RESUMO
CLINICAL QUESTION: Is monitoring of liver function, lipids and full blood count necessary in healthy people taking isotretinoin? BACKGROUND: Routine blood testing was recommended in the original licence for Roaccutane™ (isotretinoin) in 1983. In recent years, less frequent monitoring has been suggested by various authors. DATA SOURCES: We performed four individual systematic searches of the MEDLINE database, via PubMed, from origin to 2 May 2021, supplemented by a hand search of all references in the identified papers. STUDY SELECTION: Inclusion criteria were any description of clinical symptoms, laboratory abnormalities and/or physical findings, and any paper that explicitly described the patients as asymptomatic, during treatment with oral isotretinoin. DATA EXTRACTION: Two independent reviewers (J.A. and D.J.) assessed articles for eligibility of inclusion. Evaluation of the data was done also by two of the authors (A.A., D.J. and J.A.) for each section, with the aim to use the presented evidence including guidelines, databases, case series, case reports, cohort studies and randomized clinical trials to delineate the clinical presentation and frequency of adverse events that might be amenable to laboratory monitoring. RESULTS: We identified 407 papers in our searches and reviewed 125 papers in four sections. Overall, reported adverse events were very rare (< 1 in 10 000) and were either idiosyncratic or not preventable by monitoring, accompanied by symptoms, or seen in identifiable predisposed individuals who might benefit from monitoring because of pre-existing conditions. RECOMMENDATION FOR CLINICAL CARE: We could not find evidence to support the benefit of monitoring to detect adverse events. We suggest that in healthy young people laboratory monitoring for oral isotretinoin is unnecessary and risks detecting nonserious biochemical abnormalities. However, we recognize that new information about adverse events may change that recommendation.
Assuntos
Isotretinoína , Humanos , Adolescente , Estudos de CoortesAssuntos
Hidradenite Supurativa , Sepse , Síndrome de Resposta Inflamatória Sistêmica , Humanos , Hidradenite Supurativa/imunologia , Hidradenite Supurativa/complicações , Sepse/imunologia , Sepse/etiologia , Sepse/complicações , Síndrome de Resposta Inflamatória Sistêmica/imunologia , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/complicaçõesAssuntos
Hidradenite Supurativa , Sepse , Síndrome de Resposta Inflamatória Sistêmica , Humanos , Hidradenite Supurativa/imunologia , Hidradenite Supurativa/complicações , Síndrome de Resposta Inflamatória Sistêmica/imunologia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Sepse/imunologia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Bases de Dados Factuais/estatística & dados numéricosAssuntos
Fármacos Dermatológicos/economia , Dermatologia/economia , Custos de Medicamentos/legislação & jurisprudência , Política de Saúde/economia , Dermatopatias/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Dermatologia/legislação & jurisprudência , Dermatologia/tendências , Custos de Medicamentos/tendências , Indústria Farmacêutica/economia , Indústria Farmacêutica/legislação & jurisprudência , Indústria Farmacêutica/tendências , Medicamentos Genéricos/economia , Medicamentos Genéricos/uso terapêutico , Farmacoeconomia/tendências , Política de Saúde/legislação & jurisprudência , Política de Saúde/tendências , Humanos , Seguro Saúde/economia , Seguro Saúde/legislação & jurisprudência , Seguro Saúde/tendências , Legislação Farmacêutica/economia , Legislação Farmacêutica/tendências , Dermatopatias/economia , Estados UnidosAssuntos
Fármacos Dermatológicos/uso terapêutico , Acessibilidade aos Serviços de Saúde , Uso Off-Label/legislação & jurisprudência , Dermatopatias/tratamento farmacológico , United States Food and Drug Administration/legislação & jurisprudência , Adulto , Criança , Dermatologia , Aprovação de Drogas/legislação & jurisprudência , Feminino , Humanos , Masculino , Avaliação das Necessidades , Dermatopatias/patologia , Estados UnidosRESUMO
Cosmetic and laser procedures are increasingly popular among patients and are skills in which dermatologists are regarded as well trained. Most dermatology residents intend to incorporate cosmetic procedures into their practice and prefer to learn such procedures during residency through direct patient care. However, there are notable challenges in optimizing how residents are trained in cosmetic and laser dermatology. To address these barriers and elevate the practice of cosmetic dermatology in academic medicine, the Association of Academic Cosmetic Dermatology (AACD) was founded in 2021 as the lead professional society for dermatologists who direct the education of resident trainees in cosmetic and laser dermatology. The AACD, a group of board-certified dermatologists who teach cosmetic and laser dermatology to residents, aims to improve cosmetic dermatology education through collaboration, research, and advocacy.
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Dermatologia , Internato e Residência , Humanos , Dermatologia/educação , Currículo , Inquéritos e QuestionáriosRESUMO
Cosmetic dermatology is a key subspecialty of academic dermatology. As such, academic centers are expected to demonstrate excellence in the teaching of cosmetic dermatology skills to trainees, the clinical delivery of cosmetic dermatology services to patients, and the performance of clinical research that advances knowledge and uncovers new therapies in cosmetic dermatology. The Association of Academic Cosmetic Dermatology (AACD), a newly formed medical professional society, includes as its principal aims the support of all of these areas. AACD is comprised of group of board-certified dermatologists who teach cosmetic and laser dermatology at US dermatology residency programs. An expert panel constituted by the AACD recently convened a workshop to review gaps pertaining to academic cosmetic dermatology. This panel considered needs and potential corrective initiatives in three domains: resident education, patient experience, and clinical research. The work of the panel was used to develop a roadmap, which was adopted by consensus, and which will serve to guide the AACD moving forward.
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Dermatologia , Internato e Residência , Humanos , Dermatologia/educação , Assistência ao Paciente , Sociedades MédicasRESUMO
Importance: Scoring systems for Stevens-Johnson syndrome and epidermal necrolysis (EN) only estimate patient prognosis and are weighted toward comorbidities and systemic features; morphologic terminology for EN lesions is inconsistent. Objectives: To establish consensus among expert dermatologists on EN terminology, morphologic progression, and most-affected sites, and to build a framework for developing a skin-directed scoring system for EN. Evidence Review: A Delphi consensus using the RAND/UCLA appropriateness criteria was initiated with a core group from the Society of Dermatology Hospitalists to establish agreement on the optimal design for an EN cutaneous scoring instrument, terminology, morphologic traits, and sites of involvement. Findings: In round 1, the 54 participating dermatology hospitalists reached consensus on all 49 statements (30 appropriate, 3 inappropriate, 16 uncertain). In round 2, they agreed on another 15 statements (8 appropriate, 7 uncertain). There was consistent agreement on the need for a skin-specific instrument; on the most-often affected skin sites (head and neck, chest, upper back, ocular mucosa, oral mucosa); and that blanching erythema, dusky erythema, targetoid erythema, vesicles/bullae, desquamation, and erosions comprise the morphologic traits of EN and can be consistently differentiated. Conclusions and Relevance: This consensus exercise confirmed the need for an EN skin-directed scoring system, nomenclature, and differentiation of specific morphologic traits, and identified the sites most affected. It also established a baseline consensus for a standardized EN instrument with consistent terminology.
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Síndrome de Stevens-Johnson , Humanos , Síndrome de Stevens-Johnson/diagnóstico , Consenso , Técnica Delphi , Pele/patologia , Cabeça , Vesícula/patologiaAssuntos
Fármacos Dermatológicos/economia , Dermatologia/economia , Custos de Medicamentos/legislação & jurisprudência , Uso de Medicamentos/economia , Padrões de Prática Médica/legislação & jurisprudência , Fármacos Dermatológicos/uso terapêutico , Uso de Medicamentos/legislação & jurisprudência , Feminino , Pesquisas sobre Atenção à Saúde , Pessoal de Saúde/economia , Humanos , Masculino , Avaliação das Necessidades , Sociedades Médicas , Estados UnidosAssuntos
Fármacos Dermatológicos/economia , Custos de Medicamentos/legislação & jurisprudência , Seguro de Serviços Farmacêuticos/economia , Assistência Farmacêutica/economia , Fármacos Dermatológicos/uso terapêutico , Medicamentos Genéricos/economia , Medicamentos Genéricos/uso terapêutico , Gastos em Saúde , Humanos , Seguro de Serviços Farmacêuticos/legislação & jurisprudência , Medicaid/economia , Medicare/economia , Avaliação das Necessidades , Estados Unidos , United States Food and Drug Administration/economia , United States Food and Drug Administration/legislação & jurisprudênciaRESUMO
INTRODUCTION: Strengthening The Reporting Of Cohort Studies in Surgery (STROCSS) guidelines were developed in 2017 in order to improve the reporting quality of observational studies in surgery and updated in 2019. In order to maintain relevance and continue upholding good reporting quality among observational studies in surgery, we aimed to update STROCSS 2019 guidelines. METHODS: A STROCSS 2021 steering group was formed to come up with proposals to update STROCSS 2019 guidelines. An expert panel of researchers assessed these proposals and judged whether they should become part of STROCSS 2021 guidelines or not, through a Delphi consensus exercise. RESULTS: 42 people (89%) completed the DELPHI survey and hence participated in the development of STROCSS 2021 guidelines. All items received a score between 7 and 9 by greater than 70% of the participants, indicating a high level of agreement among the DELPHI group members with the proposed changes to all the items. CONCLUSION: We present updated STROCSS 2021 guidelines to ensure ongoing good reporting quality among observational studies in surgery.
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Relatório de Pesquisa , Estudos de Casos e Controles , Estudos de Coortes , Estudos Transversais , Técnica Delphi , HumanosRESUMO
BACKGROUND: Case reports are part of the evidence hierarchy in evidence-based practice and guide an important part of dermatologic practice. OBJECTIVE: This article discusses the role of case reports and series in evidence-based practice and suggests how to improve reporting. METHODS: This article was inspired by a forum on the role of case reporting in dermatologic practice presented at a meeting of the American Academy of Dermatology. It is based on an informal literature review and the authors' experience in systematically reviewing case reports in medicine and dermatology. RESULTS: Case reports significantly influence medicine. Often they are the first line of evidence for new therapies but rarely are sufficient to establish treatment efficacy. Frequently they are the first and sometimes major source for detecting rare adverse events. Guidelines for improving the reporting of case reports and series are discussed. LIMITATIONS: This paper represents the views of the authors and is neither a systematic review of the literature nor a formal consensus document. CONCLUSION: Case reports are an important part of medical literature and need to be taken seriously.