bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Web-Based Intervention for Relatives of People Experiencing Psychosis or Bipolar Disorder: Design Study Using a User-Centered Approach
Authors: Honary Mahsa , Fisher Naomi Ruth , McNaney Roisin , Lobban Fiona 
Published: October 2018

BackgroundRelatives of people experiencing bipolar mood episodes or psychosis face a multitude of challenges (eg, social isolation, limited coping strategies, and issues with maintaining relationships). Despite this, there is limited informational and emotional support for people who find themselves in supporting or caring roles. Digital technologies provide us with an opportunity to offer accessible tools, which can be used flexibly to provide evidence-based information and support, allowing relatives to build their understanding of mental health problems and learn from others who have similar experiences. However, to design tools that are useful to relatives, we first need to understand their needs.ObjectiveThe aim of this study was to use a user-centered design approach to develop an accessible Web-based intervention, based on the Relatives Education And Coping Toolkit (REACT) booklet, to support the informational and emotional needs of relatives of people experiencing psychosis or bipolar disorder.MethodsWe engaged relatives of people with experiences of bipolar disorder or psychosis in workshops to identify their needs and design requirements for developing a Web-based version of a paper-based toolkit. We used a 2-phase qualitative approach to explore relatives’ views on content, design, and functionalities, which are considered to be engaging and useful in a Web-based intervention. In phase 1, we consulted 24 relatives in 2 workshops to better understand their existing support infrastructure, their barriers for accessing support, unmet needs, and relatives’ views on online support. On the basis of the results of these workshops, we developed a set of design considerations to be explored in a smaller workshop. Workshop 3 then involved working with 2 digitally literate relatives to design a usable and acceptable interface for our Web-based toolkit. Finally, in phase 2, we conducted a heuristic evaluation to assess the usability of the toolkit.ResultsOur findings indicated that relatives require technologies that (1) they can place their trust in, particularly when discussing a highly sensitive topic, (2) enable learning from the lived experiences of others while retaining confidentiality, and (3) they can work through at their own pace in a personalized manner.ConclusionsOur study highlights the need for providing a trustworthy, supportive tool where relatives can engage with people who have similar experiences to their own. Our heuristic evaluation showed promise in terms of perceived usability of the REACT Web-based intervention. Through this work, we emphasize the need to involve stakeholders with various characteristics, including users with limited computer literacy or experience in online support.
Fall Risk Classification in Community-Dwelling Older Adults Using a Smart Wrist-Worn Device and the Resident Assessment Instrument-Home Care: Prospective Observational Study (Preprint)
Authors: Yang Yang , Hirdes John P , Dubin Joel A , Lee Joon 
Published: October 2018

BACKGROUND

Little is known about whether off-the-shelf wearable sensor data can contribute to fall risk classification or complement clinical assessment tools such as the Resident Assessment Instrument-Home Care (RAI-HC).

OBJECTIVE

This study aimed to (1) investigate the similarities and differences in physical activity (PA), heart rate, and night sleep in a sample of community-dwelling older adults with varying fall histories using a smart wrist-worn device and (2) create and evaluate fall risk classification models based on (i) wearable data, (ii) the RAI-HC, and (iii) the combination of wearable and RAI-HC data.

METHODS

A prospective, observational study was conducted among 3 faller groups (G0, G1, G2+) based on the number of previous falls (0, 1, ≥2 falls) in a sample of older community-dwelling adults. Each participant was requested to wear a smart wristband for 7 consecutive days while carrying out day-to-day activities in their normal lives. The wearable and RAI-HC assessment data were analyzed and utilized to create fall risk classification models, with 3 supervised machine learning algorithms: logistic regression, decision tree, and random forest (RF).

RESULTS

Of 40 participants aged 65 to 93 years, 16 (40%) had no previous falls, whereas 8 (20%) and 16 (40%) had experienced 1 and multiple (≥2) falls, respectively. Level of PA as measured by average daily steps was significantly different between groups (P=.04). In the 3 faller group classification, RF achieved the best accuracy of 83.8% using both wearable and RAI-HC data, which is 13.5% higher than that of using the RAI-HC data only and 18.9% higher than that of using wearable data exclusively. In discriminating between {G0+G1} and G2+, RF achieved the best area under the receiver operating characteristic curve of 0.894 (overall accuracy of 89.2%) based on wearable and RAI-HC data. Discrimination between G0 and {G1+G2+} did not result in better classification performance than that between {G0+G1} and G2+.

CONCLUSIONS

Both wearable data and the RAI-HC assessment can contribute to fall risk classification. All the classification models revealed that RAI-HC outperforms wearable data, and the best performance was achieved with the combination of 2 datasets. Future studies in fall risk assessment should consider using wearable technologies to supplement resident assessment instruments.
Type I Hypersensitivity in an Asthmatic Child Allergic to Peanuts: Was Soy Lecithin to Blame?
Authors: Béliveau Solange , Gaudreault Pierre , Goulet Lise , Primeau Marie-Noëlle , Marcoux Danielle 
Published: October 2018

Background: Soy lecithin is widely used as an emulsifier, not only in topical skin care products but also in various drugs administered either topically, orally, or intravenously or by inhalation. Patients strongly allergic to soy and/or peanuts can develop an anaphylactic reaction when exposed to soy lecithin. Method: We report a 3-year-old asthmatic boy, allergic to peanuts, who was treated at the emergency department for an exacerbation of asthma following an upper respiratory tract infection. Within an hour after receiving the second of two inhalations of an ipratropium bromide (Atrovent) metered dose inhaler, he developed respiratory distress and generalized urticaria, an adverse event that regressed within 48 hours of withdrawal of the suspected drug. Soy lecithin, contained as an excipient in the metered dose inhaler, was strongly suspected of being responsible for this reaction. Conclusion: Drug products containing soy lecithin can cause severe allergic reactions in patients allergic to peanuts or soy. Physicians should be aware that adverse drug reactions can be due to both the active medical component and the excipient ingredients.
Becker Nevus on the Lower Limb: Case Report and Review of the Literature
Authors: Alhusayen Raed , Kanigsberg Nordau , Jackson Robert 
Published: October 2018

Background: Becker nevus is a hamartoma with brown hyperpigmentation and hypertrichosis that usually affects young males. It has a predilection for the upper half of the trunk and proximal upper extremity. Objective: This is a case report of a 38-year-old male with a Becker nevus without hypertrichosis on the lower limb and a review of the literature. Results: Including our case report, 12 cases of Becker nevus on the lower limb were identified in the English literature (8 males and 4 females). It has never been reported below the knee. In males, the lesion was not associated with other anomalies, and all but two showed hypertrichosis (six of eight). In 50% (two of four) of women, it was associated with localized lipoatrophy. In one woman, it presented without hypertrichosis. Conclusion: The presence of Becker nevi on the lower limb is unusual, and hypertrichosis is not always a feature. Larger studies are required to look into the true prevalence of this presentation and its prognostic value as a marker for other anomalies.
Skin-Related Quality of Life among Migrant Farmworkers
Authors: Quandt Sara A. , Schulz Mark R. , Vallejos Quirina M. , Feldman Steven R. , Preisser John S. , Arcury Thomas A. 
Published: October 2018

Background: Farmworkers in North America work in an environment likely to produce skin injuries and illnesses that affect quality of life (QOL). Objective: We identified the dimensions of skin-related QOL that were most impaired and examined predictors in a cohort of North Carolina farmworkers. Methods: We conducted a longitudinal survey of 304 Latino farmworkers across a work season (1,048 interviews). We assessed skin-related QOL using the Dermatology Life Quality Index. Results: Effects on QOL were reported in 38.7% of observations. The greatest impacts of skin impairments were seen in the Symptoms and Feelings and Work and School Subscales. In multivariate analysis, specific work tasks and high temperatures were associated with greater decrements in QOL. Conclusions: Skin disease among farmworkers is sufficiently severe to affect QOL. Future research should test the effectiveness of interventions on modifiable factors such as facilities for personal hygiene and field sanitation on skin-related QOL.
Violaceous Papules on the Palms and Soles
Authors: Cheung-Lee Melody J. , Rao Jaggi 
Published: October 2018

Background: Lichen planus (LP) is a condition with many clinical variants that can be quite varied in their presentation. Objective: We report a case of a 60-year-old woman who presented with a very unusual palmoplantar eruption characterized by violaceous pustule-like papules that was subsequently diagnosed as LP. Methods: The above case is reported, along with biopsy results. The patient was subsequently treated with a combination of topical corticosteroids and oral acitretin, and her clinical course was followed. Results: The eruption responded dramatically to our combination treatment and resolved by the 2-month follow-up. Conclusion: Palmoplantar LP is a rare variant of LP that bears little resemblance to its classic LP. This condition responds well to a combination of potent topical corticosteroids and oral acitretin.
Use of Anakinra (Kineret) in the Treatment of Familial Cold Autoinflammatory Syndrome with a 16-Month Follow-Up
Authors: Ross J. Barrie , Finlayson Laura A. , Klotz P. Jennifer , Langley Richard G. , Gaudet Roxanne , Thompson Kara , Churchman Sarah M. , McDermott Michael F. , Hawkins Philip N. 
Published: October 2018

Background: The susceptibility gene for familial cold autoinflammatory syndrome (FCAS) has been mapped to chromosome 1q44 and a point mutation determined to be present in all affected members of a large Canadian kindred. Anakinra (Kineret) is known to block IL-1 receptor and in the few patients with FCAS in whom it has been used, it has been shown to provide relief for this lifelong disability. Objective: To demonstrate the efficacy and safety of anakinra (Kineret) in FCAS. Methods: Eight affected family members aged 29 to 77 years received anakinra 100 mg subcutaneously daily for 4 weeks preceded and followed by a 2-week control period. Results: The treatment was rapidly effective paralleled by the immediate fall of the C-reactive protein and serum amyloid A protein. The only significant side effect was an injection-site reaction in 50%, which declined in the follow-up period. The effect was sustained in all who continued to use the treatment at 4 and 16 months of follow-up. Conclusion: This is the first treatment of FCAS that is completely effective while it is used.
Propranolol in the Treatment of Problematic Infantile Hemangioma: Review of 35 Consecutive Patients from a Vascular Anomalies Clinic
Authors: Bertrand Janie , Sammour Rita , Mccuaig Catherine , Dubois Josée , Hatami Afshin , Ondrejchak Sandra , Boutin Christine , Bortoluzzi Patricia , Laberge Louise C. , Powell Julie 
Published: October 2018

Background: Propranolol, a nonselective β-blocker, has been reported as efficient for controlling the growth of complicated infantile hemangiomas (IHs). No uniformly accepted protocol exists regarding the administration of oral propranolol for IH. Objective: We sought to share our experience using propranolol for problematic IH and to evaluate the efficacy of this treatment modality. Methods: A retrospective chart review analysis was performed for 35 consecutive children treated with propranolol as an oral solution on an outpatient basis in our dermatology/vascular anomalies clinic. A protocol was established with the help of our pediatric cardiologists, including pretreatment electrocardiography and echocardiography. Medical photographs taken after 2 months of treatment were rated by two independent evaluators. Results: We treated 31 girls and 4 boys with a median age of 3.5 months. Rapid improvement was reported in the first days of treatment in 34 patients. Mean improvement after 2 months was 61.5%. No serious adverse effects were reported. Conclusion: Propranolol was effective in controlling the proliferative phase of problematic IH. It was well tolerated in our study. Outpatient treatment is possible if parents follow strict guidelines. Propranolol should be a first-line treatment for problematic IH in carefully selected patients.
Is Necrolytic Migratory Erythema Due to Glucagonoma a Misnomer? A More Apt Name Might Be Mucosal and Intertriginous Erosive Dermatitis
Authors: Grewal Parbeer , Salopek Thomas G. 
Published: October 2018

Background: In dermatology, many conditions are given names that ultimately prove to be a misnomer (eg, mycosis fungoides, pyogenic granuloma). For most misnomers, continued use of the inappropriate word(s) rarely results in a delay in diagnosis and/or treatment. An argument can be made that the term necrolytic migratory erythema (NME) due to glucagonoma results in a delay in diagnosis, often with fatal consequences. Objective: We reviewed the literature of the past 30 years concerning the dermatologic and histologic findings of NME in association with glucagonoma. The most striking feature evident in nearly all reported cases is the presence of mucosal lesions and annular, eroded, eczematous patches and plaques of intertriginous areas. Conclusion: We propose the renaming of the eruption associated with glucagonoma to one that emphasizes its unique localization to the mucosa and intertriginous areas: mucosal and intertriginous erosive dermatitis. It is hoped that this will lead to a more timely recognition of the condition and a possible improvement in prognosis.
Physician Survey Regarding Patient Nonattendance at Follow-up Appointments at a University-Affiliated Medical Dermatology Clinic
Authors: Nasseri Eiman , Bertrand Janie , Brassard Danielle , Fortier-Riberdy Geneviève , Marcil Isabelle 
Published: October 2018

Background: Patient nonattendance is a frequent occurrence in dermatology clinics, and our responsibility regarding the follow-up of these patients remains nebulous. Objective: This study sought to evaluate the beliefs and practices of physicians at a university-affiliated medical dermatology clinic regarding patient nonattendance at follow-up appointments and to provide an algorithm to deal appropriately with absentee patients based on various Canadian medical association guidelines. Methods: A questionnaire was distributed to the 17 dermatologists practicing at the Centre Hospitalier de l'Université de Montréal medical dermatology clinic. We contacted provincial and national medical associations regarding directives for patient follow-up. Results: There is a lack of consensus among dermatologists at the Centre Hospitalier de l'Université de Montréal regarding responsibility toward patients who miss their follow-up appointments. However, the majority of survey respondents consider that patient follow-up must be adjusted on a case-by-case basis and that diagnoses at risk for high morbidity and mortality require particular attention, which is in line with various Canadian medical association guidelines. Conclusion: Dermatologists should have a structured approach to dealing with patients who miss their follow-up appointments to ensure the appropriate care of all patients.
Use of Pioglitazone in Patients with Lichen Planopilaris
Authors: Baibergenova Akerke , Walsh Scott 
Published: October 2018

Background: Recent basic science research has revealed a decreased tissue expression of peroxisome proliferator-activated receptor (PPAR) γ in lichen planopilaris (LPP). Therefore, thiazolidinediones, being PPARγ agonists, could be used to treat LPP. Methods: We followed 24 patients with LPP who were treated with oral pioglitazone hydrochloride. Improvement in LPP was defined as a decrease in or disappearance of symptoms and perifollicular erythema in the context of halted spread of old patches. Results: Twenty of 24 patients were females. The average age was 52.5 years, and ages ranged from 22 to 70 years. Five of 24 patients have achieved remission; improvement was noted in half of the patients; there was no change in 3 patients; and 4 patients discontinued treatment due to side effects. Side effects were mild and included left calf pain, lightheadedness and nausea, dizziness, and hives. Conclusion: Use of thiazolidinediones might be a new promising venue of LPP treatment.
Local Infiltrative Anesthetic Effect of Tramadol Compared to Lidocaine for Excision of Cutaneous Lesions: Pilot Randomized, Double-Blind Clinical Study
Authors: Kakagia Despoina , Vogiatzaki Theodosia , Eleftheriadis Savvas , Trypsiannis Gregory , Iatrou Christos 
Published: October 2018

Background: In this double-blind, randomized study, the efficacy of tramadol, an atypical opioid, was tested versus lidocaine in excision of cutaneous lesions of the face. Methods: Eighty-eight patients were randomly assigned to receive either 2 mg/kg tramadol 2% plus adrenaline 1:200,000 (group T, n = 46) or 3 mg/kg lidocaine 2% plus adrenaline 1:200,000 (group L, n = 42) for excision of cutaneous lesions. Pain at the injection site, 2 and 20 minutes postinjection and 3, 6, and 12 hours postoperatively, was monitored on a 0 to 10 numerical rating scale (NRS). Irritation at the injection point and the duration of postoperative analgesia were also recorded. Results: There were no significant differences in demographic data, topography, size of the lesions removed, and operative time between the two groups. A tendency toward lower injection NRS pain scores was observed in group L compared to group T (p = .064). No statistically significant differences between the two groups were found at 2 and 20 minutes postinjection (p = .741 and p = .142, respectively); however, pain scores were significantly higher in group L at 3, 6, and 12 hours postoperatively (all p < .001). Erythema at the injection site was observed in nine group T and two group L patients (p = .076). No postoperative analgesics were required in the tramadol group of patients, whereas acetaminophen with or without codeine was administered in all but five lidocaine group patients during the first 12 hours. Conclusion: Tramadol may be used as a reliable local anesthetic agent, providing longer postoperative analgesia compared to lidocaine; however, it bears a higher incidence of irritation at the injection site.
Outcomes of Wound Closure with the Reading Man Flap Technique
Authors: Wagner Justinus A. , Simon Jan C. , Wetzig Tino , Kendler Michael 
Published: October 2018

Background: In dermatologic surgery, numerous flap types have been described for wound closure after skin cancer surgery. The reading man flap was first published in 2008 for the closure of skin defects of the face, trunk, and extremities. Technically, this flap is based on an asymmetrical Z-plasty. Objective: To investigate the feasibility, clinical outcomes, and postoperative complications for wound closure with the reading man flap technique. Methods: We treated seven patients (facial and extremity defects) after microscopically controlled surgery using the reading man flap technique. The median defect size was 491.71 mm2. All of the patients were treated under tumescent local anesthesia. Results: A tension-free defect closure was created in all patients. One minor complication, a wound infection on one leg, was observed. Conclusion: The described technique is an easy and safe dermatologic surgery procedure that can be performed under local anesthesia.
Eruptive Squamous Cell Carcinomas after Vemurafenib Therapy
Authors: Mays Rana , Curry Jonathan , Kim Kevin , Tsai Kenneth , Arora Anita , Khan Farhan , Ramirez-Fort Marigdalia , Ciurea Ana 
Published: October 2018

Background: Vemurafenib is an oral BRAF inhibitor recently approved for the treatment of metastatic melanoma. Patients treated with this medication have been reported to have the occurrence of squamous cell carcinoma (SCC) and/or actinic keratosis (AK). Objective: We report the case of a patient treated with vemurafenib for papillary thyroid carcinoma who subsequently developed multiple SCCs and AK of the skin. The lesions were deemed related to the medication and treated with excision. In addition, subsequent development of SCCs and AK was successfully prevented with a combination of isotretinoin and 5-fluorouracil in this patient. We discuss postulated mechanisms for these findings, as well as potential preventive therapy with the aforementioned combination regimen in patients undergoing treatment with vemurafenib.
Acute Generalized Exanthematous Pustulosis Induced by Hydroxychloroquine: First Case Report in Canada and Review of the Literature
Authors: Bailey Kristy , Mckee Daniel , Wismer Judy , Shear Neil 
Published: October 2018

Background: Acute generalized exanthematous pustulosis (AGEP) is a rare drug eruption presenting with an acute, extensive formation of nonfollicular sterile pustules on an erythematous and edematous base. Typically, the rash is accompanied by fever and leukocytosis, with spontaneous resolution in < 15 days. The incidence of AGEP is estimated at one to five cases per million people per year. Only 18% of these are from nonantibiotics. Hydroxychloroquine (HCQ) is an antimalarial agent that is also used to treat various dermatologic and rheumatologic conditions. Objective: We report the first observation in Canada of a patient with AGEP induced by HCQ. Methods and Results: AGEP was diagnosed in a 48-year-old female who had been taking HCQ for 2 weeks and then developed a diffuse erythematous and edematous pustular eruption. Clinical and pathologic findings were consistent with a diagnosis of AGEP. The patient was treated with steroids and supportive measures. The rash resolved after 18 days and a complicated course in hospital. Conclusion: AGEP is a rare drug eruption, usually to antibiotics. We report the first case in Canada of AGEP as an adverse reaction to HCQ. Clinicians should keep in mind the possibility of this severe skin eruption.