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Kalita V, Abs D, Bursztejn AC. Barriers and suggestions for improving the implementation of guidelines in the systemic treatment of moderate to severe psoriasis: A literature review. Ann Dermatol Venereol 2024; 151:103280. [PMID: 38776863 DOI: 10.1016/j.annder.2024.103280] [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: 08/14/2023] [Revised: 12/21/2023] [Accepted: 04/02/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Despite the availability of a wide range of therapies for the systemic treatment of moderate to severe psoriasis, many psoriasis patients do not receive adequate treatment, suggesting that guidelines may not be correctly applied by physicians. OBJECTIVES The aim of this study was to analyze data on physicians' implementation of, and reasons for noncompliance with, guidelines for the systemic treatment of moderate to severe psoriasis. METHODS We conducted a systematic literature review according to the Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the PubMed and Embase databases for studies on guideline adherence in the systemic treatment of moderate to severe psoriasis. All eligible articles were retrieved in full text and the relevant references of retrieved articles were included. RESULTS A total of 20 studies were selected. Four studies investigated knowledge of the guidelines, six studies examined their application, and five studies focused on the various barriers to implementation. Finally, five studies discussed ways to improve implementation. Several studies on the quality of psoriasis care have revealed discrepancies between the reality and the optimal care described in national and international guidelines. CONCLUSION Various barriers to implementation of recommendations exist, such as economic barriers, lack of dermatologic orientation towards, lack of knowledge of recommendations by other specialists, lack of applicability, and country- and practice-specific features (e.g., different benefit/risk ratios, different reimbursement rates and conditions). This review can help the everyday practitioner to better understand these barriers, which will have a direct impact on improving the quality of life of psoriasis patients.
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Affiliation(s)
- V Kalita
- Dermatology Department, Nancy University Hospital, Bâtiment P Canton, 6 allée du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - D Abs
- Dermatology Department, Nancy University Hospital, Bâtiment P Canton, 6 allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - A-C Bursztejn
- Dermatology Department, Nancy University Hospital, Bâtiment P Canton, 6 allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
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Salgado-Boquete L, Arias-Santiago S, Belinchón-Romero I, de la Cuadra-Grande A, de la Cueva P, Gilaberte Y, Notario J, Rivera-Díaz R, Ruiz-Villaverde R, Carrascosa JM. Selection of Quality Indicators for the Certification of Psoriasis Units: The CUDERMA Project Delphi Consensus Study. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:865-883. [PMID: 36796538 DOI: 10.1016/j.ad.2023.02.002] [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: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
Defining quality indicators is a key strategy for ensuring the quality and standardization of health care. The CUDERMA project, an initiative of the Spanish Academy of Dermatology and Venerology (AEDV), was undertaken to define quality indicators for the certification of specialized units in dermatology; the first 2 areas selected were psoriasis and dermato-oncology. The aim of this study was to reach a consensus on what should be assessed by the indicators used to certify psoriasis units. The structured process used to do this comprised a literature review to identify potential indicators, the selection of an initial set of indicators to be evaluated by a multidisciplinary group of experts and, finally, a Delphi consensus study. A panel of 39 dermatologists evaluated the selected indicators and classified them as either "essential" or "of excellence". Consensus was finally reached on 67 indicators, which will be standardized and used to develop the certification standard for psoriasis units.
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Affiliation(s)
- L Salgado-Boquete
- Servicio de Dermatología, Complejo Hospitalario de Pontevedra, Pontevedra, Galicia, España
| | - S Arias-Santiago
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Andalucía, España; Facultad de Medicina, Universidad de Granada, Granada, Andalucía, España; Instituto Biosanitario de Granada (IBS), Granada, Andalucía, España.
| | - I Belinchón-Romero
- Servicio de Dermatología, Hospital General Universitario Dr. Balmis, Alicante, Comunidad Valenciana, España; Facultad de Medicina, Universidad Miguel Hernández, Alicante, Comunidad Valenciana, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Comunidad Valenciana, España
| | - A de la Cuadra-Grande
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España
| | - Y Gilaberte
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, Aragón, España
| | - J Notario
- Servicio de Dermatología, Hospital Universitario de Bellvitge, Barcelona, Catalunya, España
| | - R Rivera-Díaz
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, España
| | - R Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Andalucía, España; Instituto Biosanitario de Granada (IBS), Granada, Andalucía, España
| | - J M Carrascosa
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol (HUGTiP), Barcelona, Catalunya, España; Facultad de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalunya, España; Institut d'Investigació en Ciènces de la Salut Germans Trias i Pujol (IGTP), Barcelona, Catalunya, España
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Salgado-Boquete L, Arias-Santiago S, Belinchón-Romero I, de la Cuadra-Grande A, de la Cueva P, Gilaberte Y, Notario J, Rivera-Díaz R, Ruiz-Villaverde R, Carrascosa JM. [Translated article] Selection of Quality Indicators for the Certification of Psoriasis Units: The CUDERMA Project Delphi Consensus Study. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T865-T883. [PMID: 37678630 DOI: 10.1016/j.ad.2023.09.001] [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: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 09/09/2023] Open
Abstract
Defining quality indicators is a key strategy for ensuring the quality and standardization of health care. The CUDERMA project, an initiative of the Spanish Academy of Dermatology and Venerology (AEDV), was undertaken to define quality indicators for the certification of specialized units in dermatology; the first 2 areas selected were psoriasis and dermato-oncology. The aim of this study was to reach a consensus on what should be assessed by the indicators used to certify psoriasis units. The structured process used to do this comprised a literature review to identify potential indicators, the selection of an initial set of indicators to be evaluated by a multidisciplinary group of experts and, finally, a Delphi consensus study. A panel of 39 dermatologists evaluated the selected indicators and classified them as either "essential" or "of excellence". Consensus was finally reached on 67 indicators, which will be standardized and used to develop the certification standard for psoriasis units.
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Affiliation(s)
- L Salgado-Boquete
- Servicio de Dermatología, Complejo Hospitalario de Pontevedra, Pontevedra, Galicia, Spain
| | - S Arias-Santiago
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Andalucía, Spain; Facultad de Medicina, Universidad de Granada, Granada, Andalucía, Spain; Instituto Biosanitario de Granada (IBS), Granada, Andalucía, Spain.
| | - I Belinchón-Romero
- Servicio de Dermatología, Hospital General Universitario Dr. Balmis, Alicante, Comunidad Valenciana, Spain; Facultad de Medicina, Universidad Miguel Hernández, Alicante, Comunidad Valenciana, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Comunidad Valenciana, Spain
| | - A de la Cuadra-Grande
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, Spain
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Y Gilaberte
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, Aragón, Spain
| | - J Notario
- Servicio de Dermatología, Hospital Universitario de Bellvitge, Barcelona, Catalunya, Spain
| | - R Rivera-Díaz
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - R Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Andalucía, Spain; Instituto Biosanitario de Granada (IBS), Granada, Andalucía, Spain
| | - J M Carrascosa
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol (HUGTiP), Barcelona, Catalunya, Spain; Facultad de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalunya, Spain; Institut d'Investigació en Ciènces de la Salut Germans Trias i Pujol (IGTP), Barcelona, Catalunya, Spain
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Peters S, Sukumar K, Blanchard S, Ramasamy A, Malinowski J, Ginex P, Senerth E, Corremans M, Munn Z, Kredo T, Remon LP, Ngeh E, Kalman L, Alhabib S, Amer YS, Gagliardi A. Trends in guideline implementation: an updated scoping review. Implement Sci 2022; 17:50. [PMID: 35870974 PMCID: PMC9308215 DOI: 10.1186/s13012-022-01223-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background Guidelines aim to support evidence-informed practice but are inconsistently used without implementation strategies. Our prior scoping review revealed that guideline implementation interventions were not selected and tailored based on processes known to enhance guideline uptake and impact. The purpose of this study was to update the prior scoping review. Methods We searched MEDLINE, EMBASE, AMED, CINAHL, Scopus, and the Cochrane Database of Systematic Reviews for studies published from 2014 to January 2021 that evaluated guideline implementation interventions. We screened studies in triplicate and extracted data in duplicate. We reported study and intervention characteristics and studies that achieved impact with summary statistics. Results We included 118 studies that implemented guidelines on 16 clinical topics. With regard to implementation planning, 21% of studies referred to theories or frameworks, 50% pre-identified implementation barriers, and 36% engaged stakeholders in selecting or tailoring interventions. Studies that employed frameworks (n=25) most often used the theoretical domains framework (28%) or social cognitive theory (28%). Those that pre-identified barriers (n=59) most often consulted literature (60%). Those that engaged stakeholders (n=42) most often consulted healthcare professionals (79%). Common interventions included educating professionals about guidelines (44%) and information systems/technology (41%). Most studies employed multi-faceted interventions (75%). A total of 97 (82%) studies achieved impact (improvements in one or more reported outcomes) including 10 (40% of 25) studies that employed frameworks, 28 (47.45% of 59) studies that pre-identified barriers, 22 (52.38% of 42) studies that engaged stakeholders, and 21 (70% of 30) studies that employed single interventions. Conclusions Compared to our prior review, this review found that more studies used processes to select and tailor interventions, and a wider array of types of interventions across the Mazza taxonomy. Given that most studies achieved impact, this might reinforce the need for implementation planning. However, even studies that did not plan implementation achieved impact. Similarly, even single interventions achieved impact. Thus, a future systematic review based on this data is warranted to establish if the use of frameworks, barrier identification, stakeholder engagement, and multi-faceted interventions are associated with impact. Trial registration The protocol was registered with Open Science Framework (https://osf.io/4nxpr) and published in JBI Evidence Synthesis. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01223-6.
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Akhlaghi M, Karrabi M, Atabti H, Raoofi A, Mousavi Khaneghah A. Investigation of the role of IL18, IL-1β and NLRP3 inflammasome in reducing expression of FLG-2 protein in Psoriasis vulgaris skin lesions. Biotech Histochem 2021; 97:277-283. [PMID: 34313166 DOI: 10.1080/10520295.2021.1954692] [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] [Indexed: 01/25/2023] Open
Abstract
We investigated the effects of the NACHT leucine-rich repeat- and PYD-containing proteins (NLRP3) inflammasome, interleukin -18 (IL-18) and interleukin-1 beta (IL-1β) cytokines on the expression of filaggrin-2 (FLG-2) protein in psoriasis patients. Peripheral blood mononuclear cells (PBMC), including T cells, were isolated from psoriasis patients and healthy donors. Ribonucleic acid (RNA) extraction and reverse transcription-polymerase chain reaction (RT-PCR) were performed for all specimens. Immunohistochemical analysis for FLG-2 in normal and psoriatic epidermal tissue also was performed. Western blot was used to separate and identify FLG-2 protein, and immunohistochemical staining was performed to assess FLG-2 expression for psoriasis skin lesions and normal skin. RT-PCR analysis indicated that NLRP3 inflammasome, IL-18 cytokine and IL-1β cytokine expression were increased in psoriatic epidermis compared to normal skin. We found that the expression of FLG-2 was decreased in psoriatic epidermis compared to normal skin. Higher levels of NLRP3 help decrease the FLG-2 level.
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Affiliation(s)
- Maedeh Akhlaghi
- Student Research Committee, Cellular and Molecular Research Center, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Maryam Karrabi
- Cellular and Molecular Research Center, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Hadi Atabti
- Department of Immunology and Biology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Raoofi
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran.,Department of Anatomy, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Amin Mousavi Khaneghah
- Department of Food Science and Nutrition, Faculty of Food Engineering, University of Campinas (UNICAMP), Campinas, Brazil
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King AA, Baumann AA. Sickle cell disease and implementation science: A partnership to accelerate advances. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26649. [PMID: 28556441 PMCID: PMC6026013 DOI: 10.1002/pbc.26649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/05/2017] [Accepted: 04/24/2017] [Indexed: 12/11/2022]
Abstract
Sickle cell disease (SCD) results in end organ damage and a shortened lifespan. Both the pathophysiology of the disease and the social determinants of health affect patient outcomes. Randomized controlled trials have been completed among this population and resulted in medical advances; however, the gestation of these advances and the lack of penetrance into clinical practice have limited advancements in clinical improvements for many people with SCD. We discuss the role of implementation science in SCD and highlight the need for this science to shorten the length of time to implement evidence-based care for more people with SCD.
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Affiliation(s)
- Allison A. King
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
- Division of Hematology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Ana A. Baumann
- Brown School, Washington University, St. Louis, Missouri
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