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PubMed1999

[Dermatologic rehabilitation--chances in crisis].

The political activities concerning the health care system in recent months have made the chronic crisis involving dermatological rehabilitation clinics in Germany more apparent. While dermatology has continual to evolve in acute care clinical facilities, no critical analysis of dermatological rehabilitation clinics has occurred. A commonly accepted, standardized document defining precisely the goals of dermatological rehabilitation as well as the appropriate ways to measure the quality of the treatment and its results is not available. An expert panel appointed by the responsible working group of the Bavarian public health care system succeeded in defining mandatory structural requirements which will soon be obligatory for all Bavarian dermatological rehabilitation clinics. In the future, a general concept for the medical care of patients with chronic dermatological diseases on the appropriate level--ambulatory or hospital--has to be established. A close cooperation between clinicians working in acute care facilities and dermatologists in ambulatory practices could, at least in the long run, result in establishing local and national centers of competence for diagnosis, therapy, prevention, and rehabilitation of chronic dermatological diseases.

Dermatology↗
PubMed2004

Statistical reviewing policies in dermatology journals: results of a questionnaire survey of editors.

BACKGROUND: Problems with statistical methods and reporting have been noted in articles published in dermatology journals. Conclusions presented in published reports may be misleading if based on inappropriate or misinterpreted statistical analysis. OBJECTIVE: We sought to assess dermatology journal editors' policies and perceptions regarding statistical review of submitted manuscripts. DESIGN: We mailed and e-mailed a questionnaire survey. PARTICIPANTS: A total of 43 dermatology journal editors, representing 35 dermatology journals from the United States and abroad, participated in this study. RESULTS: In all, 32 editors (74.4%), representing 30 journals (85.7%), returned questionnaires. A total of 24 editors (75%) reported having requested statistical reviews on less than 5% of published manuscripts containing original quantitative analysis (ie, excluding reviews and case reports), whereas 3 editors (9.4%) reported having requested statistical reviews on more than 75% of such manuscripts. Most editors reported requesting statistical reviews on a case-by-case basis either after initial favorable review by subject-matter (nonstatistical) reviewers (12 editors; 37.5%) or at the same time that subject-matter review was requested (6 editors; 18.8%). A total of 4 editors (12.5%) reported requesting statistical review for all manuscripts at the same time they are sent for subject-matter review. Another 10 editors (31.3%) said their journals had no general policy on statistical reviewing, and statistical review is almost never needed. For 15 editors (46.9%), ideal statistical reviewing policy was identical to their current policy, whereas 13 (40.6%) favored a more rigorous and 3 (9.4%) a less rigorous policy. CONCLUSIONS: Dermatology journals infrequently perform statistical reviews of submitted manuscripts. Dermatology journal editors' statistical review policies range from no general policy to (most frequently) requesting reviews on a case-by-case basis to reviewing all submitted manuscripts. Many editors favor more rigorous statistical reviewing policies for their journals. Increased use of statistical reviewing may increase the reliability of conclusions published in dermatology journals.

Dermatology↗
PubMed2005

Analysis of original contributions in three dermatology journals.

In a cross-sectional analysis, the three top ranking dermatology journals ( Archives of Dermatology , British Journal of Dermatology , and the Journal of the American Academy of Dermatology ) were evaluated for their scientific content, the characteristics of their authors, and funding aspects in 2002. A flood of scientific papers are published each year covering a broad variety of dermatologic topics. Aside from the actual content, a scientific article provides information about the number of authors, their nationality and affiliations, and, with some limitation, about previous presentations and funding. The present study analyzes this situation in dermatology by evaluating the content in the three top dermatologic journals.

Advertising↗
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↗
PubMed1997

Patients' opinions regarding direct access to dermatologic specialty care.

Many factors such as cost have been used by managed care systems to limit patient access to specialty care, including dermatology. To date, however, patients' opinions regarding these decisions have not been analyzed. The purpose of the study was to survey patient opinions regarding the efficacy, costs, and desirability of gatekeeper-mediated versus direct access to dermatologic specialty care. One hundred fifteen of 150 consecutive patients who were seen in an outpatient dermatology clinic completed an anonymous survey concerning their current visit. They were asked about referral to the dermatologist by other physicians, number of prior physician visits, and efficacy of therapies received. Patients rated their level of satisfaction with generalist versus specialist care for their condition and evaluated the importance of direct access to dermatologic specialty care. Thirty-nine percent of respondents (42 of 108) were on their first visit to the dermatologist for their current condition. One half of respondents (57 of 115) had previously seen another physician for this condition. Thirty percent (34 of 115) had been referred to the dermatologist by another physician, most often a family practitioner or internist. Two thirds (38 of 57) of those seen by a previous physician had received therapy from that physician, but only one third (12 of 35) believed it to have been of any benefit. Twenty-three percent (11 of 47) claimed to have incurred more than five visits to the other physician before seeing the dermatologist. Twenty-four percent of patients (12 of 50) were "very satisfied" with the previous physician's care compared with 89% (100 of 112) with the dermatologist's care. Only 6% of respondents (7 of 122) believed a generalist could adequately treat their skin disease. Eighty-seven percent (100 of 115) described direct access to dermatology as being "very important" to their health care. The results of this study suggest that many patients may prefer dermatologic specialists over generalists as primary caregivers for diseases of the skin. They may favor direct access to dermatologic specialty care for its efficacy and for cost and time savings.

Adolescent↗
PubMed2003

Complementary and alternative medicine use among patients attending a hospital dermatology clinic in Taiwan.

BACKGROUND: Recent studies have indicated that complementary and alternative medicine (CAM) has been gaining popularity around the world. Previous studies showed that CAM use was common among dermatology patients in Western nations. This study presents the prevalence and types of CAM use among a group of patients in a dermatology clinic in Taiwan. METHODS: A convenient sample of 198 patients was recruited from the dermatology clinic of Show Chwan Memorial Hospital in Changhua City, Taiwan. Each patient completed a standardized questionnaire. Chi-square tests were used to compare the demographic characteristics of those who did and did not use CAM. Logistic regression analyses were performed to determine the strength of association between correlate variables and CAM use. RESULTS: Forty-one per cent of subjects had used CAM to treat their dermatological conditions. Subjects in the younger (< 30 years) and older (> 50 years) age groups were more likely to use CAM than those in the 30-50-year age group. Those that participated in religious or social groups were more likely to use CAM. CAM users felt a more negative impact of their dermatological conditions on daily living, relationships, emotional well-being and physical health. CONCLUSIONS: As in Western nations, CAM use is prevalent among dermatology patients in Taiwan: not only the traditionally popular Chinese CAM, but also Western CAM. With CAM being popular in the younger age group, dermatologists will likely encounter more CAM users in the future. Because some CAM may produce serious side-effects, dermatologists need to help and guide patients to assess the benefits and dangers of using CAM to treat dermatological conditions.

Adult↗
PubMed2000

A history of dermatologic surgery in the United States.

BACKGROUND: Dermatologic surgery has a long and distinguished history in the United States. OBJECTIVE: To examine the specific contributions of American dermatologic surgeons. METHOD: The medical literature on cutaneous reconstructive and cosmetic surgery for the last century and a half was researched. RESULTS: Numerous American dermatologic surgeons have had a major impact on scientific and technological discoveries in cutaneous surgery. Dermatologic surgeons have been significantly involved in cutaneous surgery since the second half of the 19th century. Dermatologic surgeons have contributed many important advances to the fields of chemical peeling, cryosurgery, dermabrasion, electrosurgery, hair transplantation, soft tissue augmentation, tumescent liposuction, laser surgery, phlebology, Mohs chemosurgery, cutaneous reconstruction, wound healing, botulium toxin, blepharoplasty, and rhytidectomy. CONCLUSION: Dermatologic surgeons in the United States have contributed significantly to the history of reconstructive and cosmetic surgery. Dermatologic surgeons have been leaders in advancing this field and are poised to continue in the future.

Dermatology↗
PubMed2001

Use of the Dermatology Life Quality Index (DLQI) in a midwestern US urban clinic.

BACKGROUND: The Dermatology Life Quality Index (DLQI), a self-administered general dermatology quality of life instrument, was originally developed and published in a dermatology clinic at University Hospital of Wales. OBJECTIVE: Our goal was to test the feasibility of having patients answer the DLQI in a busy dermatology clinic and to find out to what extent results vary from those published in Wales. We also wanted to examine the validity of the index in terms of the correlation between DLQI scores and stage of illness (disease severity). METHODS: We administered the DLQI to 200 consecutive patients who were seen in a dermatology clinic at Indiana University Medical Center. Results were examined in light of results found by those who originated the DLQI. A pilot group of patients were given the DLQI and rated for severity of disease by means of the Dermatology Index of Disease Severity (DIDS). RESULTS: Overall, the DLQI is easy to administer and can be completed within 3 minutes. The scores in our study were compatible with those previously reported by the DLQI originators. There was a "ceiling" effect in that 11% of the patients indicated no quality of life impairment on the DLQI rating. This index shows stratification with severity of disease. CONCLUSION: The DLQI is an easy and efficient instrument for assessing quality of life in dermatology patients. Patients needed minimal assistance with the form. Our results were similar to those of the DLQI originators, and this further shows reliability and validity of the DLQI. In addition, this study further supports the use of DLQI as a quality of life instrument suitable for use in international studies.

Adolescent↗
PubMed2006

Adherence in dermatology: a review of the last 20 years.

BACKGROUND: Adherence has been studied in many areas of medicine; however, there are few published articles pertaining to adherence and dermatology. OBJECTIVE: The purpose of this review is to summarize the current literature on medical adherence as it specifically applies to dermatology. METHODS: We conducted a PUBMED search between the years of 1985 and 2005 using the following terms: 1-[adherence AND dermatology] and 2-[dermatology AND treatment]. The search was limited to articles in English and human subjects. RESULTS: The literature search yielded 57 articles. Seventeen of these articles met the inclusion criteria and were reviewed in order to define, measure, quantify, validate, and understand adherence in dermatology. CONCLUSIONS: Adherence to topical therapy among dermatology patients is difficult to measure reliably, hence the few articles available on this topic. A small number of studies using new electronic monitoring technology have shown that dermatology patients have low adherence rates to treatment regimens. There are socioeconomic, cognitive, and psychological factors that contribute to non-adherence among patients. Improving patient knowledge and the doctor-patient relationship are ways to improve patient adherence.

Communication↗
PubMed2004

Dermatology in Nigeria: evolution, establishment and current status.

The history of dermatology in Nigeria can be summarized by listing the "first events and people" who played major roles. The first dermatologist to work in Nigeria was George HV Clarke in the mid 1950s. He was based in Lagos. Organized training/teaching and research in dermatology was first established at the University of Ibadan in the western region of Nigeria, in collaboration with the Institute of Dermatology, London. The first set of dermatologists from the Institute on secondment who established dermatology as a discipline at the University of Ibadan were Roger RM Harman as lecturer and GC Wells as the Visitor/supervising consultant in 1962. The first indigenous dermatologist was Anezi Okoro. The first female dermatologist was Yetunde M Olumide. The first (and still the only) Department of Dermatology was at the Obafemi Awolowo University in Ile-ife in the western region of Nigeria, started by a German trained dermatologist: F. Soyinka, the junior brother of Nigeria's first (and only) Nobel Laureate. The first leprologist in Nigeria was George Stanley Browne, a medical missionary. He worked briefly as an associate lecturer (1963-65) under Professor Alexander Brown at the University of Ibadan. Most of the events in Nigeria's dermatology history as well as the greatest concentration of dermatologists in the country have been around the south-western part of the country: Lagos, Ibadan, and Ile-ife. The military coup and the political events that occurred thereafter had a great negative impact on the development/growth of dermatology in Nigeria. The documentation by Ryan as of 1990 indicates that many African countries still do not have a single trained dermatologist.

Academic Medical Centers↗
PubMed2006

Cross validation of the Turkish version of dermatology life quality index.

BACKGROUND: The aim of this study was to test the linguistic validation of the Turkish version of the Dermatology Life Quality Index (DLQI) for Turkish speaking dermatology patients. METHODS: The DLQI is a 10-item dermatology specific index developed originally in English. The methodology of this study consists of four consecutive sections: Translation, cognitive debriefing, field testing and statistical analysis. Translation steps: (a) Two forward independent translations into Turkish, (b) reconciliation of these translations by a dermatologist, (c) backward translation of the consensus Turkish version by a bilingual person into its original language (English), (d) and comparing the original questionnaire with the backward translated one. Cognitive debriefing: Sessions were performed on five patients from each of the seven different dermatological diagnosis groups. Field testing: The final Turkish version on which the face validity was approved by specialists on a total of 79 inpatients/outpatients with various dermatological diagnoses treated at Celal Bayar University Hospital. STATISTICAL ANALYSIS: Internal consistency (using Cronbach a) and item-total score correlations (Pearson correlation) were used for reliability analysis. Validity analysis was carried out by construct testing (principal components factor analysis), convergent (Pearson correlation) and (discriminate Student's t-test and Mann-Whitney U-test) validity, and SF-36 was used in parallel with DLQI in order to test convergent validity. The data were analyzed by the SPSS version 10.0 (SPSS Inc., Chicago, IL, USA) statistical package. RESULTS: The mean age of the patients in the study was 30.77+/-15.91 years; the mean score of DLQI was 7.61+/-6.12. The median of item-total correlation coefficient was found to be 0.66, within a range of 0.48-0.81. The internal consistency of the index was found to be highly sufficient (alpha=0.85). The DLQI was found to be highly related to the physical domain of SF-36. Life quality score was found to be significantly low for the inpatients compared with outpatients (differential validity). CONCLUSION: It was found that the Turkish version of the DLQI was an acceptable index for dermatologists and dermatology patients and, moreover, to be valid and reliable in a cross-sectional level. The responsiveness of the Turkish version of the DLQI needs to be tested further on a variety of dermatological conditions with different severities.

Adolescent↗
PubMed2004

Current guidelines applicable for the approval of topically applied dermatological drugs in the EU.

Dermatologicals as well as other medicinal products are submitted to the rules governing medicinal products in the European Union (EU) (Directive 2001/83/EC). With appreciation of the EU enlargement those regulatories deserve a recent consideration with special regard to the peculiarities of external dermatological therapy, recently passed novel and future guidelines. As regards the criteria for authorization of a medicinal product it is set out in Regulation (EEC) 2309/93 Article 11(1) that a marketing authorization shall be refused if it appears that the quality, the safety or efficacy of the medicinal product have not been adequately or sufficiently demonstrated by the applicant. Article 26(1) of Council Directive 2001/83/EC is worded a little differently but the criteria are the same irrespective of the procedure for the marketing authorization. For the final evaluation of the benefit/risk profile of a topically applied dermatological medicinal product not only the active agent but the whole galenic formulation as well has to be taken into account as the extent of penetration of the active compound might be influenced by changing the non-active substances. Furthermore the vehicle itself - independent of the active agent - influence the dermatological disorder, often in dependence on the stage of the dermatopathy. With special concern to safety/tolerability the (photo)toxic and (photo)allergic potential of the dermatological drug have to be taken into consideration too. In case of total body therapy in children the differing percutaneous resorption due to another body surface/body weight relation deserves special concern. The following review gives a survey of the current most important EU-guidelines for the evaluation of the benefit/risk profile of topically applied dermatological medicinal drugs and an outlook on further developments. As systemically applied dermatological medicinal products are assessed like other systemically applied drugs they are not treated in the following contribution.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Women leaders in American dermatology. Interview by Marylou C. Thelmo, E. Dorinda Shelley, Gloria F. Graham.

BACKGROUND: Women leaders in dermatology opened doors that allowed many men and women to follow in their footsteps. Their achievements have included presidencies of national and state medical organizations, teaching, and research. They changed the specialty through words and leadership. OBJECTIVE: This study highlights four women who significantly influenced American dermatology. METHODS: We selected four female leaders in American dermatology, one of whom is deceased. For the other physicians, a questionnaire was sent to two and a telephone interview was conducted with one. Other responses were garnered through an autobiography, a self-recorded interview, and journal articles. RESULTS: Brief biographies with career highlights are presented for Minerva Smith Buerk, MD, founder of the Women's Dermatologic Society; Naomi Marilyn Kanof, MD, the first female editor of The Journal of Investigative Dermatology; Wilma Fowler Bergfeld, MD, the first female president of the American Academy of Dermatology; and Antoinette Foote Hood, MD, the first female executive director of the American Board of Dermatology.

Dermatology↗
PubMed1998

Undergraduate dermatology education in Canada: a survey.

BACKGROUND: Two reviews done in the 1980's showed that many Canadian medical schools scheduled relatively little time for dermatological teaching. Many students did not have a real clinical exposure to dermatology. OBJECTIVE: The purpose of this study was to obtain new data to reevaluate the undergraduate training in dermatology in Canada. METHODS: A survey was sent to the coordinators of undergraduate dermatology of all 16 Canadian medical schools. RESULTS: The survey of medical schools demonstrates the current status of dermatology undergraduate teaching across Canada. Although many improvements have been made in the way dermatology is taught to medical students, many of the problems noticed in the 1980s remain unresolved. CONCLUSION: Because dermatological care in Canada is often rendered by nondermatologists, the dermatologists should emphasize the importance of undergraduate training in their specialty.

Canada↗
PubMed1983

Dermatologic practice: implications for a primary care residency curriculum.

The problems encountered, diagnostic procedures performed, and treatments prescribed in dermatology were studied in a primary care practice and in a dermatology clinic. Referrals from a primary care practice to a dermatology practice were analyzed. It was determined that nine disease categories accounted for more than 75 percent of the problems encountered in both settings. Only one diagnostic procedure was performed commonly in both the primary care and dermatology practices--skin scraping for fungal infection. Approximately 90 percent of the treatments prescribed in both settings fell within 13 categories. It is proposed that these findings be the basis for designing the curriculum in dermatology for residents in primary care medicine. The curriculum also should provide practical experience in dermatology and familiarity with selected, rarely encountered dermatologic conditions that have important therapeutic implications.

Boston↗
PubMed1993

Citation classics in clinical dermatologic journals. Citation analysis, biomedical journals, and landmark articles, 1945-1990.

BACKGROUND AND DESIGN: Analysis of the most frequently cited dermatology articles and the journals in which they appear identifies and emphasizes the impact of works of colleagues and predecessors, recognizes key advances in cutaneous medicine and surgery, and adds useful data about historical developments in dermatology. Use of citation analysis to examine the dermatologic literature reveals quantitative information about authors, articles, and journals helpful in identifying classic works and high-impact journals. We analyze the characteristics of all dermatology articles cited 100 or more times in one of the 10 most highly ranked clinical dermatology journals as indicated by the Institute of Scientific Information (Philadelphia, Pa) database from 1945 through 1990 and also discuss the standard and, as well, more recently described bibliometric indexes for dermatologic journals. RESULTS: Thirty-one institutions located in 11 different countries produced 129 landmark articles. Ninety-two percent of the citation classics originated in the United States, United Kingdom, Sweden, and Germany. There were 16 authors with three or more top-cited articles. Fifty-two percent of the articles were of the clinical type, 22% were clinical review articles, and 26% discussed basic science topics. The mean number of authors has increased gradually over the past 80 years. The average classic article was published in 1969, peaked in popularity 9 years later with 26 peer citations, and received only 11 citations in 1990. CONCLUSIONS: Citation frequency and citation analysis reveal useful and interesting information about scientific communication. The data on citation classics we describe can be interpreted in many ways, but certainly reflects the attention that articles have received over the past 48 years. The half-life of the average citation classic of about 10 years reflects the rapid pace of advances in the science and practice of dermatology over the past several decades. This information, along with current bibliometric indexes, may assist physicians in optimizing the time they spend reading the medical literature.

Bibliometrics↗
PubMed1993

Future trends in dermatology.

If the specialty of dermatology is to enjoy a bright future in medicine, excellence in education and basic research, use of technologic advances, and advancement of our scientific and clinical knowledge through general and subspecialty dermatology must continue. The specialty needs to be unified and must learn to function in local, state, and federal governmental appropriations, regulations, legislation, and administration. The specialty needs to establish dermatologists as primary care physicians for dermatologic medical and surgical services. Dermatologists deliver the highest quality of dermatologic care and are cost-effective health care providers. The specialty of dermatology has developed a strong organizational structure to effectively deal with these six strategic components so as to afford a bright future for dermatology. Effective actions by the specialty will require increased participation by the constituents and continued involvement of the varied dermatology organizations. The future cannot be predicted with certainty, but a well-prepared society can continue its past success and look forward to a future beyond its highest expectations.

Dermatology↗
PubMed1997

[Dermatology in current medicine].

Dermatology evolved in the second part of the last century as a branch of internal medicine and was for many years confined to morphologic descriptions. Skin diseases are common and vary enormously in severity. Although most of the conditions are not life threatening, many of them are debilitating due to functional loss, pain and itch, and the social problems they cause. Skin diseases are a major public health problem in developing countries. After the second world war there has been an explosion both in the amount of scientific knowledge and with regard to the treatment of dermatoses, many of which can now be managed adequately. The dermatologist is also involved in prevention of skin diseases, as e.g. contact dermatitis and malignant tumors of the skin. Increasing specialisation within dermatology has become more common with the expansion of expertise in dermatopathology, photodermatology, contact dermatology, dermatological surgery, dermatologic pediatrics, phlebology. There are too many dermatologists in our country. If an increasing role in caring for minor skin diseases would be assigned to the generalist, the government he will have to decide how contraction of dermatology manpower would occur and how the dermatology training of the generalist should be improved.

Belgium↗