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Lisa M Schilling

Publications and source records attributed to Lisa M Schilling.

17 recordsLinked to original sources
PubMed2006

What dermatologists do not know about smallpox vaccination: results from a worldwide electronic survey.

The risk of a bioterrorist attack with smallpox has increased owing to breakthroughs in the de novo synthesis of long-chain DNA molecules. Although the leading roles of dermatologists in diagnosing recent outbreaks of cutaneous anthrax and monkeypox demonstrate the importance of dermatologist preparedness for bioterrorism, dermatologist knowledge regarding smallpox vaccination has not been extensively examined. We conducted a cross-sectional worldwide electronic survey of all members of the American Academy of Dermatology with available e-mail addresses. The response rate was 23% (1,303/5,723): 34% of respondents were women, 52% were age 50 or older, 85% practiced in the US, and 90% reported English as their primary language. Less than 37% indicated the Centers for Disease Control and Prevention estimated rate of death owing to smallpox vaccination (1 in 1,000,000), and many failed to identify vaccination contraindications: previous myocardial infarction (83%), angina (83%), congestive heart failure (78%), steroid eye drop use (65%), and the non-emergency vaccination of those younger than age 18 (95%). Widespread dermatologist smallpox vaccination knowledge deficits pinpoint opportunities for educational efforts.

Adult↗
PubMed2006

What do attending physicians contribute in a house officer-based ambulatory continuity clinic?

OBJECTIVE: To study the educational contributions of attending physicians in an internal medicine house staff ambulatory clinic. DESIGN: Cross-sectional, self-administered survey. SETTING: University-affiliated general internal medicine practice. PATIENTS/PARTICIPANTS: Internal medicine residents and attendings. MEASUREMENTS AND MAIN RESULTS: Attending and resident perceptions of whether attendings made contributions to teaching points, diagnosis (DX), therapy (RX), and health care maintenance (HCM) were assessed in 428 patient encounters. Resident assessments significantly exceeded attending self-assessments of contributions to teaching points (82% vs 74%, P=.001), DX (44% vs 34%, P=.001), RX (61% vs 55%, P=.02), and HCM (19% vs 15%, P=.04). Both residents and attendings perceived that contributions declined progressively with increasing resident year (P<.05). Primary care and categorical residents assessed attending contributions comparably. However, attendings perceived contributing more to RX and HCM for categorical residents than primary care (P<.05). Male and female residents assessed attending contributions comparably. However, attendings perceived contributing generally more to DX in male residents than female (P=.003). In 8% of encounters, either residents or attendings felt that patient evaluation by the attending was needed. In these encounters with personal patient evaluation by attendings, both residents and attendings felt that attendings made more contributions to DX (P=.001) and teaching points than in other encounters. CONCLUSIONS: Attending physicians consistently underestimate their perceived contributions to house officer ambulatory teaching. Their personal patient evaluation increases assistance with DX and teaching points. Given perceived declining contributions by training year, attendings may need to identify other teaching strategies for interactions with senior residents.

Aged↗
PubMed2005

Compliance with youth access regulations for indoor UV tanning.

OBJECTIVES: To describe youth access to indoor UV tanning and youth discount pricing incentives in 4 states with different age restrictions: Colorado (no age restrictions), Texas (age 13 years), Illinois (age 14 years), and Wisconsin (age 16 years). DESIGN: Cross-sectional telephone survey conducted in October 2003 using a standardized script to assess the practices of randomly selected UV tanning operators. PARTICIPANTS: Randomly selected licensed indoor UV tanning facility operators in Colorado, Texas, Illinois, and Wisconsin. MAIN OUTCOME MEASURES: Number of facilities (1) complying with indoor UV tanning minimum age regulations for a 12-year-old potential patron and a 15-year-old potential patron and (2) offering youth discounts. RESULTS: For a 12-year-old potential patron, 62% of facilities in states with minimum age restrictions prohibiting 12-year-olds had an operator report that they would not permit indoor tanning (Texas, 23%; Illinois, 74%; and Wisconsin, 89%) compared with 18% in Colorado, a state without youth access regulations. For a 15-year-old patron, most facilities in Wisconsin, the only state with a minimum age restriction for 15-year-olds, prohibited access (77%). Overall, 15% of operators offered youth discounts: Texas, 23%; Illinois, 14%; Wisconsin, 11%; and Colorado, 11%. CONCLUSIONS: Tanning facilities in 4 states offered price incentives directed at youths. State youth access regulations were associated with decreased youth access to indoor tanning. High compliance levels in states with long-standing youth access regulations (Illinois and Wisconsin) demonstrate the potential for successful tanning industry youth access regulation.

Adolescent↗
PubMed2005

Residents' patient-specific clinical questions: opportunities for evidence-based learning.

PURPOSE: Resident physicians generate many patient-related questions in the outpatient setting, but rarely answer them. This study examined how answering a patient-specific clinical question affected residents' patient care decisions. METHOD: From October 2001 to June 2002, 43 internal medicine residents at the University of Colorado Health Sciences Center outpatient clinic formulated and attempted to answer specific clinical questions based on patients seen in the out-patient setting. Residents completed a questionnaire after finishing their clinical question exercise. RESULTS: Residents completed 158 exercises (68%) out of 234 opportunities and found answers to 89% of questions (141/158). Questions most commonly addressed therapy (43%), diagnosis (15%), disease management (13%), and prevention (9%). The most frequently used methods to retrieve clinical information were Medline 73% (115/158) and UpToDate 70% (110/158). UpToDate (45%, 71/158) and journal articles (42%, 66/158) were the most helpful final information sources. Residents rated the impact of the information on a five-point scale (1 = strongly disagree; 5 = strongly agree) for the following: can be used to assist patient's care (mean 4.1), improved care (mean 4.0), improved communication (mean 4.3), improved confidence in care (mean 4.3), improved knowledge (mean 4.6), and will improve care for future patients (mean 4.4). The information affected clinical decision making in 78% (110/141) of cases. CONCLUSION: Internal medicine residents practicing self-directed learning by answering patient-specific clinical questions reported improvement in knowledge and changes in patient care decisions.

Education, Medical↗
PubMed2004

Indoor UV tanning operator opinion regarding youth access: an electronic survey.

BACKGROUND: Adolescents frequently use indoor tanning facilities, but little is known about tanning facility operator opinions regarding this use. Objective To assess indoor tanning operator attitudes and stated practices regarding youth access. METHODS: We electronically surveyed 89 indoor tanning facilities and 130 spas with active e-mail addresses. RESULTS: The survey response rate was 21% for both indoor tanning facilities (19/89) and spas (27/130). Most tanning operators (92%) felt that a client can be too young to receive indoor tanning, and most felt that written parental permission should be required (80%). Most facilities required adult accompaniment (92%), and most operators had discouraged a customer from receiving indoor tanning based on age (77%). The reported age of the youngest patron receiving indoor tanning ranged from 5 to 21 years. CONCLUSION: Our sample of indoor tanning facility operators believed that minimum age and parental consent regulations for indoor tanning should be required.

Adolescent↗
PubMed2004

What is the point of databases of reviews for dermatology if all they compile is "insufficient evidence"?

BACKGROUND: The use of review databases for dermatology has been questioned because of the impression that these reviews frequently report finding insufficient evidence to guide therapeutic recommendations. OBJECTIVE: We sought to determine the number of review database entries most relevant to dermatology (addressing diseases with skin manifestations whereby a dermatologist may be the primary caregiver) and the percentage of these entries that report sufficient evidence to guide clinical decision making. METHODS: We conducted computerized searches and analysis of reviews in the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness. Database entries were categorized using the face value reports of the original reviewers as: (1) finding sufficient evidence to inform clinical decisions; (2) finding insufficient evidence; or (3) unable to classify with regard to degree of evidence found. RESULTS: Of all review database entries, 3% (54/1235 in Cochrane Database of Systematic Reviews and 65/2208 in the Database of Abstracts of Reviews of Effectiveness) were deemed relevant to dermatology. In all, 14 entries from the Database of Abstracts of Reviews of Effectiveness were in the process of being written and not available for further evaluation. Of the remaining entries, 40% (42/105) reported finding sufficient evidence. Of the 10 most common dermatologic diagnoses, 8 were addressed in 30% (31/105) of these reviews. Of entries addressing common dermatologic diagnoses, 32% (10/31) reported finding sufficient evidence. CONCLUSIONS: Although few (3%) entries in review databases currently address dermatology topics, entries address many (8/10) of the top 10 dermatology diagnoses. Contrary to popular belief, a substantial number (40%) of such reviews report sufficient evidence to inform clinical decisions making.

Databases, Bibliographic↗
PubMed2003

Information science. Going, going, gone: lost Internet references.

The use of Internet references in academic literature is common, and Internet references are frequently inaccessible. The extent of Internet referencing and Internet reference activity in medical or scientific publications was systematically examined in more than 1000 articles published between 2000 and 2003 in the New England Journal of Medicine, The Journal of the American Medical Association, and Science. Internet references accounted for 2.6% of all references (672/25548) and in articles 27 months old, 13% of Internet references were inactive. Publishers, librarians, and readers need to reassess policies, archiving systems, and other resources for addressing Internet reference attrition to prevent further information loss.

Information Storage and Retrieval↗
PubMed2003

Assessing evidence-based dermatology and evidence-based internal medicine curricula in US residency training programs: a national survey.

OBJECTIVES: To examine attitudes toward evidence-based medicine and evidence-based dermatology and to assess evidence-based training in US internal medicine and dermatology residency programs. METHODS: A 1-page self-administered questionnaire was mailed to residency training directors and chief residents at 104 dermatology and 103 internal medicine residency programs from the same or affiliated medical centers. RESULTS: Questionnaires were returned by respondents from 70 (68%) of 103 internal medicine programs and 86 (83%) of 104 dermatology programs. Most respondents (91% internal medicine and 70% dermatology) strongly agreed or agreed that evidence-based internal medicine/dermatology is valuable and should be included in residency training (93% internal medicine and 70% dermatology). Respondents from internal medicine programs agreed more strongly with both statements than respondents from dermatology programs (P =.001). Dedicated evidence-based curricula were in place at significantly more internal medicine programs (50 [71%] of 70) than dermatology programs (20 [23%] of 86) (P<.001). Curricula at internal medicine programs offered significantly more evidence-based medicine training sessions (24 vs 6; P<.001) and biostatistics sessions (10 vs 2.3; P =.03), and internal medicine programs more frequently evaluated the curricula using clinical question applications (56% vs 30%; P =.04). CONCLUSION: Despite favorable attitudes toward evidence-based dermatology, compared with internal medicine programs, dedicated evidence-based training is underdeveloped in dermatology programs.

Attitude of Health Personnel↗
PubMed2003

Youth access laws: in the dark at the tanning parlor?

OBJECTIVE: To compare laws governing youth access to UV irradiation at indoor tanning facilities with laws governing youth access to tobacco. DESIGN: Tobacco and UV irradiation youth access laws were assessed via correspondence with public health offices and computerized legal searches of 6 industrialized nations with widely differing skin cancer incidence rates. SETTING: National, provincial, and state legal systems in Australia, Canada, France, New Zealand, the United Kingdom, and the United States. PARTICIPANTS: Public health, legal, information science, and medical professionals and government and tanning industry representatives. MAIN OUTCOME MEASURES: Statutes specifying age restrictions for the purchase of indoor tanning services or tobacco products. RESULTS: The 5 English-speaking countries with common law-based legal systems unilaterally prohibit youth access to tobacco but rarely limit youth access to UV irradiation from tanning salons. Only very limited regions in the United States and Canada prohibit youth access to indoor tanning facilities: Texas, Illinois, Wisconsin, and New Brunswick prohibit tanning salon use by minors younger than 13, 14, 16, and 18 years, respectively. In contrast, French law allows minors to purchase tobacco but prohibits those younger than 18 years from patronizing tanning salons. CONCLUSIONS: Youth access laws governing indoor tanning display remarkable variety. Uniform indoor tanning youth access laws modeled on the example of tobacco youth access laws merit consideration.

Adolescent↗
PubMed2002

The third person in the room: frequency, role, and influence of companions during primary care medical encounters.

OBJECTIVE: We wanted to characterize patient accompaniment to medical encounters and to explore the rationale and influence of the companion on the primary care medical encounter. STUDY DESIGN: This was a descriptive study. POPULATION: Academic general internal medicine physicians, patients, and patient companions participated. OUTCOMES MEASURED: We measured the frequency of waiting and examination room companions, the reasons for accompaniment, the influence on the encounter, and the overall helpfulness of the companion as assessed by patients and companions. We also determined the physicianamprsquos assessment of the companionamprsquos influence, helpfulness, and behavior during the encounter. RESULTS: Companions were in the examination room for 16% of visits; 93% were family members. The rationales for waiting and examination room companions were to help with transportation, provide emotional support, and provide company. Examination room companions helped communicate concerns to the physician, remember the physicianamprsquos advice, make decisions, and communicate their own concerns to the physician. Patients believed that examination room companions influenced 75% of medical encounters, mainly by improving communication between physician and patient. Physicians agreed that examination room companions favorably influenced physician and patient understanding (60% and 46% of encounters, respectively). Patients indicated that waiting and examination room companions were very helpful for 71% and 83% of visits, respectively. CONCLUSIONS: Companions frequently accompany patients to their primary care medical encounters. They are often family members, and they assume important roles in enhancing patient and physician understanding.

Adolescent↗
PubMedDate not supplied

Melanoma chemoprevention: a role for statins or fibrates?

Although numerous second-generation isoprenylation inhibitors are proposed or under investigation for the treatment and/or prevention of cancer (eg, R115777, SCH 66336, L-778,123, BMS-214662), the chemotherapeutic and chemopreventive potential of commonly prescribed first-generation isoprenylation inhibitors, the statins, and other classes of lipid-lowering medications, the fibrates, has yet to be seriously explored. Two lipid-lowering medications, lovastatin and gemfibrozil, have been associated with a decreased incidence of melanoma in large, prospective, randomized, double-blind, placebo-controlled clinical cardiology trials. This article reviews melanoma biology and the clinical evidence for the use of lipid-lowering medications for melanoma chemoprevention and/or adjuvant chemotherapy.

Anticarcinogenic Agents↗