Does Male Skin Care Content on Instagram Neglect Skin Cancer Prevention?

This research letter assesses male skin care content on social media in order to bring to light the lack of content regarding skin cancer prevention posted on Instagram for male audiences.

Cutaneous Manifestations of Anabolic-Androgenic Steroid Use in Bodybuilders and the Dermatologist's Role in Patient Care.

Young adults have been increasingly facing pressure to achieve an appealing athletic physique, often influenced by social media influencers on platforms like Instagram. This viewpoint highlights the association between image-centric social media, dissatisfied body image, the use of anabolic-androgenic steroids (AAS) to achieve desired results, and the overlooked dermatological side effects of AAS, including acne and acne fulminans. We underscore the importance of recognizing acne fulminans as an indicator of possible AAS abuse and encourage dermatologists to actively identify and address AAS use to improve their patients' well-being.

Women at work: Changes in sexual harassment between September 2016 and September 2018.

Over the last two years, awareness about the sexual mistreatment of women has stunned the world. According to analysis by the New York Times, the defeat of Hilary Clinton and election of Donald Trump spurred a women's movement in the US that began in November of 2016 and resulted in protests across the country, including the largest single-day protest in history on January 21, 2017. Later that year, the #MeToo movement (starting in October 2017) and subsequent #TimesUp movement (starting in January 2018) galvanized women to unite against sexual assault and sexual harassment, which has become the hallmark of the current women's movement. But has anything changed over this time period in regard to the sexual harassment of women? Using a repeat cross-sectional survey from over 500 women collected at two points in time (September 2016 and September 2018), we found reduced levels of the most egregious forms of sexual harassment (unwanted sexual attention and sexual coercion) but increased levels of gender harassment in 2018. More importantly, sexual harassment had a weaker relationship with women's negative self-views (lower self-esteem, higher self-doubt) in 2018 compared to 2016. Qualitative interviews collected from women in the fall of 2016 and in the fall of 2018 from the same women, support the quantitative data. They suggest that the changes in sexual harassment are due to the increased scrutiny on the topic. The interviewees also emphasize that they feel better supported and empowered and are not ashamed to speak up about sexual harassment.

ENDO ECHO IMPROVES PRIMARY CARE PROVIDER AND COMMUNITY HEALTH WORKER SELF-EFFICACY IN COMPLEX DIABETES MANAGEMENT IN MEDICALLY UNDERSERVED COMMUNITIES.

OBJECTIVE: To determine whether participation in a multidisciplinary telementorship model of healthcare delivery improves primary care provider (PCP) and community health worker (CHW) confidence in managing patients with complex diabetes in medically underserved regions. METHODS: We applied a well-established healthcare delivery model, Project ECHO (Extension for Community Healthcare Outcomes), to the management of complex diabetes (Endo ECHO) in medically underserved communities. A multidisciplinary team at Project ECHO connected with PCPs and CHWs at 10 health centers across New Mexico for weekly videoconferencing virtual clinics. Participating PCPs and CHWs presented de-identified patients and received best practice guidance and mentor-ship from Project ECHO specialists and network peers. A robust curriculum was developed around clinical practice guidelines and presented by weekly didactics over the ECHO network. After 2 years of participation in Endo ECHO, PCPs and CHWs completed self-efficacy surveys comparing confidence in complex diabetes management to baseline. RESULTS: PCPs and CHWs in rural New Mexico reported significant improvement in self-efficacy in all measures of complex diabetes management, including PCP ability to serve as a local resource for other healthcare providers seeking assistance in diabetes care. Overall self-efficacy improved by 130% in CHWs ( P<.0001) and by 60% in PCPs ( P<.0001), with an overall large Cohen's effect size. CONCLUSION: Among PCPs and CHWS in rural, medically underserved communities, participation in Endo ECHO for 2 years significantly improved confidence in complex diabetes management. Application of the ECHO model to complex diabetes care may be useful in resource-poor communities with limited access to diabetes specialist services. ABBREVIATIONS: CHW = community health worker; CME = Continuing Medical Education; ECHO = Extension for Community Healthcare Outcomes; FQHC = federally qualified health center; PCP = primary care provider.

Taking Telemedicine to the Next Level in Diabetes Population Management: a Review of the Endo ECHO Model.

Worldwide increases in diabetes prevalence in the face of limited medical resources have prompted international interest in innovative healthcare delivery models. Project ECHO (Extension for Community Healthcare Outcomes) is a "telementoring" program which has been shown to increase capacity for complex disease management in medically underserved regions. In contrast to a traditional telemedicine model which might connect a specialist with one patient, the ECHO model allows for multiple patients to benefit simultaneously by building new expertise. We recently applied the ECHO model to improve health outcomes of patients with complex diabetes (Endo ECHO) living in rural New Mexico. We describe the design of the Endo ECHO intervention and a 4-year, prospective program evaluation assessing health outcomes, utilization patterns, and cost-effectiveness. The Endo ECHO evaluation will demonstrate whether and to what extent this intervention improves outcomes for patients with complex diabetes living in rural New Mexico, and will serve as proof-of-concept for academic medical centers wishing to replicate the model in underserved regions around the world.

Orthopaedic management improves the rate of early osteoporosis treatment after hip fracture. A randomized clinical trial.

BACKGROUND: Although osteoporosis is strongly associated with hip fractures, the initiation of osteoporosis treatment following hip fractures occurs at surprisingly low rates of between 5% and 30%. Currently, most patients receiving treatment have been referred back to their primary care physician for osteoporosis management. The purpose of this study was to compare the effect of osteoporosis management initiated by the orthopaedic team and osteoporosis management initiated by the primary care physician on the rates of treatment at six months. METHODS: A prospective randomized trial was conducted to assess the difference in the rate of osteoporosis treatment when an in-house assessment of osteoporosis was initiated by the orthopaedic surgeon and follow-up was conducted in a specialized orthopaedic osteoporosis clinic compared with osteoporosis education and "usual" care. RESULTS: Sixty-two patients were enrolled in the study. Thirty-one patients each were in the control and intervention groups. The percentage of patients who were on pharmacologic treatment for osteoporosis at six months after the fracture was significantly greater when the evaluation was initiated by the orthopaedic surgeon and was managed in a specialized orthopaedic osteoporosis clinic (58%) than when treatment was managed by a primary care physician (29%) (p = 0.04). CONCLUSIONS: An active role by orthopaedic surgeons in the management of osteoporosis improves the rate of treatment at six months following a hip fracture.

Questionnaire study of neuromonitoring availability and usage for spine surgery.

STUDY DESIGN: Questionnaire study presented to practicing spine surgeons. OBJECTIVE: To evaluate surgeon preference and availability of selected electrophysiologic neuromonitoring for different spine surgeries. SUMMARY OF BACKGROUND DATA: Maximizing the safety of spinal procedures and limiting potential iatrogenic neurologic injury has made intraoperative neuromonitoring an attractive option. METHODS: We distributed a questionnaire to 180 orthopedic spine surgeons and neurosurgeons at a clinically oriented spine meeting asking surgeon preference and availability of various types of intraoperative neuromonitoring modalities for different types of surgical procedures. Demographic data were also gathered. RESULTS: Somatosensory evoked potentials (SSEPs) were the most available neuromonitoring modality, followed by electromyographies and motor-evoked potentials. In both anterior and posterior cervical surgery, SSEPs were the most preferred modality. MEPs were frequently preferred in myelopathic cervical cases. Almost 70% preferred some neuromonitoring for anterior thoracic/thoracolumbar cases and 55% for posterior thoracic/thoracolumbar cases. Surgeon satisfaction was related to the number of available neuromonitoring modalities. No significant differences were found between orthopedist and neurosurgeon preferences. Fellowship-trained surgeons were more likely to use neuromonitoring for specific indications. CONCLUSIONS: SSEPs remains the most widely available and preferred type of neuromonitoring for spine surgeons. The type of case and neurologic status of patient (eg, presence of myelopathy) affects these choices. Surgeons were more satisfied with greater neuromonitoring availability, and were more likely to use neuromonitoring if they had a fellowship background.

Spontaneous septic arthritis caused by Burkholderia cepacia.

We describe the first reported case of a spontaneous septic arthritis caused by Burkholderia cepacia, the organism responsible for onion skin rot. The source of infection was most likely from hematogenous spread, as the patient's blood cultures were positive for B. cepacia. Treatment involved arthroscopic irrigation and drainage of the affected shoulder. Despite post-operative resolution of this immunocompromised patient's shoulder symptoms, he was unable to survive the B. cepacia bacteremia. Our report not only describes the case but also reviews the difficulty in treating B. cepacia infections.