Wound Healing Society 2023 update on guidelines for arterial ulcers.

The Wound Healing Society guidelines for the treatment of arterial insufficiency ulcers were originally published in 2006, with the last update in 2014. These guidelines provided recommendations, along with their respective levels of evidence, on seven categories: diagnosis, surgery, infection control, wound bed preparation, dressings, adjuvant therapy and long-term maintenance. Over the last 9 years, additional literature regarding these aspects of arterial ulcer management has been published. An advisory panel comprised of academicians, clinicians and researchers was chosen to update the 2014 guidelines. Members included vascular surgeons, internists, plastic surgeons, anaesthesiologists, emergency medicine physicians and dermatologists, all with expertise in wound healing. The goal of this article is to evaluate relevant new findings upon which an updated version of the guidelines will be based.

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.

Introducing a curriculum in ethics and professionalism for dermatology residencies.

There is general agreement on what constitutes ethical reasoning and professional behavior, but standardized methods to teach these skills in dermatology residency are currently unavailable. We introduce a model curriculum designed to impart the knowledge and skills to meet the Accreditation Council for Graduate Medical Education Dermatology Milestones for Professionalism over a 3-year cycle.

A pilot program for community dermatologists working with primary care residents to provide dermatology consults to a regional hospital.

With the high demand and limited supply of dermatologists, the majority dedicate their time primarily to outpatient practice. A number ofobstacles to inpatient dermatology consults have been described, as well as the essential benefits for some of the sickest patients. Dermatology residency programs partially relieve this need, however with the transition to a single Graduate Medical Education accreditation system and many previously American Osteopathic Association-accredited dermatologyprograms ceasing to train residents after 2020, it is prudent to recruit additional possible consultants. One possible solution is to involve non-dermatology residents as part of the consult service team. We report on our experience of piloting such a program, for community dermatologists providing consults to a regional hospital utilizing family medicine andinternal medicine residents.

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.

Depression screening using health questionnaires in patients receiving oral isotretinoin for acne vulgaris.

Isotretinoin is used to treat severe and recalcitrant acne. Possible side effects include depression, suicide, and suicidal ideation; however, other studies suggest isotretinoin may improve mood and quality of life. Although iPLEDGE consenting warns about the risk of depression and suicidal ideation, there is no recommendation for screening tools. The patient health questionnaire-2 and the patient health questionnaire-9 are validated instruments that enable dermatologists to efficiently screen for depression before and after isotretinoin is initiated.

Motivating medical students by utilizing dermatology-oriented online quizzes.

BACKGROUND: Online quiz competitions can facilitate extra-classroom interactions between faculty and medical students. Owing to decreased class attendance nationwide, teaching faculty might revamp their approach to medical education by providing online resources and methods for communication. OBJECTIVE: To explore if the use of online quizzes and social media can result in improved interactions between faculty and students. METHODS: A pilot study conducted from April 7th, 2015 to June 11th, 2015 at Northeast Ohio Medical University (NEOMED) among participants from the second year medical school class. Ten one-question quizzes created using Google Forms were announced over Twitter and email at the rate of one quiz per week. The first correct responder of each quiz chose a five-dollar coffee shop gift card, movie ticket, or a meeting with a NEOMED faculty person as their prize. RESULTS: An average of 23.8% of the second year medical student class at NEOMED participated per quiz. A total of 80 individuals (55.9%) submitted 340 responses during the competition. LIMITATIONS: This is a single-center study with a limited sample size. CONCLUSIONS AND RELEVANCE: This study presents a process evaluation for the use of online quiz competitions amongst medical students. Optional online quizzes with small incentives may foster motivational competition among medical students, increase online interactions with faculty, and serve as study material for exams.

Eczema herpeticum in a wrestler.

Eczema herpeticum (EH), first described in 1887, is characterized by a disseminated skin infection consisting of dome-shaped papules and is associated with fever, lymphadenopathy, and malaise. The condition commonly occurs on the trunk, head, and neck and is associated with numerous skin conditions, including atopic dermatitis. It is a result of a superimposed herpes simplex virus infection on otherwise compromised skin. It is a rapidly spreading infection, and early antiviral treatment is essential. Herpes gladiatorum is a common infection in the wrestling population, and atopic dermatitis is a common skin condition in the general population. Together, these 2 conditions can greatly increase the risk of EH infection. It is important for both sports medicine physicians and dermatologists to be aware of the risk of EH infection in this population, the presenting signs and symptoms, and be ready to respond quickly with antiviral treatment.

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.