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1.
South Med J ; 113(9): 462-465, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32885267

RESUMO

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has drastically changed resident training in the United States. Here, we explore the early perceived effects of COVID-19 on dermatology residents through an electronic sample survey and identify possible areas for targeted improvement in lieu of a possible second wave of COVID-19 cases. METHODS: On April 3, 2020, a survey of link with 25 questions was sent to dermatology program coordinators to be disseminated among dermatology residents in the United States. The survey was closed on April 13, 2020. All of the questions were optional and no personal identifiers were collected. RESULTS: A total of 140 dermatology residents from 50 different residency programs across 26 states responded to the survey. The majority of respondents (85%) reported negative effects of COVID-19 on their overall wellness. Despite the majority of residents (92%) speculating that COVID-19 will have negative long-term effects on the US economy, only 33% agreed or strongly agreed that it will affect their job prospects. Teledermatology was widely implemented following the declaration of a national emergency (96% of represented residencies compared with only 30% before the pandemic), with heavy resident involvement. The majority of residents (99%) reported having virtual didactics and that they found them to be beneficial. Most residents were uncomfortable with the prospect of being reassigned to a nondermatology specialty during the pandemic. In addition, 22% of residents believed that their leadership were not transparent and prompt in addressing changes relating to COVID-19. CONCLUSIONS: Dermatology residents were affected negatively by COVID-19 in regard to their well-being, clinical training, and education. Several areas of improvement were identified that could improve our preparedness for a second wave of the virus.


Assuntos
Infecções por Coronavirus , Dermatologia , Pandemias , Administração dos Cuidados ao Paciente/tendências , Pneumonia Viral , Dermatopatias/terapia , Telemedicina , Adulto , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Dermatologia/educação , Dermatologia/métodos , Educação/métodos , Feminino , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Inovação Organizacional , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Percepção Social , Inquéritos e Questionários , Telemedicina/métodos , Telemedicina/tendências , Estados Unidos
3.
Cochrane Database Syst Rev ; 8: CD012927, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32813281

RESUMO

BACKGROUND: The widespread use of mobile technologies can potentially expand the use of telemedicine approaches to facilitate communication between healthcare providers, this might increase access to specialist advice and improve patient health outcomes. OBJECTIVES: To assess the effects of mobile technologies versus usual care for supporting communication and consultations between healthcare providers on healthcare providers' performance, acceptability and satisfaction, healthcare use, patient health outcomes, acceptability and satisfaction, costs, and technical difficulties. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and three other databases from 1 January 2000 to 22 July 2019. We searched clinical trials registries, checked references of relevant systematic reviews and included studies, and contacted topic experts. SELECTION CRITERIA: Randomised trials comparing mobile technologies to support healthcare provider to healthcare provider communication and consultations compared with usual care. DATA COLLECTION AND ANALYSIS: We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS: We included 19 trials (5766 participants when reported), most were conducted in high-income countries. The most frequently used mobile technology was a mobile phone, often accompanied by training if it was used to transfer digital images. Trials recruited participants with different conditions, and interventions varied in delivery, components, and frequency of contact. We judged most trials to have high risk of performance bias, and approximately half had a high risk of detection, attrition, and reporting biases. Two studies reported data on technical problems, reporting few difficulties. Mobile technologies used by primary care providers to consult with hospital specialists We assessed the certainty of evidence for this group of trials as moderate to low. Mobile technologies: - probably make little or no difference to primary care providers following guidelines for people with chronic kidney disease (CKD; 1 trial, 47 general practices, 3004 participants); - probably reduce the time between presentation and management of individuals with skin conditions, people with symptoms requiring an ultrasound, or being referred for an appointment with a specialist after attending primary care (4 trials, 656 participants); - may reduce referrals and clinic visits among people with some skin conditions, and increase the likelihood of receiving retinopathy screening among people with diabetes, or an ultrasound in those referred with symptoms (9 trials, 4810 participants when reported); - probably make little or no difference to patient-reported quality of life and health-related quality of life (2 trials, 622 participants) or to clinician-assessed clinical recovery (2 trials, 769 participants) among individuals with skin conditions; - may make little or no difference to healthcare provider (2 trials, 378 participants) or participant acceptability and satisfaction (4 trials, 972 participants) when primary care providers consult with dermatologists; - may make little or no difference for total or expected costs per participant for adults with some skin conditions or CKD (6 trials, 5423 participants). Mobile technologies used by emergency physicians to consult with hospital specialists about people attending the emergency department We assessed the certainty of evidence for this group of trials as moderate. Mobile technologies: - probably slightly reduce the consultation time between emergency physicians and hospital specialists (median difference -12 minutes, 95% CI -19 to -7; 1 trial, 345 participants); - probably reduce participants' length of stay in the emergency department by a few minutes (median difference -30 minutes, 95% CI -37 to -25; 1 trial, 345 participants). We did not identify trials that reported on providers' adherence, participants' health status and well-being, healthcare provider and participant acceptability and satisfaction, or costs. Mobile technologies used by community health workers or home-care workers to consult with clinic staff We assessed the certainty of evidence for this group of trials as moderate to low. Mobile technologies: - probably make little or no difference in the number of outpatient clinic and community nurse consultations for participants with diabetes or older individuals treated with home enteral nutrition (2 trials, 370 participants) or hospitalisation of older individuals treated with home enteral nutrition (1 trial, 188 participants); - may lead to little or no difference in mortality among people living with HIV (RR 0.82, 95% CI 0.55 to 1.22) or diabetes (RR 0.94, 95% CI 0.28 to 3.12) (2 trials, 1152 participants); - may make little or no difference to participants' disease activity or health-related quality of life in participants with rheumatoid arthritis (1 trial, 85 participants); - probably make little or no difference for participant acceptability and satisfaction for participants with diabetes and participants with rheumatoid arthritis (2 trials, 178 participants). We did not identify any trials that reported on providers' adherence, time between presentation and management, healthcare provider acceptability and satisfaction, or costs. AUTHORS' CONCLUSIONS: Our confidence in the effect estimates is limited. Interventions including a mobile technology component to support healthcare provider to healthcare provider communication and management of care may reduce the time between presentation and management of the health condition when primary care providers or emergency physicians use them to consult with specialists, and may increase the likelihood of receiving a clinical examination among participants with diabetes and those who required an ultrasound. They may decrease the number of people attending primary care who are referred to secondary or tertiary care in some conditions, such as some skin conditions and CKD. There was little evidence of effects on participants' health status and well-being, satisfaction, or costs.


Assuntos
Pessoal de Saúde , Telemedicina/estatística & dados numéricos , Tempo para o Tratamento , Adulto , Viés , Telefone Celular/estatística & dados numéricos , Agentes Comunitários de Saúde/estatística & dados numéricos , Segurança Computacional , Dermatologistas , Retinopatia Diabética/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Custos de Cuidados de Saúde , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Nível de Saúde , Humanos , Satisfação do Paciente , Satisfação Pessoal , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Encaminhamento e Consulta/estatística & dados numéricos , Insuficiência Renal Crônica/terapia , Dermatopatias/terapia , Telemedicina/economia , Fatores de Tempo , Ultrassonografia
4.
Dermatol Online J ; 26(6)2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32815688

RESUMO

Calcinosis cutis, although common in systemic sclerosis, has been rarely reported in patients with morphea. We describe four patients with calcinosis cutis arising within morphea plaques, discuss their treatments and outcomes, and review previously published cases. Current management recommendations for concomitant morphea and dystrophic calcinosis cutis are based on limited data and expert opinion, which has primarily focused on reduction of active inflammation and reduction of symptoms related to calcinosis or ulceration. In most cases, no improvement of calcinosis was noted. The use of intralesional corticosteroids to active lesions in conjunction with systemic treatment, including methotrexate when indicated, appear promising treatments to halt progression of the disease. Surgical excision seems to be the most definitive treatment for calcinosis affecting morphea plaques, but the current literature lacks details regarding disease recurrence following operative management.


Assuntos
Calcinose/etiologia , Esclerodermia Localizada/complicações , Dermatopatias/patologia , Pele/patologia , Corticosteroides/uso terapêutico , Calcinose/patologia , Calcinose/cirurgia , Criança , Feminino , Humanos , Injeções Intralesionais , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Esclerodermia Localizada/tratamento farmacológico , Esclerodermia Localizada/patologia , Dermatopatias/terapia
5.
J Drugs Dermatol ; 19(7): e1-e9, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32726557

RESUMO

The COVID-19 pandemic, originating in Wuhan, China, has become a major public health and economic challenge for countries around the world. As of May 08, 2020, there are over 3 million COVID-19 cases, and 250,000 COVID-19- associated deaths in 215 countries. As more data is collected, updated infection control measures are continuously released and published by government, public health authorities, and physician specialty associations. Across the globe, dermatological practices have had to limit their operations to varying degrees to facilitate disease control, but as the pandemic subsides, they will broaden their operations. In light of the uncertainty surrounding safe and effective practice of medical and aesthetic dermatology in the era of COVID-19, fourteen international experts in the field contributed to recommendations for effective infection control protocols and practice management modifications. While guidance from the World Health Organization and local public health officials comes first, these recommendations are crafted as a starting point for dermatologists worldwide to commence either reopening their doors to patients or expanding available service offerings. This can help ensure that patients receive needed care in the short term and improve long term practice viability. J Drugs Dermatol. 2020;19(7):e-1-e-9. doi:10.36849/JDD.2020.5293.


Assuntos
Infecções por Coronavirus , Dermatologia , Pandemias , Consultórios Médicos/organização & administração , Pneumonia Viral , Humanos , Controle de Infecções , Equipamento de Proteção Individual , Médicos , Dermatopatias/terapia , Telemedicina
7.
J Travel Med ; 27(6)2020 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-32657340

RESUMO

BACKGROUND: Before the impact of the coronavirus disease 2019 pandemic, cruise travel had experienced exponential growth in the preceding decade. Travel medicine practitioners were increasingly called upon to provide pre-cruise travel advice and medical clearance. Demand for these services will return at some time in the future. METHODS: The clinical conditions seen in those presenting for care on six small-vessel scientific cruises to Antarctica were analysed. RESULTS: Personnel presented on 196 occasions resulting in 257 consultations (when initial plus all follow-up consultations were included). Personnel presented with a clinical condition at a rate of 17.9 per 1000 person-days at sea. The total consultation rate was 23.5 per 1000 person-days at sea. Injury accounted for 24% of all presentations at a rate of 4.3 per 1000 person-days at sea. Dermatological, soft tissue and musculoskeletal, general malaise and motion sickness were the four most common presentations. CONCLUSIONS: Pre-cruise advice for travellers planning small-vessel cruises to polar regions needs to include skin care, prevention and management of sea sickness and how to reduce the risk of injury. Those providing medical care on such cruises should be prepared to manage a wide range of clinical presentations.


Assuntos
Encaminhamento e Consulta/estatística & dados numéricos , Navios , Medicina de Viagem/estatística & dados numéricos , Regiões Antárticas , Humanos , Infecções/epidemiologia , Infecções/terapia , Enjoo devido ao Movimento/epidemiologia , Enjoo devido ao Movimento/terapia , Dermatopatias/epidemiologia , Dermatopatias/terapia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia
9.
Hautarzt ; 71(9): 677-685, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32710130

RESUMO

BACKGROUND: In recent years, many medical specialties with a visual focus have been revolutionized by image analysis algorithms using artificial intelligence (AI). As dermatology belongs to this field, it has the potential to play a pioneering role in the use of AI. OBJECTIVE: The current use of AI for the diagnosis and follow-up of dermatoses is reviewed and the future potential of these technologies is discussed. MATERIALS AND METHODS: This article is based on a selective review of the literature using Embase and MEDLINE and the keywords "psoriasis", "eczema", "dermatoses" and "acne" combined with "artificial intelligence", "machine learning", "deep learning", "neural network", "computer-guided", "supervised machine learning" or "unsupervised machine learning" were searched. RESULTS: In comparison to examiner-dependent intra- and interindividually fluctuating scores for the assessment of inflammatory dermatoses (e.g. the Psoriasis Areas Severity Index [PASI] and body surface area [BSA]), AI-based algorithms can potentially offer reproducible, standardized evaluations of these scores. Whereas promising algorithms have already been developed for the diagnosis of psoriasis, there is currently only scarce work on the use of AI in the context of eczema. CONCLUSIONS: The latest developments in this field show the enormous potential of AI-based diagnostics and follow-up of dermatological clinical pictures by means of an autonomous computer-based image analysis. These noninvasive, optical examination methods provide valuable additional information, but dermatological interaction remains indispensable in daily clinical practice.


Assuntos
Inteligência Artificial , Redes Neurais de Computação , Dermatopatias/diagnóstico , Dermatopatias/terapia , Aprendizado Profundo , Humanos , Aprendizado de Máquina
10.
Clin Dermatol ; 38(3): 348-353, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32563348

RESUMO

Dermatology patients are expressing a growing interest in complementary and alternative medicine (CAM) and natural treatment options for management of dermatologic conditions. Counseling on the optimal integration of CAM with conventional therapeutic approaches can be daunting for practitioners who do not feel well-versed in these modalities. A productive conversation between the clinician and patient seeking natural treatments should address the appropriate role and scope of CAM in a therapeutic plan, which is best suited for use as maintenance therapy or to augment traditional pharmaceutical or procedural interventions. Understanding the patient's goals, discussing evidence-based conventional and complementary treatment options, and employing shared decision making can enhance the clinical encounter and strengthen the physician-patient relationship.


Assuntos
Terapias Complementares/psicologia , Tomada de Decisão Compartilhada , Dermatologia , Assistência ao Paciente/métodos , Pacientes/psicologia , Relações Médico-Paciente , Dermatopatias/terapia , Humanos
11.
J Am Acad Dermatol ; 83(3): 958-959, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32531304
14.
J Cosmet Dermatol ; 19(8): 1826-1827, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32502318

RESUMO

The rapidly increasing number of COVID-19-infected patients and evidence of human-to-human transmission even within the asymptomatic incubation period prompted the attention of the entire world. The field of dermatology and procedural dermatology is not exempt from this global issue. We cannot deny the fact that this situation will have a lasting impact on the health-seeking behaviors of our patients. It is necessary for dermatologists and dermatologic surgeons to be aware of the potential risks and precautions when re-emerging their practices after COVID-19.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Dermatologia/tendências , Controle de Infecções/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Dermatopatias/terapia , Telemedicina/tendências , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Técnicas Cosméticas/economia , Técnicas Cosméticas/normas , Técnicas Cosméticas/tendências , Dermatologia/economia , Dermatologia/organização & administração , Dermatologia/normas , Diagnóstico Diferencial , Humanos , Controle de Infecções/economia , Controle de Infecções/organização & administração , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Dermatopatias/diagnóstico , Dermatopatias/economia , Dermatopatias/virologia , Telemedicina/economia , Telemedicina/organização & administração , Telemedicina/normas
15.
J Eur Acad Dermatol Venereol ; 34(8): 1666-1671, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32498128

RESUMO

The pandemic of COVID-19 is a global challenge for health care, and dermatologists are not standing apart from trying to meet this challenge. The European Academy of Dermatology and Venereology (EADV) has collected recommendations from its Task Forces (TFs) related to COVID-19. The Journal of the EADV has established a COVID-19 Special Forum giving free access to related articles. The psychosocial effects of the pandemic, an increase in contact dermatitis and several other skin diseases because of stress, disinfectants and protective equipment use, especially in healthcare workers, the temporary limited access to dermatologic care, the dilemma whether or not to pause immunosuppressive therapy, and, finally, the occurrence of skin lesions in patients infected by COVID-19 all contribute to significant quality of life (QoL) impairment. Here, we present detailed recommendations of the EADV TF on QoL and patient-oriented outcomes on how to improve QoL in dermatologic patients during the COVID-19 pandemic for several different groups of patients and for the general population.


Assuntos
Infecções por Coronavirus/epidemiologia , Dermatologia/organização & administração , Pneumonia Viral/epidemiologia , Qualidade de Vida , Dermatopatias/etiologia , Dermatopatias/terapia , Venereologia/organização & administração , Comitês Consultivos , Betacoronavirus , Infecções por Coronavirus/psicologia , Europa (Continente)/epidemiologia , Humanos , Controle de Infecções/organização & administração , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias , Publicações Periódicas como Assunto , Pneumonia Viral/psicologia , Dermatopatias/psicologia , Sociedades Médicas
19.
Clin Dermatol ; 38(2): 251-253, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32513404

RESUMO

Platelet-rich plasma (PRP) has become a popular and trendy treatment in dermatology for various skin ailments, most notably for acne scars, traumatic scars, hair regrowth, and cutaneous rejuvenation. Although PRP has been utilized in the world of orthopedics for many years, its recent entry into dermatology has been wrought with controversy, especially as some have marketed it to consumers as a type of cure-all; however, the studies behind PRP treatment, especially for cutaneous rejuvenation, are currently limited, while we await additional larger studies. Clinicians should have an understanding of the evidence behind such new trends, especially in the fast-pace world of esthetics.


Assuntos
Plasma Rico em Plaquetas , Rejuvenescimento , Dermatopatias/terapia , Fenômenos Fisiológicos da Pele , Cosméticos , Face , Feminino , Humanos , Envelhecimento da Pele , Dermatopatias/fisiopatologia
20.
Clin Dermatol ; 38(2): 265-269, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32513408

RESUMO

Daniel Turner (1667-1740) is credited with having written the first book in English on the diagnosis and treatment of skin disease. In De Morbis Cutaneis, Turner distinguishes two types of skin conditions: those that affect the inside of the body but are symptomatic on the surface, and those that are of an outward origin. Turner also underlines the necessity for prophylaxis against venereal diseases. Turner's book Syphilis. A Practical Dissertation on the Venereal Disease contains the first description of the "condum," a word that derives from the Latin condio, condo and means "to preserve." Turner should be remembered as a champion of his era for advocating that each patient should be viewed as an individual and for heralding the importance of observing the skin as part of a routine physical examination. Turner may be considered to be the father of British dermatology.


Assuntos
Dermatologia/história , Dermatopatias/terapia , Inglaterra , História do Século XVII , História do Século XVIII , Humanos , Masculino , Doenças Sexualmente Transmissíveis/prevenção & controle
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