and moderate-to-severe disease. OBJECTIVE: To draft a proposal for the definition and characterization of moderate psoriasis based on PASI and Dermatology Life Quality Index (DLQI) scores. MATERIAL AND METHODS: A group of 6 dermatologists with experience in the treatment of psoriasis undertook a critical review of the literature and a discussion of cases to draft a proposal. RESULTS: In order of priority, PASI, DLQI, and body surface area (BSA) are the parameters to be used in daily practice to classify psoriasis as mild, moderate, or severe. Severity should be assessed on the basis of a combined evaluation and interpretation of the PASI and DLQI. And 3, PASI and DLQI should carry equal weight in the determination of disease severity. On this basis, psoriasis severity was defined using the following criteria: mild, PASI<7 and DLQI<7; moderate, PASI=7-15 and DLQI=5-15 (classified as severe when difficult-to-treat sites are affected or when there is a significant psychosocial impact); severe, PASI >15, independently of the DLQI score. CONCLUSIONS: A more precise classification of psoriasis according to disease severity will improve the risk-benefit assessment essential to therapeutic decision making in these patients.
Subject(s)
Psoriasis , Severity of Illness Index , Consensus , Humans , Psoriasis/classification , Psoriasis/pathology , Psoriasis/psychology , Quality of Life , Risk Assessment , Surveys and Questionnaires , Symptom AssessmentABSTRACT
BACKGROUND: Patients' perception of disease management can influence compliance to treatment and thus affect outcome. OBJECTIVE: To survey patients and physicians on their perceptions of biologic therapy for treating psoriasis in an outpatient setting. METHODS: The subjective impact of intravenous treatment of severe psoriasis on patients and physicians in the outpatient setting was determined via two surveys. RESULTS: Between September and November 2014, 24 dermatologists and 90 patients were surveyed. Treatment with biologic agents in the outpatient setting was associated with a high level of patient satisfaction: 93.3% of patients considered their psoriasis well controlled and 46.1% reported complete control. Patients highly valued the feeling of greater disease control (72.2%), regular follow-up (66.7%) and rapid improvement of psoriasis (58.9%) when attending an outpatient setting. Other positive aspects of outpatient treatment were control of other health issues and perceived improvements in quality of life (QoL). Outpatient attendance was high; with 90% of patients keeping scheduled appointments and 79.2% of physicians acknowledged that they were able to monitor their patients' condition more closely. CONCLUSION: Administration of treatment in an outpatient setting may provide a feeling of improved QoL and disease control.
Subject(s)
Dermatologists/psychology , Psoriasis/therapy , Adult , Aged , Ambulatory Care , Female , Humans , Male , Medication Adherence , Middle Aged , Outpatients , Perception , Quality of Life , Surveys and QuestionnairesABSTRACT
INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic skin disease which causes a great impact in the quality of life. Multiple therapeutic options have been proposed, and recently the potential use of biological drugs in severe cases has been postulated. MATERIAL AND METHODS: A retrospective study from seven tertiary Spanish centers reviewing the charts of patients with HS treated with biological drugs was performed. Retrieved information included epidemiological data, clinical features, pain intensity, Hurley stage, laboratory data and therapeutic outcomes. RESULTS: Nineteen patients were included in the study; 10 men (52.6%) and 9 women. Eight patients (42%) showed a Hurley severity stage II and 11 a stage III (57.8%). Adalimumab was prescribed as the first biological treatment in nine out of 19 cases (47.3%), whereas infliximab was prescribed in seven cases (36.8%), ustekinumab in two cases (10.5%) and etanercept in one (5.2%). A complete response was observed in three patients (two cases with infliximab and one case with ustekinumab), a partial improvement in 10 patients and in six patients no clinical improvement was noted. One patient referred worsening of the skin symptoms. In 6 cases, a second biological treatment was prescribed. In three of such cases, a partial improvement was noted, whereas in three cases no clinical improvement was observed. In two cases a switch to a third biological drug was indicated, with a partial improvement in one case. DISCUSSION AND CONCLUSIONS: Biological drugs could be a potential and effective therapeutic option for patients with severe HS. Complete and persistent clinical responses are rarely obtained (15%) and partial responses are achieved in approximately 50% of patients. No specific markers for a therapeutic response have been identified. No definitive conclusions regarding the most effective biological drug for HS could be drawn. Higher dosage schedules seem to be associated with higher response rates. The lack of response of one particular drug does not preclude a potential efficacy to another biological treatment.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Antibodies, Monoclonal/therapeutic use , Biological Therapy , Hidradenitis Suppurativa/drug therapy , Immunoglobulin G/therapeutic use , Receptors, Tumor Necrosis Factor/therapeutic use , Adalimumab , Adolescent , Adult , Drug Substitution , Etanercept , Female , Humans , Infliximab , Male , Retrospective Studies , Severity of Illness Index , Treatment Outcome , Ustekinumab , Young AdultABSTRACT
No disponible
Subject(s)
Humans , Pharmaceutical Preparations/analysis , Pharmaceutical Preparations/supply & distribution , Biological Therapy , Biological Therapy/ethics , Biological Therapy/methods , Pharmaceutical Preparations/classification , Dermatology/methods , Survivorship/physiologyABSTRACT
No disponible
