Teaching dermatology to medical students: a Scoping Review of published interventional studies.

It is unclear how dermatology should be optimally taught to medical students. Therefore, this scoping review was conducted aiming to identify and structure all published interventional studies that investigated dermatological teaching approaches with medical students. The methodology of this scoping review followed the PRISMA Extension for Scoping Reviews. The databases Medline and Embase were searched without restriction until 30.06.2020. A categorization and a descriptive analysis of the studies published as full articles were performed. The database search yielded 36,627 hits. 114 studies met all inclusion criteria. These came from 19 countries, were mainly published since 2010 and were distributed across 64 different journals. 32 randomized controlled trials were identified. A wide variety of teaching approaches was found, including both E-learning and conventional teaching formats. The results of the studies are presented in structured tables. This scoping review documents a large number of studies published worldwide on teaching dermatology to medical students. The teaching of dermatology appears to be successful with numerous teaching approaches, whereby interventions that incorporate didactic principles were verifiably more successful. This literature review can serve as an aid for evidence-based teaching design in dermatology as well as a basis for future research approaches.

Therapy of psoriasis during pregnancy and breast-feeding.

There have been multiple systemic drugs approved for the therapy of psoriasis vulgaris and psoriasis arthritis (PsA) in the last decade. However, treatment decisions are difficult to make in women planning a pregnancy and in pregnant and lactating women due to the paucity of data for such cases. The strongest evidence for psoriasis therapy during pregnancy exists for topical corticosteroids. Medically controlled use of UVB-therapy is also considered safe. The best evidence regarding systemic therapy during pregnancy and lactation is available for the group of TNF-alpha inhibitors, which is also reflected in the respective medical product information. This is especially important in cases of psoriatic arthritis. Among traditional systemic therapeutics, the largest clinical experience exists for ciclosporin, which, if medically necessary, may be continued during gestation. However, TNF-alpha inhibitors, especially the pegylated form, should be preferred in case of pregnancy. Furthermore, an elective pregnancy termination is not necessary due to systemic therapy of psoriasis with many further substances during the first pregnancy weeks. The current work provides a comprehensive review of the scientific literature on treatment of psoriasis during pregnancy and lactation. Based on the available scientific information, severity of psoriasis and patient's comorbidities, the best possible therapeutic approach can be found in consensus with the patient.

S1 guideline: Differential diagnosis of acute and chronic redness of the lower legs.

Acute or chronic redness of the lower leg is a frequent reason for visits to clinics and practices. The differential diagnosis is often challenging. The aim of this guideline is to define criteria and procedures for the differential diagnosis of acute or chronic, unilateral or bilateral redness of the lower leg. Finding the correct diagnosis is essential for selecting an appropriate treatment and can help to reduce the inappropriate use of antibiotics. The guideline committee identified the most relevant differential diagnoses: 1. erysipelas, 2. stasis dermatitis, 3. hyperergic ictus reaction, 4. superficial and deep vein thrombosis, 5. gout, 6. chronic allergic contact dermatitis, and 7. acute toxic or allergic contact dermatitis. Algorithms/diagnostic pathways, each of which can be broken down into anamnesis, clinical examination, and diagnostics, have been developed for these seven diagnoses. In addition, the guideline group identified over 40 other relevant diagnoses and summarized their characteristics in a table to facilitate further differential diagnoses.

How can fertility counseling be implemented for every newly diagnosed pediatric patient facing gonadotoxic treatment?-A single-center experience.

Since the survival rates of pediatric patients undergoing cancer treatment or hematopoietic stem cell transplantation (HSCT) have increased rapidly in recent decades, the late effects of treatment are now an important focus of patient care. Access to fertility preservation (FP) procedures as well as their financing differs considerably across Europe. However, some countries in Europe have recently changed the legal basis for financing FP procedures; therefore, the implementation of structures is mandatory to give patients access to FP. In this prospective cohort study, we characterized the process for establishing pediatric fertility counseling, including the development of an in-house standard procedure for recommendations regarding FP with potentially gonadotoxic treatment and valuating data from all FP counseling sessions. All data concerning patient characteristics (pubertal status, disease group) and recommendation of FP measures were prospectively collected and adoption of FP measures analyzed. Prior to the establishment of a structured process for FP in our pediatric oncology and stem cell transplantation center, there was no standardized FP counseling. We demonstrate that with the establishment of an inhouse standard procedure, it is possible to give consistent yet individualized FP counseling to approximately 90% of our patients facing gonadotoxic treatment, counseling over 200 patients between 2017 and 2019. This pilot study could potentially be adapted in other pediatric hematology, oncology, and stem cell transplantation centers to allow a more standardized handling of FP counseling for all patients facing gonadotoxic treatment.

First description of immune complex vasculitis after COVID-19 vaccination with BNT162b2: a case report.

BACKGROUND: Cases of immune complex vasculitis have been reported following COVID-19 infections; so far none in association with novel mRNA-based COVID-19 vaccination. This case report describes a cutaneous immune complex vasculitis after vaccination with BNT162b2. CASE PRESENTATION: A 76-year old male with liver cirrhosis developed an immune complex vasculitis 12 days after the second injection of BNT162b2. On physical examination, the patient presented with pruritic purpuric macules on hands and feet, flexor and extensor parts of both legs and thighs and lower abdomen, and bloody diarrhoea. Laboratory testing showed elevated inflammatory markers. After short treatment with oral steroids all clinical manifestations and laboratory findings resolved. CONCLUSIONS: An increasing number of clinical manifestations have been attributed to COVID-19 infection and vaccination. This is the first written report of immune complex vasculitis after vaccination with BNT162b2. We present our case report and a discussion in the light of type three hypersensitivity reaction.

[Competence-oriented specialist training in dermatology]. / Kompetenzorientierte Weiterbildung in der Dermatologie.

The new M WBO (Musterweiterbildungsordnung) has been developed for 6 years and will be put into force by most LÄK (Landesärztekammern) on 01.07.2020. Future training to become a dermatologist is competency-based. This is to enable observable, successful problem solving in practice. Thus, the acquisition of competence is only dependent on whether the goal has been achieved. New procedures are required to determine achievement of the respective competencies, including annual continuing education interviews, workplace-based examinations, and an eLogbuch (electronic logbook). Minimum inpatient periods will be eliminated in the future. In principle, continuing education can take place entirely on an outpatient basis. The M WBO Dermatology comprises 14 thematic blocks with differentiated description of cognitive and methodological or action competencies. The guideline numbers of dermatological additional training courses have been shifted considerably into the period of basic training. Additional training courses can be acquired while working. Fachlich empfohlene Weiterbildungspläne (FEWP) are the concrete implementation regulations of the M WBO. They are not part of the WBO and can be adapted. In connection with this new approach, numerous questions are currently still open, such as documentation in practice or financing.

Semen cryopreservation in adolescent and adult men undergoing fertility compromising cancer treatment: A systematic review.

Treatment-related infertility is a common problem in cancer survivors. Semen cryopreservation is the most established option for male oncological patients wishing to preserve their fertility. We conducted a systematic review to analyse the existing literature regarding the frequency of offers and attempts of semen cryopreservation. We systematically searched MEDLINE and EMBASE for eligible literature without restrictions to language, study type or year of publication. Two authors independently screened and evaluated the citations for eligibility. Studies were included if they reported on pubertal or post-pubertal patients at risk of fertility impairment prior to their cancer therapy. We excluded studies neither reporting the prevalence of offer nor attempt of semen cryopreservation. Possible factors for heterogeneity between the studies were examined by meta-regression analyses. Out of 6,105 returned citations, 42 studies were included in the analysis. The prevalence of offer varied from 8% to 100% and corresponding attempts ranged from 3% to 79%, showing a vast heterogeneity with inconsistent reporting of influencing variables. Measured by the number of scientific publications, the awareness for fertility preservation is increasing while actual prevalences are diverse. In order to identify variables influencing offer and attempt prevalences, consistent reporting of a core set of factors is required.

Two-year analysis of dermatological out-of-hours consultations at Frankfurt University Hospital.

BACKGROUND: In recent years, emergency consultations have become more common in all medical disciplines. In Germany, dermatological out-of-hours consultations are handled by emergency practices, emergency departments and tertiary care providers. Little information is available on the reasons for these dermatological consultations. OBJECTIVES: The aim of this study was to analyze patient characteristics, diagnoses and admission rates resulting from these consultations. METHODS: We conducted a retrospective study covering two years of out-of-hours consultations at a dermatological tertiary referral center. RESULTS: A total of 3635 patients presented at the referral center. The most frequent outpatient diagnoses were acute urticaria (13.8 %) and bacterial infections (12.3 %). 83 % of the outpatient diagnoses required the most advanced competence level according to the new German curriculum for undergraduate education of medical students. 405 (11.01 %) patients did not require dermatological treatment, and 430 patients (13.6 %) were admitted to hospital. Most admissions were due to bacterial infections and herpes zoster. Advanced age, pain and fever were associated with a relatively high risk of admission. CONCLUSIONS: Admission rates at the dermatological tertiary referral center were substantially lower than at interdisciplinary emergency departments. A few diagnoses accounted for more than half of all consultations. These diagnoses are well represented within the new German curriculum.

Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne.

Scientific advances are continually improving the knowledge of acne and contributing to the refinement of treatment options; it is important for clinicians to regularly update their practice patterns to reflect current standards. The Global Alliance to Improve Outcomes in Acne is an international group of dermatologists with an interest in acne research and education that has been meeting regularly since 2001. As a group, we have continuously evaluated the literature on acne. This supplement focuses on providing relevant clinical guidance to health care practitioners managing patients with acne, with an emphasis on areas where the evidence base may be sparse or need interpretation for daily practice.

[Fertility Preservation in Prepubertal und Pubertal Children and Adolescents]. / Fertilitätserhalt bei präpubertären und pubertären Kindern und Jugendlichen.

BACKGROUND: Due to rising survival rates in cancer and autoimmune diseases fertility preservation before gonadotoxic therapies has become increasingly important. Although fertility can be significantly affected by gonadotoxic therapies, the possibility of fertility preservation during childhood has not been sufficiently considered so far. METHODS: Selective literature research with presentation of fertility preservation methods, their indications, implementations, risks and efficacy. RESULTS: Measures are indicated in all girls and boys at high risk of gonadal damage. The complexity of the techniques requires special expertise in the counseling and implementation, which is offered to girls in counselling Germany especially in the centers of FertiPROTEKT (www.fertiprotekt.com). In girls, mainly cryopreservation of ovary tissue is considered. In postpubertal girls cryopreservation of oocytes is also possible. In postpubertal boys sperm can be preserved. Freezing of testicular tissue is still experimental in prepubertal boys. Success rates are still difficult to quantify; birth rates of about 50% are discussed. All procedures are not covered by health insurance. CONCLUSION: In children and adolescents, measures of fertility preservation should be considered in cases of highly gonadotoxic therapies, and appropriate advice should be given by specialists.

Emotion recognition and extraversion of medical students interact to predict their empathic communication perceived by simulated patients.

BACKGROUND: This study assessed the impact of medical students' emotion recognition ability and extraversion on their empathic communication, as perceived by simulated patients in a training context. METHODS: This study used a crossed-effect data structure and examined 245 students in their fourth year of medical school. The students' personality traits were assessed based on a self-assessment questionnaire of the short form of the Big Five Inventory; their emotion recognition ability was measured using a performance test (Diagnostic Analysis of Nonverbal Accuracy-2, Adult Facial Expressions). Simulated patients evaluated the medical students' empathic communication. RESULTS: Students with a combination of high emotion recognition ability and extraversion received more positive ratings from simulated patients than their fellow students with a combination of emotion recognition ability and low extraversion. The main effects of emotion recognition or extraversion were not sufficient to yield similar effects. There were no other effects related to the remaining Big Five variables. CONCLUSIONS: The results support the hypothesis that to build rapport with patients, medical staff need to combine emotional capabilities with a dispositional interest in interpersonal encounters.

[Examination procedure and description of skin lesions]. / Untersuchungsgang und Effloreszenzenlehre.

The dermatologic examination follows a clear structure. After a short history is taken, the whole skin is inspected. The description, which is ideally provided in writing, forces one to look at the skin more closely. The description should include an accurate description of the location, the distribution, the form, and the type of lesion. The article contains tables with internationally approved definitions to describe skin changes. The analysis of these findings allows one to deduce pathophysiologic mechanisms occurring in the skin and to deduce hypotheses, i. e., suspected and differential diagnoses. These are confirmed or excluded by further diagnostic measures. The expert comes to a diagnosis very quickly by a pattern-recognition process, whereby novices must still develop this kind of thinking. Experts can minimize cognitive bias by reflective analytical reasoning and reorganization of knowledge.

Akne.

Akne ist eine chronische Erkrankung mit hoher Prävalenz unter Jugendlichen. Pathogenetische Hauptfaktoren (und ihre klinischen Korrelate) sind gesteigerte Talgproduktion (Seborrhoe), follikuläre Hyperkeratose (Komedonen) und perifollikuläre Entzündungsvorgänge (Papulopusteln). Die Krankheit wird von endogenen (Androgene, IGF-1, neuroendokrine Faktoren) und exogenen (Propionibacterium acnes, Diät, mechanische Irritation, Inhaltsstoffe medizinischer oder kosmetischer Externa) Einflüssen moduliert. Akne geht mit zum Teil hoher Morbidität einher und kann bereits bei leichter Ausprägung eine erhebliche Verschlechterung der Lebensqualität bewirken. Zu Therapie stehen wirksame topische und systemische Behandlungsverfahren zur Verfügung. Eine optimale Behandlung erfordert eine stadiengerechtes Management und kontinuierliche ärztliche Begleitung der Patienten über den erforderlichen Behandlungszeitraum.

Acne.

Acne is a chronic disease with a high prevalence among adolescents. Key pathogenetic factors (and their clinical correlates) are increased sebum production (seborrhea), follicular hyperkeratosis (comedones), and perifollicular inflammation (papules and pustules). The disease is modulated by a variety of endogenous (androgens, IGF-1, neuroendocrine factors) and exogenous (Propionibacterium acnes, diet, friction, ingredients of medical or cosmetic topical products) triggers. Acne is associated with high morbidity, and even mild manifestations may potentially cause considerable impairment in quality of life. Effective topical and systemic treatments are available. Optimal therapeutic results require continuous patient management over the course of the entire treatment period as well as adjustment of treatment modalities based on symptoms and disease severity.

Evaluating differently tutored groups in problem-based learning in a German dental curriculum: a mixed methods study.

BACKGROUND: It is still unclear to what extent the PBL tutor affects learning in PBL-sessions. This mixed-methods study (Part 1 and 2) evaluated the effects of facilitative (f) versus non-facilitative (nf) tutoring roles on knowledge-gain and group functioning in the field of endodontics. METHODS: Part 1 was a quantitative assessment of tutor effectiveness within a prospective, experimental, single-blind, stratified, randomized, two-group intervention study. Participants attended PBL in the context of a hybrid curriculum. A validated questionnaire was used and knowledge assessments were conducted before and after the intervention. External observers rated tutor performance. Part 2 was a qualitative assessment of tutor effectiveness and consisted of semi-structured expert interviews with tutors and focus group discussions with students. RESULTS: Part 1: f tutors obtained significantly higher scores than nf tutors with respect to learning motivation and tutor effectiveness (p ≤ 0.05). nf tuition resulted in a slightly larger knowledge gain (p = 0.08). External observers documented a significantly higher activity among facilitative tutors compared to non-facilitative tutors. Part 2: Tutors found the f role easier although this led to a less autonomous working climate. The students rated f tutoring as positive in all cases. CONCLUSIONS: With respect to PBL-group performance, students felt that groups guided in a non-facilitative fashion exhibited a higher level of independence and autonomy, especially with increasing PBL experience. In addition, students reported that more preparation was necessary for sessions guided by a non-facilitative tutor. Tutors were able to modify their role and influence group processes in a controlled manner. Results are useful for future "Train-the-Teacher" sessions.