Irma Richardson

Determinants of Parental Discipline Practices: A National Sample From Primary Care Practices

National guidelines urge pediatricians to address discipline as part of anticipatory guidance, yet pediatricians know little about what leads parents to use different discipline approaches. Parents seen in Pediatric Research in Office Settings practices participated in an office-based survey before the well-child visit for children 2 to 11 years old (N = 2134). Parents reported using the following discipline approaches frequently: time-outs (42%), removal of privileges (41%), sent to bedroom (27%), yelling (13%), and spanking (9%). A third of parents believe their discipline approach to be ineffective. This directs the pediatric provider to help families develop effective discipline practices tailored to their context.

Recruitment and retention of Latino children in a lifestyle intervention.

OBJECTIVE To describe promising recruitment and retention strategies for transient Latino populations, assisting investigators who work with this population in their research design and implementation. METHODS Strategies in recruitment and retention from a year-long intervention in children and their families are described. RESULTS Of the 159 families who agreed to participate in the program, 123 parent-child dyads were enrolled. Retention rates were 59% in the control group, 67% in the intervention group. CONCLUSION Building and maintaining relationships between a consistent study team contact and participants promote strong recruitment and retention outcomes. Barriers such as child care and transportation must be minimized.

Long-term adherence to topical psoriasis treatment can be abysmal: a 1-year randomized intervention study using objective electronic adherence monitoring

Most people with psoriasis have limited disease that could be treated with topicals, but topical efficacy is limited by low short‐term adherence. Psoriasis is a chronic disease, and long‐term adherence is an even bigger problem.

Rosacea patients seeking advice: Qualitative analysis of patients’ posts on a rosacea support forum

Abstract Background: Social media have become outlets for patients to voice opinions and ask questions. Since suffering from rosacea is an isolating experience and the disease is poorly understood, patients use social media to expand their knowledge about the condition. Objective: To understand rosacea patients’ online health information seeking habits to obtain a better insight of their educational needs. Methods: Ten percent of posts in online rosacea forum composed of 3350 members and 27 051 posts, discussing patient viewpoints and concern, selected by stratified random sampling. Three hundred and nine queries were directly categorized to patients “seeking advice” by two investigators and qualitatively analyzed. Results: Patients primarily sought advice about treatments (n = 155, 50.1%), triggers (n = 53, 17.1%), diet (n = 48, 15.5%), skin care (n = 37, 11.9%) and special presentations of the disease (n = 22, 7.1%). Questions frequently pertained to adverse effects, efficacy and target of therapy (78, 49, 30 posts, respectively). Conclusion: Proactively providing reliable resources and comprehensive explanations on treatments, triggers, diet and skin care could be helpful in reducing patients’ confusion about rosacea and enhancing rosacea patient–physician relationships.

Treatment Changes in Patients With Moderate to Severe Psoriasis: A Retrospective Chart Review

Background: Psoriasis treatment involves topical medications, oral medications, phototherapy, and/or biologics. The treatments used depend on a myriad of factors that change over time. Objective: To characterise the frequency of and reasons for treatment changes in patients with moderate to severe psoriasis. Methods: A chart review examined treatment changes at 902 visits by 116 patients seen between January 1, 2010, and June 30, 2015, for moderate to severe psoriasis and the physicians’ justifications for those changes. ‘Treatment change’ was defined as switching between, adding, or removing medication classes or switching within the oral or biologic class. Results: There were 221 visits with treatment changes identified, and a change occurred every 4.1 visits. On average, there were 1.2 treatment changes per year. Patients treated for at least 1 year averaged 1 treatment change every 16 months. The most common type of change was from one biologic to another biologic (24.9%), followed by adding a nonbiologic to a biologic (18.6%). The most common reason for switching was poor control or flare of psoriasis. Affordability was a more common problem for biologics than for nonbiologic treatments. Conclusions: Biologic treatment options provide a major improvement over older systemic treatments, but patients still undergo frequent treatment changes to help control their disease.

Pilot study of the feasibility of a double-blind, randomized, placebo-controlled localized area ultraviolet phototherapy trial methodology

Localized ultraviolet (UV) phototherapy is an effective treatment for many inflammatory dermatoses.1 Localized UV treatment modalities include excimer lasers, excimer nonlaser devices, and nonexcimer devices.2 In order to delineate the efficacy of the different options, wellcontrolled clinical trials are critical. However, trials comparing the efficacy of phototherapy devices are often not blinded, leading to participation and expectancy biases. The purpose of this study is to test a methodology suitable for robust doubleblind, randomized, placebocontrolled, localized area UV phototherapy intervention trials.

Patients’ preferences for different corticosteroid vehicles are highly variable

Abstract Introduction: Topical corticosteroids, available in an array of vehicles are used to control a variety of inflammatory skin diseases. Patients preferences for different vehicles may affect their willingness to use treatment. We assess corticosteroid vehicle preference and potential impact of topical characteristics on adherence and quality of life in patients with psoriasis. Methods: Subjects with psoriasis were recruited from Wake Forest University Dermatology Clinic. Subjects sampled desoximetasone 0.25% spray, betamethasone valerate 0.1% cream, triamcinolone acetonide 0.1% ointment, fluocinonide 0.05% gel, betamethasone valerate 0.1% lotion, clobetasol propionate 0.05% foam, and fluocinonide 0.05% solution in a predetermined randomized order. Subjects completed a Vehicle Preference Measure, Determinants of Adherence Measure, and a Determinants of Quality of Life Measure. Results: Patients preferences for the various products were highly variable. Regarding Determinants of Adherence, patients perception of absorption of the medication was ranked as ‘quite important/extremely important’ by 85% of total subjects. A majority of patients rated medication side effects as ‘quite important/extremely important’ when asked to consider topical characteristics effect on quality of life. Discussion: There was wide variation in patient preference for topical medication vehicles used for treating psoriasis. Several vehicle characteristics were considered important to adherence. Given the marked variation in vehicle preference, topical treatment should be individualized according to patients preferences.

A Pilot Study Characterizing Factors in Adherence to Cutaneous Lupus Treatment

Cutaneous lupus erythematosus (CLE) is an autoimmune skin disease that manifests as scarring, dyspigmentation, erythema, and pain. Topical corticosteroids are a mainstay of treatment. Irritation, messiness, and tediousness may deter use. Thus, nonadherence, rather than nonresponse, can result in treatment failure. Prior adherence studies were limited to systemic lupus erythematosus. We performed a single-center, open-label pilot study to assess adherence to topical medication in patients with CLE. CLE adherence to topical medications is suboptimal and declines over time. Shorter treatment duration and greater patient perception of disease severity may contribute to higher adherence. Improving adherence to existing treatments could be as or more valuable than new therapies for the disease.

Patient Costs Associated with Rosacea

The recalcitrance of rosacea to many treatment options may prompt patients to spend exorbitant amounts of money on unsubstantiated treatment regimens in an effort to achieve relief. The authors examine the relationship between disease severity and treatment cost across several demographic and socioeconomic strata. Familiarization of evidence-based clinical recommendations and consensus guidelines may equip physicians to educate patients about the most efficacious and cost-effective treatment options to assist patients in making cost-conscious decisions in the management of their rosacea.

Validity and Reliability of a Rosacea Self-Assessment Tool

The lack of validated rosacea assessment tools is a hurdle in assessing rosacea severity. This article discusses a valid and reliable rosacea severity self-assessment tool (RSAT) to measure rosacea severity. To determine test-retest validity, participants completed the self-assessment twice. A blinded physician graded the participants disease severity with the Investigator Global Severity (IGS) score. Pearson correlations were used to assess the relationship between the self-assessment measure and the IGS. Test-retest RSAT measurements were correlated. The RSAT represents a valid and reliable tool. This tool may facilitate determination of rosacea severity in survey research studies.