Long-term adherence to topical psoriasis treatment can be abysmal: a 1-year randomized intervention study using objective electronic adherence monitoring.

BACKGROUND: Most people with psoriasis have limited disease that could be treated with topicals, but topical efficacy is limited by low short-term adherence. Psoriasis is a chronic disease, and long-term adherence is an even bigger problem. OBJECTIVES: To determine how well medication is used in the long-term topical treatment of psoriasis and to assess the potential of an internet-based reporting intervention to improve treatment adherence and outcomes. METHODS: An investigator-blinded, prospective study evaluated topical fluocinonide adherence in 40 patients with mild-to-moderate psoriasis over 12 months. Subjects were randomized in a 1 : 1 ratio to standard-of-care or internet-based reporting group. Adherence was objectively monitored with Medication Event Monitoring System® caps. RESULTS: Fifty per cent of subjects discontinued the treatment. Greater adherence was seen in the intervention group compared with the standard-of-care group (50% vs. 35%, P = 0·08). Psoriasis Area and Severity Index improved more in the intervention group at month 1 (1·61 vs. -0·12, P = 0·003), month 3 (2·50 vs. 0·79, P = 0·025) and month 12 (3·32 vs. 0·34, P = 0·038) than in the standard-of-care group. CONCLUSIONS: This study likely underestimates the challenge of long-term adherence, as adherence tends to be better in research studies than in clinical practice. This study also did not fully account for primary nonadherence. Adherence to topical treatment is low in the short term and decreased further in the long term, a considerable challenge for dermatologists to address. A reporting intervention may be one of the ways we can improve our patients' treatment outcomes.

Recent trends in the award of postgraduate medical degrees by the University of Aberdeen.

Recent trends in the award of higher medical degrees by the University of Aberdeen are reported. The proportion of graduates proceeding to a higher degree has remained relatively stable over recent decades. The numbers taking the Ch.M. or Ph.D. has increased while the number taking the M.D. has declined. The proportion of M.D.'s awarded with 'Honours' has fallen progressively.

Consumer views on the medical curriculum: a retrospective study of Aberdeen graduates.

In a postal follow-up study of five annual cohorts of Aberdeen medical graduates, 371 respondents (out of 423 approached) gave their views on their undergraduate curriculum. Three out of four thought the curriculum had satisfactorily prepared them for their choice of career. But when asked about four areas of medical care these postgraduates thought that patient management outside hospital, social services relevant to medicine, and individual patient problems had been inadequately represented. Of the twenty-five curricular subjects on which respondents were asked to comment, anatomy and biochemistry were most often rated as excessively taught, while general practice was most often stated to be under-represented. This study raises the question of more active participation by experienced consumers of medical education in shaping the content of the undergraduate curriculum.

Trainee learning.

A study of the learning achieved by a small group of vocational trainees during the first six months of their year in general practice showed significant gains (p<0.001) in factual recall as measured by multiple choice questions.Changes were also observed in the answers to a repeated modified essay question test, suggesting that the same trainees were becoming more aware of emotional and social factors in their patients.

Examination performance and the future careers of Aberdeen medical graduates.

School certificate attainment, performance at medical school, and early postgraduate career, were linked in a study of five cohorts of Aberdeen medical graduates. The results show a measure of correlation but it is argued that the time has come for long-term prospective research into the validity of selection of entrants to medical schools.

Undergraduate learning in general practice: the views of 1,000 final-year students.

One thousand final-year medical students were asked to record what they had learned during a three-and-a-half week attachment to a general practice, under the headings of diagnosis, treatment, prevention, workload, use of medical care; they were also invited to criticize the teaching programme. It is suggested that this clinical education and vocational experience should now be made available earlier in the undergraduate course.

Job satisfaction in Aberdeen medical graduates of 1969--73.

In a postal follow-up study of five annual cohorts of Aberdeen medical graduates, respondents (88% of those approached) were asked how satisfied they were with their jobs 4--5 years after qualifying. Eight out of ten males and seven out of ten females appeared to be content with their jobs, the proportion being rather higher among those in or training for general practice. Reasons for good job satisfaction tended to be different among those in training for hospital medical careers compared to general practice.