Patient Satisfaction with Treatment for Onychocryptosis: A Systematic Review

Nails in older adults

As the world's population of adults greater than 60 years old continues to increase, it is important to manage nail disorders that may impact their daily lives. Nail disorders may have significant impact on quality of life due to decreased functionality, extreme pain, or social embarrassment. In this review, we discuss nail disorders affecting older patients, including physiologic, traumatic, drug-induced, infectious, environmental, inflammatory, and neoplastic conditions. Diagnosis of these conditions involves a detailed history, physical examination of all 20 nails, and depending on the condition, a nail clipping or biopsy and/or diagnostic imaging. Nails grow even more slowly in older adults compared to younger individuals, and therefore it is important for accurate diagnosis, and avoidance of inappropriate management and delay of treatment. Increased awareness of nail pathologies may help recognition and management of nail conditions in older adults.

Development and Validation of a Patient-Reported Outcome Measure for Fingernail and Toenail Conditions: The NAIL-Q

Background

Patient-reported outcome measures (PROMs) are needed to measure outcomes that matter to people with nail conditions, from their perspective.

Objective

To design a comprehensive new PROM (NAIL-Q) to measure outcomes important in toenail and fingernail conditions.

Methods

A mixed methods iterative approach was used. Phase 1 involved concept elicitation interviews that were audio-recorded, transcribed, and coded line-by-line. Concepts were developed into scales and refined through cognitive debriefing interviews with patients and expert input. Data was then collected from an international sample using a crowdsource platform. Eligible participants were aged ≥18 years with a nail condition for at least 3 months. Rasch Measurement Theory (RMT) analysis was used to examine item and scale performance. Other psychometric tests included test-retest reliability, and convergent and construct validity.

Results

Phase 1 interviews involved 23 patients with 10 nail conditions and input from 11 dermatologists. The analysis led to the development of 84 items for field-testing. In Phase 2, 555 participants completed the survey. Toenail conditions (n = 441) were more common than fingernail conditions (n = 186). The RMT analysis reduced the number of items tested to 45 in 7 scales measuring nail appearance, health-related quality of life concerns, and treatment outcomes. All items had ordered thresholds and nonsignificant chi-square p values. Reliability statistics with and without extremes for the Person Separation Index were ≥0.79 and Cronbach's alpha were ≥0.83, and for intraclass correlation coefficients were ≥0.81. Construct validity was further supported in that most participants agreed that the NAIL-Q was easy to understand, asked relevant and important questions in a respectful way, and that it should be used to inform clinical care.

Conclusion

The NAIL-Q is a rigorously designed and tested PROM that measures nail appearance, health-related quality of life and treatment outcomes. This PROM can be used in clinical practice to inform patient care and to include the patient perspective in research.

A review of skin disease in military soldiers: challenges and potential solutions

Introduction: Military soldiers comprised 1,195 million United States active-duty members and 778,000 reserve members in 9/2021. Soldiers are often exposed to drastic climates, environments, and living conditions which may make them more susceptible to cutaneous diseases.Methods: A PubMed search of studies published between 1/1/2002 - 8/30/2022, using MeSH terms: ((("Military Personnel"[Majr]) OR "Military Hygiene"[Majr])) OR "Military Medicine"[Majr]) AND "Skin Diseases"[Majr]), the reference lists of select articles, and other applicable sources were reviewed to identify articles on skin conditions affecting military soldiers and treatment options.Discussion: In this article, we review skin conditions that affect military soldiers in both the deployed and non-deployed settings including infectious diseases, arthropod associated diseases, sexually transmitted infections, ultraviolet radiation related skin disease, acne, diseases of hair and hair follicles, dermatitis, onychocryptosis, and conditions caused by extreme weather conditions and occupational exposures. We also discuss treatment options and prevention methods as they relate to military settings.Conclusion: Dermatological conditions can considerably impact soldiers' wellbeing and military performance, often lead to evacuation of military personnel, and are associated with high financial costs. Cutaneous disease is one of most common reasons for soldiers to seek medical care and may cause significant morbidity. Serving in the military often impacts and limits treatment options.