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3.
Dermatitis ; 30(5): 294-299, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31524757

RESUMO

Atopic dermatitis (AD) often requires combination treatment regimens. However, little is known about treatment combinations and polypharmacy in AD. We sought to characterize patterns of outpatient prescriptions and polypharmacy among US children and adults with AD. Data from the 1993-2015 National Ambulatory Medical Care Survey were analyzed, including 128,300 pediatric and 623,935 adult outpatient visits. Among AD visits, dermatologists prescribed more topical corticosteroids (TCSs, P = 0.01) than any other clinicians, particularly multiple TCSs (P < 0.0001), topical calcineurin inhibitors (TCI, P = 0.009), combination TCIs with TCSs (P = 0.004), and systemic immunosuppressants (P = 0.003). Prescriptions for multiple TCSs increased from ages 0 to 19 years, 20 to 39 years, and peaked at 40 to 59 years (P = 0.0002). Prescriptions for prednisone peaked at ages of 40 to 59 years (P = 0.003). A subset of AD patients was prescribed oral antibiotics (7.1%), although fewer than half had a diagnosis of bacterial infection (42.1%). The proportion of patients receiving multiple prescriptions was higher in visits to primary care practitioners versus dermatologists, those with private versus public insurance, and 50 years or older versus 20 to 49 years versus 0 to 19 years. Visits with 4 or more prescriptions by dermatologists increased between 1993-2000 (10%) and 2011-2015 (29%, P = 0.0001). In conclusion, significant treatment variation exists among specialists managing AD, with increasing polypharmacy over time.


Assuntos
Corticosteroides/uso terapêutico , Inibidores de Calcineurina/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Imunossupressores/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Administração Cutânea , Adolescente , Corticosteroides/administração & dosagem , Adulto , Fatores Etários , Antibacterianos/uso terapêutico , Inibidores de Calcineurina/administração & dosagem , Criança , Pré-Escolar , Dermatologia/estatística & dados numéricos , Quimioterapia Combinada , Glucocorticoides/uso terapêutico , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Seguro Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Polimedicação , Prednisona/uso terapêutico , Estados Unidos , Adulto Jovem
4.
J Drugs Dermatol ; 18(8): 798-802, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31424710

RESUMO

Cutaneous fungal infections account for millions of office visits per year, yet their varied presentations often lead to misdiagnosis. If dermatology clinics are Clinical Laboratory Improvement Amendment (CLIA) certified, direct microscopy with potassium hydroxide or other stains can be used to inexpensively and rapidly diagnose fungal infections. In this survey, we examined dermatologists' perceptions of fungal preparations and CLIA certification to identify barriers that prevent the use of these bedside diagnostics. The response rate was 13% (n=308, based on the number of emails opened). When a cutaneous fungal infection is suspected, 20.94% rarely/never and 19.86% sometimes perform fungal preparations, often because they think clinical diagnosis is adequate or that preparations take too long. 21.32% reported not having CLIA certification, most frequently because the process requires too much work, or they do not know how to apply. Of providers with CLIA certification, over 25% thought it was difficult to obtain. Our results demonstrate that numerous barriers prevent the common use of fungal preparations, including the perception that clinical diagnosis is sufficient and the lack of required CLIA certification. These barriers emphasize the need for additional education about cutaneous fungal infections and use of bedside diagnostics. Additionally, policy-based interventions are necessary to ease the process of CLIA certification.


Assuntos
Dermatomicoses/diagnóstico , Fungos/isolamento & purificação , Indicadores e Reagentes/química , Adulto , Idoso , Dermatologistas/estatística & dados numéricos , Dermatologia/métodos , Dermatologia/estatística & dados numéricos , Dermatomicoses/microbiologia , Dermatomicoses/patologia , Diagnóstico Diferencial , Feminino , Humanos , Hidróxidos/química , Masculino , Técnicas Microbiológicas/métodos , Técnicas Microbiológicas/estatística & dados numéricos , Microscopia , Pessoa de Meia-Idade , Visita a Consultório Médico/estatística & dados numéricos , Compostos de Potássio/química , Padrões de Prática Médica/estatística & dados numéricos , Pele/microbiologia , Pele/patologia , Inquéritos e Questionários/estatística & dados numéricos
6.
Am J Clin Pathol ; 152(6): 701-705, 2019 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-31332424

RESUMO

OBJECTIVES: Multiple practice guidelines discourage indiscriminate use of broad panels of allergen-specific IgE (sIgE) tests due to increased risk of false positives and misinterpretation of results. We provide an analytical framework to identify specialty-specific differences in ordering patterns and effectiveness, which can be used to improve test utilization. METHODS: Test results from a tertiary pediatric hospital were analyzed by ordering specialty to evaluate size of allergen workups. Positivity rates were analyzed to determine effectiveness in selecting tests with high positive pretest probabilities. Laboratory test menu components were also evaluated. RESULTS: Our findings demonstrate 29% of sIgE tests are ordered as part of broad workups (>20 sIgE tests/date of service) contrary to the recommended testing approach. Detailed descriptions of ordering patterns and positivity rates are provided. CONCLUSIONS: This study provides a framework for using a cross-sectional analytical approach to assess test utilization patterns and evaluate components of laboratory testing menus.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Hipersensibilidade/diagnóstico , Imunoglobulina E/sangue , Padrões de Prática Médica/estatística & dados numéricos , Alergia e Imunologia/estatística & dados numéricos , Criança , Estudos Transversais , Dermatologia/estatística & dados numéricos , Feminino , Gastroenterologia/estatística & dados numéricos , Humanos , Masculino , Naturopatia/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Pneumologia/estatística & dados numéricos
7.
Acta Med Port ; 32(6): 448-452, 2019 Jun 28.
Artigo em Português | MEDLINE | ID: mdl-31292026

RESUMO

INTRODUCTION: Cellulitis and erysipelas represent the most frequent cause of hospitalization in the dermatology department of Santa Maria Hospital in Lisbon, Portugal. The aim of this study was to investigate whether patient demographics, comorbidities, previous episodes of cellulitis/erysipelas, the presence of complications, laboratory markers at admission, microbial isolation or previous use of antibiotics, are associated with prolonged stays. MATERIAL AND METHODS: Retrospective analysis, including patients admitted with cellulitis/erysipelas in the inpatient dermatology department of Santa Maria Hospital between July 1st 2012 and June 30th 2017. RESULTS: There were 372 admissions, corresponding to 348 patients. The median length of stay was 11 days. Increased age (p = 0.002, OR 1.03, 95% CI 1.01 - 1.04), previous episode of cellulitis/erysipelas requiring hospitalization (p = 0.005, OR 4.81, 95% CI 1.63 - 14.23), the presence of cellulitis/erysipelas-associated complications (p = 0.001, OR 3.28, 95% CI 1.63 - 6.59), leukocytosis (p = 0.049, OR 1.81, 95% CI 1.00 - 3.30), high levels of C-reactive protein (p = 0.035, OR 1.03, 95% CI 1.00 - 1.06) and a positive culture result (p = 0.002, OR 2.59, 95% CI 1.41 - 4.79) were associated with prolonged hospitalization. DISCUSSION: Prolonged hospitalization for cellulitis/erysipelas is associated with higher costs, additional clinical investigation, invasive treatments, prolonged courses of antibiotic therapy, risk of nosocomial infections, and delayed return to activities of daily living. Thus, the investigation of clinical-laboratory factors associated with prolonged hospitalization for cellulitis / erysipelas is essential and may be useful for the construction of a severity score. CONCLUSION: The knowledge of the characteristics that are associated with prolonged stay among patients with cellulitis/erysipelas may be relevant to improve health care, by reducing the length of hospital stay and associated risks and costs.


Assuntos
Celulite (Flegmão)/epidemiologia , Erisipela/epidemiologia , Tempo de Internação/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Antibacterianos/uso terapêutico , Proteína C-Reativa/análise , Celulite (Flegmão)/sangue , Celulite (Flegmão)/complicações , Celulite (Flegmão)/microbiologia , Comorbidade , Dermatologia/estatística & dados numéricos , Erisipela/sangue , Erisipela/complicações , Erisipela/microbiologia , Feminino , Humanos , Leucocitose/epidemiologia , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Estudos Retrospectivos , Fatores Sexuais
8.
Actas Dermosifiliogr ; 110(8): 659-665, 2019 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31153547

RESUMO

BACKGROUND AND OBJECTIVE: Skin lesions are a common reason for consulting a primary care physician. Current legislation in Spain states that purely aesthetic skin problems that do not pose a health problem are not to be treated within the National Health Service. The aim of this study was to estimate the proportion of referrals from primary care physicians to dermatologists that were for cystic lesions or benign tumors and could potentially have been avoided. MATERIAL AND METHODS: We consulted cases registered in the DIADERM study dataset, which is representative of dermatology practice in Spain, and collected the main diagnoses given on referring patients from primary care. A referral diagnosis was classified as potentially avoidable if it corresponded to one of the primary care discharge diagnoses listed in a consensus paper of the Andalusian section of the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: We collected 2171 main reasons for first-visit referrals to dermatologists; 686 of them (31.6%) were for cystic lesions or benign tumors and classified as potentially avoidable. In 478 cases (22%) the patients were discharged on the first visit. The most frequent diagnoses in such cases were seborrheic keratosis (9.3%) and melanocytic nevus (8.6%). CONCLUSIONS: Nearly a third of referrals from primary care to a dermatologist were for cystic lesions and benign tumors and could have been avoided. A clearer understanding of our caseload can be useful for improving planning, training, and health care system management.


Assuntos
Dermatologia/estatística & dados numéricos , Mau Uso de Serviços de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Dermatopatias/diagnóstico , Cistos/diagnóstico , Mau Uso de Serviços de Saúde/prevenção & controle , Humanos , Ceratose Seborreica/diagnóstico , Espanha
9.
Actas Dermosifiliogr ; 110(8): 653-658, 2019 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31151666

RESUMO

BACKGROUND: Teledermatology was introduced in Chile to make up for the lack of dermatologists and improve the primary care system's ability to resolve problems. This strategy was implemented in the province of Palena in 2013, but outcomes were not analyzed and reported until now. MATERIAL AND METHODS: Descriptive, cross-sectional study with analysis of inter-rater agreement on diagnoses. All the teledermatology consultations made on behalf of patients in Ayacara, Chaitén, Futaleufú, and Palena from 2013 through 2017 were analyzed. Data were extracted from the MINSAL platform. The κ statistic was used to assess diagnostic agreement. RESULTS: A total of 326 teledermatology consultations were made. The mean (SD) age of the patients was 35.8 (22.4) years. The majority (59.8%) were female. Palena generated the largest volume of cases (40.8%). The mean time until a teledermatology diagnosis was given was 12.6 (22.8) days. This response time decreased to 6.4 (5.2) days after a staff dermatologist from Hospital Puerto Montt joined the program (P=.0005). Diagnosis concordance between the general practitioner and the dermatologist was moderate (κ=0.5). Physical examination by the dermatologist at the hospital of reference (Puerto Montt) was necessary for 20.6% of the patients, and time until a definitive diagnosis for the patient took longer in such cases (25.7 [41.2] days) than for the cases that didn't need a physical evaluation at the Hospital of Puerto Montt (P<.0001). CONCLUSIONS: Teledermatology provides a necessary diagnostic and therapeutic resource for general practitioners in isolated locations. Diagnostic agreement is moderate between the generalist and the specialist, similar to agreement in international studies but lower than agreement reported in other Chilean studies. The reduction in diagnostic response time after incorporation of a dermatologist on staff at the hospital of Puerto Montt was significant. The significant difference between the time for diagnosis under teledermatology and the delay when physical examination is required at the hospital of Puerto Montt identifies an aspect of care management to improve.


Assuntos
Dermatologia/métodos , Dermatopatias/diagnóstico , Telemedicina , Adulto , Chile , Estudos Transversais , Dermatologia/estatística & dados numéricos , Feminino , Medicina Geral , Humanos , Masculino , Variações Dependentes do Observador , Exame Físico/estatística & dados numéricos , Consulta Remota/métodos , Consulta Remota/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Fatores de Tempo
11.
Dermatol Surg ; 45(4): 588-597, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30946699

RESUMO

BACKGROUND: Nonphysicians are expanding practice into specialty medicine. There are limited studies on patient and physician perspectives as well as safety outcomes regarding the nonphysician practice of cosmetic procedures. OBJECTIVE: To identify the patient (consumer) and physician perspective on preferences, adverse events, and outcomes following cosmetic dermatology procedures performed by physicians and nonphysicians. MATERIALS AND METHODS: Internet-based surveys were administered to consumers of cosmetic procedures and physician members of the American Society for Dermatologic Surgery. Descriptive statistics and graphical methods were used to assess responses. Comparisons between groups were based on contingency chi-square analyses and Fisher exact tests. RESULTS: Two thousand one hundred sixteen commenced the patient survey with 401 having had a cosmetic procedure performed. Fifty adverse events were reported. A higher number of burns and discoloration occurred in the nonphysician-treated group and took place more often in a spa setting. Individuals seeing nonphysicians cited motivating factors such as level of licensure (type) of nonphysician, a referral from a friend, price, and the location of the practitioner. Improper technique by the nonphysician was cited most as a reason for the adverse event. Both groups agree that more regulation should be placed on who can perform cosmetic procedures. Recall bias associated with survey data. CONCLUSION: Patients treated by nonphysicians experienced more burns and discoloration compared with physicians, and they are encountering these nonphysicians outside a traditional medical office, which are important from a patient safety and regulatory standpoint. Motivating factors for patients seeking cosmetic procedures may also factor into the choice of provider. KEY POINTS: Both patients and physicians think more regulation should be in place on who can perform cosmetic procedures. More adverse events such as burns and discolorations occurred with patients seeing nonphysicians compared with those seeing physicians. In addition, for those seeing nonphysicians, a majority of these encounters took place in spa settings. Patient safety is of utmost concern when it comes to elective cosmetic medical procedures. More adverse events and encounters occurring outside traditional medical settings when nonphysicians performed these procedures call into question the required training and oversight needed for such procedures.


Assuntos
Técnicas Cosméticas/normas , Dermatologia/normas , Pessoal de Saúde/normas , Atitude do Pessoal de Saúde , Competência Clínica , Técnicas Cosméticas/estatística & dados numéricos , Dermatologia/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/estatística & dados numéricos , Humanos , Estados Unidos/epidemiologia
12.
Int J Dermatol ; 58(11): 1317-1322, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31006848

RESUMO

BACKGROUND: Potassium hydroxide preparations (KOH) and tissue examinations for ova and parasites (O&P) are cost-effective office-based tests. No studies have quantified their utilization and economic impact. METHODS: The objective is to determine the billing patterns and costs of office-based diagnostic procedures in the Medicare population. We conducted a cross sectional study using the Part B National Summary Data File (2000-2016) and the Physician and Other Supplier Public Use File (2012-2015) released by the Centers for Medicare & Medicaid Services. RESULTS: In 2016, the total number of claims among all providers was 28,432 (KOH) and 52,182 (O&P), representing a decrease since 2000 (KOH, -41.8%; O&P, -43.4%). The total claims for in-office procedures by dermatologists per 10,000 beneficiaries decreased between 2012 and 2015 (KOH, -18.8%; O&P, -26.6%). Fewer dermatologists submitted claims for the tests (KOH, -11.3%; O&P, -16.6%). The total single (SB) and multiple (MB) biopsy claims by dermatologists per 10,000 beneficiaries decreased between 2012 and 2015 (SB, -1.8%; MB, -2.7%). The 2016 aggregate payments (% change since 2000) for KOH and O&P were $163,127.75 (-60.4%) and $299,074.18 (-61.6%), respectively; for SB and MB, they were $240,047,487.98 (+142.3%) and $38,214,117.22 (+79.2%), respectively. CONCLUSION: Fewer dermatologists submit claims for KOH and O&P each year. Future studies should evaluate whether this is due to a loss of cost-efficacy, and secondly, if it is related to decreased reimbursement, burdensome in-office laboratory regulations, or changing provider preferences.


Assuntos
Medicare/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Dermatopatias Parasitárias/diagnóstico , Biópsia/economia , Biópsia/estatística & dados numéricos , Técnicas de Laboratório Clínico/economia , Técnicas de Laboratório Clínico/estatística & dados numéricos , Estudos Transversais , Dermatologia/economia , Dermatologia/estatística & dados numéricos , Humanos , Hidróxidos/economia , Indicadores e Reagentes , Medicare/economia , Visita a Consultório Médico/economia , Compostos de Potássio/economia , Utilização de Procedimentos e Técnicas/economia , Pele/parasitologia , Dermatopatias Parasitárias/economia , Dermatopatias Parasitárias/parasitologia , Estados Unidos
13.
Int J Dermatol ; 58(8): 953-960, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30888053

RESUMO

INTRODUCTION: Individuals infected with the human T-cell lymphotropic virus type 1 (HTLV-1) commonly present skin lesions, which may be a warning sign for the diagnosis of infection. This study describes the most prevalent skin manifestations in HTLV carriers attended at the clinic of Núcleo de Medicina Tropical (NMT) of the Universidade Federal do Pará (UFPA) in Belém, Pará, Brazil. METHODS: This is a study of a series of cases of patients infected with human T-cell lymphotropic virus types 1 and 2 (HTLV-1/2) treated at NMT UFPA between 1999 and 2016. A descriptive analysis of data was applied. RESULTS: Among 788 surveyed medical records in the service, 15.10% (n = 119) were referred to the dermatology clinic. From the series of cases that presented with skin lesions, 66.39% were female and 33.61% were male, and the average age of this group was 48 years. There was a predominance of patients with noninfectious inflammatory manifestations (64.2%), followed by infectious ones (24.6%), and 1.58% with lymphoproliferative diseases. As for the group of lesions, 45.26% of the erythematous-squamous type were observed, followed by dyschromia (24.21%), and eczematous (14.74%). One patient with a diagnosis of adult T-cell leukemia/lymphoma, another with parapsoriasis, and four with infective dermatitis are highlighted. CONCLUSION: Skin disorders in the HLTV positive patient are important causes of referral to the dermatologist with etiological and skin lesions groups diversity. In the series of cases studied, lymphoproliferatives diseases and infective dermatitis associated with HTLV-1 were presented as a challenge for the diagnosis and clinical management of these patients.


Assuntos
Portador Sadio/epidemiologia , Infecções por HTLV-I/epidemiologia , Infecções por HTLV-II/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Dermatopatias Infecciosas/epidemiologia , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Portador Sadio/virologia , Dermatologia/estatística & dados numéricos , Feminino , Infecções por HTLV-I/virologia , Infecções por HTLV-II/virologia , Vírus Linfotrópico T Tipo 1 Humano/isolamento & purificação , Vírus Linfotrópico T Tipo 2 Humano/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Dermatopatias Infecciosas/virologia , Adulto Jovem
14.
Int J Dermatol ; 58(12): 1423-1429, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30916785

RESUMO

BACKGROUND: Little research has been done in teledermatology to examine the effects of standardized templates and subject-specific learning modules. METHODS: We performed a prospective study examining the effects of standardized templates and standardized cutaneous oncology learning modules on teledermatology referrals at Mayo Clinic. This data was then compared to previous teledermatology referrals before standardized templates were adopted. RESULTS: A total of 42 teledermatology consultations were performed during the 4-month study period. The use of standardized templates resulted in an absolute reduction in face-to-face referrals. Teledermatology consultation increased the absolute diagnostic and management concordance by 26.2% (P = 0.02) and 33.3% (P < 0.01), respectively, and decreased the absolute diagnostic and management discordance by 19.1% (P = 0.03) and 31.0% (P < 0.01), respectively. The largest knowledge gaps were identified in cutaneous oncology. Educational intervention improved theoretical referral rates and confidence in diagnosis and management overall. CONCLUSION: The implementation of standardized intake templates reduces the rate of face-to-face referrals. Teledermatology improves primary care-based dermatological care and reduces theoretical referral rates.


Assuntos
Dermatologistas/educação , Dermatologia/organização & administração , Consulta Remota/organização & administração , Neoplasias Cutâneas/diagnóstico , Adulto , Idoso , Competência Clínica/estatística & dados numéricos , Dermatologistas/organização & administração , Dermatologistas/estatística & dados numéricos , Dermatologia/educação , Dermatologia/estatística & dados numéricos , Educação Médica Continuada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Educacionais , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Pesquisa Qualitativa , Consulta Remota/estatística & dados numéricos , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/terapia , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos/epidemiologia
15.
Dermatol Surg ; 45(4): 581-587, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30829773

RESUMO

BACKGROUND: The regulation of medical spas (med-spas) in the United States varies considerably from state to state with important ramifications for patient safety. OBJECTIVE: To describe the current state of med-spas in the United States and degree of medical oversight in these facilities. MATERIALS AND METHODS: Descriptive study based on web search and standardized phone interviews of med-spas in the most heavily populated cities in each state of the United States. Information obtained included the following: whether medical directors were listed; if so, whether they were advertised as being on site; medical directors' training and board certification; and services offered. RESULTS: Of 247 medical spas reviewed, 72% advertised a medical director on their website, and 6.5% claimed that the director was on site. Of listed medical directors, 41% were trained in dermatology and/or plastic surgery. In phone interviews, 79% of med-spas endorsed the medical director to be board certified, and 52% stated that the medical director was on site less than 50% of the time. CONCLUSION: There is significant variation in medical directorship and oversight among medical spas in the United States. Appropriate regulation of medical directors' training and the degree of oversight provided are warranted to optimize patient safety.


Assuntos
Técnicas Cosméticas/normas , Dermatologia/normas , Instalações de Saúde/legislação & jurisprudência , Instalações de Saúde/normas , Diretores Médicos/legislação & jurisprudência , Diretores Médicos/normas , Certificação/legislação & jurisprudência , Certificação/normas , Técnicas Cosméticas/estatística & dados numéricos , Dermatologia/estatística & dados numéricos , Regulamentação Governamental , Instalações de Saúde/estatística & dados numéricos , Humanos , Segurança do Paciente/legislação & jurisprudência , Segurança do Paciente/normas , Estados Unidos/epidemiologia
16.
Dermatol Surg ; 45(6): 782-790, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30829776

RESUMO

BACKGROUND: The management of skin cancers has evolved with the development of Mohs micrographic surgery and a greater emphasis on surgical training within dermatology. It is unclear whether these changes have translated into innovations and contributions to the reconstructive literature. OBJECTIVE: To assess contributions from each medical specialty to the cutaneous head and neck oncologic reconstructive literature. METHODS: The authors conducted a systematic review of the head and neck reconstructive literature from 2000 through 2015 based on a priori search terms relating to suture technique, linear closure, advancement, rotation, transposition and interpolation flaps, and identified the specialty of the senior authors. RESULTS: The authors identified 74,871 articles, of which 1,319 were relevant. Under suture technique articles, the senior authors were primarily dermatologists (58.2%) and plastic surgeons (20.3%). Under linear closure, the authors were dermatologists (48.1%), plastic surgeons (22.2%), and otolaryngologists (20.4%). Under advancement and rotation flaps, the senior authors were plastic surgeons (40.5%, 38.9%), dermatologists (38.1%, 34.2%), and otolaryngologists (14.4%, 21.6%). Under transposition and interpolation flaps, the senior authors were plastic surgeons (47.3%, 39.4%), dermatologists (32.3%, 27.0%), and otolaryngologists (15.3%, 23.4%). CONCLUSION: The primary specialties contributing to the cutaneous head and neck reconstructive literature are plastic surgery, dermatology, and otolaryngology.


Assuntos
Cirurgia de Mohs/normas , Procedimentos Cirúrgicos Reconstrutivos/normas , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos/normas , Competência Clínica , Dermatologia/normas , Dermatologia/estatística & dados numéricos , Humanos , Cirurgia de Mohs/métodos , Cirurgia de Mohs/estatística & dados numéricos , Otolaringologia/normas , Otolaringologia/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Cirurgia Plástica/normas , Cirurgia Plástica/estatística & dados numéricos , Retalhos Cirúrgicos/estatística & dados numéricos , Técnicas de Sutura/normas , Técnicas de Sutura/estatística & dados numéricos , Estados Unidos/epidemiologia , Técnicas de Fechamento de Ferimentos/normas , Técnicas de Fechamento de Ferimentos/estatística & dados numéricos
18.
Clin Exp Dermatol ; 44(8): 874-881, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30767255

RESUMO

BACKGROUND: There is a paucity of published evidence of established teledermatology (TD) services in the UK. An in-house TD service using store-and-forward technology was set up at a large regional dermatology department in 2004. AIM: To review the TD service at our centre, including teleconsultation numbers, coding of diagnoses and patient outcomes. METHODS: Retrospective data were retrieved using the electronic patient database, from 31 July 2004 to 31 July 2018. More detailed information on patient outcomes was obtained from patient notes and histology records. A paper questionnaire was distributed to 100 patients to obtain patient feedback. RESULTS: In total, 40 201 teleconsultations were made over 14 years, and 64% of cases were coded (n = 25 555), of which 77% were lesions. The most common coded lesions were benign naevus (25%), seborrhoeic keratosis (22%) and basal cell carcinoma (19%). Of the total number of cases, 50% were discharged to their general practitioner with advice, 34% were booked for surgery and 16% were booked for a face-to-face appointment. In the survey, 82% of patients surveyed felt that the service was 'good' or 'very good'. A detailed study between 1 January 2015 and 1 January 2016 showed that there were 383 patients (10%) with no diagnosis made following teleconsultation, suggesting diagnostic uncertainty. Reasons for this included lack of diagnostic features, possibility of malignancy and service factors. Within this cohort, there was 68% diagnostic concordance. CONCLUSIONS: We have set up a successful TD service at a UK centre, which has prevented 16 282 face-to-face appointments over 14 years. Patient feedback has been very good. Review of cases with diagnostic uncertainty provides important information for service improvement and has not previously been documented.


Assuntos
Dermatologia/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Dermatopatias/diagnóstico , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Satisfação do Paciente , Estudos Retrospectivos , Dermatopatias/terapia
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