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Recent work in human-computer interaction has demonstrated the use of unconstrained text entry protocols, which provide a more natural environment for research participants. We demonstrate the application of this approach to the analysis of word completion. Eleven participants (five nondisabled and six with disabilities) were recruited and asked to transcribe sentences using an on-screen keyboard both with and without word completion while time-stamped keystroke data were collected. The subsequent analysis demonstrates how the entire input stream (including erroneous keystrokes and the keystrokes used to correct errors) can be included in evaluation of performance with a text entry device or keystroke reduction method. Three new measures of keystroke savings are introduced, and the application of these measures is demonstrated. [ABSTRACT FROM AUTHOR]

Several studies have shown that tx)th children and adults benefit substantially from access to a means of independent mobility. While the needs of many individuals with disabilities can be satisfied with traditional manual or powered wheelchairs, a segment of the disabled community finds it difficult or impossible to use wheelchairs independently. To accommodate this population, researchers have used technologies originally developed for mobile robots to create 'smart wheelchairs.' Smart wheelchairs have been the subject of research since the early 1980s and have been developed on four continents. This article presents a summary of the current state of the art and directions for future research. [ABSTRACT FROM AUTHOR]

Background: Lichen sclerosus (LS) is a chronic inflammatory condition mainly affecting genital skin. It causes distressing symptoms that impact daily quality of life as well as progressive anatomical changes and potential risk of cancer. Vulval LS is often misdiagnosed and treatment delayed. If non-experts are supported to identify clinical features of LS, they may diagnose the condition sooner and commence timely treatment or refer to specialist services for assessment and confirmatory biopsy., Objectives: To reach international expert consensus on clinical diagnostic features for vulval LS., Methods: Between March and May 2023, a four-stage electronic-Delphi consensus exercise was conducted. In the first three rounds, participants were asked to rate the importance of a list of clinical features. Responses from round one were summarised and presented in rounds two and three, along with additional features suggested by participants. Any items which met the definition of consensus as 'very important/critical', or 'not important' were not voted upon again in subsequent rounds. In round four, items which met agreement for 'important but not critical' were ranked in order of their importance. Consensus was defined a priori, and all rounds were conducted anonymously., Results: A total of 47 participants from 14 countries completed round one with 42 (89%) retained by round 3 when consensus was determined. Round four was completed by 36 (77%) participants. Participants completing all four rounds predominantly included healthcare professionals (78%, n=28) and patient support group representatives (19%, n=7). In round one, 21 diagnostic features were voted upon. Participants suggested an additional 10 features which were subsequently added to the round two survey. After three rounds, consensus was achieved for five diagnostic features: whiteness, itch, changes in anatomy, burying of the clitoral area, and improvement in response to topical steroids. There were also 12 features voted as 'important but not critical' and participants subsequently ranked them in the 4th round., Conclusions: Experts have agreed on five critical diagnostic features for vulval LS in adults and an additional 12 features that may also be important. Future research should assess these clinical features for diagnostic validity through a multicentre diagnostic test accuracy study., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists.)

Introduction: Flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) are frequently performed in children with known or suspected aspiration, however, the additive value of FB in conjunction with direct laryngoscopy and rigid bronchoscopy (DLB) has not been previously quantified. This study details the common endoscopic/cytological findings and associated management impact of FB and BAL in pediatric Aerodigestive patients undergoing combined airway evaluation (FB and DLB) for oropharyngeal dysphagia., Materials and Methods: A retrospective chart review was performed in children <3 years of age followed through a large Aerodigestive center undergoing outpatient, combined airway endoscopy for dysphagia. Patient and procedural characteristics, endoscopic and BAL findings, and management metrics were collected and analyzed. A secondary analysis evaluated the association between endoscopic findings and medication changes., Results: Ninety-one procedures (median patient age, 15 months) were identified. All procedures included both FB and DLB, and just over half (52.7%) included esophagogastroduodenoscopy. Common endoscopic findings included bronchitis (73.6%), adenoidal hypertrophy (31.9%), and tracheomalacia (10.8%). BAL cytology frequently identified neutrophilic inflammation (mean 39.6% neutrophils [interquartile range 6.5%-71%)]. Cultured pathogens commonly included Streptococcus viridans (46.6%), Hemophilus influenzae (36.3%), Moraxella catarrhalis (30.1%), and Streptococcus pneumoniae (25.0%). FB and BAL results contributed to clinical decisions in 65 of 91 (71.4%) patients. Endoscopically-diagnosed bronchitis (odds ratio [OR] 7.27, 95% confidence interval [CI] 2.4-21.99) and tracheomalacia (OR 5.79, 95% CI 1.20-27.85) were significantly associated with increased odds of medication adjustments following FB., Conclusion: In pediatric Aerodigestive patients undergoing combined airway evaluation for oropharyngeal dysphagia, FB and BAL are high-yield and clinically impactful procedures., (© 2023 Wiley Periodicals LLC.)

The gut microbiota modulates immune processes both locally and systemically. This includes whether and how the immune system reacts to emerging tumours, whether antitumour immune responses are reactivated during treatment with immune-checkpoint inhibitors (ICIs), and whether unintended destructive immune pathologies accompany such treatment. Advances over the past decade have established that the gut microbiota is a promising target and that modulation of the microbiota might overcome resistance to ICIs and/or improve the safety of treatment. However, the specific mechanisms through which the microbiota modulates antitumour immunity remain unclear. Understanding the biology underpinning microbial associations with clinical outcomes in patients receiving ICIs, as well as the landscape of a 'healthy' microbiota would provide a critical foundation to facilitate opportunities to effectively manipulate the microbiota and thus improve patient outcomes. In this Review, we explore the role of diet and the gut microbiota in shaping immune responses during treatment with ICIs and highlight the key challenges in attempting to leverage the gut microbiome as a practical tool for the clinical management of patients with cancer., (© 2023. Springer Nature Limited.)

Background and Purpose: To describe the development and implementation of professional and personal identity formation content in a virtual pre-health pathway program., Educational Activity and Setting: Content within a six-week pre-health program for underrepresented and/or disadvantaged college students was redesigned to a virtual format with enhanced focus on professional and personal identity formation. Sessions on personal identity formation were also enhanced through a partnership with local mental health clinicians specializing in trauma-informed care and culturally relevant practices and strategies., Findings: The 2020 and 2021 programs were restructured to include pharmacy professional identity formation content around the following weekly themes: Roadmap to Pharmacy, What Does it Mean to be a Pharmacist?, Expanding Knowledge of Pharmacy, Gaining Insight and Dispelling Myths, Practicing Knowledge and Exploration, and Moving Forward. These pre-pharmacy components emphasized diversity of career paths, pharmacy-based clinical services, and the pharmacist's role in promoting health equity. Overarching components of interprofessional collaboration coupled with health policy applications further emphasized the professional identity of a pharmacist in the collaborative design and delivery of health care. New personal identity formation sessions were implemented in tandem with this content and centering around the following themes: Supporting Scholars in Self-Authorship, Building a Community among Peers, and Strategies for Coping in Times of Challenge., Summary: This project has the potential to serve as a model for the implementation of both personal and professional identity formation initiatives at other programs to promote pharmacy as a desirable and attainable career to pre-health students., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Lichen sclerosus (LS) is a chronic inflammatory condition mainly affecting genital skin. It causes distressing symptoms that impact daily quality of life (QoL). It causes progressive anatomical changes and a potential risk of cancer. Published randomized controlled trials are of varying methodological quality and difficult to combine in meta-analyses. This is partly due to lack of agreed outcome measures to assess treatment response. Identification of core outcome sets (COSs), which standardize key outcomes to be measured in all future trials, is a solution to this problem., Objectives: To obtain international agreement on which outcome domains should be measured in interventional trials of genital LS., Methods: Recommended best practice for COS domain development was followed: (i) identification of potential outcome domains: a long list was generated through an up-to-date LS literature search, including information collected during the LS priority-setting partnership; (ii) provisional agreement of outcome domains: a three-stage multi-stakeholder international electronic-Delphi (e-Delphi) consensus study; (iii) final agreement of outcome domains: online consensus meeting with international stakeholders including anonymized voting., Results: In total, 123 participants (77 patients, 44 health professionals, 2 researchers) from 20 countries completed three rounds of the e-Delphi study. Eleven outcome domains were rated as 'critical' and were discussed at the online consensus meetings. The first set of consensus meetings involved 42 participants from 12 countries. Consensus was met for 'symptoms' (100% agreed) and 'QoL - LS-specific' (92% agreed). After the second set of meetings, involving 29 participants from 12 countries, 'clinical (visible) signs' also met consensus (97% agreed)., Conclusions: The international community has agreed on three key outcome domains to measure in all future LS clinical trials. We recommend that trialists and systematic reviewers incorporate these domains into study protocols with immediate effect. CORALS will now work with stakeholders to select an outcome measurement instrument per prioritized core domain., Competing Interests: Conflicts of interest There are no conflicts of interest to declare from any members of the Steering Group., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Association of Dermatologists.)

Competing Interests: Conflicts of interest the author declares they have no conflicts of interest.

The gut microbiota shapes the response to immune checkpoint inhibitors (ICIs) in cancer, however dietary and geographic influences have not been well-studied in prospective trials. To address this, we prospectively profiled baseline gut (fecal) microbiota signatures and dietary patterns of 103 trial patients from Australia and the Netherlands treated with neoadjuvant ICIs for high risk resectable metastatic melanoma and performed an integrated analysis with data from 115 patients with melanoma treated with ICIs in the United States. We observed geographically distinct microbial signatures of response and immune-related adverse events (irAEs). Overall, response rates were higher in Ruminococcaceae-dominated microbiomes than in Bacteroidaceae-dominated microbiomes. Poor response was associated with lower fiber and omega 3 fatty acid consumption and elevated levels of C-reactive protein in the peripheral circulation at baseline. Together, these data provide insight into the relevance of native gut microbiota signatures, dietary intake and systemic inflammation in shaping the response to and toxicity from ICIs, prompting the need for further studies in this area., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Background: Lichen sclerosus (LS) is a chronic, inflammatory dermatosis. Initial treatment with superpotent topical corticosteroids is the accepted and evidence-based first-line therapy. For those who do not respond after exclusion of other potentiating factors, the best second-line therapy is unclear. Laser therapy is an emerging treatment for genital LS and despite uncertain efficacy its use is gaining popularity in the private sector., Objectives: We aimed to review the effectiveness of laser therapy for genital LS in men, women and children., Methods: We conducted a systematic review of all primary studies reporting the use of laser in genital LS. Ovid MEDLINE, PubMed, Ovid Embase, Cochrane CENTRAL, Web of Science, CINAHL and PsycINFO were searched from inception to February 2021. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials, ROBINS-I tool for non-randomized trials and Joanna Briggs Institute checklist for case studies., Results: A total of 24 studies, involving 616 adults, met inclusion criteria. These were six randomized controlled trials (RCTs), one non-randomized trial, nine single arm trials and eight case series. Where assessed, most studies suggest that laser therapy in patients with LS may improve symptoms, clinical signs, quality of life and sexual function. However, results were highly heterogeneous and methodological quality was very low, therefore meta-analysis was not possible., Conclusions: There is poor evidence to support the use of laser therapy for genital LS at present. Effectiveness of laser needs to be robustly investigated in well-conducted RCTs., Competing Interests: None to declare., (© 2021 The Authors. Skin Health and Disease published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)

Immune checkpoint inhibition has revolutionized the treatment of many cancers, including melanoma. However, primary and acquired resistance remain key challenges for the field. Promising results from a phase I clinical trial recently published in Science highlight the potential of modulating the microbiome via fecal transplant to overcome resistance to immunotherapy., Competing Interests: Declarations of Interests G.V.L. is a consultant advisor for Aduro Biotech Inc., Amgen Inc., Array Biopharma Inc., Boehringer Ingelheim International GmbH, Bristol-Myers Squibb, Hexel AG, Highlight Therapeutics S.L., Merck Sharpe & Dohme, Novartis Pharma AG, Pierre Fabre, QBiotics Group Limited, Regeneron Pharmaceuticals Inc, SkylineDX B.V., and Specialised Therapeutics Australia Pty Ltd. R.A.S. has received fees for professional services from Qbiotics, Novartis, Merck Sharp & Dohme, NeraCare, AMGEN Inc., Bristol-Myers Squibb, Myriad Genetics, and GlaxoSmithKline., (Crown Copyright © 2021. Published by Elsevier Inc. All rights reserved.)

Objective: The objective of this study was to investigate older adults' performance on the paper and electronic Montreal Cognitive Assessment (eMoCA)., Design: Repeated measures and correlational design., Participants: A convenience sample of 40 adults over 65 years of age living in the community., Interventions: Participants completed the eMoCA and paper Montreal Cognitive Assessment (MoCA) in a randomized order during 1 session. Participants reported their touchscreen experience and comfort and indicated their modality preferences., Main Outcome Measures: The primary outcome measures were paper MoCA and eMoCA total and subscale scores. Secondary outcome measures included participants' reported touchscreen experience and comfort, as well as post-administration preferences., Results: A moderate statistically significant correlation was found between eMoCA and paper MoCA performance across all participants. Analysis comparing first administration modality only (eMoCA vs. paper MoCA) found no statistically significant difference in total scores; however, there was a statistically significant difference for the visuospatial/executive subscale, which required physical interaction with paper or the tablet. For this subscale, participants scored lower on the eMoCA versus paper MoCA. There was a statistically significant correlation between experience with touchscreen devices and performance on the eMoCA, but not between modality preference and performance., Conclusion: Modality of administration can affect performance on cognitive assessments. Clinicians should consider individuals' level of touchscreen experience before selecting administration modality.

Scanning Wizard software helps scanning users improve the setup of their switch and scanning system. This study evaluated Scanning Wizard's effectiveness and usability. Ten people who use switch scanning and ten practitioners used Scanning Wizard in the initial session. Usability was high, based on survey responses averaging over 4.5 out of 5, and qualitative feedback was very positive. Five switch users were able to complete the multi-week protocol, using settings on their own scanning system that were recommended from the Scanning Wizard session. Using these revised settings, text entry rates improved by an average of 71%, ranging from 29% to 172% improvement. Results suggest that Scanning Wizard is a useful tool for improving the configuration of scanning systems for people who use switch scanning to communicate. Implications for Rehabilitation Some individuals with severe physical impairments use switch scanning for spoken and written communication. Scanning Wizard software helps scanning users improve the setup of their switch and scanning system. This study demonstrated high usability of Scanning Wizard (with 10 switch userpractitioner teams) and increased text entry rate by an average of 71% (for five switch users). Results suggest that Scanning Wizard is a useful tool for improving the configuration of scanning systems for people who use switch scanning to communicate.

Purpose: This study assessed the: (1) effect of an LGBTQI + health equity curriculum (eQuality) on implicit attitudes among first (M1) and second year (M2) medical students and (2) utility of dedicated time to explore implicit bias., Method: Implicit biases were assessed at baseline using implicit association tests (IAT) for all M2s and a random sample of first years (M1A). These students were then debriefed on strategies to mitigate bias. Following eQuality, all M1 and M2s completed post-intervention IATs. The remaining first years (M1B) were then debriefed. Paired sample t-tests assessed differences between pre/post. Independent sample t-tests assessed differences in post-IATs between M1 groups., Results: IATs indicated preferences for "Straight," "White," and "Thin" at both pre and post. M2s demonstrated statistically significant improvements pre to post for sexuality (p = 0.01) and race (p = 0.03). There were significant differences in post-intervention IAT scores between M1As who received the IAT and debriefing prior to eQuality and M1Bs for sexuality (p = 0.002) and race (p = 0.046). There were no significant changes for weight., Conclusion: eQuality reduced implicit preference for "Straight" and "White." Differences in M1 post-intervention IAT scores between groups suggest dedicating time to debrief implicit attitudes enhances bias mitigation.

Purpose: To evaluate the performance of the circling interface, which is an alternative interaction method for selecting and manipulating on-screen objects based on circling the target, rather than pointing and clicking., Method: We conducted empirical evaluations with actual head-mounted mouse emulator users from two different groups: individuals with spinal cord injury (SCI) and individuals with cerebral palsy (CP), comparing each group's performance and satisfaction level on pointing tasks with the circling interface to performance on the same tasks when using dwell-clicking software., Results: Across all operations, for both subjects with SCI and with CP, the circling interface showed faster performance than the dwell-clicking interface. For the single-click operation, the circling interface showed slower performance than dwell selection, but for both double-click and drag-and-drop operations, the circling interface produced faster performance. Subjects with CP required much longer time to complete the tasks compared to subjects with SCI. If errors caused by circling on an area with no target and unintentional circling caused by jerky movements and an abnormally tiny circle are automatically corrected by the circling interface, their performance accuracy with the circling interface outperformed existing solutions without a steep learning curve., Conclusions: Circling interface can be used in conjunction with existing techniques and this kind of combined approach achieve more effective mouse use for some individuals with pointing problems. It is also expected to be useful for both computer access and augmentative communication software. Implications for Rehabilitation A circling interface will improve clinical practice by providing an alternative pointing method that does not require physically activating mouse buttons and is more efficient than dwell-clicking. Being used in conjunction with existing techniques, some individuals who are head mouse users can achieve more effective mouse use. The Circling interface can also work with AAC devices.

Purpose: To investigate a new alternative interaction method, called circling interface, for manipulating on-screen objects. To specify a target, the user makes a circling motion around the target. To specify a desired pointing command with the circling interface, each edge of the screen is used. The user selects a command before circling the target., Method: To evaluate the circling interface, we conducted an experiment with 16 participants, comparing the performance on pointing tasks with different combinations of selection method (circling interface, physical mouse and dwelling interface) and input device (normal computer mouse, head pointer and joystick mouse emulator)., Results: A circling interface is compatible with many types of pointing devices, not requiring physical activation of mouse buttons, and is more efficient than dwell-clicking. Across all common pointing operations, the circling interface had a tendency to produce faster performance with a head-mounted mouse emulator than with a joystick mouse. The performance accuracy of the circling interface outperformed the dwelling interface., Conclusions: It was demonstrated that the circling interface has the potential as another alternative pointing method for selecting and manipulating objects in a graphical user interface. Implications for Rehabilitation A circling interface will improve clinical practice by providing an alternative pointing method that does not require physically activating mouse buttons and is more efficient than dwell-clicking. The Circling interface can also work with AAC devices.

Scanning Wizard software helps scanning users improve the setup of their switch and scanning system. This study is evaluating Scanning Wizard's effectiveness, with nine people who use single-switch scanning participating to date. Text entry rates have improved by an average of 71%, ranging from 29 to 172% improvement.

Background: Erosive lichen planus affecting the vulva (ELPV) is a relatively rare, chronic condition causing painful raw areas in the vulvovaginal region. Symptoms are pain and burning, which impact upon daily living. There is paucity of evidence regarding therapy. A 2012 Cochrane systematic review found no randomised controlled trials (RCTs) in this field. Topically administered corticosteroids are the accepted first-line therapy: however, there is uncertainty as to which second-line treatments to use. Several systemic agents have been clinically noted to show promise for ELPV refractory to topically administered corticosteroids but there is no RCT evidence to support these. The 'hELP' study is a RCT with an internal pilot phase designed to provide high-quality evidence., Methods/design: The objective is to test whether systemic therapy in addition to standard topical therapy is a beneficial second-line treatment for ELPV. Adjunctive systemic therapies used are hydroxychloroquine, methotrexate, mycophenolate mofetil and prednisolone. Topical therapy plus a short course of prednisolone given orally is considered the comparator intervention. The trial is a four-armed, open-label, pragmatic RCT which uses a blinded independent clinical assessor. To provide 80 % power for each comparison, 96 participants are required in total. The pilot phase aims to recruit 40 participants. The primary clinical outcome is the proportion of patients achieving treatment success at 6 months. 'Success' is defined by a composite measure of Patient Global Assessment score of 0 or 1 on a 4-point scale plus improvement from baseline on clinical photographs scored by a clinician blinded to treatment allocation. Secondary clinical outcomes include 6-month assessment of: (1) Reduction in pain/soreness; (2) Global assessment of disease; (3) Response at other affected mucosal sites; (4) Hospital Anxiety and Depression Scale scores; (5) Sexual function; (6) Health-related quality of life using 'Short Form 36' and 'Skindex-29' questionnaires; (7) Days of topical steroid use; (8) Treatment satisfaction; (9) Discontinuation of medications due to treatment failure; (10) Per participant cost of intervention in each treatment group. Adverse events will also be reported., Discussion: 'hELP' is the first RCT to address second-line treatment of ELPV. The trial has encountered unique methodological challenges and has required collaborative efforts of the UK Dermatology Clinical Trials Network alongside expert clinicians., Current Controlled Trials: ISRCTN 81883379 . Date of registration 12 June 2014.

Telerehabilitation (TR) services for assistive technology evaluation and training have the potential to reduce travel demands for consumers and assistive technology professionals while allowing evaluation in more familiar, salient environments for the consumer. Sixty-five consumers received TR services for augmentative and alternative communication or alternative computer access, and consumer satisfaction was compared with twenty-eight consumers who received exclusively in-person services. TR recipients rated their TR services at a median of 6 on a 6-point Likert scale TR satisfaction questionnaire, although individual responses did indicate room for improvement in the technology. Overall satisfaction with AT services was rated highly by both in-person (100% satisfaction) and TR (99% satisfaction) service recipients.

A method, using liquid chromatography with tandem mass spectrometric detection (LC-MS/MS), was developed for the determination of suvorexant (MK-4305, Belsomra(®)), a selective dual orexin receptor antagonist for the treatment insomnia, in human plasma over the concentration range of 1-1000ng/mL. Stable isotope labeled (13)C(2)H3-suvorexant was used as an internal standard. The sample preparation procedure utilized liquid-liquid extraction, in the 96-well format, of a 100μL plasma sample with methyl t-butyl ether. The compounds were chromatographed under isocratic conditions on a Waters dC18 (50×2.1mm, 3μm) column with a mobile phase consisting of 30/70 (v/v %) 10mM ammonium formate, pH3/acetonitrile at a flow rate of 0.3mL/min. Multiple reaction monitoring of the precursor-to-product ion pairs for suvorexant (m/z 451→186) and (13)C(2)H3-suvorexant (m/z 455→190) on an Applied Biosystems API 4000 tandem mass spectrometer was used for quantitation. Intraday assay precision, assessed in six different lots of control plasma, was within 10% CV at all concentrations, while assay accuracy ranged from 95.6 to 105.0% of nominal. Quality control (QC) samples in plasma were stored at -20°C. Initial within day analysis of QCs after one freeze-thaw cycle showed accuracy within 9.5% of nominal with precision (CV) of 6.7% or less. The plasma QC samples were demonstrated to be stable for up to 25 months at -20°C. The method described has been used to support clinical studies during Phase I through III of clinical development., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Paediatric vulvar skin conditions are relatively common but often cause diagnostic difficulties for clinicians, which can lead to anxiety within the children's families. Vulvar skin conditions can be caused by various underlying aetiologies. Most are general dermatologic conditions that occur in the vulvar area, such as eczema, psoriasis, skin lesions or infections. However, other conditions such as lichen sclerosus and napkin dermatitis ('nappy rash') only affect the genital region. Every affected child needs a sensitive evaluation of the complaint including an assessment of the impact of the condition on the patient and her family. Paediatric vulvar disease often influences bowel and bladder habits and may lead to behavioural problems. General measures such as avoidance of irritants or soap substitution and regular use of emollients are helpful for all patients. Specific therapy depends upon the underlying diagnosis. Time spent reassuring the families, reinforcing regimens and providing written documentation can all be very helpful in successful management of paediatric vulvar skin conditions., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Single-switch scanning is a technique used by some individuals for spoken and/or written communication. We developed a method for adjusting the settings in a single-switch scanning interface to increase a user's text entry rate (TER). We evaluated that method with nine individuals who use single-switch scanning to communicate. Text entry rates improved by an average of 120% (p = 0.003). All nine subjects increased their TER by at least 40%, and five of the nine increased their TER by over 100%. At baseline, TER averaged 1.42 words per minute (wpm), ranging from 0.28 to 2.92 wpm. With the revised settings, TER averaged 2.72 wpm and ranged from 1.12 to 6.51 wpm.

Symptoms and signs of vulval skin disorders are common. These conditions can have a considerable impact on quality of life, restricting physical activities and causing difficulty in everyday activities and may also affect social, psychosexual and psychological well-being. There are no standardized measures routinely used to assess the impact of vulval disease on daily life. To report outcome measures used in clinically based randomized controlled trials (RCTs) investigating therapeutic interventions in vulval disease. The Medline, EMBASE and CENTRAL databases were searched to identify RCTs of vulval skin conditions written in English. Studies with laboratory tests or survival rates as the primary outcome, or those investigating menopausal symptoms or infections were excluded. Twenty-eight published RCTs were included. The vulval conditions represented were vulvodynia (n = 14), lichen sclerosus (n = 9), vulval intraepithelial neoplasia (n = 2), vulval pruritus (n = 2) and lichen planus (n = 1). The 28 RCTs measured 25 different outcomes, using 49 different scales. The method of outcome assessment was lacking on nine occasions. Only 21% (six of 28) of included trials had a clearly stated primary outcome. Patient-reported outcomes were more commonly reported than clinician-related outcome measures. The most commonly reported patient-rated outcome measure was a reduction in pain (measured 15 times) and an overall improvement in symptoms using a patient global assessment (measured 11 times). The most commonly reported clinician-rated outcome was an overall assessment of the appearance of affected sites (measured 13 times). There were no agreed standard scales used for the global assessments. Only nine of the recorded outcome measure tools were designed to assess vulval disease or sexual functioning, the remainder were general measures. There is heterogeneity in the outcome measures used when reporting therapeutic interventions in vulval disease. This field of dermatology would benefit from development of a vulval-specific outcome measure and the establishment of a core outcome measure set., (© 2013 British Association of Dermatologists.)

Background: There is no defined set of criteria for diagnosing erosive lichen planus affecting the vulva (ELPV) and there is geographical variation in management., Objectives: To reach consensus on clinicopathological diagnostic criteria for ELPV., Methods: This was a three-stage international electronic-Delphi exercise with a subsequent formal feedback process. In the first two rounds participants were asked to rate the importance of a list of clinicopathological criteria. Responses from round 1 were summarized and presented in round 2, along with additional criteria suggested by participants. In round 3, participants were asked to rate the items that had reached consensus as 'essential' or 'supportive' features in diagnosing ELPV. Consensus was defined as being reached if 75% of participants agreed on the importance of an item., Results: A total of 73 experts representing dermatology, gynaecology, histopathology and genitourinary medicine participated; 69 (95%) completed all three rounds. Consensus was achieved for the following 'supportive' diagnostic criteria: (i) well-demarcated erosions/erythematous areas at the vaginal introitus; (ii) presence of a hyperkeratotic border to lesions and/or Wickham striae in surrounding skin; (iii) symptoms of pain/burning; (iv) scarring/loss of normal architecture; (v) presence of vaginal inflammation; (vi) involvement of other mucosal surfaces; (vii) presence of a well-defined inflammatory band involving the dermoepidermo junction; (viii) presence of an inflammatory band consisting predominantly of lymphocytes; and (ix) signs of basal layer degeneration. It was suggested that at least three supportive features should be present to make a diagnosis of ELPV, although this number is subject to further discussion., Conclusions: This study has identified a diagnostic dataset for ELPV that can be adopted into clinical practice and clinical trials., (© 2013 The Authors BJD © 2013 British Association of Dermatologists.)

Purpose: For individuals with severe motor and communicative disabilities, single switch scanning provides a way to access a computer and communicate. A model was developed that utilizes scanning interface settings, error tendencies, error correction strategies, and the matrix configuration to predict a user's communication rate., Method: Five individuals who use single switch scanning transcribed sentences using an on-screen keyboard configured with the settings from their communication devices. Data from these trials were used as input to a model that predicted TER for the baseline configuration and at least three other system configurations. Participants transcribed text with each of these new configurations and the predicted TER was compared to the actual TER., Results: Results showed that predicted TER was accurate to within 90% on average. The scan rate was also entered into a previously published model which assumes error-free performance. For our model, the average error for each participant was 10.49%, compared to 79.7% for the model assuming error-free performance., Conclusions: Our model of row-column scanning was much more accurate than a model that did not consider the likelihood of an error occurring. There is still room for improvement, however, and the results of the study will lead to additional modifications of the model.

Objective: Reliable and valid outcome measures are essential both in clinical practice and in clinical trials to be able to monitor response to treatments. In this review, we consider existing outcome measures currently used in clinical practice and discuss the need for vulvar specific measures., Materials and Methods: We have reviewed the existing literature describing outcome measure and disease impact scales for dermatologic and vulvar conditions., Results: A combination of measures including clinician-determined severity and patient-related quality-of-life indices are often used to assess different aspects of a disease. Health-related quality-of-life measures as scored by the patient are being increasingly recognized as the main driver in therapeutic decision making and are also important in developing service provision. Numerous disease-specific severity scores exist within dermatology, as do quality-of-life indices. However, none has been specifically designed to cover all aspects of vulvar disease., Conclusions: It is timely to consider the assessment of vulvar disease both in terms of impact on the patient and disease severity as assessed by the clinician to design well-constructed clinical trials for the management of vulvar disease. Owing to the sensitive nature of the problem, patients' needs and expectations are often different from general dermatology patients. We suggest that scales to monitor outcomes in the vulvar population should be devised by adapting and combining existing scales so they are relevant to our patients' needs.

Background: There is a lack of published evidence for treatment and outcome measures for vulval erosive lichen planus (ELPV)., Objectives: To conduct a multicentre case note review to examine real-life management of ELPV comparing current U.K. practice against an agreed audit standard., Methods: Criteria for standards of care for which to evaluate current service provision were set following communication with experts from the British Society for the Study of Vulval Disease. Participants from 10 U.K. centres included nine dermatologists and one gynaecologist who run specialist vulval clinics. Standards examined the documentation of disease severity/impact measures, the use of diagnostic biopsies, treatments used and assessment of treatment response., Results: Audit data were collected from 172 patients. Documentation of symptoms/clinical findings was excellent (99%, 170/172). A schematic diagram was present in the notes of 87% (150/172). Patient-related disease impact measures including Dermatology Life Quality Index (3%, 6/172) or visual analogue scales (1%, 2/172) were less well documented. Biopsies were performed in 78% (135/172); 71% (96/135) showed histological features consistent with erosive lichen planus. Squamous cell carcinoma developed in four patients (two vulval, two oral) and vulval intraepithelial neoplasia in two further patients. Recommended first-line treatment with a very potent topical steroid was used in 75% (129/172) with improvement in 66% (85/129). Significant variation in second-line therapy was seen., Conclusions: Wide variation in U.K. practice demonstrates the absence of standardized guidance for treating ELPV and the need for vulval-specific outcomes. This audit should act as a framework towards improving ELPV management and to plan future research in this area., (© 2012 The Authors. BJD © 2012 British Association of Dermatologists.)

Nonambulatory, visually impaired individuals mostly rely on caregivers for their day-to-day mobility needs. The Drive-Safe System (DSS) is a modular, semiautonomous smart wheelchair system aimed at providing independent mobility to people with visual and mobility impairments. In this project, clinical evaluation of the DSS was performed in a controlled laboratory setting with individuals who have visual impairment but no mobility impairment. Their performance using DSS was compared with their performance using a standard cane for navigation assistance. Participants rated their subjective appraisal of the DSS by using the National Aeronautics and Space Administration-Task Load Index inventory. DSS significantly reduced the number and severity of collisions compared with using a cane alone and without increasing the time required to complete the task. Users rated DSS favorably; they experienced less physical demand when using the DSS, but did not feel any difference in perceived effort, mental demand, and level of frustration when using the DSS alone or along with a cane in comparison with using a cane alone. These findings suggest that the DSS can be a safe, reliable, and easy-to-learn and operate independent mobility solution for visually impaired wheelchair users.

This review summarizes important clinical developments in acne treatment identified in five systematic reviews and two significant primary research studies, published between March 2010 and February 2011. Although evidence showing a direct link between development of bacterial resistance and oral antibiotic therapy for acne is not convincing, prescribers can still tailor their practice to minimize future risks by stopping treatment when appropriate, using benzoyl peroxide, and avoiding combining topical and systemic antimicrobials. A systematic review evaluating combination products containing benzoyl peroxide did not show convincing evidence that such products are superior to monotherapies. A systematic review of combined oral contraceptives confirmed their efficacy for acne in women. However, another systematic review of botanical products for acne failed to provide any good-quality evidence of benefit. A large, well-reported retrospective cohort study attempted to clarify the potential link between isotretinoin and depression/suicide. Although suicide risk peaked 6 months after isotretinoin treatment, an increased risk was present before initiation of isotretinoin, making it difficult to attribute the increased risk to isotretinoin alone. However, those with a history of suicide attempts before treatment made fewer new attempts than those whose behaviour started during treatment. This suggests that patients with severe acne with a history of attempted suicide should not automatically be refused isotretinoin. Another randomized controlled trial of 60 patients from Korea suggested that low-dose isotretinoin dose than might provide a better long-term outcome with minimal side-effects for people with moderate acne., (© The Author(s). CED © 2011 British Association of Dermatologists.)

A 35-year-old male with classical Hodgkin's lymphoma (nodular sclerosing, grade 1 histology, clinical stage 2A) underwent a positron emission tomography (PET) scan to assess response to treatment. Half body CT PET imaging was obtained using a Siemens Biograph scanner from eyes to thighs. 405 MBq of 18-fluorodeoxyglucose (FDG) was injected with acquisition starting at 60 min. There was unexpected intense focal uptake in the superficial subcutaneous tissues of the abdomen, pelvis and lateral chest wall with overlying skin thickening seen on the CT component. This was initially of concern, but the patient was known to have a history of hidradenitis suppurativa (HS). On further examination, the radiological abnormalities corresponded to the clinical sites of involvement. To the best of our knowledge, this is the first documentation of the appearance of HS on PET scan.