ABSTRACT
Teledermatology is now fully incorporated into our clinical practice. However, after reviewing current legislation on the ethical aspects of teledermatology (data confidentiality, quality of care, patient autonomy, and privacy) as well as insurance and professional responsibility, we observed that a specific regulatory framework is still lacking and related legal aspects are still at a preliminary stage of development. Safeguarding confidentiality and patient autonomy and ensuring secure storage and transfer of data are essential aspects of telemedicine. One of the main topics of debate has been the responsibilities of the physicians involved in the process, with the concept of designating a single responsible clinician emerging as a determining factor in the allocation of responsibility in this setting. A specific legal and regulatory framework must be put in place to ensure the safe practice of teledermatology for medical professionals and their patients.
Subject(s)
Confidentiality , Dermatology , Telemedicine , COVID-19/epidemiology , Computer Security/ethics , Computer Security/legislation & jurisprudence , Confidentiality/ethics , Confidentiality/legislation & jurisprudence , Dermatology/ethics , Dermatology/legislation & jurisprudence , Emergencies , European Union , Humans , Informed Consent/legislation & jurisprudence , Insurance, Liability/legislation & jurisprudence , Pandemics , Personal Autonomy , SARS-CoV-2 , Spain , Telemedicine/ethics , Telemedicine/legislation & jurisprudenceABSTRACT
BACKGROUND: The quality of systematic reviews and meta-analyses on psoriasis, a chronic inflammatory skin disease that severely impairs quality of life and is associated with high costs, remains unknown. OBJECTIVES: To assess the methodological quality of systematic reviews published on psoriasis. METHODS: After a comprehensive search in MEDLINE, Embase and the Cochrane Database (PROSPERO: CDR42016041611), the quality of studies was assessed by two raters using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Article metadata and journal-related bibliometric indices were also obtained. Systematic reviews were classified as low (0-4), moderate (5-8) or high (9-11) quality. A prediction model for methodological quality was fitted using principal component and multivariate ordinal logistic regression analyses. RESULTS: We classified 220 studies as high (17·2%), moderate (55·0%) or low (27·8%) quality. Lower compliance rates were found for AMSTAR question (Q)5 (list of studies provided, 11·4%), Q10 (publication bias assessed, 27·7%), Q4 (status of publication included, 39·5%) and Q1 (a priori design provided, 40·9%). Factors such as meta-analysis inclusion [odds ratio (OR) 6·22; 95% confidence interval (CI) 2·78-14·86], funding by academic institutions (OR 2·90, 95% CI 1·11-7·89), Article Influence score (OR 2·14, 95% CI 1·05-6·67), 5-year impact factor (OR 1·34, 95% CI 1·02-1·40) and article page count (OR 1·08, 95% CI 1·02-1·15) significantly predicted higher quality. A high number of authors with a conflict of interest (OR 0·90, 95% CI 0·82-0·99) was significantly associated with lower quality. CONCLUSIONS: The methodological quality of systematic reviews published about psoriasis remains suboptimal. The type of funding sources and author conflicts may compromise study quality, increasing the risk of bias.
Subject(s)
Meta-Analysis as Topic , Psoriasis , Review Literature as Topic , Authorship , Conflict of Interest , Dermatology/statistics & numerical data , Ethics, Research , Humans , Journal Impact Factor , Periodicals as Topic/ethics , Periodicals as Topic/standards , Publication Bias , Research Support as TopicABSTRACT
A new generation of biologics targeting the interleukin-23-T helper 17 pathway has been developed. This study aimed to assess the short-term effectiveness and safety of these new agents using a network meta-analysis. Twenty-seven randomized clinical trials (10 629 patients) were identified by a comprehensive systematic literature review (PROSPERO 2015: CRD42015025472). Quality of evidence was assessed following Cochrane-compliant rules and the Grading of Recommendations, Assessment, Development and Evaluations approach. Efficacy and safety outcomes at weeks 10-16 were compared using a random-effects network meta-analysis within a frequentist framework to estimate pooled odds ratios (ORs) of direct and indirect comparisons among the therapeutic options. There were six direct drug-to-drug comparisons in the network, with a high degree of consistency between the direct and indirect evidence. From the available evidence, infliximab 5 mg kg-1 every 8 weeks [OR 118·89, 95% confidence interval (CI) 60·91-232·04] and secukinumab 300 mg every 4 weeks (OR 87·07, 95% CI 55·01-137·82) are shown to be among the most effective short-term treatments, but are ranked as the biologics most likely to produce any adverse event or an infectious adverse event, respectively. Ustekinumab 90 mg every 12 weeks, the third most efficacious treatment (OR 73·67, 95% CI 46·97-115·56), was the only agent that did not show increased risk of adverse events compared with placebo. Treatment recommendations should also consider long-term outcomes and costs.
Subject(s)
Biological Factors/therapeutic use , Dermatologic Agents/therapeutic use , Interleukin-23/metabolism , Psoriasis/drug therapy , Th17 Cells/drug effects , Adult , Biological Factors/adverse effects , Chronic Disease , Dermatologic Agents/adverse effects , Female , Humans , Male , Middle Aged , Patient Safety , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Adult , Humans , Male , Paraneoplastic Syndromes/metabolism , Paraneoplastic Syndromes/pathology , Gangrene/blood , Gangrene/pathology , Angiography/methods , Biopsy, Fine-Needle/instrumentation , Paraneoplastic Syndromes/complications , Paraneoplastic Syndromes/diagnosis , Gangrene/complications , Gangrene/genetics , Angiography/standards , Biopsy, Fine-Needle/methods , Case ReportsSubject(s)
Arterial Occlusive Diseases/etiology , Carcinoma, Large Cell/complications , Lung Neoplasms/complications , Paraneoplastic Syndromes/etiology , Raynaud Disease/etiology , Alcoholism/complications , Arterial Occlusive Diseases/diagnostic imaging , Carcinoma, Large Cell/diagnosis , Carcinoma, Large Cell/surgery , Hand/blood supply , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/surgery , Male , Middle Aged , Pneumonectomy , Remission Induction , Smoking/adverse effectsABSTRACT
INTRODUCTION: In the past 10 years, bullous pemphigoid has been associated with other comorbidities and neurologic and psychiatric conditions in particular. Case series, small case-control studies, and large population-based studies in different Asian populations, mainland Europe, and the United Kingdom have confirmed this association. However, no data are available for the Spanish population. MATERIAL AND METHODS: This was an observational, retrospective, case-control study with 1:2 matching. Fifty-four patients with bullous pemphigoid were selected. We compared the percentage of patients in each group with concurrent neurologic conditions, ischemic heart disease, diabetes, chronic obstructive pulmonary disease, and solid tumors using univariate logistic regression. An association model was constructed with conditional multiple logistic regression. RESULTS: The case group had a significantly higher percentage of patients with cerebrovascular accident and/or transient ischemic attack (odds ratio [OR], 3.06; 95% CI, 1.19-7.87], dementia (OR, 5.52; 95% CI, 2.19-13.93), and Parkinson disease (OR, 5; 95% CI, 1.57-15.94). A significantly higher percentage of cases had neurologic conditions (OR, 6.34; 95% CI, 2.89-13.91). Dementia and Parkinson disease were independently associated with bullous pemphigoid in the multivariate analysis. CONCLUSIONS: Patients with bullous pemphigoid have a higher frequency of neurologic conditions.
Subject(s)
Nervous System Diseases/epidemiology , Pemphigoid, Bullous/epidemiology , Aged , Aged, 80 and over , Case-Control Studies , Comorbidity , Databases, Factual , Dementia/epidemiology , Diabetes Mellitus/epidemiology , Female , Hospitals, University/statistics & numerical data , Humans , Male , Mental Disorders/epidemiology , Middle Aged , Myocardial Ischemia/epidemiology , Neoplasms/epidemiology , Parkinson Disease/epidemiology , Prevalence , Pulmonary Disease, Chronic Obstructive/epidemiology , Retrospective Studies , Spain/epidemiologyABSTRACT
La acroqueratoelastoidosis (AKE) de Costa es una forma de queratodermia palmopalmar poco frecuente que puede aparecer de forma esporádica o tener un patrón autosómico dominante. Rara vez está presente en el nacimiento; en la mayoría de las ocasiones lo hace a partir de la adolescencia en forma de pápulas translúcidas, amarillentas o del color de la piel normal. Tienen una localización típica en las eminencias tenar e hipotenar, pudiendo también afectar las palmas de las manos y las zonas laterales de los dedos. La asociación de hiperhidrosis es un hecho habitual. Histológicamente, los datos más característicos son hiperqueratosis, discreta acantosis, fragmentación y desestructuración de las fibras elásticas de la dermis reticular. Los tratamientos son pocos eficaces. Comentamos el caso de una niña de 10 años afectada por esta enfermedad y revisamos el diagnóstico diferencial con el grupo de las llamadas acroqueratodermias papulares marginales (AU)
Subject(s)
Female , Child , Humans , Hyperhidrosis/complications , Hyperhidrosis/diagnosis , Hyperhidrosis/etiology , Capsaicin/administration & dosage , Capsaicin/therapeutic use , Keratoderma, Palmoplantar/complications , Keratoderma, Palmoplantar/diagnosis , Keratoderma, Palmoplantar/drug therapy , Keratosis/diagnosis , Keratosis/drug therapy , Diagnosis, Differential , Histological Techniques , Diagnostic Imaging , Hand Dermatoses/diagnosis , Hand Dermatoses/drug therapy , Hand Dermatoses/epidemiologyABSTRACT
A retroauricular flap to reconstruct scaphoid fossa defects is presented. It is an easy, quick and aesthetic flap for this purpose.