Elizabeth E. Bailey

Melanoma incidence and mortality in Europe: New estimates, persistent disparities

Background  Melanoma incidence and mortality in Europe are high but there are significant gaps in the epidemiological information available across the continent.

The use of diet in the treatment of epilepsy

Fasting and other dietary regimens have been used to treat epilepsy since biblical times. The ketogenic diet, which mimics the metabolism of fasting, was used by modern physicians to treat intractable epilepsy beginning in the 1920s. With the rising popularity of drug treatments however, the ketogenic diet lost its previous status and was used in only a handful of clinics for most of the 20th century. The diet regained widespread recognition as a viable treatment option beginning in 1992 due to the efforts of parent advocate groups. Despite challenges to implementation of the treatment, the ketogenic diet has significant potential as a powerful tool for fighting epilepsy.

Combination Treatments for Psoriasis: A Systematic Review and Meta-analysis

OBJECTIVE To summarize the current state of evidence for combination topical and systemic therapies for mild to severe psoriasis. DATA SOURCES We performed a systematic search for all entries in PubMed, CINAHL, Cochrane Review, and EMBASE related to combination treatments for psoriasis through July 2010. STUDY SELECTION We included randomized controlled trials that reported proportion of disease clearance or mean change in clinical severity score (or provided these data through communication with study authors) for efficacy of a combination treatment for psoriasis compared with 1 or more corresponding monotherapies. DATA EXTRACTION Study data were extracted by 3 independent investigators, with disagreement resolved by consensus. The proportion of patients who achieved clearance, definition of clearance, means and standard deviations for baseline disease symptom score and final disease symptom score, and major design characteristics were extracted for each study. DATA SYNTHESIS Combination treatments consisting of vitamin D derivative and corticosteroid, vitamin D derivative and UV-B, vitamin A derivative and psoralen-UV-A, vitamin A derivative and corticosteroid, vitamin A derivative and UV-B, corticosteroid and hydrocolloid occlusion dressings, UV-B and alefacept, and vitamins A and D derivatives were more effective than 1 or more monotherapies using the likelihood of clearance as the outcome. Blinding status and potency of the corticosteroid treatment used were significant sources of heterogeneity between studies. CONCLUSIONS The results demonstrate the need for additional long-term trials with standardized outcome measures to evaluate the efficacy and adverse effects of combination therapies for psoriasis and highlight the possible effects of trial design characteristics on results.

Cellulitis: diagnosis and management

Cellulitis is an acute infection of the dermal and subcutaneous layers of the skin, often occurring after a local skin trauma. It is a common diagnosis in both inpatient and outpatient dermatology, as well as in the primary care setting. Cellulitis classically presents with erythema, swelling, warmth, and tenderness over the affected area. There are many other dermatologic diseases, which can present with similar findings, highlighting the need to consider a broad differential diagnosis. Some of the most common mimics of cellulitis include venous stasis dermatitis, contact dermatitis, deep vein thrombosis, and panniculitis. History, local characteristics of the affected area, systemic signs, laboratory tests, and, in some cases, skin biopsy can be helpful in confirming the correct diagnosis. Most patients can be treated as an outpatient with oral antibiotics, with dicloxacillin or cephalexin being the oral therapy of choice when methicillin‐resistant Staphylococcus aureus is not a concern.

Amyopathic Dermatomyositis: Definitions, Diagnosis, and Management

Amyopathic dermatomyositis can be a challenging diagnosis because patients lack traditional muscle findings. “Clinically amyopathic” dermatomyositis (CADM) accounts for the presence of subclinical muscle disease in some of these patients. These patients represent a substantial minority of dermatomyositis cases and have similar co-morbidities to “classic” dermatomyositis patients, including interstitial lung disease and malignancy. Clinically amyopathic dermatomyositis patients should not be considered as a distinct clinical entity from “classic” dermatomyositis, as they share antibody sub-types and associated co-morbidities, likely representing clinical spectrum of a common disease. It is essential for the clinician to be familiar with the clinical presentation of clinically amyopathic dermatomyositis, in order to facilitate early, accurate diagnosis and appropriate clinical management.

Anti-laminin-332 mucous membrane pemphigoid associated with recurrent metastatic prostate carcinoma: hypothesis for a paraneoplastic phenomenon

Anti-epiligrin cicatricial pemphigoid is an autoimmune blistering disorder that has recently been associated with the development of solid organ malignancy. We describe a patient with recurrent metastatic prostate carcinoma who was diagnosed with this disorder. We provide a hypothesis as to the relationship between the development of this disease and its possible association with cancer pathogenesis.

Affordable medical technologies: bringing Value-Based Design into global health

The implementation of the Affordable Care Act (ACA) has spurred a renewed focus on the concept of value , or health outcome per cost expended.1 Though interventions have generally centred around insurance reform and healthcare delivery, medical technology comprises a significant component of US healthcare costs and is an underemphasised sector in the push for reform. The drivers of medical technology costs, accounting for as much as 65% of the increase in overall healthcare spending, include developing new or improved medical procedures, pharmaceutical products and devices or diagnostics.2 Currently, medical technology development and sales are concentrated in high income countries (HICs). In 2009, approximately 75% of the sales of medical devices were in the USA, Japan and Europe.3 Currently, only 13% of manufacturers are located in low and middle income countries (LMICs). Despite this asymmetric market, there is both growing interest and market potential in investing in health technologies in LMICs, as evidenced by a recent WHO report analysing medical devices in LMICs.4 Nine of the top 10 medical device companies state in their annual report that they hope to expand their activities in emerging markets.5 In Africa alone, there has been a 7.5% annual increase in the importation of medical devices.6 With a new emphasis on value in the US healthcare sector, and an increased interest globally in the development of medical technologies, investing in low cost health technologies could be of mutual benefit to both high and low income countries.4 In addition to filling a great need in LMICs, ideas can flow from LMICs to more developed countries in a process called Reverse Innovation. 7 Traditional medical technology innovation arises in academic medical centres, pharmaceutical companies or biotechnology companies in HICs. In the traditional model, products were stripped down or donated …

Skin Cancer Education among Massage Therapists: A Survey at the 2010 Meeting of the American Massage Therapy Association

Massage therapists encounter skin on a daily basis and have a unique opportunity to recognize potential skin cancers. The purpose of this study was to describe the skin cancer education provided to massage therapists and to assess their comfort regarding identification and communication of suspicious lesions. An observational retrospective survey study was conducted at the 2010 American Massage Therapy Association Meeting. Sixty percent reported receiving skin cancer education during and 25% reported receiving skin cancer education after training. Massage therapists who examine their own skin are more likely to be comfortable with recognizing a suspicious lesion and are more likely to examine their client’s skin. Greater number of clients treated per year and greater frequency of client skin examinations were predictors of increased comfort level with recognizing a suspicious lesion. Massage therapists are more comfortable discussing than identifying a potential skin cancer. Massage therapists may be able to serve an important role in the early detection of skin cancer.

Health hackathons: theatre or substance? A survey assessment of outcomes from healthcare-focused hackathons in three countries

Background Healthcare-focused hackathons are 48-hour platforms intended to accelerate novel medical technology. However, debate exists about how much they contribute to medical technology innovation. The Consortium for Affordable Medical Technologies (CAMTech) has developed a three-pronged model to maximise their effectiveness. To gauge the success of this model, we examined follow-up outcomes. Methods Outcomes of 12 hackathons from 2012 to 2015 in India, Uganda and the USA were measured using emailed surveys. To minimise response bias, non-responding teams were coded as having made no progress. Results 331 individuals provided information on 196 of 356 projects (55.1% response rate), with no difference in responses from teams participating in different countries (Cramers V=0.09, p=0.17). 30.3% of projects had made progress after a mean of 12.2 months. 88 (24.7%) teams had initiated pilot testing, with 42 (11.8%) piloting with care providers and 24 (6.7%) with patients. Overall, 97 teams (8.1 per hackathon) drafted business plans, 22 (1.8 per hackathon) had filed patents on their innovations and 15 (1.3 per hackathon) had formed new companies. Teams raised US

Health Hackathons Drive Affordable Medical Technology Innovation Through Community Engagement

64.08 million in funding (average US