A pilot quality-of-life instrument for pruritus.

OBJECTIVE: We sought to develop a validated, reliable pruritus-specific quality-of-life (QOL) instrument, ItchyQoL. METHODS: From 21 in-depth interviews with patients with pruritus, we developed 22 pruritus-specific items, and hypothesized 3 major constructs that explain the way pruritus affects patients' QOL: symptoms, functional limitations, and emotions. We developed two versions of the pruritus QOL instrument, which assess for level of bother or frequency using items from the interviews and from generic skin QOL instruments, Skindex-16 (bother) and Skindex-29 (frequency). The instrument was tested for validity, reliability, and responsiveness. The frequency version was subsequently applied clinically to further evaluate its face validity. RESULTS: A total of 89 patients with dermatologic conditions participated in the validation phase and 101 patients participated in the clinical application phase of the study. Construct validity was demonstrated by principal axes factor analyses and by demonstrating that differences in symptoms, functioning, and emotion differed among the varying levels of self-reported pruritus severity more than would be expected by chance (P < .05 by analysis of variance). The instrument demonstrated reliability with internal consistency (Cronbach alpha: frequency 0.72-0.93 and bother 0.78-0.81) and reproducibility (intraclass correlation coefficient: frequency 0.91 and bother 0.84-0.87). The instrument suggested preliminary responsiveness for patients with improved disease for both frequency and bother items with both overall scores and the majority of the subscales scored demonstrating significant changes. Discriminant validity was shown by comparing differences in and the number of insensitive items between the pruritus-specific QOL instrument and the generic Skindex instruments. LIMITATIONS: Lack of generalizability and potential selection bias are limitations. CONCLUSIONS: This study represents, to our knowledge, the first attempt at a pruritus-specific QOL instrument that is reliable, valid, and responsive.

Ultrasound as an outcome measure to assess disease activity in disorders of skin thickening: an example of the use of radiologic techniques to assess skin disease.

Good outcome measures are required to determine whether a therapy is effective, both in routine clinical practice and in experimental clinical trials. In disorders of skin thickening such as morphea and scleroderma, more commonly used outcome measures that use a subjective score based on palpated skin thickening are fraught with error. By contrast, measurements made by ultrasound have great promise as outcome measures that are quantitative, valid, reproducible, and responsive. Further studies should establish its role in the field. In this paper, the present authors used ultrasound to illustrate the criteria that are required to establish a technology-based outcome measure.

Language disparities between patients and dermatologists in describing acne lesions.

BACKGROUND: There are no studies evaluating the comprehension of terms used by dermatologists to describe acne lesions. OBJECTIVE: The goal is to evaluate the comprehension of terms and pictures representing various acne lesions. METHODS: Patients were asked to describe terms and pictures of various acne lesions. Responses were graded as nonspecific, consistent, or inconsistent with physicians' description of the same lesion. RESULTS: For 5 of 9 terms and for 2 of 6 pictures, the majority of responses were inconsistent or nonspecific. LIMITATIONS: Our sample size was limited and did not represent all ethnic groups, educational levels, and geographic regions. We did not record which patients had acne versus which patients did not. Finally, the wording of the question "What words would you use to describe what you see in the picture?" may be misleading. CONCLUSIONS: Patients have limited understanding of terminology commonly used by dermatologists to describe acne lesions.

Imaging for suspected appendicitis: negative appendectomy and perforation rates.

PURPOSE: To determine which patients suspected of having acute appendicitis benefit from preoperative imaging. MATERIALS AND METHODS: The medical records of 462 consecutive patients who underwent appendectomy for clinically suspected acute appendicitis and underwent preoperative evaluation at our institution were retrospectively reviewed. Patients were divided into four groups: women (n = 166), girls (n = 46), men (n = 178), and boys (n = 72). Preoperative computed tomography (CT) or ultrasonography (US), requested by the referring clinician, was performed in 313 of the 462 patients. Unnecessary, or negative, appendectomy and perforation rates were calculated for each group for preoperative evaluation with CT, with US, and with neither CT nor US. In addition, the sensitivity and positive predictive value of CT and US were calculated for diagnosing appendicitis. RESULTS: In women, the negative appendectomy rate was significantly lower for those who underwent preoperative CT (7% [six of 85 patients], P =.005) or US (8% [four of 49 patients], P =.019), as compared with 28% [nine of 32 patients] for those who underwent no preoperative imaging (P >.35 for all groups). The negative appendectomy rates for girls, men, and boys were not significantly affected by preoperative imaging. The sensitivity of CT and US for diagnosing acute appendicitis exceeded 93% and 77%, respectively, in all groups. The positive predictive values for both CT and US were greater than 92% in all groups. CONCLUSION: Women suspected of having appendicitis benefit the most from preoperative CT or US, with a statistically significantly lower negative appendectomy rate than women who undergo no preoperative imaging. Therefore, we propose that preoperative imaging be considered part of the routine evaluation of women suspected of having acute appendicitis.