Radiodermatitis (radiation dermatitis, radiation-induced skin reactions, or radiation injury) is a significant side effect of ionizing radiation delivered to the skin during cancer treatment as well as a result of nuclear attacks and disasters, such as that which occurred in Fukushima in 2011. More specifically, 95 % of cancer patients receiving radiation therapy will develop some form of radiodermatitis, including erythema, dry desquamation, and moist desquamation. These radiation skin reactions result in a myriad of complications, including delays in treatment, diminished aesthetic appeal, and reduced quality of life. Recent technological advancements and novel treatment regimens have only been successful in partly ameliorating these adverse side effects. This article examines the current knowledge surrounding the pathogenesis, clinical manifestations, differential diagnoses, prevention, and management of radiodermatitis. Future research should examine therapies that incorporate the current understanding of the pathophysiology of radiodermatitis while measuring effectiveness using objective and universal outcome measures.
The clinical applications of point-of-care ultrasound (US) have expanded rapidly over the past decade. To promote early exposure to point-of-care US, there is widespread support for the integration of US curricula within undergraduate medical education. However, despite growing evidence and enthusiasm for point-of-care US education in undergraduate medical education, the curricular design and delivery across undergraduate medical education programs remain variable without widely adopted national standards and guidelines. This article highlights the educational and teaching applications of point-of-care US with a focus on outcomes. We then review the evidence on curricular design, delivery, and integration and the assessment of competency for point-of-care US in undergraduate medical education.
Melanomas affecting different components of the uvea occur with differing frequencies and clinical presentations. Uveal melanoma is diagnosed via funduscopic exam and ancillary tests. These lesions may present with visual findings or incidental findings on physical exam. Metastasis occurs in approximately half of all patients with primary uveal melanoma. The liver is the most common site of metastasis. Enucleation was at one time considered the definitive local treatment for primary uveal melanoma, but has been largely replaced by other therapeutic procedures that aim to prevent metastasis while preserving vision. Unfortunately, metastasis of uveal melanoma almost always proves to be fatal. The current treatment of metastatic uveal melanoma is limited by the intrinsic resistance of uveal melanoma to conventional systemic therapies. Advancements in molecular biology have resulted in the identification of a number of promising prognostic and therapeutic targets. Early detection and therapy are important factors in disease survival. It is imperative that the treating physician be familiar with the clinical features of uveal melanoma and distinguish it from mimickers in order to ensure effective and timely treatment.
Treatment with laser therapy has the potential to greatly improve hypertrophic scarring in individuals who have sustained burn injuries. More specifically, recent research has demonstrated the success of using pulsed dye laser therapy to help reduce redness and postburn pruritus and using ablative fractional CO2 laser therapy to improve scar texture and thickness. This study describes our early experience using laser therapy in our pediatric burn program and details our specific treatment approach when using each laser individually and in combination during the same procedure. A retrospective before-after study of patients with hypertrophic burn scars who were treated with laser therapy at our pediatric institution was performed. One hundred and twenty-five patients were treated over a total of 289 laser sessions with more than 50% of patients under the age of 5 years at the first treatment. The majority of procedures were performed using both the pulsed dye and CO2 lasers in combination. Before-after Vancouver Scar Scale scores decreased from 7.37 (SD, 2.46) to 5.76 (SD, 2.29) after a single treatment. The results obtained from this study support the use of laser therapy to improve hypertrophic burn scars in the pediatric population. Rigorous randomized controlled trials are needed to confirm the effectiveness of this therapy.
Physician advocacy and leadership is increasingly recognized as an important part of our social responsibility. Frameworks, such as CanMEDS, have set out definitions of health advocacy and leadership for medical education. Despite calls for mandatory advocacy and leadership teaching and potential wellness benefits, presently medical curricula do not usually teach practical advocacy and leadership skills to learners. There is also a demonstrated disconnect between staff and resident perceptions of advocacy. Our group set out to create an innovative Advocacy and Leadership Curriculum (ALC) to fill this gap. A collaboration of over twenty medical students and professors from across Canada and the U.S worked over the past year to survey students, conduct curriculum mapping, Page | 2 examine current literature and practices in order to inform the creation of an ALC. A competency-and milestonebased ALC was created based on this data and reviewed by experts in medical education and/or physician advocacy. This ALC addresses three spheres of advocacy: the Patient level, the Institutional level, and the Population level (which includes the Community). A guiding principle of the ALC is to form positive working partnerships with communities and patients and to collaborate with other health professionals to advocate with, and on behalf of, patients. CanMEDS-based Learning Objectives, divided into theoretical, skills-based, and application-based categories, form the core of the program. The curriculum prepares learners for real-world advocacy through longitudinal projects, interdisciplinary work, and community-based service learning. Novel engagement of other professionals and physician advocates to act as advocacy preceptors is central to the curriculum. Innovative assessment techniques-such as advocacy simulations, longitudinal study of physician advocacy activity, and focus on attitudes and behaviour as well as knowledge and practical advocacy skills-are introduced. The ALC serves as an adaptable model for the training of socially responsible medical learners who are conversant in advocacy techniques and able to advocate with patients, within institutions, and with populations. Projects resulting from the ALC will improve medical school social accountability.
The category of this article was incorrectly published as an Original Research Article, when it should have been published as a Review.
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