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J Am Acad Dermatol ; 81(2): 438-447, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30885756


BACKGROUND: Transgender patients have many unique dermatologic needs, yet the literature concerning dermatologic care of transgender individuals is lacking. OBJECTIVE: We aimed to provide a systematic review of the literature on dermatology care in transgender individuals to provide a foundation for future research and education. METHODS: We systematically reviewed peer-reviewed published studies that examined dermatologic treatment of transgender patients. RESULTS: A total of 110 articles met the inclusion criteria for systematic review. LIMITATIONS: Because of a lack of quantitative research in transgender dermatology, much of the available literature included in this review relies on case reports and expert opinions. CONCLUSION: Dermatologists have the ability to greatly affect the care of transgender patients, and there are ample opportunities for dermatologists to expand the literature pertaining to this population.

Dermatologia , Hormônios Gonadais/farmacologia , Serviços de Saúde para Pessoas Transgênero , Papel do Médico , Competência Cultural , Preenchedores Dérmicos/efeitos adversos , Dermatologia/ética , Feminino , Hormônios Gonadais/efeitos adversos , Cabelo/efeitos dos fármacos , Humanos , Masculino , Relações Médico-Paciente , Procedimentos de Readequação Sexual , Dermatopatias/induzido quimicamente , Dermatopatias/diagnóstico
Actas dermo-sifiliogr. (Ed. impr.) ; 110(1): 20-27, ene.-feb. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-176882


La seguridad clínica y la responsabilidad profesional médica son hoy en día preocupaciones de primer orden en el ejercicio de la medicina. Interesa la valoración de las circunstancias en las que el ejercicio de la medicina no se ajusta a la lex artis, así como el impacto de las reclamaciones sobre los facultativos. Debe existir además un aprendizaje del error médico, identificando, mediante el estudio de reclamaciones, áreas específicas de mejora. La dermatología es una especialidad con bajo riesgo de reclamación a nivel internacional y también en nuestro contexto. Gran variedad de circunstancias clínicas dan lugar a reclamaciones por praxis médica en dermatología, y entre ellas destaca la actuación en caso de melanoma cutáneo maligno. Por otro lado, existen riesgos potenciales en las consultas de dermatología que merecen especial atención. El quehacer clínico está sujeto a un riesgo inherente de reclamación y por tanto son necesarias una serie de recomendaciones para prevenirlas

Clinical safety and medical liability are first-order concerns in today's medical practice. It is important to understand the circumstances under which medical acts fail to live up to the accepted standard of care and to recognize the impact that malpractice claims have on physicians. Practitioners must also grasp the concept of medical error, studying malpractice claims in order to identify the areas where improvement is needed. The risk of accusations of malpractice in dermatology is comparatively low, both in Spain and worldwide. However, a great variety of clinical scenarios in dermatology can potentially give rise to a claim, and malignant melanoma is most susceptible to risk. Dermatologists should know which actions during clinical consultation merit particular attention and care. Clinical practice carries inherent risk of malpractice claims, but taking certain recommended precautions can prevent them

Humanos , Dermatologia/ética , Dermatologia/legislação & jurisprudência , Dermatopatias/epidemiologia , Segurança do Paciente/legislação & jurisprudência , Melanoma/patologia , Terapia de Aceitação e Compromisso/métodos , Carcinoma de Célula de Merkel/patologia , Responsabilidade Social
Int J Dermatol ; 58(7): 788-794, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30168846


The term "off-label drug use" involves the prescription of medications for unapproved indications or in unapproved dosage, dosage form, or route of administration. Off-label medications are common in the management of dermatologic diseases. In the recent years, new indications for botulinum toxin, biologics, spironolactone, topical calcineurin, and topical vitamin D analogues emerged, and these drugs are being used off-label to treat a variety of conditions. The high cost and long time required for the approval discourage pharmaceutical companies from developing studies and pursuing the approval by regulatory agencies. Patients and physicians may have a different perspective regarding the off-label use of medications. The ethical discussion is based on the different opinions concerning the need for informed consent by the patient and how this could be applicable in the clinical practice.

Dermatologia/ética , Indústria Farmacêutica/ética , Uso Off-Label/ética , Segurança do Paciente , Dermatopatias/tratamento farmacológico , Ensaios Clínicos como Assunto , Dermatologia/economia , Dermatologia/métodos , Aprovação de Drogas , Indústria Farmacêutica/economia , Humanos , Uso Off-Label/economia , Rotulagem de Produtos/economia , Rotulagem de Produtos/ética , Dermatopatias/economia , Resultado do Tratamento
J Am Acad Dermatol ; 81(3): 683, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-29128452
Dermatol Surg ; 44(12): 1571-1577, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29985862


BACKGROUND: A 2017 New York Times (NYT) article questioning the appropriateness of skin cancer treatment modality by dermatology providers stimulated discussion among the public pertaining to ethics in the current state of dermatologic practice. OBJECTIVE: The purpose of this study is to characterize issues raised by the comments on the NYT article, discuss strategies to address these concerns, and encourage reflection on ethics in dermatologic care. MATERIALS AND METHODS: A qualitative analysis was performed on the 309 comments on the NYT article. General themes were identified, resulting in the inclusion of 222 comments. These comments were reviewed and characterized by the type of commenter, his or her stance on health care, and what issues they raised. RESULTS: Providers interested in "profit over patient" was the most common theme, followed by mistrust of APPs, health care system interested in "profit over patient," inadequate supervision by advanced practice providers (APPs), finding the "right" provider, support for coordinated APP and physician care, support for APP credentials, and finally inappropriate elderly care. CONCLUSION: The NYT article raises the concern of identifying quality care and choosing the "right provider"-one who successfully balances the various incentives affecting skin cancer management including appropriate usage of APPs.

Dermatologia/ética , Dermatologia/normas , Opinião Pública , Qualidade da Assistência à Saúde , Neoplasias Cutâneas/terapia , Dermatologia/economia , Custos de Cuidados de Saúde , Humanos , Sobremedicalização , Jornais como Assunto , Percepção , Pesquisa Qualitativa
Int J Dermatol ; 57(11): 1358-1362, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29693243


BACKGROUND: Teledermatology may improve dermatologic care access in underserved areas and expand the clinical experience of dermatologists-in-training. The potential for teledermatology to supplement global health curricula in dermatology residency education has not been explored. METHODS: An international virtual grand rounds (VGR) curriculum was created based on teledermatology cases from Kabul, Afghanistan. The learning objectives included understanding the diagnosis and management of skin diseases in unfamiliar resource-limited settings and highlighting socioeconomic, cross-cultural, and ethical issues. A 17-item, Likert scale questionnaire was used to assess the effectiveness of the curriculum, including specific Accreditation Council for Graduate Medical Education (ACGME) competencies, as well as interest in global health and teledermatology. RESULTS: The survey was completed by 85 of 118 VGR attendees (72% response rate). Most respondents considered the curriculum valuable to their education (mean 4.5 on a 5-point Likert scale; standard deviation, 0.5), learned more about diagnosis and treatment of skin diseases in international settings (4.5; 0.6) and in the US (4.1; 0.8), and learned more about socioeconomic, cultural, and ethical issues in skin health (4.6; 0.5). The majority also reported being more interested in global dermatology (4.1; 0.8) and would recommend VGR to a colleague (4.5; 0.6). CONCLUSION: This pilot curriculum provided an innovative platform to enhance undergraduate and graduate medical education in international dermatology. International teledermatology education may be used to address multiple ACGME core competencies and increase resident awareness of sociocultural determinants of skin health.

Dermatologia/educação , Educação Médica/métodos , Dermatopatias , Visitas com Preceptor/métodos , Telemedicina , Afeganistão , Atitude do Pessoal de Saúde , Assistência à Saúde Culturalmente Competente , Currículo , Dermatologia/ética , Humanos , Internacionalidade , Projetos Piloto , Dermatopatias/diagnóstico , Dermatopatias/terapia , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos
J Cosmet Dermatol ; 17(3): 396-397, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29520955


This study addresses the dilemma concerned with meeting patients who may have encountered counterfeit esthetic devices in the marketplace. Over the past several years, we have witnessed a rise in counterfeit injectables and medical devices in our field. Often times, the procedures are marketed to patients at significantly reduced prices compared to competitors. Patients may be unaware that counterfeit devices exist and may unknowingly have procedures completed using untested and uncertified devices. It is important for clinicians to recognize when their patients may be encountering counterfeit devices, know what to do in this situation, and offer the best recommendations.

Técnicas Cosméticas/ética , Técnicas Cosméticas/instrumentação , Dermatologia/ética , Segurança do Paciente , Bioética , Dermatologia/economia , Equipamentos e Provisões/normas , Estética , Humanos