Awareness and Counseling Among Dermatologists of the Association Between Hydrochlorothiazide and Nonmelanoma Skin Cancer: Barriers and Opportunities.

BACKGROUND: Cumulative hydrochlorothiazide (HCTZ) use is linked to the development of nonmelanoma skin cancers. In August 2020, the U.S. FDA approved changes to the HCTZ drug label to indicate this. OBJECTIVE: To uncover what proportion of dermatologists are aware of this association and how often screening and counseling are performed. MATERIALS AND METHODS: An observational, cross-sectional survey assessing risk awareness and counseling frequency and barriers was distributed among academic dermatologists. Chi-square tests compared resident and attending respondent data. RESULTS: A total of 83 respondents completed the questionnaire; most endorsed awareness of the association between HCTZ use and nonmelanoma skin cancer development before the survey, yet only 28.9% of respondents were aware of changes to the HCTZ drug label. A greater proportion of attendings than residents were aware of the association and drug label changes. The most reported barrier to counseling was the lack of specific screening guidelines for patients taking HCTZ. CONCLUSION: Concerted efforts should be made in residency training and continuing medical education to ensure dermatologists are aware of this well-established link. Specialty-specific efforts should be made to implement clear guidelines on best screening practices and optimized counseling strategies for patients taking HCTZ.

Increased medical student understanding of dementia through virtual embodiment.

Given the growing prevalence of Alzheimer's disease (AD), we assessed the impact of virtually embodying someone with progressive AD. This pilot explored students' understanding of individuals' needs with dementia, as well as, the efficacy of virtual reality (VR) as a curricular tool. Second-year medical students (n = 150) completed a pre-survey, Embodied Labs, Inc. Beatriz Lab VR module, and a post-survey. Most students knew someone with dementia (72%), were a family member of someone with dementia (52%) or had worked with a patient (61%) with dementia. Using paired survey questions, students reported significant increases in understanding how their lives would be affected by dementia (71% vs. 94%) and the needs of a person with dementia (64% vs. 95%) after VR. They reported increased understanding of being a caregiver of someone with dementia (24% vs. 81%) and the impact it can have on the entire family (64% vs. 97%). Overall students agreed this simulation made them think about their approach to clinical skills (94%) and should be utilized more in the curriculum (76%). This pilot study indicated that this VR experience can be used to advance understanding of a person's experiences with dementia and that integrating VR into the medical curricula should be considered.

Evaluating the Impact of a Medical School Student-Run Research Organization on Scholarly Activity.

Introduction The United States Medical Licensing Examination Step 1 change to Pass/Fail scoring has motivated medical students to pursue more research opportunities. To support students, a student-led organization was created at an allopathic medical school, offering initiatives such as workshops, mentorship, and research projects. Here, we evaluate its impact on medical student research. Methods An observational survey study was conducted to assess students' research involvement and productivity and their sense of support, confidence, and comfort in pursuing research at an institution during the first two years of medical school. These variables were compared between three contiguous classes of students and between club members and non-members. Analyses included t-tests, Chi-square tests, and ANOVA, among others. Results Findings revealed that organization membership was associated with an increased number of research projects. Club members (M= 4.49) reported a significantly greater number of projects compared to non-members (M= 4.49) (p= 0.002). Students who had access to the organization during their preclinical years (M= 4.38) reported significantly more projects compared to students whose preclinical years were before the organization's conception (M= 2.21) (p= 0.041). However, research productivity and feelings of support and confidence in research did not differ by class or club membership.  Conclusions Club members engaged in a greater number of research projects as compared to non-members and students who had access to the organization during their preclinical years. The implementation of similar organizations at every medical school can allow more students to engage in scholarly work.

Utilizing a quality of life tool to examine the presence of fatigue in subjects with diabetes mellitus.

Introduction: The prevalence of fatigue in patients with diabetes mellitus (DM) can be as high as 50 %. Physical, mental, and psychosocial components of fatigue negatively impact quality of life (QOL), morbidity and mortality. Several tools have been developed to address fatigue, but none specifically for measuring fatigue in DM. The aim of this study was to assess the impact of diabetes and neuropathy on fatigue using the Norfolk QOL-Fatigue (QOL-F) survey. Methods: 605 adult participants from [Anonymous] were recruited (400 subjects with type 1 or type 2 DM and 205 subjects without diabetes (controls)). All subjects completed the Norfolk QOL-F. Demographics, weight, BMI, and duration of diabetes were obtained. The Norfolk QOL-F, a 35-item validated questionnaire, assesses five domains: subjective fatigue, physical and cognitive fatigue, reduced activities, impaired activities of daily living, and depression. Results: Subjects with DM reported significantly higher fatigue total scores (52.63vs33.89, p < 0.0001) and in all five domains when compared to controls. Patients with DM with neuropathy were significantly more fatigued than those without (59.72vs27.83, p < 0.0001). Fatigue scores in patients with DM without neuropathy were similar to controls (27.83vs33.89, p = NS). In multivariate analysis, age, gender, and presence of neuropathy significantly impacted fatigue scores. Conclusions: The Norfolk QOL-F questionnaire can potentially identify the impact of chronic diseases such as diabetes on fatigue. Assessing the different components of fatigue is important for clinicians in improving disease management and outcomes. Further investigations are needed to confirm these observations in specific cohorts with other comorbidities.

A Distinctive Histological Form of Squamous Cell Carcinoma With Perineural Invasion.

A modest proportion of individuals diagnosed with squamous cell carcinoma (SCC) display perineural invasion (PNI), the neoplastic invasion of one or more nerves. It is associated with a marked increase in mortality in patients with SCC and is oftentimes only diagnosed after a significant invasion occurs. An 84-year-old male, otherwise in good health, presented to us with a fast-growing, 3-cm nodule on his right malar region associated with paresthesia and radiating pain. Biopsy of the lesion revealed moderately differentiated infiltrative squamous cell carcinoma, which was later discovered to involve the perineural fascia of the trigeminal nerve. Excision of the infraorbital nerve and maxillary bone was performed to remove the tumor, with the resulting defect later reconstructed. Here, we present findings of SCC with unique histological features predictive of potential PNI. These features include a rim of cuboidal cells which quickly transition into a well-differentiated, eosinophilic parakeratotic core, reminiscent of a "fried egg" appearance. Awareness of these histological findings may allow clinicians to detect PNI in patients with SCC before widespread and irreversible involvement.

Cryotherapy-Enhanced Chemowrap Treatment of Squamous Cell Carcinoma: A Case Series.

An estimated 20% of all malignant cutaneous neoplasms are diagnosed as squamous cell carcinoma (SCC). Chemotherapeutic wraps, or chemowraps, consist of application of topical 5-fluorouracil (5-FU) 5% cream along with occlusive zinc oxide and a compressive bandage (e.g., Unna boot). This treatment modality is often used as a less invasive option compared to surgery, especially in the presence of numerous SCCs. Cryotherapy, the use of liquid nitrogen gas, can be utilized to obliterate pre-malignant and malignant skin lesions. In this report, we present four cases in which females between the ages of 65 and 80 with multiple lower extremity SCCs were treated with cryotherapy prior to each chemowrap application, resulting in favorable clinical tumor improvement. Our observations indicate that cryotherapy may enhance the effectiveness of chemowrap treatment when used before each application. To our knowledge, the use of cryotherapy to synergistically enhance the efficacy of chemowraps has not yet been reported. We hypothesize that cryotherapy induces edema and first strips the outer, hyperkeratotic layers of skin, which facilitates deeper penetration of the 5-FU cream from chemowraps. Chemowraps may also relieve the pain associated with cryotherapy. Therefore, dual cryotherapy and chemowrap treatment may be considered to maximize skin penetration, thus minimizing the extent of surgical intervention in patients with a significant number of SCC lesions.