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Fonjungo FE, Barnes LA, Cai ZR, Naik HB, Eid E, Aleshin MA, Nava V, Johnson T, Chren MM, Linos E. Longitudinal remote monitoring of hidradenitis suppurativa: a pilot study. Br J Dermatol 2024; 190:274-276. [PMID: 37823362 PMCID: PMC10805523 DOI: 10.1093/bjd/ljad385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/07/2023] [Accepted: 10/29/2023] [Indexed: 10/13/2023]
Abstract
We sought to investigate the feasibility of longitudinal monitoring of disease activity from home in people with hidradenitis suppurativa (HS). Over 6 months, our novel digital tool collected 421 photos of HS-affected skin from 27 participants and captured trends in pain and quality of life scores. We found that participants with mild disease were more likely to share their progress than those with more severe disease, which is favourable as it may suggest a role for remote monitoring in tracking disease progression. This pilot provides proof of concept that will support future studies.
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Affiliation(s)
- Fonette E Fonjungo
- Department of Dermatology, Stanford Medicine, Palo Alto, CA
- Meharry Medical College, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
| | | | - Zhuo Ran Cai
- Department of Dermatology, Stanford Medicine, Palo Alto, CA
| | - Haley B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA
, USA
| | - Edward S Eid
- Department of Dermatology, Stanford Medicine, Palo Alto, CA
| | | | - Vanessa Nava
- Department of Dermatology, Stanford Medicine, Palo Alto, CA
| | | | | | - Eleni Linos
- Department of Dermatology, Stanford Medicine, Palo Alto, CA
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Snyder AM, Chen SC, Chren MM, Ferris LK, Edwards LD, Swerlick RA, Flint ND, Cizik AM, Hess R, Kean J, Secrest AM. Patient-Reported Outcome Measures and Their Clinical Applications in Dermatology. Am J Clin Dermatol 2023:10.1007/s40257-023-00758-8. [PMID: 36723756 PMCID: PMC9890442 DOI: 10.1007/s40257-023-00758-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 02/02/2023]
Abstract
With more disease- and symptom-specific measures available and research pointing to increased usefulness, patient-reported outcome measures (PROMs) can be routinely used in clinical care. PROMs increase efficiency in healthcare, improve the clinician-patient relationship, and increase patient satisfaction with their care. PROMs can be administered before, during, and after clinic visits using paper-and-pencil, mobile phones, tablets, and computers. Herein, we combine available literature with expert views to discuss overcoming barriers and helping dermatologists incorporate PROMs into routine patient-centered care. We believe dermatology patients will benefit from broader PROM implementation and routine clinical use. However, a few major barriers exist: (1) cost to implement the technology, (2) selecting the right PROMs for each disease, and (3) helping both patients and clinicians understand how PROMs add to and complement their current clinical experience. We provide recommendations to assist dermatologists when considering whether to implement PROMs in their practices.
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Affiliation(s)
- Ashley M Snyder
- Department of Dermatology, University of Utah, 30 N 1900 East, 4A330, Salt Lake City, UT, 84132, USA
- Department of Population Health Sciences, University of Utah, UT, Salt Lake City, USA
| | - Suephy C Chen
- Department of Dermatology, Duke University, Durham, NC, USA
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA, USA
| | - LaVar D Edwards
- Department of Population Health Sciences, University of Utah, UT, Salt Lake City, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
- SyTrue, Inc., Stateline, NV, USA
| | | | - Nicholas D Flint
- Department of Dermatology, University of Utah, 30 N 1900 East, 4A330, Salt Lake City, UT, 84132, USA
| | - Amy M Cizik
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, UT, Salt Lake City, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jacob Kean
- Department of Population Health Sciences, University of Utah, UT, Salt Lake City, USA
| | - Aaron M Secrest
- Department of Dermatology, University of Utah, 30 N 1900 East, 4A330, Salt Lake City, UT, 84132, USA.
- Department of Population Health Sciences, University of Utah, UT, Salt Lake City, USA.
- Department of Dermatology, Canterbury District Health Board, Health New Zealand, Christchurch, New Zealand.
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van Egmond S, de Vere Hunt I, Cai ZR, Rizk N, Wakkee M, Chren MM, Goldfarb N, Simard JF, Linos E. The perspectives of 606 US dermatologists on active surveillance for low-risk basal cell carcinoma. Br J Dermatol 2023; 188:136-137. [PMID: 36689496 DOI: 10.1093/bjd/ljac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/04/2022] [Accepted: 09/24/2022] [Indexed: 01/22/2023]
Abstract
In this survey study of over 600 US dermatologists, identical clinical scenarios (10mm primary asymptomatic BCC) were presented except for randomly varied patient characteristics including age, life expectancy, and tumor location. Most dermatologists (62%) recommended active surveillance for patients with advanced age (91 years) and a 1-year life expectancy. The odds ratio for choosing active surveillance was 20.31 (95% CI 14.10-35.30) comparing a patient with a 1-year life expectancy to a healthy patient.
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Affiliation(s)
- Sven van Egmond
- Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Isabella de Vere Hunt
- Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Zhuo Ran Cai
- Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Nada Rizk
- Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Marlies Wakkee
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Noah Goldfarb
- Departments of Medicine and Dermatology, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - Julia F Simard
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Eleni Linos
- Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
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Wheless L, Anand N, Hanlon A, Chren MM. Differences in Skin Cancer Rates by Transplanted Organ Type and Patient Age After Organ Transplant in White Patients. JAMA Dermatol 2022; 158:1287-1292. [PMID: 36169974 PMCID: PMC9520444 DOI: 10.1001/jamadermatol.2022.3878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/26/2022] [Indexed: 11/14/2022]
Abstract
Importance Although it is known that patients with thoracic organ transplants develop skin cancer more frequently than those who receive nonthoracic organ transplants, patterns of risk for subsequent skin cancers are unknown. Objective To further characterize organ transplant recipients who develop multiple skin cancers and assess for patterns of development of additional skin cancers beyond the first skin cancer diagnosis by patient age and transplanted organ type. Design, Setting, and Participants This cohort study used validated electronic health record-based data from a single tertiary care academic medical center to identify 5129 solid organ transplant recipients who underwent transplant surgery between 1992 and 2017 and were older than 18 years at the time of transplant. The cohort was limited to White patients because they have the highest skin cancer risk based on phenotype. The mean follow-up was 6.6 years. Data were analyzed June 9, 2021, to May 31, 2022. Main Outcomes and Measures Differences in rates of skin cancer development for first and subsequent skin cancers were measured using t test or analysis of variance and χ2 tests for continuous and categorical variables. Rates of skin cancer development were compared based on organ type and patient age at transplant using Fine-Gray tests and cumulative incidence plots. Results A total of 5129 organ transplant recipients (mean [SD] age, 51.3 [12.9] years; 3287 men [64.1%]) were included. Of these, 695 patients (13.6%) had development of at least 1 skin cancer, with 6842 skin cancers identified in the cohort overall. Compared with liver transplant recipients, heart, lung, or kidney recipients were more likely to develop at least 1 skin cancer (χ2 test, 25.6; df, 4; P < .001). There was no significant difference by transplanted organ type in the rate of developing a second or third skin cancer; however, the age at transplant was associated with the time to developing a second (χ2 test, 20.4; df, 4; P < .001) or third (χ2 test, 10.9; df, 4; P < .02) skin cancer. Conclusions and Relevance This cohort study found that there was no difference by organ type for development of subsequent skin cancers in organ transplant recipients, and recipients of all organ types developed additional skin cancers at high rates after the initial skin cancer.
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Affiliation(s)
- Lee Wheless
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- VA Tennessee Valley Healthcare System, Nashville
| | - Nimay Anand
- Meharry Medical College, Nashville, Tennessee
| | - Allison Hanlon
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
- VA Tennessee Valley Healthcare System, Nashville
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
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Affiliation(s)
- Matthew Philip Dizon
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Christina Topham
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Dylan Haynes
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Molly Brazil
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
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Wongvibulsin S, Frech TM, Chren MM, Tkaczyk ER. Expanding Personalized, Data-Driven Dermatology: Leveraging Digital Health Technology and Machine Learning to Improve Patient Outcomes. JID Innov 2022; 2:100105. [PMID: 35462957 PMCID: PMC9026581 DOI: 10.1016/j.xjidi.2022.100105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022] Open
Abstract
The current revolution of digital health technology and machine learning offers enormous potential to improve patient care. Nevertheless, it is essential to recognize that dermatology requires an approach different from those of other specialties. For many dermatological conditions, there is a lack of standardized methodology for quantitatively tracking disease progression and treatment response (clinimetrics). Furthermore, dermatological diseases impact patients in complex ways, some of which can be measured only through patient reports (psychometrics). New tools using digital health technology (e.g., smartphone applications, wearable devices) can aid in capturing both clinimetric and psychometric variables over time. With these data, machine learning can inform efforts to improve health care by, for example, the identification of high-risk patient groups, optimization of treatment strategies, and prediction of disease outcomes. We use the term personalized, data-driven dermatology to refer to the use of comprehensive data to inform individual patient care and improve patient outcomes. In this paper, we provide a framework that includes data from multiple sources, leverages digital health technology, and uses machine learning. Although this framework is applicable broadly to dermatological conditions, we use the example of a serious inflammatory skin condition, chronic cutaneous graft-versus-host disease, to illustrate personalized, data-driven dermatology.
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Affiliation(s)
- Shannon Wongvibulsin
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tracy M. Frech
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- VA Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee, USA
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric R. Tkaczyk
- VA Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Engineering, School of Engineering, Vanderbilt University, Nashville, Tennessee, USA
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Linos E, Berger T, Chren MM. In reply: Counterpoint: Limited life expectancy, basal cell carcinoma, health care today, and unintended consequences. J Am Acad Dermatol 2022; 86:e203. [PMID: 35430052 DOI: 10.1016/j.jaad.2015.10.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 09/29/2015] [Accepted: 10/02/2015] [Indexed: 10/18/2022]
Affiliation(s)
- Eleni Linos
- Department of Dermatology, University of California, San Francisco, California.
| | - Timothy Berger
- Department of Dermatology, University of California, San Francisco, California
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco, California; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
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Secrest AM, Chren MM. Incorporating patient-reported outcomes as a vital sign for dermatologic clinical care and clinical investigations. J Invest Dermatol 2022; 142:1529-1532. [DOI: 10.1016/j.jid.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022]
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Anand N, Edwards L, Baker LX, Chren MM, Wheless L. Validity of Using Billing Codes From Electronic Health Records to Estimate Skin Cancer Counts. JAMA Dermatol 2021; 157:1089-1094. [PMID: 34379079 DOI: 10.1001/jamadermatol.2021.2856] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Patients can develop multiple skin cancers, and their medical data can be spread over multiple health care systems. This fragmented care, combined with the lack of skin cancer registries, has limited our ability both to provide accurate estimates of incidence and to study the pathogenesis of multiple skin cancers. Objective To assess whether standard diagnostic and procedural codes present in the electronic health records at a single health care system are a valid proxy for estimating the number of overall skin cancers. Design, Setting, and Participants Retrospective cohort study of patients seen at a single-center tertiary care hospital (ie, Vanderbilt University Medical Center) between July 1, 2008, and June 30, 2018. All patients with at least 1 electronic health record-based diagnostic or procedural code for any skin cancer and at least 1 pathology report of a skin cancer. Exposure The number of International Classification of Disease (ICD) or Current Procedural Terminology (CPT) codes relating to skin cancer. Main Outcomes and Measures Pearson correlation coefficient and R2 were calculated for the total number of ICD or CPT codes for skin cancer and histologically verified skin cancers. Results In this cohort study of 35 901 patients, the mean (SD) age was 70.4 (14.4) years, 20 404 (56.8%) were men, and 31 623 (88.1%) were White individuals. Of these patients, 6307 had at least 1 ICD or CPT code or pathology report for a skin cancer, of whom 5688 patients had both a CPT code related to skin malignancy and a histologically verified skin cancer. There was a strong linear correlation between the number of CPT codes and pathology records (r = 0.87). There was a poor correlation between the number of ICD codes and pathology records (r = 0.22). Conclusions and Relevance This cohort study found that the use of ICD codes was a poor proxy measure for the number of skin cancers per patient. In contrast, CPT codes accounted for more than 75% of the variability in the number of skin cancers (R2 = 0.76) and were a better proxy measure for the total number of skin cancers per patient.
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Affiliation(s)
- Nimay Anand
- School of Medicine, Meharry Medical College, Nashville, Tennessee
| | - LaVar Edwards
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee.,SyTrue Inc, Brentwood, Tennessee
| | - Laura X Baker
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lee Wheless
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
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Affiliation(s)
- Eleni Linos
- Department of Dermatology, Stanford University, Stanford, California
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
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Secrest AM, Hopkins ZH, Frost ZE, Taliercio VL, Edwards LD, Biber JE, Chen SC, Chren MM, Ferris LK, Kean J, Hess R. Quality of Life Assessed Using Skindex-16 Scores Among Patients With Acne Receiving Isotretinoin Treatment. JAMA Dermatol 2021; 156:1098-1106. [PMID: 32639529 DOI: 10.1001/jamadermatol.2020.2330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Acne is a common dermatologic condition and significantly affects psychosocial health and quality of life. An international task force recommended routine use of quality-of-life measures for clinic visits associated with acne management, but this has yet to translate into clinical practice. Objective To assess mean Skindex-16 scores over time among patients with moderate to severe acne receiving isotretinoin treatment. Design, Setting, and Participants A longitudinal, retrospective case series study of Skindex-16 data collected at monthly visits from 57 consecutive patients with acne receiving isotretinoin; data were collected and evaluated between November 23, 2016, and January 22, 2019. Continuous variables were compared using quantile regression. Multivariable linear mixed models evaluated mean (95% CI) score trajectory over time. Main Outcomes and Measure Skindex-16 scores, including normalized scores for the emotional, symptomatic, and functional aspects of having skin disease as well as an overall score. Results Fifty-seven patients (31 [54.4 %] males, with median [interquartile range] age of 17.2 [15.9-18.1] years) in this case series study completed the Skindex-16 at baseline and at least once during follow-up. Baseline Skindex-16 scores were similar by sex but worse with increasing age. Emotional impact was more bothersome to patients with acne requiring isotretinoin treatment than either symptoms or functioning. Improvements of greater than 50% in overall and Emotional domain scores were seen by month 2 of receiving isotretinoin treatment (eg, overall scores decreased from 39.4 to 17.5 by month 2; a decrease of 22.0; P < .001). Qualitatively, Skindex-16 scores reached their nadir between months 3 and 5; at month 4, overall Skindex-16 scores showed a 4.4-fold improvement (from 39.4 at baseline to 8.9; P < .001) and Emotional domain scores showed a 4.8-fold improvement (from 57.7 at baseline to 11.9; P < .001). Conclusions and Relevance The findings of this case series suggest that patients receiving isotretinoin treatment achieve greater than a 50% improvement in quality of life by month 2 and can expect approximately 4-fold to 5-fold improvements from baseline with a full course of isotretinoin. This study shows the potential of routine administration of quality of life measures to assess patient care in dermatology.
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Affiliation(s)
- Aaron M Secrest
- Department of Dermatology, University of Utah, Salt Lake City.,Department of Population Health Sciences, University of Utah, Salt Lake City
| | | | - Zachary E Frost
- Department of Dermatology, University of Utah, Salt Lake City
| | | | - LaVar D Edwards
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joshua E Biber
- Department of Population Health Sciences, University of Utah, Salt Lake City
| | - Suephy C Chen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.,Regional TeleHealth Services, Atlanta Veterans Affairs Health Care System, Atlanta, Georgia
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jacob Kean
- Department of Population Health Sciences, University of Utah, Salt Lake City
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City.,Department of Internal Medicine, University of Utah, Salt Lake City
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Joseph A, Prasad S, Hynan LS, Chren MM, Chong B. Differences in quality of life in patients with cutaneous lupus erythematosus with varying income levels. Lupus 2021; 30:972-980. [PMID: 33663251 DOI: 10.1177/0961203321999724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cutaneous lupus erythematosus (CLE) is an autoimmune photosensitive skin condition. The impact of income on quality of life has been incompletely characterized in CLE. OBJECTIVES We aimed to assess how annual income affects quality of life among CLE patients. METHODS In this cross-sectional study of 238 patients with CLE, relationships between predictor variables including annual income and each SKINDEX-29 + 3 subdomain were identified using univariate and multivariable analyses. In addition, answers to individual SKINDEX-29 + 3 questions were compared across income groups. Clinical factors in patients making less than <10,000 USD (N = 85) with worse SKINDEX-29 + 3 scores were also identified by univariate and multivariable analyses. RESULTS Patients making <10,000 USD annually experienced worse quality of life across multiple SKINDEX-29 + 3 subdomains (p < 0.05). These patients specifically experienced poorer quality of life relating to social isolation and self-consciousness. (p < 0.001). Among those making <10,000 USD, predictors for worse quality of life included females, smokers, and those with higher skin disease activity were identified (p < 0.05).Limitations: This is a single center study. Income was also self-reported and could not be verified. CONCLUSIONS Lower income is related to poorer quality of life in patients with CLE. Specifically, patients experience limitations regarding social isolation and self-consciousness.
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Affiliation(s)
- Adrienne Joseph
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Smriti Prasad
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Linda S Hynan
- Department of Population and Data Sciences and Psychiatry, University of Texas at Southwestern , Dallas, TX, USA Medical Center
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin Chong
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
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Prasad S, Hynan L, Chren MM, Chong B. AB002. Quality of life is inversely related to income in patients with cutaneous lupus. Ann Transl Med 2021. [PMCID: PMC8033296 DOI: 10.21037/atm.2021.ab002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recent studies demonstrated cutaneous lupus erythematosus (CLE)’s profound impact on quality of life (QoL), but few have examined the association between income and QoL in CLE patients. To address this knowledge gap, we performed a cross-sectional analysis of 238 patients with CLE from outpatient dermatology clinics at University of Texas Southwestern Medical Center and Parkland Health and Hospital System, a safety-net hospital in Dallas, TX, from November 2008 to December 2018. First, we investigated differences in overall QoL, as measured by the four SKINDEX 29+3 subdomain scores (emotions, function, symptoms and lupus-specific), amongst CLE patients of different income groups (<$10,000/year, $10,000–$50,000/year, >$50,000/year). Next, we identified which aspects of QoL, as specified by individual SKINDEX 29+3 questions, were most frequently impaired in CLE patients of various incomes. Chi-squared tests were used to assess how responses to each question varied across income groups. Of the 238 patients, the majority of patients earned between $10,000–$50,000/year (n=88) or <$10,000/year (n=85). The four SKINDEX 29+3 subdomain scores decreased as annual income increased. In all cases, the lowest income group had higher scores (or worse QoL) than the other two groups (P<0.05 for lupus-specific, P<0.01 for function and symptoms, P<0.001 for emotions). Chi-square results of all SKINDEX 29+3 questions with annual income revealed 9 significant questions. Compared with patients with $10,000–$50,000/year, and >$50,000/year, those with <$10,000/year more often reported impairment in aspects regarding emotion, such as anger and embarrassment, as well as general function, particularly pertaining to isolation and desire to be with others (P≤0.001 for all questions). In conclusion, we have shown that annual income has an inverse relationship to QoL in patients with CLE. Poor QoL, particularly in the context of social detachment, may hinder patients of low socioeconomic status to seek out necessary care, follow physician recommendations and communicate freely about changes in their disease state. We recommend clinicians remain cognizant of the socioeconomic status of patients with CLE, given its effects on their QoL.
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Affiliation(s)
- Smriti Prasad
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Linda Hynan
- Department of Population and Data Sciences, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Dallas, TX, USA
| | - Benjamin Chong
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
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Wheless L, Baker L, Edwards L, Anand N, Birdwell K, Hanlon A, Chren MM. Development of Phenotyping Algorithms for the Identification of Organ Transplant Recipients: Cohort Study. JMIR Med Inform 2020; 8:e18001. [PMID: 33156808 PMCID: PMC7759442 DOI: 10.2196/18001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/21/2020] [Accepted: 10/31/2020] [Indexed: 12/20/2022] Open
Abstract
Background Studies involving organ transplant recipients (OTRs) are often limited to the variables collected in the national Scientific Registry of Transplant Recipients database. Electronic health records contain additional variables that can augment this data source if OTRs can be identified accurately. Objective The aim of this study was to develop phenotyping algorithms to identify OTRs from electronic health records. Methods We used Vanderbilt’s deidentified version of its electronic health record database, which contains nearly 3 million subjects, to develop algorithms to identify OTRs. We identified all 19,817 individuals with at least one International Classification of Diseases (ICD) or Current Procedural Terminology (CPT) code for organ transplantation. We performed a chart review on 1350 randomly selected individuals to determine the transplant status. We constructed machine learning models to calculate positive predictive values and sensitivity for combinations of codes by using classification and regression trees, random forest, and extreme gradient boosting algorithms. Results Of the 1350 reviewed patient charts, 827 were organ transplant recipients while 511 had no record of a transplant, and 12 were equivocal. Most patients with only 1 or 2 transplant codes did not have a transplant. The most common reasons for being labeled a nontransplant patient were the lack of data (229/511, 44.8%) or the patient being evaluated for an organ transplant (174/511, 34.1%). All 3 machine learning algorithms identified OTRs with overall >90% positive predictive value and >88% sensitivity. Conclusions Electronic health records linked to biobanks are increasingly used to conduct large-scale studies but have not been well-utilized in organ transplantation research. We present rigorously evaluated methods for phenotyping OTRs from electronic health records that will enable the use of the full spectrum of clinical data in transplant research. Using several different machine learning algorithms, we were able to identify transplant cases with high accuracy by using only ICD and CPT codes.
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Affiliation(s)
- Lee Wheless
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Laura Baker
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - LaVar Edwards
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Nimay Anand
- Meharry Medical College, Nashville, TN, United States
| | - Kelly Birdwell
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Allison Hanlon
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, United States
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Junn A, Shukla NR, Morrison L, Halley M, Chren MM, Walter LC, Frosch DL, Matlock D, Torres JS, Linos E. Development of a patient decision aid for the management of superficial basal cell carcinoma (BCC) in adults with a limited life expectancy. BMC Med Inform Decis Mak 2020; 20:81. [PMID: 32349762 PMCID: PMC7191775 DOI: 10.1186/s12911-020-1081-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 03/29/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Basal cell carcinoma (BCC) is a slow-growing, rarely lethal skin cancer that affects people 65 years or older. A range of treatment options exist for BCC, but there is little evidence available to guide patients and providers in selecting the best treatment options. OBJECTIVES This study outlines the development of a patient decision aid (PDA) for low-risk BCC that can be used by patients and providers to assist in shared decision-making. METHODS In accordance with the International Patient Decision Aids Standards (IPDAS) Collaboration framework, feedback from focus groups and semi-structured interviews with patients and providers, an initial prototype of the PDA was developed. This was tested using cognitive interviews and iteratively updated. RESULTS We created eighteen different iterations using feedback from 24 patients and 34 providers. The key issues identified included: 1) Addressing fear of cancer; 2) Communicating risk and uncertainty; 3) Values clarification; and 4) Time lag to benefit. LIMITATIONS The PDA does not include all possible treatment options and is currently paper based. CONCLUSIONS Our PDA has been specifically adapted and designed to support patients with a limited life expectancy in making decisions about their low risk BCC together with their doctors.
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Affiliation(s)
- Alexandra Junn
- Program for Clinical Research, Department of Dermatology, University of California San Francisco, San Francisco, USA
| | - Neha R Shukla
- Program for Clinical Research, Department of Dermatology, University of California San Francisco, San Francisco, USA
| | - Lily Morrison
- Department of Dermatology, Stanford University, CCSR Building Room 4235, 269 Campus Drive, Stanford, USA
| | - Meghan Halley
- Department of Dermatology, Stanford University, CCSR Building Room 4235, 269 Campus Drive, Stanford, USA
- Palo Alto Medical Foundation Research Institute, Palo Alto, USA
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Centre, Tennessee, Nashville, USA
| | - Louise C Walter
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, USA
- San Francisco and San Francisco VA Medical Center, San Francisco, USA
| | - Dominick L Frosch
- Palo Alto Medical Foundation Research Institute, Palo Alto, USA
- Department of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Dan Matlock
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Centre, Denver, USA
| | - Jeanette S Torres
- Program for Clinical Research, Department of Dermatology, University of California San Francisco, San Francisco, USA
| | - Eleni Linos
- Department of Dermatology, Stanford University, CCSR Building Room 4235, 269 Campus Drive, Stanford, USA.
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16
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Affiliation(s)
- Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
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17
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Adekunle L, Chen R, Morrison L, Halley M, Eng V, Hendlin Y, Wehner MR, Chren MM, Linos E. Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning: systematic review. BMJ 2020; 368:m7. [PMID: 32019742 PMCID: PMC7190068 DOI: 10.1136/bmj.m7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess whether an association exists between financial links to the indoor tanning industry and conclusions of indoor tanning literature. DESIGN Systematic review. DATA SOURCES PubMed, Embase, and Web of Science, up to 15 February 2019. STUDY SELECTION CRITERIA Articles discussing indoor tanning and health were eligible for inclusion, with no article type restrictions (original research, systematic reviews, review articles, case reports, editorials, commentaries, and letters were all eligible). Basic science studies, articles describing only indoor tanning prevalence, non-English articles, and articles without full text available were excluded. RESULTS 691 articles were included in analysis, including empiric articles (eg, original articles or systematic reviews) (357/691; 51.7%) and non-empiric articles letters (eg, commentaries, letters, or editorials) (334/691; 48.3%). Overall, 7.2% (50/691) of articles had financial links to the indoor tanning industry; 10.7% (74/691) articles favored indoor tanning, 3.9% (27/691) were neutral, and 85.4% (590/691) were critical of indoor tanning. Among the articles without industry funding, 4.4% (27/620) favored indoor tanning, 3.5% (22/620) were neutral, and 92.1% (571/620) were critical of indoor tanning. Among the articles with financial links to the indoor tanning industry, 78% (39/50) favored indoor tanning, 10% (5/50) were neutral, and 12% (6/50) were critical of indoor tanning. Support from the indoor tanning industry was significantly associated with favoring indoor tanning (risk ratio 14.3, 95% confidence interval 10.0 to 20.4). CONCLUSIONS Although most articles in the indoor tanning literature are independent of industry funding, articles with financial links to the indoor tanning industry are more likely to favor indoor tanning. Public health practitioners and researchers need to be aware of and account for industry funding when interpreting the evidence related to indoor tanning. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019123617.
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Affiliation(s)
- Lola Adekunle
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Rebecca Chen
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Lily Morrison
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Meghan Halley
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Victor Eng
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Yogi Hendlin
- School of Philosophy Erasmus University, Rotterdam, Netherlands
| | - Mackenzie R Wehner
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
- Departments of Health Services Research and of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eleni Linos
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
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18
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Affiliation(s)
- Eleni Linos
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ken Covinsky
- Department of Medicine, University of California, San Francisco, San Francisco
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19
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Cenzer I, Nkansah-Mahaney N, Wehner M, Chren MM, Berger T, Covinsky K, Berger K, Abuabara K, Linos E. A multiyear cross-sectional study of U.S. national prescribing patterns of first-generation sedating antihistamines in older adults with skin disease. Br J Dermatol 2019; 182:763-769. [PMID: 31021412 DOI: 10.1111/bjd.18042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND First-generation antihistamines (FGAs) are classified as 'potentially inappropriate' for use in older patients (patients aged ≥ 65 years). However, the prevalence of and factors associated with FGA prescription have not been studied. OBJECTIVES To examine FGA prescription rates for older patients who visited dermatology offices, and compare them to those for younger patients (patients aged 18-65 years) who visited dermatology offices and those for older patients who visited primary-care physicians (PCPs). METHODS This was a multiyear cross-sectional observational study using data from the U.S. National Ambulatory Medical Care Survey (2006-2015). Visits by patients aged 18 years or older were included in the study; the data comprised 15 243 dermatology office visits and 66 036 PCP office visits. The main outcome was FGA prescription. Other variables included physician specialty (dermatologist or PCP), patient's age, diagnosis of dermatological conditions and reason for visit. RESULTS For dermatology visits, the overall FGA prescription rate for older patients was similar to that for younger patients (1·5% vs. 1·2%; P = 0·19), even when the diagnosis was dermatitis or pruritus (3·7% vs. 4·8%; P = 0·21) or when itch was a complaint (7·6% vs. 6·7%; P = 0·64). However, the rate of FGA prescription for dermatology visits was lower than that for PCP visits, in analyses matched for patient and visit characteristics (3·9% vs. 7·4%; P = 0·02). CONCLUSIONS Our findings suggest that FGAs are overprescribed to older patients but that dermatologists are less likely to prescribe FGAs than PCPs. What's already known about this topic? First-generation antihistamines (FGAs) have been shown to pose substantial risks to older adults, including cognitive impairment, falls, confusion, dry mouth and constipation. Therefore, FGAs have been classified as 'potentially inappropriate' for use in older patients by the American Geriatrics Society. It has also been shown that dermatologists do not always take patient characteristics (e.g. age or life expectancy) into account when deciding on a treatment, instead following a 'one-size-fits-all' approach. What does this study add? FGAs are often prescribed during dermatology visits, and prescription rates do not differ between older and younger patients. There were no significant differences in prescription rates when comparing younger and older adults with the same diagnosis or symptom (e.g. dermatitis, pruritus or itch). FGAs are prescribed at higher rates in primary-care offices than in dermatology offices.
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Affiliation(s)
- I Cenzer
- Division of Geriatrics, University of California, San Francisco, CA, U.S.A.,Department of Medicine III, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - N Nkansah-Mahaney
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - M Wehner
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - M M Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, U.S.A
| | - T Berger
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, CA, U.S.A
| | - K Covinsky
- Division of Geriatrics, University of California, San Francisco, CA, U.S.A.,Veterans Affairs Medical Center, San Francisco, CA, U.S.A
| | - K Berger
- Division of Geriatrics, University of California, San Francisco, CA, U.S.A
| | - K Abuabara
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, CA, U.S.A
| | - E Linos
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, U.S.A
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20
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Ramirez FD, Chen S, Langan SM, Prather AA, McCulloch CE, Kidd SA, Cabana MD, Chren MM, Abuabara K. Assessment of Sleep Disturbances and Exhaustion in Mothers of Children With Atopic Dermatitis. JAMA Dermatol 2019; 155:556-563. [PMID: 30892577 PMCID: PMC6506883 DOI: 10.1001/jamadermatol.2018.5641] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance The well-being and development of children is strongly influenced by parents' physical and psychosocial health. Data from small, clinic-based studies suggest that sleep loss may be common in parents of children with atopic dermatitis (AD), but longitudinal population-based studies are lacking. Objectives To compare sleep disturbances over time between mothers of children with and without AD and to determine whether these disturbances are associated with the child's disease severity and the child's sleep disturbances. Design, Setting, and Participants In the ongoing Avon Longitudinal Study of Parents and Children, all pregnant women residing in Avon, United Kingdom, with an expected delivery date between April 1, 1991, and December 31, 1992, were recruited. Analyses for this study, a secondary analysis of this cohort, were performed from September 2017 to September 2018. Mother-child pairs were followed up with a time-varying measure of child AD activity and severity and self-reported maternal sleep measures repeated at multiple time points between child ages 6 months and 11 years. Main Outcomes and Measures Time-varying binary measures of maternal sleep duration (<6 vs ≥6 hours per night), difficulty falling asleep, early morning awakening, subjectively insufficient sleep, and daytime exhaustion. Results The study followed up 13 988 mother-child pairs from birth for a median duration of 11 (interquartile range, 7-11) years. Among the cohort, 11 585 of 13 972 mothers (82.9%) were aged 21 to 34 years and 12 001 of 12 324 (97.4%) were of white race/ethnicity; 7220 of 13 978 children (51.7%) were male. Sleep duration (adjusted odds ratio [AOR], 1.09; 95% CI, 0.90-1.32) and early morning awakenings (AOR, 1.16; 95% CI, 0.93-1.46) were similar between mothers of children with and without AD. In contrast, mothers of children with AD were more likely to report difficulty falling asleep (AOR, 1.36; 95% CI, 1.01-1.83), subjectively insufficient sleep (AOR, 1.43; 95% CI, 1.24-1.66), and daytime exhaustion (AOR, 1.41; 95% CI, 1.12-1.78) independent of the child's comorbid asthma and/or allergic rhinitis. For all measures, worse child AD severity was associated with worse maternal sleep outcomes. The magnitude and significance of the associations were largely unchanged after adjustment for child sleep disturbances. Conclusions and Relevance Mothers of children with AD reported difficulty falling asleep, subjectively insufficient sleep, and daytime exhaustion throughout the first 11 years of childhood. However, child sleep disturbances did not fully explain maternal sleep disturbances, and future research should investigate other mechanisms. In caring for children with AD, clinicians should consider maternal sleep disturbances and caregiver fatigue.
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Affiliation(s)
- Faustine D Ramirez
- Medical student, Department of Dermatology Program for Clinical Research, University of California, San Francisco
| | - Shelley Chen
- Medical student, Department of Dermatology Program for Clinical Research, University of California, San Francisco
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aric A Prather
- Department of Psychiatry, University of California, San Francisco
| | - Charles E McCulloch
- Department of Dermatology Program for Clinical Research, University of California, San Francisco
| | - Sharon A Kidd
- Department of Dermatology Program for Clinical Research, University of California, San Francisco
| | - Michael D Cabana
- Department of Epidemiology & Biostatistics, University of California, San Francisco.,Department of Pediatrics, University of California, San Francisco.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katrina Abuabara
- Department of Dermatology Program for Clinical Research, University of California, San Francisco
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21
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Abstract
Importance Pruritus, a hallmark of atopic dermatitis (AD), is thought to disrupt sleep, yet little is known about how variations in disease activity and severity of this common childhood condition may be associated with sleep patterns over time. Objective To determine whether children with active AD have impaired sleep duration and quality at multiple time points throughout childhood and whether disease severity affects sleep outcomes. Design, Setting, and Participants This longitudinal cohort study used data of children enrolled in the Avon Longitudinal Study of Parents and Children, a population-based birth cohort in Avon, United Kingdom. Participants were children (N = 13 988) alive at 1 year and followed up with repeated measures of self-reported AD and sleep through 16 years of age. This study was based on data collected from 1990 to 2008. Data analysis was performed from September 2017 to September 2018. Main Outcomes and Measures Standardized measure of sleep duration and composite measure of sleep quality, including nighttime awakenings, early morning awakenings, difficulty falling asleep, and nightmares, were repeated at multiple time points between 2 and 16 years of age. Results The study sample comprised 13 988 children (7220 male [51.6%]) followed up for a median (interquartile range [IQR]) duration of 11 (5-14) years. Of this total, 4938 children (35.3%) met the definition of having atopic dermatitis between 2 and 16 years of age. Total sleep duration was similar between children with active AD and without AD at all ages, and the average estimated difference across childhood was a clinically negligible difference of 2 minutes less per day for children with AD (95% CI, -4 to 0 minutes). In contrast, children with active AD were more likely to report worse sleep quality at all time points, with a nearly 50% higher odds of experiencing more sleep-quality disturbances (adjusted odds ratio [aOR], 1.48; 95% CI, 1.33 to 1.66). Children with more severe active disease (quite bad or very bad AD: aOR, 1.68; 95% CI, 1.42 to 1.98) and with comorbid asthma or allergic rhinitis (aOR, 1.79; 95% CI, 1.54 to 2.09) had worse sleep quality. However, even children with mild AD (OR, 1.40; 95% CI, 1.27 to 1.54) or inactive AD (OR, 1.41; 95% CI, 1.28 to 1.55) had statistically significantly increased odds of impaired sleep quality. Conclusions and Relevance Atopic dermatitis appeared to be associated with impaired sleep quality throughout childhood; thus, it is suggested that clinicians should consider sleep quality among all children with AD, especially those with comorbid asthma or allergic rhinitis and severe disease, and that interventions to improve sleep quality are needed.
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Affiliation(s)
- Faustine D Ramirez
- Department of Dermatology Program for Clinical Research, University of California, San Francisco, San Francisco
| | - Shelley Chen
- Department of Dermatology Program for Clinical Research, University of California, San Francisco, San Francisco
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aric A Prather
- Department of Psychiatry, University of California, San Francisco, San Francisco
| | - Charles E McCulloch
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco
| | - Sharon A Kidd
- Department of Dermatology Program for Clinical Research, University of California, San Francisco, San Francisco
| | - Michael D Cabana
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco.,Department of Pediatrics, University of California, San Francisco, San Francisco.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katrina Abuabara
- Department of Dermatology Program for Clinical Research, University of California, San Francisco, San Francisco
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22
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Siegel JA, Beatson M, Chren MM, Weinstock MA. Effects of new keratinocyte carcinomas on skin-related quality of life: Results from the Veterans Affairs Keratinocyte Carcinoma Chemoprevention Trial. J Am Acad Dermatol 2019; 80:1458-1459. [PMID: 30639882 DOI: 10.1016/j.jaad.2018.12.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/06/2018] [Accepted: 12/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Julia A Siegel
- Center for Dermatoepidemiology 111D, Veterans Affairs Medical Center, Providence, Rhode Island; Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Meghan Beatson
- Center for Dermatoepidemiology 111D, Veterans Affairs Medical Center, Providence, Rhode Island; Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island; George Washington University School of Medicine, Washington, DC.
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Martin A Weinstock
- Center for Dermatoepidemiology 111D, Veterans Affairs Medical Center, Providence, Rhode Island; Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island
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Linos E, Chren MM, Covinsky K. Creating a Partnership Between Dermatologists and Geriatricians-Reply. JAMA Dermatol 2019; 155:125-126. [PMID: 30484815 DOI: 10.1001/jamadermatol.2018.3660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Eleni Linos
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco
| | - Mary-Margaret Chren
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco
| | - Ken Covinsky
- Department of Medicine, University of California, San Francisco
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24
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Neugebauer R, Su KA, Zhu Z, Sokil M, Chren MM, Friedman GD, Asgari MM. Comparative effectiveness of treatment of actinic keratosis with topical fluorouracil and imiquimod in the prevention of keratinocyte carcinoma: A cohort study. J Am Acad Dermatol 2018. [PMID: 30458208 DOI: 10.1016/j.jaad.2018.11.024.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The effectiveness of 5-fluorouracil compared with that of imiquimod for preventing keratinocyte carcinoma is unknown. OBJECTIVE To compare the effectiveness of 5-fluorouracil and that of imiquimod in preventing keratinocyte carcinoma in a real-world practice setting. METHODS We identified 5700 subjects who filled prescriptions for 5-fluorouracil or imiquimod for treatment of actinic keratosis in 2007. An intention-to-treat analysis controlling for potential confounding variables was used to calculate 2- and 5-year cumulative risk differences for subsequent keratinocyte carcinoma overall and in field-treated areas. RESULTS 5-Fluorouracil was associated with a statistically significant decreased risk of any keratinocyte carcinoma compared with imiquimod (adjusted hazard ratio [aHR], 0.86; 95% confidence interval [CI], 0.76-0.97), but there were no significant differences in risk by tumor subtype (for squamous cell carcinoma: aHR, 0.89; 95% CI, 0.74-1.07; for basal cell carcinoma: aHR, 0.87; 95% CI, 0.74-1.03) or site-specific keratinocyte carcinoma (aHR, 0.96; 95% CI, 0.81-1.14). There were no significant differences in 2- or 5-year cumulative risk of keratinocyte carcinoma among those treated with 5-fluorouracil versus with imiquimod. LIMITATIONS Generalizability to other practice settings may be limited. CONCLUSIONS Whereas 5-fluorouracil was more effective in reducing keratinocyte carcinoma risk overall, we found no differences in the short- or long-term risk of subsequent site-specific keratinocyte carcinoma in a real-world practice setting.
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Affiliation(s)
- Romain Neugebauer
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Katherine A Su
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Zheng Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Monica Sokil
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gary D Friedman
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Maryam M Asgari
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
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25
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Neugebauer R, Su KA, Zhu Z, Sokil M, Chren MM, Friedman GD, Asgari MM. Comparative effectiveness of treatment of actinic keratosis with topical fluorouracil and imiquimod in the prevention of keratinocyte carcinoma: A cohort study. J Am Acad Dermatol 2018; 80:998-1005. [PMID: 30458208 DOI: 10.1016/j.jaad.2018.11.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/30/2018] [Accepted: 11/11/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The effectiveness of 5-fluorouracil compared with that of imiquimod for preventing keratinocyte carcinoma is unknown. OBJECTIVE To compare the effectiveness of 5-fluorouracil and that of imiquimod in preventing keratinocyte carcinoma in a real-world practice setting. METHODS We identified 5700 subjects who filled prescriptions for 5-fluorouracil or imiquimod for treatment of actinic keratosis in 2007. An intention-to-treat analysis controlling for potential confounding variables was used to calculate 2- and 5-year cumulative risk differences for subsequent keratinocyte carcinoma overall and in field-treated areas. RESULTS 5-Fluorouracil was associated with a statistically significant decreased risk of any keratinocyte carcinoma compared with imiquimod (adjusted hazard ratio [aHR], 0.86; 95% confidence interval [CI], 0.76-0.97), but there were no significant differences in risk by tumor subtype (for squamous cell carcinoma: aHR, 0.89; 95% CI, 0.74-1.07; for basal cell carcinoma: aHR, 0.87; 95% CI, 0.74-1.03) or site-specific keratinocyte carcinoma (aHR, 0.96; 95% CI, 0.81-1.14). There were no significant differences in 2- or 5-year cumulative risk of keratinocyte carcinoma among those treated with 5-fluorouracil versus with imiquimod. LIMITATIONS Generalizability to other practice settings may be limited. CONCLUSIONS Whereas 5-fluorouracil was more effective in reducing keratinocyte carcinoma risk overall, we found no differences in the short- or long-term risk of subsequent site-specific keratinocyte carcinoma in a real-world practice setting.
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Affiliation(s)
- Romain Neugebauer
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Katherine A Su
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Zheng Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Monica Sokil
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gary D Friedman
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Maryam M Asgari
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
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Armstrong AW, Chambers CJ, Maverakis E, Cheng MY, Dunnick CA, Chren MM, Gelfand JM, Wong DJ, Gibbons BM, Gibbons CM, Torres J, Steel AC, Wang EA, Clark CM, Singh S, Kornmehl HA, Wilken R, Florek AG, Ford AR, Ma C, Ehsani-Chimeh N, Boddu S, Fujita M, Young PM, Rivas-Sanchez C, Cornejo BI, Serna LC, Carlson ER, Lane CJ. Effectiveness of Online vs In-Person Care for Adults With Psoriasis: A Randomized Clinical Trial. JAMA Netw Open 2018; 1:e183062. [PMID: 30646223 PMCID: PMC6324453 DOI: 10.1001/jamanetworkopen.2018.3062] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Innovative, online models of specialty-care delivery are critical to improving patient access and outcomes. OBJECTIVE To determine whether an online, collaborative connected-health model results in equivalent clinical improvements in psoriasis compared with in-person care. DESIGN, SETTING, AND PARTICIPANTS The Patient-Centered Outcomes Research Institute Psoriasis Teledermatology Trial is a 12-month, pragmatic, randomized clinical equivalency trial to evaluate the effect of an online model for psoriasis compared with in-person care. Participant recruitment and study visits took place at multicenter ambulatory clinics from February 2, 2015, to August 18, 2017. Participants were adults with psoriasis in Northern California, Southern California, and Colorado. The eligibility criteria were an age of 18 years or older, having physician-diagnosed psoriasis, access to the internet and a digital camera or mobile phone with a camera, and having a primary care physician. Analyses were on an intention-to-treat basis. INTERVENTIONS Participants were randomized 1:1 to receive online or in-person care (148 randomized to online care and 148 randomized to in-person care). The online model enabled patients and primary care physicians to access dermatologists online asynchronously. The dermatologists provided assessments, recommendations, education, and prescriptions online. The in-person group sought care in person. The frequency of online or in-person visits was determined by medical necessity. All participants were exposed to their respective interventions for 12 months. MAIN OUTCOMES AND MEASURES The prespecified primary outcome was the difference in improvement in the self-administered Psoriasis Area and Severity Index (PASI) score between the online and in-person groups. Prespecified secondary outcomes included body surface area (BSA) affected by psoriasis and the patient global assessment score. RESULTS Of the 296 randomized participants, 147 were women, 149 were men, 187 were white, and the mean (SD) age was 49 (14) years. The adjusted difference between the online and in-person groups in the mean change in the self-administered PASI score during the 12-month study period was -0.27 (95% CI, -0.85 to 0.31). The difference in the mean change in BSA affected by psoriasis between the 2 groups was -0.05% (95% CI, -1.58% to 1.48%). Between-group differences in the PASI score and BSA were within prespecified equivalence margins, which demonstrated equivalence between the 2 interventions. The difference in the mean change in the patient global assessment score between the 2 groups was -0.11 (95% CI, -0.32 to 0.10), which exceeded the equivalence margin, with the online group displaying greater improvement. CONCLUSIONS AND RELEVANCE The online, collaborative connected-health model was as effective as in-person management in improving clinical outcomes among patients with psoriasis. Innovative telehealth delivery models that emphasize collaboration, quality, and efficiency can be transformative to improving patient-centered outcomes in chronic diseases. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02358135.
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Affiliation(s)
- April W. Armstrong
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Cindy J. Chambers
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Emanual Maverakis
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Michelle Y. Cheng
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Cory A. Dunnick
- Department of Dermatology, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joel M. Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - David J. Wong
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Brittany M. Gibbons
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Caitlin M. Gibbons
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Josefina Torres
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Andrea C. Steel
- Department of Dermatology, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | - Elizabeth A. Wang
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Caitlin M. Clark
- University of Hawaii–Manoa John A. Burns School of Medicine, Honolulu
| | - Sanminder Singh
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | | | - Reason Wilken
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Aleksandra G. Florek
- Department of Dermatology, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | - Adam R. Ford
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Chelsea Ma
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Nazanin Ehsani-Chimeh
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Sucharita Boddu
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Mayumi Fujita
- Department of Dermatology, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | - Paulina M. Young
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Cesar Rivas-Sanchez
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Brenda I. Cornejo
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Laura C. Serna
- Clinical and Translational Science Institute, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Eric R. Carlson
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado
| | - Christianne J. Lane
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles
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27
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Wehner MR, Dalma N, Landefeld C, Pare-Anastasiadou A, Koutelidas I, Chren MM, Aji N, Teng CE, Koenig BA, Tang J, Covinsky K, Linos E. Natural history of lesions suspicious for basal cell carcinoma in older adults in Ikaria, Greece. Br J Dermatol 2018; 179:767-768. [PMID: 29741766 DOI: 10.1111/bjd.16730] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- M R Wehner
- Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, U.S.A
| | - N Dalma
- Institute of Preventive Medicine, Environmental and Occupational Health, Maroussi, Greece
| | - C Landefeld
- Cleveland Clinic, Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, U.S.A
| | - A Pare-Anastasiadou
- Institute of Preventive Medicine, Environmental and Occupational Health, Maroussi, Greece.,Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - I Koutelidas
- Institute of Preventive Medicine, Environmental and Occupational Health, Maroussi, Greece
| | - M M Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, U.S.A.,Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A
| | - N Aji
- University of California Davis, Davis, CA, U.S.A
| | - C E Teng
- University of California Berkeley, Berkeley, CA, U.S.A
| | - B A Koenig
- Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A.,School of Nursing, University of California San Francisco, San Francisco, CA, U.S.A
| | - J Tang
- Stanford University, Stanford, CA, U.S.A
| | - K Covinsky
- Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A
| | - E Linos
- Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A
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28
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Wehner MR, Cidre Serrano W, Nosrati A, Schoen PM, Chren MM, Boscardin J, Linos E. All-cause mortality in patients with basal and squamous cell carcinoma: A systematic review and meta-analysis. J Am Acad Dermatol 2018; 78:663-672.e3. [PMID: 29146125 PMCID: PMC5886016 DOI: 10.1016/j.jaad.2017.11.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 08/29/2017] [Accepted: 11/07/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND There are varying reports of the association of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) with mortality. OBJECTIVE To synthesize the available information on all-cause mortality after a diagnosis of BCC or SCC in the general population. METHODS We searched PubMed (1966-present), Web of Science (1898-present), and Embase (1947-present) and hand-searched to identify additional records. All English articles that reported all-cause mortality in patients with BCC or SCC were eligible. We excluded case reports, case series, and studies in subpopulations of patients. Random effects model meta-analyses were performed separately for BCC and SCC. RESULTS The searches yielded 6538 articles, and 156 were assessed in a full-text review. Twelve studies met the inclusion criteria, and 4 were included in the meta-analysis (encompassing 464,230 patients with BCC and with 175,849 SCC), yielding summary relative mortalities of 0.92 (95% confidence interval, 0.83-1.02) in BCC and 1.25 (95% confidence interval, 1.17-1.32) in SCC. LIMITATIONS Only a minority of studies controlled for comorbidities. There was significant heterogeneity in meta-analysis (χ2P < .001, I2 > 98%), but studies of SCC were qualitatively concordant: all showed statistically significant increased relative mortality. CONCLUSIONS We found that patients with SCC are at higher risk for death from any cause compared with the general population.
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Affiliation(s)
- Mackenzie R Wehner
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wilmarie Cidre Serrano
- Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Stanford University, Stanford, California
| | - Adi Nosrati
- Dermatology Service, Veterans Affairs Medical Center, San Francisco, California; Department of Dermatology, University of California, San Francisco, California
| | | | - Mary-Margaret Chren
- Dermatology Service, Veterans Affairs Medical Center, San Francisco, California; Department of Dermatology, University of California, San Francisco, California
| | - John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Eleni Linos
- Department of Dermatology, University of California, San Francisco, California.
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29
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Abuabara K, Asgari MM, Chen SC, Dellavalle RP, Kalia S, Secrest AM, Silverberg JI, Solomon JA, Weinstock MA, Wu JJ, Chren MM. How data can deliver for dermatology. J Am Acad Dermatol 2018; 79:400-402. [PMID: 29574090 DOI: 10.1016/j.jaad.2018.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 03/01/2018] [Accepted: 03/13/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Katrina Abuabara
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, California.
| | - Maryam M Asgari
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Suephy C Chen
- Department of Dermatology, Emory University, Atlanta, Georgia; Atlanta Veterans Affairs Medical Center, Aurora, Colorado
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado
| | - Sunil Kalia
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron M Secrest
- Department of Dermatology, University of Utah, Salt Lake City, Utah; Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Jonathan I Silverberg
- Department of Dermatology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - James A Solomon
- Dermatology Department, University of Central Florida, College of Medicine, Orlando, Florida; Ameriderm Research, Ormond Beach, Florida; Department of Medicine, University of Illinois, College of Medicine, Urbana, Illinois
| | - Martin A Weinstock
- Center for DermatoEpidemiology, Veterans Affairs Medical Center, Providence, Rhode Island; Departments of Dermatology and Epidemiology, Brown University, Providence, Rhode Island
| | - Jashin J Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Mary-Margaret Chren
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, California; Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN
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30
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Nosrati A, Pimentel MA, Falzone A, Hegde R, Goel S, Chren MM, Eye R, Linos E, Pagoto S, Walkosz BJ. Skin cancer prevention messages on Facebook: Likes, shares, and comments. J Am Acad Dermatol 2018. [PMID: 29518459 DOI: 10.1016/j.jaad.2018.02.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Adi Nosrati
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California.
| | - Matthew A Pimentel
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Ashley Falzone
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Roshini Hegde
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Shilpa Goel
- Veterans Affairs Medical Center, San Francisco, California
| | - Mary-Margaret Chren
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California
| | | | - Eleni Linos
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Sherry Pagoto
- Department of Medicine, University of Massachusetts, Worcester, Massachusetts
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31
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McLellan C, Frey MP, Thiboutot D, Layton A, Chren MM, Tan J. Development of a Comprehensive Quality-of-Life Measure for Facial and Torso Acne. J Cutan Med Surg 2018; 22:304-311. [PMID: 29383947 DOI: 10.1177/1203475418756379] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Acne is a chronic skin disorder which generally presents in adolescence but continues into adulthood, and negatively affects both physical and psychosocial well-being. Presently, there are no validated acne-specific quality-of-life (QoL) measures that include dimensions for both facial and torso acne. OBJECTIVE The objective of this study was to develop a QoL instrument for both facial and torso acne (CompAQ) in accordance with recommended standards. METHODS A literature review and Delphi survey of patients and clinicians were used to develop the conceptual framework for outcomes perceived important to acne patients. An initial version of the measure was developed, CompAQ-v1, and pilot tested with patients via cognitive interviews. RESULTS The Delphi survey generated 4 domains (physical, psychological, sociological, and treatment) and 54 items. These, along with a literature review and input from clinical experts, informed the development of the CompAQ-v1. Eleven cognitive interviews were conducted, resulting in the second version of the measure, CompAQ-v2. Psychometric validation resulted in the final 20-item CompAQ measure comprising 5 domains. An abbreviated 5-item measure was also developed (CompAQ-SF). CONCLUSION CompAQ and CompAQ-SF are instruments intended to evaluate QoL in patients with acne on their face or torso. The former is a 21-item QoL intended for research, while the latter is intended for clinical practice.
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Affiliation(s)
- Chelsea McLellan
- 1 Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Marc P Frey
- 1 Department of Psychology, University of Windsor, Windsor, ON, Canada
| | | | - Alison Layton
- 4 Harrogate & District NHS Foundation Trust Harrogate and District NHS Foundation Trust, Harrogate, England
| | - Mary-Margaret Chren
- 5 University of California at San Francisco, Department of Dermatology, San Francisco, CA, USA
| | - Jerry Tan
- 2 Windsor Clinical Research, Inc, Windsor, ON, Canada.,6 Department of Medicine, University of Western Ontario, London, ON, Canada
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32
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Affiliation(s)
- Caroline Opene
- Program for Clinical Research, Department of Dermatology, University of California-San Francisco, San Francisco
| | - Mary-Margaret Chren
- Program for Clinical Research, Department of Dermatology, University of California-San Francisco, San Francisco
| | - Eleni Linos
- Program for Clinical Research, Department of Dermatology, University of California-San Francisco, San Francisco
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Wehner M, Korgavkar K, Chren MM, Stuart S, Vaiyavatjamai P, Jaturapatporn D, Linos E. Interventions for established stretch marks. Hippokratia 2017. [DOI: 10.1002/14651858.cd010926.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Mackenzie Wehner
- University of California, San Francisco; Department of Dermatology; San Francisco California USA
| | - Kaveri Korgavkar
- Brown University; Dermatology; 593 Eddy Street APC 1018 Providence Rhode Island USA 02903
| | - Mary-Margaret Chren
- University of California, San Francisco; Department of Dermatology; San Francisco California USA
| | - Sarah Stuart
- University of California, San Francisco; Department of Dermatology; San Francisco California USA
| | - Premjit Vaiyavatjamai
- Faculty of Medicine Ramathibodi Hospital, Mahidol University; Division of Dermatology, Department of Medicine; Rama 6, Ratchathewi Bangkok Thailand 10400
| | - Darin Jaturapatporn
- Mahidol University; Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital; Bangkok Thailand
- University of Toronto; Baycrest Centre for Geriatric Care; Toronto ON Canada
| | - Eleni Linos
- University of California, San Francisco; Department of Dermatology; San Francisco California USA
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Falzone AE, Brindis CD, Chren MM, Junn A, Pagoto S, Wehner M, Linos E. Teens, Tweets, and Tanning Beds: Rethinking the Use of Social Media for Skin Cancer Prevention. Am J Prev Med 2017; 53:S86-S94. [PMID: 28818251 PMCID: PMC5886032 DOI: 10.1016/j.amepre.2017.04.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 03/22/2017] [Accepted: 04/20/2017] [Indexed: 12/14/2022]
Abstract
The incidence of skin cancer is rising in the U.S., and melanoma, the deadliest form, is increasing disproportionately among young white women. Indoor tanning is a modifiable risk factor for all skin cancers and continues to be used at the highest rates in young white women. Adolescents and young adults report personal appearance-based reasons for using indoor tanning. Previous research has explored the influences on tanning bed use, including individual factors as well as relationships with peers, family, schools, media influences, legislation, and societal beauty norms. Adolescents and young adults also have high rates of social media usage, and research is emerging on how best to utilize these platforms for prevention. Social media has the potential to be a cost-effective way to reach large numbers of young people and target messages at characteristics of specific audiences. Recent prevention efforts have shown that comprehensive prevention campaigns that include technology and social media are promising in reducing rates of indoor tanning among young adults. This review examines the literature on psychosocial influences on indoor tanning among adolescents and young adults, and highlights ways in which technology and social media can be used for prevention efforts.
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Affiliation(s)
- Ashley E Falzone
- School of Medicine, the Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies and the Adolescent and Young Adult Health National Resource Center at the University of California, San Francisco, San Francisco, California
| | - Mary-Margaret Chren
- School of Medicine, the Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, California; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Alexandra Junn
- School of Medicine, the Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Sherry Pagoto
- Department of Medicine, University of Massachusetts Medical School, Worchester, Massachusetts
| | - Mackenzie Wehner
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eleni Linos
- School of Medicine, the Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, California.
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Bhutani T, Abrouk M, Sima CS, Sadetsky N, Hou J, Caro I, Chren MM, Arron ST. Risk of cutaneous squamous cell carcinoma after treatment of basal cell carcinoma with vismodegib. J Am Acad Dermatol 2017; 77:713-718. [PMID: 28780365 DOI: 10.1016/j.jaad.2017.03.038] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/19/2017] [Accepted: 03/26/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Vismodegib is a first-in-class agent targeting the hedgehog signaling pathway for treatment of patients with locally advanced basal cell carcinoma (BCC) and metastatic BCC. There have been concerns about the development of squamous cell carcinoma (SCC) in patients treated with this drug. OBJECTIVE We sought to determine whether treatment with vismodegib is associated with an increase in the risk of cutaneous SCC. METHODS In this retrospective cohort study, patients treated with vismodegib as part of phase I and II clinical studies were compared with participants from the University of California, San Francisco, Nonmelanoma Skin Cancer Cohort who received standard therapy for primary BCC. In total, 1675 patients were included in the analysis, and the development of SCC after vismodegib exposure was assessed. RESULTS The use of vismodegib was not associated with an increased risk of subsequent development of SCC (adjusted hazard ratio, 0.57; 95% confidence interval, 0.28-1.16). Covariates including age, sex, history of previous nonmelanoma skin cancer, and number of visits per year were significantly associated with the development of SCC. LIMITATIONS A limitation of the study was that a historic control cohort was used as a comparator. CONCLUSIONS Vismodegib was not associated with an increased risk of subsequent SCC when compared with standard surgical treatment of BCC.
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Affiliation(s)
- Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Michael Abrouk
- Department of Dermatology, University of California San Francisco, San Francisco, California.
| | | | | | - Jeannie Hou
- Genentech, Inc, South San Francisco, California
| | - Ivor Caro
- Genentech, Inc, South San Francisco, California
| | - Mary-Margaret Chren
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Sarah T Arron
- Department of Dermatology, University of California San Francisco, San Francisco, California
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Linos E, Bhatia S, Chren MM. More than skin-deep: is basal cell carcinoma a marker for a cancer-prone phenotype? Br J Dermatol 2017; 176:305-306. [PMID: 28244077 DOI: 10.1111/bjd.15017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E Linos
- Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A
| | - S Bhatia
- Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - M M Chren
- Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A.,Dermatology Service, Veterans Affairs Medical Center, San Francisco, CA, U.S.A
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Dizon MP, Linos E, Arron ST, Hills NK, Chren MM. Comparing the Quality of Ambulatory Surgical Care for Skin Cancer in a Veterans Affairs Clinic and a Fee-For-Service Practice Using Clinical and Patient-Reported Measures. PLoS One 2017; 12:e0171253. [PMID: 28141817 PMCID: PMC5283736 DOI: 10.1371/journal.pone.0171253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 01/17/2017] [Indexed: 11/18/2022] Open
Abstract
The Institute of Medicine has identified serious deficiencies in the measurement of cancer care quality, including the effects on quality of life and patient experience. Moreover, comparisons of quality in Veterans Affairs Medical Centers (VA) and other sites are timely now that many Veterans can choose where to seek care. To compare quality of ambulatory surgical care for keratinocyte carcinoma (KC) between a VA and fee-for-service (FFS) practice, we used unique clinical and patient-reported data from a comparative effectiveness study. Patients were enrolled in 1999-2000 and followed for a median of 7.2 years. The practices differed in a few process measures (e.g., median time between biopsy and treatment was 7.5 days longer at VA) but there were no substantial or consistent differences in clinical outcomes or a broad range of patient-reported outcomes. For example, 5-year tumor recurrence rates were equally low (3.6% [2.3-5.5] at VA and 3.4% [2.3-5.1] at FFS), and similar proportions of patients reported overall satisfaction at one year (78% at VA and 80% at FFS, P = 0.69). These results suggest that the quality of care for KC can be compared comprehensively in different health care systems, and suggest that quality of care for KC was similar at a VA and FFS setting.
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Affiliation(s)
- Matthew P. Dizon
- Program for Clinical Research, Department of Dermatology, University of California San Francisco, San Francisco, California, United States of America
| | - Eleni Linos
- Program for Clinical Research, Department of Dermatology, University of California San Francisco, San Francisco, California, United States of America
| | - Sarah T. Arron
- Program for Clinical Research, Department of Dermatology, University of California San Francisco, San Francisco, California, United States of America
- San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America
| | - Nancy K. Hills
- Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, United States of America
| | - Mary-Margaret Chren
- Program for Clinical Research, Department of Dermatology, University of California San Francisco, San Francisco, California, United States of America
- San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America
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Mirmirani P, Maurer TA, Berger TG, Sands LP, Chren MM. Skin-Related Quality of Life in HIV-Infected Patients on Highly Active Antiretroviral Therapy. J Cutan Med Surg 2016. [DOI: 10.1177/120347540200600102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The overall health status and survival of HIV-infected patients has changed with the advent of highly active antiretroviral therapy (HAART). With this improved survival, there is a greater urgency to study quality-of-life issues. Objective: Our objectives were to measure skin-related quality of life in a cohort of HIV-infected patients and to determine whether the use of highly active antiretroviral therapy is associated with improved skin-related quality of life. Methods: We assembled a retrospective cohort of patients who were seen in our HIV-Dermatology Clinic at San Francisco General Hospital in June, July, or August of 1996. Eligible subjects were contacted by mail and asked (1) to complete a questionnaire (Skindex) and (2) to have a skin exam. Information on medication use and laboratory parameters was also collected. Results: Of 107 eligible patients, 76 (71%) responded to the questionnaire; 60 patients were examined. Many patients had multiple skin conditions. For most diagnoses (except warts and onychomycosis), there were no consistent differences in Skindex scores of HIV-infected patients compared with scores of patients not known to be infected with HIV. Patients on HAART for longer duration had significantly lower Skindex scores (improved skin-related quality of life) compared with those on HAART for a shorter duration. Conclusion: HAART is associated with improved quality of life with regard to HIV-associated skin diseases. Antécédents: L'état de santé général et le taux de survie des patients inféctés par le VIH ont changé grâce à l'avènement de traitements antirétroviraux hautement actifs (HAART). Cette amélioration du taux de survie implique un besoin urgent d'étudier les questions relatives à la qualité de vie. Objectifs: Mesurer la qualité de vie sur le plan dermatologique d'une cohorte de patients infectés par le VIH et déterminer si le recours à un traitement antirétroviral hautement actif est associé à une amélioration de la qualité de vie sur le plan dermatologique. Méthodes: Nous avons rassemblé une cohorte rétrospective de patients qui étaient suivis dans notre clinique de dérmatologie-VIH au San Francisco General Hospital, en juin, juillet ou aoôt de 1996. Nous avons contacté par courrier les sujets admissibles et leur avons demandé (1) de remplir un questionnaire (Skindex) et (2) de se soumettre à un examen dermatologique. Également, nous avons recueilli de l'information sur la consommation des médicaments et les paramètres de laboratoire. Résultats: Parmi les 107 patients admissibles, 76 (71%) ont retourné le questionnaire et 60 ont été examinés. Un grand nombre de patients présentaient multiples affections cutanées. Dans la plupart des diagnostics (sauf pour les verrues et les onychomycoses), les différences sont minimes entre les résultats du Skindex des patients infectés par le VIH et ceux des patients qui ne le seraient pas. Les patients qui ont suivi le traitement HAART pendant une plus longue durée accusent des résultats Skindex sensiblement inférieurs (meilleure qualité de vie sur le plan dermatologique) à ceux des patients ayant suivi un traitement HAART pendant une plus courte durée. Conclusion: Le traitement HAART est associé à une qualité de vie améliorée en ce qui concerne les maladies dermatologiques liées du VIH.
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Affiliation(s)
- Paradi Mirmirani
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Toby A. Maurer
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Timothy G. Berger
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Laura P. Sands
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco, California, USA
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Siegel JA, Chren MM, Weinstock MA, Weinstock MA, Marcolivio K, Weinstock MA, Chen SC, Dellavalle RP, Warshaw EM, DiGiovanna JJ, Ferguson R, Lew RA, Ringer RJ, Yoon J, Phibbs CS, Kraemer K, Hogan D, Eilers D, Swetter SM, Chen SC, Jacob S, Romero L, Warshaw EM, Stricklin GP, Dellavalle RP, Konnikov N, Werth V, Sidhu-Malik N, Keri JE, Swan JW, Nord K, Pollack B, Kempiak S, High W, Fett N, Hall RP, Alonso-Llamazares J, Rodriguez G, Sisler L, O'Sullivan M, Wilson S, Agrawal M, Bartenfeld D, Nicalo K, Johnson D, Parks P, Bidek B, Boyd N, Watson B, Wolfe D, Zacheis M, Okawa J, Iannacchione MA, Quintero J, Cuddapah S, Muller K, Lichon V, Anhalt T, Khosravi V, Rahman Z, Lawley L, McCoy R, Foman N, Bershow A, Zic J, Miller J, Arbuckle HA, Hemphill L, Fujita M, Norris D, Ramaswamy P, Nevas J, Rao CH, Gifford AJ, Asher KA, Cardones ARG, Richardson AF, Patrick CA, Fiore L, Ferguson R, Thwin SS, Lew RA, Kebabian CE, Pavao J, Sather M, Fye C, Ringer RJ, Hunt D, Robinson-Bostom L, Telang G, Wilkel C, Haynes HA, Brookhart MA, Mostow EN, Rector T. Correlates of skin-related quality of life (QoL) in those with multiple keratinocyte carcinomas (KCs): A cross-sectional study. J Am Acad Dermatol 2016; 75:639-642. [DOI: 10.1016/j.jaad.2016.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/18/2016] [Accepted: 05/02/2016] [Indexed: 11/25/2022]
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Abstract
The centerpiece of evidence-based medicine is the randomized controlled trial, a rigorous experiment. We use the study by Roozeboom et al. to illustrate how research guides clinical decisions. We describe levels of evidence, review criteria for assessing a trial regarding noninferiority of a therapy, and discuss challenges for evidence-based medicine in guiding care precisely targeted to an individual patient.
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Affiliation(s)
- Mary-Margaret Chren
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, California, USA; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
| | - Sarah T Arron
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, California, USA; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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Abstract
Objectives To examine whether life expectancy influences treatment pattern of nonmelanoma skin cancer, or keratinocyte carcinoma (KC), the most common malignancy and the fifth most costly cancer to Medicare. Design Nationally representative cross‐sectional study. Setting Nationally representative Health and Retirement Study linked to Medicare claims. Participants Treatments (N = 9,653) from individuals aged 65 and older treated for basal or squamous cell carcinoma between 1992 and 2012 (N = 2,702) were included. Measurements Limited life expectancy defined according to aged 85 and older, medical comorbidities, Charlson Comorbidity Index score of 3 or greater, difficulty in at least one activity of daily living (ADL), and a Lee index of 13 or greater. Treatment type (Mohs micrographic surgery (MMS) (most intensive, highest cost), excision, or electrodesiccation and curettage (ED&C) (least intensive, lowest cost)), according to procedure code. Results Most KCs (61%) were treated surgically. Rates of MMS (19%), excision (42%), and ED&C (39%) were no different in participants with limited life expectancy and those with normal life expectancy. For example, 19% of participants with difficulty or dependence in ADLs, 20% of those with a Charlson comorbidity score greater than 3, and 15% of those in their last year of life underwent MMS; participants who died within 1 year of diagnosis were treated in the same way as those who lived longer. Conclusion A one‐size‐fits‐all approach in which advanced age, health status, functional status, and prognosis are not associated with intensiveness of treatment appears to guide treatment for KC, a generally nonfatal condition. Although intensive treatment of skin cancer when it causes symptoms may be indicated regardless of life expectancy, persons with limited life expectancy should be given choices to ensure that the treatment matches their goals and preferences.
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Affiliation(s)
- Eleni Linos
- Department of Dermatology, University of California at San Francisco, San Francisco, California
| | - Mary-Margaret Chren
- Department of Dermatology, University of California at San Francisco, San Francisco, California
| | - Irena Stijacic Cenzer
- Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Kenneth E Covinsky
- Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
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Affiliation(s)
| | - Mary-Margaret Chren
- Department of Dermatology, School of Medicine, University of California, San Francisco
| | - Jack S Resneck
- Department of Dermatology, School of Medicine, University of California, San Francisco3Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco
| | - Nepheli N Aji
- undergraduate student, College of Biological Sciences, University of California, Davis
| | - Sherry Pagoto
- Department of Medicine, School of Medicine, University of Massachusetts, Boston
| | - Eleni Linos
- Department of Dermatology, School of Medicine, University of California, San Francisco
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Wehner MR, Linos E, Boscardin WJ, Chren MM. Competing Risk of Death in Kaplan-Meier Curves When Analyzing Subsequent Keratinocyte Cancer-Reply. JAMA Dermatol 2016; 152:494-5. [PMID: 27074364 DOI: 10.1001/jamadermatol.2015.5153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Eleni Linos
- Department of Dermatology, University of California, San Francisco
| | - W John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco4Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
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Siegel JA, Chren MM, Weinstock MA. New keratinocyte carcinomas worsen skin-related quality of life. Dermatol Online J 2016. [DOI: 10.5070/d3229032551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
Importance Skin cancer, the most common cancer in the United States, is highly associated with outdoor and indoor tanning behaviors. Although indoor tanning has been suggested to be more common among sexual minority (self-reported as homosexual, gay, or bisexual) men compared with heterosexual men, whether rates of skin cancer vary by sexual orientation is unknown. Objective To investigate whether skin cancer prevalence and indoor tanning behaviors vary by sexual orientation in the general population. Design, Setting, and Participants We performed a cross-sectional study using data from the 2001, 2003, 2005, and 2009 California Health Interview Surveys (CHISs) and the 2013 National Health Interview Survey (NHIS) of population-based samples of the California and US noninstitutionalized civilian population. Participants included 192 575 men and women 18 years or older who identified as heterosexual or a sexual minority. Main Outcomes and Measures Self-reported lifetime history of skin cancer and 12-month history of indoor tanning. Results The study included 78 487 heterosexual men, 3083 sexual minority men, 107 976 heterosexual women, and 3029 sexual minority women. Sexual minority men were more likely than heterosexual men to report having skin cancer (2001-2005 CHISs: adjusted odds ratio [aOR], 1.56; 95% CI, 1.18-2.06, P < .001; 2013 NHIS: aOR, 2.13; 95% CI, 1.14-3.96, P = .02) and having tanned indoors (2009 CHIS: aOR, 5.80; 95% CI, 2.90-11.60, P < .001; 2013 NHIS: aOR, 3.16; 95% CI, 1.77-5.64, P < .001). Sexual minority women were less likely than heterosexual women to report having had nonmelanoma skin cancer (2001-2005 CHIS: aOR, 0.56; 95% CI, 0.37-0.86, P = .008) and having tanned indoors (2009 CHIS: aOR, 0.43; 95% CI, 0.20-0.92, P = .03; 2013 NHIS: aOR, 0.46; 95% CI, 0.26-0.81, P = .007). Conclusions and Relevance Sexual minority men indoor tan more frequently and report higher rates of skin cancer than heterosexual men. Primary and secondary prevention efforts targeted at sexual minority men might reduce risk factors for, and consequences of, skin cancer.
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Affiliation(s)
- Matthew Mansh
- Department of Dermatology, University of California, San Francisco2Stanford University School of Medicine, Stanford, California
| | - Kenneth A Katz
- Department of Dermatology, Kaiser Permanente, Pleasanton, California
| | - Eleni Linos
- Department of Dermatology, University of California, San Francisco
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco4Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Sarah Arron
- Department of Dermatology, University of California, San Francisco4Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
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Linos E, Berger T, Chren MM. Point: Care of potential low-risk basal cell carcinomas (BCCs) at the end of life: The key role of the dermatologist. J Am Acad Dermatol 2015; 73:158-61. [PMID: 26089051 DOI: 10.1016/j.jaad.2015.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 01/23/2015] [Accepted: 02/01/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Eleni Linos
- Department of Dermatology, University of California, San Francisco, San Francisco, California.
| | - Timothy Berger
- Department of Dermatology, University of California, San Francisco, San Francisco, California; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco, San Francisco, California; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
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Mathias SD, Chren MM, Crosby RD, Colwell HH, Yim YM, Reyes C, Chen DM, Fosko SW. Reliability and validity of the Advanced Basal Cell Carcinoma Index (aBCCdex). Br J Dermatol 2015; 173:713-9. [PMID: 25939524 DOI: 10.1111/bjd.13877] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient-reported outcome (PRO) questionnaires were recently developed specifically for use with patients with advanced basal cell carcinoma (aBCC) and basal cell carcinoma naevus syndrome (BCCNS). OBJECTIVES To evaluate the measurement properties of PRO questionnaires for use in patients with aBCC or BCCNS. METHODS In total 129 patients from 10 clinical sites in the U.S.A. and the BCCNS Support Network completed the two newly developed questionnaires multiple times over 3 months. Patients also completed the Skindex-16 and the 12-Item Short-Form Health Survey as collateral measures. Psychometric properties of the questionnaires were evaluated, including internal consistency and test-retest reliability, construct and known-groups validity, and responsiveness. RESULTS Based on the results of exploratory factor analysis and clinical input, the two newly developed questionnaires were combined into a single questionnaire, called the aBCCdex, which is relevant for patients with both aBCC and BCCNS. The internal consistency reliability was acceptable, and all aBCCdex scale scores correlated significantly with conceptually similar scales. When divided into groups that differed based on scores from collateral measures, aBCCdex scale scores differentiated between groups (known-groups validity) and were responsive to change. CONCLUSIONS The aBCCdex is a brief and comprehensive questionnaire appropriate for use with patients with aBCC and BCCNS. Its reliability and validity have been confirmed. Further research is necessary to estimate the minimally important difference in a larger patient population.
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Affiliation(s)
- S D Mathias
- Health Outcomes Solutions, 2351 Via Tuscany, Winter Park, FL, 32789, U.S.A
| | - M M Chren
- Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A
| | - R D Crosby
- Health Outcomes Solutions, Neuropsychiatric Research Institute, and University of North Dakota School of Medicine and Health Sciences, Fargo, ND, U.S.A
| | - H H Colwell
- Health Outcomes Solutions, 2351 Via Tuscany, Winter Park, FL, 32789, U.S.A
| | - Y M Yim
- Genentech, San Francisco, CA, U.S.A
| | - C Reyes
- Genentech, San Francisco, CA, U.S.A
| | - D M Chen
- Genentech, San Francisco, CA, U.S.A
| | - S W Fosko
- Departments of Dermatology, Internal Medicine, Head and Neck Surgery-Otolaryngology and Ophthalmology, Saint Louis University Cancer Center, Saint Louis University School of Medicine, St Louis, MO, U.S.A
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Wehner MR, Linos E, Parvataneni R, Stuart SE, Boscardin WJ, Chren MM. Timing of Subsequent New Tumors in Patients Who Present With Basal Cell Carcinoma or Cutaneous Squamous Cell Carcinoma. JAMA Dermatol 2015; 151:382-8. [DOI: 10.1001/jamadermatol.2014.3307] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mackenzie R. Wehner
- Medical student at Stanford University School of Medicine, Stanford, California, now with Department of Dermatology, University of California, San Francisco
| | - Eleni Linos
- Department of Dermatology, University of California, San Francisco
| | - Rupa Parvataneni
- Department of Dermatology, University of California, San Francisco
| | - Sarah E. Stuart
- Department of Dermatology, University of California, San Francisco
| | - W. John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco4Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
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Tsao H, Olazagasti JM, Cordoro KM, Brewer JD, Taylor SC, Bordeaux JS, Chren MM, Sober AJ, Tegeler C, Bhushan R, Begolka WS. Early detection of melanoma: reviewing the ABCDEs. J Am Acad Dermatol 2015; 72:717-23. [PMID: 25698455 DOI: 10.1016/j.jaad.2015.01.025] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 12/11/2022]
Abstract
Over the course of their nearly 30-year history, the ABCD(E) criteria have been used globally in medical education and in the lay press to provide simple parameters for assessment of pigmented lesions that need to be further evaluated by a dermatologist. In this article, the efficacy and limitations of the ABCDE criteria as both a clinical tool and a public message will be reviewed.
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Affiliation(s)
| | - Hensin Tsao
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeannette M Olazagasti
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, California
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | - Susan C Taylor
- Society Hill Dermatology and Cosmetic Center, Philadelphia, Pennsylvania
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Case Medical Center, and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco, California; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Arthur J Sober
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Reva Bhushan
- American Academy of Dermatology, Schaumburg, Illinois
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He Z, Lu C, Chren MM, Zhang Z, Li Y, Ni X, Buchtel V HA, Ryan PF, Li GZ. Development and psychometric validation of the Chinese version of Skindex-29 and Skindex-16. Health Qual Life Outcomes 2014; 12:190. [PMID: 25539748 PMCID: PMC4305222 DOI: 10.1186/s12955-014-0190-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/12/2014] [Indexed: 11/11/2022] Open
Abstract
Background Dermatological disease significantly affects patient’s health-related quality of life (HrQoL). Skindex is one of the most frequently used dermatology-specific HrQoL measures. Currently no Chinese version of Skindex is available. The aim of this study was to translate and culturally adapt Skindex-29 and Skindex-16 into Chinese, and to evaluate their reliability and validity. Methods Translation and cultural adaption were performed following guidelines for cross-cultural adaption of health-related quality of life measures. Subsequently, a cross-sectional study was conducted in which patients with dermatological disease (n = 225) were enrolled. The Chinese version of Skindex-29 and Skindex-16 and Dermatology Life Quality Index (DLQI) were completed. Reliability was evaluated with internal consistency using Cronbach’s alpha. Validity was evaluated using known-groups validity, convergent validity and factor structure validity. Results There were both seven items of Skindex-29 and Skindex-16 requiring a second forward- and backward- translation to achieve the final satisfactory Chinese version. The internal consistency reliability was high (range of Cronbach’s alpha for the scales of Skindex-29 0.85-0.97, Skindex-16 0.86-0.96). Known-group validity was demonstrated by higher scores from patients with inflammatory dermatosis than from patients with isolated skin lesions (P < 0.05). Evidence of factor structure validity of the Skindex-29 and Skindex-16 was demonstrated by both exploratory factor analysis that accounted for 68.66% and 77.78% of the total variance, respectively, and confirmatory factor analysis with acceptable fitness into the expected three-factor structure. Conclusion This study has developed semantically equivalent translations of Skindex-29 and Skindex-16 into Chinese. The evaluation of the instruments’ psychometric properties shows they have substantial evidence of reliability and validity for use as HrQoL instruments in Chinese patients with dermatological disease.
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Affiliation(s)
- Zehui He
- Department of Clinical Epidemiology, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Chuanjian Lu
- Department of Dermatology, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, No.111 Da De Road, Guangdong, 510120, China.
| | | | - Zhongzhao Zhang
- Department of Dermatology, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, No.111 Da De Road, Guangdong, 510120, China.
| | - Yan Li
- Department of Sleep and Mental Disorder, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Xiaojia Ni
- Department of Evidence-based Medicine and Clinical Research of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Henry A Buchtel V
- Michigan Association of Acupuncture and Oriental Medicine, The Lotus Center of Ann Arbor, Ann Arbor, USA.
| | - Paul F Ryan
- Department of Neurology, Lutheran Medical Center, New York, USA.
| | - Guo-Zheng Li
- Department of Clinical Epidemiology, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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