Publications by authors named "Valerie Harvey"

28 Publications

  • Page 1 of 1

Post Discharge after Surgery Virtual Care with Remote Automated Monitoring Technology (PVC-RAM): protocol for a randomized controlled trial.

CMAJ Open 2021 Jan-Mar;9(1):E142-E148. Epub 2021 Mar 2.

School of Nursing (McGillion, Levesque, Lounsbury, Bird, Ouellette), McMaster University, Hamilton, Ont.; Population Health Research Institute (McGillion, Whitlock, Devereaux, Belley-Cote, Borges, Vincent, Lamy, Bangdiwala, Le Manach, Harvey, Conen), Hamilton, Ont.; Department of Anesthesiology and Perioperative Medicine (Parlow, Arellano), Queen's University, Kingston, Ont.; Department of Anesthesiology and Perioperative Medicine (Parlow, Shelley, DuMerton, Arellano), Kingston Health Sciences Centre, Kingston, Ont.; Department of Medicine (Belley-Cote, Yousef, Borges, Marcucci, Chaudhry, Haider, Guyatt, Patel, Conen, Tandon), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (Whitlock, Devereaux, Marcucci, Bangdiwala, Guyatt), McMaster University, Hamilton, Ont.; Departments of Critical Care and Anesthesiology (Jacka), University of Alberta, Edmonton, Alta.; Department of Surgery (Adili, Harlock, Simunovic, Nenshi), McMaster University, Hamilton, Ont.; St. Joseph's Healthcare Hamilton (Adili, LeBlanc, Nenshi, Tandon), Hamilton, Ont.; Department of Anesthesiology and Pain Medicine (Lalu, McCartney, Hamilton), University of Ottawa and The Ottawa Hospital, Ottawa, Ont.; Ottawa Hospital Research Institute (Moloo, Lalu, Halman, Forster, Hamilton), Ottawa, Ont.; Department of Anesthesia and Perioperative Medicine (Sehmbi, Nagappa, Yang), Schulich School of Medicine, University of Western Ontario, London, Ont.; Department of Anesthesia and Perioperative Medicine (Sehmbi, Nagappa, Yang), London Health Sciences Centre, London, Ont.; Hamilton Health Sciences (Meyer, Paulin, Pettit, Lamy, Lounsbury, Scott, Patel, Ouellette, O'Leary), Hamilton, Ont.; Department of Anesthesia (Shanthanna, Paul, Le Manach, O'Leary), McMaster University, Hamilton, Ont.; Department of Medicine (Roshanov, Mrkobrada), Schulich School of Medicine, University of Western Ontario, London, Ont.; Department of Internal Medicine (Ofori), University of Port Harcourt, Port Harcourt, Nigeria, West Africa; Department of Medicine (Graham, Taylor), University of Alberta, Edmonton, Alta.; Department of Medicine (Halman, Forster), University of Ottawa and The Ottawa Hospital, Ottawa, Ont.; Lawrence S. Bloomberg Faculty of Nursing (Peter), University of Toronto, Toronto, Ont.; Department of Medicine (Marosi), Queen's University, Kingston, Ont.; Alberta Health Services (Deuchar), Alberta, Canada; Department of Surgery (Parry, Schlachta, Schemitsch), University of Western Ontario and London Health Sciences Centre, London, Ont.; Department of Surgery (Williams), University of Alberta, Edmonton, Alta.; Department of Oncology (Meyer), McMaster University, Hamilton, Ont.; Department of Surgery (Pichora), Queen's University and Kingston Health Sciences Centre, Kingston, Ont.; Department of Surgery (Moloo), University of Ottawa and The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital (Waggott), Ottawa, Ont.

Background: After nonelective (i.e., semiurgent, urgent and emergent) surgeries, patients discharged from hospitals are at risk of readmissions, emergency department visits or death. During the coronavirus disease 2019 (COVID-19) pandemic, we are undertaking the Post Discharge after Surgery Virtual Care with Remote Automated Monitoring Technology (PVC-RAM) trial to determine if virtual care with remote automated monitoring (RAM) compared with standard care will increase the number of days adult patients remain alive at home after being discharged following nonelective surgery.

Methods: We are conducting a randomized controlled trial in which 900 adults who are being discharged after nonelective surgery from 8 Canadian hospitals are randomly assigned to receive virtual care with RAM or standard care. Outcome adjudicators are masked to group allocations. Patients in the experimental group learn how to use the study's tablet computer and RAM technology, which will measure their vital signs. For 30 days, patients take daily biophysical measurements and complete a recovery survey. Patients interact with nurses via the cellular modem-enabled tablet, who escalate care to preassigned and available physicians if RAM measurements exceed predetermined thresholds, patients report symptoms, a medication error is identified or the nurses have concerns they cannot resolve. The primary outcome is number of days alive at home during the 30 days after randomization.

Interpretation: This trial will inform management of patients after discharge following surgery in the COVID-19 pandemic and offer insights for management of patients who undergo nonelective surgery in a nonpandemic setting. Knowledge dissemination will be supported through an online multimedia resource centre, policy briefs, presentations, peer-reviewed journal publications and media engagement.

Trial Registration: ClinicalTrials.gov, no. NCT04344665.
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http://dx.doi.org/10.9778/cmajo.20200176DOI Listing
March 2021

COVID-19 compels closer scrutiny of disparities in dermatology.

J Am Acad Dermatol 2021 02 1;84(2):e103-e104. Epub 2020 Oct 1.

Hampton University Skin of Color Research Institute, Hampton University, Virginia. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.09.077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527280PMC
February 2021

Effects of accelerated versus standard care surgery on the risk of acute kidney injury in patients with a hip fracture: a substudy protocol of the hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) international randomised controlled trial.

BMJ Open 2019 09 24;9(9):e033150. Epub 2019 Sep 24.

Departments of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada

Introduction: Inflammation, dehydration, hypotension and bleeding may all contribute to the development of acute kidney injury (AKI). Accelerated surgery after a hip fracture can decrease the exposure time to such contributors and may reduce the risk of AKI.

Methods And Analysis: Hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) is a multicentre, international, parallel-group randomised controlled trial (RCT). Patients who suffer a hip fracture are randomly allocated to either accelerated medical assessment and surgical repair with a goal of surgery within 6 hours of diagnosis or standard care where a repair typically occurs 24 to 48 hours after diagnosis. The primary outcome of this substudy is the development of AKI within 7 days of randomisation. We anticipate at least 1998 patients will participate in this substudy.

Ethics And Dissemination: We obtained ethics approval for additional serum creatinine recordings in consecutive patients enrolled at 70 participating centres. All patients provide consent before randomisation. We anticipate reporting substudy results by 2021.

Trial Registration Number: NCT02027896; Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2019-033150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6773307PMC
September 2019

Basal Cell Carcinoma, Squamous Cell Carcinoma, and Cutaneous Melanoma in Skin of Color Patients.

Dermatol Clin 2019 Oct;37(4):519-526

Hampton University Skin of Color Research Institute, Hampton, VA, USA; TPMG Hampton Roads Center for Dermatology, Newport News, VA, USA. Electronic address:

Skin cancers are relatively rare in patients with skin of color; however, they are an important public health concern because of disparities in patient outcomes. Gaps in skin cancer knowledge exist because of lack of large-scale studies involving people of color, and limitations in data collection methods and skin classification paradigms. Additional research is needed to address questions regarding risk and reasons for disparate skin cancer outcomes in these patients. We summarize the clinical and epidemiologic features for basal cell carcinoma, squamous cell carcinoma, and melanoma and touch on some of their unique features in patients with skin of color.
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http://dx.doi.org/10.1016/j.det.2019.05.009DOI Listing
October 2019

Rationale and design of the HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) Trial: a protocol for an international randomised controlled trial evaluating early surgery for hip fracture patients.

BMJ Open 2019 05 1;9(4):e028537. Epub 2019 May 1.

Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada.

Introduction: Annually, millions of adults suffer hip fractures. The mortality rate post a hip fracture is 7%-10% at 30 days and 10%-20% at 90 days. Observational data suggest that early surgery can improve these outcomes in hip fracture patients. We designed a clinical trial-HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) to determine the effect of accelerated surgery compared with standard care on the 90-day risk of all-cause mortality and major perioperative complications.

Methods And Analysis: HIP ATTACK is a multicentre, international, parallel group randomised controlled trial (RCT) that will include patients ≥45 years of age and diagnosed with a hip fracture from a low-energy mechanism requiring surgery. Patients are randomised to accelerated medical assessment and surgical repair (goal within 6 h) or standard care. The co-primary outcomes are (1) all-cause mortality and (2) a composite of major perioperative complications (ie, mortality and non-fatal myocardial infarction, pulmonary embolism, pneumonia, sepsis, stroke, and life-threatening and major bleeding) at 90 days after randomisation. All patients will be followed up for a period of 1 year. We will enrol 3000 patients.

Ethics And Dissemination: All centres had ethics approval before randomising patients. Written informed consent is required for all patients before randomisation. HIP ATTACK is the first large international trial designed to examine whether accelerated surgery can improve outcomes in patients with a hip fracture. The dissemination plan includes publishing the results in a policy-influencing journal, conference presentations, engagement of influential medical organisations, and providing public awareness through multimedia resources.

Trial Registration Number: NCT02027896; Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2018-028537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501985PMC
May 2019

Postoperative Remote Automated Monitoring: Need for and State of the Science.

Can J Cardiol 2018 07 25;34(7):850-862. Epub 2018 Apr 25.

McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.

Worldwide, more than 230 million adults have major noncardiac surgery each year. Although surgery can improve quality and duration of life, it can also precipitate major complications. Moreover, a substantial proportion of deaths occur after discharge. Current systems for monitoring patients postoperatively, on surgical wards and after transition to home, are inadequate. On the surgical ward, vital signs evaluation usually occurs only every 4-8 hours. Reduced in-hospital ward monitoring, followed by no vital signs monitoring at home, leads to thousands of cases of undetected/delayed detection of hemodynamic compromise. In this article we review work to date on postoperative remote automated monitoring on surgical wards and strategy for advancing this field. Key considerations for overcoming current barriers to implementing remote automated monitoring in Canada are also presented.
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http://dx.doi.org/10.1016/j.cjca.2018.04.021DOI Listing
July 2018

Melanoma in US Hispanics: recommended strategies to reduce disparities in outcomes.

Authors:
Valerie M Harvey

Cutis 2018 Apr;101(4):243-246

Hampton University Skin of Color Research Institute, Virginia, and the Hampton Roads Center for Dermatology, Newport News, Virginia, USA.

Cutaneous melanoma is the most fatal form of skin cancer and presents a considerable public health concern in the United States. Although the age-adjusted incidence of melanoma among US Hispanics is lower than that of non-Hispanic whites (NHWs), Hispanics who are diagnosed with melanoma are more likely to present with thicker primary tumors, metastatic disease, and lower 5-year melanoma-specific survival rates than NHWs. Melanoma risk factors and reasons for late presentation among Hispanics are not completely understood. In this review, the epidemiology and clinical presentation of melanoma in Hispanics is summarized, and recommendations for a research agenda to advance understanding of this disease in the most rapidly growing segment of the US population is provided.
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April 2018

Laugier-Hunziker syndrome.

Cutis 2017 09;100(3):E17-E19

Department of Dermatology, United States Naval Hospital, Yokosuka, Japan.

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September 2017

Prostaglandin D2 Uses Components of ROS Signaling to Enhance Testosterone Production in Keratinocytes.

J Investig Dermatol Symp Proc 2017 10;18(2):S81-S84

Hampton University Skin of Color Research Institute (HUSCRI), Hampton, Virginia, USA; Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia, USA. Electronic address:

Elevated levels of prostaglandin D2 (PGD2) have been shown to be present in the bald scalp of androgenic alopecia (AGA) patients and to functionally inhibit hair growth. However, its precise mechanism in AGA has yet to be clearly defined. Although testosterone plays a critical role in the initiation and progression of AGA, the existence of a possible link between PGD2 and testosterone in skin has not been investigated. Here we show that human keratinocytes treated with PGD2 show enhanced capacity to convert the weak androgen, androstenedione, to testosterone. At the same time, treatment with PGD2 induced reactive oxygen species as indicated by generation of the lipid peroxidation product, 4-hydroxynonenal. To determine whether these two events are linked, we used the reactive oxygen species scavenger N-acetyl-cysteine, which blocked the enhanced testosterone production from PGD2-treated keratinocytes. Our study suggests the existence of a possible crosstalk between the PGD2-reactive oxygen species axis and testosterone metabolism in keratinocytes. Thus, we propose that AGA patients might benefit from the use of N-acetyl-cysteine or other antioxidants as a supplement to currently available or emerging AGA therapies such as finasteride, minoxidil, and PGD2 receptor blockers.
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http://dx.doi.org/10.1016/j.jisp.2017.01.003DOI Listing
October 2017

From Bench to Bedside: The Hampton University Skin of Color Research Institute 2015 Skin of Color Symposium.

J Investig Dermatol Symp Proc 2017 10;18(2):S29-S30

Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia, USA; Hampton University Skin of Color Research Institute, Hampton, Virginia, USA. Electronic address:

The Hampton University Skin of Color Research Institute Skin of Color Symposium 2015: From Bench to Bedside was held in Williamsburg, Virginia at the Williamsburg Lodge, November 13-15, 2015. The conference was designed to promote, develop, and advance the education, knowledge, and research of cutaneous disorders disproportionately affecting people of racial and ethnic minority groups. Centered on the theme of "From Bench to Bedside", the symposium provided a program featuring a diverse panel of nationally recognized physician-scientists, basic scientists, and clinicians who updated attendees on the latest research advances across multiple relevant disciplines, including public health, basic science, and the clinical diagnosis and management of select complex and rare dermatologic conditions. Featured sessions included recent advances in vitiligo, disorders of hyperpigmentation, keloids, central centripetal cicatricial alopecia, and cutaneous lupus. We expect that the scientific sessions and interactive panel discussions, combined with the synergistic environment that has characterized this conference, will spur the formation of new collaborations and scientific discovery and, ultimately, will culminate in novel treatments for dermatologic disorders disproportionately affecting individuals with skin of color.
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http://dx.doi.org/10.1016/j.jisp.2016.10.001DOI Listing
October 2017

The Role of Neighborhood Characteristics in Late Stage Melanoma Diagnosis among Hispanic Men in California, Texas, and Florida, 1996-2012.

J Cancer Epidemiol 2017 18;2017:8418904. Epub 2017 Jun 18.

Sealy Center on Aging and Center to Eliminate Health Disparities, University of Texas Medical Branch, Galveston, TX, USA.

Background: Hispanics diagnosed with cutaneous melanoma are more likely to present at advanced stages but the reasons for this are unknown. We identify at high risk for late stage melanoma diagnosis (LSMD) and examine the contextual predictors of LSMD in California, Texas, and Florida.

Methods: We conducted a cross-sectional study using geocoded state cancer registry data. Using hierarchical multilevel logistic regression models we estimated ORs and 95% confidence intervals for the impact of socioeconomic, Hispanic ethnic concentration, index of dissimilarity, and health resource availability measures on LSMD.

Results: We identified 12,493 cases. In California, late stage cases were significantly more likely to reside within census tracts composed mostly of Hispanics and immigrants. In Texas, LSMD was associated with residence in areas of socioeconomic deprivation and a higher proportion of immigrants. In Florida, living in areas of low education attainment, high levels of poverty, and a high percentage of Hispanic residents was significantly associated with LSMD. Residential segregation did not independently affect LSMD.

Conclusion: The influence of contextual predictors on LSMD varied in magnitude and strength by state, highlighting both the cosegregation of social adversity and poverty and the complexity of their interactions.
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http://dx.doi.org/10.1155/2017/8418904DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494113PMC
June 2017

Melanoma Disparities among US Hispanics: Use of the Social Ecological Model to Contextualize Reasons for Inequitable Outcomes and Frame a Research Agenda.

J Skin Cancer 2016 29;2016:4635740. Epub 2016 Aug 29.

University of Texas Medical Branch, Sealy Center on Aging, Galveston, TX, USA; University of Texas Medical Branch, Center to Eliminate Health Disparities, Galveston, TX, USA.

Cutaneous melanoma is a significant public health concern, accounting for thousands of deaths annually in the US. Early detection and diagnosis are critical given the poor prognosis and limited treatment options of advanced-stage disease. While non-Hispanic whites have higher incidence rates of melanoma, Hispanics are typically diagnosed at later disease stages and suffer higher morbidity and mortality. Currently, there is a paucity of literature investigating the root causes underlying these trends among Hispanics. Given that Hispanics are the most rapidly expanding demographic segment in the US, it is essential for cancer control efforts to elucidate the major determinants of their poor melanoma outcomes. Herein, we use the social ecological model as a framework to explore the multitude of influences on melanoma disparities among Hispanics and provide recommendations for planning future studies and interventions.
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http://dx.doi.org/10.1155/2016/4635740DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5019891PMC
September 2016

Fluoroscopy-induced chronic radiation dermatitis (FICRD) after endovascular abdominal aortic aneurysm endoleak repair.

JAAD Case Rep 2015 Nov 23;1(6):403-5. Epub 2015 Nov 23.

Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia; Children's Hospital of the King's Daughters, Norfolk, Virginia.

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http://dx.doi.org/10.1016/j.jdcr.2015.09.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809396PMC
November 2015

A rare case of late-onset lichenoid photodermatitis after vandetanib therapy.

JAAD Case Rep 2015 May 25;1(3):141-3. Epub 2015 May 25.

Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia.

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http://dx.doi.org/10.1016/j.jdcr.2015.03.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808707PMC
May 2015

Oral melanoma in a gravid, HIV-positive woman.

JAAD Case Rep 2015 May 2;1(3):120-2. Epub 2015 May 2.

Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia; Hampton University Skin of Color Research Institute, Hampton, Virginia.

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http://dx.doi.org/10.1016/j.jdcr.2015.02.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808706PMC
May 2015

Keloids and Hypertrophic Scars: A Spectrum of Clinical Challenges.

Am J Clin Dermatol 2016 Jun;17(3):201-23

Hampton University Skin of Color Research Institute, Hampton University, Hampton, VA, USA.

Since their earliest description, keloids and hypertrophic scars have beleaguered patients and clinicians alike. These scars can be aesthetically disfiguring, functionally debilitating, emotionally distressing, and psychologically damaging, culminating in a significant burden for patients. Our current understanding of keloid pathophysiology has grown and continues to advance while molecular biology, genetics, and technology provide ever-deepening insight into the nature of wound healing and the pathologic perturbations thereof. Greater understanding will lead to the development and application of refined therapeutic modalities. This article provides an overview of our current understanding of keloids, highlighting clinical characteristics and diagnostic criteria while providing a comprehensive summary of the many therapeutic modalities available. The proposed mechanism, application, adverse events, and reported efficacy of each modality is evaluated, and current recommendations are summarized.
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http://dx.doi.org/10.1007/s40257-016-0175-7DOI Listing
June 2016

Patient-provider communication, concordance, and ratings of care in dermatology: Results of a cross-sectional study.

Dermatol Online J 2016 Nov 15;22(11). Epub 2016 Nov 15.

Department of Dermatology, Andrews Hall, Eastern Virginia Medical School, Norfolk Virginia Hampton University Skin of Color Research Institute, Hampton, VA.

ObjectiveTo determine the impact of race concordance on patient perception of quality of dermatologic care.Study designCross-sectional study.SettingAcademic outpatient practices in the Departments of Dermatology of Eastern Virginia Medical School and the Johns Hopkins University School of Medicine.ParticipantsThe study cohort comprised 124 participants including 6 providers and 118 established patients.Main Outcome MeasuresWe hypothesized, a priori, that patients in race-discordant dyads would report lower ratings of participatory decision-making (PDM), satisfaction, trust in the provider, and similarities with providers.ResultsPatients in race-discordant dyads reported less positive ratings on 4 out of 8 participatory decision-making questionnaire items (p values < 0.05), and were significantly more likely to perceive differences with providers in race and culture (p values < 0.05). These differences persisted to varying degrees after controlling for key confounders such as education and income level. Participants in race-concordant and race-discordant dyads did not differ in their perceptions of satisfaction or trust.ConclusionsPatient perception of participation in the decision-making process and of shared similarities with their providers is attributable in varying degrees to race concordance. Continued strengthening of cultural competency skills during medical and dermatology residency training as well as increased diversification of the dermatologic workforce could attenuate the adverse influences of race discordance and other socioeconomic factors on patient-provider communication.
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November 2016

IMAGES IN CLINICAL MEDICINE. Acral Lentiginous Melanoma.

N Engl J Med 2015 Nov;373(19):1864

Eastern Virginia Medical School, Norfolk, VA

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http://dx.doi.org/10.1056/NEJMicm1500906DOI Listing
November 2015

P2X7/PANX1 as a new target for melanoma?

Exp Dermatol 2015 May 9;24(5):336-7. Epub 2015 Mar 9.

Hampton University Skin of Color Research Institute, Hampton University, Hampton, VA, USA.

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http://dx.doi.org/10.1111/exd.12633DOI Listing
May 2015

Social determinants of racial and ethnic disparities in cutaneous melanoma outcomes.

Cancer Control 2014 Oct;21(4):343-9

Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA 23507, USA.

Background: This article sought to elucidate how aspects of poverty and culture may contribute to race- and ethnicity-based disparities in cutaneous melanoma outcomes.

Methods: We identified published studies addressing the social determinants of melanoma. Selected review articles included US-based studies comprised of patients representing adults, children, and adolescents.

Results: African Americans and Hispanics diagnosed with cutaneous melanoma are more likely to present with more advanced stages of disease at diagnosis and have higher rates of mortality than their nonminority counterparts. These disparities may be a consequence of economic, social, and cultural barriers such as low income, public forms of health insurance, lower levels of education, lower levels of melanoma awareness and knowledge, and lower rates of participation in melanoma screening. No studies in the literature examined the potential impact of social injustice, English proficiency, immigrant status, and health literacy.

Conclusions: Substantial gaps exist in our knowledge of the pathways linking social determinants and race- and ethnicity-based disparities in melanoma. More studies are warranted to inform the development of effective interventions aimed at narrowing inequities and improving cutaneous melanoma outcomes among minority populations.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4505912PMC
http://dx.doi.org/10.1177/107327481402100411DOI Listing
October 2014

Secondary cutaneous marginal zone B-cell lymphoma presenting as lipoatrophy in a patient with hepatitis C.

J Dermatol Case Rep 2014 Jun 30;8(2):46-9. Epub 2014 Jun 30.

Eastern Virginia Medical School, Department of Dermatology, 721 Fairfax Avenue, Suite 200, Norfolk, VA, 23507, USA; ; Hampton University Skin of Color Research Institute, Hampton University, Hampton, VA, USA.

Background: Hepatitis C viral infection is a significant public health problem; 170 million persons are infected worldwide and the prevalence in the southern part of the United States exceeds two percent. Extrahepatic manifestations of hepatitis C viral infection are common; notably, 15-20% of patients will develop cutaneous manifestations of their disease. There are numerous dermatologic diseases associated with hepatitis C infection, including lichen planus, leukocytoclasticvasculitis, and porphyria cutaneatarda.

Main Observation: Recently, epidemiological studies have also demonstrated an association between hepatitis C infection and the development of non-Hodgkin lymphoma, especially marginal zone B-cell lymphoma. Herein we report the unusual case of a systemic marginal zone lymphoma in a patient with hepatitis C infection presenting clinically as localized lipoatrophy.

Conclusions: Lipoatrophy can be a rare and diagnostically challenging presentation of secondary cutaneous marginal zone B-cell lymphoma. The importance of early recognition and detection cannot be over emphasized, as new and effective anti-viral treatments can lead to lymphoma regression in up to 75% of patients. To our knowledge, this is the first case of hepatitis C viral infection associated marginal zone lymphoma to present as localized lipoatrophy.
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http://dx.doi.org/10.3315/jdcr.2014.1171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4094737PMC
June 2014

Reporting, representation, and subgroup analysis of race and ethnicity in published clinical trials of atopic dermatitis in the United States between 2000 and 2009.

Pediatr Dermatol 2012 Nov-Dec;29(6):749-55. Epub 2012 Sep 28.

Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.

To review the literature on atopic dermatitis (AD) clinical trials published in the United States between 2000 and 2009 to examine the representation of racial and ethnic minorities in those trials and determine the extent to which investigators reported on demographic variables and performed a subanalysis. A PubMed search was performed including all clinical trials for management of AD published between 2000 and 2009. Three reviewers analyzed articles matching the search criteria. Data recorded included incorporation of demographic data at baseline and in the analysis and result interpretations. Of 645 PubMed search results, only 78 articles originated in the United States and fit the search criteria; 59.5% of these included reports of race or ethnicity. Of the studies reporting race or ethnicity, the subject population mainly included 62.1% white, 18.0% black, 6.9% Asian, and 2.0% Hispanic. Despite increasing awareness in the United States of the importance of reporting demographic data in clinical trials, there has been no significant improvement in reporting in AD clinical trials over the past 10 years. When reporting occurs, the categorization of ethnicities, methods of reporting data, and incorporation of the data into the results are lacking or flawed. In addition, aside from blacks, U.S. minorities appear to be underrepresented in AD clinical trials.
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http://dx.doi.org/10.1111/j.1525-1470.2012.01797.xDOI Listing
September 2013

The co-occurrence of neurofibromatosis type I and nail-patella syndrome in a 5-generation pedigree.

J Am Acad Dermatol 2011 Oct;65(4):873-875

Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia.

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http://dx.doi.org/10.1016/j.jaad.2010.06.042DOI Listing
October 2011

Necrolytic acral erythema: case report and review of the literature.

Cutis 2008 Apr;81(4):355-60

Department of Dermatology, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas, USA.

Necrolytic acral erythema is a novel member of the necrolytic erythema family found exclusively in patients with hepatitis C virus (HCV) infection. Acrally distributed, dusky, erythematous plaques with vesiculation evolve into hyperkeratotic lesions resembling psoriasis. Given the prevalence of chronic HCV infection, necrolytic acral erythema probably is a commonly encountered entity misdiagnosed as an inflammatory dermatosis. The paucity of case reports in the United States is likely the result of unfamiliarity with the condition and its viral association. We report a case of necrolytic acral erythema and review the literature summarizing its diagnosis, pathogenesis, and treatment.
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April 2008

Interstitial granulomatous dermatitis associated with the use of tumor necrosis factor alpha inhibitors.

Arch Dermatol 2006 Feb;142(2):198-202

Department of Dermatology, University of Maryland, Baltimore 21201, USA.

Background: Tumor necrosis factor alpha (TNF-alpha) has been implicated in the pathogenesis of numerous inflammatory and autoimmune disorders. Accordingly, TNF-alpha inhibitors, such as thalidomide, infliximab (Remicade), adalimumab (Humira), and etanercept (Enbrel), have been used with success in the treatment of autoimmune disorders, including psoriasis, rheumatoid arthritis, inflammatory bowel diseases, and lymphoproliferative disorders. Although anti-TNF-alpha therapy is safe and well tolerated, various adverse cutaneous reactions have been reported.

Observations: We encountered 5 patients who developed erythematous annular plaques on the trunk and extremities while receiving 4 different medications with inhibitory activity against TNF-alpha. One patient was treated with lenalidomide (Revlimid) for multiple myeloma, 2 received infliximab, and 1 received etanercept for severe rheumatoid arthritis; the last patient was in a clinical trial of adalimumab for psoriatic arthritis. Skin biopsy specimens revealed diffuse interstitial granulomatous infiltrates of lymphocytes, histiocytes, and eosinophils, palisading degenerated collagen. Withdrawal of the medications led to complete resolution of the skin lesions.

Conclusion: Interstitial granulomatous dermatitis should be considered in the differential diagnosis of skin lesions occurring in the setting of anti-TNF-alpha therapy.
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http://dx.doi.org/10.1001/archderm.142.2.198DOI Listing
February 2006

The challenge of negation in health care searches and queries.

AMIA Annu Symp Proc 2003 :858

Department of Computer and Information Systems, Robert Morris University, USA.

This poster deals with exclusionary queries implemented using the database language SQL and the VA FileMan database system and the retrieval searches involving negated concepts in medical narratives. The poster describes and presents error patterns and designing database queries, underlying comprehension issues regarding negative statements and queries, strategies and software for avoiding false positives in searches, and makes practical recommendations on identifying potential sources of error and avoiding incorrect or misleading results.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1480075PMC
December 2004