250 research outputs found
Oral spironolactone for acne vulgaris in adult females: an update of the literature
No full textDear Editor,In 2016, the article Oral Spironolactone for Acne Vulgaris inAdult Females: A Hybrid Systematic Review, was publishedin your journal [1]. This article considered all available dataon spironolactone for acne in adult females, and concludedthat the quality of research was not of a high enough standard to guide prescribing recommendations. Spironolactonetherefore continues to be prescribed of license in the treatment of acne, based on case reports and expert opinionrather than robust evidence.An updated search of the literature, using the same searchstrategy as the original review, was performed on 5 February, 2020 to identify any new published data in the feld.Electronic searches were conducted on EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials,Cochrane Skin, Science Citation Index and LILACS databases. Trial databases searched included the meta Registerof Controlled Trials, US National Institutes of Health ongoing trials register, ANZCTR, World Health Organizationand the European Union’s clinical trials register. Finally, aGoogle hand search was performed using the search termsacne and spironolacton
Stemming the tide of antimicrobial resistance: implications for management of acne vulgaris
No full textCompetencies and clinical guidelines for managing acne with isotretinoin in general practice: a scoping review
No full textBackground: acne is a common, chronic, and burdensome disease. There is evidence of delayed and inequitable patient access to isotretinoin. Overuse of antibiotics in patients with acne raises antimicrobial stewardship concerns. Aim: to identify clinical practice guideline (CPG) and consensus statement recommendations regarding the clinical competencies required for prescribing oral isotretinoin for acne.Design and setting: this was a scoping review of acne CPGs and consensus statements, globally. Method: the Arksey and O’Malley framework informed design in conjunction with Joanna Briggs Institute guidance. The PRISMA extension for Scoping Reviews guided reporting. The search was conducted across six databases (Embase, Scopus, Web of Science, PubMed, CINAHL, PsycINFO), three guideline repositories (Scottish Intercollegiate Guidelines Network, Guidelines International Network, Trip), and grey literature. Two researchers independently screened titles and abstracts, and full-text papers. The AGREE II checklist appraised CPG quality. Results: from the initial 2292 articles, eight CPGs were included after applying inclusion and exclusion criteria. Five were from Europe, with one each from the US, Canada, and Malaysia. The CPG guidance varied regarding 'Which doctor may prescribe isotretinoin?' All CPGs indicated dermatologists and four identified GPs as appropriate prescribers. The CPGs identify the clinical competencies to safely manage people with acne using isotretinoin: dermatology, pregnancy prevention, mental health assessment, and blood testing. Conclusion: this scoping review has identified the key clinical competencies that underpin safe management of people with acne using isotretinoin: dermatology, pregnancy prevention, mental health assessment, and blood testing. Resourcing and supporting GPs to incrementally adopt this role may promote safe, timely, and equitable patient access to isotretinoin, while enhancing antimicrobial stewardship
U.S.S. Macon The Last U.S. Navy Rigid Airship
No full textRecorded for a talk presented at the Naval Postgraduate School's Dudley Knox Library, December 14, 2010.Included are slides for a talk by Prof. Layton. Note that each slide contains a "play" button that initiates a recorded narrative by the author. In addition is a set of U.S.S. Macon images to accompany the presentation
Patient reported outcome measures for Acne: a mixed methods validation study (Acne PROMS)
No full textFactors that influence women’s enrolment and ongoing participation in a partially decentralised randomised controlled dermatology trial: a qualitative interview study with participants in the SAFA (Spironolactone for Adult Female Acne) trial
No full textBackground: The use of decentralised clinical trials (which bring trials to patients through remote processes and technology versus central on-site visits) has been thought to be a potential solution to common recruitment and retention barriers. However, there is a lack of evidence to understand the experiences, needs and preferences of the public to inform trial methodologies that appeal to different populations. We report participant experiences of SAFA, a partially decentralised randomised clinical trial, to inform the methodology used in future dermatology trials that aim to appeal to women aged 18 and over. Methods: Participants of the SAFA (Spironolactone for Adult Female Acne) trial were invited to take part in a qualitative semi-structured interview to explore their experience and perspectives of taking part in the trial. Questions focused on their experience of using decentralised methods to access and enrol in the trial (e.g. social media advertising), in addition to the decentralised trial visit and data collection methods used throughout. Interviews were conducted remotely, recorded, and transcribed. Data were analysed using reflexive thematic analysis. Results: Twelve SAFA participants (all women, age range 22–36 years) were interviewed. Initially, participants were influenced to enrol by trusted online information, the feeling of validation the trial provided, and the convenience and flexibility offered by the decentralised methods and research staff made participants feel valued and enabled them to engage in the trial with minimal interference to existing commitments. SAFA participants were generally accepting of trial demands, such as the text-heavy paperwork and on-site visits for blood collection and highlighted several areas relevant for trial conduct going forwards including where decentralised methods may (and may not) be accepted and how trial accessibility and understanding could be improved. Conclusions: The study has shown that decentralised methods used by responsive and approachable staff were widely accepted in the SAFA trial. Interviewees found the methods adopted in the SAFA trial helped the trial to fit with their needs and promoted a sense of feeling valued that encouraged ongoing trial engagement. Decentralised methods should be considered favourably when designing a dermatology trial as they can potentially enhance both recruitment and retention. Trial registration number: ISRCTN 12892056. Registered on October 15, 2018.</p
Identifying acne treatment uncertainties via a James Lind Alliance Priority Setting Partnership
No full textObjectives: The Acne Priority Setting Partnership
(PSP) was set up to identify and rank treatment
uncertainties by bringing together people with acne,
and professionals providing care within and beyond the
National Health Service (NHS).
Setting: The UK with international participation.
Participants: Teenagers and adults with acne,
parents, partners, nurses, clinicians, pharmacists,
private practitioners.
Methods: Treatment uncertainties were collected via
separate online harvesting surveys, embedded within the
PSP website, for patients and professionals. A wide
variety of approaches were used to promote the surveys
to stakeholder groups with a particular emphasis on
teenagers and young adults. Survey submissions were
collated using keywords and verified as uncertainties by
appraising existing evidence. The 30 most popular
themes were ranked via weighted scores from an online
vote. At a priority setting workshop, patients and
professionals discussed the 18 highest-scoring questions
from the vote, and reached consensus on the top 10.
Results: In the harvesting survey, 2310 people,
including 652 professionals and 1456 patients (58%
aged 24 y or younger), made submissions containing at
least one research question. After checking for relevance
and rephrasing, a total of 6255 questions were collated
into themes. Valid votes ranking the 30 most common
themes were obtained from 2807 participants. The top 10
uncertainties prioritised at the workshop were largely
focused on management strategies, optimum use of
common prescription medications and the role of nondrug
based interventions. More female than male patients
took part in the harvesting surveys and vote. A wider
range of uncertainties were provided by patients
compared to professionals.
Conclusions: Engaging teenagers and young adults in
priority setting is achievable using a variety of
promotional methods. The top 10 uncertainties reveal an
extensive knowledge gap about widely used interventions
and the relative merits of drug versus non-drug based
treatments in acne management
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