Dermatoepidemiology

Analysis of patient demographics and attendance at a Far North Queensland public dermatology outpatient clinic

BACKGROUND/OBJECTIVES

There is limited literature focussing on the demographics of patients presenting to public dermatology outpatient clinics, with an even smaller amount focussing on clinics in regional Australia. This study presents the first patient demographic analysis for the Cairns Hospital's Dermatology Outpatient Department and analyses the cohort of patients who did not attend their appointments. In doing so, it recommends potential strategies that should be considered to address the issues of patient absenteeism and wait times in a regional setting, while also suggesting future data points that should be collected for analysis.

METHODS

A 4-year retrospective cohort study using demographic data from all referrals with medical officers (N = 10,333) from 1 January 2018 to 31 December 2021 at the Cairns Hospital Dermatology Outpatient Department. The hospital is the only facility with a dermatology service within the Cairns and Hinterland Hospital and Health Service. Data were extracted from the Cairns Hinterland Analytical Intelligence (CHAI) system.

RESULTS

Data pertaining to patient demographics, attendance of appointments, triage categories and wait times were collected and reviewed for patients referred during the study period.

CONCLUSION

The Dermatology Outpatient Department services an ever-growing and diverse patient cohort. Barriers to access and long wait times exist for patients referred to the Department. Strategies to combat these issues, such as an increase in funding and resourcing, should be considered to better optimise patient care and the utilisation of health resources.

The Cochrane Skin Group: a vanguard for developing and promoting evidence-based dermatology

AIM

The Cochrane Skin Group (CSG) is part of the international Cochrane Collaboration (http://www.cochrane.org/). The CSG prepares, maintains and disseminates high quality evidence-based summaries on the prevention, diagnosis and treatment of skin diseases. We present a synopsis of the history, scope and priorities of the CSG. In addition, we report outcomes of CSG reviews and critically assess clinical value.

METHODS

Descriptive analysis of systematic reviews published by the CSG since its inception including output, impact factor, associated methodological studies, and influence in clinical guidelines, promoting patient and public engagement and in triggering new primary research.

RESULTS

The CSG started in 1997, and has published 61 reviews, 34 protocols and 31 registered titles by August 2013. The CSG scope includes 1000 skin diseases; 80% of reviews cover the top ten diagnoses and 40% of reviews provide clear guidance for clinical practice. CSG reviews had an impact factor of 6.1 in 2011 which places it alongside top dermatology journals. CSG reviews are typically broad in focus and have been shown to be of better quality than non-Cochrane reviews. They are highly cited in clinical guidelines. Several reviews have identified evidence gaps that have led to better primary research.

CONCLUSIONS

The CSG has emerged as a vanguard of evidence-based dermatology by growing a community interested in applying best external evidence to the care of skin patients and by identifying topics for research. CSG reviews are high impact, clinically relevant and have tangibly influenced international dermatology clinical practice guidelines and new research.

[Dermato-epidemiology]

Dermato-epidemiology is an important scientific discipline which investigates skin diseases using epidemiological methods. Epidemiology is the science of the distribution and determinants of disease in specified populations. We describe fundamental terms of dermato-epidemiology (measures of disease occurrence, measures of risk), different study types (observational studies, interventional studies), the selection of statistical tests, bias and confounding as well as the principles of evidence-based dermatology, and give illustrative examples.

Cutaneous lesions of the nose

Skin diseases on the nose are seen in a variety of medical disciplines. Dermatologists, otorhinolaryngologists, general practitioners and general plastic and dermatologic surgeons are regularly consulted regarding cutaneous lesions on the nose. This article is the second part of a review series dealing with cutaneous lesions on the head and face, which are frequently seen in daily practice by a dermatologic surgeon. In this review, we focus on those skin diseases on the nose where surgery or laser therapy is considered a possible treatment option or that can be surgically evaluated.

CONSORT adoption and quality of reporting of randomized controlled trials: a systematic analysis in two dermatology journals

BACKGROUND

CONSORT (Consolidated Standards for Reporting Trials) guidelines were constructed to ensure optimal reporting quality of randomized controlled trials (RCTs).

OBJECTIVES

To determine the effect of the adoption of CONSORT on the reporting quality of RCTs, we performed a systematic evaluation of RCTs published in two dermatology journals pre- and post-CONSORT adoption.

METHODS

The journals selected for the study were the Journal of the American Academy of Dermatology and the British Journal of Dermatology. We selected RCTs published in 1997 and 2006 using both Medline and hand searching. The following critical CONSORT criteria were recorded: sample size, type of disease studied, type of control, single-centre or multicentre study, type of funding, blinding, methods and type of randomization, definition of a primary endpoint, justification for sample size selection and power calculation, population for analysis, and adequacy of group comparison. A multivariable analysis was conducted to determine factors associated with optimal reporting quality.

RESULTS

In total, 98 studies were included. Improvement in reporting quality was evident for the specification of the randomization method (20% in 1997 vs. 45% in 2006, P < 0.01) and for the justification of sample size (22% in 1997 vs. 43% in 2006, P = 0.027). The percentage of studies with optimal reporting quality increased from 11% in 1997 to 28% in 2006 (P = 0.03). Factors significantly associated with a good methodological quality were pharmaceutical industry funding and publication in 2006 vs. 1997.

CONCLUSIONS

There is a need to improve the reporting quality of RCTs published in dermatology journals.

Reporting of study design in titles and abstracts of articles published in clinically oriented dermatology journals

BACKGROUND

Dermatologists may have difficulty in identifying the types of study design used in published articles, hindering their ability to appraise the literature critically.

OBJECTIVES

To assess the frequency with which titles or abstracts of articles published in clinically oriented dermatology journals reported the type of study design using standard key words, including 'randomized control trial', 'nonrandomized control trial', 'double-blind', 'placebo control', 'crossover trial', 'before-after trial', 'gold standard', 'blinded or masked comparison', 'cohort', 'inception cohort', 'validation cohort', 'validation sample', 'survey', 'case series', 'cost-effectiveness analysis', 'cost-benefit analysis', 'cost-utility analysis', 'cross-sectional study' and 'case-control'.

METHODS

A cross-sectional study analysed articles published between December 2004 and November 2005 in the 'Epidemiology and Health Services Research' and 'Therapeutics' sections of the British Journal of Dermatology (BJD), in the 'Studies' section of the Archives of Dermatology (Arch Dermatol) and in the 'Reports' section of the Journal of the American Academy of Dermatology (JAAD).

RESULTS

In the BJD, 15 of 37 articles (40.5%, 95% confidence interval, CI 24.8-57.9%) included at least one standard key word in the title or abstract, compared with 43 of 87 articles (49.4%, 95% CI 38.5-60.4%) in the Arch Dermatol and 19 of 93 articles (20.4%, 95% CI 12.8-30.1%) in the JAAD (P < 0.001).

CONCLUSIONS

Most articles in the three journals did not report the study design used in the title or abstract. A consistent and clear indication of the design used in studies may better enable editors, reviewers and readers to assess critically articles published in clinically oriented dermatology journals.

Practicing evidence-based dermatology: a short guide

Evidence-based medicine (EBM) is a paradigm for systematically collecting, evaluating, and applying the best information currently available to improve patient outcomes. Effective evidence-based practice requires defining an answerable, well-built question, systematically searching for the best current evidence, and appraising that evidence for validity. Essential components of EBM also require using our clinical expertise to integrate these data with our patients' characteristics, values, and circumstances; archiving the results of our EBM search; and evaluating the efficiency and effectiveness of the EBM process. Incorporating EBM to bring the best current evidence into our field can be mastered with practice and a commitment to apply the process daily.

The relationship between family medical history and childhood vitiligo

BACKGROUND

The association between a family history of vitiligo and other autoimmune/endocrine diseases and increased incidence of childhood vitiligo has been described; however, the influence of family history on the clinical characteristics of childhood vitiligo has rarely been investigated.

OBJECTIVE

We sought to examine the relationship between family history and the incidence, extent, and course of childhood vitiligo.

METHODS

A retrospective chart review and telephone interviews were performed for 137 pediatric patients with vitiligo and 140 control patients (patients with acne, warts, or molluscum contagiosum matched in age, sex, and ethnicity to the study group). Information about the age, sex, ethnicity, age of onset and diagnosis, site of onset, distribution, treatment, course of disease, and family history was obtained.

RESULTS

Patients with vitiligo and an extended family history of vitiligo were more likely to have an earlier age of onset of disease than those with a negative family history (odds ratio = 3.70, P = .024). There was no association between family history and site of onset, distribution, or course of disease.

LIMITATIONS

A relatively small sample size, recall bias, disease misclassification, and confounding factors are potential limitations of this study.

CONCLUSION

Earlier onset of pediatric vitiligo is linked to a family history of vitiligo. Awareness of this association can allow for closer monitoring, earlier detection, and earlier initiation of treatment.