Biomedical subjects

Robyn Bluhm

Publications and source records attributed to Robyn Bluhm.

8 recordsLinked to original sources

PubMed2005

Theatre as a public engagement tool for health-policy development.

PURPOSE: To explore theatre as a public engagement tool for health-policy development. BACKGROUND: In a justice-based democracy, engagement of a large number of citizens of diverse perspectives is required for legitimate health-policy development. However, all current strategies of citizen participation are limited in their capacity to engage, either by lack of opportunity to educate citizens prior to soliciting their opinions or lack of large numbers of citizens. METHODS: A series of 12 nested case studies was conducted, with each case study consisting of a performance of a 70-min play, specifically written to educate citizens to scientific, clinical, and psychosocial issues of adult predictive genetic testing, and to foster empathy for persons immersed therein; and a 1-h audience discussion that was taped and transcribed for qualitative analysis (modified thematic). The script was based on key informant interviews, literature review, and six script readings for key informants and communities. Audience members were recruited through conference or educational event programs, posters, newsletters, and electronic announcements, as well as newspaper advertisements and other public, community and institutional postings. RESULTS: More than 1,000 citizens were engaged. The analysis indicated that audience members were engaged emotionally and cognitively in the position of the characters and the health-policy issues. Audience members' comments forwarded from personal or professional lived experience confirmed the validity of the script and promoted further emotional and cognitive engagement of other audience members. Audience members offered informed and diverse opinions on policy issues, including resource allocation, patenting of genetic tests, research funding, genetic test-based insurance discrimination, and imperative for public education. The potential for harm to key informants and audience members (and those in relationships with them) were observed, usually related to learning or offering personal information regarding their genetic risk. CONCLUSION: As many citizens can be engaged in theatre-based policy development as surveyed through public opinion polls, and many times the number that can be engaged in strategies that educate citizens prior to soliciting their opinions, likely at a similar cost per citizen engaged.

Community Participation↗

PubMed2005

From hierarchy to network: a richer view of evidence for evidence-based medicine.

Evidence-based medicine (EBM) advocates the improvement of patient care through the use of current best research evidence in medical decision making. In practice, "best evidence" generally refers to where a study fits on a hierarchy of evidence, which places randomized controlled trials (RCTs) and other population-level research above laboratory research. Because population research is concerned primarily with average results obtained from large groups of people, ranking evidence on the basis of its place in the hierarchy is shortsighted and ultimately limits the ability of research results to inform the care of individual patients. The history and methodology of epidemiology reveals a close relationship between population-level and laboratory research; both types of research are necessary if we are to understand the causes of a disease. What EBM does not take into account in its hierarchy of evidence is that the same thing is true for research on the safety and efficacy of medical interventions. To maximize the information that clinical research can provide for clinical care, RCTs should be designed to elucidate within-group variability. This can only be done if the hierarchy of evidence is replaced by a network that takes into account the relationship between epidemiological and laboratory research.

Biomedical Research↗

PubMed2004

Skin diseases associated with Malassezia species.

The yeasts of the genus Malassezia have been associated with a number of diseases affecting the human skin, such as pityriasis versicolor, Malassezia (Pityrosporum) folliculitis, seborrheic dermatitis and dandruff, atopic dermatitis, psoriasis, and--less commonly--with other dermatologic disorders such as confluent and reticulated papillomatosis, onychomycosis, and transient acantholytic dermatosis. Although Malassezia yeasts are a part of the normal microflora, under certain conditions they can cause superficial skin infection. The study of the clinical role of Malassezia species has been surrounded by controversy because of their fastidious nature in vitro, and relative difficulty in isolation, cultivation, and identification. Many studies have been published in the past few years after the taxonomic revision carried out in 1996 in which 7 species were recognized. Two new species have been recently described, one of which has been isolated from patients with atopic dermatitis. This review focuses on the clinical, mycologic, and immunologic aspects of the various skin diseases associated with Malassezia. It also highlights the importance of individual Malassezia species in the different dermatologic disorders related to these yeasts.

Dermatitis, Atopic↗

PubMed2003

Onychomycosis: quality of studies.

OBJECTIVE: The quality of original clinical trial publications pertaining to the use of oral antifungal agents to treat onychomycosis was evaluated using predetermined criteria. METHODS: The list of studies included in this analysis was determined by conducting a search in Medline. For each clinical trial, two independent reviewers each determined a composite score by evaluating a list of criteria that were felt to represent a good study, for example, randomization and blinding, prior sample size calculated, and treatment regimen clearly explained. A citation count was performed to determine whether higher-quality papers were cited more often than lower-quality papers. RESULTS: Forty-five studies were included in this quality analysis of study design. Of these, 27 were considered to be "high quality" (score greater than or equal to 11 out of 20). A significant correlation coefficient of 0.997 was found between the two reviewers (P < 0.00001). Higher-quality papers were cited significantly more often than lower-quality papers (P = 0.03). CONCLUSION: The scale that we use to evaluate the quality of onychomycosis studies has high interrater reliability. According to this scale, many published studies (18 out of 45) pertaining to treatments for onychomycosis do not meet the criteria required to be considered "high quality."

Administration, Oral↗

PubMed2003

Seborrheic dermatitis.

Seborrheic dermatitis is present in 1% to 3% of immunocompetent adults, and is more prevalent in men than in women. Seborrheic dermatitis may be seen in conjunction with other skin diseases, such as rosacea, blepharitis or ocular rosacea, and acne vulgaris. Malassezia yeasts have been associated with seborrheic dermatitis. Abnormal or inflammatory immune system reactions to these yeasts may be related to development of seborrheic dermatitis. Treatment modalities for seborrheic dermatitis include keratolytic agents, corticosteroids, and more recently, antifungal agents. Antifungal agents do not carry a risk of skin atrophy or telangiectasia with prolonged use, and it is more prudent to consider antifungals than corticosteroid preparations. The wide range of antifungal formulations available (creams, shampoos, or oral) provides safe, effective, and flexible treatment options for seborrheic dermatitis.

Administration, Cutaneous↗

PubMed2003

Pityriasis versicolor.

Pityriasis versicolor is a mild or chronic condition characterized by scaly hypopigmented or hyperpigmented lesions usually affecting the trunk. The lesions vary depending on tropical or temperate climates. The disease seems to occur mainly at adolescence when the sebaceous glands are more active. Malassezia yeasts have been implicated in the pathogenesis of this disease. The mycelial form of the fungus has been suggested to be the cause of lesions. Antifungal preparations have been used to treat the initial presentation effectively, although in a proportion of patients the disease tends to reoccur. They are available in a wide range of formulations and have been shown to be safe.

Administration, Cutaneous↗

PubMed2002

Imiquimod: a review.

BACKGROUND AND OBJECTIVE: Imiquimod (Aldara) is an immune response modifier used primarily to treat anogenital warts. Imiquimod induces cytokines and enhances cell-mediated cytolytic antiviral activity in vivo. It exhibits antiviral and antitumor effects; however, it does not exhibit direct antiviral effects in vitro. By inducing cytokines, such as interferon a, imiquimod stimulates both the innate immune response and the cellular arm of acquired immunity. Currently, imiquimod is approved for use in the treatment of external genital and perianal warts in adults. CONCLUSION: Beyond its established use, there are case reports and preliminary studies suggesting the effectiveness of imiquimod 5% cream in the treatment of nongenital human papillomavirus warts, molluscum contagiosum, actinic keratosis, basal cell carcinoma, squamous cell carcinoma, Bowen's disease, nongenital human papillomavirus infection, and vulvar intraepithelial neoplasia.

Adjuvants, Immunologic↗

PubMed2002

Nonpsoriatic uses of calcipotriol.

BACKGROUND: Calcipotriol is a synthetic vitamin D3 analog that binds to vitamin D receptors in epidermal cells. In vitro studies have shown that calcipotriol stimulates terminal cell differentiation and has antiproliferative effects. In vivo, calcipotriol has been shown to reduce the number of cycling epidermal cells. Calcipotriol also has less effect on calcium metabolism than calcitriol, which is the natural, bioactive, 1,25-dihydroxyvitamin D3. OBJECTIVE: These properties make calcipotriol an ideal candidate for the topical treatment of hyperproliferative skin disorders. While it has been approved for topical use in psoriasis, its potential for use in other dermatological disorders has not yet been fully investigated. CONCLUSION: This survey of the literature suggests that calcipotriol may show promise in the treatment of other conditions involving abnormal keratinization and hyperproliferation of epidermal cells. While some of these disorders are rare, and therefore difficult to study, further study into the nonpsoriatic uses of calcipotriol may be rewarding.

Calcitriol↗