ABSTRACT
Diffuse neurofibroma is a rare type of neurofibroma uncommonly reported in infancy. It is a slow growing tumor originating in the peripheral nerve sheath. We present the case of a 17-month-old boy with diffuse neurofibroma of the scalp associated with hypertrichosis. His genetic and clinical workup for neurofibromatosis was negative.
Subject(s)
Hypertrichosis , Neurofibroma , Humans , Hypertrichosis/diagnosis , Hypertrichosis/pathology , Male , Infant , Neurofibroma/pathology , Neurofibroma/diagnosis , Skin Neoplasms/pathology , Skin Neoplasms/diagnosis , Scalp/pathology , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/pathologyABSTRACT
Physician burnout and its association with the use of electronic health records (EHRs) is well known. The impact of scribes for academic dermatologists and their patients needs to be explored. As physician burnout increases, system-based solutions are needed. To assess the impact of a scribe on physician and patient satisfaction at an academic dermatology clinic. Prospective, pre-post-pilot intervention study. During the pilot intervention, clinicians had clinic sessions with and without a scribe. We assessed changes in (1) clinician satisfaction and burnout, (2) time spent on EHR, and (3) patient satisfaction. An electronic 7-item baseline survey, 23-item mid-study survey, and a 22-item end-of-study survey to assess clinician burnout and feedback on satisfaction with medical scribes. A 19-item post visit satisfaction survey was given to patients. EHR was queried to compare amount of time spent on EHR, closure of charts, and number of patients seen during scribe coverage and at baseline. Of the six clinicians, 100% felt that there was value to scribe support. Physician burnout was low at baseline and did not change post-pilot. Active documentation time, on average, decreased by 67% per patient with a 28% increase in patients seen per clinic. Over 88% of patients disagreed with the statement, "I was uncomfortable disclosing personal information when a scribe was present" (p < 0.001). In an academic dermatology and Mohs surgery setting, medical scribes increased clinician satisfaction without compromising patient satisfaction.
Subject(s)
Attitude of Health Personnel , Dermatology , Documentation/methods , Electronic Health Records , Job Satisfaction , Patient Satisfaction , Physicians/psychology , Efficiency, Organizational , Humans , Pilot Projects , Prospective Studies , Surveys and Questionnaires , Time FactorsABSTRACT
Dermatofibromas (DF) are common skin lesions composed of a dermal proliferation of fibroblasts and histiocytes. Among the variants of DFs, adenodermatofibroma are characterized by a dense proliferation of fibroblasts and histiocytes admixed with entrapped dilated glandular structures. We report two additional cases of adenodermatofibromas, review the literature, theorize on the histopathogenesis of this variant, and suggest that there are different patterns among adenodermatofibromas, from primarily cystic to primarily glandular.
Subject(s)
Adenofibroma , Cell Proliferation , Fibroblasts , Histiocytes , Skin Neoplasms , Adenofibroma/metabolism , Adenofibroma/pathology , Adult , Aged , Fibroblasts/metabolism , Fibroblasts/pathology , Histiocytes/metabolism , Histiocytes/pathology , Humans , Male , Skin Neoplasms/metabolism , Skin Neoplasms/pathologySubject(s)
Anti-Infective Agents, Local/therapeutic use , Benzoyl Peroxide/therapeutic use , Bleaching Agents/therapeutic use , Chlorhexidine/therapeutic use , Hidradenitis Suppurativa/drug therapy , Medication Adherence/statistics & numerical data , Administration, Cutaneous , Adult , Anti-Infective Agents, Local/administration & dosage , Baths , Benzoyl Peroxide/administration & dosage , Bleaching Agents/administration & dosage , Chlorhexidine/administration & dosage , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Nonprescription DrugsSubject(s)
Anti-Bacterial Agents/pharmacology , Anti-Infective Agents, Local/pharmacology , Bacteria/drug effects , Drug Resistance, Bacterial/drug effects , Hidradenitis Suppurativa/drug therapy , Adult , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents, Local/therapeutic use , Baths , Cross-Sectional Studies , Drug Therapy, Combination , Female , Hidradenitis Suppurativa/microbiology , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Young AdultABSTRACT
Importance: Nurse practitioners (NPs) and physician assistants (PAs) are nonphysician clinicians (NPCs) who can deliver dermatology services. Many of these services are provided independently. Little is known about the types of services provided or where NPCs provide independent care. Objective: To examine characteristics of dermatology care for Medicare enrollees billed independently by NPCs. Design, Setting, and Participants: Retrospective review of the 2014 Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File, which reflects fee-for-service payments to clinicians for services rendered to Medicare beneficiaries. Clinician location was matched with county-level demographic data from the American Community Survey, US Census Bureau. Clinicians identified using National Provider Identifier as NPs or PAs with at least 11 claims for common dermatology-associated Healthcare Common Procedure Coding System procedure codes were included. Main Outcomes and Measures: Total services provided by service type category, density of dermatologists and nondermatologists who perform dermatology-related services, and geographic location by county. Results: Among the cohort of NPCs were 824 NPs (770 [93.5%] female) and 2083 PAs (1602 [76.9%] female) who independently billed Medicare $59â¯438â¯802 and $171â¯645â¯943, respectively. Dermatologists were affiliated with 2667 (92%) independently billing NPCs. Most payments were for non-evaluation and management services including destruction of premalignant lesions, biopsies, excisions of skin cancer, surgical repairs, flaps/grafts, and interpretation of pathologic analysis. Nurse practitioners and PAs billed for a similar distribution of service categories overall. A total of 2062 (70.9%) NPCs practiced in counties with dermatologist density of greater than 4 per 100â¯000 population. Only 3.0% (86) of independently billing NPCs practiced in counties without a dermatologist. Both dermatologists and NPCs were less likely to be in rural counties than in urban counties. Conclusions and Relevance: Nonphysician clinicians independently billed for a wide variety of complex dermatologic procedures. Most independently billing NPCs practice in counties with higher dermatologist densities, and nearly all these NPCs were affiliated with dermatologists. Further study of NPC training and integration with the dermatology discipline is an important part of addressing the changing US dermatology workforce.