Photographic Confirmation of Biopsy Sites Saves Lives.

Quality photographic documentation of lesions prior to biopsy can decrease the risk of wrong site surgery, improve patient care, and save lives.

Analysis of the patient experience measure.

Assessing the patient experience has been a component of national health care policy for years in various forms, and it is now incorporated into many areas affecting physician practice. This review will focus on the origin and importance of this measure and address its critiques. The evolution of the measure as it progressed from patient satisfaction to patient experience and the rationale behind this shift will be detailed, the thought process behind the measure as an indicator of a culture of patient-centeredness and quality rather than as strictly a score will be reviewed, and the various motivators for physicians to improve patient experience will be divided into extrinsic and intrinsic and discussed.

Recommendations for improving the patient experience in specialty encounters.

The relationship between patient experience and health care quality has generated significant interest in the patient experience measure. However, it is challenging to find information on how to improve one's patient experience score because scientific data on this topic are weak or lacking, and suggestions provided by scoring vendors are often overgeneralized and not specialty-specific. This review will focus on the current state of evidence supporting factors influencing patient experience (both positive and negative) in outpatient specialist encounters that are applicable to general and surgical dermatology. The literature review includes research from multiple medical specialties. Identified studies were based on title and abstract and sourced from Medline, PubMed, and Scopus databases. Medical subject headings terms in PubMed and Ovid Medline included "dermatology/standards," "patient satisfaction," "surgery/standards," "physician-patient relations," "surgery," "practice management," "practice management, medical," "office management," "patient experience," "practice guidelines," "best practice," and "outpatient surgery." During this review, three main themes affecting the patient experience emerged: communication, time, and access. Of the three, communication appears to be the dominant theme affecting the patient experience measure.

Practice Patterns and Job Satisfaction of Mohs Surgeons.

BACKGROUND: There is a paucity of data on Mohs surgery workforce patterns. OBJECTIVE: To identify if gender differences exist in practice patterns of Mohs surgeons, factors that influence these differences, and factors influencing job satisfaction among Mohs surgeons. MATERIALS AND METHODS: An electronic survey was distributed to dermatology organizations targeting members of the American College of Mohs Surgery (ACMS), from October 2015 to April 2016. RESULTS: Two hundred twenty-seven ACMS members responded; 37% were women. Twenty-five percent of women and 19% of men work part time. Thirty-seven percent of women practice in academia versus 22% of men. Forty-three percent of women and 23% of men identified children as a factor affecting their ability to work full time. Gender comparisons for current job satisfaction show 57% of men and 35% of women being very satisfied. Supervision/feedback/recognition adds to satisfaction at a higher rate for women (53%) than for men (29%). For both genders combined, work content, patient base, and autonomy had the highest average job satisfaction ratings. CONCLUSION: Gender differences exist in practice patterns and job satisfaction of Mohs surgeons. This study demonstrates factors that could influence job satisfaction among female Mohs surgeons-knowledge that is important to individuals who lead, mentor, or supervise female Mohs surgeons.

Combined closures in reconstructive surgery.

It is common for dermatology surgery patients to present on the day of surgery with more than one skin cancer needing Mohs micrographic surgery. When these carcinomas are located near one another, it may be more practical to treat both at the same time as the reconstruction for one defect may involve or otherwise affect the treatment or reconstruction for the other carcinoma. Treating both cancers on the same day creates an opportunity for efficient repairs where a creative single reconstruction may minimize the amount of tissue wasted during reconstruction,and minimize morbidity for the patient. Further,combining multiple defects into one closure may reduce cost as it has been shown that reconstructive choice affects the cost-effectiveness of Mohs surgery relative to a traditional excision and Mohs surgeons more commonly select less costly options for wound management. We present a case series of two-in-one closures - repairing two defects with one closure.

Inflamed skin predisposes to sensitization to less potent allergens.

BACKGROUND: Irritant dermatitis, caused by genetic barrier dysfunction in atopic dermatitis or wet work in hand dermatitis, induces innate immune response that might predispose to allergic contact sensitization to less potent sensitizers. OBJECTIVES: We sought to determine if positive patch test results to less potent allergens are more prevalent in patients with a history of childhood flexural dermatitis or current wet work. METHODS: We examined our database of patients presenting to a contact dermatitis clinic tested to potential contact allergens as indicated by their history. Allergens from our most recent standard were studied if they could be classified as weak, moderate, or strong sensitizers based on published data from the local lymph node assay. Patients were stratified by a history of childhood-onset flexural dermatitis as a proxy for atopic dermatitis and by occupation. RESULTS: History of childhood-onset dermatitis predisposed to contact allergy to weak sensitizers and wet work to medium-potency sensitizers. Neither predisposed to contact allergy from strong sensitizers. LIMITATIONS: Association cannot prove causation. CONCLUSIONS: We conclude that strong sensitizers do not require wet work or atopy to cause sensitization. Barrier defects associated with childhood eczema and wet work may promote sensitization to weak antigens.

Necrotizing community-acquired methicillin-resistant Staphylococcus aureus pneumonia: an emerging problem in correctional facilities.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections have been common in prisons for more than a decade. However, CA-MRSA as a cause of pneumonia has been reported infrequently. This infection can present with flu-like symptoms and rapidly progress, possibly leading to death in a matter of days. Two cases of MRSA community-acquired pneumonia (CAP) associated with influenza-like illness in correctional officers employed in two separate prisons within the California prison system are presented. Both individuals were previously healthy, but one died of this disease. MRSA is an uncommon, but now recognized, cause of CAP. These cases are notable for their unique presentation and occurrence in non-health care, occupational settings. Prompt diagnosis and intervention by occupational health nurses and physicians are critical to improving outcomes, especially in high-risk settings such as prisons. These worksites need an effective occupational health program to manage MRSA, with adequate training for both employees and inmates.

Occupational allergic contact dermatitis due to thioureas.

Thioureas are used as additives in rubber products and as antidegradants for natural rubber latex. They are an uncommon cause of allergic contact dermatitis. This case represents an example of occupational allergic contact dermatitis solely from thioureas in rubber products and no cross-reactivity with other rubber allergens. Standard patch tests may fail to detect thiourea-induced allergic contact dermatitis, so clinicians should consider thiourea sensitization in rubber allergy.

High-pressure injection injury in a furniture repairman--an outwardly minor injury with the potential for a devastating outcome.

The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney. Inquiries and contributions to the Forum should be forwarded to Joseph J. Schwerha, MD, MPH by e-mail at schwer@pitt.edu.

Pachyonychia congenita: a case report.

A 21-year-old man presented with hypertrophic nail dystrophy and subungual debris of all 20 nails, hyperkeratotic plaques on the heels of both feet, and oral leukokeratosis. He had an extensive family history of similar clinical findings. The patient's clinical presentation and history were consistent with pachyonychia congenita (PC), an autosomal dominant genodermatosis caused by mutations in the genes for keratin 6, K6a and K6b; keratin 16, K16; and keratin 17, K17.