SCAN! A pharmacy-based, sun safety feasibility study.

OBJECTIVES: Skin cancer is the most common form of cancer, and individuals from the medically underserved Appalachian region are at elevated risks for cancer morbidity and mortality. Skin cancer can be prevented by decreasing ultraviolet light exposure (sunscreen sun protection factor 30, shade, clothing, sunglasses, hats) and can be caught at an early treatable stage through a routine skin examination. The Skin Cancer Awareness Now! (SCAN!) pilot project promoted skin cancer prevention and screening in community pharmacies, using a dynamic communication model. The objectives of the study were to understand (1) the feasibility of the SCAN! and (2) the preliminary impact of the SCAN! METHODS: We conducted pre- and postintervention surveys of the SCAN!, a student pharmacist-led or pharmacy resident-led intervention in community pharmacies (n = 3). RESULTS: Participants (n = 90) had a mean age of 43.8 (SD= 18.4) years, were predominantly white (92.1%), without a college degree (65.6%), and had an average family income in the range of $25,000-$49,999, with approximately 16% falling below the poverty level. To begin, the SCAN! scored highly in attention (mean = 5.8), liking (mean = 6.1), comprehension (mean = 6.7), and intentions to be sun safe (mean = 6.0). Most improved in their knowledge of the amount of sunscreen needed per application for sun safety (66%, P < 0.01) and of melanoma features from pre- and postintervention (39%, P < 0.01). A multivariate analysis of variance indicated that knowledge and intentions improved (all P's < 0.01). Interaction effects indicated that improvements in knowledge were greater for those in the rural pharmacy (P = 0.03), and improvements in perceived importance were greater for those in urban pharmacies (P = 0.01). CONCLUSION: The SCAN! intervention was well received by the population. Our study provides evidence that community pharmacy is a novel venue for skin cancer prevention interventions, particularly for rural, medically underserved populations.

Spontaneous haemarthrosis causing anterior shoulder dislocation.

Nontraumatic haemarthrosis secondary to anticoagulant therapy is a recognized clinical problem. The involved joints are usually large weight-bearing joints, particularly the knee. We describe a case of spontaneous haemarthrosis in a 53-year-old female patient, who had been started on anticoagulant drugs after a pulmonary embolism in the past (international normalized ratio on admission: 2.4). The patient presented with acute onset of severe shoulder pain with no history of trauma. Her shoulder showed radiological signs of anterior dislocation. Attempts to relocate her shoulder under intravenous sedation with midazolam were unsuccessful. The patient subsequently underwent aspiration of the shoulder joint and made full recovery after a course of physiotherapy. The case is unusual because it occurred in a previously healthy shoulder joint and because the bleeding caused the shoulder to appear clinically and radiologically anteriorly dislocated. No history of trauma was reported before presentation; the apparent dislocation was caused solely by spontaneous haemarthrosis. This case emphasizes that it is important to consider spontaneous haemarthrosis as a possible diagnosis in patients with no history of trauma, particularly in those on anticoagulant drugs, who present with what appears to be an anterior shoulder dislocation.