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PubMed2004

[Assessment on the reliability and validity of the Dermatology Life Quality Index in Chinese version].

OBJECTIVE: Since 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, our goal was to popularize the disease-specific scale used in measuring the quality of life of patients with skin diseases and to assess the reliability and validity of its Chinese version. METHODS: We administered the DLQI to 236 out-patients attending our dermatology clinic and results that had been found by those who originated the DLQI, were examined. The reliability and validity of DLQI were assessed by means of reliability analysis and factor analysis. RESULTS: Overall, the DLQI seemed easy to administer and could be completed within 3 minutes. The internal consistency coefficient rates of this unidimensional measure were 0.87 (Cronbach's alpha) and 0.85 (Spearman-brown, s) with high inter-correlations found between the dimensions with a correlation coefficient ranging from 0.4024 - 0.6569. Factor analysis resulted in a unidimensional pattern, which supported the use of a total DLQI-C score. CONCLUSION: DLQI was an easy and efficient instrument for assessing the quality of life in patients with dermatological problems and with better reliability and validity. Thus, it could be used in both research and clinical settings in China.

Eczema↗
PubMedDate not supplied

Coping with exacerbation in psoriasis and eczema prior to admission in a dermatological ward.

Chronic dermatologic diseases, such as psoriasis and eczema, may cause significant psycho-social problems and stress. Our objectives were to characterize how hospitalised patients coped with psoriasis and eczema, and to investigate the relationship between coping and quality of life. Data are based on survey forms completed upon admission to the dermatology ward from 212 patients with chronic dermatological diseases, 146 with psoriasis and 66 with eczema. 108 were men, average age 48 years. The Norwegian versions of the standardized survey questionnaires, Jalowiec Coping Scale and Dermatological Life Quality Index, were used to evaluate coping and quality of life. We found that optimism, belief-in-oneself and confrontational coping strategies were most frequently used. Long duration of the disease was correlated to the belief-in-oneself strategy, while short duration was related to supportive strategies. More frequent use of confrontational and optimistic modes was significantly related to better quality of life. More frequent use of emotional and evasive modes was significantly related to poorer quality of life. There was no significant difference between the psoriasis and eczema groups in terms of use of coping strategies, with exception of emotional strategies. Knowledge of coping strategies and quality of life among patients with chronic dermatological diseases is important for improvement in health services for these patients.

Adaptation, Psychological↗
PubMed2000

Hypnosis in dermatology.

BACKGROUND: Hypnosis is an alternative or complementary therapy that has been used since ancient times to treat medical and dermatologic problems. OBJECTIVE: To describe the various uses for hypnosis as an alternative or complementary therapy in dermatologic practice. METHODS: A MEDLINE search was conducted from January 1966 through December 1998 on key words related to hypnosis and skin disorders. RESULTS: A wide spectrum of dermatologic disorders may be improved or cured using hypnosis as an alternative or complementary therapy, including acne excoriée, alopecia areata, atopic dermatitis, congenital ichthyosiform erythroderma, dyshidrotic dermatitis, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, nummular dermatitis, postherpetic neuralgia, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo. CONCLUSION: Appropriately trained clinicians may successfully use hypnosis in selected patients as alternative or complementary therapy for many dermatologic disorders.

Complementary Therapies↗
PubMed2004

Teaching and evaluation of surgical skills in dermatology: results of a survey.

OBJECTIVES: To assess how the surgical skills of residents are taught and evaluated within dermatology residency programs in the United States; to assess which surgical techniques training directors and residents consider important for residents to perform or at least understand by the end of residency training. METHODS: A 126-question survey was sent to all 106 of the US dermatology residency programs accredited by the Accreditation Council for Graduate Medical Education. Contact was initially made via e-mail. Surveys were addressed to the program director, surgical training director, and chief resident of each program. A follow-up survey was mailed to nonresponders. RESULTS: Ninety-five surveys were returned representing 71 (67%) of 106 programs. Eighty-nine percent of programs (n=63) reported having a formal curriculum in dermatologic surgery. Among programs represented, 97% (n=69) taught surgical skills in the procedure room, 84% (n=57) used pigs' feet, and fewer than 10% (n=6) used human cadavers. Ninety-four percent of programs (n=61) scheduled surgical lectures; two thirds (n=41) formally assigned surgical reading, and over half (n=36) used Web-based lectures to teach skills. To assess training, most programs (86%; n=50) used subjective global evaluation at the end of a surgery rotation. Fewer than 30% (n=15) discussed specific objectives prior to the rotation. Only about 25% of programs (n=17) reported the use of written or oral examinations to assess resident surgery skills. Traditional biopsy and simple surgical procedures were reported as most important to know and perform. Interest by both faculty members and residents in more advanced surgical techniques was more limited and variable. Cosmetic surgery techniques were most likely to be viewed as unimportant. CONCLUSIONS: Most dermatology programs teach surgical skills by traditional apprenticeship methods supplemented by work in pigs' feet laboratory classes and regularly scheduled lectures. Skill assessment is mainly done through subjective means. Almost all respondents thought that basic biopsy and excisional skills were essential for residents to know and perform. More complex surgical techniques and the use of lasers were considered less important. Cosmetic techniques were those most frequently viewed as unimportant.

Animals↗
PubMed1995

[Dresden dermatology--an example?].

Since the first dermatological outpatient clinic was started in Dresden in 1869, it has seen the practice of dermatology in the broadest sense, with scientific research activity and innovation. The good working relationship between the dermatologists in private practice and those in the clinics has been the main factor in this successful development. The traditional background of the following sectors is highlighted: outpatient clinic, X-ray and UV light treatment, allergology and occupational dermatology, psychosomatic dermatology, dermatosurgery, and phlebology.

Dermatology↗
PubMed1997

[Dermatology and the Internet--uses for the clinic and research].

The Internet is about to become the most important source of information in virtually any academic profession. Dermatology has a growing presence in many areas of the Internet: discussion groups and continuing education programs invite regular participation, dermatologic data in the form of text and images provide support in daily clinical and scientific work. In this paper important sources of dermatologically relevant information on the Internet are given, and the Dermatologic Online Image Atlas (DOIA) which is available on the World Wide Web is introduced.

Computer Communication Networks↗
PubMed2001

[Ernst Schweninger, personal physician of the German chancellor and director of the Charite Dermatology Clinic 1884-1902].

Ernst Schweninger was at the age of 33 years already world renowned for being Bismarck's personal physician. In 1884, his grateful patient made him chief of the Department of Dermatology in Berlin and Professor of Dermatology. The subsequent years were marked by political struggles within the university, but he still produced a number of scientific publications, and is still remember for his first description of anetoderma type Schweninger-Buzzi. Dermatology and his activities at the Berlin clinic from whose direction he resigned in 1902 accounted for only one period in his life. His main interest was the physiologic-dietetic therapeutic method which he applied also to dermatology. Later on, he dissociated himself from scientific medicine and became the founder of a school for natural healing methods. The present report is designed to keep alive the memories of this politically active physician.

Berlin↗
PubMed2001

[Clinical dermatology at the Central Hospital Sankt-Jürgen-Strasse in Bremen.. A 110-year history].

The history of clinical dermatology in Bremen began in 1891 with a dermatology unit founded in the main building of the then so-called "Big Hospital", nowadays Central Hospital Sankt-Juergen-Street. Friedrich B. Hahn became the first director and served in this position for more than four decades. In 1913, the dermatology wards moved to a new building, still home to the Dermatologic Clinic today. In 1933, the son of F.B. Hahn, Carl F. Hahn, became director until 1938, when the state officials named Konrad Burchardi as head of the department. Immediately after World War II, Friedrich Fölsch replaced K. Burchardi. He served as director until his retirement in 1964, when Joachim J. Herzberg became his successor until 1979. Wolfgang P. Herrmann then directed the clinic until 1994, when the author of this article was elected.

Dermatology↗
PubMed2004

The dermatology workforce shortage.

BACKGROUND: While many dermatology workforce projections over the past two decades forecasted an impending oversupply, more recent reports have begun to suggest a shortage of dermatologic services. METHODS: Anonymous surveys administered to practicing dermatologists and to recent training graduates were examined for surrogate indicators of the supply and demand for dermatologic services. RESULTS: The mean wait time for new patient appointments with dermatologists was 36 calendar days, but ranged widely based on location (means ranged from 9-120 days by state). About half (49%) of practicing dermatologists feel that they need more dermatologists in their communities, while only 20% describe the local supply as too high. The reported need for medical and general dermatologists is far more acute than for dermatologic subspecialists. Many practices (33%) are looking for new associates, and not surprisingly, most new graduates entering the workforce over the past 4 years (86-93%) do not describe any difficulty finding desirable positions. Fewer than 10% of recent graduates are dissatisfied with their current jobs. CONCLUSION: Based on survey data examining wait times, physician perception, use of physician extenders, searches for new employees, and experience of recent graduates entering the workforce, it appears there is an inadequate supply of dermatologists to meet the demand for services.

Adult↗
PubMed2005

Extent and impact of industry sponsorship conflicts of interest in dermatology research.

BACKGROUND: Many published clinical trials are authored by investigators with financial conflicts of interest. The general medical literature documents the pervasive extent and sometimes problematic impact of these conflicts. Accordingly, there is renewed discussion about author disclosure and clinical trial registry to minimize publication bias from financial conflicts of interest. Despite this evolving discussion in the general medical literature, little is known about the extent or role of financial conflicts of interest in dermatology research. OBJECTIVE: Our purpose was to determine the extent and impact of industry sponsorship conflicts of interest in dermatology research. METHODS: We recorded potential financial conflicts of interest, study design, and study outcome in 179 clinical trials published between Oct 1, 2000 and Oct 1, 2003 in four leading dermatology journals. RESULTS: Forty-three percent of analyzed studies included at least one author with a reported conflict of interest. These studies were more likely to report a positive result, demonstrate higher methodological quality, and include a larger sample size. CONCLUSIONS: Conflict of interest in clinical investigations in dermatology appears to be prevalent and associated with potentially significant differences in study methodology and reporting.

Biomedical Research↗
PubMed2006

Median dermatology base incomes in senior academia and practice are comparable, but a significant income gap exists at junior levels.

BACKGROUND: The perception that dermatologists in practice have substantially higher incomes than in academics is often cited as the primary reason people choose to practice outside academic institutions. OBJECTIVE: We sought to compare the incomes of dermatologists in academics versus various practice settings. METHODS: Data from various surveys of dermatologists from 2002 to 2004 were adjusted for annual inflation to the year 2004 and compared. Benefits and bonuses were not included. The income level of clinical instructors, who are 7.0% of all academic dermatology faculty, were not available for inclusion. RESULTS: Median dermatology faculty income (combined average of assistant, associate, and professor levels) was 192,267 dollars, 12.0% less than the median practice income of 215,303 dollars. There was substantial variation across regions, institutions, and types of nonacademic practice. Median starting incomes for dermatology residency graduates were comparable in practice across multiple data sources (182,116 dollars-200,000 dollars) and private universities (189,336 dollars); however, both were significantly higher than median starting incomes in public universities (83,349 dollars). LIMITATIONS: This study relied on self-reported data. Although all attempts were made to use comparable information, variances in how data were collected and classified may exist. CONCLUSIONS: Initial income for those entering practice is equivalent to those entering academia in private universities; however, incomes for both of these groups are 2- to 3-fold higher than those entering academia in public universities. This discrepancy may discourage some recent trainees, some of whom have high debt and high expenses, from entering the field of academic dermatology. Because incomes in academia increase predictably with increasing rank, overall self-reported incomes for established dermatologists in practice and senior academia are comparable.

Academic Medical Centers↗
PubMed2005

Accreditation and certification in dermatologic surgery.

The Accreditation Council for Graduate Medical Education (ACGME) is an agency that accredits residency-training programs, thus assuring the public of the highest-quality medical education in the United States. Only those residents who complete ACGME-accredited programs qualify for certification by an American Board of Medical Specialties (ABMS)-sponsored board. Certification by the ABMS assures the public that a physician has become competent in a defined body of medical knowledge. Because medicine continuously evolves, the ACGME and the ABMS sponsor a process by which new specialties or subspecialties can be defined, programs accredited, and physicians certified. Procedural dermatology is a surgical subspecialty of dermatology that includes cutaneous oncology (along with Mohs micrographic surgery), cutaneous reconstructive surgery, and cosmetic surgery of the skin. The recent approval by the ACGME to accredit procedural dermatology fellowships establishes the specialty of dermatology as an organ-based body of knowledge that includes medical, pathologic, and surgical skills.

Accreditation↗
PubMed2006

[Analysis of the reasons for consultation and dermatology care cost in a primary care site].

INTRODUCTION: The objective of the study was to the visits for esthetic reasons in an out-patient dermatology consultation and their cost and calculate the invoicing of these visits for a site other than the medical specialist consulted. METHOD: Prospective study in an out-patient dermatology clinic for 12 random days in February 2005. Endpoints of age, gender, diagnosis, cost per visit, cryotherapy and electrocoagulation were collected. Patients were divided into 3 groups: request for esthetic treatment (A), request for dermatology visit (B) and did not come (C). RESULTS: Group B was the largest, with 205 users (46 %), followed by C with 134/455 (29 %) and by A with 116/455 (25 %). In the latter group, the diagnoses were: seborrheic keratosis 39/455 (9 %), acrocordons 21/455 (5 %), remaining diagnoses (intradermal melanocytic nevi, cherry angioma, solar lentigos): 56/116 (11 %). The cost of these visits was 2,528. 8 euros in the 12 days analyzed and treatment of a subgroup of 85 patients (18.75 %) with cryotherapy or electrocoagulation increased it up to 5,043.80 euros. Estimated cost for one year would be 82,950 euros. Calculation of the invoicing for a non-public supplier site to the National Health Service would be: 8769.60 euros/month and 97,875 euros/year. If we add the treatments described, we go from 28,403.40 euros/month to 317,113.80 euros/year. CONCLUSIONS: These data and daily experience should make us think about the ethical consequences (do all the patients have to wait the same time?) as well as legal and collective ones (what type of dermatology do we want to specialize in?).

Costs and Cost Analysis↗
PubMed2005

[Assessment of dermatological emergencies in a French university hospital].

INTRODUCTION: The aim of our study was to understand the motivations of outpatients who come to dermatological emergencies in a university hospital. PATIENTS AND METHOD: This 6-week prospective study included outpatients who came to the dermatology emergency unit. This consultation is proposed each morning (from 8 to 9), from Mondays to Fridays. A questionnaire was distributed to outpatients. They answered questions on the functioning of this consultation and their own symptoms. The consulting dermatologist answered questions on the referring physician, the really urgent characteristics of the disease and the diagnosis. RESULTS: Patients were satisfied by the functioning of the consultation. Indeed, 59 p. 100 of outpatients thought that the timetable was convenient and 70 p. 100 that the delay before getting a consultation was rapid. 75 p. 100 felt they needed treatment rapidly. Nonetheless, 45 p. 100 did not think they had a serious disease. More than half of the outpatients were referred by their general practitioner; the others came spontaneously, or were referred by other departments or general emergencies. The most frequent diagnoses were cutaneous infections (27.6 p. 100), eczema (21 p. 100), then benign tumors, psoriasis, physical dermatoses, viral eruptions... DISCUSSION: A consultation for dermatological emergencies appears to reply to patients' demands. Nonetheless, most of these outpatients do not present with real dermatological emergencies. Criteria for real emergencies needs to be further defined and understood by citizens.

Dermatology↗
PubMedDate not supplied

[Skin diseases observed in the dermatology departments of three French university teaching hospitals].

BACKGROUND: We recently carried out a study concerning consultations by French dermatologists in private practice. We evaluated consultations at the dermatology departments of 3 university teaching hospitals in France. MATERIALS AND METHODS: This was a 2-month prospective study conducted in 2003 at the dermatology departments of the university teaching hospitals of Amiens, Lille and Rouen. Each consultant completed a questionnaire covering the duration of the study. The following data were recorded: consultation date, function of the consultant, study centre, type of consultation, type of disease, and whether or not the patient was hospitalised after the consultation. RESULTS: 7296 files were examined during the study. 38% of the consultations were performed by part-time hospital consultants, 29% by dermatology interns, 18% by hospital practitioners, 9% by university professors and 6% by clinical heads or assistant heads. The most commonly encountered diseases were allergies (17%), cancer (16%), arteriovenous disease (15%) and infectious disease (11%). Three types of consultation were identified: emergency consultations without an appointment, consultations by appointment for a specific problem and consultations by appointment without a specific problem. The number of resulting hospital admissions ranged from 2 to 10% of consultations, depending on the type of consultation and the role of the consultant in question. DISCUSSION: This study shows that in France, consultations at hospital dermatology departments differ greatly from those of dermatologists in private practice. The main diseases seen (cancer, arteriovenous disease, allergy, infectious dermatosis) accounted for the majority of hospitalisations in these departments. The organisation of hospital consultations is increasingly tending both towards treatment of highly specialised diseases through specifically oriented consultations and also towards the emergency treatment of certain forms of acute dermatosis.

Appointments and Schedules↗
PubMed1998

Thalidomide and its impact in dermatology.

Thalidomide, originally marketed as a sedative, was introduced in West Germany in 1956 and in numerous other countries soon thereafter. In part because it did not impair coordination or respiratory function, the drug rapidly became extremely popular. By 1961, however, there were mounting reports of phocomelia and other severe congenital abnormalities associated with maternal use of thalidomide, and the drug was withdrawn from the market and its availability highly restricted. A few years later, thalidomide would find use in dermatology after it was reported that leprosy patients with erythema nodosum leprosum (ENL) experienced rapid and dramatic improvement after taking the drug as a sedative. Additional data quickly confirmed thalidomide's efficacy in ENL, and today it is the drug of choice in the condition. In subsequent decades, the drug has been successfully tried in treatment of a variety of apparently unrelated dermatologic disorders. Meanwhile, thalidomide has been shown to possess a range of biologic actions, including inhibition of tumor necrosis factor alpha, possibly relevant to its clinical efficacy. Dermatologic disorders in addition to ENL in which thalidomide's effectiveness is well documented include aphthous stomatitis, discoid lupus erythematosus, actinic prurigo, Behçet's disease, and prurigo nodularis. More recently, the drug has been employed in dermatologic conditions associated with HIV infection. When used with safeguards to prevent teratogenicity and the drug's other major adverse effect, peripheral neuropathy, thalidomide may offer a good therapeutic option for many patients in whom other drug therapies have proven inadequate.

Dermatologic Agents↗
PubMed1998

Evidence-based dermatologic out-patient treatment.

OBJECTIVE: To determine the evidence base for routine therapeutic decisions in dermatologic out-patients. DESIGN: A retrospective review of a random sample of primary therapy and literature. SETTING: University hospital, dermatologic out-patient clinic in Copenhagen MATERIAL: A random sample of the case notes from 115 out-patients. METHOD: The evidence base of therapy prescribed when the diagnosis was ascertained was studied in literature searches in MEDLINE and EMBASE. Evidence was structured into primary evidence consisting of randomized controlled trials, and secondary evidence consisting of follow-up studies or the application of trial results between diseases with pathogenic or clinical similarities, e.g. atopic and seborrheic dermatitis. RESULTS: Randomized controlled trials could be found describing 38% (95% confidence interval: 30-47) of all treatments. Secondary evidence was found for 33% (24-41), while no evidence was found for 23% (16-31) of the given treatments. CONCLUSIONS: Approximately three-quarters of dermatologic out-patient therapy is based on scientific evidence ranging from randomized controlled trials to logical deduction from analogous clinical situations. The proportion of evidence-based medicine in dermatologic therapy therefore appears to be comparable with that of internal medicine and may thus be above expectations.

Adolescent↗
PubMed2002

Inpatient dermatology: characteristics of patients and admissions in a Spanish hospital.

BACKGROUND: Inpatient dermatology has not been properly described in many countries. National differences might be important in the evaluation of its usefulness and the applicability of politics of health expenditure restrictions. OBJECTIVE: To describe inpatient activity and readmission rates in a dermatology department in Spain. STUDY DESIGN: Cross-sectional prospective study in a single hospital. SETTING: Secondary care hospital of the National Health Service in Pontevedra (Spain). METHODS: From May 1997 to December 2000, all discharge sheets (1048) were included in the study, codified and described. RESULTS: Surgery was the reason for admission in 37% of the inpatients. The most frequent diagnosis were: neoplasm (36%), infection (15%), psoriasis (10%), other (10%), dermatitis (6%) and drug reaction (5%). Readmission rates were 1.8% within 30 days, and 12.5% within 1 year. CONCLUSIONS: Inpatient dermatology is different in different countries. Compared with what has been described in the USA or UK, our data suggest an important surgical content of inpatient dermatology in Spain, not reported in those countries. Medical diagnoses also differ, consisting of more infections, and less psoriasis and dermatitis in our setting. Readmission rates are low when compared with previously published ones, a finding that supports a long-term benefit of hospitalization.

Adult↗