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Juay L, Bhupendrabhai MN, Ahmad SHB, Wong HC, Chong JWM, Tan WH, Chandran NS. Prevalence of dermatoses in geriatric singaporeans in the community - a cross-sectional study. BMC PRIMARY CARE 2024; 25:290. [PMID: 39123111 PMCID: PMC11312226 DOI: 10.1186/s12875-024-02525-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/15/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Little is known about the prevalence of dermatoses in "skin-well" geriatric Singaporeans. We aim to identify the prevalence of dermatoses and their associations within the geriatric population in Singapore, and to understand the distribution of dermatological encounters presenting to primary care physicians, and the resultant referral behaviour. METHODS A joint quantitative-qualitative study was performed across 8 months. Patients aged 65 years and above who visited a local polyclinic for management of non-dermatological chronic diseases were recruited. They were administered questionnaires, and underwent full skin examinations. Online surveys were disseminated to polyclinic physicians under the same healthcare cluster. RESULTS 201 patients and 53 physicians were recruited. The most common dermatoses identified in patients were benign tumours and cysts (97.5%), and asteatosis (81.6%). For every 1-year increase in age, the odds of having asteatosis increased by 13.5% (95% CI 3.4-24.7%, p = 0.008), and urticarial disorders by 14.6% (95% CI 0.3-30.9%, p = 0.045). Patients who used any form of topical preparations on a daily basis had higher odds of having eczema and inflammatory dermatoses (OR 2.51, 95% CI 1.38 to 4.56, p = 0.003). Physicians reported dermatological conditions involving 20% of all clinical encounters. Eczema represented the most commonly reported dermatosis within the first visit. 50% of dermatology referrals were done solely at the patient's own request. CONCLUSION The prevalence of dermatoses in the elderly in Singapore is high, especially asteatosis. Prompt recognition by the primary healthcare provider potentially prevents future morbidity. Outreach education for both primary care physicians and the general public will be key. ETHICS APPROVAL National Healthcare group (NHG) Domain Specific Review Board (DSRB), Singapore, under Trial Registration Number 2020/00239, dated 11 August 2020.
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Affiliation(s)
- Lester Juay
- Division of Dermatology, National University Hospital, 5 Lower Kent Ridge Road, Singapore city, 119074, Singapore.
| | - Monil Nagad Bhupendrabhai
- Division of Dermatology, National University Hospital, 5 Lower Kent Ridge Road, Singapore city, 119074, Singapore
| | | | - Hung Chew Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore city, Singapore
| | - Justin Wee-Min Chong
- National University Polyclinics, National University Health System, Singapore city, Singapore
| | - Wee Hian Tan
- National University Polyclinics, National University Health System, Singapore city, Singapore
| | - Nisha Suyien Chandran
- Division of Dermatology, National University Hospital, 5 Lower Kent Ridge Road, Singapore city, 119074, Singapore
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2
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Escalé-Besa A, Vidal-Alaball J, Miró Catalina Q, Gracia VHG, Marin-Gomez FX, Fuster-Casanovas A. The Use of Artificial Intelligence for Skin Disease Diagnosis in Primary Care Settings: A Systematic Review. Healthcare (Basel) 2024; 12:1192. [PMID: 38921305 PMCID: PMC11202856 DOI: 10.3390/healthcare12121192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 06/27/2024] Open
Abstract
The prevalence of dermatological conditions in primary care, coupled with challenges such as dermatologist shortages and rising consultation costs, highlights the need for innovative solutions. Artificial intelligence (AI) holds promise for improving the diagnostic analysis of skin lesion images, potentially enhancing patient care in primary settings. This systematic review following PRISMA guidelines examined primary studies (2012-2022) assessing AI algorithms' diagnostic accuracy for skin diseases in primary care. Studies were screened for eligibility based on their availability in the English language and exclusion criteria, with risk of bias evaluated using QUADAS-2. PubMed, Scopus, and Web of Science were searched. Fifteen studies (2019-2022), primarily from Europe and the USA, focusing on diagnostic accuracy were included. Sensitivity ranged from 58% to 96.1%, with accuracies varying from 0.41 to 0.93. AI applications encompassed triage and diagnostic support across diverse skin conditions in primary care settings, involving both patients and primary care professionals. While AI demonstrates potential for enhancing the accuracy of skin disease diagnostics in primary care, further research is imperative to address study heterogeneity and ensure algorithm reliability across diverse populations. Future investigations should prioritise robust dataset development and consider representative patient samples. Overall, AI may improve dermatological diagnosis in primary care, but careful consideration of algorithm limitations and implementation strategies is required.
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Affiliation(s)
- Anna Escalé-Besa
- Centre d’Atenció Primària Navàs-Balsareny, Institut Català de la Salut, 08670 Navàs, Spain;
- Health Promotion in Rural Areas Research Group, Gerència d’Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, 08242 Manresa, Spain; (Q.M.C.); (F.X.M.-G.)
- Faculty of Medicine, University of Vic-Central University of Catalonia, 08500 Vic, Spain
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència d’Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, 08242 Manresa, Spain; (Q.M.C.); (F.X.M.-G.)
- Faculty of Medicine, University of Vic-Central University of Catalonia, 08500 Vic, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 082424 Manresa, Spain;
| | - Queralt Miró Catalina
- Health Promotion in Rural Areas Research Group, Gerència d’Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, 08242 Manresa, Spain; (Q.M.C.); (F.X.M.-G.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 082424 Manresa, Spain;
| | | | - Francesc X. Marin-Gomez
- Health Promotion in Rural Areas Research Group, Gerència d’Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, 08242 Manresa, Spain; (Q.M.C.); (F.X.M.-G.)
- Servei d’Atenció Primària Osona, Gerència Territorial de la Catalunya Central, Institut Català de La Salut, 08500 Vic, Spain
| | - Aïna Fuster-Casanovas
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 082424 Manresa, Spain;
- eHealth Lab Research Group, School of Health Sciences and eHealth Centre, Universitat Oberta de Catalunya (UOC), 08018 Barcelona, Spain
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3
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Barlow R, Shah A, Mohandas P. Pigmented skin lesions. BMJ 2024; 385:e077845. [PMID: 38857912 DOI: 10.1136/bmj-2023-077845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Affiliation(s)
- Richard Barlow
- Birmingham Queen Elizabeth Hospital, Birmingham, UK
- Patient author
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4
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Kliesener T, Jandek M, Navarini A, Brandt O, Müller S. Dermatology teaching for undergraduate medical students in clinical routine - a structured four-week curriculum. BMC MEDICAL EDUCATION 2024; 24:116. [PMID: 38321407 PMCID: PMC10848555 DOI: 10.1186/s12909-023-04921-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/30/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Dermatology teaching is fundamental for the promotion of young colleagues in our specialty. However, traditional teaching methods are being scrutinized by students of the 'Generation Y and Z', which can pose new challenges for teaching institutions. We therefore aimed to assess the motivational impact and reception of a newly created four-week curriculum containing modernized teaching methods integrated into clinical routine. METHODS In this single-center study, 67 medical students completed this curriculum composed of weekly learning objectives including knowledge of morphological terms, 10 common dermatoses, communication and presentation skills. The participants provided information on their level of interest in dermatology each week as well as positive and negative aspects of the curriculum. RESULTS During the curriculum a significant median increase in interest in dermatology was reported with no differences between the genders. Low initial interest could be improved, high initial interest maintained. Participants with an interest in scientific work (20.9%) were more motivated during the curriculum. The variety, quality of teaching and structure were the main aspects rated positively. Suggestions for improvement included the need for more teaching by senior doctors, transfer of responsibility, and a working environment updated to the latest technology standards. CONCLUSION The presented curriculum was well received by the participants and allowed to better define learning preferences of new generations which can be helpful to modernize traditional teaching methods. Interest in scientific work could be a factor to identify students with a particularly strong interest in dermatology.
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Affiliation(s)
- Tobias Kliesener
- Dermatologische Klinik, Universitätsspital Basel, Basel, Switzerland.
| | - Madeleine Jandek
- Dermatologische Klinik, Universitätsspital Basel, Basel, Switzerland
| | | | - Oliver Brandt
- Dermatologische Klinik, Universitätsspital Basel, Basel, Switzerland
| | - Simon Müller
- Dermatologische Klinik, Universitätsspital Basel, Basel, Switzerland
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5
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Sugarman JL, Hebert A, Browning JC, Paller AS, Stripling S, Green LJ, Cartwright M, Enloe C, Wells N, Maeda-Chubachi T. Berdazimer gel for molluscum contagiosum: An integrated analysis of 3 randomized controlled trials. J Am Acad Dermatol 2024; 90:299-308. [PMID: 37804936 DOI: 10.1016/j.jaad.2023.09.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND An out-of-office therapeutic agent indicated for molluscum contagiosum is needed. OBJECTIVE To assess the efficacy and safety of berdazimer gel, 10.3% (a topical, antiviral, nitric oxide-releasing medication) versus vehicle. METHODS Berdazimer gel, 10.3% or vehicle was applied once daily to all molluscum contagiosum lesions for 12 weeks in patients ≥6 months with 3-70 mollusca. Efficacy assessment: complete lesion clearance and partial clearance at week 12. Safety and tolerability assessment: adverse events through week 24 and local skin reactions through week 12. RESULTS There were 1598 patients enrolled (n = 917 berdazimer, n = 681 vehicle). Berdazimer was superior to vehicle at week 12 in complete clearance rates, 30.0% versus 19.8% (odds ratio, 1.75; 95% CI, 1.38-2.23, P < .001). Subgroup analyses of primary efficacy showed consistent favorable efficacy for berdazimer across most subgroups, including age, sex, baseline lesion count, and disease duration. Berdazimer provided favorable outcome for partial clearance. Application-site pain (18.7% vs 4.8% in berdazimer vs vehicle) and erythema (11.7% vs 1.3%), mostly mild to moderate, were the most common local skin reactions. LIMITATIONS Berdazimer sodium in molluscum patients with lesions (B-SIMPLE) trials enrolled only US patients; no efficacy assessments beyond week 12. CONCLUSIONS Berdazimer gel, 10.3% showed favorable efficacy and safety across subgroups.
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Affiliation(s)
- Jeffrey L Sugarman
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Adelaide Hebert
- Department of Dermatology, UTHealth McGovern Medical School, Houston, Texas
| | | | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen Stripling
- Pediatric Department, Coastal Pediatric Research, Charleston, South Carolina
| | - Lawrence J Green
- Department of Dermatology, George Washington University School of Medicine, Washington, DC
| | | | | | - Nick Wells
- Syneos Health, Hampshire, United Kingdom
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Beeler N, Ziegler E, Navarini AA, Kapur M. Factors related to the performance of laypersons diagnosing pigmented skin cancer: an explorative study. Sci Rep 2023; 13:22790. [PMID: 38123698 PMCID: PMC10733329 DOI: 10.1038/s41598-023-50152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
It is important but challenging for prospective health professionals to learn the visual distinction between potentially harmful and harmless skin lesions, such as malignant melanomas and benign nevi. Knowledge about factors related to diagnostic performance is sparse but a prerequisite for designing and evaluating evidence-based educational interventions. Hence, this study explored how the characteristics of 240 skin lesions, the number of classified lesions and the response times of 137 laypeople were related to performance in diagnosing pigmented skin cancer. Our results showed large differences between the lesions, as some were classified correctly by more than 90% and others by less than 10% of the participants. A t-test showed that for melanomas, the correct diagnosis was provided significantly more often than for nevi. Furthermore, we found a significant Pearson correlation between the number of solved tasks and performance in the first 50 diagnostic tasks. Finally, t-tests for investigating the response times revealed that compared to true decisions, participants spent longer on false-negative but not on false-positive decisions. These results provide novel knowledge about performance-related factors that can be useful when designing diagnostic tests and learning interventions for melanoma detection.
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Affiliation(s)
- Nadja Beeler
- Professorship for Learning Sciences and Higher Education, ETH Zurich, Clausiusstrasse 59, 8092, Zurich, Switzerland.
| | - Esther Ziegler
- Professorship for Learning Sciences and Higher Education, ETH Zurich, Clausiusstrasse 59, 8092, Zurich, Switzerland
| | - Alexander A Navarini
- Department of Dermatology, University Hospital Basel, Burgfelderstrasse 101, 4055, Basel, Switzerland
| | - Manu Kapur
- Professorship for Learning Sciences and Higher Education, ETH Zurich, Clausiusstrasse 59, 8092, Zurich, Switzerland
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7
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Alfouzan YA, Alhumaidan LS, Alsaif M, Alsaif H, Alharbi L, Almuhaymidi R, Almohaimeed FY, AlGhofaili FA. Patterns of Skin Diseases in Qassim Province, Saudi Arabia. Cureus 2023; 15:e50125. [PMID: 38186479 PMCID: PMC10771262 DOI: 10.7759/cureus.50125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Objective Dermatological complaints are one of the most common reasons to see a physician. Identifying the incidence and prevalence of different skin conditions is essential to improve health outcomes. Only a few studies regarding the pattern of skin diseases have been conducted in Saudi Arabia, especially in the Qassim region. This study aims to identify, evaluate, and compare the pattern of skin conditions in the Qassim region regarding age and sex, and to compare the results with previous studies. Methods A retrospective record-based study included all Saudi patients who attended the dermatology clinics at Qassim University Medical City, for 12 months, from 2021/08/26 to 2022/07/1. Data were collected from the electronic medical records. Results The study included 2775 Saudi patients comprising 1654 (59.6%) females and 1121 (40.4%%) males, with a male-to-female ratio of 1: 1.475. Around 75% of patients were between 15 and 34 years of age. The top most common diagnoses were pilosebaceous disorders (49.2%), with acne vulgaris being the predominant condition, followed by hair disorders (15.6%), dermatitis (9.2%), pigmentary disorders (7.2%), infections (3.9%), and papulosquamous disorders (3%). The prevalence of dermatological conditions was significantly higher in females than males for pilosebaceous disorders (P=.01) and hair disorders (P=.02). Conclusion There is a changing trend in the prevalence of skin disorders in the Qassim province of Saudi Arabia. Pilosebaceous disorders are being diagnosed more frequently compared to previous years and females visit dermatology clinics more than males. Due to its hospital-based setting, this study only gives a rough estimate of the pattern of skin diseases, and extensive epidemiological studies are needed to estimate the prevalence accurately.
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Affiliation(s)
| | - Lulwah S Alhumaidan
- College of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Buraydah, SAU
| | - Maha Alsaif
- College of Medicine, Qassim University, Buraydah, SAU
| | - Haitham Alsaif
- College of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Buraydah, SAU
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Ward BM, Riccio DA, Cartwright M, Maeda-Chubachi T. The Antiviral Effect of Berdazimer Sodium on Molluscum Contagiosum Virus Using a Novel In Vitro Methodology. Viruses 2023; 15:2360. [PMID: 38140601 PMCID: PMC10747301 DOI: 10.3390/v15122360] [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: 10/04/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Molluscum contagiosum (MC) is characterized by skin lesions containing the highly contagious molluscum contagiosum poxvirus (MCV). MCV primarily infects children, with one US Food and Drug Administration (FDA)-approved drug-device treatment in use but no approved medications. Assessing antivirals is hindered by the inability of MCV to replicate in vitro. Here, we use vaccinia virus as a surrogate to provide evidence of the anti-poxvirus properties of berdazimer sodium, a new chemical entity, and the active substance in berdazimer gel, 10.3%, a nitric oxide-releasing topical in phase 3 development for the treatment of MC. We show that berdazimer sodium reduced poxvirus replication and, through a novel methodology, demonstrate that cells infected with drug-treated MCV virions have reduced early gene expression. Specifically, this is accomplished by studying the nuclear factor kappa-light-chain-enhancer of activated B cell (NF-kB)-blocking protein MC160 as an example of an early gene. The results provide a plausible unique antiviral mechanism of action supporting increased MCV resolution observed in patients treated with berdazimer gel, 10.3% and describe a novel methodology that overcomes limitations in investigating MCV response in vitro to a potential new MC topical medication.
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Affiliation(s)
- Brian M. Ward
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY 14642, USA;
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Richard MA, Paul C, Nijsten T, Gisondi P, Salavastru C, Taieb C, Trakatelli M, Puig L, Stratigos A. Public perception of dermatologists in Europe: Results from a population-based survey. J Eur Acad Dermatol Venereol 2023; 37 Suppl 7:27-37. [PMID: 37806001 DOI: 10.1111/jdv.18988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/15/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The public perception of dermatology has been poorly investigated in Europe. OBJECTIVE To determine the general public's perception of dermatologists in Europe. METHODS This multinational, cross-sectional study was conducted within the framework of the EADV population-based survey on the 'Burden of skin diseases in Europe'. Data were collected using a web-based online survey on a representative sample of the general populations aged 18 years or more of 27 European countries. Proportional quota sampling with replacement design was used for each country. RESULTS A total of 44,689 adult participants responded to the questionnaire, of whom 18,004 visited a dermatologist in the preceding 3 years. The dermatologist was the second most often visited specialist among all medical specialties, with 69.7%, 72.1%, 42.1% and 78.1% of participants in Western Europe (WE), Eastern Europe (EE), Northern Europe (NE) and Southern Europe (SE), respectively, having consulted a dermatologist over the past 24 months. Most participants across all regions agreed that the dermatologist was the first healthcare provider for chronic skin diseases (61.9% in WE, 69.8% in EE, 45.7% in NE and 60.4% in SE) and for skin cancers (65.5% in WE, 67.6% in EE, 42.4% in NE and 63.0% in SE). The five most common reasons for visiting a dermatologist among all participants were: naevi check-up or skin cancer screening (20.2%), chronic skin diseases (16.5%), acute skin diseases (12.4%), cosmetic advice or procedure (10.2%), hyperpigmentation or congenital lesions (9.1%) and hair or nail disorder (7.7%). Most participants (84.6% in WE, 82.5% in EE, 78.3% in NE and 82.8% in SE) were very swatisfied/somewhat satisfied with the service provided. CONCLUSION Our study findings underscore the central role of dermatologists in skin health and highlights them as valued and trusted care providers across Europe. Understanding the perceived position of the dermatologist is the first step in improving health policy development and implementation. Notably, access to a dermatologist was lowest in NE, probably reflecting differences in healthcare organizational structures or possibly cultural differences in healthcare seeking behaviour.
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Affiliation(s)
- Marie Aleth Richard
- CEReSS-EA 3279, Research Centre in Health Services and Quality of Life Aix Marseille University, Dermatology Department, Assistance Publique Hôpitaux de Marseille, APHM, University Hospital Timone, Marseille, France
| | - Carle Paul
- Service de Dermatologie, Université de Toulouse et CHU, Toulouse, France
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Carol Davila University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
| | | | - Myrto Trakatelli
- Second Department of Dermatology and Venerology of Aristotle School of Medicine Papageorgiou Hospital, Thessaloniki, Greece
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Stratigos
- Department of Dermatology, Andreas Syggros Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Richard MA, Paul C, Nijsten T, Gisondi P, Salavastru C, Taieb C, Stratigos A, Trakatelli M, Puig L. The journey of patients with skin diseases from the first consultation to the diagnosis in a representative sample of the European general population from the EADV burden of skin diseases study. J Eur Acad Dermatol Venereol 2023; 37 Suppl 7:17-24. [PMID: 37806003 DOI: 10.1111/jdv.18916] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/09/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The journey of patients with skin diseases through healthcare has been scarcely investigated. OBJECTIVE To analyse the journey of people with skin diseases in the different healthcare environment in Europe. METHODS This multinational, cross-sectional, European study was conducted on a representative sample of the adult general population of 27 European countries. The prevalence of the most frequent skin diseases was determined. Information was collected on the patient journey from the first medical consultation to the diagnosis, and the reasons for not consulting a healthcare professional. RESULTS On a total of 44,689 individuals, 30.3% reported to have consulted a dermatologist during the previous 2 years. Participants consulted mainly for mole control or skin cancer screening (22.3%), followed by chronic skin diseases (16.2%). The diagnoses of acne, atopic dermatitis, psoriasis and rosacea were made most frequently by a dermatologist, while fungal skin infections were diagnosed more often by a general practitioner (GP), and sexually transmitted diseases (STD) by other specialists. The diagnosis was not always definitive at the first consultation, in particular for STD. The percentage of people who did not consult a healthcare professional for their skin disease was particularly high for acne (36.4%), alopecia (44.7%) and fungal infection (30.0%). Moreover, 17.7% of respondents with psoriasis did not consult. A high percentage of participants with alopecia thought that the disease was not worrying, while patients with psoriasis often answered that they were able to manage the disease since they had already consulted a doctor. Many patients with acne (41.1%) and fungal infection (48.2%) thought that they were able to handle the disease by themselves. CONCLUSION The analysis of the self-reported medical journey of patients with common skin diseases may allow to understand the unmet needs of patients, thus improving outcomes and reducing expenses.
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Affiliation(s)
- Marie Aleth Richard
- CEReSS-EA 3279, Research Center in Health Services and Quality of Life Aix Marseille University, Dermatology Department, University Hospital Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Carle Paul
- INSERM Infinity U1291, Université de Toulouse et CHU, Toulouse, France
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Carol Davila University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
| | | | - Alex Stratigos
- Department of Dermatology, Andreas Syggros Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Myrto Trakatelli
- Second Dermatology Department, Faculty of Medicine, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Henderson AD, Adesanya E, Mulick A, Matthewman J, Vu N, Davies F, Smith CH, Hayes J, Mansfield KE, Langan SM. Common mental health disorders in adults with inflammatory skin conditions: nationwide population-based matched cohort studies in the UK. BMC Med 2023; 21:285. [PMID: 37542272 PMCID: PMC10403838 DOI: 10.1186/s12916-023-02948-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 06/19/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Psoriasis and atopic eczema are common inflammatory skin diseases. Existing research has identified increased risks of common mental disorders (anxiety, depression) in people with eczema and psoriasis; however, explanations for the associations remain unclear. We aimed to establish the risk factors for mental illness in those with eczema or psoriasis and identify the population groups most at risk. METHODS We used routinely collected data from the UK Clinical Practice Research Datalink (CPRD) GOLD. Adults registered with a general practice in CPRD (1997-2019) were eligible for inclusion. Individuals with eczema/psoriasis were matched (age, sex, practice) to up to five adults without eczema/psoriasis. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for hazards of anxiety or depression in people with eczema/psoriasis compared to people without. We adjusted for known confounders (deprivation, asthma [eczema], psoriatic arthritis [psoriasis], Charlson comorbidity index, calendar period) and potential mediators (harmful alcohol use, body mass index [BMI], smoking status, and, in eczema only, sleep quality [insomnia diagnoses, specific sleep problem medications] and high-dose oral glucocorticoids). RESULTS We identified two cohorts with and without eczema (1,032,782, matched to 4,990,125 without), and with and without psoriasis (366,884, matched to 1,834,330 without). Sleep quality was imbalanced in the eczema cohorts, twice as many people with eczema had evidence of poor sleep at baseline than those without eczema, including over 20% of those with severe eczema. After adjusting for potential confounders and mediators, eczema and psoriasis were associated with anxiety (adjusted HR [95% CI]: eczema 1.14 [1.13-1.16], psoriasis 1.17 [1.15-1.19]) and depression (adjusted HR [95% CI]: eczema 1.11 [1.1-1.12], psoriasis 1.21 [1.19-1.22]). However, we found evidence that these increased hazards are unlikely to be constant over time and were especially high 1-year after study entry. CONCLUSIONS Atopic eczema and psoriasis are associated with increased incidence of anxiety and depression in adults. These associations may be mediated through known modifiable risk factors, especially sleep quality in people with eczema. Our findings highlight potential opportunities for the prevention of anxiety and depression in people with eczema/psoriasis through treatment of modifiable risk factors and enhanced eczema/psoriasis management.
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Affiliation(s)
- Alasdair D Henderson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Elizabeth Adesanya
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Amy Mulick
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Julian Matthewman
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Nhung Vu
- Patient and Public Advisory Panel, Skin Disease Epidemiology Research Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Firoza Davies
- Patient and Public Advisory Panel, Skin Disease Epidemiology Research Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine H Smith
- King's College London, St John's Institute of Dermatology, London, UK
| | - Joseph Hayes
- Division of Psychiatry, University College London, London, UK
- Camden & Islington NHS Foundation Trust, London, UK
| | - Kathryn E Mansfield
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Sinéad M Langan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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12
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Alotaibi HM, Alruwaili ZM, Dilli AA, Altaleb AA, Asiri MM, Alwadani OJ, Alshaalan ZM, Dar UF. Assessment of Primary Care Physicians' Expertise of Common Dermatological Conditions in the Jouf Region, Saudi Arabia: A Mixed Methods Study. Healthcare (Basel) 2023; 11:1705. [PMID: 37372823 DOI: 10.3390/healthcare11121705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Primary care physicians (PCPs) are the first line of defense for the management of common dermatological conditions (DCs). This study aimed to assess how dermatological diseases are identified, managed, and referred to in primary healthcare centers (PHCs). This was a mixed methods study comprising a cross-sectional survey and semi-structured interviews recruited through PHCs across the Jouf region of Saudi Arabia. Sixty-one PCPs completed the data, and eight participants were interviewed. A survey based on a sample of 22 photographs of common DCs in the Kingdom was administered to the participants to answer questions about the correct diagnosis, appropriate management, referral strategy, and encounter rate. In our sampled population, the mean overall knowledge level on a scale of 10 was 7.08 (±1.3). Among participants that had good to acceptable scores, 51 (83.6%) were in the overall knowledge parameter, 46 (75.4%) in the diagnosis parameter, and 49 (80.3%) in the management parameter. PCPs with five years or more of experience were found to have significantly higher overall knowledge and management scores. Most of our PCPs demonstrated sufficient knowledge of common DCs and had good to acceptable scores in all parameters. However, educational and regulatory aspects of PCPs' clinical management were identified. Focused training, provision of workshops, and improving medical school curricula regarding common DCs are recommended.
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Affiliation(s)
- Hatem M Alotaibi
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | | | - Ahmed A Dilli
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | | | - Mohanad M Asiri
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Osama J Alwadani
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Ziad M Alshaalan
- Division of Dermatology, Department of Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Umar-Farooq Dar
- Department of Family & Community Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
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13
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Samannodi M. Hospital Admissions Related to Infections and Disorders of the Skin and Subcutaneous Tissue in England and Wales. Healthcare (Basel) 2022; 10:healthcare10102028. [PMID: 36292475 PMCID: PMC9601618 DOI: 10.3390/healthcare10102028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate hospital admissions in England and Wales due to infections and diseases of the skin and subcutaneous tissue. METHODS Data from the Patient Episode Database for Wales (PEDW) and the Hospital Episode Statistics (HES) database in England for the years between April 1999 and April 2020 were used in this study. Using all the relevant diagnosis codes (L00-L99), hospital admissions related to various skin infections and diseases of the subcutaneous tissue were identified. RESULTS Hospital admissions for all causes increased overall by 78.8%, from 276,464 in 1999 to 494,433 in 2020, representing an increase in hospital admission rate of 56.1% (from 530.23 (95% CI 528.26-532.20) in 1999 to 827.92 (95% CI 825.62-830.22) per 100,000 people in 2020, p ≤ 0.05). The most prevalent diagnoses were disorders of the skin's appendages, infections of the skin and subcutaneous tissue, and other disorders of the skin and subcutaneous tissue. Nearly half of all hospital admissions were for males and for patients between the ages of 15 and 59. In 2020, the hospital admission rate for males increased by 60.2%, from 540.16 (95% CI 537.32-543.01) per 100,000 people in 1999 to 865.10 (95% CI 861.76-868.44) in 2020. From 520.75 (95% CI 518.02-523.48) in 1999 to 791.03 (95% CI 787.86-794.19) in 2020, the hospital admission rate for females grew by 51.9%. CONCLUSION Hospital admission due to infections and disorders of the skin and subcutaneous tissue increased during the past two decades in England and Wales. Further studies are needed to explore the risk factors associated with infections and disorders of the skin and subcutaneous tissue complications, and its associated admissions.
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Affiliation(s)
- Mohammed Samannodi
- Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
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14
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McNiven A, Ryan S. Unsettling experiences: A qualitative inquiry into young peoples’ narratives of diagnosis for common skin conditions in the United Kingdom. Front Psychol 2022; 13:968012. [PMID: 36186350 PMCID: PMC9521611 DOI: 10.3389/fpsyg.2022.968012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/09/2022] [Indexed: 12/02/2022] Open
Abstract
Skin conditions such as eczema and psoriasis are relatively prevalent health concerns in children, adolescents and young adults. Experiences of these dermatology diagnoses in adolescence have hitherto not been the focus of research, perhaps owing to assumptions that these diagnoses are not particularly impactful or intricate processes, events or labels. We draw on a thematic secondary analysis of in-depth interviews with 42 adolescents and young people living in the United Kingdom and, influenced by the sociologies of diagnosis and time, highlight the psychological, emotional, social and temporal complexities involved in their diagnosis experiences. Firstly, we describe how participants remembered, re- and co-constructed their diagnosis experiences during the interview. Secondly, we explore the pace and rhythm of diagnosis, including mis-diagnoses, highlighting the jarring potential for adolescents on being diagnosed, even for conditions typically deemed minor. Thirdly, we consider the ways in which these diagnoses have the capacity to reformulate notions of past, present and future, including projecting into imagined futures and reinterpreting past bodily sensations. Finally, we examine how memories about and the meaning of diagnosis are revisited, revised and potentially replaced as a child or adolescent grows older, and increases their management of their condition and encounters with healthcare professionals. In unsettling an assumption that diagnosis experiences for adolescents of common skin conditions is unproblematic or straightforward, our qualitative analysis critically engages with and contribute to tenets of health research that are of interest to quantitative and qualitative researchers, clinicians and patients.
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Affiliation(s)
- Abigail McNiven
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- *Correspondence: Abigail McNiven,
| | - Sara Ryan
- Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, North West England, United Kingdom
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15
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Enhanced deep bottleneck transformer model for skin lesion classification. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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16
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Escalé-Besa A, Fuster-Casanovas A, Börve A, Yélamos O, Fustà-Novell X, Esquius Rafat M, Marin-Gomez FX, Vidal-Alaball J. Using Artificial Intelligence as a Diagnostic Decision Support Tool in Skin Disease: Protocol for an Observational Prospective Cohort Study. JMIR Res Protoc 2022. [PMID: 36044249 PMCID: PMC9475422 DOI: 10.2196/37531 ] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Dermatological conditions are a relevant health problem. Each person has an average of 1.6 skin diseases per year, and consultations for skin pathology represent 20% of the total annual visits to primary care and around 35% are referred to a dermatology specialist. Machine learning (ML) models can be a good tool to help primary care professionals, as it can analyze and optimize complex sets of data. In addition, ML models are increasingly being applied to dermatology as a diagnostic decision support tool using image analysis, especially for skin cancer detection and classification. OBJECTIVE This study aims to perform a prospective validation of an image analysis ML model as a diagnostic decision support tool for the diagnosis of dermatological conditions. METHODS In this prospective study, 100 consecutive patients who visit a participant general practitioner (GP) with a skin problem in central Catalonia were recruited. Data collection was planned to last 7 months. Anonymized pictures of skin diseases were taken and introduced to the ML model interface (capable of screening for 44 different skin diseases), which returned the top 5 diagnoses by probability. The same image was also sent as a teledermatology consultation following the current stablished workflow. The GP, ML model, and dermatologist's assessments will be compared to calculate the precision, sensitivity, specificity, and accuracy of the ML model. The results will be represented globally and individually for each skin disease class using a confusion matrix and one-versus-all methodology. The time taken to make the diagnosis will also be taken into consideration. RESULTS Patient recruitment began in June 2021 and lasted for 5 months. Currently, all patients have been recruited and the images have been shown to the GPs and dermatologists. The analysis of the results has already started. CONCLUSIONS This study will provide information about ML models' effectiveness and limitations. External testing is essential for regulating these diagnostic systems to deploy ML models in a primary care practice setting.
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Affiliation(s)
- Anna Escalé-Besa
- Centre d'Atenció Primària Navàs-Balsareny, Institut Català de la Salut, Navàs, Spain
| | - Aïna Fuster-Casanovas
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Alexander Börve
- iDoc24 Inc, San Francisco, CA, United States
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Oriol Yélamos
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Francesc X Marin-Gomez
- Servei d'Atenció Primària Osona, Gerència Territorial de Barcelona, Institut Català de la Salut, Vic, Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
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17
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Escalé-Besa A, Fuster-Casanovas A, Börve A, Yélamos O, Fustà-Novell X, Esquius Rafat M, Marin-Gomez FX, Vidal-Alaball J. Using Artificial Intelligence as a Diagnostic Decision Support Tool in Skin Disease: Protocol for an Observational Prospective Cohort Study. JMIR Res Protoc 2022; 11:e37531. [PMID: 36044249 PMCID: PMC9475422 DOI: 10.2196/37531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Dermatological conditions are a relevant health problem. Each person has an average of 1.6 skin diseases per year, and consultations for skin pathology represent 20% of the total annual visits to primary care and around 35% are referred to a dermatology specialist. Machine learning (ML) models can be a good tool to help primary care professionals, as it can analyze and optimize complex sets of data. In addition, ML models are increasingly being applied to dermatology as a diagnostic decision support tool using image analysis, especially for skin cancer detection and classification. OBJECTIVE This study aims to perform a prospective validation of an image analysis ML model as a diagnostic decision support tool for the diagnosis of dermatological conditions. METHODS In this prospective study, 100 consecutive patients who visit a participant general practitioner (GP) with a skin problem in central Catalonia were recruited. Data collection was planned to last 7 months. Anonymized pictures of skin diseases were taken and introduced to the ML model interface (capable of screening for 44 different skin diseases), which returned the top 5 diagnoses by probability. The same image was also sent as a teledermatology consultation following the current stablished workflow. The GP, ML model, and dermatologist's assessments will be compared to calculate the precision, sensitivity, specificity, and accuracy of the ML model. The results will be represented globally and individually for each skin disease class using a confusion matrix and one-versus-all methodology. The time taken to make the diagnosis will also be taken into consideration. RESULTS Patient recruitment began in June 2021 and lasted for 5 months. Currently, all patients have been recruited and the images have been shown to the GPs and dermatologists. The analysis of the results has already started. CONCLUSIONS This study will provide information about ML models' effectiveness and limitations. External testing is essential for regulating these diagnostic systems to deploy ML models in a primary care practice setting.
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Affiliation(s)
- Anna Escalé-Besa
- Centre d'Atenció Primària Navàs-Balsareny, Institut Català de la Salut, Navàs, Spain
| | - Aïna Fuster-Casanovas
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Alexander Börve
- iDoc24 Inc, San Francisco, CA, United States
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Oriol Yélamos
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Francesc X Marin-Gomez
- Servei d'Atenció Primària Osona, Gerència Territorial de Barcelona, Institut Català de la Salut, Vic, Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
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19
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Salava A, Rieppo R, Lauerma A, Salo V. Age-dependent Distribution of Atopic Dermatitis in Primary Care: A Nationwide Population-based Study from Finland. Acta Derm Venereol 2022; 102:adv00738. [PMID: 35670326 PMCID: PMC9593474 DOI: 10.2340/actadv.v102.2287] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The burden of atopic dermatitis (AD) appears to be increasing in adult and elderly patients. The aim of this study was to analyse the nationwide database of the Finnish Institute for Health and Welfare regarding the number of patients with AD and of general practitioner consultations in Finland during 2018. The database comprised the main diagnoses of all visits to public primary healthcare. There were 2,094,673 primary care patients (males/females 43.19/56.81%) and 20,905 patients with AD (1.00%) and 24,180 consultations due to AD (0.45%). The highest numbers of patients with AD were in the age groups 0–14 years (9,922 patients, 47.46%) and 15–65 years (9,144 patients, 43.74%). A substantial proportion of patients with AD were aged > 50 years (3,515 patients, 16.81%) or >65 years (1,947 patients, 9.31%). Regression analysis indicated a statistically significant association of age group with patient numbers (p = 0.032) and number of consultations (p = 0.030). There were no differences between direct age group comparisons (p = 0.303), sex (p = 0.389), or number of consultations/patient (p = 0.235). Patients with AD are prevalent in all age groups in Finnish primary care. Patient numbers were also relatively high in groups other than childhood, indicating that age-related distribution in primary care may be shifting to older ages.
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Affiliation(s)
- Alexander Salava
- Department of Dermatology and Allergology, Helsinki University Hospital, Meilahdentie 2, FIN-00250 Helsinki, Finland.
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20
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Mandeng Ma Linwa E, Sigha OB, Djeumen Touka AJ, Eposse Ekoube C, Ngo Linwa EE, Budzi MN, Meh MG, Nzozone HF, Kouotou EA, Zoung Kanyi Bissek A. Trends in dermatology consultations in the COVID‐19 era in Cameroon. SKIN HEALTH AND DISEASE 2022; 2:e113. [PMID: 35600146 PMCID: PMC9111051 DOI: 10.1002/ski2.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/13/2022] [Accepted: 03/19/2022] [Indexed: 11/23/2022]
Abstract
Introduction With the advent of COVID‐19, a highly infectious viral pandemic, first declared in Cameroon in March 2020, access to expert dermatology care was postulated to decrease. We carried out a descriptive study to understand the epidemiology of skin diseases amongst patients consulting at an outpatient dermatology clinic and its variations with the onset of COVID‐19. Methods We conducted a retrospective database study over a period of 2 years at Laquintinie hospital, Cameroon. Two periods were distinguished: 1 March 2019 to 29 February 2020 (pre‐COVID‐19 era) and 1 March 2020 to 28 February 2021 (COVID‐19 era). Results Overall, 5946 patients with one or more clinical conditions were analysed. The most common age group described was young adults (18–40 years). Females consulted twice as much as males (M/F ratio; 1:1.7). The mean age was 28.9 (±18.0) years with an age range of 1 month to 89 years. Infectious dermatoses predominated. However, the single most prevalent dermatologic condition was acne. There was a 35.6% drop in consultation frequency in the COVID‐19 era. Conclusion Three in four patients consulting at dermatology clinic are below 40 years, with a female predominance. Epidemiological profile of dermatoses in Cameroon is similar to that in the rest of Africa. Consultation frequency decreased in the COVID‐19 era but trends in consultations were rather unaltered except for patients above 50 years where eczema and scabies increased. More studies should be conducted to understand these trends better at a national level and envisage training of health personnel on prevalent dermatoses.
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Affiliation(s)
- Edgar Mandeng Ma Linwa
- Faculty of Health Sciences University of Buea Buea Cameroon
- Hopital Laquintinie de Douala Douala Cameroon
| | - Odette Berline Sigha
- Hopital Laquintinie de Douala Douala Cameroon
- Faculty of Health Sciences University of Bamenda Bamenda Cameroon
| | | | - Charlotte Eposse Ekoube
- Hopital Laquintinie de Douala Douala Cameroon
- Faculté de Médecine et des Sciences Pharmaceutiques Université de Douala Douala Cameroun
| | | | - Michael Ngenge Budzi
- Faculty of Health Sciences University of Buea Buea Cameroon
- Non‐Communicable Disease Prevention and Control Programme Cameroon Baptist Convention, Health Services Yaounde Cameroon
| | - Martin Geh Meh
- Faculty of Health Sciences University of Buea Buea Cameroon
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Richard MA, Paul C, Nijsten T, Gisondi P, Salvalastru C, Taieb C, Trakatelli M, Puig L, Stratigos A. Prevalence of most common skin diseases in Europe: a population-based study. J Eur Acad Dermatol Venereol 2022; 36:1088-1096. [PMID: 35274366 PMCID: PMC9415115 DOI: 10.1111/jdv.18050] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The assessment of the prevalence of diseases is of primary importance in planning health policies. No complete data on the prevalence of skin diseases across European countries are available. OBJECTIVE To estimate the prevalence of the most frequent skin conditions or diseases in 27 European countries (24 EU countries, plus Norway, Switzerland, and UK). METHODS We conducted a population-based study on representative and extrapolable samples of the general population aged 18 years or more in each of the 27 countries surveyed. Participants were selected using a stratified, proportional sampling with replacement design. Data were collected using a web-based online survey. All participants were asked to fill in a questionnaire with sociodemographic data and to declare if they have had one or more skin conditions or diseases during the previous 12 months. RESULTS A total of 44,689 participants from 27 countries responded to the questionnaire, 21,887 (48.98%) men and 22,802 (51.02%) women. The proportion of participants who reported having suffered from at least one dermatological condition or disease during the previous 12 months was 43.35% [95% CI 42.89%, 43.81%)]. The projection in the total population of the 27 countries included in the study resulted in 185,103,774 individuals affected by at least one dermatological condition or disease. Accordingly, we can estimate that more 94 million Europeans complain of uncomfortable skin sensations like itch, burning, or dryness. The most frequent conditions were fungal skin infections (8.9%), acne (5.4%), and atopic dermatitis or eczema (5.5%). Alopecia, acne, eczema and rosacea were more common in women, whereas men were more likely to suffer from psoriasis and sexually transmitted infections. CONCLUSION Skin diseases are an important public health concern. Their high prevalence has to be taken into account in planning access to dermatological care to address patient needs.
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Affiliation(s)
- Marie Aleth Richard
- CEReSS-EA 3279, Research Centre in Health Services and Quality of Life Aix Marseille University , Dermatology Department, University Hospital Timone, Assistance Publique Hôpitaux de Marseille, APHM, 13385, Marseille, France
| | - Carle Paul
- Service de dermatologie, Université de Toulouse et CHU, Toulouse
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Carmen Salvalastru
- Department of Pediatric Dermatology, Colentina Clinical Hospital, Bucharest, Romania
| | | | - Myrto Trakatelli
- Second department of Dermatology and Venerology of Aristotle School of Medicine Papageorgiou Hospital, Thessaloniki, Greece
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Stratigos
- Department of Dermatology, Andreas Syggros Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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22
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Stephens M. The skin and associated disorders. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:202-206. [PMID: 35220749 DOI: 10.12968/bjon.2022.31.4.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article aims to increase knowledge of the skin and associated disorders. Anatomy and physiology of the skin are briefly reviewed, and reference is made to common skin disorders. The main characteristics of a holistic skin assessment are discussed, and the signs to look for when undertaking an examination. The article concludes with a case study for context and reflection.
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Affiliation(s)
- Melanie Stephens
- Senior Lecturer in Adult Nursing and Head of Interprofessional Education, School of Health and Society, University of Salford
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23
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Chow A, Teo SH, Kong JW, Lee S, Heng YK, van Steensel M, Smith H. Patients' Experiences of Telemedicine for Their Skin Problems: Qualitative Study. JMIR DERMATOLOGY 2022; 5:e24956. [PMID: 37632855 PMCID: PMC10334905 DOI: 10.2196/24956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/20/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Teledermatology is a cost-effective treatment modality for the management of skin disorders. Most evaluations use quantitative data, and far less is understood about the patients' experience. OBJECTIVE This qualitative study aimed to explore patients' perceptions of a teledermatology service linking public primary care clinics to the national specialist dermatology clinic in Singapore. A better understanding of patients' experiences can help refine and develop the care provided. METHODS Semistructured in-depth interviews were conducted with patients who had been referred to the teledermatology service. The interviews were digitally recorded and transcribed before undergoing thematic content analysis. RESULTS A total of 21 patients aged between 22 and 72 years were recruited. The following 3 themes were identified from the data of patients' experiences: positive perceptions of teledermatology, concerns about teledermatology, and ideas for improving the teledermatology service. The patients found the teledermatology service convenient, saving them time and expense and liberating them from the stresses incurred when making an in-person visit to a specialist facility. They valued the confidence and reassurance they gained from having a dermatologist involved in deciding their management. The patients' concern included data security and the quality of the images shared. Nonetheless, they were keen to see the service expanded beyond the polyclinics. Their experiences and perceptions will inform future service refinement and development. CONCLUSIONS This narrative exploration of users' experiences of teledermatology produced rich data enabling a better understanding of the patients' journey, the way they understand and interpret their experiences, and ideas for service refinement. Telemedicine reduces traveling and enables safe distancing, factors that are much needed during pandemics.
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Affiliation(s)
- Aloysius Chow
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sok Huang Teo
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Jing Wen Kong
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Simon Lee
- National Healthcare Group Polyclinics, Singapore, Singapore
| | | | - Maurice van Steensel
- Skin Research Institute of Singapore, Singapore, Singapore
- Dermatology and Skin Biology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Helen Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Magin PJ, Tng ETV. Specialists and generalists in skin disease management: educational, clinical and research imperatives. Br J Dermatol 2022; 186:1-2. [PMID: 34988983 DOI: 10.1111/bjd.20575] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- P J Magin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Mayfield West, NSW, Australia
| | - E T V Tng
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Department of Dermatology, John Hunter Hospital, New Lambton Heights, NSW, Australia
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25
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McPhillips H, Wood AF, Harper-McDonald B. Critical thinking and diagnostic reasoning when advanced practitioners assess and treat skin conditions. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:1278-1286. [PMID: 34889674 DOI: 10.12968/bjon.2021.30.22.1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Advanced clinical practitioner (ACP) roles require a broad range of knowledge of both medical and surgical medicine and the ability to work autonomously in a variety of settings. Despite around half of the UK adult population presenting with a skin condition requiring attention, this is something many ACPs feel unprepared to be consulted on. However, due to the complexity and large number of potential diagnoses, it is imperative that ACPs develop their confidence and knowledge to diagnosis, request investigations and initiate treatment for a patient with a skin complaint. In the first part of this clinical review the authors presented the key elements of history taking, consultation and assessment of the skin. This second clinical review discusses the main differential diagnoses, mimics, common investigations and treatments. This article is designed to support novice ACPs from acute hospital settings to primary care to develop a foundation of understanding in the main diagnosis and treatment options that should be considered following a clinical assessment of patients' skin outside the dermatology setting.
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Affiliation(s)
- Hazel McPhillips
- Advanced Nurse Practitioner, Hospital at Night Team, NHS Lothian
| | - Alison F Wood
- Programme Leader, Queen Margaret University, Edinburgh
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26
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Palamaras I, Wark H, Short B, Hameed OA, Sheraz AA, Thomson P, Kalirai K, Rose L. Clinical outcomes and operational impact of a medical photography based teledermatology service with over 8,000 patients in the UK. J Vis Commun Med 2021; 45:6-17. [PMID: 34854359 DOI: 10.1080/17453054.2021.2004883] [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: 10/19/2022]
Abstract
A new, store-and-forward, fully digitised Teledermatology (TD) pathway was designed and implemented in an urban setting for non-two-week wait routine patients. In total 8,352 new patients had a TD consultation over 37 months. Of these, 4,748 (56.8%) were referred back to their GP, 1,634 (19.6%) were referred directly for a surgical procedure and 1,970 (23.6%) for a face-to-face review with a Dermatologist (F2F). The average waiting time for a TD appointment was 3 vs. 30 weeks for a routine F2F appointment. Between 2019 and 2018, TD referrals rose by 38%, routine dermatology referrals reduced by 16% and cancer referrals increased by 6%. Using medical photographers proved to be effective with only two cases (0.02%) of images being of insufficient quality to form a clinical opinion. Hitherto, savings for the local Commissioning Groups were estimated at £671,218. Last financial year savings (2019-2020) were £284,671. The average cost savings per TD patient appointment was £80.36. Savings in the Trust's overhead costs were £53,587. TD consultants reviewed almost twice the number of patients vs. F2F for the same amount of consultant programmed activities. 95% of surveyed patients would be likely or extremely likely to recommend this service to friends and family.
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Affiliation(s)
- Ioulios Palamaras
- Royal Free London NHS Foundation Trust, Dermatology, London, United Kingdom of Great Britain and Northern Ireland
| | - Helen Wark
- Royal Free London NHS Foundation Trust, Dermatology, London, United Kingdom of Great Britain and Northern Ireland
| | - Billy Short
- Royal Free London NHS Foundation Trust, Cerner, London, United Kingdom of Great Britain and Northern Ireland
| | - Omair Akhtar Hameed
- Royal Free London NHS Foundation Trust, Dermatology, London, United Kingdom of Great Britain and Northern Ireland
| | - Adil Ahmed Sheraz
- Royal Free London NHS Foundation Trust, Dermatology, London, United Kingdom of Great Britain and Northern Ireland
| | - Penelope Thomson
- Royal Free London NHS Foundation Trust, Dermatology, London, United Kingdom of Great Britain and Northern Ireland
| | - Kam Kalirai
- Royal Free London NHS Foundation Trust, Clinical Practice Group (CPG), London, United Kingdom of Great Britain and Northern Ireland
| | - Lisa Rose
- Royal Free London NHS Foundation Trust, Dermatology, London, United Kingdom of Great Britain and Northern Ireland
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27
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Zhao M, Kawahara J, Abhishek K, Shamanian S, Hamarneh G. Skin3D: Detection and Longitudinal Tracking of Pigmented Skin Lesions in 3D Total-Body Textured Meshes. Med Image Anal 2021; 77:102329. [DOI: 10.1016/j.media.2021.102329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/27/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
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28
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Salava A. Critical evaluation of the undergraduate curriculum-are we asking the right questions? SKIN HEALTH AND DISEASE 2021; 1:e67. [PMID: 35663776 PMCID: PMC9059998 DOI: 10.1002/ski2.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 01/04/2023]
Abstract
The curricular content in medical education needs continuous development and therefore must regularly undergo a critical evaluation. Here, the author describes an implemented shift in the teaching substance of an undergraduate dermatology course aimed to focus on relevance and practicability for general practitioners. The changes were based on a comprehensive nationwide database analysis of the spectrum of skin-related conditions seen in primary care.
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Affiliation(s)
- A. Salava
- Department of Dermatology, Allergology and VenereologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
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29
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Salava A, Oker-Blom A, Remitz A. The spectrum of skin-related conditions in primary care during 2015-2019-A Finnish nationwide database study. SKIN HEALTH AND DISEASE 2021; 1:e53. [PMID: 35663141 PMCID: PMC9060089 DOI: 10.1002/ski2.53] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 12/18/2022]
Abstract
Background Skin‐related conditions are the frequent cause of doctors’ consultations in primary care. Methods Based on nationwide data bank information of the Finnish Institute for Health and Welfare, we analysed the 20 most frequent main diagnoses for each ICD‐10 category of all general practitioners’ visits in the public health care in Finland over the years 2015–2019. Results The total amount of doctor’s visits was 19 204 613 of which 1 489 228 consultations (7.80%) had a skin‐related condition as the main diagnosis. The most frequent skin‐related conditions were eczematous eruptions, bacterial skin infections and benign skin neoplasms accounting for 749 351 consultations (50.32%). The spectrum of skin‐related conditions was diverse, with a large quantity of rarer diagnoses. Some diagnoses showed significant proportional changes. Conclusions The results demonstrate that a limited amount of conditions comprises most of the skin‐related consultations in primary care in Finland. Undergraduate education in dermatology should concentrate on the most frequent conditions seen by general practitioners, but also address the wide range of skin problems.
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Affiliation(s)
- A Salava
- Department of Dermatology and Allergology Helsinki University Hospital Helsinki Finland
| | - A Oker-Blom
- Department of Dermatology and Allergology Helsinki University Hospital Helsinki Finland
| | - A Remitz
- Department of Dermatology and Allergology Helsinki University Hospital Helsinki Finland
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30
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Skayem C, Rostom H, Hirsch G, Duong TA. Teledermatology: The perspective of French general practitioners. Ann Dermatol Venereol 2021; 148:251-252. [PMID: 34226033 DOI: 10.1016/j.annder.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/09/2020] [Accepted: 04/01/2021] [Indexed: 11/30/2022]
Affiliation(s)
- C Skayem
- Department of Dermatology, hôpital Henri-Mondor, AP-HP, 94010 Créteil cedex, France; Faculté de médecine, Sorbonne université, 91, boulevard de l'Hôpital, 75013 Paris, France; Faculté de médecine, université de Paris, 15, rue de l'École de Médecine, 75006 Paris, France.
| | - H Rostom
- Cabinet médical et esthétique, 4, avenue Henri-Varagnat, 93140 Bondy, France
| | - G Hirsch
- Department of Dermatology, hôpital Henri-Mondor, AP-HP, 94010 Créteil cedex, France
| | - T-A Duong
- Department of Dermatology, hôpital Henri-Mondor, AP-HP, 94010 Créteil cedex, France; Chaire avenir santé numérique, équipe 8 IMRB, Inserm, université Paris Est Créteil, 94010 Créteil cedex, France; Department of design engineering, EA 2606, université de Saclay, centrale Supelec, 3, rue Joliot Curie, 91190 Gif-sur-Yvette, France
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31
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Toron F, Neary MP, Smith TW, Gruben D, Romero W, Cha A, Patel K, Vasileva SZ, Ameen M. Clinical and Economic Burden of Mild-to-Moderate Atopic Dermatitis in the UK: A Propensity-Score-Matched Case-Control Study. Dermatol Ther (Heidelb) 2021; 11:907-928. [PMID: 33846907 PMCID: PMC8163940 DOI: 10.1007/s13555-021-00519-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/24/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction The burden of mild-to-moderate atopic dermatitis (AD) in the United Kingdom (UK) is not well understood. Long-lasting AD flares may lead to systemic inflammation resulting in reversible progression from mild to more severe AD. This study aimed to assess the clinical and economic burden of mild-to-moderate AD in the UK. Methods AD patients were identified in the Health Improvement Network (THIN) from 2013 to 2017 and propensity score matched to non-AD controls by demographics. Patients were identified based on continuous disease activity using validated algorithms and sufficient patient status to fully validate data integrity for the entire period. Mild-to-moderate AD patients were identified by using treatment as a surrogate. Demographics, clinical characteristics and healthcare resource use (HCRU) were obtained from THIN. Literature reviews were conducted to obtain additional outcomes. A cost-of-illness model was developed to extrapolate the burden in 2017 to the UK population and in subsequent years (2018–2022). Results In 2017, the prevalence of mild-to-moderate AD in THIN was 1.28%. These patients reported higher comorbidity rates and significantly higher (p < 0.0001) HCRU, encompassing mean general practitioner visits (5.57 versus 3.59), AD-related prescriptions (5.85 versus 0.68) and total referrals (0.97 versus 0.82) versus matched non-AD controls. The model projected total HCRU and drug excess costs of €462.99M over the 5 years. The excess cost decreased to €417.35M after excluding patients on very potent topical corticosteroids, who most likely had at least moderate disease. The excess costs increased to €1.21B and €7.06B when considering comorbidity burden and productivity losses, respectively. Conclusion Mild-to-moderate AD patients had higher comorbidity burden, HCRU and cost compared with matched non-AD controls. Overall, UK country-based economic burden was high given partly the high prevalence of this disease. Moreover, productivity burden and comorbidities had considerable impact on the economic burden, which further suggests the importance of optimal disease management. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00519-7.
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Affiliation(s)
- Farah Toron
- Health Economics and Outcomes Research, Real World Solutions, IQVIA, 210 Pentonville Road, London, N1 9JY, UK
| | - Maureen P Neary
- Inflammation & Immunology, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Timothy W Smith
- Inflammation & Immunology, Pfizer Inc, New York, New York, USA
| | - David Gruben
- Global Biometrics and Data Management (Statistics), Pfizer Inc, Groton, Connecticut, USA
| | | | - Amy Cha
- Inflammation & Immunology, Pfizer Inc, New York, New York, USA
| | - Keyur Patel
- Health Economics and Outcomes Research, Real World Solutions, IQVIA, 210 Pentonville Road, London, N1 9JY, UK
| | - Simona Z Vasileva
- Health Economics and Outcomes Research, Real World Solutions, IQVIA, 210 Pentonville Road, London, N1 9JY, UK.
| | - Mahreen Ameen
- Royal Free London National Health Services Foundation Trust, London, UK
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32
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Finstad A, Almuhanna N, Alhusayen R. Provision of Dermatologic Care in a Universal Health Care System: A 17-Year Review. J Cutan Med Surg 2021; 25:511-520. [PMID: 33840256 PMCID: PMC8474328 DOI: 10.1177/12034754211008164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Limited data is available on the burden of dermatologic disease including
disease distribution and providers of care. Research is needed to facilitate
health care planning and improve patient care. Objectives To investigate the demographics and economics of the provision of
dermatologic care in a universal health care system from fiscal year 2000 to
2016. Methods A retrospective population-based analysis was performed on physician billing
claims for dermatologic conditions from April 1, 2000 to March 31, 2017.
Data came from the province of Ontario’s universal health care plan claims
records accessed through IntelliHealth. Results Dermatologic claims made up 3.6% of all physician claims, with a 20% increase
seen over time. The cost of dermatologic claims increased by 70% between
fiscal 2000 and 2016, with the average cost per claim increasing by 41%.
However, the cost of dermatologic claims as a percentage of all health care
claims experienced a decline from 3.5% in fiscal 2000 to 2.8% in fiscal
2016. Over the study period, family physicians submitted 56% to 62% of
dermatologic claims, dermatologists 24% to 29%, pediatricians 3% to 4%, and
internists 1%. Overall, internists billed the highest average cost per
dermatologic claim ranging from $39 in 2000 to $60 in 2016, followed by
pediatricians at $33 to $58, dermatologists at $28 to $39, and family
physicians at $23 to $30. Conclusions The demographic and economic burden of dermatologic disease is changing over
time, with implications for health care planning, advancing medical
education, and patient care.
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Affiliation(s)
| | - Nouf Almuhanna
- 37849 Division of Dermatology, Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Raed Alhusayen
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,71545 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Hivechi A, Milan PB, Modabberi K, Amoupour M, Ebrahimzadeh K, Gholipour AR, Sedighi F, Amini N, Bahrami SH, Rezapour A, Hamidi M, Delattre C. Synthesis and Characterization of Exopolysaccharide Encapsulated PCL/Gelatin Skin Substitute for Full-Thickness Wound Regeneration. Polymers (Basel) 2021; 13:polym13060854. [PMID: 33802198 PMCID: PMC8000589 DOI: 10.3390/polym13060854] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
Loss of skin integrity can lead to serious problems and even death. In this study, for the first time, the effect of exopolysaccharide (EPS) produced by cold-adapted yeast R. mucilaginosa sp. GUMS16 on a full-thickness wound in rats was evaluated. The GUMS16 strain's EPS was precipitated by adding cold ethanol and then lyophilized. Afterward, the EPS with polycaprolactone (PCL) and gelatin was fabricated into nanofibers with two single-needle and double-needle procedures. The rats' full-thickness wounds were treated with nanofibers and Hematoxylin and eosin (H&E) and Masson's Trichrome staining was done for studying the wound healing in rats. Obtained results from SEM, DLS, FTIR, and TGA showed that EPS has a carbohydrate chemical structure with an average diameter of 40 nm. Cell viability assessments showed that the 2% EPS loaded sample exhibits the highest cell activity. Moreover, in vivo implantation of nanofiber webs on the full-thickness wound on rat models displayed a faster healing rate when EPS was loaded into a nanofiber. These results suggest that the produced EPS can be used for skin tissue engineering applications.
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Affiliation(s)
- Ahmad Hivechi
- Department of Textile Engineering, School of Materials and Advanced Processing, Amirkabir University of Technology, Tehran 1591639675, Iran; (A.H.); (S.H.B.)
| | - Peiman Brouki Milan
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran 1591639675, Iran; (P.B.M.); (N.A.)
- Department of Tissue Engineering and Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran 1591639675, Iran
| | - Khashayar Modabberi
- Department of Medical Biotechnology, Faculty of Paramedicine, Guilan University of Medical Sciences, Rasht 4477166595, Iran; (K.M.); (A.R.G.); (F.S.)
| | - Moein Amoupour
- Department of Medical Biotechnology, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran 1591639675, Iran;
| | - Kaveh Ebrahimzadeh
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1591639675, Iran;
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1591639675, Iran
| | - Amir Reza Gholipour
- Department of Medical Biotechnology, Faculty of Paramedicine, Guilan University of Medical Sciences, Rasht 4477166595, Iran; (K.M.); (A.R.G.); (F.S.)
| | - Faezeh Sedighi
- Department of Medical Biotechnology, Faculty of Paramedicine, Guilan University of Medical Sciences, Rasht 4477166595, Iran; (K.M.); (A.R.G.); (F.S.)
| | - Naser Amini
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran 1591639675, Iran; (P.B.M.); (N.A.)
| | - S. Hajir Bahrami
- Department of Textile Engineering, School of Materials and Advanced Processing, Amirkabir University of Technology, Tehran 1591639675, Iran; (A.H.); (S.H.B.)
| | - Alireza Rezapour
- Department of Tissue Engineering, School of Medicine, Qom University of Medical Sciences, Qom 3716993456, Iran;
| | - Masoud Hamidi
- Department of Medical Biotechnology, Faculty of Paramedicine, Guilan University of Medical Sciences, Rasht 4477166595, Iran; (K.M.); (A.R.G.); (F.S.)
- Correspondence: (M.H.); (C.D.); Tel.: +32-26-50-3681 (M.H.); +33-(0)4-73-40-7423 (C.D.)
| | - Cédric Delattre
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, F-63000 Clermont-Ferrand, France
- Institut Universitaire de France (IUF), 1 Rue Descartes, 75005 Paris, France
- Correspondence: (M.H.); (C.D.); Tel.: +32-26-50-3681 (M.H.); +33-(0)4-73-40-7423 (C.D.)
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Chang RJND, Mahmudzade Y, Hussain K. Comment on 'The British Association of Dermatologists' Undergraduate Curriculum Update 2021'. Clin Exp Dermatol 2021; 46:751-752. [PMID: 33481274 DOI: 10.1111/ced.14564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 11/26/2022]
Affiliation(s)
- R J N D Chang
- Imperial College School of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Y Mahmudzade
- Imperial College School of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - K Hussain
- Department of Dermatology, Imperial College Healthcare NHS Trust, London, UK
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35
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Firouzi M, Sherkatolabbasieh H, Shafizadeh S. Clinical Signs, Prevention and Treatment of Viral Infections in Infants. Infect Disord Drug Targets 2021; 22:e160921190908. [PMID: 33511936 DOI: 10.2174/1871526521666210129145317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/22/2020] [Accepted: 11/23/2020] [Indexed: 11/22/2022]
Abstract
Certain infectious diseases are common in infants than any other age groups and are associated with morbidities in childhood and adulthood, and even mortality in severe cases. Environment, epidemic and maternal immunity are the main causes of these infections. Early diagnosis using molecular methods and treatment is therefore important to prevent future complications. Vaccines are recommended during infancy and childhood to prevent these infections. This review highlights some of the most commonly reported viral infections in children, their clinical signs, prevention and treatment.
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Affiliation(s)
- Majid Firouzi
- Department of Pediatrics, Faculty of Medicine, Lorestan University of Medical Sciences, Khoramabad. Iran
| | | | - Shiva Shafizadeh
- Department of Internal Medicine, Lorestan University of Medical Sciences, Khoramabad. Iran
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36
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The content and conduct of GP consultations for dermatology problems: a cross-sectional study. Br J Gen Pract 2020; 70:e723-e730. [PMID: 32895240 PMCID: PMC7480176 DOI: 10.3399/bjgp20x712577] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/02/2020] [Indexed: 01/16/2023] Open
Abstract
Background Skin complaints are common in primary care, and poor outcomes in long-term conditions are often due to low adherence to treatment. Shared decision making and self-management support may help, yet there is little understanding of patient involvement or the support provided by GPs. Aim To describe the content of primary care consultations for skin problems, including shared decision making practice, delivery of self-management advice, and follow-up. Design and setting Cross-sectional study of video-recorded UK adult GP consultations and linked data. Method A coding tool was developed and applied to all consultations with skin problems. Shared decision making was assessed using the observer OPTION5 scale. Results A total of 45/318 consultations (14.2%) related to one or more skin problems, which were discussed alongside other problems in 71.1% (32/45) of consultations. Of the 100 different problems discussed in these consultations, 51 were dermatological. The mean amount of time spent on skin problems in the consultations was 4 minutes 16 seconds. Medication was recommended for 66.7% (34/51) of skin problems, with low shared decision making (mean OPTION5 score = 10.7). Self-management advice (verbal only) was given for 47.1% (24/51) of skin problems. Most skin problems (84.3%; 43/51) were not referred to secondary care; 32.6% (14/43) of the skin problems not referred were seen again in primary care within 12 weeks, of which 35.7% (5/14) follow-up appointments were not planned. Conclusion In this study, skin problems were usually presented alongside other complaints and resulted in a medication recommendation. Shared decision making was uncommon and self-management advice not consistently given, with re-attendance for the same problem common. GPs’ training should reflect how frequently skin problems are seen and seek to improve patient involvement in decision making and support self-management.
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37
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Cho SI, Han B, Hur K, Mun JH. Perceptions and attitudes of medical students regarding artificial intelligence in dermatology. J Eur Acad Dermatol Venereol 2020; 35:e72-e73. [PMID: 32852856 DOI: 10.1111/jdv.16812] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/24/2020] [Accepted: 06/30/2020] [Indexed: 12/21/2022]
Affiliation(s)
- S I Cho
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - B Han
- Seoul National University College of Medicine, Seoul, Korea
| | - K Hur
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - J-H Mun
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea
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38
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Diagnostik von psychischen Faktoren bei chronischem Pruritus. Hautarzt 2020; 71:506-510. [DOI: 10.1007/s00105-020-04596-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Zusammenfassung
Hintergrund
Pruritus ist ein häufiges und quälendes Symptom in der Bevölkerung sowie in ärztlichen Praxen.
Ziel der Arbeit
Der vorliegende Beitrag gibt einen Überblick über die Systematik psychischer Faktoren in Entstehung bzw. Verlauf des Pruritus sowie Hinweise zu ihrer jeweiligen Diagnostik
Material und Methode
Es handelt sich um eine Überblicksarbeit.
Ergebnisse
Psychische Beeinträchtigungen/Störungen können als Reaktion auf chronischen Pruritus auftreten, z. B. als Anpassungsstörungen, depressive Störungen, Angststörungen. Psychische Faktoren können auch in Entstehung und Verlauf eines chronischen Pruritus eine Rolle spielen, entweder im Zusammenspiel mit organischen Ursachen oder bei deren Fehlen als somatoformer Pruritus oder Pruritus bei coenästhetischer Schizophrenie. Ferner können selbstinduzierte Kratzartefakte mit oder ohne Pruritus im Rahmen von Störungen der Impulskontrolle, Zwangsstörungen oder Artefaktstörungen auftreten. Auch eine primär unabhängige Komorbidität mit einer sonstigen psychischen oder psychosomatischen Störung kann das Management des Pruritus erschweren und den Krankheitsverlauf beeinflussen. Es werden Hinweise zur Diagnostik der genannten Faktoren gegeben.
Diskussion
Die Diagnostik psychischer Einflussfaktoren und psychischer Aspekte des chronischen Pruritus ist komplex. Das wichtigste diagnostische Werkzeug ist die gründliche Anamneseerhebung auch bezüglich psychischer Aspekte. Zusätzlich können psychometrische Instrumente zum Einsatz kommen, die das ärztliche Gespräch jedoch nicht ersetzen.
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Marin-Gomez FX, Vidal-Alaball J, Poch PR, Sariola CJ, Ferrer RT, Peña JM. Diagnosis of Skin Lesions Using Photographs Taken With a Mobile Phone: An Online Survey of Primary Care Physicians. J Prim Care Community Health 2020; 11:2150132720937831. [PMID: 32590923 PMCID: PMC7328057 DOI: 10.1177/2150132720937831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Skin conditions are one of the most frequent reasons for visiting a primary
health care facility, making it of vital importance that general practitioners
(GPs) have the right knowledge and tools to diagnose the most frequent
dermatological conditions. Methods: This study evaluates the
accuracy of dermatological diagnoses made by 120 GPs based on photographs taken
with a smartphone by an anonymous online cross-sectional survey.
Results: The study was carried out between August and October
2018. The results show that the majority of the participants are in favor of
using mobile phones to communicate with other professionals and use them to
consult medical images. The majority (69%) took dermatological photographs and
the preferred device was a smartphone (70%). From 22 different images evaluated,
in 69% of responses, participants expressed a high degree of confidence in their
ability to diagnose the lesion shown and in 72% of the cases, the diagnosis
chosen was correct. Conclusions: The study confirms that the use of
smartphone to send medical images is growing rapidly and its potential for
taking medical images is an opportunity to help primary care teams deal with
dermatological problems. The results suggest that GPs need further training in
interpreting dermatological images, to increase their diagnostic confidence and
to avoid the need for referrals to face-to-face visits.
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Affiliation(s)
- Francesc X Marin-Gomez
- Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Josep Vidal-Alaball
- Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Pere Roura Poch
- Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | | | | | - Jacobo Mendioroz Peña
- Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
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40
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Heapy C, Montgomery K, Ersser S, Gass M, Goad N, Thompson AR. A Psychosocial Support Website From the British Association of Dermatologists for People Living With a Skin Condition: Mixed Methods Evaluation. JMIR DERMATOLOGY 2020. [DOI: 10.2196/17052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background
There is a lack of psychological support for individuals with skin conditions, and few low-intensity self-help interventions are available.
Objective
This study aimed to test the acceptability and usability of a support website and its embedded self-help resources.
Methods
A mixed methods approach was utilized. A total of 583 participants (426 with a skin condition, 97 relatives and friends, and 60 dermatology professionals) viewed the British Association of Dermatologist’s SkinSupport website and then completed a survey about their well-being and the usability of the website. A comparison group comprising 816 participants also completed the well-being measures. In total, 37 participants (19 living with a skin condition, and the relatives and friends of individuals with a skin condition, and 18 dermatology professionals) viewed the SkinSupport website and then took part in focus groups. Participants were recruited via social media, professional networks, and volunteer lists. Data from the survey were analyzed using descriptive and inferential statistics and qualitative content analysis.
Results
Both quantitative and qualitative responses suggest that the SkinSupport website was viewed positively by both patients and health professionals. Overall, 79.8% (417/523) of individuals with a skin condition, and the relatives and friends of individuals with a skin condition, said that they would use the website again; and 86.7% (52/60) of dermatology professionals said that they would recommend the site to somebody with a skin condition. Qualitative responses related to the website fell into 4 key themes: (1) appearance, (2) use and navigation, (3) information, and (4) areas for development.
Conclusions
The SkinSupport website was considered acceptable and usable. A range of areas requiring modification were identified. The website provides a useful resource that patients can access freely. Given the lack of services available to patients with skin conditions, health care professionals could routinely inform patients of this resource at assessment.
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41
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van den Bogaart EHA, Kroese MEAL, Spreeuwenberg MD, Martens H, Steijlen PM, Ruwaard D. Reorganising dermatology care: predictors of the substitution of secondary care with primary care. BMC Health Serv Res 2020; 20:510. [PMID: 32503509 PMCID: PMC7275501 DOI: 10.1186/s12913-020-05368-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/26/2020] [Indexed: 01/18/2023] Open
Abstract
Background The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch ‘Blue Care’ pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision. Methods This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors. Results A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient’s diagnosis independently influenced the referral decisions following PC+. Conclusion The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.
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Affiliation(s)
- Esther H A van den Bogaart
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229, GT, The Netherlands.
| | - Mariëlle E A L Kroese
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229, GT, The Netherlands
| | - Marieke D Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229, GT, The Netherlands.,Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Herm Martens
- Department of Dermatology and GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Peter M Steijlen
- Department of Dermatology and GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229, GT, The Netherlands
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42
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Sheppeard R, Samuels A, Davies P. i-DERMIFY: does using practical illustration and verbal description in a game format improve recognition and confidence in describing common skin diseases? Clin Exp Dermatol 2020; 45:610-611. [PMID: 32017161 DOI: 10.1111/ced.14189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 01/06/2020] [Accepted: 02/01/2020] [Indexed: 11/28/2022]
Affiliation(s)
- R Sheppeard
- Gloucestershire Academy (University of Bristol), Gloucestershire Hospital NHS Foundation Trust, Gloucester, UK
| | - A Samuels
- Gloucestershire Academy (University of Bristol), Gloucestershire Hospital NHS Foundation Trust, Gloucester, UK
| | - P Davies
- Gloucestershire Academy (University of Bristol), Gloucestershire Hospital NHS Foundation Trust, Gloucester, UK
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43
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Nguyen SH, Vu GT, Nguyen LH, Nguyen CT, Le THT, Tran TH, Tran BX, Latkin CA, Tam WWS, Ho CSH, Ho RCM. Understanding Social Media Use and Engagement Among Dermatology Patients to Inform Dermatological Prevention and Care in Vietnam: Cross-sectional Study. JMIR DERMATOLOGY 2020. [DOI: 10.2196/13424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background
Social media has emerged as a common source of dermatological information. Monitoring the patterns of social media use and engagement is important to counteract the limitations of social media. However, evidence in Vietnamese dermatology patients is lacking.
Objective
This study aimed to explore social media use and engagement by dermatology patients and to identify factors associated with social media use and engagement.
Methods
A cross-sectional study was conducted with 519 participants at the Vietnam National Hospital of Dermatology and Venereology during September to November 2018. Data about sociodemographic characteristics, social media use, and social media engagement were collected. Multivariate logistic and tobit regression models were used to identify factors associated with social media use and engagement.
Results
Interest in information about “cosmetic, beauty, and skincare techniques” was the greatest (184/519, 46.2%). The mean engagement score was 8.4 points (SD 2.4 points). Female patients were more likely to use social media (odds ratio [OR] 2.23, 95% CI 1.23-4.06) and be interested dermatological information on social media (OR 3.09, 95% CI 1.35-7.09). Women also had higher social media engagement scores (coefficient=0.68, 95% CI 0.17-1.18). Higher social media engagement scores were related with Instagram use (coefficient=0.58, 95% CI 0.00-1.15) and higher credibility scores for “family members” (coefficient=0.15, 95% CI 0.03-0.26) and “dermatology companies” (coefficient=0.22, 95% CI 0.04-0.39).
Conclusions
This study discovered high social media usage among dermatology patients. However, only moderate utilization and credibility levels were reported regarding the use of social media as a source of dermatological information. More efforts should focus on involving dermatologists in the development of individualized information on social media targeting specific groups of dermatology patients.
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44
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Sharma M, Scorer M, Kent D, Murphy R, Doody G. Mapping the undergraduate dermatology curriculum: a useful tool towards implementation of national recommendations. Clin Exp Dermatol 2019; 45:337-339. [PMID: 31630424 DOI: 10.1111/ced.14125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the high prevalence of skin complaints in primary care and secondary care, dermatology undergraduate (UG) education remains inconsistent across medical schools. The British Association of Dermatologists (BAD) published a revised national UG curriculum in 2016 to guide UK medical schools on the minimum competencies required in dermatology. AIM The aim of the study was to determine the alignment of the BAD UG curriculum with the dermatology curriculum of the University of Nottingham School of Medicine. METHODS A curriculum mapping study was undertaken with the development of an electronic searchable database tool to map key areas. RESULTS Of the 70 intended learning outcomes (ILOs) for dermatology in the medical school, 55 (79%) were mapped to the BAD curriculum, while 14 (20%) required modifications to align them with the BAD ILOs. Two BAD ILOs were unspecified in the current curriculum, and one was deemed redundant. CONCLUSION Curriculum mapping is a useful tool to standardize local dermatology ILOs to national recommendations and provides transparency to stakeholders for implementation of the dermatology curriculum.
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Affiliation(s)
- M Sharma
- Department of Medical Education, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK.,Department of Dermatology, Derby Hospitals NHS Foundation Trust, London Road Community Hospital, Derby, UK
| | - M Scorer
- Department of Medical Education, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK.,Department of Dermatology, Derby Hospitals NHS Foundation Trust, London Road Community Hospital, Derby, UK
| | - D Kent
- Department of Medical Education, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - R Murphy
- Department of Medical Education, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - G Doody
- Department of Medical Education, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
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45
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Carruthers E, Oakeshott P. Refugee and asylum seeker usage of primary care: medical student survey at two inner-city general practices. EDUCATION FOR PRIMARY CARE 2019; 30:248-250. [PMID: 31145869 DOI: 10.1080/14739879.2019.1613676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Refugees and asylum seekers face a number of barriers in accessing healthcare. However, there is a lack of quantitative research examining healthcare usage by refugees and asylum seekers in the UK. Using EMIS data from two GP practices in South London, all patients who had registered as refugees or asylum seekers were identified (n=35). The following data were extracted: date of registration; number of appointments in the 12 months from registration; reason for appointment; secondary care referrals and whether these were attended; and demographic data (age, sex, ethnicity). The mean number of appointments in 12 months was 5.8, and the median was 4. 60% of patients had 5 or fewer appointments. The most common reasons for appointments were psychiatric, musculoskeletal, and dermatological. 51% had a secondary care referral, of which 72% were attended; the most common referrals were to radiology. Of 35 patients, 20 were male and 15 female; the mean age was 32 and the most common ethnic category was Black African. Comparing this data to UK averages suggests that the survey cohort consulted their GP with roughly the same frequency as the average member of the public. There was a higher frequency of psychiatric symptoms, although referrals to secondary psychiatric care were infrequent. The survey cohort attended fewer secondary care referrals than comparable UK-wide data. This suggests that more work is necessary on identifying barriers to healthcare access for this population, and that they present with complex needs. This has implications for policy and for training GPs.
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Affiliation(s)
- Elspeth Carruthers
- Population Health Research Institute, St. George's, University of London , London , UK
| | - Pippa Oakeshott
- Population Health Research Institute, St. George's, University of London , London , UK
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46
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Noels EC, Hollestein LM, van Egmond S, Lugtenberg M, van Nistelrooij LPJ, Bindels PJE, van der Lei J, Stern RS, Nijsten T, Wakkee M. Healthcare utilization and management of actinic keratosis in primary and secondary care: a complementary database analysis. Br J Dermatol 2019; 181:544-553. [PMID: 30636037 PMCID: PMC6850060 DOI: 10.1111/bjd.17632] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2019] [Indexed: 12/25/2022]
Abstract
Background The high prevalence of actinic keratosis (AK) requires the optimal use of healthcare resources. Objectives To gain insight in to the healthcare utilization of people with AK in a population‐based cohort, and the management of AK in a primary and secondary care setting. Methods A retrospective cohort study using three complementary data sources was conducted to describe the use of care, diagnosis, treatment and follow‐up of patients with AK in the Netherlands. Data sources consisted of a population‐based cohort study (Rotterdam Study), routine general practitioner (GP) records (Integrated Primary Care Information) and nationwide claims data (DRG Information System). Results In the population‐based cohort (Rotterdam Study), 69% (918 of 1322) of participants diagnosed with AK during a skin‐screening visit had no previous AK‐related visit in their GP record. This proportion was 50% for participants with extensive AK (i.e. ≥ 10 AKs; n = 270). Cryotherapy was the most used AK treatment by both GPs (78%) and dermatologists (41–56%). Topical agents were the second most used treatment by dermatologists (13–21%) but were rarely applied in primary care (2%). During the first AK‐related GP visit, 31% (171 of 554) were referred to a dermatologist, and the likelihood of being referred was comparable between low‐ and high‐risk patients, which is inconsistent with the Dutch general practitioner guidelines for ‘suspicious skin lesions’ from 2017. Annually, 40 000 new claims representing 13% of all dermatology claims were labelled as cutaneous premalignancy. Extensive follow‐up rates (56%) in secondary care were registered, while only 18% received a claim for a subsequent cutaneous malignancy in 5 years. Conclusions AK management seems to diverge from guidelines in both primary and secondary care. Underutilization of field treatments, inappropriate treatments and high referral rates without proper risk stratification in primary care, combined with extensive follow‐up in secondary care result in the inefficient use of healthcare resources and overburdening in secondary care. Efforts directed to better risk differentiation and guideline adherence may prove useful in increasing the efficiency in AK management. What's already known about this topic? The prevalence of actinic keratosis (AK) is high and, in particular, multiple AKs are a strong skin cancer predictor. The high prevalence of AK requires optimal use of healthcare resources. Nevertheless, (population based) AK healthcare utilization and management data are very rare.
What does this study add? Although AK‐related care already consumes substantial resources, about 70% of the AK population has never received care. Primary care AK management demonstrated underutilization of topical therapies and high referral rates without proper risk stratification, while in secondary care the extensive follow‐up schedules were applied. This inefficient use of healthcare resources highlights the need for better harmonization and risk stratification to increase the efficiency of AK care.
Linked Comment: https://doi.org/10.1111/bjd.17862. https://doi.org/10.1111/bjd.18269 available online https://www.bjdonline.com/article/
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Affiliation(s)
- E C Noels
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - L M Hollestein
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - S van Egmond
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands.,Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - M Lugtenberg
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands.,Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - P J E Bindels
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - J van der Lei
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - R S Stern
- Department of Dermatology, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, U.S.A
| | - T Nijsten
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - M Wakkee
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands
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47
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Peters J. Managing the skin manifestations of systemic conditions. Br J Community Nurs 2019; 24:174-178. [PMID: 30969856 DOI: 10.12968/bjcn.2019.24.4.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Jill Peters
- Dermatology Nurse Practitioner and Nurse Supplementary Independent Prescriber, East Suffolk and North Essex NHS Foundation Trust
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48
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Moncrieff G, Lied-Lied A, Nelson G, Holy CE, Weinstein R, Wei D, Rowe S. Cost and effectiveness of prescribing emollient therapy for atopic eczema in UK primary care in children and adults: a large retrospective analysis of the Clinical Practice Research Datalink. BMC DERMATOLOGY 2018; 18:9. [PMID: 30373584 PMCID: PMC6206824 DOI: 10.1186/s12895-018-0076-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/27/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND The Clinical Practice Research Datalink (CPRD) was used to evaluate the overall costs to the National Health Service, including healthcare utilisation, of prescribing emollients in UK primary care for dry skin and atopic eczema (DS&E). METHODS Primary care patients in the UK were identified using the CPRD and their records were interrogated for the 2 years following first diagnosis of DS&E. Data from patients with (n = 45,218) and without emollient prescriptions (n = 9780) were evaluated. Multivariate regression models were used to compare healthcare utilisation and cost in the two matched groups (age, sex, diagnosis). Two sub-analyses of the Emollient group were performed between matched groups receiving (1) a colloidal oatmeal emollient (Aveeno-First) versus non-colloidal oatmeal emollients (Aveeno-Never) and (2) Aveeno prescribed first-line (Aveeno-First) versus prescribed Aveeno later (Aveeno-Subsequently). Logistic regression models calculated the odds of prescription with either potent / very potent topical corticosteroids (TCS) or skin-related antimicrobials. RESULTS Costs per patient were £125.80 in Emollient (n = 7846) versus £128.13 in Non-Emollient (n = 7846) matched groups (p = 0.08). The Emollient group had fewer visits/patient (2.44 vs. 2.66; p < 0.0001) and lower mean per-visit costs (£104.15 vs. £113.25; p < 0.0001), compared with the Non-Emollient group. Non-Emollient patients had 18% greater odds of being prescribed TCS and 13% greater odds of being prescribed an antimicrobial than Emollient patients. In the Aveeno-First (n = 1943) versus Aveeno-Never (n = 1943) sub-analysis, costs per patient were lower in the Aveeno-First compared with the Aveeno-Never groups (£133.46 vs. £141.11; p = 0.0069). The Aveeno-Never group had ≥21% greater odds of being prescribed TCS or antimicrobial than the Aveeno-First group. In the Aveeno-First (n = 1357) versus Aveeno-Subsequently (n = 1357) sub-analysis, total costs were lower in the Aveeno-First group (£140.35 vs. £206.43; p < 0.001). Patients in the Aveeno-Subsequently group had 91% greater odds of being prescribed TCS and 75% greater odds of being prescribed an antimicrobial than the Aveeno-First group. CONCLUSIONS Acknowledging limitations from unknown disease severity in the CRPD, the prescription of emollients to treat DS&E was associated with fewer primary care visits, reduced healthcare utilisation and reduced cost. Prescribing emollients, especially those containing colloidal oatmeal, was associated with fewer TCS and antimicrobial prescriptions. TRIAL REGISTRATION The study is registered at http://isrctn.com/ISRCTN91126037 .
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Affiliation(s)
| | | | - Gill Nelson
- Johnson & Johnson Ltd (UK), Maidenhead, Berkshire, UK
| | | | | | - David Wei
- Johnson & Johnson, Inc, New Brunswick, NJ USA
| | - Simon Rowe
- NHS Wakefield Clinical Commissioning Group, West Yorkshire, UK
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49
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Le Roux E, Powell K, Banks JP, Ridd MJ. GPs' experiences of diagnosing and managing childhood eczema: a qualitative study in primary care. Br J Gen Pract 2018; 68:e73-e80. [PMID: 29335327 PMCID: PMC5774966 DOI: 10.3399/bjgp18x694529] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/15/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Eczema is common among children, and in the UK the majority are managed by GPs. The most common cause of poor disease control is incorrect use of topical treatments. There is a lack of research into the challenges faced by GPs in diagnosing and managing this condition. AIM To explore the experiences of GPs in assessing and managing children with eczema. DESIGN AND SETTING Qualitative study in primary care in England. METHOD Semi-structured interviews with 15 GPs were audiorecorded, transcribed verbatim, and analysed thematically using the framework method. RESULTS GPs described a paucity of dermatology training. Although most GPs were confident diagnosing uncomplicated eczema, they reported using a trial-and-error approach to prescribing emollients, and were uncertain about quantities of topical treatments to issue. Mild and moderate potency topical corticosteroids (TCS) were commonly used, but most GPs lacked confidence in recommending potent TCS, and viewed parents or carers to be fearful of using all strengths of TCS. GPs perceived adherence to treatments to be low, but provision of information to support self-care was variable. Routine review of medication use or disease control was uncommon, which GPs attributed to service constraints. Participants' views on the causes and management of eczema were perceived to be at odds with parents and carers, who were said to be overly focused on an underlying cause, such as allergy. CONCLUSION GP uncertainty in managing eczema, lack of routine information and review, and perceived dissonance with parents around causation and management may be contributing to low concordance with treatments.
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Affiliation(s)
- Emma Le Roux
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol
| | - Kingsley Powell
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol
| | - Jonathan P Banks
- National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Mathew J Ridd
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol
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50
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Hambly R, O'Higgins L, Hughes R. Response to: ‘Dermatological content of U.K. undergraduate curricula: where are we now?’. Br J Dermatol 2017; 177:593-594. [DOI: 10.1111/bjd.15505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R. Hambly
- The Charles Centre; Department of Dermatology; St Vincent's University Hospital; Elm Park Dublin Ireland
| | - L. O'Higgins
- Medical Student, University College Dublin School of Medicine and Medical Sciences; Dublin Ireland
| | - R. Hughes
- The Charles Centre; Department of Dermatology; St Vincent's University Hospital; Elm Park Dublin Ireland
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