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PubMed · 9479076

Editorial

Abstract

I am delighted to inform our readership that we have been accepted for inclusion in EMBASE and MEDLINE, the indexing databases of Excerpta Medica and Index Medicus. You are now able to obtain journal article citations commencing with this issue, by searching EMBASE, and in the near future, by searching MEDLINE. Both databases are also accessible through Silver Platter. With continued concern over the increasing incidence of melanoma, this issue of the Journal focuses on a number of important areas related to this subject. In our our Point-Counterpoint editorials, Drs. Frans Rampen and Martin Weinstock evaluate the pros and cons of mass screening programs in a cogent fashion. An ongoing controversy in the treatment of melanoma has been the margin required for optimal excision of the primary lesion. Over the past several decades, there has been a steady reduction in the extent of the resection of the primary tumour. Drs. Beasley and Cartotto retrospectively analyzed over 100 primary melanomas. Two local recurrences were seen in melanomas less than 2 mm thick, despite a margin of 1.7 and 2.4 cm. While larger studies are needed, this analysis stimulates some question on the true safety of currently accepted margins for 1 to 2 mm thick melanomas. Continuing with the theme of melanoma, our Grand Rounds from the University of British Columbia discusses a patient with melanoma and unilateral vascular tumours. In their article on familial melanomas, Hogg et al. review the area of the genetics of melanoma, with particular reference to the role of cyclin dependent kinase inhibitor gene CDKN2A, on chromosome 9p21 and its potential predictive role in identifying at risk individuals for melanoma. I am pleased to have Dr. Robert Jackson introduce a new section in the Journal, Classics in Dermatology. This series provides a historical perspective on dermatologic disease. While the above article on melanoma illustrates how advances in molecular biology have dramatic impacts on our diagnostic skills, as dermatologists we still greatly value accurate clinical skills. The Classics in Dermatology focuses, from a historical perspective, on the importance of clinical acumen. Advances in dermatologic surgery have dramatically transformed our specialty. Hair transplantation was one of the initial areas of dermatologic surgery and dermatologists have been at the forefront of this field since the landmark studies by Dr. Orentreich in 1959. Since that time there have been major changes in the technique of hair transplantation that have greatly enhanced the outcomes. Drs. Bertucci, Berg, and Pollack update us on current techniques in this field.

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DN Sauder. 1998. Editorial. https://doi.org/10.1177/120347549800200301

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Effectiveness of high-dose versus standard-dose influenza vaccines against hospitalisation according to frailty risk: a prespecified analysis of the randomised trial DANFLU-2.

BACKGROUND: Frailty is a major risk factor for influenza-related complications and can influence vaccine effectiveness. We aimed to assess the relative vaccine effectiveness (rVE) of high-dose (HD-IIV) versus standard-dose inactivated influenza vaccine (SD-IIV) in older adults aged 65 years or older according to frailty risk. METHODS: This study was a prespecified analysis of DANFLU-2, an open-label, individually randomised trial, conducted in Denmark during three consecutive influenza seasons (2022-23, 2023-24, and 2024-25). Adults aged 65 years or older were randomised (1:1) to the HD-IIV or SD-IIV group. The primary endpoint was hospitalisation for influenza or pneumonia. Frailty was defined according to the validated Hospital Frailty Risk Score (HFRS) based on ICD-10 codes within 10 years before randomisation. Participants were stratified into three HFRS categories, namely low (<5 points), intermediate (5-15 points), and high (>15 points) frailty risk. The rVE of HD-IIV versus SD-IIV against the primary endpoint was assessed across prespecified HFRS categories and treating HFRS as a continuous variable. Pearson's chi-square test was used to compare safety events across frailty risk groups and randomisation groups. FINDINGS: Among 332&#x2009;438 randomised participants (mean age 73&#xb7;7 years [SD 5&#xb7;8]; 161&#x2009;538 [48&#xb7;6%] were female), 276&#x2009;173 (83&#xb7;1%) had low frailty risk, 52&#x2009;395 (15&#xb7;8%) had intermediate frailty risk, and 3861 (1&#xb7;2%) had high frailty risk. The primary endpoint of hospitalisation for influenza or pneumonia occurred in 1424 (0&#xb7;5%) of 276&#x2009;173 participants with low frailty risk, 761 (1&#xb7;5%) of 52&#x2009;395 with intermediate frailty risk, and 163 (4&#xb7;2%) of 3861 with high frailty risk (relative risk [RR] for intermediate vs low frailty risk 2&#xb7;8 [95% CI 2&#xb7;6-3&#xb7;1]; RR for high vs low frailty risk 8&#xb7;2 [7&#xb7;0-9&#xb7;6]). HFRS as a continuous variable significantly modified the effect of HD-IIV versus SD-IIV against the primary endpoint with higher rVE estimates with increasing HFRS (pinteraction=0&#xb7;020). The rVE was 0&#xb7;2% (95% CI -10&#xb7;8 to 10&#xb7;2) among those with low frailty risk, 13&#xb7;1% (-0&#xb7;4 to 24&#xb7;8) among those with intermediate frailty risk, and 19&#xb7;9% (-10&#xb7;3 to 42&#xb7;1) among those with high frailty risk. No significant interaction was observed when HFRS was assessed according to the prespecified categorical frailty groups (pinteraction=0&#xb7;17). The proportion of participants with at least one serious adverse event increased across frailty risk groups (13&#x2009;366 [4&#xb7;8%] of 275&#x2009;795 for low frailty risk, 5475 [10&#xb7;5%] of 52&#x2009;315 for intermediate frailty risk, and 777 [20&#xb7;2%] of 3850 for high frailty risk; p<0&#xb7;0001), with similar proportions of serious adverse events in the HD-IIV and SD-IIV groups for each frailty risk group. INTERPRETATION: Among adults aged 65 years or older in Denmark, frailty risk might modify the effects of HD-IIV versus SD-IIV against hospitalisation for influenza or pneumonia, with higher rVE estimates with increasing frailty risk. These findings might support considering high-dose influenza vaccines for frail older adults. However, effect modification was not evident when frailty was assessed using prespecified categorical subgroups, and subgroup-specific estimates were imprecise, with 95% CIs crossing the null. These results should be considered exploratory, warranting further investigation. FUNDING: The DANFLU-2 trial was funded by Sanofi.

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