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1.
Cutis ; 105(4): 163-164;E2, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32463846
3.
Dermatol Online J ; 26(1)2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-32155020

RESUMO

Medical board organizations have accumulated large asset balances, in part due to the monetization of physician board recertification, as well as capital gains in positive investment conditions. Physicians across the country have raised concerns regarding the effectiveness and efficiency of existing recertification processes, to which the American Board of Medical Specialties and independent accreditation boards have responded with newly instituted changes. The present article analyzes the publicly available F990 tax forms of the medical boards in an effort to provide data to the ongoing debate. Although some boards have begun to mobilize assets in recent years, many continue to accumulate wealth. It remains to be seen whether the new recertification programs will bring about change or perpetuate organizational wealth.


Assuntos
Certificação/economia , Declarações Financeiras/tendências , Conselhos de Especialidade Profissional/economia , Acreditação/economia , Conselhos de Especialidade Profissional/organização & administração , Conselhos de Especialidade Profissional/tendências , Estados Unidos
4.
Dermatol Surg ; 46(2): 186-191, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30939523

RESUMO

BACKGROUND: Dermatologists routinely perform office-based surgical procedures that result in cutaneous wounds. Wound care instructions are an important resource for postoperative patients. As there is no consensus on the ideal wound care regimen after dermatologic procedures, recommendations may vary. OBJECTIVE: To evaluate the current recommendations for wound care following dermatologic procedures. METHODS: The authors conducted a cross-sectional assessment of dermatology wound care handouts available online. The handouts were evaluated based on predefined parameters: topical agent recommendations for wound healing, caution against topical antibiotic use, and discussion of scarring, infection, bleeding, analgesia, and lifestyle considerations. RESULTS: A total of 169 handouts were evaluated. The majority (84%) recommended the application of petrolatum-based products, specifically Vaseline (75%) and Aquaphor (43%). Nearly half (43%) recommended the use of topical antibiotics, whereas 24% advised patients to avoid antibiotic ointments. Handouts variably addressed scarring (36%), infection (72%), bleeding (69%), pain (66%), and lifestyle modifications (64%). CONCLUSION: The instructions provided in dermatology patient handouts are highly variable, with various topical agents being recommended for wound healing. Topical antibiotics are not indicated for prophylaxis in clean dermatologic procedures but are still widely used. Greater efforts should be made to ensure that patients receive consistent and evidence-based wound care guidance.

6.
Trials ; 20(1): 432, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307501

RESUMO

BACKGROUND: Skin fibrosis is a significant global health problem that affects over 100 million people annually and has a profoundly negative impact on quality of life. Characterized by excessive fibroblast proliferation and collagen deposition, skin fibrosis underlies a wide spectrum of dermatologic conditions ranging from pathologic scars secondary to injury (e.g., burns, surgery, trauma) to immune-mediated diseases. Effective anti-scarring therapeutics remain an unmet need, underscoring the importance of developing novel approaches to treat and prevent skin fibrosis. Our in vitro data show that light emitting diode-red light (LED-RL) can modulate key cellular and molecular processes involved in skin fibrosis. In two phase I clinical trials (STARS 1 and STARS 2), we demonstrated the safety and tolerability of LED-RL at fluences of 160 J/cm2 up to 480 J/cm2 on normal human skin. METHODS/DESIGN: CURES (Cutaneous Understanding of Red-light Efficacy on Scarring) is a dose-ranging, randomized, parallel group, split-face, single-blind, mock-controlled phase II study to evaluate the efficacy of LED-RL to limit post-surgical skin fibrosis in subjects undergoing elective mini-facelift surgery. Thirty subjects will be randomly allocated to three treatment groups to receive LED-RL phototherapy or temperature-matched mock irradiation (control) to either periauricular incision site at fluences of 160 J/cm2, 320 J/cm2, or 480 J/cm2. Starting one week post-surgery (postoperative days 4-8), treatments will be administered three times weekly for three consecutive weeks, followed by efficacy assessments at 30 days, 3 months, and 6 months. The primary endpoint is the difference in scar pliability between LED-RL-treated and control sites as determined by skin elasticity and induration measurements. Secondary outcomes include clinical and photographic evaluations of scars, 3D skin imaging analysis, histological and molecular analyses, and adverse events. DISCUSSION: LED-RL is a therapeutic modality of increasing importance in dermatology, and has the potential to limit skin fibrosis clinically by decreasing dermal fibroblast activity and collagen production. The administration of LED-RL phototherapy in the early postoperative period may optimize wound healing and prevent excessive scarring. The results from this study may change the current treatment paradigm for fibrotic skin diseases and help to pioneer LED-RL as a safe, non-invasive, cost-effective, portable, at-home therapy for scars. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03795116 . Registered on 20 December 2018.


Assuntos
Cicatriz/prevenção & controle , Fototerapia/métodos , Cuidados Pós-Operatórios/métodos , Doses de Radiação , Pele/efeitos da radiação , Cicatriz/etiologia , Cicatriz/patologia , Ensaios Clínicos Fase II como Assunto , Fibrose , Humanos , New York , Fototerapia/efeitos adversos , Cuidados Pós-Operatórios/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Pele/patologia , Fatores de Tempo , Resultado do Tratamento
7.
Dermatol Online J ; 25(5)2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31220892

RESUMO

The Pigmented Lesion Assay (PLA, sensitivity 91-95%, specificity 69-91%, negative predictive value ?99%) is a commercially available, non-invasive gene expression test that helps dermatologists guide pigmented lesion management decisions and rule out melanoma. Earlier studies have demonstrated high clinical utility and no missed melanomas in a 3-6-month follow-up period. We undertook the current investigations to provide 12-month follow-up data on PLA(-) tests, and to further confirm utility. A 12-month chart review follow-up of 734 pigmented lesions that had negative PLA results from 5 US dermatology centers was performed. Thirteen of these lesions (1.8%) were biopsied in the follow-up period and submitted for histopathologic review. None of the lesions biopsied had a histopathologic diagnosis of melanoma. The test's utility was studied further in a registry (N=1575, 40 US dermatology offices, 62 participating providers), which demonstrated that 99.9% of PLA(-) lesions were clinically monitored, thereby avoiding a surgical procedure, and 96.5% of all PLA(+) lesions were appropriately biopsied, most commonly with a tangential shave. This long-term follow-up study confirms the PLA's high negative predictive value and high utility in helping guide the management of pigmented lesions to avoid unnecessary surgical procedures.


Assuntos
Melanoma/diagnóstico , Nevo Pigmentado/diagnóstico , Neoplasias Cutâneas/diagnóstico , Biópsia/estatística & dados numéricos , Diagnóstico Diferencial , Feminino , Seguimentos , Perfilação da Expressão Gênica , Testes Genéticos/métodos , Humanos , Masculino , Melanoma/genética , Melanoma/patologia , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Valor Preditivo dos Testes , Sistema de Registros , Sensibilidade e Especificidade , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/patologia , Estados Unidos
8.
Nature ; 569(7755): 241-244, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31068724

RESUMO

The production of elements by rapid neutron capture (r-process) in neutron-star mergers is expected theoretically and is supported by multimessenger observations1-3 of gravitational-wave event GW170817: this production route is in principle sufficient to account for most of the r-process elements in the Universe4. Analysis of the kilonova that accompanied GW170817 identified5,6 delayed outflows from a remnant accretion disk formed around the newly born black hole7-10 as the dominant source of heavy r-process material from that event9,11. Similar accretion disks are expected to form in collapsars (the supernova-triggering collapse of rapidly rotating massive stars), which have previously been speculated to produce r-process elements12,13. Recent observations of stars rich in such elements in the dwarf galaxy Reticulum II14, as well as the Galactic chemical enrichment of europium relative to iron over longer timescales15,16, are more consistent with rare supernovae acting at low stellar metallicities than with neutron-star mergers. Here we report simulations that show that collapsar accretion disks yield sufficient r-process elements to explain observed abundances in the Universe. Although these supernovae are rarer than neutron-star mergers, the larger amount of material ejected per event compensates for the lower rate of occurrence. We calculate that collapsars may supply more than 80 per cent of the r-process content of the Universe.

9.
Cutis ; 103(4): 233-236;E1;E2, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31116811

RESUMO

Patient requests for nature-based products have increased in dermatologic practices over the last decade. Patients express many reasons for turning to these products, including avoidance of potentially harmful chemicals and the belief that nature-based products are safer than conventional cosmetic products or prescription formulations. Natural products are used in dermatology for both cosmetic and medical purposes. The responsible physician makes prescription and product recommendations based on empirical evidence, labeling, and education, explaining when and how to use the products. Yet much of the evidence, labeling, and education on topical nature-based products is inadequate to fully describe their utility in dermatology and support credible physician recommendations. For these reasons, we recommend: (a) a clear and thorough peer-reviewed compendium of natural ingredients, their intended efficacy, their sources, and rigorous scientific clinical evidence supporting their use; (b) that manufacturers provide standardized transparency into the composition of nature-based formulations through detailed labeling, including amounts and concentrations of ingredients and parts of plants used; and (c) clear preclinical and clinical data using standardized measures and end points demonstrating the efficacy and benefit claims of nature-based formulations.


Assuntos
Produtos Biológicos/administração & dosagem , Fármacos Dermatológicos/administração & dosagem , Dermatopatias/tratamento farmacológico , Administração Cutânea , Humanos
10.
Cutis ; 103(4): 208-211, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31116817

RESUMO

With the implementation of the new Medicare Physician Fee Schedule on January 1, 2019, it can be beneficial for all practitioners to grasp an understanding of how reimbursement is determined. With the new Physician Fee Schedule also came new relative value units (RVUs) and new billing codes. Biopsy codes, in particular, were changed to reflect the complexity of the sampling technique (ie, tangential, punch, incisional). In this article, we explain RVUs and how they determine reimbursement. This article also highlights changes and additions to billing codes, specifically for biopsies and telemedicine services.


Assuntos
Current Procedural Terminology , Dermatologia , Grupos Diagnósticos Relacionados , Tabela de Remuneração de Serviços , Humanos , Estados Unidos
13.
Dermatol Surg ; 45(8): 1035-1041, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30640783

RESUMO

BACKGROUND: There have been recent claims of overdiagnosis and unnecessary treatment in dermatology. One potential manifestation of overutilization would be providers who perform numerous biopsies per patient. OBJECTIVE: To identify the frequency of skin biopsy rate outliers. MATERIALS AND METHODS: Data on biopsy rates at the individual provider level were obtained from Medicare Provider Utilization and Payment Data Public Use Files. The total number of biopsies for each provider was obtained by summing the number of claimed biopsy services for each unique National Provider Identifier. The visit count for each provider was obtained by summing all evaluation and management services claimed. Provider biopsy rates were calculated by dividing the total number of biopsies associated with each National Provider Identifier by the corresponding visit count. RESULTS: The mean provider biopsy rate was 0.31 services per visit, or approximately 1 biopsy every 3 visits. Defining outliers as providers who averaged 3 or more biopsies per visit, there were 38 outliers out of 18,260 providers. Physicians had a lower mean biopsy rate than nonphysician clinicians (p = 1.70E-28). CONCLUSION: Contrary to claims, the authors' results do not indicate widespread overutilization of skin biopsy services.


Assuntos
Biópsia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Neoplasias Cutâneas/patologia , Revisão da Utilização de Recursos de Saúde , Idoso , Feminino , Humanos , Masculino , Medicare , Estados Unidos , Procedimentos Desnecessários/estatística & dados numéricos
15.
JAMA Dermatol ; 154(9): 1025-1031, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29998292

RESUMO

Importance: A recently described noninvasive gene expression test (the pigmented lesion assay [PLA]) with adhesive patch-based sampling has the potential to rule out melanoma and the need for surgical biopsy of pigmented lesions suggestive of melanoma with a negative predictive value of 99% compared with 83% for the histopathologic standard of care. The cost implications of using this molecular test vs visual assessment followed by biopsy and histopathologic assessment (VAH) have not been evaluated. Objective: To determine potential cost savings of PLA use vs the VAH pathway. Design, Setting, and Participants: This health economic analysis performed from a US payer perspective was based on consensus treatment guidelines and fee schedules from the Centers for Medicare & Medicaid Services. Data for model input were derived from routine use of the test in US dermatology practices and literature. Participants included patients with primary cutaneous pigmented lesions suggestive of melanoma. Data were analyzed from February 8 to December 1, 2017. Main Outcomes and Measures: The primary analysis consisted of the relative reduction in costs of diagnostic surgical procedures for PLA vs VAH management. Additional analyses included stage-related treatment costs associated with delays in diagnosis. Results: In the cost analysis for this economic model, the relative reduction in surgical procedure costs (biopsy and subsequent excision), assuming $0 for the PLA to facilitate multiple comparison scenarios, was -$395 compared with VAH. The relative reduction in stage-related treatment costs associated with the PLA was -$433 compared with VAH, primarily associated with avoidance of delays due to false-negative diagnoses. Surveillance costs were reduced by -$119 with the PLA. The total cost of fully adjudicating a lesion suggestive of melanoma by VAH was $947. At a mean selling price reference point for PLA of $500, cost savings of $447 (47%) per lesion tested could be realized. Conclusions and Relevance: The results of this analysis suggest that the PLA reduces cost and may improve the care of patients with primary pigmented skin lesions suggestive of melanoma.


Assuntos
Testes Genéticos/economia , Melanoma/diagnóstico , Melanoma/patologia , Técnicas de Diagnóstico Molecular/economia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Biópsia/economia , Redução de Custos , Diagnóstico Tardio/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Modelos Econômicos , Pele/patologia
16.
Melanoma Res ; 28(5): 478-482, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30004988

RESUMO

About 3 million surgical pigmented skin lesion biopsies are performed each year in the USA alone to diagnose fewer than 200 000 new cases of invasive melanoma and melanoma in situ using the current standard of care that includes visual assessment and histopathology. A recently described noninvasive adhesive patch-based gene expression rule-out test [pigmented lesion assay (PLA)] may be helpful in identifying high-risk pigmented skin lesions to aid with surgical biopsy decisions. The main objective of this utility study was to determine the real-world clinical performance of PLA use and assess how the PLA changes physician behavior in an observational cohort analysis of 381 patients assessed with the PLA. All (100%) of 51 PLA(+) test results were clinically managed with surgical biopsy. Of these, 19 (37%) were melanomas, corresponding to a number needed to biopsy of 2.7 and a biopsy ratio of 1.7. All melanomas were histopathologically classified as melanoma in situ or stage 1. Nearly all (99%) of 330 PLA(-) test results were clinically managed with surveillance. None of the three follow-up biopsies performed in the following 3-6 months, were diagnosed as melanoma histopathologically. The estimated sensitivity and specificity of the PLA from these data sets are 95 and 91%, respectively. Overall, 93% of PLA results positive for both LINC00518 and PRAME were diagnosed histopathologically as melanoma. PRAME-only and LINC00518-only lesions were melanomas histopathologically in 50 and 7%, respectively. The PLA alters clinical management of pigmented lesions and shows high clinical performance. The likelihood of positive histopathologic diagnosis of melanoma is higher in PLA results that are positive for both LINC00518 and PRAME.


Assuntos
Expressão Gênica/genética , Melanoma/genética , Nevo Pigmentado/genética , Neoplasias Cutâneas/genética , Feminino , Humanos , Masculino , Melanoma/patologia , Nevo Pigmentado/patologia , Neoplasias Cutâneas/patologia
18.
Clin Dermatol ; 36(3): 399-419, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29908582

RESUMO

The plant and mushroom kingdoms have species used for intoxication, inebriation, or recreation. Some of these species are toxic. Given that many of these plants or substances are illegal and have histories of abuse, much of the research regarding therapeutic application is based on basic science, animal studies, and traditional use. This review examines Cannabis, Euphorbia, Ricinus, Podophyllum, Veratrum, mushrooms, and nightshades, along with resveratrol and cocaine as they relate to dermatology.


Assuntos
Agaricales , Cannabis , Fitoterapia , Preparações de Plantas/uso terapêutico , Dermatopatias/tratamento farmacológico , Pele/patologia , Solanum , Animais , Canabinoides/uso terapêutico , Dermatologia , Dermatomicoses/tratamento farmacológico , Dronabinol/uso terapêutico , Etanolaminas/uso terapêutico , Euphorbia , Fibrose , Humanos , Inflamação/tratamento farmacológico , Ácidos Palmíticos/uso terapêutico , Preparações de Plantas/farmacologia , Podophyllum peltatum , Resveratrol , Ricinus , Envelhecimento da Pele/efeitos dos fármacos , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/prevenção & controle , Estilbenos/uso terapêutico , Veratrum
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