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Hartono SP, Chatrath S, Aktas ON, Kubala SA, Capozza K, Myles IA, Silverberg JI, Schwartz A. Interventions for anxiety and depression in patients with atopic dermatitis: a systematic review and meta-analysis. Sci Rep 2024; 14:8844. [PMID: 38632375 PMCID: PMC11024101 DOI: 10.1038/s41598-024-59162-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease that is associated with anxiety and depression. Few studies have addressed interventions for symptoms of anxiety and depression in this population. To determine the efficacy of interventions for anxiety and depression in patients with AD. PubMed, MEDLINE, EMBASE, and PsycINFO were searched from inception to November 2023. English-language studies published in peer-reviewed journals evaluating the effect of interventions on anxiety and/or depression using validated assessment tools on patients with AD were included. Titles, abstracts, and articles were screened by at least two independent reviewers. Of 1410 references that resulted in the initial search, 17 studies were included. Fourteen of these studies are randomized controlled trials, while the other 3 studies are prospective controlled trials with pre and post-test designs. Data were extracted using a standardized extraction form, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. To accommodate trials with multiple interventions (each compared to a control group), we conducted a mixed-effects meta-analysis with the trial as a random effect. Prespecified outcomes were changes in symptoms of anxiety and depression in patients with AD as evaluated using standardized assessment tools. Of the 17 studies included in this systematic review, 7 pharmacological intervention studies with 4723 participants examining 5 different medications were included in a meta-analysis. Of these studies, only 1 study evaluated medications prescribed to treat anxiety and/or depression; the rest evaluated medications prescribed to treat AD. Meta-analysis of all the pharmacological interventions resulted in significant improvement in anxiety, depression, and combined anxiety-depression scale scores (standardized mean difference [95% CI]: - 0.29 [- 0.49 to - 0.09], - 0.27 [- 0.45 to - 0.08], - 0.27 [- 0.45 to - 0.08]) respectively. The 10 non-pharmacological studies with 2058 participants showed general improvement in anxiety but not depression. A meta-analysis of the non-pharmacological interventions was not conducted due to variable approaches and limited data. Pharmacological interventions designed to improve AD were found to improve anxiety and depression in patients with moderate-severe disease. More comprehensive studies on non-pharmacological and pharmacological interventions that primarily target anxiety and depression are needed.
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Affiliation(s)
- Stella P Hartono
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, 10 Center Drive, Bethesda, MD, 20852, USA.
| | | | - Ozge N Aktas
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, 10 Center Drive, Bethesda, MD, 20852, USA
| | - Stephanie A Kubala
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, 10 Center Drive, Bethesda, MD, 20852, USA
| | - Korey Capozza
- Global Parents for Eczema Research, Santa Barbara, CA, USA
| | - Ian A Myles
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Patel N, Feldman S. Adherence in Atopic Dermatitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1447:169-190. [PMID: 38724793 DOI: 10.1007/978-3-031-54513-9_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Atopic dermatitis is a chronic dermatologic condition requiring extended treatment times with topical application of medications. While atopic dermatitis treatments can be highly effective when used as directed, oftentimes patients do not respond as expected, raising concern for nonadherence versus nonresponse. This chapter aims to describe what is currently known about adherence in atopic dermatitis and to discuss strategies to improve adherence in order to improve treatment outcomes. Whether intentional or unintentional, nonadherence to treatment can limit patient outcomes of this disease for a variety of reasons. These include frustration with medication efficacy, inconvenience, and fear of side effects. Other factors include forgetfulness, financial burden of treatment, lack of trust in the physician, dislike of prescribed medication, or lack of understanding of disease or treatment. Several interventions have been studied with the aim of improving adherence in atopic dermatitis-such as educational workshops for patients and caregivers, earlier follow-up visits, and text messages reminders-however, these are often limited by sample size and power. Further research is needed to study both specific patterns of nonadherence in atopic dermatitis, as well as methods to improve them.
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Affiliation(s)
- Nupur Patel
- Department of Dermatology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Steven Feldman
- Department of Dermatology, Wake Forest University School of Medicine, Winston Salem, NC, USA
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Sy W, Bhayana M, Lamb AJ. Atopic Dermatitis Disease Education. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1447:209-215. [PMID: 38724795 DOI: 10.1007/978-3-031-54513-9_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
There has been an influx of new educational resources for atopic dermatitis (AD) patients in recent years. The two primary organizations in the United States offering educational materials, online resources, and other forms of support include the National Eczema Association (NEA) and the American Academy of Dermatology (AAD). Educational workshops and interventions have emerged as tools that can deliver comprehensive information on AD, such as symptoms, treatments, and disease management. In regard to these workshops, studies have proven longer interventions to be more effective. Studies have also found multidisciplinary teams, including psychologists, dietitians, and AD specialists, to be more effective in AD treatment and education. Additionally, video-based education was found to be the most effective delivery medium compared to various written modes of education. Given the psychosocial impacts of AD, support groups have been found to improve life quality and decrease disease severity, with age-specific groups offering the greatest benefits. Technology such as social media and smartphones has also improved education. Social media has allowed the rapid exchange of information to wider audiences, but due to its unregulated nature, false information has also been disseminated. Despite this, web-based interventions have still been found to be satisfying, convenient, and effective in increasing treatment awareness. The advent of smartphone applications has provided patients with access to information on AD symptoms and treatment on demand. While the effectiveness of these promising applications hasn't been confirmed by studies, patient provider interactions via smartphone (teledermatology) have been found to be as effective as in-person appointments. This chapter will discuss these different types of emerging resources available to AD patients including educational materials, interventions, support groups, organizational support, and technological resources and their effectiveness.
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Affiliation(s)
- Wayne Sy
- Department of Dermatology, The Mount Sinai Hospital, New York, NY, USA
| | - Mahima Bhayana
- Department of Dermatology, Howard University School of Medicine, Washington, DC, USA
| | - Angela J Lamb
- Department of Dermatology, The Mount Sinai Hospital, New York, NY, USA
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Mostafa N, Smith SD. Improving Psychological Health Outcomes in Children with Atopic Dermatitis. Clin Cosmet Investig Dermatol 2023; 16:2821-2827. [PMID: 37841063 PMCID: PMC10576503 DOI: 10.2147/ccid.s393254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
Introduction Atopic dermatitis (AD) is a chronic inflammatory skin disease that usually develops in early childhood. AD has a significant impact on quality of life and psychological health outcomes in both adults and children. There are increased reported rates of psychiatric comorbidities including anxiety, depression, ADHD and suicidal ideation compared to the general population. Primary caregivers of children with pediatric eczema and their families may also have derangements in psychological health and quality of life. A number of interventions exist for AD and address wellbeing outcomes as an important aspect of effective treatment. Methods A comprehensive literature search was conducted using PubMed/Medline, Embase, the Cochrane Central Register of Controlled Trials in February 2023. Published studies up to April 2023 were included related to interventions for childhood AD that included psychological health or quality of life outcomes. These interventions were stratified according to type and evidence quality. Results Search strategy revealed a wide variety of interventions with demonstrated improvements in quality of life or wellbeing of patients with pediatric AD or their families. Both pharmacological and non-pharmacological interventions demonstrated effectiveness in improving disease outcomes. Conclusion A variety of both pharmacological and non-pharmacological interventions may be employed to improve psychological health outcomes in children with AD.
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Affiliation(s)
- Niyaz Mostafa
- Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Saxon D Smith
- ANU Medical School, ANU College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
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Kishimoto S, Watanabe N, Yamamoto Y, Imai T, Aida R, Germer C, Tamagawa-Mineoka R, Shimizu R, Hickman S, Nakayama Y, Etoh T, Sahker E, Carnie MB, Furukawa TA. Efficacy of Integrated Online Mindfulness and Self-compassion Training for Adults With Atopic Dermatitis: A Randomized Clinical Trial. JAMA Dermatol 2023; 159:628-636. [PMID: 37163257 PMCID: PMC10173097 DOI: 10.1001/jamadermatol.2023.0975] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/10/2023] [Indexed: 05/11/2023]
Abstract
Importance Quality of life (QOL) of patients with atopic dermatitis (AD) is reported to be the lowest among skin diseases. To our knowledge, mindfulness and self-compassion training has not been evaluated for adults with AD. Objective To evaluate the efficacy of mindfulness and self-compassion training in improving the QOL for adults with AD. Design, Setting, and Participants This randomized clinical trial conducted from March 2019 through October 2022 included adults with AD whose Dermatology Life Quality Index (DLQI) score, a skin disease-specific QOL measure, was greater than 6 (corresponding to moderate or greater impairment). Participants were recruited from multiple outpatient institutes in Japan and through the study's social media outlets and website. Interventions Participants were randomized 1:1 to receive eight 90-minute weekly group sessions of online mindfulness and self-compassion training or to a waiting list. Both groups were allowed to receive any dermatologic treatment except dupilumab. Main Outcomes and Measures The primary outcome was the change in the DLQI score from baseline to week 13. Secondary outcomes included eczema severity, itch- and scratching-related visual analog scales, self-compassion and all of its subscales, mindfulness, psychological symptoms, and participants' adherence to dermatologist-advised treatments. Results The study randomized 107 adults to the intervention group (n = 56) or the waiting list (n = 51). The overall participant mean (SD) age was 36.3 (10.5) years, 85 (79.4%) were women, and the mean (SD) AD duration was 26.6 (11.7) years. Among participants from the intervention group, 55 (98.2%) attended 6 or more of the 8 sessions, and 105 of all participants (98.1%) completed the assessment at 13 weeks. The intervention group demonstrated greater improvement in the DLQI score at 13 weeks (between-group difference estimate, -6.34; 95% CI, -8.27 to -4.41; P < .001). The standardized effect size (Cohen d) at 13 weeks was -1.06 (95% CI, -1.39 to -0.74). All secondary outcomes showed greater improvements in the intervention group than in the waiting list group. Conclusions and Relevance In this randomized clinical trial of adults with AD, integrated online mindfulness and self-compassion training in addition to usual care resulted in greater improvement in skin disease-specific QOL and other patient-reported outcomes, including eczema severity. These findings suggest that mindfulness and self-compassion training is an effective treatment option for adults with AD. Trial Registration https://umin.ac.jp/ctr Identifier: UMIN000036277.
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Affiliation(s)
- Sanae Kishimoto
- Department of Health Promotion and Human Behavior, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Norio Watanabe
- Department of Psychiatry, Soseikai General Hospital, Kyoto, Japan
| | - Yosuke Yamamoto
- Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takumi Imai
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Rei Aida
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Christopher Germer
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, Massachusetts
| | | | | | - Steven Hickman
- Center for Mindfulness, University of California San Diego
- Global Compassion Coalition, San Rafael, California
| | - Yujiro Nakayama
- Faculty of Medical Sciences, Shonan University of Medical Sciences, Yokohama, Kanagawa, Japan
| | | | - Ethan Sahker
- Department of Health Promotion and Human Behavior, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Population Health & Policy Research Unit, Medical Education Center, Kyoto University, Kyoto, Japan
| | - Martha B. Carnie
- Center for Patients and Families, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Toshi A. Furukawa
- Department of Health Promotion and Human Behavior, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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de Wijs LEM, van Egmond S, Devillers ACA, Nijsten T, Hijnen D, Lugtenberg M. Needs and preferences of patients regarding atopic dermatitis care in the era of new therapeutic options: a qualitative study. Arch Dermatol Res 2023; 315:75-83. [PMID: 35112162 PMCID: PMC8809237 DOI: 10.1007/s00403-021-02321-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 01/07/2023]
Abstract
To optimally tailor atopic dermatitis (AD) care to patients' needs, especially considering the many emerging therapeutic options, insight into patients' needs and preferences regarding AD care is needed. To explore patients' needs and preferences regarding AD care, a qualitative study consisting of three focus groups with a total of 20 adult AD patients was conducted. All sessions were transcribed verbatim and inductively analyzed using several phases of coding to create an overview of patients' needs and preferences. AD patients emphasized the need for a patient-tailored approach in all identified aspects of AD care. With regard to consultations, patients stressed the need for a personal approach and increased recognition of the disease impact, which should mainly be determined by patients. With regard to the organization of AD care, the need for psychosocial and medical supportive care as well as quick access to health-care providers during disease flares was emphasized. Within the decision-making process, patients indicated that the provided information, the role of the patient and physician, whether or not treatment goals should be set, and decisive factors for indication and feasibility of novel therapies should be patient dependent. AD care should be patient tailored with increased attention for the psychosocial burden, as well as better access to health care during disease flares. To provide patient-tailored care, the personal situation, needs, and preferences of the patient should be taken into account in the therapeutic decision-making process, with respect for the autonomy of the patient.
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Affiliation(s)
- Linde E. M. de Wijs
- grid.5645.2000000040459992XDepartment of Dermatology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Sven van Egmond
- grid.5645.2000000040459992XDepartment of Dermatology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Arjan C. A. Devillers
- grid.416213.30000 0004 0460 0556Department of Dermatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Tamar Nijsten
- grid.5645.2000000040459992XDepartment of Dermatology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - DirkJan Hijnen
- grid.5645.2000000040459992XDepartment of Dermatology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Marjolein Lugtenberg
- grid.5645.2000000040459992XDepartment of Dermatology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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Kobusiewicz AK, Tarkowski B, Kaszuba A, Lesiak A, Narbutt J, Zalewska-Janowska A. The relationship between atopic dermatitis and atopic itch in children and the psychosocial functioning of their mothers: A cross-sectional study. Front Med (Lausanne) 2023; 10:1066495. [PMID: 36873862 PMCID: PMC9978477 DOI: 10.3389/fmed.2023.1066495] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/27/2023] [Indexed: 02/18/2023] Open
Abstract
Atopic dermatitis is a chronic inflammatory skin disease significantly affecting patients' and their parents' lives. Mothers are mostly responsible for the long-term treatment and their wellbeing is essential. The major objective of this cross-sectional study was to investigate the relationship between atopic dermatitis in children, especially concomitant itch, and the quality of life, stress, sleep quality, anxiety, and depression of their mothers. The study included 88 mothers of children with atopic dermatitis and 52 mothers of children without atopic dermatitis. All mothers completed sociodemographic questionnaire, the Perceived Stress Scale, the Athens Insomnia Scale and the Hospital Anxiety and Depression Scale. Additionally, mothers of children with atopic dermatitis filled in the Family Dermatology Life Quality Index. The severity of atopic dermatitis and pruritus intensity were evaluated by the Scoring Atopic Dermatitis Index and the Numerical Rating Scale, respectively. The severity of atopic dermatitis and itch significantly correlated with the quality of life, insomnia, and perceived stress of the mothers. Mothers whose children had had atopic dermatitis for more than 6 months had significantly higher scores of anxiety and depression. The results highlight the importance of screening mothers for functional impairment to provide adequate support. More attention should be directed to the standardization of stepped care interventions addressing factors resulting in the impaired functioning of mothers.
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Affiliation(s)
- Aleksandra K Kobusiewicz
- Psychodermatology Department, Pulmonology, Rheumatology and Clinical Immunology Chair, Medical University of Lodz, Lodz, Poland.,Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
| | - Bartlomiej Tarkowski
- Psychodermatology Department, Pulmonology, Rheumatology and Clinical Immunology Chair, Medical University of Lodz, Lodz, Poland
| | - Andrzej Kaszuba
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
| | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
| | - Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, Medical University of Lodz, Lodz, Poland
| | - Anna Zalewska-Janowska
- Psychodermatology Department, Pulmonology, Rheumatology and Clinical Immunology Chair, Medical University of Lodz, Lodz, Poland
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Santer M, Muller I, Becque T, Stuart B, Hooper J, Steele M, Wilczynska S, Sach TH, Ridd MJ, Roberts A, Ahmed A, Yardley L, Little P, Greenwell K, Sivyer K, Nuttall J, Griffiths G, Lawton S, Langan SM, Howells LM, Leighton P, Williams HC, Thomas KS. Eczema Care Online behavioural interventions to support self-care for children and young people: two independent, pragmatic, randomised controlled trials. BMJ 2022; 379:e072007. [PMID: 36740888 DOI: 10.1136/bmj-2022-072007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the effectiveness of two online behavioural interventions, one for parents and carers and one for young people, to support eczema self-management. DESIGN Two independent, pragmatic, parallel group, unmasked, randomised controlled trials. SETTING 98 general practices in England. PARTICIPANTS Parents and carers of children (0-12 years) with eczema (trial 1) and young people (13-25 years) with eczema (trial 2), excluding people with inactive or very mild eczema (≤5 on POEM, the Patient-Oriented Eczema Measure). INTERVENTIONS Participants were randomised (1:1) using online software to receive usual eczema care or an online (www.EczemaCareOnline.org.uk) behavioural intervention for eczema plus usual care. MAIN OUTCOME MEASURES Primary outcome was eczema symptoms rated using POEM (range 0-28, with 28 being very severe) every four weeks over 24 weeks. Outcomes were reported by parents or carers for children and by self-report for young people. Secondary outcomes included POEM score every four weeks over 52 weeks, quality of life, eczema control, itch intensity (young people only), patient enablement, treatment use, perceived barriers to treatment use, and intervention use. Analyses were carried out separately for the two trials and according to intention-to-treat principles. RESULTS 340 parents or carers of children (169 usual care; 171 intervention) and 337 young people (169 usual care; 168 intervention) were randomised. The mean baseline POEM score was 12.8 (standard deviation 5.3) for parents and carers and 15.2 (5.4) for young people. Three young people withdrew from follow-up but did not withdraw their data. All randomised participants were included in the analyses. At 24 weeks, follow-up rates were 91.5% (311/340) for parents or carers and 90.2% (304/337) for young people. After controlling for baseline eczema severity and confounders, compared with usual care groups over 24 weeks, eczema severity improved in the intervention groups: mean difference in POEM score -1.5 (95% confidence interval -2.5 to -0.6; P=0.002) for parents or carers and -1.9 (-3.0 to -0.8; P<0.001) for young people. The number needed to treat to achieve a 2.5 difference in POEM score at 24 weeks was 6 in both trials. Improvements were sustained to 52 weeks in both trials. Enablement showed a statistically significant difference favouring the intervention group in both trials: adjusted mean difference at 24 weeks -0.7 (95% confidence interval -1.0 to -0.4) for parents or carers and -0.9 (-1.3 to -0.6) for young people. No harms were identified in either group. CONCLUSIONS Two online interventions for self-management of eczema aimed at parents or carers of children with eczema and at young people with eczema provide a useful, sustained benefit in managing eczema severity in children and young people when offered in addition to usual eczema care. TRIAL REGISTRATION ISRCTN registry ISRCTN79282252.
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Affiliation(s)
- Miriam Santer
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, UK
| | - Ingrid Muller
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, UK
| | - Taeko Becque
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, UK
| | - Beth Stuart
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, UK
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Julie Hooper
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, UK
| | - Mary Steele
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, UK
| | - Sylvia Wilczynska
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Tracey H Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Matthew J Ridd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Amanda Roberts
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amina Ahmed
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Paul Little
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, UK
| | - Kate Greenwell
- School of Psychology, University of Southampton, Southampton, UK
| | - Katy Sivyer
- School of Psychology, University of Southampton, Southampton, UK
| | - Jacqui Nuttall
- Southampton Clinical Trial Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gareth Griffiths
- Southampton Clinical Trial Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Sinéad M Langan
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Laura M Howells
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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Akbaş A, Emeksiz ZŞ, Yorulmaz A, Hayran Y, Kılınç F, Yakut HI, Toyran M, Demir Kİ. Complementary and Alternative Treatment Methods Practiced by Parents in Pediatric Cases Diagnosed with Atopic Dermatitis. J DERMATOL TREAT 2022; 33:3014-3021. [PMID: 35775854 DOI: 10.1080/09546634.2022.2097159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Atopic Dermatitis (AD) is a chronic, recurrent and inflammatory skin disease experienced mostly in childhood. Chronicity of the disease, relapses, constant need of regular skin care causes seeking for alternative treatments. AIM The aim of this study is to evaluate the complementary and alternative treatments (CAT) used by parents' caregivers in pediatric patients diagnosed with AD, and the association between CAT use and patient characteristics. MATERIALS AND METHODS A questionnaire questioning the sociocultural and demographic characteristics of the family, the clinical findings of the patients, their treatments and CAT applications was recorded. RESULTS 83 patients were included in the study. 68.7% of the patients used at least 1 type of CAT. Vitamins and oils were the most commonly used CATs (48.8% and 47%, respectively) and 73.3% of the patients using CAT continued normal AD treatment while using CAT. The biggest factor affecting CAT choice was the advice of the immediate circle (75%), and 40.6% of the patients stated that they benefited from the complementary therapy. CONCLUSION CATs are widely used in AD. Physicians should know the socio-cultural structure of the region they are in, the CATs used and their side effects, and inform the families.
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Affiliation(s)
- Ayşe Akbaş
- Associate professor, Ankara City Hospital, Dermatology, Ankara, Turkey
| | - Zeynep Şengül Emeksiz
- Ankara City Hospital, Pediatric Allergy and Immunology Clinic specialist doctor Ankara, Turkey
| | - Ahu Yorulmaz
- Associate professor, Ankara City Hospital, Dermatology, Ankara, Turkey
| | - Yıldız Hayran
- Associate professor, Ankara City Hospital, Dermatology, Ankara, Turkey
| | - Fadime Kılınç
- Associate professor, Ankara City Hospital, Dermatology, Ankara, Turkey
| | | | - Müge Toyran
- Professor, Ankara City Hospital, Pediatric Allergy and Immunology Clinic Ankara, Turkey
| | - Kezban İpek Demir
- Ankara City Hospital, Pediatric Allergy and Immunology Clinic specialist doctor Ankara, Turkey
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10
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Wiegmann S, Ernst M, Ihme L, Wechsung K, Kalender U, Stöckigt B, Richter-Unruh A, Vögler S, Hiort O, Jürgensen M, Marshall L, Menrath I, Schneidewind J, Wagner I, Rohayem J, Liesenkötter KP, Wabitsch M, Fuchs M, Herrmann G, Lutter H, Ernst G, Lehmann C, Haase M, Roll S, Schilling R, Keil T, Neumann U. Development and evaluation of a patient education programme for children, adolescents, and young adults with differences of sex development (DSD) and their parents: study protocol of Empower-DSD. BMC Endocr Disord 2022; 22:166. [PMID: 35761280 PMCID: PMC9235086 DOI: 10.1186/s12902-022-01079-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/15/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Differences in sexual development (DSD) are rare diseases, which affect the chromosomal, anatomical or gonadal sex differentiation. Although patient education is recommended as essential in a holistic care approach, standardised programmes are still lacking. The present protocol describes the aims, study design and methods of the Empower-DSD project, which developed an age-adapted multidisciplinary education programme to improve the diagnosis-specific knowledge, skills and empowerment of patients and their parents. METHODS The new patient education programme was developed for children, adolescents and young adults with congenital adrenal hyperplasia, Turner syndrome, Klinefelter syndrome or XX-/or XY-DSD and their parents. The quantitative and qualitative evaluation methods include standardised questionnaires, semi-structured interviews, and participatory observation. The main outcomes (assessed three and six months after the end of the programme) are health-related quality of life, disease burden, coping, and diagnosis-specific knowledge. The qualitative evaluation examines individual expectations and perceptions of the programme. The results of the quantitative and qualitative evaluation will be triangulated. DISCUSSION The study Empower-DSD was designed to reduce knowledge gaps regarding the feasibility, acceptance and effects of standardised patient education programmes for children and youth with DSD and their parents. A modular structured patient education programme with four generic and three diagnosis-specific modules based on the ModuS concept previously established for other chronic diseases was developed. The topics, learning objectives and recommended teaching methods are summarised in the structured curricula, one for each diagnosis and age group. At five study centres, 56 trainers were qualified for the implementation of the training programmes. A total of 336 subjects have been already enrolled in the study. The recruitment will go on until August 2022, the last follow-up survey is scheduled for February 2023. The results will help improve multidisciplinary and integrated care for children and youth with DSD and their families. TRIAL REGISTRATION German Clinical Trials Register, DRKS00023096 . Registered 8 October 2020 - Retrospectively registered.
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Affiliation(s)
- Sabine Wiegmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, and Berlin Institut of Health, SPZ Interdisziplinär, Kinderendokrinologie und -diabetologie, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Martina Ernst
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, and Berlin Institut of Health, SPZ Interdisziplinär, Kinderendokrinologie und -diabetologie, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Loretta Ihme
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, and Berlin Institut of Health, SPZ Interdisziplinär, Kinderendokrinologie und -diabetologie, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Katja Wechsung
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, and Berlin Institut of Health, SPZ Interdisziplinär, Kinderendokrinologie und -diabetologie, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Ute Kalender
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Barbara Stöckigt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Annette Richter-Unruh
- Pediatric Endocrinology & Diabetology, St. Josefs Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Sander Vögler
- Pediatric Endocrinology & Diabetology, St. Josefs Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Olaf Hiort
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Martina Jürgensen
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Louise Marshall
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Ingo Menrath
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Julia Schneidewind
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Isabel Wagner
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Julia Rohayem
- Centre for Reproductive Medicine and Andrology, Clinical and Operative Andrology, University Hospital Münster, Münster, Germany
| | | | - Martin Wabitsch
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendmedizin, Sektion Pädiatrische Endokrinologie und Diabetologie, Hormonzentrum für Kinder und Jugendliche, Ulm, Germany
| | - Malaika Fuchs
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendmedizin, Sektion Pädiatrische Endokrinologie und Diabetologie, Hormonzentrum für Kinder und Jugendliche, Ulm, Germany
| | - Gloria Herrmann
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendmedizin, Sektion Pädiatrische Endokrinologie und Diabetologie, Hormonzentrum für Kinder und Jugendliche, Ulm, Germany
| | - Henriette Lutter
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendmedizin, Sektion Pädiatrische Endokrinologie und Diabetologie, Hormonzentrum für Kinder und Jugendliche, Ulm, Germany
| | - Gundula Ernst
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Christine Lehmann
- Förderkreis Schulung chronisch kranker Kinder und Jugendlicher e.V., Berlin, Germany
| | - Martina Haase
- Institute of Clinical Epidemiology and Biometry, Würzburg University, Würzburg, Germany
| | - Stephanie Roll
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Ralph Schilling
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Thomas Keil
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
- Institute of Clinical Epidemiology and Biometry, Würzburg University, Würzburg, Germany
- State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Uta Neumann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, and Berlin Institut of Health, SPZ Interdisziplinär, Kinderendokrinologie und -diabetologie, Augustenburger Platz 1, 13353, Berlin, Germany
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Sivyer K, Teasdale E, Greenwell K, Steele M, Ghio D, Ridd MJ, Roberts A, Chalmers JR, Lawton S, Langan SM, Cowdell F, Le Roux E, Wilczynska S, Williams HC, Thomas KS, Yardley L, Santer M, Muller I. Supporting families managing childhood eczema: developing and optimising eczema care online using qualitative research. Br J Gen Pract 2022; 72:e378-e389. [PMID: 35577586 PMCID: PMC9119812 DOI: 10.3399/bjgp.2021.0503] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 02/01/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Childhood eczema is often poorly controlled owing to underuse of emollients and topical corticosteroids (TCS). Parents/carers report practical and psychosocial barriers to managing their child's eczema, including child resistance. Online interventions could potentially support parents/carers; however, rigorous research developing such interventions has been limited. AIM To develop an online behavioural intervention to help parents/carers manage and co-manage their child's eczema. DESIGN AND SETTING Intervention development using a theory-, evidence-, and person-based approach (PBA) with qualitative research. METHOD A systematic review and qualitative synthesis of studies (n = 32) and interviews with parents/carers (n = 30) were used to identify barriers and facilitators to effective eczema management, and a prototype intervention was developed. Think-aloud interviews with parents/carers (n = 25) were then used to optimise the intervention to increase its acceptability and feasibility. RESULTS Qualitative research identified that parents/carers had concerns about using emollients and TCS, incomplete knowledge and skills around managing eczema, and reluctance to transitioning to co-managing eczema with their child. Think-aloud interviews highlighted that, while experienced parents/carers felt they knew how to manage eczema, some information about how to use treatments was still new. Techniques for addressing barriers included providing a rationale explaining how emollients and TCS work, demonstrating how to use treatments, and highlighting that the intervention provided new, up-to-date information. CONCLUSION Parents/carers need support in effectively managing and co-managing their child's eczema. The key output of this research is Eczema Care Online for Families, an online intervention for parents/carers of children with eczema, which is being evaluated in a randomised trial.
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Affiliation(s)
- Katy Sivyer
- Department of Psychology, University of Southampton, Southampton; lecturer, University of Portsmouth, Portsmouth
| | | | | | | | - Daniela Ghio
- University of Manchester, Manchester; research fellow, University of Southampton, Southampton
| | | | | | | | | | | | | | | | | | | | | | - Lucy Yardley
- University of Bristol, Bristol; professor of health psychology, University of Southampton, Southampton
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12
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systematic review on role of hypnotherapeutic intervention in promoting positive psychological health. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns2.6123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In this world of fast moving day to day activities, it is of utmost importance that every individual is aware of their personal well- being and take steps towards improving these over the course of time (Al-Asmi et al., 2015; Amato et al., 2001). The state of well – being can be described as understanding the quality of life led by various individuals (Statham & Chase, 2010). The concept of well- being in humans is broadly classified into two aspects - the first one is associated with having life satisfaction and a positive effect in one’s life.the study here is only focused towards the use of hypnotherapeutic interventions in the process of promoting a positive psychological heath scenario all across. The study undertakes a systematic review approach with 51 articles and aims to put forward a summarised version of the literature in the aspect of hypnotherapeutic interventions.The result of the study identifies a total of three themes from the systematic literature review conducted. It is found that the three identified themes have been put forward by researchers as the most effective impact of hypnotherapeutic interventions.
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13
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Parental Disease Specific Knowledge and Its Impact on Health-Related Quality of Life. CHILDREN 2022; 9:children9010098. [PMID: 35053722 PMCID: PMC8774947 DOI: 10.3390/children9010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/08/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022]
Abstract
Objective: Structured education programs have been shown to improve somatic outcome and health-related quality of life (HRQOL) in a variety of chronic childhood diseases. Similar data are scarce in paediatric liver transplantation (pLTx). The purpose of this study was to examine the relationship of parental disease-specific knowledge and psychosocial disease outcome in patients after pLTx. Methods: Parents of 113 children (chronic liver disease n = 25, after pLTx n = 88) completed the transplant module of the HRQOL questionnaire PedsQL, the “Ulm quality of life inventory for parents of children with chronic diseases” ULQUI, and a tailor-made questionnaire to test disease-specific knowledge. Results: Parental knowledge was highest on the topic of “liver transplantation” and lowest in “basic background knowledge” (76% and 56% correct answers respectively). Knowledge performance was only marginally associated with HRQOL scores, with better knowledge being related to worse HRQOL outcomes. In contrast, self-estimation of knowledge performance showed significant positive correlations with both PedsQL and ULQUI results. Conclusion: Patient HRQOL and parental emotional wellbeing after pLTx are associated with positive self-estimation of parental disease-specific knowledge. Objective disease-specific knowledge has little impact on HRQOL. Parental education programs need to overcome language barriers and address self-efficacy in order to improve HRQOL after pLTx.
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14
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Jagadeesan S, Parikh D, Dhar S. Counseling strategies in atopic dermatitis: How best can they be integrated in dermatological practice? INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2022. [DOI: 10.4103/ijpd.ijpd_103_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Singh A. A Comprehensive Review of Therapeutic Approaches Available for the Treatment of Dermatitis. RECENT PATENTS ON NANOTECHNOLOGY 2022; 16:172-197. [PMID: 34365934 DOI: 10.2174/1872210515666210806143015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/16/2021] [Accepted: 05/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Dermatitis or eczema is a prevalent skin disorder worldwide and is also very common as a pediatric inflammatory skin disorder. Its succession gets worse with the multiple comorbidities which exhibit mechanisms that are poorly understood. Its management further becomes a challenge due to the limited effective treatment options available. However, the Novel Drug Delivery Systems (NDDS) along with new targeting strategies can easily bypass the issues associated with dermatitis management. If we compare the active constituents against phytoconstituents effective against dermatitis then phytoconstituents can be perceived to be more safe and gentle. OBJECTIVE Administration of NDDS of plant extract or actives displays improved absorption behavior, which helps them to permeate through lipid-rich biological membrane leading to increased bioavailability. The newer efficient discoveries related to eczema can face various exploitations. This can be intervened by the subjection of patent rights, which not only safeguard the novel works of individual(s) but also give them the opportunity to share details of their inventions with people globally. CONCLUSION The present review focuses on the available research about the use of nanoformulations in the topical delivery. It further elaborates the use of different animal models as the basis to characterize the different features of dermatitis. The review also highlights the recent nanoformulations which have the ability to amplify the delivery of active agents through their incorporation in transfersomes, ethosomes, niosomes or phytosomes, etc.
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Affiliation(s)
- Apoorva Singh
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University Uttar Pradesh, Lucknow, India
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16
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Singleton H, Hodder A, Boyers D, Doney L, Almilaji O, Heaslip V, Thompson AR, Boyle RJ, Axon E, Van Onselen J, O'Meara S, Roberts A, Ersser SJ. Psychological and educational interventions for managing eczema. Hippokratia 2021. [DOI: 10.1002/14651858.cd014932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Heidi Singleton
- Department of Nursing Science; Bournemouth University; Bournemouth UK
| | - Andrew Hodder
- Department of Dermatology; Royal Cornwall Hospitals NHS Trust; Truro UK
- Department of Dermatology; University Hospitals Dorset; Christchurch UK
| | - Dwayne Boyers
- Health Economics Research Unit; University of Aberdeen; Aberdeen UK
| | - Liz Doney
- Cochrane Skin, Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | - Orouba Almilaji
- Department of Medical Science and Public Health; Bournemouth University; Bournemouth UK
| | - Vanessa Heaslip
- Department of Nursing Science; Bournemouth University; Bournemouth UK
| | - Andrew R Thompson
- South Wales Clinical Psychology Training Programme; Cardiff and Vale University Health Board & Cardiff University; Cardiff UK
| | - Robert J Boyle
- Cochrane Skin, Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
- National Heart & Lung Institute, Section of Inflammation and Repair; Imperial College London; London UK
| | - Emma Axon
- Cochrane Skin, Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | | | | | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema; Nottingham UK
| | - Steven J Ersser
- Department of Nursing Science; Bournemouth University; Bournemouth UK
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Graubard R, Perez-Sanchez A, Katta R. Stress and Skin: An Overview of Mind Body Therapies as a Treatment Strategy in Dermatology. Dermatol Pract Concept 2021; 11:e2021091. [PMID: 34631261 DOI: 10.5826/dpc.1104a91] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 01/24/2023] Open
Abstract
Stress has multiple and wide-ranging physiologic and clinical impacts on skin disease. This has led to an interest in mind body therapies as potential adjunct treatments for skin disease. The stress response results in the activation of the endocrine, neurologic, and immune systems, with a resulting cascade of impacts, that are both systemic and cutaneous. The 2 main arms of the stress response are the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. The resultant release of cortisol, catecholamines, and neuropeptides has multiple effects. Clinically, these have been shown to increase skin inflammation, increase itching, impair skin barrier function, impair wound healing, and suppress immunity. Mind body therapies are those that focus on the interaction between the mind and the body, with the goal to influence physical function and impact health. These have been shown to ameliorate some of the harmful physiologic changes attributed to stress or to reduce harmful behaviors. In some cases, such as with biofeedback, they may also result in beneficial physiologic changes. Treatments such as meditation, biofeedback, hypnosis, guided imagery, and others have been evaluated in the treatment of skin disease and have shown some benefits. Although randomized controlled trials are limited, these interventions have shown beneficial effects on itching, psychosocial outcomes, and even skin severity. These interventions have been evaluated in diseases such as atopic dermatitis, psoriasis, trichotillomania, and others. Given the potential benefits, improvements in psychosocial outcomes, and a low risk profile, referral to qualified practitioners or multidisciplinary clinics should be considered for some patients.
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Affiliation(s)
| | | | - Rajani Katta
- Baylor College of Medicine, Houston, TX, USA.,McGovern Medical School at the University of Texas Houston, USA
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18
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Two Sides of a Coin: Parental Disease-Specific Training as Seen by Health Care Practitioners and Parents in Pediatric Liver Transplantation. CHILDREN 2021; 8:children8090827. [PMID: 34572259 PMCID: PMC8469562 DOI: 10.3390/children8090827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/03/2021] [Accepted: 09/15/2021] [Indexed: 12/04/2022]
Abstract
In the absence of widely accepted education standards for parents of children after liver transplantation (LTx), the content and structure of parental training are influenced by health care practitioners’ (HCP) individual knowledge and assessment of the relevance of its contents. This study examines the hypothesis that expectations towards training differ between HCPs and parents, and that the quality of parental training affects the job-satisfaction of HCPs. Attitudes towards disease-specific education were assessed by tailor-made questionnaires in HCPs (n = 20) and parents of children with chronic liver disease or after LTx (n = 113). These were supplemented by focused interviews in n = 7 HCPs and n = 16 parents. Parents were more satisfied with current counseling than HCP. Language barriers and low parental educational background were perceived as obstacles by 43% of HCPs. The quality of parental knowledge was felt to have a strong influence on HCPs job satisfaction. The expectations towards the content of disease-specific education largely overlap but are not synonymous. HCP and parents agreed with regards to the importance of medication knowledge. Parents rated the importance about the meaning of laboratory values and diagnostic procedures significantly higher (3.50 vs. 2.85, p < 0.001 and 3.42 vs. 2.80, p < 0.001) than HCPs. Parents and HCPs would prefer a structured framework with sufficient staff resources for disease-specific counseling.
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Carvello M, Lupo R, Muro M, Grilli G, Ogorzalek K, Rubbi I, Artioli G. Nurse's knowledge and perceptions on communicative hypnosis: an observational study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021027. [PMID: 34328143 PMCID: PMC8383218 DOI: 10.23750/abm.v92is2.11211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/22/2021] [Indexed: 11/29/2022]
Abstract
Background and aim of the study. Much evidence shows that hypnotic communication can have a pain-relieving effect and reduce complications such as anxiety, insomnia and depression. Whenever this technique was applied, the use of pharmaceuticals was reduced, there were fewer side effects, shorter hospitalization times frames and lower treatment costs. The aim of this study is to evaluate the knowledge and perceptions of nurses about hypnotic communication and the causes for which this technique is not frequently used. A secondary objective pointed to measuring the effectiveness of an educational event on hypnosis. Method. The evaluation was done by directly administering an anonymous and voluntary survey created ad hoc, in a pre-test and post-test modality, to nurses subscribed to a four-hour formative event on hypnotic communication organized in 2019 by the Nursing Order, Province of Ravenna. Results. 78 nurses (85.7%) participated in the study. The analysis of the pre-test results shows a gap of knowledge regarding hypnotic communication. The variation of answers between the pre-test and post-test (T-Student) has shown a radical difference in knowledge (95%-100% correct answers). The main causes were found regarding the lack of use for hypnotic communication: stereotypes and prejudices related to this technique and insufficient university education. Conclusions. The implementation of this technique, effective and efficient under various aspects, requires a preliminary creation of culture regarding this theme, capable of surpassing the stereotypes and resistances brought by a lack of theoretical elements.
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Affiliation(s)
| | - Roberto Lupo
- Hospital "San Giuseppe da Copertino", ASL (Local Health Authority) (Le), Italy.
| | - Milena Muro
- 1) Nurse at "Città della Salute e della Scienza" Hospital, Torino, Italy; 2) President of A.S.I.E.C.I, Italian Scientific Association of Experienced Nurses in Hypnotic Communication.
| | - Gloria Grilli
- Nurse at Villa Montefeltro Hospital, Sassocorvaro, Italy.
| | - Kody Ogorzalek
- Student in Foreign languages, cultures and literatures, Salento University .
| | - Ivan Rubbi
- School of Nursing, University of Bologna, Bologna, Italy.
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Fieten KB, John SM, Nowak D. Secondary and Tertiary Prevention: Medical Rehabilitation. Handb Exp Pharmacol 2021; 268:449-470. [PMID: 34196810 DOI: 10.1007/164_2021_511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Allergies are a major public health burden, and targeted measures are required in terms of prevention and treatment. The most common allergic conditions encompass atopic dermatitis (AD), food allergy (FA), allergic asthma (AA), and allergic rhino-conjunctivitis (AR). Primary prevention aims at preventing the onset of allergic disease, before the disease process begins. Secondary prevention aims at preventing progression and exacerbation of allergic disease whereas tertiary prevention aims at reducing disease burden in patients with established disease, by allergen immunotherapy (AIT) or medical rehabilitation. Rehabilitation programs are used for treatment of AA and AD and usually consist of extensive patient assessment, optimization of treatment management, patient education, and behavioral interventions, ideally involving a multidisciplinary treatment team and sometimes provided in a specific climate, usually alpine or maritime. Similarly, prevention of occupational skin diseases requires interdisciplinary approaches on the level of secondary and tertiary preventive intervention; if this is provided, then prevention programs have proven highly (cost-) effective. Unfortunately, the recently published Minimal Standards of Prevention of these dermatoses, underlining especially the importance of meticulous allergological diagnosis and subsequent multidisciplinary patient education, are so far being adhered to only in very few European countries.
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Affiliation(s)
- Karin B Fieten
- Swiss Institute of Allergy and Asthma Research (SIAF), Davos, Switzerland.
| | | | - Dennis Nowak
- Munich Center of Health Sciences, Munich, Germany
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Impact of Oral Abrocitinib Monotherapy on Patient-Reported Symptoms and Quality of Life in Adolescents and Adults with Moderate-to-Severe Atopic Dermatitis: A Pooled Analysis of Patient-Reported Outcomes. Am J Clin Dermatol 2021; 22:541-554. [PMID: 33954933 PMCID: PMC8200343 DOI: 10.1007/s40257-021-00604-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Atopic dermatitis imparts a substantial patient burden, including itch, sleep disturbance, and decreased health-related quality of life. OBJECTIVE This analysis evaluated changes in patient-reported outcomes of disease-specific signs/symptoms and health-related quality of life in adult and adolescent patients with moderate-to-severe atopic dermatitis treated with once-daily oral abrocitinib 200-mg or 100-mg monotherapy. METHODS Pooled data from one phase IIb (NCT02780167) and two phase III (NCT03349060, JADE MONO-1; NCT03575871, JADE MONO-2) monotherapy trials in adult and adolescent patients with moderate-to-severe atopic dermatitis were analyzed. Patient-reported outcome assessments included: global severity, itch, and multi-item measures that assess other signs and symptoms of atopic dermatitis. Additional patient-reported outcome assessments measured depression, anxiety, fatigue, disease-specific and general health-related quality of life, and work and general productivity among employed patients. RESULTS Overall, 942 patients were included in this analysis. Improvements were observed from the first post-baseline assessment to week 12 across all patient-reported outcomes, including Patient Global Assessment (PtGA) score of 0/1 (35.5%, 19.8%, and 5.9% for 200 mg, 100 mg, and placebo, respectively), ≥ 4-point improvement in Night Time Itch Scale (NTIS; 57.0%, 42.7%, and 12.7%), change from baseline in Patient-Oriented Eczema Measure (POEM) score (- 11.4, - 8.2, and - 3.4), 1-point improvement in Pruritus and Symptoms Assessment for Atopic Dermatitis (PSAAD; 75.2%, 65.1%, and 33.5%), Hospital Anxiety and Depression Scales (HADS) anxiety (- 2.0, - 1.7, and - 1.0) and depression (- 1.7, - 1.3, and - 0.1). CONCLUSIONS Abrocitinib monotherapy improved disease-specific signs/symptoms and health-related quality of life across multiple domains as reported by adult and adolescent patients with moderate-to-severe atopic dermatitis, complementing clinician-reported efficacy and safety outcomes. CLINICAL TRIAL REGISTRATION NCT02780167 (registered 23 May, 2016), NCT03349060 (registered 21 November, 2017), NCT03575871 (registered 3 July, 2018).
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22
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Chong JH. Atopic dermatitis in children: when topical steroid treatment "does not work". BMJ 2021; 372:n297. [PMID: 33602868 DOI: 10.1136/bmj.n297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jin Ho Chong
- Raffles Children's Centre, Raffles Hospital, Singapore
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Lundborg M, Holm JOH, Sandvik L, Lossius AH, Rehbinder EM, Sitek JC, Berents TL. Multidisciplinary educational programme for caregivers of children with atopic dermatitis- in South East Norway - an observational study. BMC DERMATOLOGY 2020; 20:20. [PMID: 33298043 PMCID: PMC7727126 DOI: 10.1186/s12895-020-00119-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/30/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Educational programmes for caregivers of children with atopic dermatitis (AD) are reported to reduce the severity of AD and improve quality of life (QOL). Oslo University Hospital (OUH) in Norway offers a multidisciplinary educational programme for caregivers of children with AD. We aimed to evaluate the AD educational programme by assessing QOL of the family, the severity of the disease and caregiver's fear of topical corticosteroid (TCS) before and after attending the programme. METHODS This was a small observational prospective cohort study including 41 caregiver-child pairs. The children (mean age 3.4 years) had doctors' diagnosed AD with a difficult to treat eczema. The children's caregivers were referred from physicians to attend the AD educational programme at our hospital. At inclusion and at a 3 months follow-up QOL was assessed by Dermatitis Family Impact (DFI), the eczema severity by Patient-Orientated - SCORing Atopic Dermatitis (PO-SCORAD) and caregivers fear of TCS was recorded by asking a dichotomous "yes" or "no" question: "Are you worried about using TCS on your child?" RESULTS Three months after caregivers attending the educational programme there was an improvement in QOL by reduced mean DFI from 9.6 (SD 6.3) to 6.8 (SD 5.4), the mean PO-SCORAD was reduced from 38.5 (SD 15.1) to 24.6 (SD13.6), the number of caregivers reporting fear of TCS use was reduced from 33/46 (72%) to 12/41 (29%). All results p < 0.001. CONCLUSION Our study suggests beneficial effects by improving QOL of the family, the severity of the eczema and in reducing the fear of TCS when caregivers of children with difficult to treat AD attend an AD multidisciplinary educational programme. Lack of control group makes it difficult to draw definite conclusions.
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Affiliation(s)
- M Lundborg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - J-O H Holm
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - L Sandvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - A H Lossius
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - E M Rehbinder
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - J C Sitek
- Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - T L Berents
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway. .,Department of Dermatology, Oslo University Hospital, Oslo, Norway.
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Brunner C, Theiler M, Weibel L, Schlüer AB. Storytelling als innovative Methode zur videobasierten Edukation für Eltern von Kindern mit atopischer Dermatitis. Pflege 2020; 33:397-403. [PMID: 33236694 DOI: 10.1024/1012-5302/a000771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Storytelling as an innovative method of video-based education for parents of children with atopic dermatitis Abstract. Background: Atopic Dermatitis (AD) is the most chronic skin disease in children and affects up to 20 % of children in developed countries. Chronic inflammation of the skin, itching, redness, and non-dermatologic symptoms like sleep disturbance are frequent and have a negative impact on the child's quality of life and their family. Education is one of the most important aspects of managing AD. Aim: Production and evaluation of educational videos with the method storytelling for parents of children aged 0 to 5 years with atopic dermatitis. Methods: We produced the videos with the method of storytelling. The aim of storytelling is to help to recall important information more easily. A multi-professional team and parents of affected children tested the videos to ensure the understandability, the helpfulness and importance of the educational videos. Results: We created six different videos in all. The content of the educational videos includes information on the causes of AD, symptoms, skin care, treatment instruction and living with AD. We implemented the method of storytelling by two families with affected children who reported about their experience with the disease and the treatment. Three different specialists gave expert information. The evaluation showed that the information in the videos is simple, understandable and relevant. Conclusions: Evidence-based videos are an innovative, creative and modern method to support education. Storytelling is a user-friendly method to give simple and understandable information.
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Affiliation(s)
- Corinne Brunner
- Zentrum Kinderhaut - Haut- und Wundbehandlung, Universitäts-Kinderspital Zürich.,Forschungszentrum für das Kind, Universitäts-Kinderspital Zürich
| | - Martin Theiler
- Zentrum Kinderhaut - Dermatologie, Universitäts-Kinderspital Zürich.,Forschungszentrum für das Kind, Universitäts-Kinderspital Zürich
| | - Lisa Weibel
- Zentrum Kinderhaut - Dermatologie, Universitäts-Kinderspital Zürich.,Forschungszentrum für das Kind, Universitäts-Kinderspital Zürich
| | - Anna-Barbara Schlüer
- Klinische Pflegewissenschaft, Universitäts-Kinderspital Zürich.,Forschungszentrum für das Kind, Universitäts-Kinderspital Zürich
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Kannenberg SM, Karabus S, Visser WI, Aboobaker J, Kriel MM, Levin M, Magigaba B, Manjra A, Misra R, Mpofu P, Tshigabe A, Luger T. Paediatric atopic eczema (atopic dermatitis) in South Africa: A practical algorithm for the management of mild-to-moderate disease in daily clinical practice. S Afr Fam Pract (2004) 2020; 62:e1-e9. [PMID: 33314940 PMCID: PMC8377852 DOI: 10.4102/safp.v62i1.5190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022] Open
Abstract
Background Atopic eczema (AE) is a chronic, highly pruritic, inflammatory skin condition with increasing prevalence worldwide. Atopic eczema mostly affects children, impairing quality of life with poor disease control leading to progression of other atopic disorders. As most patients in South Africa have no access to specialist healthcare, a practical approach is needed for the management of mild-to-moderate AE in paediatric patients for daily clinical practice. Methods A panel of experts in AE convened to develop a practical algorithm for the management of AE for children and adolescents in South Africa. Results Regular moisturising with an oil-based emollient remains the mainstay of AE treatment. Severe AE flares should be managed with topical corticosteroids (TCSs). For mild-to-moderate AE flares in sensitive skin areas, a topical calcineurin inhibitor (TCI) should be applied twice daily from the first signs of AE until complete resolution. Topical corticosteroids may be used when TCIs are unavailable. In non-sensitive skin areas, TCSs should be used for mild-to-moderate AE, but TCIs twice daily may be considered. Proactive maintenance treatment with low-dose TCI or TCS 2–3 times weekly and the liberal use of emollients is recommended for patients with recurrent flares. Conclusions This algorithm aims to simplify treatment of paediatric AE, optimising clinical outcomes and reducing disease burden. This approach excludes treatment of patients with severe AE, who should be referred to specialist care. Emphasis has been given to the importance of general skincare, patient education and the topical anti-inflammatory medications available in South Africa (TCSs and TCIs).
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Affiliation(s)
- Susanna M Kannenberg
- Division of Dermatology, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Cape Town.
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van Os-Medendorp H, Deprez E, Maes N, Ryan S, Jackson K, Winders T, De Raeve L, De Cuyper C, Ersser S. The role of the nurse in the care and management of patients with atopic dermatitis. BMC Nurs 2020; 19:102. [PMID: 33292229 PMCID: PMC7640616 DOI: 10.1186/s12912-020-00494-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/20/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The purpose of this paper is to provide an overview of key aspects of specialised dermatology nursing practice in the management of patients with moderate to severe atopic dermatitis. The role of dermatology nurse specialists in supporting patients and promoting disease understanding, education and treatment adherence continues to evolve. As features of specialised nursing care can also inform other nursing staff in a wide range of care settings, an overview of key components is examined. Observations presented are from a pan-European perspective and represent the collected view of a group of dermatology nurse specialists, dermatologists and patient advocates following two round-table discussions. MAIN BODY Atopic dermatitis is a common, chronic, inflammatory disease characterised by erythematous/scaling skin lesions, with often intense pruritus. Disease course is cyclic with periodic disease flares of varying intensity, presenting management challenges to patients and families. Dermatology nurse specialists play a key role in providing education and substantial patient support to improve treatment outcomes and quality of life to patients and their family, delivered within a multidisciplinary team framework. Nurse-led education and 'eczema schools' are of benefit in reducing disease severity and improving quality of life by enhancing self-management, adherence and patient engagement. eHealth tools, such as patient portals or online training platforms, can provide online learning, individualised education, and help to improve engagement. These and other initiatives, such as written action plans, are all essential to improve or maintain treatment adherence, self-management and quality of life. CONCLUSIONS Dermatology nurse specialists play a central role in the assessment and management of moderate to severe atopic dermatitis patients and families. This places them in an ideal position to build strong and often long-term relationships with patients and parents. Such engagement promotes trust, assists in setting realistic expectations of treatment and outcomes, and enhances self-management and engagement in their own care. Providing emotional support, as well as formal and systematic education (including individualised practical advice) all contribute to improved treatment adherence and can enhance the quality of life of patients and their families throughout the course of this long-term condition.
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Affiliation(s)
| | - Elfie Deprez
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
| | - Nele Maes
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
| | - Sheila Ryan
- Department of Dermatology, University Hospital Limerick, Limerick, Ireland
| | - Karina Jackson
- St John's Institute of Dermatology, Guy's and St Thomas' Foundation NHS Trust, London, UK
| | - Tonya Winders
- Allergy & Asthma Network / Global Allergy & Airways Patient Platform (GAAPP), Vienna, VA, USA
| | - Linda De Raeve
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Christa De Cuyper
- Department of Dermatology, AZ Sint Jan, Brugge-Oostende, AV, Belgium.,EADV-Nurse Association Working group Coordinator, Lugano, Switzerland
| | - Steven Ersser
- Department of Nursing Science, Bournemouth University, Poole, UK
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Depressive and anxiety symptomatology among people with asthma or atopic dermatitis: A population-based investigation using the UK Biobank data. Brain Behav Immun 2020; 90:138-144. [PMID: 32791209 DOI: 10.1016/j.bbi.2020.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/30/2020] [Accepted: 08/07/2020] [Indexed: 12/25/2022] Open
Abstract
The present study investigated the association of depression and anxiety symptomatology (DAS) with asthma and atopic dermatitis (AD) diagnosis during mid-adult years. The study employed data from 502,641 participants in the UK Biobank. Neutrophils to Lymphocytes Ratios (NLRs) of patients with asthma and AD were calculated and evaluated in relation to DAS, measured via the Patient Health Questionnaire-4 (PHQ-4). Age of asthma or AD onset association with DAS were also estimated. Multivariable regression analyses were implemented among participants with asthma or AD, compared to those without these disorders. Out of 58,833 participants with asthma and 13,462 with AD, the prevalence of DAS was 11.7% and 2.7%, respectively. DAS increased among participants with either asthma or AD, being highest within patients having both (β = 0.41, 95% confidence interval (95%CI), 0.34,0.49). NLR showed a linear increase with PHQ scores in asthma patients, (tertile 1, β = 0.30, 95% CI, 0.27,0.34; tertile 2, β = 0.36, 95%CI, 0.32,0.39, and tertile 3, β = 0.43, 95%CI, 0.39,0.46). An inverted U-shaped association was seen between age of asthma onset and PHQ, with the 40-59 age group (β = 0.54, 95%CI, 0.48,0.59) showing the highest risk followed by the 60+ (β = 0.43, 95%CI, 0.34,0.51 and 20-39 groups (β = 0.32, 95%CI, 0.27,0.38). Similar patterns emerged within AD. Asthma and AD were associated with increased DAS during mid-adult years, being strongest among participants reporting both disorders. A dose-response relationship between NLR and DAS was observed. Asthma or AD onset during mid-adult years (40-59) were associated with the highest increment in DAS.
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Gieler U, Gieler T, Peters EMJ, Linder D. Skin and Psychosomatics - Psychodermatology today. J Dtsch Dermatol Ges 2020; 18:1280-1298. [PMID: 33251751 PMCID: PMC7756276 DOI: 10.1111/ddg.14328] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023]
Abstract
Modern psychodermatology relies on the bio-psycho-social disease model in psychosomatics, according to which biological, psychological and social factors (on various levels, from molecules to the biosphere) play a major role in the disease pathogenesis through complex, non-linear interactions over the entire disease course. It is nowadays experimentally proven that "emotions get into the skin". Recent research shows close anatomical, physiological and functional connections between skin and nervous system, already known to be ontogenetically related. These connections are reflected in many skin diseases where psychological and somatic etiological factors are closely intertwined. A holistic approach by the physician should do justice to this interdependence; biological, psychological and social factors should be adequately taken into account when taking anamnesis, making a diagnosis and choosing a therapy. The "visibility" of the skin organ bestows dermatology a special position among the various other clinical subjects, and renders a holistic, psychosomatic approach to the patient that is particularly important. The life course belongs also to modern psychodermatological approaches. Based on the modern psychodermatology concept, other corresponding sub-areas such as psychogastroenterology, psychocardiology etc. have emerged. After the theoretical part of this article, some selected skin diseases are discussed in more detail from the psychosomatic point of view.
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Affiliation(s)
- Uwe Gieler
- Department of DermatologyUniversity Hospital Gießen
| | - Tanja Gieler
- Psychosomatic Medicine for Children and AdolescentsDepartment of PediatricsUniversity Hospital Gießen
| | - Eva Milena Johanne Peters
- Laboratory for PsychoneuroimmunologyDepartment of Psychosomatic Medicine and PsychotherapyUniversity Hospital Gießen in cooperation with the Department of Psychosomatic Medicine and PsychotherapyUniversity Hospital – CharitéBerlin
| | - Dennis Linder
- Department of DermatologyUniversity of PaduaItalyInstitute for Medical Psychology and PsychotherapyMedical University GrazAustria
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29
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Cowdell F, Ahmed T, Layfield C. Knowledge mobilisation: a UK co-creation study to devise strategies to amend lay and practitioner atopic eczema mindlines to improve consultation experiences and self-management practices in primary care. BMJ Open 2020; 10:e036520. [PMID: 32988943 PMCID: PMC7523205 DOI: 10.1136/bmjopen-2019-036520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/17/2020] [Accepted: 08/19/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To devise strategies to amend lay and practitioner atopic eczema mindlines 'collectively reinforced, internalised tacit guidelines', to improve consultation experiences and self-management practices in primary care. DESIGN Co-creation workshops informed by the Co:Create Coproduction Matrix. SETTING Conference centre in central England and via remote communication. PARTICIPANTS Lay people with, and parents of children with, atopic eczema, practitioners, a researcher and a facilitator (n=22). RESULTS Eczema mindline amendment needs to address people and parents of children with the condition, practitioners and wider society in parallel. For lay people trust and 'realness' of amendment activity was vital and practitioners wanted practical, locally relevant, hints and tips, tailored, 'no faff' approaches. To improve consultation experiences and self-management practices, five key, consistent, evidence-based messages need to be instilled into eczema mindlines: (1) eczema is more than just dry skin, (2) eczema does not just go away, (3) moisturisers are for every day, (4) steroid creams are okay when you need them and (5) you know your child's eczema best. CONCLUSION This co-creation study provides original insights into what eczema knowledge should be mobilised, who needs to have this knowledge, how this should be achieved to amend existing mindlines to improve consultation experiences and self-management practices in primary care.The remaining challenge is to refine, implement and evaluate the effectiveness of strategies developed to instil the five core messages and erase outdated or inaccurate information.
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Affiliation(s)
- Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Taheeya Ahmed
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Carron Layfield
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Zhao M, Liang Y, Shen C, Wang Y, Ma L, Ma X. Patient Education Programs in Pediatric Atopic Dermatitis: A Systematic Review of Randomized Controlled Trials and Meta-Analysis. Dermatol Ther (Heidelb) 2020; 10:449-464. [PMID: 32200513 PMCID: PMC7211777 DOI: 10.1007/s13555-020-00365-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Patient education is crucial for improving disease outcomes in atopic dermatitis (AD). This review aims to summarize evidence about the effectiveness of educational programs for parents of pediatric AD patients. METHODS PubMed and Embase (inception to Feb 2020) were searched and randomized controlled trials (RCTs) in English were included. Risk of bias was assessed using Cochrane risk of bias tools and quality of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation (GRADE). Pooled standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated for the disease severity instrument (Scoring of Atopic Dermatitis, SCORAD) and quality of life (QoL) instruments using the random-effects model. RESULTS A total of 13 RCTs were included in the systematic review. The meta-analysis of SCORAD contained seven studies with a total of 1853 patients. The reduction in disease severity (SCORAD) was larger in the treatment group (SMD = - 8.22, 95% CI = - 11.29, - 5.15; P < 0.001; I2 = 78.6%). Subgroup analyses revealed that the association was modified by the frequency of sessions (P for Cochran Q < 0.01) and the duration of follow-up (P for Cochran Q < 0.01). No significant effect-modification was observed for disease severity and borderline significance was observed for session delivery (individual vs group session). The pooled effect sizes for QoL measures including Dermatitis Family Index (SMD = - 0.65, 95% CI = - 1.49, 0.18), Children's Dermatology Life Quality Index (SMD = - 1.61, 95% CI = - 3.76, 0.55; I2= 89.0%) and Infants' Dermatology Quality of Life Index (SMD = 0.30, 95% CI = - 1.04, 1.63; I2= 63.1%) were not significant. CONCLUSIONS Structured patient education is beneficial and should be implemented for the management of AD patients. However, an optimal delivery mode needs to be determined.
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Affiliation(s)
- Mutong Zhao
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Yuan Liang
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Chunping Shen
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Ying Wang
- Department of Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, 102600, China
| | - Lin Ma
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, China.
| | - Xiuhua Ma
- Department of Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, 102600, China.
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Thompson D, Leach M, Smith C, Fereday J, May E. How nurses and other health professionals use learning principles in parent education practice: A scoping review of the literature. Heliyon 2020; 6:e03564. [PMID: 32211543 PMCID: PMC7082510 DOI: 10.1016/j.heliyon.2020.e03564] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 11/21/2019] [Accepted: 01/27/2020] [Indexed: 12/26/2022] Open
Abstract
Background Health Professionals (HPs) play an important role in supporting parents to care for their children, by facilitating parents' knowledge and skills development through parent education. This is achieved through teaching, whereby planned strategies, based on principles of how people learn, enable learning. Despite Learning Principles being the fundamental tenets of the learning process, how HPs perceive and use Learning Principles in their practice is neglected in the healthcare literature. Objective To identify, describe and map the existing literature on nurses' and HPs' perceptions and use of Learning Principles in parent education practice. Method A scoping review was performed using the Joanna Briggs Institute approach. A comprehensive search of 10 databases and the grey literature was undertaken between March and June 2017 to identify pertinent English-language publications. The search was limited to literature published between 1998 and 2017. Following a screening and inclusion criteria eligibility check, 89 articles were selected for inclusion. Results HPs' perceptions of Learning Principles were diverse, somewhat disorganised, divergent in meaning and implicit. This was until the Dimensions of Learning construct was applied to guide the analyses and mapping. This revealed that HPs, of whom 60.7% were nurses, used Learning Principles in parent education, but only referred to them in the context of Adult Learning. Enablers to HPs using Learning Principles included shared partnerships between parents and HPs, while barriers included parents' health beliefs, psychological issues and organisational assumptions about learning. Evaluation of parents' learning also represented implicit use of Learning Principles by HPs. Conclusion This scoping review is the first to examine HPs' perceptions and use of Learning Principles within parent education practice. The findings reveal a significant gap in this body of knowledge. The paucity of studies containing any explicit descriptions of Learning Principles strongly supports the need for further exploration and codification of Learning Principles, through qualitative methods, whereby a deeper understanding of what is happening in healthcare practice can be established.
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Affiliation(s)
- Deryn Thompson
- University of South Australia, North Terrace, Adelaide, 5000, Australia
| | | | | | - Jennifer Fereday
- Women's and Children's Health Network, University of South Australia, Australia
| | - Esther May
- University of South Australia, Dean Academic and Clinical Education, Health Sciences, Australia
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32
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Cheng NS, Chau JPC, Hon KLE, Chow CM, Choi KC, Lo SHS, Leung TF. Translation and Validation of a Chinese Version of the Parental Self-Efficacy with Eczema Care Index. Dermatology 2020; 236:361-368. [PMID: 32018261 DOI: 10.1159/000505450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/12/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Parental self-efficacy has been found to be a critical determinant of the efficacy of interventions intended to enhance the parental management of childhood eczema. OBJECTIVES The psychometric properties of a translated Chinese version of the Parental Self-Efficacy with Eczema Care Index (C-PASECI) were examined. METHODS The PASECI was translated in a 2-stage process involving both forward and backward translation. Subsequently, the psychometric properties of the C-PASECI were examined in a cohort of 147 Chinese parents or caregivers of children with eczema. Specifically, the internal consistency, 2-day test-retest reliability and construct validity were assessed. RESULTS The C-PASECI received a Cronbach's αof 0.97, and the intraclass correlation coefficients of each item ranged from 0.93 to 0.99. Negative correlations were observed among the C-PASECI, Children's Dermatology Life Quality Index and Scoring Atopic Dermatitis Scale scores, indicating the acceptable convergent validity of the C-PASECI. The moderate correlation observed between the C-PASECI and General Self-Efficacy Scale (Pearson's r = 0.53, p < 0.001) reflected the acceptable concurrent validity of the C-PASECI. The results of confirmatory factor analysis supported the factorial validity of the C-PASECI. CONCLUSION The C-PASECI appears to be a reliable and valid measure of parental self-efficacy in Chinese parents or caregivers of children with eczema.
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Affiliation(s)
- Nam Sze Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong,
| | - Kam Lun Ellis Hon
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chung Mo Chow
- Department of Paediatrics, Prince of Wales Hospital, Shatin, Hong Kong
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ting Fan Leung
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Cowdell F, Jadotte YT, Ersser SJ, Danby S, Lawton S, Roberts A, Dyson J. Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. Cochrane Database Syst Rev 2020; 1:CD011377. [PMID: 32006460 PMCID: PMC6996088 DOI: 10.1002/14651858.cd011377.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Ageing has a degenerative effect on the skin, leaving it more vulnerable to damage. Hygiene and emollient interventions may help maintain skin integrity in older people in hospital and residential care settings; however, at present, most care is based on "tried and tested" practice, rather than on evidence. OBJECTIVES To assess the effects of hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. SEARCH METHODS We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL, up to January 2019. We also searched five trials registers. SELECTION CRITERIA Randomised controlled trials comparing hygiene and emollient interventions versus placebo, no intervention, or standard practices for older people aged ≥ 60 years in hospital or residential care settings. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. Primary outcomes were frequency of skin damage, for example, complete loss of integrity (tears or ulceration) or partial loss of integrity (fissuring), and side effects. Secondary outcomes included transepidermal water loss (TEWL), stratum corneum hydration (SCH), erythema, and clinical scores of dryness or itch. We used GRADE to assess the quality of evidence. MAIN RESULTS We included six trials involving 1598 residential care home residents; no included trial had a hospital setting. Most participants had a mean age of 80+ years; when specified, more women were recruited than men. Two studies included only people with diagnosed dry skin. Studies were conducted in Asia, Australasia, Europe, and North America. A range of hygiene and emollient interventions were assessed: a moisturising soap bar; combinations of water soak, oil soak, and lotion; regular application of a commercially available moisturiser; use of two different standardised skin care regimens comprising a body wash and leave-on body lotion; bed bath with "wash gloves" containing numerous ingredients; and application of a hot towel after usual care bed bath. In five studies, treatment duration ranged from five days to six months; only one study had post-treatment follow-up (one to eight days from end of treatment). Outcomes in the hot towel study were measured 15 minutes after the skin was wiped with a dry towel. Three studies each had high risk of attrition, detection, and performance bias. Only one trial (n = 984) assessed frequency of skin damage via average monthly incidence of skin tears during six months of treatment. The emollient group (usual care plus twice-daily application of moisturiser) had 5.76 tears per month per 1000 occupied bed-days compared with 10.57 tears in the usual care only group (ad hoc or no standardised skin-moisturising regimen) (P = 0.004), but this is based on very low-quality evidence, so we are uncertain of this result. Only one trial (n = 133) reported measuring side effects. At 56 ± 4 days from baseline, there were three undesirable effects (itch (mild), redness (mild/moderate), and irritation (severe)) in intervention group 1 (regimen consisting of a moisturising body wash and a moisturising leave-on lotion) and one event (mild skin dryness) in intervention group 2 (regimen consisting of body wash and a water-in-oil emulsion containing emollients and 4% urea). In both groups, the body wash was used daily and the emollient twice daily for eight weeks. There were zero adverse events in the usual care group. This result is based on very low-quality evidence. This same study also measured TEWL at 56 ± 4 days in the mid-volar forearm (n = 106) and the lower leg (n = 105). Compared to usual care, there may be no difference in TEWL between intervention groups, but evidence quality is low. One study, which compared application of a hot towel for 10 seconds after a usual care bed bath versus usual care bed bath only, also measured TEWL at 15 minutes after the skin was wiped with a dry towel for one second. The mean TEWL was 8.6 g/m²/h (standard deviation (SD) 3.2) in the hot towel group compared with 8.9 g/m²/h (SD 4.1) in the usual care group (low-quality evidence; n = 42), showing there may be little or no difference between groups. A lower score is more favourable. Three studies (266 participants) measured SCH, but all evidence is of very low quality; we did not combine these studies due to differences in treatments (different skin care regimens for eight weeks; wash gloves for 12 weeks; and single application of hot towel to the skin) and differences in outcome reporting. All three studies showed no clear difference in SCH at follow-up (ranging from 15 minutes after the intervention to 12 weeks from baseline), when compared with usual care. A clinical score of dryness was measured by three studies (including 245 participants); pooling was not appropriate. The treatment groups (different skin care regimens for eight weeks; a moisturising soap bar used for five days; and combinations of water soak, oil soak, and lotion for 12 days) may reduce dryness compared to standard care or no intervention (results measured at 5, 8, and 56 ± 4 days after treatment was initiated). However, the quality of evidence for this outcome is low. Outcomes of erythema and clinical score of itch were not assessed in any included studies. AUTHORS' CONCLUSIONS Current evidence about the effects of hygiene and emollients in maintaining skin integrity in older people in residential and hospital settings is inadequate. We cannot draw conclusions regarding frequency of skin damage or side effects due to very low-quality evidence. Low-quality evidence suggests that in residential care settings for older people, certain types of hygiene and emollient interventions (two different standardised skin care regimens; moisturising soap bar; combinations of water soak, oil soak, and lotion) may be more effective in terms of clinical score of dryness when compared with no intervention or standard care. Studies were small and generally lacked methodological rigour, and information on effect sizes and precision was absent. More clinical trials are needed to guide practice; future studies should use a standard approach to measuring treatment effects and should include patient-reported outcomes, such as comfort and acceptability.
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Affiliation(s)
- Fiona Cowdell
- Birmingham City UniversityFaculty of Health, Education and Life SciencesCity South CampusWestbourne Road, EdgbastonBirminghamUKB15 3TN
| | - Yuri T Jadotte
- Renaissance School of Medicine at Stony Brook UniversityDepartment of Family, Population and Preventive MedicineStony BrookNYUSA11794‐8434
| | - Steven J Ersser
- Bournemouth UniversityDepartment of Nursing ScienceRoom B401, 4th floor, Bournemouth House17 Christchurch RdBournemouthUKBH1 3LT
| | - Simon Danby
- The University of SheffieldSheffield Dermatology Research, Department of Infection, Immunity & Cardiovascular DiseaseBeech Hill RoadSheffieldUKS10 2RX
| | - Sandra Lawton
- Rotherham NHS Foundation TrustDepartment of DermatologyMoorgate RoadRotherhamUKS60 2UD
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with EczemaNottinghamUKNG5 4FG
| | - Judith Dyson
- City, University of LondonSchool of Health Sciences, Division of NursingLondonUK
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Xie QW, Dai X, Tang X, Chan CHY, Chan CLW. Risk of Mental Disorders in Children and Adolescents With Atopic Dermatitis: A Systematic Review and Meta-Analysis. Front Psychol 2019; 10:1773. [PMID: 31447731 PMCID: PMC6691144 DOI: 10.3389/fpsyg.2019.01773] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 07/16/2019] [Indexed: 12/30/2022] Open
Abstract
Assessing the psychological effects on children and adolescents of suffering atopic dermatitis (AD) is essential, when planning successful management. This study aimed to systematically review the literature regarding risk of mental disorders in children and adolescents with, or without, AD; and to explore confounders. We identified potentially relevant studies from EMBASE, MEDLINE, PsycINFO, ERIC, the British Nursing Index, the Family and Society Studies Worldwide, the Social Work Abstracts, and the Sociological Abstracts from inception to Sep 30, 2018. Investigators independently screened titles and abstracts, and then full-texts. Investigators independently extracted data from included studies. Meta-analyses using random-effects models were performed, reporting odds ratios (ORs; 95% CIs). Thirty-seven studies (n = 2,068,911 children/ adolescents) were included. Meta-analysis of 35 studies found that children and adolescents with AD had significantly higher risk of total mental disorders than those without AD (OR = 1.652; 95% CI, 1.463-1.864). There was no significant difference in risks for ADHD (OR = 1.563; 95% CI, 1.382-1.769); sleep disorders (OR = 2.100; 95% CI, 1.322-3.336); anxiety (OR = 1.339; 95% CI, 1.062-1.687); depression (OR = 1.402 95% CI, 1.256-1.565); conduct disorder (OR = 1.494 95% CI, 1.230-1.815); or ASD (OR = 2.574; 95% CI, 1.469-4.510; Q b = 8.344, p = 0.138). Race/ethnicity of child, target of comparison, type of studies, representativeness of the sample, measures of AD and mental disorders were significant moderators for total mental disorders. Integrated, holistic, multidisciplinary management of pediatric AD is significantly important, which emphasizes the well-being of the whole person.
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Affiliation(s)
- Qian-Wen Xie
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Xiaolu Dai
- Department of Social Work and Social Administration, Changsha Social Work College, Changsha, China
| | - Xinfeng Tang
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Celia H. Y. Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Cecilia L. W. Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
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Cowdell F. Knowledge mobilisation: an exploratory qualitative interview study to confirm and envision modification of lay and practitioner eczema mindlines to improve consultation experiences and self-management in primary care in the UK. BMJ Open 2019; 9:e028225. [PMID: 31256031 PMCID: PMC6609068 DOI: 10.1136/bmjopen-2018-028225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/10/2019] [Accepted: 05/31/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To investigate whether initial eczema mindlines, 'collectively reinforced, internalised, tacit guidelines', are an accurate representation of the experiences of lay people and practitioners in primary care and to explore how these mindlines may best be revised to improve eczema care. DESIGN Exploratory qualitative interviews with constant comparative analysis and data mining. SETTING UK, primary care. PARTICIPANTS People with eczema or parents of children with eczema (n=19) and primary care practitioners (n=13). RESULTS Interview data were analysed using constant comparison of new data with existing initial eczema mindlines to identify areas of agreement and disagreement. Data were mined for participant's thoughts about whose mindlines should be modified, how this may be achieved and what core content is essential. Eczema mindlines and the spiral of knowledge creation, from which they evolved, intuitively made sense. Participants offered examples of how their eczema knowledge is continually produced and transformed as they interact with others. They reported diverse and wide-ranging influences on their thinking and recognised the critical relationship between lay and practitioner mindlines. For this reason they advocated modifying lay and practitioner mindlines in parallel. Participants advised amendment based on consistent information directed to all who influence eczema care. Information should come from trusted sources and be easy to access, distilled, practical, contextually relevant and amenable to assimilation. CONCLUSIONS The purpose here is to improve primary care consultation experiences and self-management in eczema. The remaining challenge is to find novel, simple and pragmatic methods of modifying eczema mindlines to instil shared and consistent understanding. Given the prevalence of eczema and the scope of people who influence self-care, interventions should transcend patient-practitioner boundaries and address the wider community. One conceptually congruent approach is to create a Ba, which in this case would be a virtual space for generating and sharing eczema knowledge.
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Affiliation(s)
- Fiona Cowdell
- Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK
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Rajagopalan M, De A, Godse K, Krupa Shankar DS, Zawar V, Sharma N, Mukherjee S, Sarda A, Dhar S. Guidelines on Management of Atopic Dermatitis in India: An Evidence-Based Review and an Expert Consensus. Indian J Dermatol 2019; 64:166-181. [PMID: 31148854 PMCID: PMC6537677 DOI: 10.4103/ijd.ijd_683_18] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a common and chronic, pruritic inflammatory skin condition that affects all age groups. There was a dearth of consensus document on AD for Indian practitioners. This article aims to provide an evidence-based consensus statement for the management of AD with a special reference to the Indian context. This guideline includes updated definition, etiological factors, classification, and management of atopic dermatitis. METHODOLOGY The preparation of guidelines was done in multiple phases. Indian Dermatology Expert Board Members (DEBM), recommended by the Skin Allergy Society of India, prepared 26 evidence-based recommendations for AD. An extensive literature search was done in MEDLINE, Google scholar, Cochrane, and other resources. Articles published in the past 10 years were reviewed and recommendations were graded based on the quality of evidence as per GRADE. After forming the initial structure, DEBM met in Mumbai and gave their decisions on an agree and disagree scale with an Indian perspective. Finally, their suggestions were compiled for preparing the article. After DEBM finalized the draft, a treatment algorithm was formulated for the management of AD. RESULTS DEBM suggested a working definition for AD. The panel agreed that moisturizers should be used as mainstay of therapy and should be continued in all lines of therapy and in maintenance phase. Topical corticosteroids and topical calcineurin inhibitors should be considered as the first line of treatment. Among systemic therapies, cyclosporin should be considered first line, followed by azathioprine, methotrexate, and mycophenolate mofetil. Phototherapy can be an effecive alternative. Empirical food restriction was recommended against. CONCLUSION These guidelines should form a reference for the management of patients with AD in an evidence-based manner.
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Affiliation(s)
| | - Abhishek De
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Kiran Godse
- Department of Dermatology, D Y Patil Hospital, Navi Mumbai, Maharashtra, India
| | - D S Krupa Shankar
- Department of Dermatology, Mallige Hospital, Bengaluru, Karnataka, India
| | - Vijay Zawar
- Department of Dermatology, Skin Diseases Center, Nashik, Maharashtra, India
| | - Nidhi Sharma
- Department of Dermatology, The Medicity, Medanta Hospital, Gurugram, Haryana, India
| | - Samipa Mukherjee
- Department of Dermatology, Cloud Nine Hospitals, Bengaluru, Karnataka, India
| | - Aarti Sarda
- Department of Dermatology, Wizderm Specialty Skin and Hair Clinic, Kolkata, West Bengal, India
| | - Sandipan Dhar
- Department of Dermatology, Institute of Child Health, Kolkata, West Bengal, India
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Law E, Fisher E, Eccleston C, Palermo TM. Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database Syst Rev 2019; 3:CD009660. [PMID: 30883665 PMCID: PMC6450193 DOI: 10.1002/14651858.cd009660.pub4] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Psychological therapies for parents of children and adolescents with chronic illness aim to improve parenting behavior and mental health, child functioning (behavior/disability, mental health, and medical symptoms), and family functioning.This is an updated version of the original Cochrane Review (2012) which was first updated in 2015. OBJECTIVES To evaluate the efficacy and adverse events of psychological therapies for parents of children and adolescents with a chronic illness. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and trials registries for studies published up to July 2018. SELECTION CRITERIA Included studies were randomized controlled trials (RCTs) of psychological interventions for parents of children and adolescents with a chronic illness. In this update we included studies with more than 20 participants per arm. In this update, we included interventions that combined psychological and pharmacological treatments. We included comparison groups that received either non-psychological treatment (e.g. psychoeducation), treatment as usual (e.g. standard medical care without added psychological therapy), or wait-list. DATA COLLECTION AND ANALYSIS We extracted study characteristics and outcomes post-treatment and at first available follow-up. Primary outcomes were parenting behavior and parent mental health. Secondary outcomes were child behavior/disability, child mental health, child medical symptoms, and family functioning. We pooled data using the standardized mean difference (SMD) and a random-effects model, and evaluated outcomes by medical condition and by therapy type. We assessed risk of bias per Cochrane guidance and quality of evidence using GRADE. MAIN RESULTS We added 21 new studies. We removed 23 studies from the previous update that no longer met our inclusion criteria. There are now 44 RCTs, including 4697 participants post-treatment. Studies included children with asthma (4), cancer (7), chronic pain (13), diabetes (15), inflammatory bowel disease (2), skin diseases (1), and traumatic brain injury (3). Therapy types included cognitive-behavioural therapy (CBT; 21), family therapy (4), motivational interviewing (3), multisystemic therapy (4), and problem-solving therapy (PST; 12). We rated risk of bias as low or unclear for most domains, except selective reporting bias, which we rated high for 19 studies due to incomplete outcome reporting. Evidence quality ranged from very low to moderate. We downgraded evidence due to high heterogeneity, imprecision, and publication bias.Evaluation of parent outcomes by medical conditionPsychological therapies may improve parenting behavior (e.g. maladaptive or solicitous behaviors; lower scores are better) in children with cancer post-treatment and follow-up (SMD -0.28, 95% confidence interval (CI) -0.43 to -0.13; participants = 664; studies = 3; SMD -0.21, 95% CI -0.37 to -0.05; participants = 625; studies = 3; I2 = 0%, respectively, low-quality evidence), chronic pain post-treatment and follow-up (SMD -0.29, 95% CI -0.47 to -0.10; participants = 755; studies = 6; SMD -0.35, 95% CI -0.50 to -0.20; participants = 678; studies = 5, respectively, moderate-quality evidence), diabetes post-treatment (SMD -1.39, 95% CI -2.41 to -0.38; participants = 338; studies = 5, very low-quality evidence), and traumatic brain injury post-treatment (SMD -0.74, 95% CI -1.25 to -0.22; participants = 254; studies = 3, very low-quality evidence). For the remaining analyses data were insufficient to evaluate the effect of treatment.Psychological therapies may improve parent mental health (e.g. depression, anxiety, lower scores are better) in children with cancer post-treatment and follow-up (SMD -0.21, 95% CI -0.35 to -0.08; participants = 836, studies = 6, high-quality evidence; SMD -0.23, 95% CI -0.39 to -0.08; participants = 667; studies = 4, moderate-quality evidence, respectively), and chronic pain post-treatment and follow-up (SMD -0.24, 95% CI -0.42 to -0.06; participants = 490; studies = 3; SMD -0.20, 95% CI -0.38 to -0.02; participants = 482; studies = 3, respectively, low-quality evidence). Parent mental health did not improve in studies of children with diabetes post-treatment (SMD -0.24, 95% CI -0.90 to 0.42; participants = 211; studies = 3, very low-quality evidence). For the remaining analyses, data were insufficient to evaluate the effect of treatment on parent mental health.Evaluation of parent outcomes by psychological therapy typeCBT may improve parenting behavior post-treatment (SMD -0.45, 95% CI -0.68 to -0.21; participants = 1040; studies = 9, low-quality evidence), and follow-up (SMD -0.26, 95% CI -0.42 to -0.11; participants = 743; studies = 6, moderate-quality evidence). We did not find evidence for a beneficial effect for CBT on parent mental health at post-treatment or follow-up (SMD -0.19, 95% CI -0.41 to 0.03; participants = 811; studies = 8; SMD -0.07, 95% CI -0.34 to 0.20; participants = 592; studies = 5; respectively, very low-quality evidence). PST may improve parenting behavior post-treatment and follow-up (SMD -0.39, 95% CI -0.64 to -0.13; participants = 947; studies = 7, low-quality evidence; SMD -0.54, 95% CI -0.94 to -0.14; participants = 852; studies = 6, very low-quality evidence, respectively), and parent mental health post-treatment and follow-up (SMD -0.30, 95% CI -0.45 to -0.15; participants = 891; studies = 6; SMD -0.21, 95% CI -0.35 to -0.07; participants = 800; studies = 5, respectively, moderate-quality evidence). For the remaining analyses, data were insufficient to evaluate the effect of treatment on parent outcomes.Adverse eventsWe could not evaluate treatment safety because most studies (32) did not report on whether adverse events occurred during the study period. In six studies, the authors reported that no adverse events occurred. The remaining six studies reported adverse events and none were attributed to psychological therapy. We rated the quality of evidence for adverse events as moderate. AUTHORS' CONCLUSIONS Psychological therapy may improve parenting behavior among parents of children with cancer, chronic pain, diabetes, and traumatic brain injury. We also found beneficial effects of psychological therapy may also improve parent mental health among parents of children with cancer and chronic pain. CBT and PST may improve parenting behavior. PST may also improve parent mental health. However, the quality of evidence is generally low and there are insufficient data to evaluate most outcomes. Our findings could change as new studies are conducted.
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Affiliation(s)
- Emily Law
- Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
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Klinnert MD, Booster G, Copeland M, Darr JM, Meltzer LJ, Miller M, Oland A, Perry S, Wise BK, Bender BG. Role of behavioral health in management of pediatric atopic dermatitis. Ann Allergy Asthma Immunol 2019; 120:42-48.e8. [PMID: 29273127 DOI: 10.1016/j.anai.2017.10.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/04/2017] [Accepted: 10/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To describe the behavioral components and complications in treating pediatric patients with atopic dermatitis (AD) and the critical role of behavioral health professionals in addressing disease impact and behavioral aspects of disease management for these patients and families. DATA SOURCES Studies and review articles were selected from medical and psychology databases for relevance to pertinent topics. RESULTS AD has significant negative effects in affected individuals and their families on quality of life, behavioral, emotional, and sleep disturbances, and family functioning. Effective treatment strategies for AD are available, but the challenges for children and parents in coping with disease-related concerns and in following through with the multiple aspects of treatment are considerable. A biopsychosocial model, which incorporates the interplay among biological, psychological, and social dimensions of medical care, can be implemented in various treatment settings to achieve an integrated medical and behavioral health care approach. By sharing a family orientation, using a stress and coping model, and taking into account children's developmental capabilities and concerns, medical and behavioral health care providers are equipped to bring an in-depth understanding and different evidence-based therapeutic tools to address emotional, behavioral, and interpersonal challenges imposed by moderate to severe AD in children and families. CONCLUSION Behavioral health and medical providers working together to provide integrated care play a critical role in helping children and families cope with the burdens imposed by AD, successfully manage the disease, and achieve optimal quality of life for affected children and their families.
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Affiliation(s)
- Mary D Klinnert
- National Jewish Health, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado.
| | | | | | | | - Lisa J Meltzer
- National Jewish Health, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | | | - Alyssa Oland
- National Jewish Health, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - Bruce G Bender
- National Jewish Health, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado
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Hon KL, Leong KF, Leung TN, Leung AK. Dismissing the fallacies of childhood eczema management: case scenarios and an overview of best practices. Drugs Context 2018; 7:212547. [PMID: 30532792 PMCID: PMC6281040 DOI: 10.7573/dic.212547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Eczema or atopic dermatitis (AD) is a common relapsing childhood dermatologic illness. Treatment of AD is primarily topical with emollients and corticosteroid/calcineurin inhibitor, which is efficacious for the majority of patients. However, AD is often complicated and difficult to manage in many Asian cities. Effective therapy is impeded by fallacies in the following aspects: (1) mistrust and unrealistic expectations about Western medicine, (2) skin care and allergy treatment, (3) ambiguity about optimal bathing and moisturizing, (4) hesitation and phobias about the usage of adequate topical corticosteroid and immunomodulatory therapies, (5) food and aeroallergen avoidance and dietary supplementation, and (6) complementary and alternative therapies. METHODS AND RESULTS Eleven anonymized case scenarios are described to illustrate issues associated with these fallacies. A literature review is performed and possible solutions to handle or dismiss these fallacies are discussed. CONCLUSIONS The first step in patient care is to accurately assess the patient and the family to evaluate possible concerns, anxiety, and phobias that could impede therapeutic efficacy. Education about the disease should be individualized. Conflicting recommendations on the usage of topical steroid have a detrimental effect on management outcomes, which must be avoided.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
| | - Kin Fon Leong
- Institut Pediatrik, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | - Theresa Nh Leung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Alexander Kc Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
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Takaoka R, Coelho E. Patient Education in Atopic Dermatitis: Why It Is Needed and How to Improve It. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0241-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Lu CL, Liu XH, Stub T, Kristoffersen AE, Liang SB, Wang X, Bai X, Norheim AJ, Musial F, Araek T, Fonnebo V, Liu JP. Complementary and alternative medicine for treatment of atopic eczema in children under 14 years old: a systematic review and meta-analysis of randomized controlled trials. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 18:260. [PMID: 30257693 PMCID: PMC6158902 DOI: 10.1186/s12906-018-2306-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 08/09/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Due to limitations of conventional medicine for atopic eczema (AE), complementary and alternative medicine (CAM) is widely used as an alternative, maintaining, or simultaneous treatment for AE. We aimed to evaluate the beneficial and harmful effects of CAM for children with AE under 14 years old. METHODS We searched for randomized trials on CAM in 12 Chinese and English databases from their inception to May 2018. We included children (< 14 years) diagnosed with AE, who received CAM therapy alone or combined with conventional medicine. We extracted data, and used the Cochrane "Risk of bias" tool to assess methodological quality. Effect was presented as relative risk (RR) or mean difference (MD) with 95% confidence interval (CI) using RevMan 5.3. RESULTS Twenty-four randomized controlled trials involving 2233 children with AE were included. Methodological quality was of unclear or high risk of bias in general. The trials tested 5 different types of CAM therapies, including probiotics, diet, biofilm, borage oil, and swimming. Compared to placebo, probiotics showed improved effect for the SCORAD index (MD 9.01, 95% CI 7.12-10.90; n = 5). For symptoms and signs such as itching, skin lesions, CAM combined with usual care was more effective for symptom relief ≥95% (RR 1.47, 95% CI 1.30-1.68; n = 8), and for ≥50% symptoms improvement (RR 1.34, 1.25-1.45; n = 9) compared to usual care. There was no statistic significant difference between CAM and usual care on ≥95% improvement or ≥ 50% improvement of symptoms. However, swimming, diet and biofilm showed improvement of clinical symptoms compared with usual care. At follow-up of 8 weeks to 3 years, CAM alone or combined with usual care showed lower relapse rate (RR 0.38, 0.28-0.51, n = 2; RR 0.31, 0.24-0.40, n = 7; respectively) compared to usual care. Twelve out of 24 trials reported no occurrence of severe adverse events. CONCLUSIONS Low evidence demonstrates that some CAM modalities may improve symptoms of childhood AE and reduce relapse rate. Safety remains unclear due to insufficient reporting. Further well-designed randomized trials are needed to confirm the potential beneficial effect and to establish safety use.
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Affiliation(s)
- Chun-li Lu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029 China
| | - Xue-han Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029 China
| | - Trine Stub
- The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9037 Tromsø, Norway
| | - Agnete E. Kristoffersen
- The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9037 Tromsø, Norway
| | - Shi-bing Liang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029 China
- School of Basic Medicine, Shanxi University of Chinese Medicine, Taiyuan, 030000 China
| | - Xiao Wang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029 China
| | - Xue Bai
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029 China
| | - Arne Johan Norheim
- The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9037 Tromsø, Norway
| | - Frauke Musial
- The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9037 Tromsø, Norway
| | - Terje Araek
- The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9037 Tromsø, Norway
| | - Vinjar Fonnebo
- The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9037 Tromsø, Norway
| | - Jian-ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029 China
- The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9037 Tromsø, Norway
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Cowdell F. Knowledge mobilisation: an ethnographic study of the influence of lay mindlines on eczema self-management in primary care in the UK. BMJ Open 2018; 8:e021498. [PMID: 30158225 PMCID: PMC6119411 DOI: 10.1136/bmjopen-2018-021498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To investigate the way in which mindlines, 'collectively reinforced, internalised tacit guidelines', are constructed among lay people with eczema in primary care. DESIGN Ethnographic study. SETTING Observation in one general practice in the UK and interviews across central England. PARTICIPANTS In observation, patients in the participating general practice regardless of presenting complaint and in interviews, people with eczema or parents of children with eczema (n=16). RESULTS Observation of over 250 hours and interview data were combined and analysed using an ethnographic approach through the lenses of mindlines and self-management. Four themes were identified: doctor knows best; not worth bothering the doctor; I need to manage this myself; and how I know what to do. Themes were set within the context of four broad typologies of lay people's approach to self-management: content to self-manage; content to accept practitioner management; self-managing by default; and those referred to secondary care. CONCLUSIONS This study is the first to examine how lay eczema mindlines are developed and to recognise typologies of people with different need for, and receptiveness to, information. Lay eczema mindlines are constructed in many ways. The outstanding challenge is to find strategies to revise or modify these mindlines by adding reliable and useful knowledge and by erasing outdated or inaccurate information.
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Affiliation(s)
- Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Mitchell AE. Bidirectional relationships between psychological health and dermatological conditions in children. Psychol Res Behav Manag 2018; 11:289-298. [PMID: 30104911 PMCID: PMC6074762 DOI: 10.2147/prbm.s117583] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Dermatological conditions are common among children. They are a frequent cause of presentation to health care services and a leading contributor to burden of disease. Evidence supports the notion that bidirectional relationships exist between children’s physical and psychological health, whereby the child’s dermatological condition can impact their psychological health and well-being, while, in the reverse direction, psychological factors (eg, stress) can impact the severity and course of the child’s skin disease. The psychological impact of dermatological conditions in childhood needs to be taken into account during the assessment, planning, and treatment phases of management. Likewise, the potential effect of children’s emotional and behavioral difficulties on management, particularly in terms of the impact on parents’ ability to implement their child’s treatment plan, should be considered. This literature review summarizes the current evidence for the relationships between three common chronic dermatological conditions of childhood – atopic dermatitis, psoriasis, and urticaria – and psychological adjustment and quality of life in childhood. Overall, a general paucity of research in the pediatric context – combined with limitations in terms of study design, variability in operationalization of constructs, and heterogeneity in measurement of outcomes – makes it difficult to draw firm conclusions in this area. Based on the available research, implications for successful long-term management of these conditions are discussed in terms of integrating psychological and parenting support with medical management to improve adherence, reduce disease severity, and improve quality of life for children and their families.
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Affiliation(s)
- Amy E Mitchell
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, QLD, Australia,
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Schmidt S, Markwart H, Bomba F, Muehlan H, Findeisen A, Kohl M, Menrath I, Thyen U. Differential effect of a patient-education transition intervention in adolescents with IBD vs. diabetes. Eur J Pediatr 2018; 177:497-505. [PMID: 29340756 DOI: 10.1007/s00431-017-3080-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 12/19/2017] [Accepted: 12/27/2017] [Indexed: 11/26/2022]
Abstract
UNLABELLED Patient education programs (PEPs) to improve disease management are part of standard and regular treatment in adolescents with diabetes. In Germany, youth with inflammatory bowel disease (IBD) receive individual counseling but not PEPs in group settings. Generic PEPs have been developed in order to improve transition from child-centered to adolescent health services. The aim of the study was to investigate the effects of a transition-oriented PEP on quality of life (QoL) and self-management in young patients with IBD (PEP naive), compared to patients with diabetes (familiar with PEPs). A 2-day transition workshop was oriented at improving psychosocial skills and addressed both generic as well as specific aspects of the condition. A controlled trial on the outcomes of a generic transition-oriented PEP was conducted in 14- to 20-year-old patients with IBD (n = 99) and diabetes (n = 153). Transition competence and QoL were assessed at baseline and 6-month follow-up. Results show that the intervention lead to a significant increase in QoL only in patients with IBD. The PEP significantly improved transition competence in both groups, however to a higher extent in subjects with IBD. CONCLUSION Transition-oriented PEPs can have differential effects in different patient groups. However, this needs further longitudinal investigations. What is Known: • To date, evidence has accumulated concerning the effectiveness of patient education programs (PEPs) in pediatric health care for chronic conditions such as type 1 diabetes, asthma, atopic dermatitis, or obesity but is less documented in inflammatory bowel disease (IBD). In particular, PEPs in the transition period have not been investigated in youth with IBD. • The current study focuses on evaluating a PEP for transition preparation and management designed to be generically used across different chronic conditions since many aspects of managing chronic conditions share commonalities across conditions. The 2-day workshop included condition-specific modules adapted to the specific medical needs but was otherwise similar in quality and organization among different conditions. What is New: • The transition-oriented PEP was effective in enhancing self-management and transition management skills in both patients with IBD and diabetes; however, effects were higher in youth with IBD. A significant impact of the intervention on patients' QoL compared to the control group was only identified in youth with IBD. • We recommend that patients with IBD have access to PEP as a standard treatment as well as to a transition program during the course of illness.
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Affiliation(s)
- Silke Schmidt
- Department Health and Prevention, Institute of Psychology, Ernst-Moritz-Arndt-University of Greifswald, Robert-Blum-Str. 13, 17487, Greifswald, Germany.
| | - Henriette Markwart
- Department Health and Prevention, Institute of Psychology, Ernst-Moritz-Arndt-University of Greifswald, Robert-Blum-Str. 13, 17487, Greifswald, Germany
| | - Franziska Bomba
- Department of Child and Adolescent Medicine, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Holger Muehlan
- Department Health and Prevention, Institute of Psychology, Ernst-Moritz-Arndt-University of Greifswald, Robert-Blum-Str. 13, 17487, Greifswald, Germany
| | - Annette Findeisen
- Department of Child and Adolescent Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Martina Kohl
- Department of Child and Adolescent Medicine, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Ingo Menrath
- Department of Child and Adolescent Medicine, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Ute Thyen
- Department of Child and Adolescent Medicine, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
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Long-term treatment with low-dose medicine in chronic childhood eczema: a double-blind two-stage randomized control trial. Ital J Pediatr 2017; 43:78. [PMID: 28874171 PMCID: PMC5585968 DOI: 10.1186/s13052-017-0393-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/17/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The efficacy of low-dose medicine (LDM) in childhood mild/moderate eczema is not known. We conducted a double-blind, two-stage, randomized, placebo-controlled clinical trial, lasting 23 months, to address this issue. METHOD Eighty children with chronic mild/moderate eczema were randomly allocated to Group A (placebo) or Group B (treatment group; Galium-Heel®, a low-dose multicomponent medicine based upon natural substances; Guna-Interleukin 12 and Guna-Interferon-γ administered twice a day for six non-consecutive months for each stage). LDM is characterized by the use of biological molecules, such as cytokines, neuropeptides, growth factors, hormones at very low concentrations, which correspond to physiological levels within the human body. The dosage of the cytokines used in this trial (IFN-γ and IL-12) is 10 fg/ml. The SCORAD index was evaluated by the same operator: subjects with a SCORAD index below 20 were considered to have mild eczema (61/80; mean: 10.79), whereas a SCORAD index between 20-50 indicated moderate eczema (19/80; mean: 26.84). The data of 66/80 children were analyzed in stage 1 and those of 62/66 children in stage 2. The primary outcome measure was reduction of eczema severity assessed by the SCORAD index. Secondary outcomes were disease-free interval, and treatment safety and tolerability. RESULTS The decrease in disease severity was greater in Group B than in Group A already in stage 1 (a decrease 63.9% versus 53.2%), but the difference was not significant (p = 0.16). Moreover, subjective symptoms (itching and sleep disturbances) initially decreased and then worsened in Group A, whereas itching decreased linearly and sleep disturbances decreased significantly (p=0.049) in Group B. CONCLUSIONS Preliminary evidence suggests potential benefit, but further work is needed to validate this approach. TRIAL REGISTRATION The trial was registered with EudraCT number 2010-018640-13 through the database of the National Clinical Trials Monitoring Centre Database (Osservatorio delle Sperimentazioni Cliniche, OsSC) of the Italian Medicines Agency.
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Ridd MJ, King AJL, Le Roux E, Waldecker A, Huntley AL. Systematic review of self-management interventions for people with eczema. Br J Dermatol 2017; 177:719-734. [PMID: 28432696 PMCID: PMC5637890 DOI: 10.1111/bjd.15601] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 01/25/2023]
Abstract
Eczema is a common long‐term condition, but inadequate support and information can lead to poor adherence and treatment failure. We have reviewed the international literature of interventions designed to promote self‐management in adults and children with eczema. MEDLINE, MEDLINE in process, Embase, CINAHL and the Global Resource for EczemA Trials database were searched from their inception to August 2016, for randomized controlled trials. Two authors independently applied eligibility criteria, assessed risk of bias for all included studies and extracted data. Twenty studies (3028 participants) conducted in 11 different countries were included. The majority (n = 18) were based in secondary care and most (n = 16) targeted children with eczema. Reporting of studies, including descriptions of the interventions and the outcomes themselves, was generally poor. Thirteen studies were face‐to‐face educational interventions, five were delivered online and two were studies of written action plans. Follow‐up in most studies (n = 12) was short term (up to 12 weeks). Only six trials specified a single primary outcome. There was limited evidence of effectiveness. Only three studies collected and reported outcomes related to cost and just one study undertook any formal cost‐effectiveness analysis. In summary, we have identified a general absence of well‐conducted and well‐reported randomized controlled trials with a strong theoretical basis. Therefore, there is still uncertainty about how best to support self‐management of eczema in a clinically effective and cost‐effective way. Recommendations on design and conduct of future trials are presented. What's already known about this topic? Eczema requires a high degree of self‐management by patients. Adherence to eczema treatments, and hence control of symptoms, can be poor. There is uncertainty about how best to support self‐management in a clinically effective and cost‐effective way.
What does this study add?A wide range of interventions designed to promote self‐management have been evaluated in 20 studies across 11 different countries. Reporting of the design and conduct of these studies is generally poor, and explicit theory describing how interventions are expected to improve care is uncommon. What works best for people with eczema and whether it is cost‐effective is unknown. Recommendations for future trials are made.
Linked Comment: Arents. Br J Dermatol 2017; 177:613–614 Plain language summary available online
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Affiliation(s)
- M J Ridd
- School of Social and Community Medicine, University of Bristol, Bristol, U.K
| | - A J L King
- School of Social and Community Medicine, University of Bristol, Bristol, U.K
| | - E Le Roux
- School of Social and Community Medicine, University of Bristol, Bristol, U.K
| | - A Waldecker
- School of Social and Community Medicine, University of Bristol, Bristol, U.K
| | - A L Huntley
- School of Social and Community Medicine, University of Bristol, Bristol, U.K
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Abstract
Atopic dermatitis (AD) is an intensely pruritic dermatosis that develops most commonly during early infancy and childhood and may follow a chronic, relapsing course into adulthood. As a chronic disease, AD requires treatment over an extended period of time, and is therefore difficult to treat. The main difficulty stems from poor adherence to treatment by patients for reasons such as frustration with medication efficacy, inconvenience, and fear of side effects. Methods that improve adherence include creating therapeutic plans with patient preferences in mind, early follow-up visit, increasing patient education through workshops, and discussing with patients and their caretakers their fears about treatment methods. AD can be exceedingly detrimental to a patient's quality of life. Simple measures to improve adherence may improve patients' treatment outcomes and quality of life.
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El Hachem M, Gesualdo F, Ricci G, Diociaiuti A, Giraldi L, Ametrano O, Occella C, Fortina AB, Milioto M, Arcangeli F, Simonetti O, Giancristoforo S, Calamelli E, Mazzatenta C, Neri I. Topical corticosteroid phobia in parents of pediatric patients with atopic dermatitis: a multicentre survey. Ital J Pediatr 2017; 43:22. [PMID: 28245844 PMCID: PMC5330138 DOI: 10.1186/s13052-017-0330-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 01/14/2017] [Indexed: 11/26/2022] Open
Abstract
Background Families of children affected with atopic dermatitis (AD) often report fear and anxiety regarding treatment with topical corticosteroids (TCS), which may lead to reduced compliance. The objective of our study was to measure, through a standardized questionnaire, fear of TCS in families of pediatric patients with AD and to identify items associated with fear. Methods Families of pediatric patients with AD were enrolled in 9 Italian centers of pediatric dermatology. Enrolled parents were invited to fill in a questionnaire including questions on sociodemographic and clinical characteristics and 3 sets of questions on corticosteroid phobia (general fear, specific fears, behaviours regarding TCS). Determinants of the level of general fear were investigated through multivariable analysis. Results A total of 300 outpatients with AD were enrolled. Most parents (80%) had a high instruction level. Eighty-one percent reported to have a certain amount of fear of TCS. At the multivariable analysis, fear of TCS was associated with the following items: believing that TCS treatment advantages do not overweight disadvantages (P = 0.011); believing that TCS may be dangerous independently from the specific side effect (P < 0.001). Moreover, TCS fear was associated with fear of applying too much cream (P = 0.001). Conclusion TCS phobia is widespread among Italian families of children with AD. Fear of TCS is associated with fear of applying too much cream, thus increasing the risk of poor compliance and treatment failure. Therapeutic education of families on the use of TCS should be implemented. Electronic supplementary material The online version of this article (doi:10.1186/s13052-017-0330-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maya El Hachem
- Pediatric Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesco Gesualdo
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Giampaolo Ricci
- Department of Medical and Surgical Sciences, Pediatric Unit, S. Orsola-Malpighi Hospital - University of Bologna, Bologna, Italy
| | - Andrea Diociaiuti
- Pediatric Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Loredana Giraldi
- Pediatric Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Ametrano
- Pediatric Dermatology, AORN Santobono-Pausilipon, Naples, Italy
| | | | - Anna Belloni Fortina
- Department of Medicine, Pediatric Dermatology Unit, University of Padua, Padua, Italy
| | - Mirella Milioto
- Department of Medicine, Unit of Pediatric Dermatology, ARNAS Civico, Palermo, Italy
| | | | - Oriana Simonetti
- Department of Clinical and Molecular Sciences, Clinic of Dermatology, Università Politecnica delle Marche, Ancona, Italy
| | | | - Elisabetta Calamelli
- Department of Medical and Surgical Sciences, Pediatric Unit, S. Orsola-Malpighi Hospital - University of Bologna, Bologna, Italy
| | | | - Iria Neri
- Division of Dermatology, Department of Specialised, Experimental and Diagnostic Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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van Zuuren EJ, Fedorowicz Z, Christensen R, Lavrijsen A, Arents BWM. Emollients and moisturisers for eczema. Cochrane Database Syst Rev 2017; 2:CD012119. [PMID: 28166390 PMCID: PMC6464068 DOI: 10.1002/14651858.cd012119.pub2] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Eczema is a chronic skin disease characterised by dry skin, intense itching, inflammatory skin lesions, and a considerable impact on quality of life. Moisturisation is an integral part of treatment, but it is unclear if moisturisers are effective. OBJECTIVES To assess the effects of moisturisers for eczema. SEARCH METHODS We searched the following databases to December 2015: Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, LILACS, the GREAT database. We searched five trials registers and checked references of included and excluded studies for further relevant trials. SELECTION CRITERIA Randomised controlled trials in people with eczema. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. MAIN RESULTS We included 77 studies (6603 participants, mean age: 18.6 years, mean duration: 6.7 weeks). We assessed 36 studies as at a high risk of bias, 34 at unclear risk, and seven at low risk. Twenty-four studies assessed our primary outcome 'participant-assessed disease severity', 13 assessed 'satisfaction', and 41 assessed 'adverse events'. Secondary outcomes included investigator-assessed disease severity (addressed in 65 studies), skin barrier function (29), flare prevention (16), quality of life (10), and corticosteroid use (eight). Adverse events reporting was limited (smarting, stinging, pruritus, erythema, folliculitis).Six studies evaluated moisturiser versus no moisturiser. 'Participant-assessed disease severity' and 'satisfaction' were not assessed. Moisturiser use yielded lower SCORAD than no moisturiser (three studies, 276 participants, mean difference (MD) -2.42, 95% confidence interval (CI) -4.55 to -0.28), but the minimal important difference (MID) (8.7) was unmet. There were fewer flares with moisturisers (two studies, 87 participants, RR 0.40, 95% CI 0.23 to 0.70), time to flare was prolonged (median: 180 versus 30 days), and less topical corticosteroids were needed (two studies, 222 participants, MD -9.30 g, 95% CI -15.3 to -3.27). There was no statistically significant difference in adverse events (one study, 173 participants, risk ratio (RR) 15.34, 95% CI 0.90 to 261.64). Evidence for these outcomes was low quality.With Atopiclair (three studies), 174/232 participants experienced improvement in participant-assessed disease severity versus 27/158 allocated to vehicle (RR 4.51, 95% CI 2.19 to 9.29). Atopiclair decreased itching (four studies, 396 participants, MD -2.65, 95% CI -4.21 to -1.09) and achieved more frequent satisfaction (two studies, 248 participants, RR 2.14, 95% CI 1.58 to 2.89), fewer flares (three studies, 397 participants, RR 0.18, 95% CI 0.11 to 0.31), and lower EASI (four studies, 426 participants, MD -4.0, 95% CI -5.42 to -2.57), but MID (6.6) was unmet. The number of participants reporting adverse events was not statistically different (four studies, 430 participants, RR 1.03, 95% CI 0.79 to 1.33). Evidence for these outcomes was moderate quality.Participants reported skin improvement more frequently with urea-containing cream than placebo (one study, 129 participants, RR 1.28, 95% CI 1.06 to 1.53; low-quality evidence), with equal satisfaction between the two groups (one study, 38 participants, low-quality evidence). Urea-containing cream improved dryness (investigator-assessed) more frequently (one study, 128 participants, RR 1.40, 95% CI 1.14 to 1.71; moderate-quality evidence) with fewer flares (one study, 44 participants, RR 0.47, 95% CI 0.24 to 0.92; low-quality evidence), but more participants in this group reported adverse events (one study, 129 participants, RR 1.65, 95% CI 1.16 to 2.34; moderate-quality evidence).Three studies assessed glycerol-containing moisturiser versus vehicle or placebo. More participants in the glycerol group noticed skin improvement (one study, 134 participants, RR 1.22, 95% CI 1.01 to 1.48; moderate-quality evidence), and this group saw improved investigator-assessed SCORAD (one study, 249 participants, MD -2.20, 95% CI -3.44 to -0.96; high-quality evidence), but MID was unmet. Participant satisfaction was not addressed. The number of participants reporting adverse events was not statistically significant (two studies, 385 participants, RR 0.90, 95% CI 0.68 to 1.19; moderate-quality evidence).Four studies investigated oat-containing moisturisers versus no treatment or vehicle. No significant differences between groups were reported for participant-assessed disease severity (one study, 50 participants, RR 1.11, 95% CI 0.84 to 1.46; low-quality evidence), satisfaction (one study, 50 participants, RR 1.06, 95% CI 0.74 to 1.52; very low-quality evidence), and investigator-assessed disease severity (three studies, 272 participants, standardised mean difference (SMD) -0.23, 95% CI -0.66 to 0.21; low-quality evidence). In the oat group, there were fewer flares (one study, 43 participants, RR 0.31, 95% CI 0.12 to 0.7; low-quality evidence) and less topical corticosteroids needed (two studies, 222 participants, MD -9.30g, 95% CI 15.3 to -3.27; low-quality evidence), but more adverse events were reported (one study, 173 participants; Peto odds ratio (OR) 7.26, 95% CI 1.76 to 29.92; low-quality evidence).All moisturisers above were compared to placebo, vehicle, or no moisturiser. Participants considered moisturisers more effective in reducing eczema (five studies, 572 participants, RR 2.46, 95% CI 1.16 to 5.23; low-quality evidence) and itch (seven studies, 749 participants, SMD -1.10, 95% CI -1.83 to -0.38) than control. Participants in both treatment arms reported comparable satisfaction (three studies, 296 participants, RR 1.35, 95% CI 0.77 to 2.26; low-quality evidence). Moisturisers led to lower investigator-assessed disease severity (12 studies, 1281 participants, SMD -1.04, 95% CI -1.57 to -0.51; high-quality evidence) and fewer flares (six studies, 607 participants, RR 0.33, 95% CI 0.17 to 0.62; moderate-quality evidence), but there was no difference in adverse events (10 studies, 1275 participants, RR 1.03, 95% CI 0.82 to 1.30; moderate-quality evidence).Topical active treatment combined with moisturiser was more effective than active treatment alone in reducing investigator-assessed disease severity (three studies, 192 participants, SMD -0.87, 95% CI -1.17 to -0.57; moderate-quality evidence) and flares (one study, 105 participants, RR 0.43, 95% CI 0.20 to 0.93), and was preferred by participants (both low-quality evidence). There was no statistically significant difference in number of adverse events (one study, 125 participants, RR 0.39, 95% CI 0.13 to 1.19; very low-quality evidence). Participant-assessed disease severity was not addressed. AUTHORS' CONCLUSIONS Most moisturisers showed some beneficial effects, producing better results when used with active treatment, prolonging time to flare, and reducing the number of flares and amount of topical corticosteroids needed to achieve similar reductions in eczema severity. We did not find reliable evidence that one moisturiser is better than another.
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Affiliation(s)
- Esther J van Zuuren
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, B1-Q, Leiden, Netherlands, 2300 RC
| | | | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Nordre Fasanvej 57, Copenhagen, Denmark, DK-2000
| | - Adriana Lavrijsen
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, B1-Q, Leiden, Netherlands, 2300 RC
| | - Bernd WM Arents
- Dutch Association for People with Atopic Dermatitis (VMCE: Vereniging voor Mensen met Constitutioneel Eczeem), PO Box 26, Nijkerk, Netherlands, NL-3860AA
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Patel N, Feldman SR. Adherence in Atopic Dermatitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1027:139-159. [DOI: 10.1007/978-3-319-64804-0_12] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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