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Personalized Photoprotection: Expert Consensus and Recommendations From a Delphi Study Among Dermatologists.
No full textBACKGROUND: Recommending comprehensive personalized photoprotection requires an accurate assessment of the patient\u27s skin, including phototype, lifestyle, exposure conditions, environmental factors, and concomitant cutaneous conditions as well as deep knowledge of the available options: sunscreen ingredients (type of filters, spectrum coverage, sun protection factor, enhanced active ingredients), oral photoprotection, and other methods of sun protection and avoidance.
OBJECTIVES: To establish consensus-based recommendations endorsed by an international panel of experts for personalized medical photoprotection recommendations that are applicable globally.
METHODS: A two-round Delphi study was designed to determine the degree of agreement and relevance of aspects related to personalized medical photoprotection. Items with ≥ 80% agreement and relevance were considered approved.
RESULTS: A list of 28 recommendations for personalized medical photoprotection was approved by a panel of dermatology professionals from seven different countries. Recommendations were categorized as: (1) updated perspectives in photoprotection, (2) clinical management, (3) skin cancer prevention, (4) dark skin phototypes and skin prone to hyperpigmentation, and (5) age and lifestyle.
CONCLUSION: This study established recommendations for the implementation of personalized medical photoprotection worldwide, highlighting areas needing further scientific and clinical evidence
Polyarticular Septic Arthritis Caused by Haemophilus Influenzae in an Asplenic Patient: A Case Report
No full textINTRODUCTION: Prevalence of serious infections from Haemophilus influenzae has diminished over the last few decades because of immunizations against the most virulent serotype. However, over the last few years a handful of septic arthritis cases secondary to H influenzae have been documented. Most of the cases documented are in the pediatric and unimmunized population. This is a case of polyarticular septic arthritis in a 69-year-old male who presented with syncope and ankle pain.
CASE REPORT: A 69-year-old male presented to the emergency department after a syncopal event at home and complaining of right ankle pain. He was tachycardic and tachypneic on presentation and had an erythematous painful right ankle and right elbow. Aspiration of both joints produced purulent aspirate that grew H influenzae. Antibiotics were started, and the patient was taken to the operating room for emergent joint lavage. The patient made a full recovery and was discharged home with a peripherally inserted central catheter line for continued intravenous (IV) antibiotics.
CONCLUSION: Our case highlights an atypical presentation for a case of polyarticular septic arthritis caused by H influenzae. We were unable to rule out endocarditis as a source of the bacterial seeding, and the patient improved with IV antibiotics and surgical lavage of the affected joints
Barriers to orthodox medical care of prostate cancer in Ghana
No full textTraditional medicine is widely used in sub-Saharan Africa, particularly in Ghana, where it is commonly integrated with modern orthodox medicine. This study examines the barriers that delay the pursuit of orthodox medical care for prostate cancer (PCa) in Ghana\u27s Central region, where a blend of traditional and modern orthodox medicine exists. The preference for indigenous traditional medicine often results in late-stage presentations of PCa, adversely affecting patient outcomes. This prospective cross-sectional study was conducted from July to December 2022 at the Cape Coast Teaching Hospital (CCTH) and in four local communities. We investigated why men prefer traditional over orthodox medicine and identified cultural beliefs, attitudes, and gaps in health awareness that contribute to delays in diagnosing and treating PCa. The study involved administering questionnaires, providing education on PCa, and conducting free prostate-specific antigen (PSA) screening. Ethical approval was obtained from the Ethics Research Committee of the Ghana Health Service. A total of 282 patients participated, including 268 men from the communities and 14 diagnosed with PCa at CCTH after initially consulting traditional healers. Of the community-recruited patients who underwent PSA testing, 26% had elevated PSA levels and underwent further diagnostic procedures. Ultimately, nine of 268 community patients were confirmed to have PCa. Most patients (57.4%) had limited education, which correlated with late presentations and various misconceptions about PCa. The study highlights significant cultural and economic barriers that lead to the late-stage presentation of PCa among men in Ghana\u27s Central region. There is a critical need for a culturally sensitive, multi-pronged strategy that enhances public education about the benefits of early diagnosis and fosters collaboration between traditional healers and orthodox healthcare providers to improve prostate cancer outcomes in Ghana
Development and Implementation of Oral Anticancer Agent Tools for a Thematic Quality Improvement Program: A Collaboration Between Hematology Oncology Pharmacist Association and ASCO Quality Training Program
No full textPURPOSE: The Hematology Oncology Pharmacist Association Oral Chemotherapy Collaborative (HOPA OCC) developed practice-based tools to use in program development and improvement for the management of patients receiving oral anticancer agents (OAAs).
METHODS: These tools include a baseline OAA program assessment, clinical OAA adherence tool, and OAA dashboard. HOPA OCC distributed these tools to teams participating in the 6-month HOPA ASCO Quality Training Programs (QTPs). Barriers in the delivery of OAA services across practice sites were determined through the use of baseline assessments, and the following domains were evaluated: (1) side-effect monitoring, (2) adherence monitoring, (3) use of patient-reported outcomes, (4) social determinants of health, and (5) collaborative practice agreements for oncology pharmacists. The OAA adherence tool offers clinical patient adherence questions and guidance for supporting adherence in practice. Finally, the dashboard includes multiple metrics that may be helpful for practices to measure their program outcomes. HOPA OCC used the Consolidated Framework for Implementation Research to assess tool usefulness by the QTP participants.
RESULTS: Barriers to implementation include deficits in information technology, resources, and competing priorities.
CONCLUSION: Standardized OAA tools can inform and support quality improvement initiatives and improve the care of patients receiving OAAs
A descriptive examination of rurality in the Environmental influences on Child Health Outcomes Cohort: Implications, illustrations, and future directions
No full textPURPOSE: The Environmental influences on Child Health Outcomes (ECHO) Cohort has enrolled over 60,000 children to examine how early environmental factors (broadly defined) are associated with key child health outcomes. The ECHO Cohort may be well-positioned to contribute to our understanding of rural environments and contexts, which has implications for rural health disparities research. The present study examined the outcome of child obesity to not only illustrate the suitability of ECHO Cohort data for these purposes but also determine how various definitions of rural and urban populations impact the presentation of findings and their interpretation.
METHODS: This analysis uses data from children in the ECHO Cohort study who had residential address information between January 2010 and October 2023, including a subset who also had height and weight data. Several rural-urban classification schemes were examined with and without collapsing into binary rural/urban groupings (ie, the Rural-Urban Continuum Codes, 2010 Rural-Urban Commuting Area [RUCA] Codes, and Urban Influence Codes).
FINDINGS: Various rural/urban definitions and classification schemes produce similar obesity prevalence (17%) when collapsed into binary categories (rural vs urban) and for urban participants in general. When all categories within a classification scheme are examined, however, the rural child obesity prevalence ranges from 5.8% to 24%.
CONCLUSIONS: Collapsing rural-urban classification schemes into binary groupings erases nuance and context needed for interpreting findings, ultimately impacting health disparities research. Future work should leverage both individual- and community-level datasets to provide context, and all categories of classification schemes should be used when examining rural populations
The relationship between the early-life gastrointestinal microbiome and childhood nocturnal cough
No full textBACKGROUND: Nocturnal cough affects approximately 1 in 3 children, can negatively affect child health, and is often attributable to asthma. The association of the gut microbiome with nocturnal cough has not been investigated.
OBJECTIVE: We investigated the association between early-life gut microbiome composition and nocturnal cough overall and in the context of asthma.
METHODS: Gut microbiota 1-month (neonate) and 6-month (infant) specimens from 512 children in the Wayne County, Health, Environment, Allergy, and Asthma Longitudinal Study were profiled using 16S ribosomal RNA V4 sequencing. Nocturnal cough (parental report) and asthma (parent-reported doctor\u27s diagnosis) were assessed at age 4 years. Microbiome regression-based kernel association tests (MiRKAT) were used to assess the relationship between gut microbiota composition and nocturnal cough overall and in the context of asthma. Operational taxonomic unit (OTU) associations were conducted using negative binomial regression, adjusting for multiple comparisons using the false discovery rate.
RESULTS: Stool microbial composition differences during infancy were associated with nocturnal cough (weighted UniFrac P = .045); 78 OTUs were significantly associated with nocturnal cough overall (false discovery rate \u3c 0.05); and 110 OTUs were significantly associated with nocturnal cough and differed by asthma status (interaction false discovery rate \u3c 0.05), with a predominance of Lachnospiraceae genera Blautia and Dorea. Thirty-two OTU were identified as having both overall effects and differences by asthma status. Among OTUs with significant nocturnal cough-by-asthma interactions, 84 retained significance in children with asthma, with 45 exclusive to those with asthma (predominance of Bacteroidaceae genus Bacteroides and Lachnospiraceae genus Dorea).
CONCLUSION: Infantile gut microbiome development is associated with nocturnal cough and differed by asthma status by age 4 years. Further studies are needed to determine if the gut microbiome may provide additional information for the early identification of children at risk for nocturnal cough, with and without asthma
Executive Summary of the American Radium Society Appropriate Use Criteria: Regional Nodal Irradiation for Breast Cancer
No full textOBJECTIVES: Recent literature has provided additional data to further individualize treatment recommendations on regional nodal irradiation (RNI) patient selection and delivery techniques, but controversies surrounding optimal RNI utilization remain, including radiation technique, modality selection, and internal mammary lymph node (IMN) inclusion. The American Radium Society (ARS) Breast Appropriate Use Criteria (AUC) Committee performed a systematic review and developed a consensus guideline to summarize recent data and provide evidence-based recommendations.
METHODS: A multidisciplinary panel comprised of 15 members representing radiation oncologists, medical oncologists, and surgical oncologists specializing in the treatment of breast cancer conducted an analysis of the medical literature from January 1, 2011 to April 1, 2024. Modified Delphi methodology was used to rate the appropriateness of treatments for variants across 3 key questions.
RESULTS: Patients with intermediate-risk breast cancer, such as limited nodal involvement or large primary tumor size, are reasonable candidates for RNI, although a subset of patients with overall favorable clinicopathologic features may be considered for treatment de-escalation. Data on the use of advanced radiation techniques for RNI were limited in scope and strength, and the panel agreed that careful patient selection is needed when using these tools. Evidence suggests that the IMN should be included when delivering RNI given the absolute benefit demonstrated in multiple randomized trials.
CONCLUSION: A systematic review and evidence-based summary of recommendations are provided in these consensus guidelines from the ARS Breast AUC Committee to provide current comprehensive guidance on the optimal management of non-metastatic breast cancer patients being considered for RNI
Trauma typologies and internalizing psychopathology: A hierarchical perspective on the unique role of congruent and incongruent criterion a stressors
No full textOBJECTIVE: Trauma exposure poses a risk for diagnoses beyond trauma and stressor-related disorders listed in current psychological taxonomies. Alternative models, such as the Hierarchical Taxonomy of Psychopathology, posit that psychological phenomena are better organized in a hierarchical manner, with broader dimensions accounting for the covariation among lower order syndromes. Thus, the present study investigated the relationships between trauma exposure and internalizing syndromes through higher order psychological dimensions.
METHOD: Undergraduates (N = 585) at a large midwestern university completed questionnaires, which included the Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), the Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), the Inventory for Depression and Anxiety Symptoms (2nd ed.), and the Childhood Trauma Questionnaire. Three structural equation models with stressors congruent and incongruent with Criterion A listed as predictors were used to examine the total, indirect, and direct effects for all internalizing indicators and first-order factors.
RESULTS: After accounting for higher order dimensions, only insomnia and panic maintained a unique portion of variance explained by trauma variety. Trauma variety and interpersonal index traumas explained unique proportions of posttraumatic stress symptoms, but not distress or fear.
CONCLUSIONS: Findings support the utility of assessing stressors through shared mechanisms within a hierarchical framework and substantiate trauma-induced insomnia theories through a novel relationship between trauma variety and insomnia. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Interhospital variability in 180-day infections following cardiac surgery
No full textOBJECTIVE: To evaluate hospital-level variation in infections following cardiac surgery and develop and evaluate a 180-day infection quality metric.
METHODS: This study evaluated Medicare claims that were merged with institutional Society of Thoracic Surgeons Adult Cardiac Surgery Database files among patients undergoing cardiac surgery across 33 Michigan centers. The primary outcome was infection occurring within 180 days of surgery. Adjusted institutional infection rates were estimated using logistic regression with robust variance estimation. Terciles of observed/expected ratios were created to assess interhospital variability in infections and associated morbidity and mortality.
RESULTS: A total of 5466 operations were evaluated. The average patient age was 71.1 ± 7.8 years, 29.5% of the patients were female, and 4.8% were black. The infection rate was 21.2% overall and higher among females. Infection was associated with lower left ventricular ejection fraction, diabetes, severe chronic lung disease, cerebrovascular disease, and urgent operations (P \u3c .0001 for all). The most common infection was pneumonia (8.5%). Adjusted infection rates varied 39.5% across hospitals (range, 7.2%-46.7%). Patients treated in hospitals in the highest tercile of observed/expected infection ratio had a higher rate of associated discharge to extended care/rehabilitation (27.9% vs 24.7%, P \u3c .0001) but comparable stroke and mortality risk compared to patients treated in hospitals in the lowest tercile.
CONCLUSIONS: One in 5 Medicare beneficiaries develop a 180-day infection following cardiac surgery, with rates varying 39.5% across hospitals. Patients at higher versus lower O:E tercile hospitals were more commonly discharged to extended care/rehabilitation settings, although rates of stroke and mortality were equivalent in the 2 groups. Collaborative learning interventions may be warranted to advance the observed variability in 180-day infections
Racial Disparities in Future Development of Lethal Prostate Cancer Based on Midlife Baseline Prostate-Specific Antigen
No full textBACKGROUND: Previous studies found that Midlife Baseline PSA (MB PSA) predicts the risk of developing lethal prostate cancer (PCa), although the cohorts were homogenous in terms of racial compositions. We aimed to investigate racial disparities in the predictive value of MB PSA for lethal PCa in a diverse, contemporary, North American population.
METHODS: Our cohort included White and Black men aged 40-59 years, who underwent MB PSA through our health system. Cumulative incidence curves depicted lethal PCa stratified by race and MB PSA above/below the median. We utilized time-dependent Receiver Operating Characteristic (ROC) curves and Area Under the ROC Curve (AUC) to compare the performance of MB PSA in predicting lethal PCa based on race. Multivariable regression (MVA) was used to examine the impact of the MB PSA in predicting lethal PCa by race.
RESULTS: We included 112,967 men, of whom 27% were Black. The cumulative incidence estimate with MB PSA values equal to the median at 15 years of follow-up was 0.13 (0.04, 0.32) for White men and 0.55 (0.24, 1.11) for Black men. AUCs comparison showed no statistically significant differences in the predictive role of MB PSA for lethal PCa between White and Black men. At MVA, using White patients with PSA ≤ median as the reference group, the HR of lethal PCa for White men with PSA \u3e median aged 40-44, 45-49, 50-54, and 55-59 was respectively 2.98 (1.59-5.57), 3.01 (1.89-4.81), 5.10 (3.38-7.70), and 3.38 (2.32-4.92). While for Black men was respectively 5.50 (2.94-10.27), 4.19 (2.59-6.78), 9.79 (6.37-15.04), and 7.53 (5.03-11.26) (all p \u3c 0.001).
CONCLUSION: Our findings indicate that for the same MB PSA and within the same age category, Black men have a greater risk of developing lethal PCa than White men. A separate cut-off should be created for MB PSA, if this is to be used to guide PSA screening in clinical practice