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Ferreira IG, Almeida CS, Bulcão LA, Ferreira DG, Weber MB, Bonamigo RR. Hospital Dermatology: analysis of dermatological consultations in a tertiary teaching hospital. An Bras Dermatol 2023; 98:620-634. [PMID: 37164792 PMCID: PMC10404506 DOI: 10.1016/j.abd.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/06/2022] [Accepted: 08/11/2022] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND In hospital settings, dermatology can offer substantial clinical support for the diagnosis and management of skin conditions, reducing morbidity and mortality. Thus, the study aimed to analyze the profile of referrals and consultations performed by the Dermatology Service of the Santa Casa de Misericordia de Porto Alegre, from August 2018 to January 2020. METHODS This study is descriptive, quantitative, and retrospective, conducted through data collection and review of medical records and referrals. The variables included were clinical data of referrals, in-patients profiles, dermatological diagnoses, complementary exams, therapeutic conduct, and recommended follow-ups. RESULTS A total of 1020 referrals were analyzed, which resulted in 641 consultations (328 men, 313 women). The most prevalent skin disease groups were 'Dermatitis and Eczema' (33.1%) and 'Other infectious skin diseases (21.8%), while the most frequent ICD-10 were 'Drug eruptions - L27' (9.9%) and 'Other and unspecified dermatitis - L30' (6.6%). Corticoids were the most recommended treatments (27.7%), followed by antifungals (13.1%). 'Consultation Discharge' (44%) and 'Outpatient' Dermatology follow-up (27%) were the most frequent causes for ending consultation. STUDY LIMITATIONS Among the study limitations, the authors highlight its retrospective nature, with data analysis based on referrals and medical records, which may present inaccurate or incomplete information. In addition to this, the study may demonstrate a certain degree of subjectivity due to the review and interpretation process conducted by the researchers. However, the definition of objective criteria based on previous studies attenuates such possible bias. Furthermore, considering that the Dermatology teams are composed of a preceptor dermatologist and residents, the established diagnoses were not submitted to third-party verification, except in the cases of skin biopsies and cultures. Thus, the professional's experience and skills may have influenced the dermatological diagnoses. CONCLUSIONS These findings underlie the importance of Dermatology in hospital assistance, contributing to the management of a wide range of skin conditions.
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Affiliation(s)
- Iago Gonçalves Ferreira
- Dermatology Service, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, RS, Brazil; Department of Dermatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil.
| | | | - Lucas Abascal Bulcão
- Department of Dermatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Diego Gonçalves Ferreira
- Department of Dermatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Magda Blessmann Weber
- Dermatology Service, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, RS, Brazil; Department of Dermatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Renan Rangel Bonamigo
- Dermatology Service, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, RS, Brazil; Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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2
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Reimer C, Lee E, Wysong A, Georgesen C. Quantitative Benefit of Inpatient Dermatology Services on Hospital Length of Stay in an Academic Hospital. Cureus 2023; 15:e43519. [PMID: 37719626 PMCID: PMC10501321 DOI: 10.7759/cureus.43519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Dermatologic disease has been shown to have high rates of diagnostic and treatment discordance between dermatologists and non-specialists. Inpatient dermatology consultative services have the potential to improve patient care, but there is a paucity of data evaluating the quantitative effects of such services. This study aimed to evaluate the impact a newly established inpatient dermatology service had on quantitative patient care outcomes. METHODS This retrospective cohort study compared quantitative care measures of dermatologic inpatients during the years both pre- and post-implementation of an academic hospital's dermatology consultative service. The primary outcomes included hospitalization duration, readmission rates, and establishment of outpatient dermatologic care. RESULTS The study found a 1.04-day reduction in hospital length of stay (p-value = 0.046) after the consultation service establishment. Additionally, there was a significant increase in the rate by which patients sought outpatient dermatology follow-up (6.7% versus 24.4%, p-value <0.001). No significant change in the all-cause readmission rate was identified. CONCLUSION The reduction of hospitalization duration supports inpatient dermatology services as a viable means to provide improved patient care and reduce health systems costs. Hospitals that do not have a consulting service for cutaneous conditions provided by a dermatology specialist should strongly consider establishing such a department.
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Affiliation(s)
- Camilla Reimer
- Department of Dermatology, University of Nebraska Medical Center, Omaha, USA
| | - Erica Lee
- Department of Dermatology, University of Nebraska Medical Center, Omaha, USA
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, USA
| | - Corey Georgesen
- Department of Dermatology, University of Nebraska Medical Center, Omaha, USA
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3
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Romanelli M, Voegeli D, Colboc H, Bassetto F, Janowska A, Scarpa C, Meaume S. The diagnosis, management and prevention of intertrigo in adults: a review. J Wound Care 2023; 32:411-420. [PMID: 37405940 DOI: 10.12968/jowc.2023.32.7.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Intertrigo is a common inflammatory skin disorder caused by skin-on-skin friction in skin folds, due to moisture becoming trapped because of poor air circulation. This can occur in any area of the body where two skin surfaces are in close contact with each other. The aim of this scoping review was to systematically map, review and synthesise evidence on intertrigo in adults. We identified a wide range of evidence and performed a narrative integration of this related to the diagnosis, management and prevention of intertrigo. A literature search was conducted within the following databases: Cochrane Library, MEDLINE, CINAHL, PubMed and EMBASE. After reviewing articles for duplicates and relevance, 55 articles were included. The incorporation of intertrigo in the ICD-11 provides a clear definition and should improve the accuracy of estimates. With regards to the diagnosis, prevention and management of intertrigo, the literature demonstrates consensus among health professionals in approach and this forms the basis for the recommendations of this review: identify predisposing factors and educate patient in reducing these; educate patients in skin fold management and adopt structured skin care routine; treat secondary infection with appropriate topical agent; consider using moisture-wicking textiles within skin folds to reduce skin-on-skin friction, wick away moisture and reduce secondary infection. Overall, the quality of evidence on which to determine the strength of any recommendations for practice remains low. There remains the need for well-designed studies to test proposed interventions and build a robust evidence base.
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Affiliation(s)
| | - David Voegeli
- Faculty of Health & Wellbeing, University of Winchester, UK
| | - Hester Colboc
- Department of Geriatrics and Wound Healing, University of Sorbonne, Rothschild Hospital, Paris, France
| | | | | | | | - Sylvie Meaume
- Department of Geriatrics and Wound Healing, University of Sorbonne, Rothschild Hospital, Paris, France
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4
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Wells A, Harmel A, Smith KN, Beers P, Qiu Y, Datta S, Schoch JJ, De Benedetto A, Longo I, Motaparthi K. Impact of Skin Biopsy and Clinical-Pathologic Correlation in Dermatology Inpatient Consults. Cureus 2022; 14:e28534. [PMID: 36185900 PMCID: PMC9517953 DOI: 10.7759/cureus.28534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background While studies of hospital dermatology have demonstrated diagnostic discordance between primary teams and dermatology consultants, little is known about the impact of biopsy and clinical-pathologic correlation (CPC) in consultation. This study compares biopsy performance based on diagnostic discordance and evaluates the impact of CPC on the diagnosis. Methods This was a retrospective review of 376 dermatologic consultations at a single academic medical center between July 1, 2017, and June 27, 2018. Results Biopsy was significantly less likely to be performed when the diagnosis by the referring primary team was unspecified (p < 0.001). In 24 percent of cases, the diagnosis based on histopathology alone differed from the diagnosis reached by formal CPC consensus review with either potential or significant impact on management. Conclusion Dermatologists who perform inpatient consultations and rely on hospital-based pathology services may consider a consensus review for CPC. Requests to perform a biopsy may be interpreted as a request for diagnostic assistance rather than pressure to perform a procedure.
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Contact Dermatitis in the Inpatient Hospital Setting–an Updated Review of the Literature. CURRENT DERMATOLOGY REPORTS 2022. [DOI: 10.1007/s13671-022-00366-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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6
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Hines A, Hazim A, Wetter DA, Bridges AG, Camilleri MJ, McEvoy MT, El-Azhary RA, Davis MDP, Sartori-Valinotti JC. Retrospective analysis of 578 inpatient dermatology consultations in hematology and hematopoietic stem cell transplant patients. Int J Dermatol 2021; 60:1385-1391. [PMID: 33991106 DOI: 10.1111/ijd.15650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/17/2021] [Accepted: 04/15/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hospitalized patients with hematologic malignancies are medically complex and commonly affected by dermatologic conditions. METHODS Retrospective chart review from January 1, 2014, to December 31, 2018, at Rochester Methodist Hospital (Rochester, Minnesota, USA). Patients hospitalized on hematology and BMT services receiving dermatology consultation were included. RESULTS In all, 578 consultations (63% male, median age 61 years) were reviewed. Drug reactions (22%), infection (17%), and malignant neoplasm (10%) accounted for nearly half of diagnoses. Exanthematous drug reaction (10%), graft-versus-host disease (7%), and lymphoma or leukemia cutis (6%) were the commonest individual diagnoses. There were significantly more drug reactions in severe neutropenia (33.2% vs. 15.0%), neutrophilic dermatoses in myeloid neoplasm (5.2% vs. 0.3%), and viral infection in lymphoid neoplasm (8.3% vs. 1.2%). Consultation frequently altered treatment (68%), diagnostic workup (63%), and the primary service's initial diagnostic impression (53%). Biopsies were performed in 52% of consultations and helped secure a diagnosis 73% of the time. A total of 16.4% of consultations did not receive a definitive final diagnosis, and 18.5% were resolved in one visit. CONCLUSION This is the largest study to date of hospital dermatology consultation in hematology patients. Biopsies are utilized frequently and are diagnostically useful. The complexity of this patient population is evidenced by the fact that a final diagnosis remains elusive in a number of cases despite the multiple visits required for the vast majority of consultations. Nevertheless, dermatology consultation alters diagnosis and treatment in the majority of patients, highlighting the critical role dermatologists have in the care of these patients.
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Affiliation(s)
- Alexander Hines
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Antonious Hazim
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - David A Wetter
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
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7
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Supportive oncodermatology-a narrative review of its utility and the way forward. Support Care Cancer 2021; 29:4931-4937. [PMID: 33712911 DOI: 10.1007/s00520-021-06124-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/02/2021] [Indexed: 11/27/2022]
Abstract
Supportive oncodermatology is an interdisciplinary field, emerging due to increasing dermatological morbidity in patients with cancer and the recognition of the need for greater collaborative and integrated care to improve patient outcomes. These two unique fields (Oncology and Dermatology) may be integrated in various ways, such as through specialised combined clinics, protocols for expedited access, multidisciplinary groups and meetings, and the development of best practices guidelines. This narrative review consolidates the small but growing literature surrounding supportive oncodermatology; discusses the potential benefit and disadvantages, and areas for future research; and suggests a framework for implementation.
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8
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Prada-García C, Gonzalo-Orden J, Benítez-Andrades J, Carvajal-Urueña A. Inpatient dermatology consultations in a tertiary care hospital in Spain: A retrospective study of 750 patients. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Langley A, Kirchhof MG. The Impact of Suspension of Dermatology On-Call Services. J Cutan Med Surg 2020; 24:380-385. [PMID: 32401045 DOI: 10.1177/1203475420926987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dermatological conditions are commonly seen in the emergency department and inpatient wards. The ability to access dermatology on-call services improves the accuracy of diagnosis and management of common and sometimes life-threatening conditions. Limitations of dermatologist availability led to the suspension of the dermatology on-call service for 3 months in Ottawa, Canada. OBJECTIVES Our objective was to assess the impact of this call suspension on patient care and the need for a dermatology on-call service at our hospital, as perceived by nondermatologist physicians at our center. METHODS A survey was sent to all departments at The Ottawa Hospital, addressed to staff physicians and residents. Participation was entirely voluntary. Descriptive statistics were used to analyze survey responses. RESULTS A total of 105 physicians completed the survey including staff physicians (85%) and resident trainees (15%). The most represented specialties were emergency medicine (N = 21), general internal medicine (N = 19), nephrology (N = 17), neurology (N = 13), and plastic surgery (N = 13). Over half of the respondents felt that the lack of dermatology on-call service impacted the care of their patients by a moderate or great extent. Over half reported performing dermatology-related clinical work during the call suspension and two-thirds of these individuals reported feeling uncomfortable or very uncomfortable doing so. Most (94%) participants felt that an on-call dermatology service was useful and 57% deemed it essential. CONCLUSION Our survey results demonstrate a significant impact of the suspension of a dermatology on-call service, as perceived by nondermatologist physicians. Hospitals need to recognize the importance of on-call dermatology consultations and provide support for divisions to enable this service to continue.
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Affiliation(s)
- Annie Langley
- 12365 Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, ON, Canada
| | - Mark G Kirchhof
- 12365 Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, ON, Canada
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10
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Barrios DM, Phillips GS, Freites-Martinez A, Hsu M, Ciccolini K, Skripnik Lucas A, Marchetti MA, Rossi AM, Lee EH, Deng L, Markova A, Myskowski PL, Lacouture ME. Outpatient dermatology consultations for oncology patients with acute dermatologic adverse events impact anticancer therapy interruption: a retrospective study. J Eur Acad Dermatol Venereol 2020; 34:1340-1347. [PMID: 31856311 DOI: 10.1111/jdv.16159] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/13/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Dermatologic adverse events (dAEs) of anticancer therapies may negatively impact dosing and quality of life. While therapy interruption patterns due to dAEs have been studied in hospitalized cancer patients, similar outcomes in outpatient oncodermatology are lacking. OBJECTIVES To analyse the therapy interruption patterns, clinico-histopathologic characteristics and management outcomes of outpatient dermatology consultations for acute dAEs attributed to the most frequently interrupted class of oncologic agents. METHODS We performed a retrospective cohort study of all cancer patients who received a same-day outpatient dermatology consultation for acute dAEs at our institution from 1 January to 30 June 2015. Relevant data were abstracted from electronic medical records, including demographics, oncologic history and explicit recommendations by both the referring clinician and consulting dermatologist on anticancer therapy interruption. Consultations with the most frequently interrupted class of oncologic treatment were characterized according to clinico-histopathologic features, dermatologic management and clinical outcomes. RESULTS There were 426 same-day outpatient dermatology consultations (median age 59, 60% female, 30% breast cancer), of which 295 (69%) had systemic anticancer therapy administered within 30 days prior. There was weak inter-rater agreement between referring clinicians and consulting dermatologists on interruption of anticancer treatment (n = 150, κ = 0.096; 95% CI -0.02 to 0.21). Seventy-three (25%) consultations involved interruption by the referring clinician, most commonly targeted therapy (24, 33%). Maculopapular rash was commonly observed in 23 consultations with 25 dAEs attributed to targeted agents (48%), and topical corticosteroids were most frequently utilized for management (22, 38%). The majority (83%) of consultations with targeted therapy-induced dAEs responded to dermatologic treatment and 84% resumed oncologic therapy, although three (19%) at a reduced dose. Rash recurred only in two instances (13%). CONCLUSIONS A high frequency of positive outcomes in the management of targeted therapy-induced dAEs by outpatient consulting dermatologists and low recurrence of skin toxicity suggests impactful reductions in interruption of anticancer therapy.
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Affiliation(s)
- D M Barrios
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,SUNY Upstate Medical University, Syracuse, NY, USA
| | - G S Phillips
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - A Freites-Martinez
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K Ciccolini
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A Skripnik Lucas
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - E H Lee
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - L Deng
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - P L Myskowski
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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11
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Prada-García C, Gonzalo-Orden JM, Benítez-Andrades JA, Carvajal-Urueña A. Inpatient dermatology consultations in a tertiary care hospital in Spain: A retrospective study of 750 patients. Rev Clin Esp 2019; 220:426-431. [PMID: 31826807 DOI: 10.1016/j.rce.2019.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Medical consultations are a healthcare task that is generally undervalued and understudied. The main objective of this study was to describe and analyse the consultations requested of dermatology departments and the aspects that are involve in resolving the consultations. PATIENTS AND METHODS We conducted an observational retrospective study that collected the consultations for patients hospitalised over a period of 36 months. We analysed variables related to the management of patients and the quality of the care. RESULTS The study included 750 patients with a mean age of 64.85 (±20.23) years. The medical departments requested the most consultations, mainly internal medicine departments (37.9%). The most common topic for the consultations was inflammatory dermatoses (36.2%). The most common individual diagnosis was drug rash (8.1%). CONCLUSIONS Consultation activities have a significant impact on the management of hospitalised patients, resulting in improved quality of care and reduced healthcare costs. These activities are also of training value for resident physicians.
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Affiliation(s)
- C Prada-García
- Servicio de Dermatología, Complejo Asistencial Universitario de León, León, España.
| | - J M Gonzalo-Orden
- Departamento de Medicina, Anatomía y Cirugía Animal, Universidad de León, León, España
| | - J A Benítez-Andrades
- Grupo de Investigación Salud, Bienestar y Sostenibilidad Sociosanitaria (SALBIS), Departamento de Ingeniería Eléctrica y de Sistemas y Automática, Universidad de León, León, España
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12
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Georgesen C, Karim SA, Liu R, Moorhead A, Falo LD, English JC. Inpatient eDermatology (Teledermatology) Can Help Meet the Demand for Inpatient Skin Disease. Telemed J E Health 2019; 26:872-878. [PMID: 31663822 DOI: 10.1089/tmj.2019.0147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Currently, the number of inpatient dermatology providers cannot meet the overall burden of inpatient skin disease in the United States. Introduction: We seek to determine whether inpatient eDermatology can meet the need for inpatient skin disease in hospitals without access to a dermatology hospitalist. Methods: This retrospective cohort study reviewed inpatient eDermatology consults at the University of Pittsburgh eDermatology Consult Service between July 1, 2014 and June 30, 2018. This included a diverse group of 1,320 patients admitted to 10 different community hospitals. Study data were reviewed for demographics, diagnostic impressions, time to discharge, and diagnostic discordance between referring and consultant physicians. Results: Forty percent of inpatient eDermatology consults were admitted with a primary dermatologic diagnosis. Referring diagnosis most commonly was rash not otherwise specified. eDermatology consulting impressions, conversely, were specific and varied. Ninety-one percent of patients received a consultant impression by the end of day, or within 8 hours. Overall, 89.3% of patients with a referring diagnosis of "cellulitis" were given a different diagnosis by the consultant. Discussion: Although this study lacked concordance data to compare the Inpatient eDermatologist with a live Inpatient Dermatologist, overall, eDermatology consultants were able to provide rapid consult recommendations that aided patient management. Conclusions: Inpatient eDermatology appears to be an effective medium to provide dermatologic care to patients at hospitals without a dermatology presence. This delivery of health care can help prevent misdiagnosis, unnecessary costs, and inappropriate systemic therapies.
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Affiliation(s)
- Corey Georgesen
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sabrina A Karim
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rebecca Liu
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Autumn Moorhead
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Louis D Falo
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pennsylvania, USA.,Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Joseph C English
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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13
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Zhang M, Markova A, Harp J, Dusza S, Rosenbach M, Kaffenberger BH. Dermatology-specific and all-cause 30-day and calendar-year readmissions and costs for dermatologic diseases from 2010 to 2014. J Am Acad Dermatol 2019; 81:740-748. [PMID: 31102603 PMCID: PMC6698216 DOI: 10.1016/j.jaad.2019.05.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/14/2019] [Accepted: 05/10/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Readmissions for skin disease, particularly for the same diagnosis and over time, have not been well studied. OBJECTIVE To characterize hospital readmissions for skin disease. METHODS A cross-sectional observational study examined the Nationwide Readmissions Database from 2010 to 2014, a national sample of hospital discharges in the United States. RESULTS Of the patients in 3,602,599 dermatologic hospitalizations from 2010 to 2014, 9.8% were readmitted for any cause, 3.3% were admitted for the same diagnosis within 30 days, and 7.8% were readmitted for the same diagnosis within the calendar year (CY). The cost of all CY same-cause readmissions was $508 million per year. Mycosis fungoides had the highest 30-day all-cause readmission rate (32%), vascular hamartomas and dermatomyositis had the highest 30-day same-cause readmission rates (21% and 18%, respectively), and dermatomyositis and systemic lupus erythematosus had the highest CY same-cause readmission rates (31% and 24%, respectively). Readmission rates stayed stable from 2010 to 2014. Readmission for the same diagnosis was strongly associated with Medicaid and morbid obesity. LIMITATIONS This study is a broad description of hospitalizations for skin disease. Conclusions for individual diseases are not intended. CONCLUSION The rates and costs of readmissions for skin diseases remained high from 2010 to 2014. This study identifies diseases associated with high risk of hospital readmission, but disease-specific studies are needed. The diseases and risk factors presented should guide additional studies focused on strategies to reduce readmissions in specific skin diseases.
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Affiliation(s)
- Myron Zhang
- Department of Dermatology, Weill Cornell Medicine, New York, New York.
| | - Alina Markova
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joanna Harp
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Stephen Dusza
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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14
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Madigan LM, Fox LP. Where are we now with inpatient consultative dermatology?: Assessing the value and evolution of this subspecialty over the past decade. J Am Acad Dermatol 2019; 80:1804-1808. [DOI: 10.1016/j.jaad.2019.01.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 01/03/2019] [Accepted: 01/17/2019] [Indexed: 11/30/2022]
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Chavez-Alvarez S, Herz-Ruelas M, Ocampo-Candiani J, Ayala-Cortes AS, Gomez-Flores M. Dermatology inpatient consultations in Latin America: 3-year experience in our University Hospital setting. Int J Dermatol 2019; 58:1172-1174. [PMID: 30891738 DOI: 10.1111/ijd.14418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/26/2018] [Accepted: 02/06/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dermatology patients are mostly seen in outpatient clinics; however, there is a significant need for consultations within the hospital setting. METHODS Here we describe the hospital consultations received by the Dermatology Service during a 3-year period. RESULTS Most of the requested consultations came from the Internal Medicine Department and the surgical departments. The most common encountered dermatoses were drug eruptions and adnexal diseases, followed by viral dermatoses. CONCLUSIONS In hospital dermatology may pose a challenge for other clinicians; therefore, dermatologists should be adequately trained to confront a wide variety of clinical scenarios.
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Affiliation(s)
- Sonia Chavez-Alvarez
- Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Maira Herz-Ruelas
- Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Jorge Ocampo-Candiani
- Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Ana S Ayala-Cortes
- Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Minerva Gomez-Flores
- Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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16
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Iatrogenic Dermatoses in Hospitalized Patients. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0227-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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17
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Sobre la necesidad y el futuro de las Unidades de Eczema. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:465-467. [DOI: 10.1016/j.ad.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Indexed: 11/17/2022] Open
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18
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Phillips GS, Freites-Martinez A, Hsu M, Skripnik Lucas A, Barrios DM, Ciccolini K, Marchetti MA, Deng L, Myskowski PL, Lee EH, Markova A, Lacouture ME. Inflammatory dermatoses, infections, and drug eruptions are the most common skin conditions in hospitalized cancer patients. J Am Acad Dermatol 2018; 78:1102-1109. [PMID: 29273489 PMCID: PMC5951751 DOI: 10.1016/j.jaad.2017.12.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/16/2017] [Accepted: 12/11/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dermatologic conditions cause morbidity and mortality among hospitalized cancer patients. An improved understanding is critical for implementing clinical and research programs in inpatient oncodermatology. OBJECTIVE To characterize inpatient dermatology consultations at a large comprehensive cancer center. METHODS Retrospective database query of new admissions and medical record review of initial inpatient dermatology consultations comparing inpatients consulted and not consulted during January-December 2015. RESULTS In total, 412 of 11,533 inpatients received 471 dermatology consultations (54% male, median age 59.5 years). Patients with hematologic cancers were 6 times more likely to receive dermatologic consultations compared with nonhematologic cancers (odds ratio 6.56, 95% confidence interval 5.35-8.05, P < .0001). Patients consulted by a dermatologist had a significantly longer length of stay than inpatients not consulted by dermatology (median 11 vs 5 days, P < .0001). Among the 645 dermatologic conditions diagnosed, the most common categories were inflammatory diseases, infections, and drug reactions; the most frequent conditions were contact dermatitis, herpes zoster, and chemotherapy-induced drug eruptions. LIMITATIONS The study's retrospective nature and single-institution setting are potential limitations. CONCLUSION Hematologic malignancies are a significant risk factor for dermatology inpatient consultations. A significantly longer length of stay was associated with dermatology consultations, suggesting high comorbidities in these patients. Increased dermatologic care of these inpatients might improve quality of life, dermatologic health, and ability to receive anticancer agents.
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Affiliation(s)
- Gregory S Phillips
- SUNY Downstate Medical Center, Brooklyn, New York; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Azael Freites-Martinez
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meier Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anna Skripnik Lucas
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dulce M Barrios
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; SUNY Upstate Medical University, Syracuse, New York
| | - Kathryn Ciccolini
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Liang Deng
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Patricia L Myskowski
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Erica H Lee
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medical College, New York, New York.
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19
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Tsai S, Scott JF, Keller JJ, Gerstenblith MR. Cutaneous malignancies identified in an inpatient dermatology consultation service. Br J Dermatol 2017; 177:e116-e118. [PMID: 28231384 DOI: 10.1111/bjd.15401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Tsai
- Department of Dermatology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Lakeside 3500, 11100 Euclid Avenue, Cleveland, OH, 44106, U.S.A
| | - J F Scott
- Department of Dermatology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Lakeside 3500, 11100 Euclid Avenue, Cleveland, OH, 44106, U.S.A
| | - J J Keller
- Department of Dermatology, Oregon Health & Science University, Portland, OR, U.S.A
| | - M R Gerstenblith
- Department of Dermatology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Lakeside 3500, 11100 Euclid Avenue, Cleveland, OH, 44106, U.S.A
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20
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Balai M, Gupta LK, Khare AK, Mittal A, Mehta S, Bharti G. Pattern of inpatient referrals to dermatology at a tertiary care centre of South Rajasthan. Indian Dermatol Online J 2017; 8:25-28. [PMID: 28217467 PMCID: PMC5297265 DOI: 10.4103/2229-5178.198759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Dermatologists besides providing service to patients in the outdoors, also play a vital role in the care of inpatients admitted to dermatology unit and other departments. Aims: The aim of this study was to evaluate the pattern of referrals sent to the dermatology department by other departments. Materials and Methods: The study included all inpatients referred to dermatology department of a tertiary care centre of South Rajasthan during a 5-year period from October 2008 to September 2013. Results: A total of 1560 consultations with 1603 diagnoses were recorded. Most (770; 49.3%) consultations were received from internal medicine, followed by surgery (177; 11.3%), pediatrics (104; 6.7%), psychiatry (86; 5.5%) and gynecology (69; 4.4%) wards. Infectious skin diseases were most common (29.7%) followed by eczema (12.0%) and drug reactions (9.0%). Conclusion: Dermatology referrals can enhance the dermatological knowledge of non-dermatologists to diagnose and manage common dermatoses thus improving overall patient care.
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Affiliation(s)
- Manisha Balai
- Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Lalit K Gupta
- Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Ashok K Khare
- Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Asit Mittal
- Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Sharad Mehta
- Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Garima Bharti
- Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan, India
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21
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Galimberti F, Guren L, Fernandez AP, Sood A. Dermatology consultations significantly contribute quality to care of hospitalized patients: a prospective study of dermatology inpatient consults at a tertiary care center. Int J Dermatol 2016; 55:e547-51. [DOI: 10.1111/ijd.13327] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/16/2016] [Accepted: 02/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Fabrizio Galimberti
- Cleveland Clinic Lerner College of Medicine; Cleveland Clinic; Cleveland OH USA
| | - Lauren Guren
- Department of Dermatology; Cleveland Clinic; Cleveland OH USA
| | - Anthony P. Fernandez
- Department of Dermatology; Cleveland Clinic; Cleveland OH USA
- Department of Pathology; Cleveland Clinic; Cleveland OH USA
| | - Apra Sood
- Department of Dermatology; Cleveland Clinic; Cleveland OH USA
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