Les interventions de sante mentale gerees par des conseillers non professionnels: revue systematique et meta-analyse Intervenciones de salud mental realizadas por consejeros no profesionales: una ...revision sistematica y un metanalisis Metodos Se realizaron busquedas en las bases de datos PubMedR, el Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials), PROSPERO y EBSCO y en las publicaciones de la seccion profesional del National Center para TEPT de los Estados Unidos para obtener ensayos controlados aleatorios de intervenciones de salud mental realizadas por consejeros legos con formacion profesional en paises con ingresos bajos y medios, publicados entre 2000 y 2019. Se excluyeron los estudios de intervenciones realizadas por trabajadores profesionales de la salud mental, profesionales medicos o trabajadores de la salud de la comunidad porque hay escasez de este personal en los paises de estudio. Se obtuvieron datos adicionales de los autores de los estudios. Los resultados primarios fueron medidas de trastorno de estres postraumatico, depresion, ansiedad y consumo de alcohol. Para estimar el tamano del efecto, se utilizo un modelo de metanalisis de efectos aleatorios.
Guidelines of care for the management of actinic keratosis Eisen, Daniel B.; Asgari, Maryam M.; Bennett, Daniel D. ...
Journal of the American Academy of Dermatology,
October 2021, 2021-10-00, Letnik:
85, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Actinic keratoses (AK) are rough scaly patches that arise on chronically ultraviolet-exposed skin and can progress to keratinocyte carcinoma.
This analysis examined the literature related to the ...management of AK to provide evidence-based recommendations for treatment. Grading, histologic classification, natural history, risk of progression, and dermatologic surveillance of AKs are also discussed.
A multidisciplinary Work Group conducted a systematic review to address 5 clinical questions on the management of AKs and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of the evidence and formulating and grading clinical recommendations. Graded recommendations were voted on to achieve consensus.
Analysis of the evidence resulted in 18 recommendations.
This analysis is based on the best available evidence at the time it was conducted. The pragmatic decision to limit the literature review to English language randomized trials may have excluded data published in other languages or limited identification of relevant long-term follow-up data.
Strong recommendations are made for using ultraviolet protection, topical imiquimod, topical 5-fluorouracil, and cryosurgery. Conditional recommendations are made for the use of photodynamic therapy and diclofenac for the treatment of AK, both individually and as part of combination therapy regimens.
The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American ...College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp (Santa Monica, CA)/University of California–Los Angeles (RAND/UCLA). At the conclusion of the rating process, consensus was reached for all 270 (100%) scenarios by the Ratings Panel, with 200 (74.07%) deemed as appropriate, 24 (8.89%) as uncertain, and 46 (17.04%) as inappropriate. For the 69 basal cell carcinoma scenarios, 53 were deemed appropriate, 6 uncertain, and 10 inappropriate. For the 143 squamous cell carcinoma scenarios, 102 were deemed appropriate, 7 uncertain, and 34 inappropriate. For the 12 lentigo maligna and melanoma in situ scenarios, 10 were deemed appropriate, 2 uncertain, and 0 inappropriate. For the 46 rare cutaneous malignancies scenarios, 35 were deemed appropriate, 9 uncertain, and 2 inappropriate. These appropriate use criteria have the potential to impact health care delivery, reimbursement policy, and physician decision making on patient selection for MMS, and aim to optimize the use of MMS for scenarios in which the expected clinical benefit is anticipated to be the greatest. In addition, recognition of those scenarios rated as uncertain facilitates an understanding of areas that would benefit from further research. Each clinical scenario identified in this document is crafted for the average patient and not the exception. Thus, the ultimate decision regarding the appropriateness of MMS should be determined by the expertise and clinical experience of the physician.
To characterize the clinical features, associated disorders, and treatment of necrobiotic xanthogranuloma (NXG), a rare non-Langerhans cell histiocytosis, we conducted a retrospective review of ...pathologically confirmed NXG at Mayo Clinic Arizona from 1987 to June 2017. Data on clinical findings, laboratory findings, associated disorders, therapy, and response to therapy were extracted. Nineteen patients were identified. Mean age was 54 years (range, 17–84) with equal gender distribution. Median follow-up was 5.5 years (range, 1–18). Most patients had a detectable monoclonal protein (84%), and IgG kappa constituted 58%. The most common cutaneous lesions involved the periorbital region (53%). The majority of patients had extracutaneous manifestations, most commonly affecting the liver (32%) and the sinuses (21%). Hematologic malignancies were diagnosed in 26% of patients and included Hodgkin lymphoma, chronic lymphocytic leukemia (CLL), smoldering myeloma, and multiple myeloma. The most common treatment was chlorambucil with or without systemic corticosteroids. Response was seen in most patients (95%), and most patients received 1–3 lines of therapy (74%). NXG is a reactive histiocytic disorder that commonly involves multiple organ systems and requires a high degree of clinical suspicion for accurate diagnosis. Treatment decisions should be based on coexisting conditions and pattern of disease involvement.
The appropriate use criteria process synthesizes evidence‐based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American ...College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate use criteria for 270 scenarios for which Mohs micrographic surgery (MMS) is frequently considered based on tumor and patient characteristics. This document reflects the rating of appropriateness of MMS for each of these clinical scenarios by a ratings panel in a process based on the appropriateness method developed by the RAND Corp (Santa Monica, CA)/University of California–Los Angeles (RAND/UCLA). At the conclusion of the rating process, consensus was reached for all 270 (100%) scenarios by the Ratings Panel, with 200 (74.07%) deemed as appropriate, 24 (8.89%) as uncertain, and 46 (17.04%) as inappropriate. For the 69 basal cell carcinoma scenarios, 53 were deemed appropriate, 6 uncertain, and 10 inappropriate. For the 143 squamous cell carcinoma scenarios, 102 were deemed appropriate, 7 uncertain, and 34 inappropriate. For the 12 lentigo maligna and melanoma in situ scenarios, 10 were deemed appropriate, 2 uncertain, and 0 inappropriate. For the 46 rare cutaneous malignancies scenarios, 35 were deemed appropriate, 9 uncertain, and 2 inappropriate. These appropriate use criteria have the potential to impact health care delivery, reimbursement policy, and physician decision making on patient selection for MMS, and aim to optimize the use of MMS for scenarios in which the expected clinical benefit is anticipated to be the greatest. In addition, recognition of those scenarios rated as uncertain facilitates an understanding of areas that would benefit from further research. Each clinical scenario identified in this document is crafted for the average patient and not the exception. Thus, the ultimate decision regarding the appropriateness of MMS should be determined by the expertise and clinical experience of the physician.
Actinic keratoses (AK) are rough scaly patches that arise on chronically ultraviolet-exposed skin and can progress to keratinocyte carcinoma. Treatment options for AK include topical medications, ...photodynamic therapy, cryosurgery, and laser ablation.
This executive summary provides a synopsis of the 18 evidence-based recommendations for the treatment of AK detailed in the Guidelines of Care for the Management of Actinic Keratosis.
A multidisciplinary workgroup conducted a systematic review to address 5 clinical questions on the management of AKs and applied the Grading of Recommendations Assessment, Development and Evaluation approach for assessing the certainty of the evidence and formulating and grading clinical recommendations. Graded recommendations were voted on to achieve consensus.
Analysis of the evidence resulted in 18 recommendations, suggesting there are several effective treatments available for AK.
The analysis informing the recommendations was based on the best available evidence at the time it was conducted. The results of future studies may necessitate a revision of current recommendations.
Strong recommendations are presented for using ultraviolet protection, topical imiquimod, topical 5-fluorouracil, and cryosurgery. Conditional recommendations are presented for the use of photodynamic therapy and diclofenac for the treatment of AK, both individually and as part of combination therapy regimens.
•A retrospective case series studied Thought Field Therapy in a setting of political instability and armed conflicts.•The results of preliminary experience with Thought Field Therapy in the Garmian ...community was encouraging.•Thought Field Therapy had positive results in reducing anxiety disorders and trauma related symptoms, as compared to Cognitive Behavioral Therapy.
Background: Mass violence, atrocities, and political upheavals have affected the prosperity and psychological health of the people of Iraq. Those living in the Garmian region of the Kurdistan Region of Iraq are among those most affected. While there is an urgent need for mental health interventions in this region, mental health resources are scarce, and only a small percentage of the population in need receive mental health care. Despite the high burden of mental illness, and the general demand by the community and local authorities for social and psychological services, effective validated cost-effective interventions tailored to address the cultural and social problems are scarce. This retrospective case series study, which is based on the lead author's experiences in the Garmian region, aims to describe the results of using two mental health interventions, cognitive behavioral therapy and thought field therapy.
Methods and findings: The files of 31 clients that met criteria of the study were selected using purposive sampling. The results showed that, of the 13 clients who received Cognitive Behavioral Therapy, one improved and others showed either no change in symptoms, deterioration of symptoms, or dropped out of treatment. All 11 clients who received only Thought Field Therapy, showed improvement in their symptoms. Seven clients who received Cognitive Behavioral Therapy and showed no improvement received Thought Field Therapy, and showed improvement finally. While the results of preliminary experience with Thought Field Therapy in the Garmian community is encouraging, conducting randomized controlled trials with follow-ups, and comparing Thought Field Therapy with other therapeutic approaches is needed to substantiate these findings.
Conclusion: We found that Thought Field Therapy had positive results in reducing anxiety disorders and trauma related symptoms, as compared to Cognitive Behavioral Therapy.
The clinical significance of Xp22.31 microduplication is controversial as it is reported in subjects with developmental delay (DD), their unaffected relatives and unrelated controls. We performed ...multifaceted studies in a family of a boy with hypotonia, dysmorphic features and DD who carried a 600 Kb Xp22.31 microduplication (7515787-8123310bp, hg19) containing two genes, VCX and PNPLA4. The duplication was transmitted from his cognitively normal maternal grandfather.
We found no evidence of the duplication causing the proband's DD and congenital anomalies based on unaltered expression of PNPLA4 in the proband and his mother in comparison to controls and preferential activation of the paternal chromosome X with Xp22.31 duplication in proband's mother. However, a de novo, previously reported deleterious, missense mutation in Pur-alpha gene (PURA) (5q31.2), with a role in neuronal differentiation was detected in the proband by exome sequencing.
We propose that the variability in the phenotype in carriers of Xp22.31 microduplication can be due to a second and more deleterious genetic mutation in more severely affected carriers. Widespread use of whole genome next generation sequencing in families with Xp22.31 CNV could help identify such cases.
Objectif Évaluer l'efficacité des interventions de santé mentale gérées au sein de la sphere communautaire par des conseillers non professionnels spécialement formés dans les pays a faibles et moyens ...revenus. Méthodes Nous avons mené nos recherches dans les bases de données de PubMed®, du Registre central Cochrane des essais contrôlés, de PROSPERO et d'EBSCO, ainsi que parmi les publications de la section professionnelle du Centre national américain du TSPT, afin d'en extraire des essais randomisés contrôlés portant sur des interventions de santé mentale gérées par des conseillers non professionnels spécialement formés dans les pays a faibles et moyens revenus, publiés entre 2000 et 2019. Les études consacrées aux interventions effectuées par des professionnels de la santé mentale, des membres du corps médical ou des agents de santé communautaires ont été écartées, car les pays observés manquent de personnel dans ce domaine. D'autres données ont été prélevées aupres des auteurs d'études. Les premiers résultats étaient des mesures relatives aux troubles de stress post-traumatique, a la dépression, a l'anxiété et a la consommation d'alcool. Nous avons employé un modele de méta-analyse a effets aléatoires pour évaluer les retombées. Résultats Nous avons identifié 1072 études; 19 d'entre elles (impliquant 20 essais et 5612 participants au total) correspondaient aux criteres d'inclusion. Le g de Hedges pour la taille de l'effet cumulé des interventions gérées par des conseillers non professionnels spécialement formés, comparé la plupart du temps avec l'absence d'intervention ou les soins habituels, s'élevait a -0,616 (intervalle de confiance de 95%: -0,866 a -0,366). Ce résultat témoigne d'un effet non négligeable, de taille moyenne. Il n'existait aucune preuve indiquant un biais de publication ou toute autre forme de biais dans les études, et les résultats ne laissaient transparaître aucune valeur extréme atypique. Conclusion Le recours a des conseillers non professionnels spécialement formés pour effectuer des interventions de santé mentale dans les pays a faibles et moyens revenus a entraíné une amélioration significative des symptômes dans de nombreuses situations.
Patch testing is a diagnostic tool for the evaluation of patients with suspected allergic contact dermatitis. A standard series of allergens similar to that used by the North American Contact ...Dermatitis Group (NACDG) is used at Mayo Clinic.
Our aim was to report the results of patch testing with a standard series at Mayo Clinic from July 1, 1998, to Dec 31, 2000 and to compare our findings with those of the NACDG during the same period.
The results of patch testing with the standard series at Mayo Clinic were examined. Positive reaction rates were compared between Mayo Clinic and the NACDG.
During the 30-month period, 1324 Mayo Clinic patients were patch tested with a standard series of allergens (mean, 60 allergens), whereas the NACDG standard series during this period included 50 allergens. Overall, 917 patients (69.3%) had at least one positive reaction and 606 patients (45.8%) had two or more positive reactions. The 10 allergens used both by Mayo Clinic and by the NACDG that most frequently caused positive reactions were nickel sulfate hexahydrate, balsam of Peru
(Myroxylon pereirae), neomycin sulfate, cobalt chloride, fragrance mix, potassium dichromate (0.25%), thimerosal, bacitracin, formaldehyde, and glutaraldehyde. Statistically significant differences in positive reaction rates (
P < .05) were observed for 12 of the 43 allergens common to both Mayo Clinic and the NACDG.
With large standard patch test series, one can identify commonly encountered and potentially relevant contact allergens.
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