METHODS: The visuals were analyzed by employing the Visual Discourses of Disability (ViDD) framework that juxtaposes the "perspectivizing-personizing" cline with the "enabling-disabling" continuum. The data studied comprise a total of 432 images sourced from three domains, namely (1) The Star, a Malaysian mainstream English newspaper (2012-2021); (2) Alzheimer's Disease Foundation Malaysia (ADFM) website (2019-2021); and (3) the Ministry of Health Malaysia (2019-2021) website. Findings from the visual analyses were corroborated by four representatives of ADFM in a group interview.
RESULTS: There is a predominance of stigmatized images, constructing dementia as a loss and deficit, thus depicting individuals in distanced suffering. Generic representations of people through stock images, a unique focus on the hands, representations of brain degeneration through abstractions and missing puzzle pieces are also prevalent. Despite these, the interview data confirmed that the perspectivizing aspect may be necessary to educate the public on what dementia entails. While personizing images that depict personhood and actual persons living with dementia are ideal, the use of stock images may be necessary if there is a need to maintain confidentiality and observe sensitivities. Similarly, images with positive emotions are encouraged but disabling ones are equally important to reflect reality and inculcate empathy.
CONCLUSION: When capturing, selecting and publishing images of dementia, organizations should deliberate on different visual elements which evoke empowerment, advocacy, handicapping and othering implications as outlined in the ViDD framework. Any decision should only be made after considering the purposes of publications and implications such images have on the intended audiences.
OBJECTIVES: Conduct a Delphi panel study to identify current evidence and gain advanced insights into GPP.
METHODS: A systematic literature review was used to identify published literature and develop statements categorized into four key domains: clinical course and flare definition; diagnosis; treatment goals; and holistic management. Statements were rated on a Likert scale by a panel of dermatologists in two rounds of online questionnaires; the threshold for consensus was agreement by ≥80%.
RESULTS: Twenty-one panellists reached consensus on 70.9%, 61.8%, 100.0% and 81.8% of statements in the 'clinical course and flare definition', 'diagnosis', 'treatment goals' and 'holistic management of GPP' domains, respectively. There was clear consensus on GPP being phenotypically, genetically and immunologically distinct from plaque psoriasis. Clinical course is highly variable, with an extensive range of complications. Clinical and histologic features supporting GPP diagnosis reached high levels of agreement, and although laboratory evaluations were considered helpful for diagnosis and monitoring disease severity, there was uncertainty around the value of individual tests. All acute and long-term treatment goals reached consensus, including rapid and sustained clearance of pustules, erythema, scaling and crust, clearance of skin lesions and prevention of new flares. Potential triggers, associated comorbidities and differential diagnoses achieved low rates of consensus, indicating that further evidence is needed.
CONCLUSIONS: Global consensus between dermatologists was reached on clinically meaningful goals for GPP treatment, on key features of GPP flares and on approaches for assessing disease severity and multidisciplinary management of patients. On this basis, we present a management algorithm for patients with GPP for use in clinical practice.