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An unplanned ICU admission was a stressful event for family members, who looked to clinicians for emotional support. Developing trust was challenging, as family members struggled to feel like integrated members of the medical team when patients transitioned from one setting to another. Interpretation Family of patients experiencing an unplanned ICU admission want high-quality communication both during and after a patient's transfer to the ICU. This communication should help family members make sense of the situation, address unmet expectations, and provide emotional support. In addition, interventions that foster family-clinician trust can help family members feel like integrated members of the care team as they face the challenge of navigating multiple different environments within the hospital.Patients with autoimmune and/or inflammatory diseases (AID) are prone to serious infectious complications such as Pneumocystis Jirovecii pneumonia (PJP). In non-HIV patients, the prognosis is poorer and diagnosis tests are of lower sensitivity. Given the low incidence of PJP in AID, with the exception of granulomatosis with polyangiitis, and the non-negligible side effects of chemoprophylaxis, routine prescription of primary prophylaxis is still debated. Absolute peripheral lymphopenia, high doses of corticosteroids, combination with other immunosuppressive agents, and concomitant lung disease are strong predictors for the development of PJP, and thus should warrant primary prophylaxis. Trimethoprim-sulfamethoxazole is considered as the first line therapy and the most extensively used drug for PJP prophylaxis. Nevertheless, it may expose patients to side effects. Effective alternative drugs could be used when trimethoprim-sulfamethoxazole is not tolerated or contraindicated such as atovaquone, or aerosolized pentamidine. No standard guidelines are available to guide PJP prophylaxis in patients with AID. This review covers the epidemiology, risk factors and prevention of pneumocystis in the context of AID.Background Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States, with 16 million Americans currently suffering from difficult breathing. Power outages could be life-threatening for those relying on electricity. However, significant gaps remain in understanding the potential impact of power outages on COPD exacerbations. Research Question How power outages affect COPD exacerbations. Study design and methods Using distributed lag nonlinear models controlling for time-varying confounders, we compared the hospitalization rate during power outage versus non-outage periods to determine the rate ratio (RR) for COPD and its subtypes at each of 0-6 lag days in New York State, 2001-2013. We conducted stratified analyses by socio-demographics, season and clinical severity, and investigated changes in numerous critical medical indicators including length of stay, hospital cost, the number of comorbidities and therapeutic procedures between the two periods. Results We observed the RR of COPD hospitalization following power outages ranged from 1.03 to 1.39 across lag days. The risk was strongest at lag0 and lag1 days and lasted significantly for 7 days. Associations were stronger for the subgroup with acute bronchitis (RR 1.08 to 1.69) than for acute exacerbation cases (RR 1.03 to 1.40). Compared with non-outage periods, the outage period was observed to be $4.67 thousand greater in hospital cost and 1.38 greater in the number of comorbidities per case. The average cost (or number of comorbidities) was elevated in all groups stratified by cost (or number of comorbidities). In contrast, changes in the average length of stay (-0.43 days) and the average number of therapeutic procedures (-0.09 procedures) were subtle. Interpretation Power outages were associated with a significantly elevated rate of COPD hospitalization as well as greater costs and number of comorbidities. The average cost and number of comorbidities were elevated in all clinical severity groups.Background Tapinarof is a topical therapeutic aryl hydrocarbon receptor modulating agent (TAMA) under investigation for atopic dermatitis (AD) and psoriasis treatment. Methods Phase IIb, double-blind, vehicle-controlled study randomized adolescents and adults with AD to receive tapinarof cream 0.5%, 1%, or vehicle, once (QD) or twice daily (BID) for 12 weeks with 4-week follow-up. Outcomes included Investigator Global Assessment (IGA), Eczema Area and Severity Index (EASI), body-surface area (BSA) affected, pruritus numeric rating scale scores, subject impressions of AD and pruritus symptom severity, and Patient-Oriented Eczema Measure (POEM) scores. Results 191/247 randomized subjects completed the study. Week-12 IGA responses were higher in tapinarof groups vs vehicle, reaching statistical significance with tapinarof 1%BID; ≥75/90% improvement in EASI from baseline were significantly higher in tapinarof groups (except 0.5%QD and 0.5%BID, respectively); EASI scores were significantly improved in all tapinarof groups; BSA affected was significantly reduced in tapinarof groups (except 0.5%BID). More subjects reported AD and pruritus symptom severity as very/moderately improved in tapinarof groups and POEM improvements were observed in all groups. Most adverse events were mild or moderate. Limitations Larger prospective studies are required to confirm reported analyses. Conclusions Tapinarof is a potential important advance in topical medicine development for AD.Background Onychomycosis is the most common nail disorder, often causing physical, emotional, and aesthetic consequences. [https://www.selleckchem.com/products/nct-503.html NCT-503 order] The impact of both the condition itself and treatment on quality of life has not been well studied. Objective The objectives of this study were to systematically review the available literature describing the impact of onychomycosis and treatment on quality of life. Methods We performed a search of the onychomycosis literature published prior to April 13, 2020. Articles were included in the review if primary data were presented, patient-reported outcome measures were used, and onychomycosis was specifically examined. Results Thirty studies were included in the final analysis. Poorest QoL scores were associated with females and fingernail involvement. QoL scores improved from baseline with all treatment types; there were greater improvements reported with orals compared to topicals. Conclusions This review affirms that onychomycosis causes significant impact on quality of life, warranting effective treatment.