Dermatology workforce in the United States - Part I: Overview, transformations, and implications.

The dermatology workforce continues to evolve to meet the growing and diversified demands of the US population. Part 1 of this continuing medical education series is designed to provide an overview of the dermatology workforce as well as delineate the motivators and socioeconomic implications of significant workforce transformations which are impacting dermatologic health care. Part 2 of the series will consider the impact of workforce challenges on patient outcomes and discuss potential actions that may help to optimize workforce organization and care delivery.

Dermatology workforce in the United States - Part II: Patient outcomes, challenges, and potential solutions.

This continuing medical education (CME) series assesses key features and ongoing transformations within the dermatology workforce. Part 1 of this series described precipitants and implications of recent workforce changes. Part 2 reviews the influence that these workforce dynamics have had on patient access, outcomes, and satisfaction. Additionally, it assesses potential solutions for optimizing care for underserved groups and the broader dermatologic patient population.

Practitioner assessment of mental health in dermatologic disease.

Patients with certain dermatologic skin diseases have been found to be at increased risk for depression and suicidal ideation. As there is not much information available on mental health interventions taken in dermatologic practices, we conducted a survey to assess the extent to which dermatologists monitor and follow up with the mental health of their patients. We discovered that dermatologists are aware of mental health issues associated with these dermatologic diseases but have no standard of care for their assessment. By obtaining this information, we can enable ourselves to fill in these deficiencies to help improve patient care.

Patient safety in dermatology: a ten-year update.

OBJECTIVE: We update and expand our 2010 article in this journal, Patient safety in dermatology: A review of the literature [4][DH1]. METHODS: PubMed at the National Center for Biotechnology Information (NCBI), United States National Library of Medicine (NLM) was searched September 2019 for English language articles published between 2009 and 2019 concerning patient safety and medical error in dermatology. Potentially relevant articles and communications were critically evaluated by the authors with selected references from 2020 added to include specific topics: medication errors, diagnostic errors including telemedicine, office-based surgery, wrong-site procedures, infections including COVID-19, falls, laser safety, scope of practice, and electronic health records. SUMMARY: Hospitals and clinics are adopting the methods of high-reliability organizations to identify and change ineffective practice patterns. Although systems issues are emphasized in patient safety, people are critically important to effective teamwork and leadership. Advancements in procedural and cosmetic dermatology, organizational and clinical guidelines, and the revolution in information technology and electronic health records have introduced new sources of potential error. CONCLUSION: Despite the growing number of dermatologic patient safety studies, our review supports a continuing need for further studies and reports to reduce the number of preventable errors and provide optimal care.

Quantitative skin assessment using spatial frequency domain imaging (SFDI) in patients with or at high risk for pressure ulcers.

BACKGROUND AND OBJECTIVE: Pressure ulcers (PU) are a significant problem facing the health system in the United States. Here, we present preliminary case studies demonstrating feasibility of Spatial Frequency Domain Imaging (SFDI) to assess skin status in high-risk populations and pre-existing wounds. SFDI is a wide-field non-contact optical imaging technology that uses structured light to obtain tissue optical properties and of tissue constituents. This study aims to determine the fit of SFDI for PU care and determine the next steps. STUDY DESIGN/MATERIALS AND METHODS: Patients at risk for pressure ulcers were imaged using a near-infrared SFDI system. SFDI-derived images of tissue function (tissue hemoglobin, tissue oxygen saturation) and structure (tissue scattering) were then compared to each other as well as a blinded dermatologist's clinical impressions. RESULTS: Four case series were chosen to demonstrate the imaging capability of this technology. The first scenario demonstrates normal skin of three patients without skin breakdown with spatially uniform measures of tissue oxygen saturation, scattering, and blood volume. The second scenario demonstrates a stage II PU; the third case shows non-blanchable erythema of an unstageable PU; a fourth scenario is a clinically indistinguishable skin rash versus early stages of a PU. In all these cases, we observe spatial changes in tissue constituents (decrease in tissue oxygen saturation, increased blood pooling, decreased scattering). CONCLUSION: We have presented the first use of SFDI for pressure ulcer imaging and staging. This preliminary study demonstrates the feasibility of this optical technology to assess tissue oxygen saturation and blood volume status in a quantitative manner. With the proposed improvements in modeling and hardware, SFDI has potential to provide a means for pressure ulcer risk stratification, healing and staging. Lasers Surg. Med. 49:827-834, 2017 © 2017 Wiley Periodicals, Inc.

Elder abuse: dermatologic clues and critical solutions.

Elder abuse affects approximately 2% to 10% of older Americans. Unfortunately, it is often unrecognized and certainly underreported. Dermatologists have a unique role in the detection and reporting of elder abuse. An analysis of risk factors, clinical signs, reporting requirements, and prevention of elder abuse brings this issue into focus.

Wound dressing absorption: a comparative study.

The purpose of this study was to compare absorption properties of a variety of wound dressing products that are available on the market. A simple, inexpensive method of evaluation was utilized so that new dressings could easily be tested and added to the data set.

Dermatology elective curriculum: Birdwatching list and travel guide.

Primary care physicians often see patients with dermatologic complaints, but do not perform as well as dermatologists in the diagnoses of common dermatologic conditions. This article describes a dermatology curriculum that aims to close the clinical practice gap by providing an efficient and effective way to teach dermatology to medical students and non-dermatology residents in the setting of a busy, outpatient dermatology practice.

A review of bioactive materials and chronic wounds.

An increasing number of bioactive materials are indicated for the treatment of chronic lower extremity ulcers. They are promising adjuncts to standard therapy. When used in conjunction with standard therapy for venous leg ulcers and diabetic foot ulcers, bioactive materials may increase the likelihood and rate of healing. This review compares commonly available bioactive materials indicated for chronic wound healing and provides an overview of the relevant Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes for these products.

In vivo skin elastography with high-definition optical videos.

BACKGROUND/AIMS: Continuous measurements of biomechanical properties of skin provide potentially valuable information to dermatologists for both clinical diagnosis and quantitative assessment of therapy. This paper presents an experimental study on in vivo imaging of skin elastic properties using high-definition optical videos. The objective is to (i) investigate whether skin property abnormalities can be detected in the computed strain elastograms, (ii) quantify property abnormalities with a Relative Strain Index (RSI), so that an objective rating system can be established, (iii) determine whether certain skin diseases are more amenable to optical elastography and (iv) identify factors that may have an adverse impact on the quality of strain elastograms. METHODS: There are three steps in optical skin elastography: (i) skin deformations are recorded in a video sequence using a high-definition camcorder, (ii) a dense motion field between two adjacent video frames is obtained using a robust optical flow algorithm, with which a cumulative motion field between two frames of a larger interval is derived and (iii) a strain elastogram is computed by applying two weighted gradient filters to the cumulative motion data. RESULTS: Experiments were carried out using videos of 25 patients. In the three cases presented in this article (hypertrophic lichen planus, seborrheic keratosis and psoriasis vulgaris), abnormal tissues associated with the skin diseases were successfully identified in the elastograms. There exists a good correspondence between the shape of property abnormalities and the area of diseased skin. The computed RSI gives a quantitative measure of the magnitude of property abnormalities that is consistent with the skin stiffness observed on clinical examinations. CONCLUSIONS: Optical elastography is a promising imaging modality that is capable of capturing disease-induced property changes. Its main advantage is that an elastogram presents a continuous description of the spatial variation of skin properties on the pixel level that would otherwise be impossible with other sensors. Its value will be further enhanced when used with a point-wise measuring device such as a cutometer that yields absolute elasticity values.

Patient-reported outcomes and health-care resource utilization in patients with psoriasis treated with etanercept: continuous versus interrupted treatment.

OBJECTIVE: The 24-week Etanercept Assessment of Safety and Effectiveness (EASE) study evaluated the effectiveness and tolerability of continuous versus interrupted etanercept treatment in patients with moderate to severe plaque psoriasis. The objective of this analysis was to assess patient-reported outcomes (PROs) and health-care resource utilization (HRU) data from the EASE study. METHODS: Patients received open-label etanercept 50 mg twice weekly for 12 weeks and then received either continued or interrupted (single round of discontinuation and re-treatment with etanercept) etanercept 50 mg once weekly for the second 12 weeks. PROs included the following: 1) the patient global assessments of psoriasis, joint pain, and itching scores; 2) the Dermatology Life Quality Index; 3) the Medical Outcomes Study Short Form 36 vitality domain; 4) the Beck Depression Inventory; 5) the European Quality-of-Life Group Feeling Thermometer; and 6) a patient satisfaction survey. HRU was evaluated using the Economic Implications of Psoriasis patient questionnaire. RESULTS: Continuous treatment with etanercept 50 mg twice weekly for 12 weeks followed by 50 mg once weekly for 12 weeks produced sustained and clinically important improvements in PROs and reductions in HRU. Reductions in some outcome measures after treatment discontinuation at week 12 were observed in the interrupted group; however, most changes did not revert to baseline levels, consistent with some residual clinical effect, and re-treatment produced improvements similar to week 12 levels. CONCLUSIONS: Continuous etanercept treatment provided greater sustained improvements in PROs than interrupted therapy; however, interrupting etanercept therapy, if needed, has predictable and manageable effects.