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2.
Dermatol Surg ; 47(2): 170-173, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33565772

RESUMO

BACKGROUND: Little is known about dermatologists' perceptions of postoperative pain and how those perceptions correlate with patient-reported pain and opioid prescribing. OBJECTIVE: To determine dermatologists' accuracy in predicting postoperative pain compared with patient-reported pain and how physicians' perceptions affect opioid prescribing practices. METHODS AND MATERIALS: A prospective observational study in which patients undergoing Mohs surgery rated pain on the Numerical Rating Scale (0-10). Using the same scale, the physician predicted how much pain the patient would experience postoperatively on the evening of surgery. All analgesic medications taken in postoperative period were recorded. RESULTS: A total of 316 patients completed the study (70% completion rate). Physician predictions were correlated with patient-reported pain (p < .001; r = 0.29) and were within 2 points of patient-reported pain in 70% of cases. When physicians overestimated patient-reported by ≥3 points, they were not more likely to prescribe opioids (p = .8094). Physicians predicted higher pain for patients who were prescribed opioids (p = .0002). CONCLUSION: Dermatologists were fairly accurate at predicting postoperative pain. Dermatologists were not more likely to prescribe opioids when pain was overpredicted.


Assuntos
Analgésicos Opioides/uso terapêutico , Dermatologistas/estatística & dados numéricos , Cirurgia de Mohs/efeitos adversos , Medição da Dor/estatística & dados numéricos , Dor Pós-Operatória/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Medidas de Resultados Relatados pelo Paciente , Percepção , Padrões de Prática Médica/estatística & dados numéricos , Prognóstico , Estudos Prospectivos , Resultado do Tratamento
4.
Clin Dermatol ; 38(3): 303-309, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32563341

RESUMO

The corporatization of dermatopathology has long preceded that of dermatology and has been driven by federal legislation and economic influences. Although the Clinical Laboratory Improvement Amendments and the Stark Law limited physician-owned laboratories, loopholes via the Safe Harbor Exemptions outlined in the Anti-Kickback Statute allowed corporate laboratories to flourish through relationships built by health information technology donations. The rise of corporatization has had widespread effects on the fields of dermatopathology and dermatology, resulting in reduced numbers of dermatology-trained dermatopathologists and decreased caseloads in academic institutions, potentially compromising dermatology residency education. Although there have been efforts to counteract these effects, more global changes will be required to alter the direction of this subspecialty.


Assuntos
Dermatologia/economia , Laboratórios/economia , Propriedade/economia , Patologia/economia , Corporações Profissionais/economia , Dermatologistas/estatística & dados numéricos , Dermatologia/educação , Educação de Pós-Graduação em Medicina , Humanos , Internacionalidade , Internato e Residência , Informática Médica
5.
Clin Dermatol ; 38(3): 310-315, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32563342

RESUMO

Dermatology is currently the second least diverse medical specialty, after orthopedic surgery, with only a minority of physicians identifying as underrepresented in medicine (UIM). To diversify our specialty, our understanding and recognition of multifactorial barriers to inclusivity such as financial barriers, lack of mentorship, and the implicit bias against minorities UIM is critical. With collaborative efforts by national dermatology organizations, dermatology residency programs, and medical schools to increase the presence of UIM dermatology physicians in the US health care, this important issue continues to receive the attention it deserves.


Assuntos
Dermatologistas/estatística & dados numéricos , Dermatologia/economia , Dermatologia/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Dermatologia/organização & administração , Humanos , Mentores/estatística & dados numéricos , Grupos Minoritários , Sociedades Médicas , Estados Unidos
6.
An Bras Dermatol ; 95(3): 298-306, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32303433

RESUMO

BACKGROUND: The increasingly frequent use of dermoscopy makes us think about the possibility of transfer of microorganisms, through the dermatoscope, between doctor and patients. OBJECTIVES: To identify the most frequent gram-positive cocci in dermatoscopes and smartphone adapters, as well as the resistance profile, and to evaluate the factors associated with a higher risk of bacterial contamination of the dermatoscopes. METHODS: A cross-sectional study was carried out with 118 dermatologists from Porto Alegre/Brazil between September 2017 and July 2018. Gram-positive cocci were identified by MALDI-TOF MS and habits of use of the dermatoscope were evaluated through an anonymous questionnaire. RESULTS: Of the dermatoscopes analysed, 46.6% had growth of gram-positive cocci on the lens and 37.3% on the on/off button. The microorganisms most frequently found were S. epidermidis, S. hominis and S. warneri. Attending a hospital, using the dermatoscope at the hospital, with inpatients and in the intensive care unit were significantly associated with colonisation by gram-positive cocci. The highest resistance rates were observed for penicillin, erythromycin and sulfamethoxazole-trimethoprim. STUDY LIMITATIONS: The non-search of gram-negative bacilli, fungi and viruses. Moreover, the small number of adapters did not make it possible to better define if the frequency differences were statistically significant. CONCLUSION: Coagulase-negative staphylococci were frequently identified. S. aureus was detected only on the lens.


Assuntos
Dermatologistas/estatística & dados numéricos , Dermoscopia/instrumentação , Infecções por Bactérias Gram-Positivas/epidemiologia , Cocos Gram-Positivos/isolamento & purificação , Smartphone , Adulto , Distribuição por Idade , Antibacterianos/farmacologia , Brasil/epidemiologia , Estudos Transversais , Farmacorresistência Bacteriana , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Cocos Gram-Positivos/efeitos dos fármacos , Cocos Gram-Positivos/crescimento & desenvolvimento , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Fatores de Risco , Distribuição por Sexo , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Inquéritos e Questionários
7.
Br J Dermatol ; 183(1): 71-77, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32348545

RESUMO

BACKGROUND: The cutaneous manifestations of COVID-19 disease are poorly characterized. OBJECTIVES: To describe the cutaneous manifestations of COVID-19 disease and to relate them to other clinical findings. METHODS: We carried out a nationwide case collection survey of images and clinical data. Using a consensus we described five clinical patterns. We later described the association of these patterns with patient demographics, the timing in relation to symptoms of the disease, the severity and the prognosis. RESULTS: The lesions may be classified as acral areas of erythema with vesicles or pustules (pseudo-chilblain) (19%), other vesicular eruptions (9%), urticarial lesions (19%), maculopapular eruptions (47%) and livedo or necrosis (6%). Vesicular eruptions appear early in the course of the disease (15% before other symptoms). The pseudo-chilblain pattern frequently appears late in the evolution of the COVID-19 disease (59% after other symptoms), while the rest tend to appear with other symptoms of COVID-19. The severity of COVID-19 shows a gradient from less severe disease in acral lesions to more severe in the latter groups. The results are similar for confirmed and suspected cases, in terms of both clinical and epidemiological findings. Alternative diagnoses are discussed but seem unlikely for the most specific patterns (pseudo-chilblain and vesicular). CONCLUSIONS: We provide a description of the cutaneous manifestations associated with COVID-19 infection. These may help clinicians approach patients with the disease and recognize cases presenting with few symptoms. What is already known about this topic? Previous descriptions of cutaneous manifestations of COVID-19 were case reports and mostly lacked illustrations. What does this study add? We describe a large, representative sample of patients with unexplained skin manifestations and a diagnosis of COVID-19, using a consensus method to define morphological patterns associated with COVID-19. We describe five clinical patterns associated with different patient demographics, timing and prognosis, and provide illustrations of these patterns to allow for easy recognition.


Assuntos
Betacoronavirus/patogenicidade , Consenso , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Dermatopatias Virais/classificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Dermatologistas/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico , Estudos Prospectivos , Dermatopatias Virais/diagnóstico , Dermatopatias Virais/virologia , Espanha/epidemiologia , Inquéritos e Questionários/estatística & dados numéricos , Terminologia como Assunto , Fatores de Tempo , Adulto Jovem
9.
Cutis ; 105(1): E24-E28, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32074163

RESUMO

The relationship between physicians and pharmaceutical companies has caused the medical community to question the degree to which pharmaceutical interactions and incentives can influence physicians' prescribing habits. Our study aimed to analyze whether a change in institutional policy that restricted the availability of in-office samples for patients resulted in any measurable change in the prescribing habits of faculty physicians in the Department of Dermatology and Cutaneous Surgery at the University of South Florida (USF)(Tampa, Florida). Medical records were retrospectively reviewed for common dermatology diagnoses-acne vulgaris, atopic dermatitis, onychomycosis, psoriasis, and rosacea-before and after the pharmaceutical policy changes, and the prescribed medications were recorded. These medications were then categorized as brand name, generic, and over-the-counter (OTC). Statistical analysis using a mixed effects ordinal logistic regression model accounting for baseline patient characteristics was conducted to determine if a difference in prescribing habits occurred.


Assuntos
Dermatologistas/estatística & dados numéricos , Prescrições de Medicamentos/economia , Padrões de Prática Médica/estatística & dados numéricos , Medicamentos sob Prescrição/administração & dosagem , Dermatologia/estatística & dados numéricos , Indústria Farmacêutica/organização & administração , Florida , Humanos , Visita a Consultório Médico , Medicamentos sob Prescrição/economia , Estudos Retrospectivos
10.
J Am Acad Dermatol ; 82(5): 1262-1267, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31972258

RESUMO

BACKGROUND: Inpatient dermatology has been shown to improve patient outcomes at a reduced cost. Few hospitals have dermatologists available. Teledermatology may allow dermatologists to assess hospitalized patients remotely. OBJECTIVE: To examine the diagnostic concordance between a hospitalist, dermatologist, and teledermatologist using store-and-forward teledermatology. METHODS: For 100 consecutive patients requiring inpatient dermatology consultation, a survey was conducted by all 3 raters to convey diagnostic impressions and therapeutic recommendations. Complete and partial agreements were assessed using the Cohen kappa statistic. RESULTS: Inpatient dermatology consultation often resulted in a change in diagnosis (50.9%) and a change in systemic therapy (41.5%). Likewise, virtual teledermatology consultation would have resulted in a change in diagnosis (54.7%) and a change in systemic therapy (47.2%) at similar rates. Comparing the dermatologist and teledermatologists, diagnostic complete and partial agreement were 52.8% and 84.9%, respectively. Systemic therapy agreement was 77.4%. Teledermatologists recommended biopsy more often (68.5% vs 43.5%). LIMITATIONS: Small sample size, tertiary academic medical center, single rater for inpatient teledermatology with specific inpatient niche. CONCLUSION: Teledermatologists performed comparably to an in-person dermatologist for the diagnosis and management of hospitalized patients with skin conditions. Teledermatology may be a suitable alternative for delivery of inpatient care if no dermatologist is available.


Assuntos
Dermatologistas/estatística & dados numéricos , Médicos Hospitalares/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Dermatopatias/diagnóstico , Centros Médicos Acadêmicos/estatística & dados numéricos , Biópsia/estatística & dados numéricos , Dermatologia/métodos , Dermatologia/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Pele/patologia , Dermatopatias/patologia , Dermatopatias/terapia , Centros de Atenção Terciária/estatística & dados numéricos
11.
JAMA Dermatol ; 156(3): 320-324, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31995131

RESUMO

Importance: Many patients presently have access to their pathologic test result reports via online patient portals, yet little is known about pathologists' perspective on this topic. Objective: To examine dermatopathologists' experience and perceptions of patient online access to pathology reports. Design, Setting, and Participants: A survey of 160 dermatopathologists currently practicing in the United States who are board certified and/or fellowship trained in dermatopathology was conducted between July 15, 2018, and September 23, 2019. Those who reported interpreting skin biopsies of melanocytic lesions within the previous year and expected to continue interpreting them for the next 2 years were included. Main Outcomes and Measures: Dermatopathologists' demographic and clinical characteristics, experiences with patient online access to pathologic test result reports, potential behaviors and reactions to patient online access to those reports, and effects on patients who read their pathologic test result reports online. Results: Of the 160 participating dermatopathologists from the 226 eligible for participation (71% response rate), 107 were men (67%); mean (SD) age was 49 (9.7) years (range, 34-77 years). Ninety-one participants (57%) reported that patients have contacted them directly about pathologic test reports they had written. Some participants noted that they would decrease their use of abbreviations and/or specialized terminology (57 [36%]), change the way they describe lesions suspicious for cancer (29 [18%]), and need specialized training in communicating with patients (39 [24%]) if patients were reading their reports. Most respondents perceived that patient understanding would increase (97 [61%]) and the quality of patient-physician communication would increase (98 [61%]) owing to the availability of online reports. Slightly higher proportions perceived increased patient worry (114 [71%]) and confusion (116 [73%]). However, on balance, most participants (114 [71%]) agreed that making pathologic test result reports available to patients online is a good idea. Conclusions and Relevance: Dermatopathologists in this survey study perceived both positive and negative consequences of patient online access to pathologic test result reports written by the respondents. Most participants believe that making pathologic test result reports available to patients online is a good idea; however, they also report concerns about patient worry and confusion increasing as a result. Further research regarding best practices and the effect on both patients and clinicians is warranted.


Assuntos
Dermatologistas/estatística & dados numéricos , Dermatologia/métodos , Patologistas/estatística & dados numéricos , Portais do Paciente , Neoplasias Cutâneas/diagnóstico , Adulto , Idoso , Atitude do Pessoal de Saúde , Biópsia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acesso dos Pacientes aos Registros , Relações Médico-Paciente , Dermatopatias/diagnóstico , Dermatopatias/patologia , Neoplasias Cutâneas/patologia , Inquéritos e Questionários , Terminologia como Assunto , Estados Unidos
12.
JAMA Dermatol ; 156(3): 296-302, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31995147

RESUMO

Importance: The qualitative grading of acne is important for routine clinical care and clinical trials, and although many useful systems exist, no single acne global grading system has had universal acceptance. In addition, many current instruments focus primarily on evaluating primary lesions (eg, comedones, papules, and nodules) or exclusively on signs of secondary change (eg, postinflammatory hyperpigmentation, scarring). Objectives: To develop and validate an acne global grading system that provides a comprehensive evaluation of primary lesions and secondary changes due to acne. Design, Setting, and Participants: This diagnostic study created a multidimensional acne severity feature space by analyzing decision patterns of pediatric dermatologists evaluating acne. Modeling acne severity patterns based on visual image features was then performed to reduce dimensionality of the feature space to a novel 2-dimensional grading system, in which severity levels are functions of multidimensional acne cues. The system was validated by 6 clinicians on a new set of images. All images used in this study were taken from a retrospective, longitudinal data set of 150 patients diagnosed with acne, ranging across the entire pediatric population (aged 0-21 years), excluding images with any disagreement on their diagnosis, and selected to adequately span the range of acne types encountered in the clinic. Data were collected from July 1, 2001, through June 30, 2013, and analyzed from March 1, 2015, through December 31, 2016. Main Outcomes and Measures: Prediction performance was evaluated as the mean square error (MSE) with the clinicians' scores. Results: The scale was constructed using acne visual features and treatment decisions of 6 pediatric dermatologists evaluating 145 images of patients with acne ranging in age from 0 to 21 years. Using the proposed scale to predict the severity scores on a new set of 40 images achieved an overall MSE of 0.821, which is smaller than the mean within-clinician differences (MSE of 0.998). Conclusions and Relevance: By integrating primary lesions and secondary changes, this novel acne global grading scale provides a more clinically relevant evaluation of acne that may be used for routine clinical care and clinical trials. Because the severity scores are based on actual clinical practice, this scoring system is also highly correlated with appropriate treatment choices.


Assuntos
Acne Vulgar/diagnóstico , Tomada de Decisões , Padrões de Prática Médica , Acne Vulgar/patologia , Acne Vulgar/terapia , Adolescente , Criança , Pré-Escolar , Dermatologistas/estatística & dados numéricos , Dermatologia , Humanos , Lactente , Estudos Longitudinais , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
14.
J Am Acad Dermatol ; 82(5): 1158-1165, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31931085

RESUMO

OBJECTIVE: To provide a formal statistical comparison of the efficacy of melanoma detection among different clinical settings. METHODS: A systematic review and meta-analysis of all relevant observational studies on number needed to treat (NNT) in relation to melanoma was performed in MEDLINE. We performed a random-effects model meta-analysis and reported NNTs with 95% confidence intervals (CIs). The subgroup analysis was related to clinical setting. RESULTS: In all, 29 articles including a total of 398,549 biopsies/excisions were analyzed. The overall NNT was 9.71 (95% CI, 7.72-12.29): 22.62 (95% CI, 12.95-40.10) for primary care, 9.60 (95% CI, 6.97-13.41) for dermatology, and 5.85 (95% CI, 4.24-8.27) for pigmented lesion specialists. LIMITATIONS: There is heterogeneity in data reporting and the possibility of missing studies. In addition, the incidence of melanoma varies among clinical settings, which could affect NNT calculations. CONCLUSION: Pigmented lesion specialists have the lowest NNT, followed by dermatologists, suggesting that involving specialists in the diagnosis and treatment of pigmented skin lesions can likely improve patient outcomes.


Assuntos
Melanoma/epidemiologia , Melanoma/cirurgia , Cirurgia de Mohs/estatística & dados numéricos , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/cirurgia , Centros Médicos Acadêmicos , Biópsia por Agulha , Procedimentos Cirúrgicos Dermatológicos/métodos , Procedimentos Cirúrgicos Dermatológicos/estatística & dados numéricos , Dermatologistas/estatística & dados numéricos , Feminino , Humanos , Imuno-Histoquímica , Incidência , Masculino , Melanoma/diagnóstico , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/diagnóstico , Resultado do Tratamento , Estados Unidos
15.
J Cosmet Dermatol ; 19(2): 289-295, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31840388

RESUMO

BACKGROUND: Laser and energy-based devices may be used for many cutaneous indications, including facial resurfacing, improving skin conditions, and reducing signs of photoaging. Currently, no consensus papers or guidelines exist concerning peri-operative agents and specifically their use for laser skin resurfacing and their potential/possible role in prevention or treatment of side effects. AIM: To explore current practice using laser and energy devices, a survey was developed to identify the trends in pre- and postprocedural treatment measures. METHODS: The survey was sent out digitally to 300 randomly selected US dermatologist and plastic surgeon physicians practicing medical esthetics using laser and other energy devices treatment for facial rejuvenation. The survey gathered information on demographics, types of devices used in the clinic and pre-/postprocedural measures for facial laser, and other energy-based devices treatment. RESULTS: The survey was active from June 15, to July 15, 2018, and fifty-eight dermatologists and plastic surgeons completed the survey (19.3% response rate, 58/300). The results showed inconsistency in skin preparation strategies and postprocedure wound care. The majority of survey participants (55/58 [96%]) reported prophylactic oral antiviral use pre- and post-treatment; however, there was inconsistency about when to start and when to stop the use. A similar inconsistency existed in the recommended period of post-treatment sun protection before and after treatment. CONCLUSION: The results of the survey confirmed the lack of consistency in the types and duration of pre- and postprocedural measures-emphasizing the need for evidence-based recommendations to optimize outcomes, prevent infection, enhance comfort, and reduce downtime.


Assuntos
Terapia com Luz de Baixa Intensidade/efeitos adversos , Regeneração da Pele por Plasma/efeitos adversos , Cuidados Pós-Operatórios/estatística & dados numéricos , Complicações Pós-Operatórias/terapia , Cuidados Pré-Operatórios/estatística & dados numéricos , Terapia por Radiofrequência/efeitos adversos , Consenso , Dermatologistas/estatística & dados numéricos , Face , Humanos , Terapia com Luz de Baixa Intensidade/normas , Terapia com Luz de Baixa Intensidade/estatística & dados numéricos , Regeneração da Pele por Plasma/normas , Regeneração da Pele por Plasma/estatística & dados numéricos , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/normas , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Terapia por Radiofrequência/normas , Terapia por Radiofrequência/estatística & dados numéricos , Rejuvenescimento , Pele/imunologia , Pele/efeitos da radiação , Envelhecimento da Pele/fisiologia , Envelhecimento da Pele/efeitos da radiação , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Resultado do Tratamento , Cicatrização
16.
Support Care Cancer ; 28(3): 967-969, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31768733

RESUMO

PURPOSE: Acute radiation dermatitis (RD) is a disfiguring and painful rash that occurs in up to 95% of patients receiving radiation therapy (RT) for cancer. Treatment for RD varies among practitioners with no evidence-based gold standard for management. While a multi-disciplinary approach has been utilized to manage other cancer-related toxicities, RD is most often managed by the treating radiation oncologist. METHODS: This study evaluated the referral practices of radiation oncologists to dermatologists for management of RD utilizing a survey of radiation oncologists across the USA. The goal was to identify the referral practices of radiation oncologists for RD and any barriers to a multidisciplinary approach. RESULTS: Of the 705 respondents, 15% reported ever referring patients to dermatology. Private practitioners referred significantly less than providers in academic or oncology centers (p < 0.01). Practitioners in urban settings were more likely to refer (p < 0.01), and radiation oncologists in the Southeastern USA were less likely to refer (p < 0.01). CONCLUSIONS: Lack of timely access to dermatologists in various geographic areas in addition to radiation oncologists' preference to treat RD are barriers to multidisciplinary management of RD. Inclusion of dermatologists and wound care specialists in cancer treatment teams could improve patient care and stimulate needed research into strategies for treatment and prevention of RD.


Assuntos
Dermatologistas/estatística & dados numéricos , Radio-Oncologistas/estatística & dados numéricos , Radiodermatite/terapia , Encaminhamento e Consulta/estatística & dados numéricos , Feminino , Humanos , Masculino , Padrões de Prática Médica , Radiodermatite/epidemiologia , Inquéritos e Questionários , Estados Unidos/epidemiologia
17.
Acta Clin Belg ; 75(2): 116-122, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30618351

RESUMO

Background: Teledermatology, the application of telemedicine in the field of dermatology, can be a valuable tool to improve the efficiency of care in general practice.Objectives: In this pilot study, we implemented a teledermatology programme in Belgian context to assess the effect on referral rate and to evaluate the acceptability of teledermatology by clinicians and patients.Material and methods: A store-and-forward teledermatology service between 12 general practitioners (GPs) and 3 academic dermatologists was evaluated for a period of 3-6 months. Clinicians and patients were questioned about satisfaction, benefits and barriers.Results: In total, 54 teledermatologic consultations were performed. The referral rate was reduced. Thirty-one teleconsulations were performed instead of physical referral, of which nine patients were actually referred. In 23 cases, performed for a second opinion, two more patients were referred on the dermatologist's advice.All clinicians want to continue working with teledermatology. GPs highlighted the educational benefit, whereas dermatologists were interested in the triage effect and reduced referral rate. Patients indicated that teledermatology would encourage them to consult a GP sooner when experiencing dermatologic problems.Conclusion: Teledermatology proved to be a feasible and acceptable tool for both clinicians and patients. It also shows to be a valuable for triage and reducing unnecessary referrals. Considering the emergent pressure on health care in the next decades, teledermatology following GP selection could be useful for the Belgian health care system and deserves further elaboration in the search for effective tools to strengthen first line health care and streamline referral to secondary care.


Assuntos
Dermatologia , Telemedicina/estatística & dados numéricos , Adulto , Bélgica , Dermatologistas/estatística & dados numéricos , Dermatologia/métodos , Dermatologia/organização & administração , Dermatologia/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Projetos Piloto , Encaminhamento e Consulta/estatística & dados numéricos , Dermatopatias/diagnóstico , Dermatopatias/terapia
18.
J Am Acad Dermatol ; 82(1): 110-116, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31408683

RESUMO

BACKGROUND: There are too few board-certified dermatologists to treat all patients with skin disease. Primary care physicians often serve at the frontline of skin cancer screening. OBJECTIVE: To compare biopsy use among dermatologist physicians, dermatology advanced practice professionals (APPs), primary care physicians (PCPs), and other nondermatology clinicians. METHODS: Pathology reports, requisition forms, and clinical notes of skin biopsies submitted to our institution during the study period were reviewed. Skin biopsies for inflammatory conditions, cosmetic or functional purposes, and re-excisions were excluded. The number needed to biopsy (NNB) was calculated as the number of biopsied lesions divided by histologically proven skin cancers. RESULTS: The NNB by clinician type was 2.82 for dermatology physicians, 4.69 for APPs, 4.55 for nondermatology PCPs, and 6.55 for other nondermatology clinicians (P < .001). The NNB was significant between clinician groups for nonmelanoma skin cancer (dermatology physicians, 2.00; APPs, 2.71; PCPs, 2.36; and other nondermatology clinicians, 3.47; P < .001) but not for melanoma (dermatology clinicians, 14.33; APPs, 20.78; PCPs, 27.80; and other nondermatology clinicians, 53.56; P = .061). LIMITATIONS: The NNB represents a measure of use but gives no insight into the number of malignant lesions that go unbiopsied and, therefore, undiagnosed. The prevalence of skin cancer varies among dermatology and nondermatology practices. The results are not generalizable to all practice settings. CONCLUSIONS: Dermatology physicians had the lowest NNB of all clinician groups. PCPs performed similarly to dermatology APPs.


Assuntos
Biópsia por Agulha/estatística & dados numéricos , Competência Clínica , Dermatologistas/estatística & dados numéricos , Detecção Precoce de Câncer/métodos , Médicos de Atenção Primária/estatística & dados numéricos , Neoplasias Cutâneas/patologia , Adulto , Idoso , Biópsia por Agulha/métodos , Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Estudos de Coortes , Feminino , Humanos , Masculino , Melanoma/epidemiologia , Melanoma/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Estados Unidos
19.
J Am Acad Dermatol ; 82(3): 622-627, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31306724

RESUMO

BACKGROUND: Computer vision has promise in image-based cutaneous melanoma diagnosis but clinical utility is uncertain. OBJECTIVE: To determine if computer algorithms from an international melanoma detection challenge can improve dermatologists' accuracy in diagnosing melanoma. METHODS: In this cross-sectional study, we used 150 dermoscopy images (50 melanomas, 50 nevi, 50 seborrheic keratoses) from the test dataset of a melanoma detection challenge, along with algorithm results from 23 teams. Eight dermatologists and 9 dermatology residents classified dermoscopic lesion images in an online reader study and provided their confidence level. RESULTS: The top-ranked computer algorithm had an area under the receiver operating characteristic curve of 0.87, which was higher than that of the dermatologists (0.74) and residents (0.66) (P < .001 for all comparisons). At the dermatologists' overall sensitivity in classification of 76.0%, the algorithm had a superior specificity (85.0% vs. 72.6%, P = .001). Imputation of computer algorithm classifications into dermatologist evaluations with low confidence ratings (26.6% of evaluations) increased dermatologist sensitivity from 76.0% to 80.8% and specificity from 72.6% to 72.8%. LIMITATIONS: Artificial study setting lacking the full spectrum of skin lesions as well as clinical metadata. CONCLUSION: Accumulating evidence suggests that deep neural networks can classify skin images of melanoma and its benign mimickers with high accuracy and potentially improve human performance.


Assuntos
Aprendizado Profundo , Dermoscopia/métodos , Interpretação de Imagem Assistida por Computador/métodos , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Colômbia , Estudos Transversais , Dermatologistas/estatística & dados numéricos , Dermoscopia/estatística & dados numéricos , Diagnóstico Diferencial , Humanos , Cooperação Internacional , Internato e Residência/estatística & dados numéricos , Israel , Ceratose Seborreica/diagnóstico , Melanoma/patologia , Nevo/diagnóstico , Curva ROC , Pele/diagnóstico por imagem , Pele/patologia , Neoplasias Cutâneas/patologia , Espanha , Estados Unidos
20.
Rev Chilena Infectol ; 36(3): 283-291, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859746

RESUMO

INTRODUCTION: Condylomas or genital warts (GW) are the most frequently diagnosed sexually transmitted infection (STI) in STI centers in Chile, but there are no population statistics available. OBJECTIVES: To describe the prevalence of GW in patients from 18-60 years of age who attend outpatient dermatology, gynecology and urology practice; the demographic characteristics of the patients and the diagnostic and treatment tools. METHODS: A sample of Chilean specialists stratified by region, population and gender of patients was provided with a logbook and answered a questionnaire. RESULTS: The GW prevalence was 2.44% for the whole group; 3.76% for the 18-34 age group and 1.29% for the 35-60 years group (p = 0.0000). The average age of patients with GW was 29.4 years in women and 32.7 years in men (p = 0.019). The distribution by age was different according to gender and health system. Visual inspection was the most frequent diagnostic method used and imiquimod cream the most common treatment, however, there were differences in the use of diagnostic and therapeutic tools according to the patient's gender, specialty of the doctor and health system. CONCLUSIONS: The high prevalence of GW confirmed the need and importance of public health interventions to address this problem.


Assuntos
Condiloma Acuminado/epidemiologia , Pacientes Ambulatoriais/estatística & dados numéricos , Adolescente , Adulto , Antineoplásicos/uso terapêutico , Chile/epidemiologia , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/tratamento farmacológico , Demografia/estatística & dados numéricos , Dermatologistas/estatística & dados numéricos , Feminino , Ginecologia/estatística & dados numéricos , Instituições Privadas de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Imiquimode/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Prática Profissional/estatística & dados numéricos , Urologistas/estatística & dados numéricos , Adulto Jovem
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