Epworth Collection:http://hdl.handle.net/11434/602024-03-28T17:06:27Z2024-03-28T17:06:27ZSystemic treatments for alopecia areata: a systematic review.Sinclair, Rodneyhttp://hdl.handle.net/11434/14062018-06-24T23:57:44Z2018-06-01T00:00:00ZTitle: Systemic treatments for alopecia areata: a systematic review.
Epworth Authors: Sinclair, Rodney
Abstract: BACKGROUND: A range of systemic treatments are used for alopecia areata (AA) with variable evidence supporting efficacy. In this systematic review, we evaluated the evidence surrounding systemic treatments used in the management of alopecia areata, alopecia totalis (AT) and alopecia universalis (AU).
METHODS: A systematic search was conducted of the peer-reviewed literature published between 1946 and March 2018 via Medline, Embase, Amed, the Cochrane Central Register of Controlled Trials, PsychINFO and Lilacs. All randomised controlled trials (RCTs) that evaluated the effectiveness of systemic treatments for individuals with AA, AT or AU were included.
RESULTS: Sixteen studies were included with a total of 768 participants. We found 8 placebo-controlled RCTs, 3 RCTs comparing 2 systemic treatments and 5 RCTs comparing 3 treatments. A total of 15 different systemic therapies were investigated. The most frequently investigated therapy was oral prednisolone pulse therapy and oral inosiplex in 3 studies each. There was significant variability in the definition of treatment success. Only 3 studies included psychometric questionnaires. Adverse events were reported in 13 studies and were corticosteroid-related or otherwise well tolerated. Relapse rates were considerable in the 4 studies that reported this outcome.
CONCLUSION: There is currently no particular systemic therapy that is supported by robust body of evidence from RCTs. The current evidence suggests efficacy of oral prednisolone pulse therapy and oral inosiplex. Evidence does not support the use of oral zinc sulphate, alefacept and efalizumab. Future RCTs should be adequately powered and employ clearly defined clinical response endpoints to allow future meta-analyses.2018-06-01T00:00:00ZFemale pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone.Sinclair, Rodneyhttp://hdl.handle.net/11434/13132021-01-19T02:29:56Z2018-01-01T00:00:00ZTitle: Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone.
Epworth Authors: Sinclair, Rodney
Abstract: BACKGROUND:
Minoxidil and spironolactone are oral antihypertensives known to stimulate hair growth.
OBJECTIVE:
To report on a case series of women with pattern hair loss (PHL) treated with once daily minoxidil 0.25 mg and spironolactone 25 mg.
METHODS:
Women newly diagnosed with a Sinclair stage 2-5 PHL were scored for hair shedding and hair density before and after 12 months of treatment with oral minoxidil 0.25 mg and spironolactone 25 mg.
RESULTS:
A total of 100 women were included in this observational pilot study. Mean age was 48.44 years (range 18-80). Mean hair loss severity at baseline was Sinclair 2.79 (range 2-5). Mean hair shedding score at baseline was 4.82. Mean duration of diagnosis was 6.5 years (range 0.5-30). Mean reduction in hair loss severity score was 0.85 at 6 months and 1.3 at 12 months. Mean reduction in hair shedding score was 2.3 at 6 months and 2.6 at 12 months. Mean change in blood pressure was -4.52 mmHg systolic and -6.48 mmHg diastolic. Side effects were seen in eight women but were generally mild. No patients developed hyperkalemia or any other blood test abnormality. Six of these women continued treatment, and two women who developed urticaria discontinued treatment.
LIMITATIONS:
Prospective, uncontrolled, open-label observational study.
DISCUSSION:
Once daily capsules containing minoxidil 0.25 mg and spironolactone 25 mg appear to be safe and effective in the treatment of FPHL. Placebo-controlled studies to investigate this further are warranted.2018-01-01T00:00:00ZImmunonutrition as an adjuvant therapy for burns.Wasiak, Jasonhttp://hdl.handle.net/11434/13052018-05-16T02:31:51Z2014-12-01T00:00:00ZTitle: Immunonutrition as an adjuvant therapy for burns.
Epworth Authors: Wasiak, Jason
Abstract: BACKGROUND:
With burn injuries involving a large total body surface area (TBSA), the body can enter a state of breakdown, resulting in a condition similar to that seen with severe lack of proper nutrition. In addition, destruction of the effective skin barrier leads to loss of normal body temperature regulation and increased risk of infection and fluid loss. Nutritional support is common in the management of severe burn injury, and the approach of altering immune system activity with specific nutrients is termed immunonutrition. Three potential targets have been identified for immunonutrition: mucosal barrier function, cellular defence and local or systemic inflammation. The nutrients most often used for immunonutrition are glutamine, arginine, branched-chain amino acids (BCAAs), omega-3 (n-3) fatty acids and nucleotides.
OBJECTIVES:
To assess the effects of a diet with added immunonutrients (glutamine, arginine, BCAAs, n-3 fatty acids (fish oil), combined immunonutrients or precursors to known immunonutrients) versus an isonitrogenous diet (a diet wherein the overall protein content is held constant, but individual constituents may be changed) on clinical outcomes in patients with severe burn injury.
SEARCH METHODS:
The search was run on 12 August 2012. We searched the Cochrane Injuries Group's Specialised Register, The Cochrane Library, MEDLINE (OvidSP), Embase (OvidSP), ISI WOS SCI-EXPANDED & CPCI-S and four other databases. We handsearched relevant journals and conference proceedings, screened reference lists and contacted pharmaceutical companies. We updated this search in October 2014, but the results of this updated search have not yet been incorporated.
SELECTION CRITERIA:
Randomised controlled trials comparing the addition of immunonutrients to a standard nutritional regimen versus an isonitrogenated diet or another immunonutrient agent.
DATA COLLECTION AND ANALYSIS:
Two review authors were responsible for handsearching, reviewing electronic search results and identifying potentially eligible studies. Three review authors retrieved and reviewed independently full reports of these studies for inclusion. They resolved differences by discussion. Two review authors independently extracted and entered data from the included studies. A third review author checked these data. Two review authors independently assessed the risk of bias of each included study and resolved disagreements through discussion or consultation with the third and fourth review authors. Outcome measures of interest were mortality, hospital length of stay, rate of burn wound infection and rate of non-wound infection (bacteraemia, pneumonia and urinary tract infection).
MAIN RESULTS:
We identified 16 trials involving 678 people that met the inclusion criteria. A total of 16 trials contributed data to the analysis. Of note, most studies failed to report on randomisation methods and intention-to-treat principles; therefore study results should be interpreted with caution. Glutamine was the most common immunonutrient and was given in seven of the 16 included studies. Use of glutamine compared with an isonitrogenous control led to a reduction in length of hospital stay (mean stay -5.65 days, 95% confidence interval (CI) -8.09 to -3.22) and reduced mortality (pooled risk ratio (RR) 0.25, 95% CI 0.08 to 0.78). However, because of the small sample size, it is likely that these results reflect a false-positive effect. No study findings suggest that glutamine has an effect on burn wound infection or on non-wound infection. All other agents investigated showed no evidence of an effect on mortality, length of stay or burn wound infection or non-wound infection rates.
AUTHORS' CONCLUSIONS:
Although we found evidence of an effect of glutamine on mortality reduction, this finding should be taken with care. The number of study participants analysed in this systematic review was not sufficient to permit conclusions that recommend or refute the use of glutamine. Glutamine may be effective in reducing mortality, but larger studies are needed to determine the overall effects of glutamine and other immunonutrition agents.2014-12-01T00:00:00ZBarriers and enablers to implementing scalp cooling in Australia: a qualitative study of health professionals' attitudes to and experience with scalp cooling.O'Brien, JaneChua, SusanDe Boer, Richardhttp://hdl.handle.net/11434/12142019-04-30T05:00:48Z2017-08-01T00:00:00ZTitle: Barriers and enablers to implementing scalp cooling in Australia: a qualitative study of health professionals' attitudes to and experience with scalp cooling.
Epworth Authors: O'Brien, Jane; Chua, Susan; De Boer, Richard
Abstract: BACKGROUND:
Chemotherapy-induced alopecia is a common and distressing adverse event for patients. Scalp cooling to reduce this alopecia has been available in Europe for more than a decade, but only recently introduced in Australia. The aim of this study was to qualitatively explore health professionals’ perceptions of the barriers and enablers to the implementation of scalp cooling in Australian cancer centres.
METHODS:
Using a qualitative methodology, telephone interviews were conducted with 21 health professionals working in a tumour stream where chemotherapy-induced alopecia is an adverse event of treatment. Participants were recruited from five centres in Australia where scalp cooling is currently available and one centre without access to the technology.
RESULTS:
Four interrelated themes were identified: (1) health professional attitudes, (2) concerns for patient equity, (3) logistical considerations and (4) organisational support.
CONCLUSIONS:
This qualitative study provides the first methodological exploration of Australian health professionals’ perceptions of barriers and enablers to scalp cooling uptake. The results highlighted health professional support drives the introduction of scalp cooling. Integration of the technology requires adjustments to nursing practice to manage the increased time, workload and change in patient flow. Strategies to manage the change in practice and organisational support for change in work flow are essential for successful implementation into routine care.2017-08-01T00:00:00Z