Report from the kick-off meeting of the Cochrane Skin Group Core Outcome Set Initiative (CSG-COUSIN).

A major obstacle of evidence-based clinical decision making is the use of nonstandardized, partly untested outcome measurement instruments. Core Outcome Sets (COSs) are currently developed in different medical fields to standardize and improve the selection of outcomes and outcome measurement instruments in clinical trials, in order to pool results of trials or to allow indirect comparison between interventions. A COS is an agreed minimum set of outcomes that should be measured and reported in all clinical trials of a specific disease or trial population. The international, multidisciplinary Cochrane Skin Group Core Outcome Set Initiative (CSG-COUSIN) aims to develop and implement COSs in dermatology, thus making trial evidence comparable and, herewith, more useful for clinical decision making. The inaugural meeting of CSG-COUSIN was held on 17-18 March 2015 in Dresden, Germany, as the exclusive theme of the Annual Cochrane Skin Group Meeting. In total, 29 individuals representing a broad mix of different stakeholder groups, professions, skills and perspectives attended. This report provides a description of existing COS initiatives in dermatology, highlights current methodological challenges in COS development, and presents the concept, aims and structure of CSG-COUSIN.

The epidemiology of hospitalised acute kidney injury not requiring dialysis in England from 1998 to 2013: retrospective analysis of hospital episode statistics.

AIMS: Epidemiology studies of acute kidney injury (AKI) have focused on cases requiring dialysis but those not requiring dialysis represent the majority. To address this gap, we interrogated hospital episode statistics (HES) to investigate population trends in temporal epidemiology of AKI not requiring dialysis between 1998 and 2013. METHODOLOGY: In this retrospective observational study of HES data covering the entire English National Health Service, we identified 1,136,167 AKI events, not requiring dialysis, diagnosed between 1998 and 2013. We explored the effect of age, gender, ethnicity, Charlson's comorbidity score (CCS), method of admission, diagnosis period and AKI in diagnosis codes on temporal changes in the incidence and case-fatality of AKI with specific examination of its predictors. RESULT: The incidence of AKI increased from 15,463 cases (317 pmp) in 1998-1999 to 213,700 cases (3995 pmp) in 2012-2013. There was increase in proportion of people over 75 years from 51.1% in 1998-1999 to 63.4% in 2012-2013. Overall unadjusted case-fatality decreased from 42.3% in 1998-2003 to 27.1% in 2008-2013, p < 0.001. Compared with 1998-2003, the multivariable adjusted odds ratio for death was 0.64 in 2003-2008 (95% CI 0.63-0.65) and 0.35 in 2008-2013 (95% CI 0.34-0.35). Odds for death were higher for patients over 85 years (2.93; 95% CI 2.89-2.97), CCS of more than five (2.75; 95% CI 2.71-2.79), emergency admissions (2.14; 95% CI 2.09-2.18) and AKI in the secondary diagnosis code (1.35; 95% CI 1.33-1.36) and AKI in other diagnoses codes (2.17; 95% CI 2.15-2.20). CONCLUSIONS: In England, the incidence of AKI not requiring dialysis has increased and case-fatality has decreased over last 15 years. Efforts to reduce the incidence of AKI and improve survival should focus on elderly people, emergency admissions and those with multi-morbidity.

Current therapy of diabetic retinopathy: laser and vitreoretinal surgery.

The advent of laser surgery and pars plana vitreous surgery has enhanced the vision and improved the lifestyle of the diabetic patient. Further research including use of the diode laser and improved vitreoretinal technology most likely will improve the current management of the diabetic patient. In addition, early detection and diagnosis of diabetic retinopathy will lead to earlier treatment and hopefully prevention of loss of sight. Future research to define the role of metabolic control of serum glucose and its relationship to diabetic retinopathy is necessary.

Diabetic retinopathy.

Retinal involvement from diabetes mellitus is the leading cause of new blindness in the United States. Many diabetic patients, though they have perfect vision and no ocular complaints or symptoms, harbor retinal pathology capable of leading to severe loss of vision. Therefore, all medical personnel caring for the diabetic patient must recognize the importance of dilated pupil retinal examinations by an ophthalmologist or vitreoretinal surgeon. Lack of timely diagnosis and treatment is a major factor leading to blindness from diabetic retinopathy. On a more positive note, prompt laser treatment of diabetic retinopathy can reduce severe visual loss by more than 50%.

The Georgia diabetic retinopathy screening study.

The diabetic retinopathy screening study represents a major collaborative effort of many volunteer groups interested in decreasing the risk of severe visual loss to Georgia citizens. Results of the present study have stimulated intense interest in screening more high risk persons, such as minorities, without the exclusion of whites. While age-related macular degeneration is the predominant cause of blindness in the U.S., diabetic retinopathy is a major new cause of blindness. With the continuation and completion of this study, we believe that many more of Georgia's citizens will seek ophthalmologic examinations and benefit from previous research regarding the use of laser photocoagulation and vitreoretinal surgery in preventing or reducing the risk of blindness. Since diabetic retinopathy requiring treatment can be present in patients with normal vision, such patients should obtain an annual dilated eye examination by an ophthalmologist. The value of statewide screening for undetected diabetic retinopathy, the determination of how and where to screen in order to give the most benefit to the potentially affected individuals and citizens of Georgia are only a few of the questions that may be answered when this study is completed. Moreover, to our knowledge this study is the first statewide screening for diabetic retinopathy in the United States.

Proliferative vitreoretinopathy. Histopathology of retroretinal membranes.

Light- and electron-microscopic studies of 43 eyes with retroretinal membranes are presented. Associated features were severe blunt or penetrating injury, total retinal detachment, surbretinal proteinaceous exudate, and concomitant presence of preretinal fibrocellular or fibrovascular proliferations. The retinal pigment epithelium was found to be the major cellular component in early (as soon as 1 week) and chronic retinal detachment cases. Isolated glial-derived membranes were less common and were found in cases with chronic retinal detachment. Macrophages and fibrocytes, along with the retinal pigment epithelium and glia, were detected in mixed membranes. Subretinal proteins are thought to influence migration and attachment of the retinal pigment epithelium, which in turn provides a template for proliferation of the various cell types described.

The incidence of retinal detachment in Rochester, Minnesota, 1970-1978.

We studied the incidence of rhegmatogenous retinal detachment in Rochester, Minnesota, for the nine-year period from 1970 through 1978. The age-adjusted rate for idiopathic rhegmatogenous retinal detachment was 10.1 per 100,000 population per year (45 cases). Including 12 cases of aphakic retinal detachments, the age-adjusted incidence was 12.9 per 100,000 population per year. Not surprisingly, the incidence rate increased with age in both sexes. By extrapolation from the Rochester rates, the number of cases per year of idiopathic retinal detachment in the United States would be expected to be about 22,000, and the number of both aphakic and idiopathic phakic cases per year would be expected to approach 28,000.

Regression patterns of uveal melanomas after proton beam irradiation.

Forty-four uveal melanomas were evaluated for patterns of tumor regression after proton beam irradiation. All tumors were followed for a minimum of ten months after treatment. Seven lesions completely disappeared, 33 have decreased in size, and 4 remained unchanged. Associated signs of tumor regression were: resolution of the secondary serous retinal detachments, central apical yellow discoloration of the tumor, destruction of the tumor's vasculature, and elimination of fluorescein leakage. This study demonstrated that regression after proton beam irradiation is a relatively slow process, and the effects of radiation could be observed in some cases more than a year after treatment.

Ocular malformation in association with ipsilateral facial nevus of Jadassohn.

A 13-year-old boy had ocular malformations and a sebaceous nevus of Jadassohn. The salient features included left frontoparietal alopecia, a pigmented flat nevus anterior to the left tragus, and a left-sided fleshy corneoscleral limbal mass. Histopathologic analysis showed a complex choristoma of lacrimal tissue and cartilage, together with intrascleral cartilage and bone. Deformity of the left sphenoid bone, dilatation of the left lateral ventricle, and localized atrophy of the left cerebral hemisphere were evident, but the patient had no history of seizures, no neurologic deficit, and normal mentality. Patients with a sebaceous nevus of Jadassohn should be examined for ocular malformations and watched closely for the development of malignant nevoid tumors within the area of the nevus.

Incidence of uveal malignant melanoma in the resident population of Rochester and Olmsted County, Minnesota.

Uveal malignant melanomas were diagnosed in 15 patients in the resident population of Rochester and Olmsted County, Minnesota, from 1935 through 1974. There were five males and ten females. In this well-defined community, the annual incidence of uveal malignant melanoma for the 40-year period was calculated to be seven per million per year. The incidence in the resident population under age 50 years was three per million, whereas for those age 50 years or older, it increased to 21 per million per year.

Osteoma: an unusual cause of amaurosis fugax.

A 16-year-old white boy presented with a history of amaurosis fugax associated with an afferent pupillary defect, proptosis, discomfort of the left eye. Tomograms of the skull and of the orbit revealed a lobulated 4-cm ivory osteoma arising from the left ethmoid sinus and extending into the maxillary sinus and left orbit. After surgical extirpation, visual acuity returned to normal and the papilledema resolved after 4 months. This patient is 1 of 37 patients with osteoma of the paranasal sinuses or of the orbit (or of both) who underwent surgical treatment at the Mayo Clinic between the years 1948 and 1977. Twelve of these patients had orbital involvement, and only these patients had ocular signs and symptoms.