Age-Appropriate Cancer Screenings Through a Dermatology Len.

BACKGROUND: Primary care physicians are often the first to identify signs and symptoms concerning for cancer. An important aspect of cancer screening is thorough skin examinations and subsequent referral to a dermatologist for atypical cutaneous presentations, which may be associated with an underlying visceral malignancy. Diagnostic considerations for pruritus without dermatitis ("itch without rash") in adults include senile pruritus, medication reaction, and paraneoplastic syndrome. Recognition of cutaneous manifestations of cancer should prompt cancer screening by primary care providers. OBJECTIVE: To update practicing physicians on current cancer screening guidelines with a specific focus on cutaneous clues to prompt further workup. METHODS: American Cancer Society and United States Preventive Services Task Force guidelines were systematically reviewed using PubMed and organizational websites during August and September, 2021, with review of Task Force Guidelines during October, 2022. RESULTS: Colorectal, cervical, breast, lung, skin, prostate, ovarian, hematologic, pancreatic, thyroid, testicular, bladder, oral, and gastric cancer screening guidelines are summarized. CONCLUSIONS: Primary care physicians can recognize atypical cutaneous conditions and facilitate referral to a dermatologist for evaluation and/or directly order tests themselves to initiate appropriate cancer screening.

Immunizations at Wisconsin Pharmacies: Results of a statewide vaccine registry analysis and pharmacist survey.

BACKGROUND: There is currently limited data in the United States on the proportion of immunization doses given at pharmacies outside the influenza vaccine. This study aims to obtain baseline information on the percentage of vaccine doses administered at pharmacies in Wisconsin and to understand the immunization barriers for Wisconsin pharmacists, to inform interventions to increase immunization access at pharmacies. METHODS: Aggregated data from the Wisconsin Immunization Registry (WIR) was obtained for all vaccines administered at pharmacies to patients over the age of six from July 2017 through June 2018. In addition, a survey on attitudes towards and barriers to vaccination was sent to 2000 Wisconsin pharmacists with 236 respondents yielding a 12% response rate. RESULTS: WIR data demonstrates that zoster and influenza vaccines have the highest proportion of doses administered at pharmacies (39% and 20%, respectively). Human papillomavirus (HPV) vaccines have the lowest proportion of doses at 0.2%. Pharmacy survey shows that 86% provide immunizations. Most stock influenza vaccines (84%), whereas much fewer stock HPV vaccines (21%). The greatest immunization barriers for the pharmacy respondents include billing and reimbursement challenges and competing demands for staff. CONCLUSIONS: Despite the barriers, community pharmacies have significant potential to address vaccination gaps. Physicians, patients, and legislative bodies are generally well-accepting of pharmacists as immunizers. Pharmacists, in order to be fully utilized as immunizers, must engage in active communication with patients and be willing to collaborate with physicians. Legislative policy and health insurance reimbursement reforms are also necessary to facilitate further pharmacist participation in immunization.