Dermatology consultations: how long do they take?

The rising demand for dermatology services calls for more -efficient clinics. However, there is a lack of evidence to guide the allocation of time for dermatological consultations. Our study analysed 607 dermatology consultations led by 23 clinicians. Consultation lengths were found to be dependent on the grade of clinician seen, nature of attendance (new or follow-up) and nature of final diagnosis. The median times taken for all consultations involving general dermatological conditions or suspected skin tumours were 16.5 minutes (IQR 12.8-24.1) and 15.5 minutes (IQR 11.7-20.1), respectively (p=0.001). Consultations with new patients took longer than follow-up cases (p<0.001). Based on our results, new patients presenting with general dermatological conditions should be allocated 25 minutes per consultant-led consultation, while follow-up cases can be allocated 15 minutes per consultation. We recommend similar analyses of consultation lengths in other specialties to inform the development of efficient, specialty-specific clinic models.

Heart, liver and spleen pathology in chronic alcohol and drug users.

Alcohol- and drug-related deaths remain a major problem in the UK. Although the pathological findings of cardio-, hepato- and splenomegaly are frequently and empirically associated with chronic alcohol and drug use, there is limited published evidence available. This study hypothesises that organomegaly is associated with chronic substance use, and may represent a prognostic indicator. The weights of hearts, livers and spleens from 280 chronic alcoholics (CA) and 33 chronic drug users (CD) were compared to those of 291 controls. Using a forensic pathology database, CA and CD subjects were identified from 4708 autopsies (January 2003-June 2006) by identifying adult cases with no known coexistent diseases. The controls were non-substance users and previously healthy adults who died of traumatic injuries. Alcohol misuse was associated with cardiomegaly (27% vs. 19%, male CA vs. control) and hepatomegaly (38% vs. 15%). Majority of cases had only one organ affected. In CA, occurrence of hepatomegaly was associated with death at a younger age (female mean age 47+/-9.4, p<0.009, male mean age 50+/-11.6, p<0.007). This study demonstrated an association between cardiomegaly and hepatomegaly with chronic alcohol misuse and identifies the potential role of hepatomegaly as a determinant of poorer outcome in chronic alcohol misusers.