Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 26
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
BMJ Open ; 9(9): e033150, 2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31551393

RESUMO

INTRODUCTION: Inflammation, dehydration, hypotension and bleeding may all contribute to the development of acute kidney injury (AKI). Accelerated surgery after a hip fracture can decrease the exposure time to such contributors and may reduce the risk of AKI. METHODS AND ANALYSIS: Hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) is a multicentre, international, parallel-group randomised controlled trial (RCT). Patients who suffer a hip fracture are randomly allocated to either accelerated medical assessment and surgical repair with a goal of surgery within 6 hours of diagnosis or standard care where a repair typically occurs 24 to 48 hours after diagnosis. The primary outcome of this substudy is the development of AKI within 7 days of randomisation. We anticipate at least 1998 patients will participate in this substudy. ETHICS AND DISSEMINATION: We obtained ethics approval for additional serum creatinine recordings in consecutive patients enrolled at 70 participating centres. All patients provide consent before randomisation. We anticipate reporting substudy results by 2021. TRIAL REGISTRATION NUMBER: NCT02027896; Pre-results.

2.
Dermatol Clin ; 37(4): 519-526, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466591

RESUMO

Skin cancers are relatively rare in patients with skin of color; however, they are an important public health concern because of disparities in patient outcomes. Gaps in skin cancer knowledge exist because of lack of large-scale studies involving people of color, and limitations in data collection methods and skin classification paradigms. Additional research is needed to address questions regarding risk and reasons for disparate skin cancer outcomes in these patients. We summarize the clinical and epidemiologic features for basal cell carcinoma, squamous cell carcinoma, and melanoma and touch on some of their unique features in patients with skin of color.

3.
BMJ Open ; 9(4): e028537, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31048449

RESUMO

INTRODUCTION: Annually, millions of adults suffer hip fractures. The mortality rate post a hip fracture is 7%-10% at 30 days and 10%-20% at 90 days. Observational data suggest that early surgery can improve these outcomes in hip fracture patients. We designed a clinical trial-HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) to determine the effect of accelerated surgery compared with standard care on the 90-day risk of all-cause mortality and major perioperative complications. METHODS AND ANALYSIS: HIP ATTACK is a multicentre, international, parallel group randomised controlled trial (RCT) that will include patients ≥45 years of age and diagnosed with a hip fracture from a low-energy mechanism requiring surgery. Patients are randomised to accelerated medical assessment and surgical repair (goal within 6 h) or standard care. The co-primary outcomes are (1) all-cause mortality and (2) a composite of major perioperative complications (ie, mortality and non-fatal myocardial infarction, pulmonary embolism, pneumonia, sepsis, stroke, and life-threatening and major bleeding) at 90 days after randomisation. All patients will be followed up for a period of 1 year. We will enrol 3000 patients. ETHICS AND DISSEMINATION: All centres had ethics approval before randomising patients. Written informed consent is required for all patients before randomisation. HIP ATTACK is the first large international trial designed to examine whether accelerated surgery can improve outcomes in patients with a hip fracture. The dissemination plan includes publishing the results in a policy-influencing journal, conference presentations, engagement of influential medical organisations, and providing public awareness through multimedia resources. TRIAL REGISTRATION NUMBER: NCT02027896; Pre-results.

4.
Can J Cardiol ; 34(7): 850-862, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29960614

RESUMO

Worldwide, more than 230 million adults have major noncardiac surgery each year. Although surgery can improve quality and duration of life, it can also precipitate major complications. Moreover, a substantial proportion of deaths occur after discharge. Current systems for monitoring patients postoperatively, on surgical wards and after transition to home, are inadequate. On the surgical ward, vital signs evaluation usually occurs only every 4-8 hours. Reduced in-hospital ward monitoring, followed by no vital signs monitoring at home, leads to thousands of cases of undetected/delayed detection of hemodynamic compromise. In this article we review work to date on postoperative remote automated monitoring on surgical wards and strategy for advancing this field. Key considerations for overcoming current barriers to implementing remote automated monitoring in Canada are also presented.


Assuntos
Monitorização Fisiológica/métodos , Cuidados Pós-Operatórios/métodos , Procedimentos Cirúrgicos Operatórios , Telemedicina/métodos , Sinais Vitais/fisiologia , Humanos
5.
Cutis ; 101(4): 243-246, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29763483

RESUMO

Cutaneous melanoma is the most fatal form of skin cancer and presents a considerable public health concern in the United States. Although the age-adjusted incidence of melanoma among US Hispanics is lower than that of non-Hispanic whites (NHWs), Hispanics who are diagnosed with melanoma are more likely to present with thicker primary tumors, metastatic disease, and lower 5-year melanoma-specific survival rates than NHWs. Melanoma risk factors and reasons for late presentation among Hispanics are not completely understood. In this review, the epidemiology and clinical presentation of melanoma in Hispanics is summarized, and recommendations for a research agenda to advance understanding of this disease in the most rapidly growing segment of the US population is provided.


Assuntos
Disparidades nos Níveis de Saúde , Melanoma/epidemiologia , Neoplasias Cutâneas/epidemiologia , Hispano-Americanos/estatística & dados numéricos , Humanos , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Resultado do Tratamento , Estados Unidos/epidemiologia
7.
J Investig Dermatol Symp Proc ; 18(2): S29-S30, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28941489

RESUMO

The Hampton University Skin of Color Research Institute Skin of Color Symposium 2015: From Bench to Bedside was held in Williamsburg, Virginia at the Williamsburg Lodge, November 13-15, 2015. The conference was designed to promote, develop, and advance the education, knowledge, and research of cutaneous disorders disproportionately affecting people of racial and ethnic minority groups. Centered on the theme of "From Bench to Bedside", the symposium provided a program featuring a diverse panel of nationally recognized physician-scientists, basic scientists, and clinicians who updated attendees on the latest research advances across multiple relevant disciplines, including public health, basic science, and the clinical diagnosis and management of select complex and rare dermatologic conditions. Featured sessions included recent advances in vitiligo, disorders of hyperpigmentation, keloids, central centripetal cicatricial alopecia, and cutaneous lupus. We expect that the scientific sessions and interactive panel discussions, combined with the synergistic environment that has characterized this conference, will spur the formation of new collaborations and scientific discovery and, ultimately, will culminate in novel treatments for dermatologic disorders disproportionately affecting individuals with skin of color.


Assuntos
Dermatologia/educação , Dermatopatias/etnologia , Dermatopatias/terapia , Humanos , Internato e Residência , Pesquisa Médica Translacional
8.
J Investig Dermatol Symp Proc ; 18(2): S81-S84, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28941500

RESUMO

Elevated levels of prostaglandin D2 (PGD2) have been shown to be present in the bald scalp of androgenic alopecia (AGA) patients and to functionally inhibit hair growth. However, its precise mechanism in AGA has yet to be clearly defined. Although testosterone plays a critical role in the initiation and progression of AGA, the existence of a possible link between PGD2 and testosterone in skin has not been investigated. Here we show that human keratinocytes treated with PGD2 show enhanced capacity to convert the weak androgen, androstenedione, to testosterone. At the same time, treatment with PGD2 induced reactive oxygen species as indicated by generation of the lipid peroxidation product, 4-hydroxynonenal. To determine whether these two events are linked, we used the reactive oxygen species scavenger N-acetyl-cysteine, which blocked the enhanced testosterone production from PGD2-treated keratinocytes. Our study suggests the existence of a possible crosstalk between the PGD2-reactive oxygen species axis and testosterone metabolism in keratinocytes. Thus, we propose that AGA patients might benefit from the use of N-acetyl-cysteine or other antioxidants as a supplement to currently available or emerging AGA therapies such as finasteride, minoxidil, and PGD2 receptor blockers.


Assuntos
Androstenodiona/metabolismo , Queratinócitos/metabolismo , Prostaglandina D2/farmacologia , Espécies Reativas de Oxigênio/metabolismo , Testosterona/biossíntese , Acetilcisteína/farmacologia , Aldeídos/metabolismo , Alopecia , Células Cultivadas , Depuradores de Radicais Livres/farmacologia , Humanos , Transdução de Sinais
9.
J Cancer Epidemiol ; 2017: 8418904, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28702054

RESUMO

BACKGROUND: Hispanics diagnosed with cutaneous melanoma are more likely to present at advanced stages but the reasons for this are unknown. We identify census tracts at high risk for late stage melanoma diagnosis (LSMD) and examine the contextual predictors of LSMD in California, Texas, and Florida. METHODS: We conducted a cross-sectional study using geocoded state cancer registry data. Using hierarchical multilevel logistic regression models we estimated ORs and 95% confidence intervals for the impact of socioeconomic, Hispanic ethnic concentration, index of dissimilarity, and health resource availability measures on LSMD. RESULTS: We identified 12,493 cases. In California, late stage cases were significantly more likely to reside within census tracts composed mostly of Hispanics and immigrants. In Texas, LSMD was associated with residence in areas of socioeconomic deprivation and a higher proportion of immigrants. In Florida, living in areas of low education attainment, high levels of poverty, and a high percentage of Hispanic residents was significantly associated with LSMD. Residential segregation did not independently affect LSMD. CONCLUSION: The influence of contextual predictors on LSMD varied in magnitude and strength by state, highlighting both the cosegregation of social adversity and poverty and the complexity of their interactions.

10.
J Skin Cancer ; 2016: 4635740, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27651954

RESUMO

Cutaneous melanoma is a significant public health concern, accounting for thousands of deaths annually in the US. Early detection and diagnosis are critical given the poor prognosis and limited treatment options of advanced-stage disease. While non-Hispanic whites have higher incidence rates of melanoma, Hispanics are typically diagnosed at later disease stages and suffer higher morbidity and mortality. Currently, there is a paucity of literature investigating the root causes underlying these trends among Hispanics. Given that Hispanics are the most rapidly expanding demographic segment in the US, it is essential for cancer control efforts to elucidate the major determinants of their poor melanoma outcomes. Herein, we use the social ecological model as a framework to explore the multitude of influences on melanoma disparities among Hispanics and provide recommendations for planning future studies and interventions.

11.
Am J Clin Dermatol ; 17(3): 201-23, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26894654

RESUMO

Since their earliest description, keloids and hypertrophic scars have beleaguered patients and clinicians alike. These scars can be aesthetically disfiguring, functionally debilitating, emotionally distressing, and psychologically damaging, culminating in a significant burden for patients. Our current understanding of keloid pathophysiology has grown and continues to advance while molecular biology, genetics, and technology provide ever-deepening insight into the nature of wound healing and the pathologic perturbations thereof. Greater understanding will lead to the development and application of refined therapeutic modalities. This article provides an overview of our current understanding of keloids, highlighting clinical characteristics and diagnostic criteria while providing a comprehensive summary of the many therapeutic modalities available. The proposed mechanism, application, adverse events, and reported efficacy of each modality is evaluated, and current recommendations are summarized.


Assuntos
Cicatriz Hipertrófica , Fibroblastos/fisiologia , Queloide , Cicatrização/fisiologia , Adjuvantes Imunológicos/administração & dosagem , Adjuvantes Imunológicos/efeitos adversos , Adjuvantes Imunológicos/uso terapêutico , Aminoquinolinas/administração & dosagem , Aminoquinolinas/efeitos adversos , Aminoquinolinas/uso terapêutico , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Antibióticos Antineoplásicos/administração & dosagem , Antibióticos Antineoplásicos/efeitos adversos , Antibióticos Antineoplásicos/uso terapêutico , Antimetabólitos/administração & dosagem , Antimetabólitos/efeitos adversos , Antimetabólitos/uso terapêutico , Bleomicina/administração & dosagem , Bleomicina/efeitos adversos , Bleomicina/uso terapêutico , Proliferação de Células , Cicatriz Hipertrófica/etiologia , Cicatriz Hipertrófica/patologia , Cicatriz Hipertrófica/terapia , Ensaios Clínicos como Assunto , Colágeno/metabolismo , Terapia Combinada/métodos , Crioterapia/métodos , Matriz Extracelular/fisiologia , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Fluoruracila/uso terapêutico , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Glucocorticoides/uso terapêutico , Humanos , Imiquimode , Inflamação/metabolismo , Queloide/etiologia , Queloide/patologia , Queloide/terapia , Terapia a Laser/métodos
12.
Dermatol Online J ; 22(11)2016 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-28329560

RESUMO

ObjectiveTo determine the impact of race concordance on patient perception of quality of dermatologic care.Study designCross-sectional study.SettingAcademic outpatient practices in the Departments of Dermatology of Eastern Virginia Medical School and the Johns Hopkins University School of Medicine.ParticipantsThe study cohort comprised 124 participants including 6 providers and 118 established patients.Main Outcome MeasuresWe hypothesized, a priori, that patients in race-discordant dyads would report lower ratings of participatory decision-making (PDM), satisfaction, trust in the provider, and similarities with providers.ResultsPatients in race-discordant dyads reported less positive ratings on 4 out of 8 participatory decision-making questionnaire items (p values < 0.05), and were significantly more likely to perceive differences with providers in race and culture (p values < 0.05). These differences persisted to varying degrees after controlling for key confounders such as education and income level. Participants in race-concordant and race-discordant dyads did not differ in their perceptions of satisfaction or trust.ConclusionsPatient perception of participation in the decision-making process and of shared similarities with their providers is attributable in varying degrees to race concordance. Continued strengthening of cultural competency skills during medical and dermatology residency training as well as increased diversification of the dermatologic workforce could attenuate the adverse influences of race discordance and other socioeconomic factors on patient-provider communication.


Assuntos
Comunicação , Tomada de Decisões , Dermatologistas , Grupos Étnicos , Participação do Paciente , Relações Médico-Paciente , Adulto , Afro-Americanos , Estudos Transversais , Competência Cultural , Diversidade Cultural , Dermatologia , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistentes Médicos , Relações Profissional-Paciente , Inquéritos e Questionários
18.
Cancer Control ; 21(4): 343-9, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25310216

RESUMO

BACKGROUND: This article sought to elucidate how aspects of poverty and culture may contribute to race- and ethnicity-based disparities in cutaneous melanoma outcomes. METHODS: We identified published studies addressing the social determinants of melanoma. Selected review articles included US-based studies comprised of patients representing adults, children, and adolescents. RESULTS: African Americans and Hispanics diagnosed with cutaneous melanoma are more likely to present with more advanced stages of disease at diagnosis and have higher rates of mortality than their nonminority counterparts. These disparities may be a consequence of economic, social, and cultural barriers such as low income, public forms of health insurance, lower levels of education, lower levels of melanoma awareness and knowledge, and lower rates of participation in melanoma screening. No studies in the literature examined the potential impact of social injustice, English proficiency, immigrant status, and health literacy. CONCLUSIONS: Substantial gaps exist in our knowledge of the pathways linking social determinants and race- and ethnicity-based disparities in melanoma. More studies are warranted to inform the development of effective interventions aimed at narrowing inequities and improving cutaneous melanoma outcomes among minority populations.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Melanoma/etnologia , Neoplasias Cutâneas/etnologia , Humanos
19.
J Dermatol Case Rep ; 8(2): 46-9, 2014 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-25024777

RESUMO

BACKGROUND: Hepatitis C viral infection is a significant public health problem; 170 million persons are infected worldwide and the prevalence in the southern part of the United States exceeds two percent. Extrahepatic manifestations of hepatitis C viral infection are common; notably, 15-20% of patients will develop cutaneous manifestations of their disease. There are numerous dermatologic diseases associated with hepatitis C infection, including lichen planus, leukocytoclasticvasculitis, and porphyria cutaneatarda. MAIN OBSERVATION: Recently, epidemiological studies have also demonstrated an association between hepatitis C infection and the development of non-Hodgkin lymphoma, especially marginal zone B-cell lymphoma. Herein we report the unusual case of a systemic marginal zone lymphoma in a patient with hepatitis C infection presenting clinically as localized lipoatrophy. CONCLUSIONS: Lipoatrophy can be a rare and diagnostically challenging presentation of secondary cutaneous marginal zone B-cell lymphoma. The importance of early recognition and detection cannot be over emphasized, as new and effective anti-viral treatments can lead to lymphoma regression in up to 75% of patients. To our knowledge, this is the first case of hepatitis C viral infection associated marginal zone lymphoma to present as localized lipoatrophy.

20.
Pediatr Dermatol ; 29(6): 749-55, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23017105

RESUMO

To review the literature on atopic dermatitis (AD) clinical trials published in the United States between 2000 and 2009 to examine the representation of racial and ethnic minorities in those trials and determine the extent to which investigators reported on demographic variables and performed a subanalysis. A PubMed search was performed including all clinical trials for management of AD published between 2000 and 2009. Three reviewers analyzed articles matching the search criteria. Data recorded included incorporation of demographic data at baseline and in the analysis and result interpretations. Of 645 PubMed search results, only 78 articles originated in the United States and fit the search criteria; 59.5% of these included reports of race or ethnicity. Of the studies reporting race or ethnicity, the subject population mainly included 62.1% white, 18.0% black, 6.9% Asian, and 2.0% Hispanic. Despite increasing awareness in the United States of the importance of reporting demographic data in clinical trials, there has been no significant improvement in reporting in AD clinical trials over the past 10 years. When reporting occurs, the categorization of ethnicities, methods of reporting data, and incorporation of the data into the results are lacking or flawed. In addition, aside from blacks, U.S. minorities appear to be underrepresented in AD clinical trials.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/reabilitação , Fármacos Dermatológicos/uso terapêutico , Grupos Étnicos/estatística & dados numéricos , Ensaios Clínicos como Assunto/estatística & dados numéricos , Humanos , Estados Unidos/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA