Summary
Background. Fungal infection of the nail affects millions of people worldwide, and has an estimated prevalence of about 10% of the general population. Laboratory confirmation of fungal ...infection is currently accepted as a requirement before initiation of antifungal treatment in clinical practice.
Aim. To examine the rationale for systemic treatment in cases of clinical onychomycosis with negative results on fungal examination (potassium hydroxide test and fungal culture).
Methods. In total, 147 patients with suspected clinical toenail onychomycosis but with negative results on fungal examination underwent up to three consecutive fungal examinations of the affected nails. Patients who were negative after these examinations underwent a fourth set of investigations, including PCR.
Results. Of the 147 cases initially thought to be negative, 138 (94%) were rated as positive after up to four consecutive sets of laboratory mycological investigations including PCR. Trichophyton rubrum was by far the commonest dermatophyte cultured from all samples.
Conclusions. In the majority of cases of initially negative examinations, consecutive laboratory fungal tests will eventually produce positive results. These findings suggest that systemic antifungal treatment should be started in patients with suspected fungal infections, even if they have negative laboratory fungal examinations.
Increasing number of service users diagnosed with schizophrenia and psychosis are being discharged from specialist secondary care services to primary care, many of whom are prescribed long-term ...antipsychotics. It is unclear if General Practitioners (GPs) have the confidence and experience to appropriately review and adjust doses of antipsychotic medication without secondary care support.
To explore barriers and facilitators of conducting antipsychotic medication reviews in primary care for individuals with no specialist mental health input.
Realist review in general practice settings.
A realist review has been conducted to synthesise evidence on antipsychotic medication reviews conducted in primary care with service users diagnosed with schizophrenia or psychosis. Following initial scoping searches and discussions with stakeholders, a systematic search and iterative secondary searches were conducted. Articles were systematically screened and analysed to develop a realist programme theory explaining the contexts (C) and mechanisms (M) which facilitate or prevent antipsychotic medication reviews (O) in primary care settings, and the potential outcomes of medication reviews.
Meaningful Antipsychotic medication reviews may not occur for individuals with only primary care medical input. Several, often mutually reinforcing, mechanisms have been identified as potential barriers to conducting such reviews, including low expectations of recovery for people with severe mental illness, a perceived lack of capability to understand and participate in medication reviews, linked with a lack of information shared in appointments between GPs and Service Users, perceived risk and uncertainty regarding antipsychotic medication and illness trajectory.
The review identified reciprocal and reinforcing stereotypes affecting both GPs and service users. Possible mechanisms to counteract these barriers are discussed, including realistic expectations of medication, and the need for increased information sharing and trust between GPs and service users.
Background Tinea pedis is a common skin disease affecting most of the population during their lifetime. Topical and systemic treatments give only temporary relief.
Objective To evaluate the ...efficacy and safety of a new topical treatment for moderate‐to‐severe tinea pedis.
Methods Fifty patients suffering from tinea pedis were treated in two stages: the active stage – single use of the novel topical solution for 45 min and novel cream twice weekly for 4 weeks; the preventive stage – cream application once weekly for 10 months.
Results Forty‐five patients completed the active stage and achieved 76% cure rate. The medication was well tolerated; one patient dropped from the study because of very mild irritation. No other topical or systemic side effects were noted. Another five patients were lost to follow‐up during the preventive stage. The total cure rate after the preventive stage was 70%.
Conclusions This novel treatment was found to be effective, well tolerated and safe in the treatment of moderate and severe tinea pedis during the active and the preventive stages.
Summary
Atopic dermatitis (AD) is a common chronic skin disease, which mainly affects children. Xerosis is one of the most troublesome signs of the disease. The aim of this study was to evaluate the ...efficacy of liquid soap containing 12% ammonium lactate + 20% urea in patients with AD. In a randomized, double‐blind study, 36 patients (both male and female patients; age range 3–40 years) with mild to moderate AD were enrolled. Patients were divided randomly into two groups, in a ratio of 2 : 1 (active : placebo). The prescribed soap was used on a daily basis during a shower for 3 weeks. All patients continued all other systemic or topical medication but avoided any other soap or emollients. After 3 weeks of treatment, efficacy was assessed both by clinician and patient. There were significant improvements in scaling (P < 0.0001), skin dryness (P < 0.0001) and redness (P = 0.03) as rated by the investigator, and subjective patient assessment of itch also improved (P < 0.001) in the study group compared with the control group. The liquid soap was found to be effective in patients with AD, as use of this soap in patients with stable mild to moderate AD improved the parameters studied.
The sensitivity of MRI volumetric measures to detect cognitive dysfunction is examined in 39 participants of an epidemiological field study (age 75–85, MMSE 19–30). According to Clinical dementia ...rating (CDR), 17 subjects had normal cognition (CDR 0), 12 had questionable (CDR 0.5) and 10 mild dementia (CDR 1). Discriminant analysis based on four hippocampal measures resulted in a correct classification of 76.9% of all subjects. Left-sided and posterior hippocampal measures were more responsible for group discrimination than right-sided and anterior measures. In CDR 0.5, a significant hippocampal volume reduction of 14.3% vs.11.3% (left vs. right) relative to normal was found. The right hippocampus was significantly greater than the left in CDR 0 and CDR 0.5, but not in CDR 1. The magnitude of non-directional hippocampal asymmetry increased with decreasing cognitive state. We conclude that hippocampal atrophy is sensitive to detect cognitive dysfunction and subjects at risk for Alzheimer’s disease in the elderly population.
Onycomycosis due to artificial nails Shemer, A; Trau, H; Davidovici, B ...
Journal of the European Academy of Dermatology and Venereology,
08/2008, Letnik:
22, Številka:
8
Journal Article
Recenzirano
Background The use of artificial nails (ANs) as part of nail‐care cosmetics is very popular. Several side effects and complications, such as contact dermatitis and bacterial and fungal infections, ...have been reported in patients using ANs.
Objective The purpose of this study was to identify the fungal pathogens in nail abnormalities appearing in patients with ANs.
Methods We evaluated 68 patients suffering from nail changes and paronychia, which appear after removal of ANs. Mycological samples were obtained from two sites: distal parts of the involved nail and the proximal nail fold. KOH examination and fungal culture were used for detection and identification of fungal infection.
Results Mycological results from the distal part of the nail showed positive KOH test in 57 cases (83.8%), and culture was positive in 67 patients (98.5%). Mycological results obtained from the proximal nail fold showed positive KOH test in 36 patients (52.9%); in 36 of the cases, culture was positive. Candida spp. were the most common pathogen. Both KOH and culture results were significantly better while sampling from the distal part of the nail compared with sampling from the proximal nail fold (P = 0.0001).
Conclusion Onychomycosis was found to be very common in nail changes due to ANs, leading to an increased risk of transmitting microbial infections. Therefore, health care personnel and workers in the food industry should avoid using ANs.
Due to considerable interindividual variability in terms of haptic threshold, the use of valid, practicable test and training systems is particularly relevant before and during manual therapy ...training and further training. The active sensory discrimination skills of participants need to be continuously assessed and, where necessary, appropriately trained.
The implementation of reliable haptic test and training systems in curricula contributes to assuring the quality of training standards and ultimately to optimizing patient care.
Based on literature review a special preparatory course to the haptic sensory discrimination skills is introduced.
Crossings of the competence areas are fluent partly and the main focus lies for the haptic sensory discrimination skills on the method competence.
The number of the training sessions compares to the individual learning progress. Per single training a temporal extent of from 60 to 90minutes should be kept because of the decrease of the attention and concentration achievements and by consideration of work everyday conditions. Under certain circumstances, they can also be used in the self-study context. Learning evaluation must be constructively for positive results. Instead of teaching commenting of the performance, success must be aware.
This test and training systems offer the option of measuring and training the haptic sensory discrimination skills of healthy individuals under objective and reproducible conditions. As part of this, the systems are oriented as far as possible to explorative occupational situations, while at the same time guaranteeing the scientific merit of a reproducible test situation. However, the consolidation of skills and knowledge requires adequate timetabling by lecturers, a clear definition of tasks, and reflection on performance, whereby simulation in the skills laboratory should be integrated in the curriculum.
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