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Medical student dermatology research in the United States.

The development of academic researchers is important for the future success of dermatology, but few dermatology trainees are entering academic practice in the United States. Because many successful researchers begin to focus on research skills during medical school, an electronic survey was conducted to evaluate dermatology research opportunities and benchmarks for U.S. medical students. First- and second-year medical students participated in case studies, clinical research projects, and laboratory benchwork, but participation significantly increased during the third and fourth years. Funded programs had higher student participation than nonfunded programs and were also more likely to have medical students present their research at meetings. A wide variety of research opportunities are currently offered to U.S. medical students, so a lack of research opportunities in medical school does not explain the dwindling supply of academic dermatologists in the United States. Because funding appears to be an important factor for successful medical student research, new mechanisms of funding should be identified and developed.

Biomedical Research↗

Spanish dermatological vocabulary used by Mexican workers.

Spanish is the second most common language spoken in the United States. Physicians can expect a growing population of patients who speak Spanish as their primary language. The purpose of this study was to develop a glossary of Spanish dermatological vocabulary commonly used by Mexican workers. Dermatologic terms were gathered from transcripts of in-depth interviews with 31 Latino farmworkers in North Carolina. Participants were asked to name and define words related to skin irritations. Farmworkers provided several definitions of some terms, and several Spanish equivalents exist for specific English words. This glossary is a supplement to other resources for learning medical Spanish and expands health care professionals' knowledge of dermatology-related Spanish vocabulary.

Dermatology↗

Cytokines in dermatology.

Cytokines are polypeptides that are produced by various cell types and act in an autocrine or paracrine manner. They have many different biological actions and have been used in dermatology to treat a wide range of dermatologic diseases. In this paper we review some of the more commonly used cytokines in dermatology, including interferon-alpha and -gamma, interleukins-2 and -10, and granulocyte-macrophage colony-stimulating factor. We specifically examine their roles in the treatment of condyloma and verruca, hemangiomas, keloids, skin cancers, atopic dermatitis, psoriasis, Behcet disease, chronic granulomatous disease, wound healing, and cutaneous T cell lymphoma. In addition, some of the adverse effects associated with these cytokines are discussed.

Cytokines↗

Integration of moisturizers and cleansers into a busy dermatology practice.

Patients with chronic dermatologic conditions desire more information from their dermatologist about their disease and treatment options, including which moisturizers and cleansers to use. The challenge for the dermatologist is how to deliver this information in a time-limited office visit. Several ideas from an office-based practice on how to optimize communication on moisturizers and cleansers are shared. The suggestions include product placement within the office, readily available educational materials that make it easy for office staff to address commonly asked questions, and staff training regarding products that are frequently recommended and educational messages that are to be communicated to the patient to reinforce the dermatologist's instructions. Incorporating these tips into a dermatology practice may provide patients with the desired information and may improve the clinical outcomes of patients with these often challenging dermatologic conditions.

Anti-Infective Agents, Local↗

AIDS and infection control in dermatologic surgery.

In summary, the AIDS epidemic has created many new questions for the dermatologist, with no clear answers. As dermatologic surgery is increasing in most dermatology practices, the dermatologic surgeon must take a careful look at his office techniques and educate his personnel on the proper handling of blood and body fluids. The medical and ethical issues raised by the AIDS epidemic are complex, with new issues being raised as more is learned about the disease. The adage "do no harm" should be kept in mind in the counseling, diagnosis, and treatment of HIV-infected individuals.

AIDS Serodiagnosis↗

[A new universal program of postgraduate physician instruction in dermatology and venereology].

The Chair for Dermatology and Venereology at the Central Institute for Advanced Medical Training has developed a new universal programme for advanced training of physicians in this field; this programme is the sole document regulating continuous education of dermatologists and venereologists. It was approved by the Head Administration of Educating Institutions of the USSR Ministry of Health. The programme structure is based on a block system. Of the 8 blocks (courses) one deals with organizational aspects of dermatological and venereological care, five with dermatology, one with syphilis, one with gonorrhea and nongonorrheal diseases. The Programme includes curricula for two cycles of general and eight cycles of topical continuous education, defines the purposes of these cycles, and specifies who should be admitted for these cycles. The Universal Programme may be used parallel with other forms of continuous education (workshops, ten-day courses, etc.) and for individual education.

Curriculum↗

Analysis of dermatological referrals (a series of 662 cases from base and army hospital complex).

An analysis of 662 patients from non-dermatological wards and specialist out-patients referred for dermatological opinion is reported. There was a high proportion of referrals of 330 (49 8%) cases from internal medicine and allied specialties, followed by 150 (22.7%) from surgical disciplines, 65 (9.8%) by Paediatricians 30 (4.5%) by Otolaryngologists, 24 (3.6%) each by Ophthalmologists and specialists in Obstetrics and Gynaecology, 21 (3 2%) by dental surgeons and 18 (2.7%) from department of Psychiatry. The youngest patient was a new born and the oldest 87 years. 333 (50.3%) were in the age group of 21 to 40 years. 505 (76.3%) were males. Almost one fourth i.e. 152 (23%) presented with cutaneous manifestations of underlying diseases, another 82 (12.4%) were drug eruptions and other complications of treatment. The study emphasizes considerable interphase between cutaneous and systemic diseases and the need for close co-operation between dermatology and other specialist medical disciplines.

Adolescent↗

[The Dermatology department of the Munich-Schabing Municipal Hospital in changing times].

In July 1914 the Department of Dermatology of the newly built municipal hospital of Munich started to work. The department head, Professor Wilhelm Heuck, established social organizations that were ahead of his time. Nevertheless, in 1931 he had to fight the threatened closure of this department that came about as a result of the increasing amount of outpatient treatment in private practice. Two dermatologists of his school became famous: Vonkennel and Kimmig. His successor, Professor August Poehlmann, managed the difficult circumstances during World War II. The hospital had been confiscated by the occupying forces and the dermatological patients were spread over the city in different hospitals. In 1950 Poehlmann was successful in transferring all patients into the Biederstein hospital. In 1955 Curt Böhm moved the dermatological department back to the hospital of Schwabing. The present head, Professor Hans-Jürgen Bandmann, has nicely refined the triad of patient treatment, teaching and research.

Dermatology↗

[Albert Wiedmann - his personality and work and his contribution to the development of Dermatology in Vienna after World War II (author's transl)].

The contribution of Albert Wiedmann (1901 to 1970) towards the development of the Viennese Dermatological School are evaluated. The following main points of interest can be focused out of a large number of scientific papers; investigations in the field of venerology, innervation and nutrition of the skin (concept of the "neuro-hormonal cells"), phlebology and the relationship between dermatological disorders and internal medical diseases. His outstanding abilities as a researcher, tutor and physician were matched by his great talents for organisation and qualities of leadership as chief of the 2nd Department of Dermatology, University of Vienna, 1946 to 1970.

Austria↗

[New lasers in dermatologic surgery].

Developments in the fields of laser technology and application have significantly broadened its clinical use over the past two decades. As lasers became more smaller, more reliable and less expensive, dermatology will benefit new laser-based therapeutic and diagnostic methods. Relevant laser systems and their clinical applications are presented, as are investigational laser systems, which may be of importance for the future in dermatology. We review advances in the use of pulsed lasers for treating vascular and non-vascular, pigmented epidermal and dermal lesions, for precise cutting of tissue, for photodynamic therapy and the future role of diode lasers in dermatological laser surgery is also discussed.

Dermatology↗

Dermatologic diseases of eastern Africa.

The countries of eastern Africa are deprived of the most basic of care for their skin disease. Diagnostic tools and treatment modalities that are commonplace in developed countries are at a bare minimum in these third world nations. In addition, there is a dearth of trained dermatologic specialists, especially in the arid areas of Kenya and Tanzania. The International Foundation for Dermatology was founded in 1987 in an attempt to address this vacuity in medical care. During the last 6 years, they have launched a campaign concentrated on the activation of Regional Training Centers in Africa, where students will enter a 2-year training program and graduate with the title of "Dermatology Officer" possessing those skills required to treat 80% of common skin diseases. It is hoped that this will lead to an increased awareness of skin pathology in general and the specific need for trained specialists in underserved areas. However, a lack of health care specialists is only part of the problem. Better nutrition, clean water, and the education of tribal communities are impending future goals, difficult to attain in a nation burdened with economic and political strife.

Africa, Eastern↗

Instrumentation in dermatologic surgery.

The practice of dermatology has changed greatly over the past 2 decades. This change has been partly characterized by an increased emphasis on the surgical approach to the diagnosis and treatment of skin disease. This new emphasis within the practice of dermatology necessarily alters the basic equipment and instrumentation needed to begin and maintain a dermatology practice in the 1990s. The following article is intended to provide the interested reader with a sound and rational basis for selection of surgical instruments to incorporate into his or her particular level of surgical practice.

Curettage↗

Local anesthesia for dermatologic surgery.

Knowledge of local anesthesia is critically important to perform dermatologic surgery. The objective of this article is to provide an updated review of local anesthesia. The principles of local anesthesia as it pertains to dermatologic surgery are reviewed. New methods of delivering local anesthesia are also presented. Local anesthetics are safe, effective drugs that provide transient insensibility to pain in a limited area of skin. There are a variety of methods of inducing local anesthesia which can be tailored to the requirements of the contemplated procedure. Local anesthetics allow dermatologists to perform a range of procedures safely. Recent developments in topical anesthetics and in tumescent local anesthesia have provided the dermatologic surgeon other methods of delivering local anesthesia.

Anesthesia, Local↗

The impact of managed care on dermatology.

The goal of managed care is to find the most effective mix of the factors of production to provide quality care to its members. The aforementioned information on the impact of managed care on dermatology suggests that the future of dermatology need not be bleak. The supply of dermatologists in the nation is far more consistent with the demand of classic MCOs for dermatologists than for almost all other specialties. In addition, any form of health care reform that increases access to health care for the uninsured and underinsured will increase the demand for dermatologic care. Similarly, a well-functioning managed care plan will move to establish the boundary line between skin care by PCPs and dermatologists in a consensual, objective, and mutually respectful process. The attempt to define this boundary will give added impetus to the development of outcomes measurement and management in managed care and serve to advance the interests of all parties concerned, including the patient. A well-defined boundary line between care appropriately rendered by PCPs and that provided by dermatologists will result in dermatologists treating a higher severity of illness--the cases for which dermatologists were trained to treat. The higher level of severity of illness could be associated with a higher level of professional satisfaction. Similarly, capitated arrangements between dermatologists and PCPs create incentives for cooperative education and communication initiatives between both parties to define appropriate ranges of care and referral timing. Where capitated arrangements do not exist, it is also important to define such appropriate ranges of care.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗

Mendelism in early 20th-century American dermatology.

Now, almost a century ago since Mendel's work was rediscovered, is a propitious time to review the appearance of mendelian concepts in American dermatology. In our world of instantaneous and sometimes overwhelming dissemination of new information and the apparent rapid incorporation of new knowledge into our specialty, it is useful to examine how heredity was incorporated in the dermatologic literature in the first 25 years of the 20th century. The dermatologic literature serves as a surrogate for the thought of the era.

Dermatology↗

Canadian dermatology.

Canadian dermatology differs from the American system by a predominant referral system in most provinces and by universal health care scheme. Canadian certification requires 1 year of internal medicine training in addition to 3 years of clinical training. The Canadian Dermatology Association has formed several links with the American Academy of Dermatology and sponsors a similar sun awareness campaign.

Canada↗

History of the Department of Dermatology of the Mount Sinai Hospital.

The Department of Dermatology at Mount Sinai has a long, distinguished history. Founded in 1891, the department started in an era of keen diagnosticians and clinicians. By the middle of the twentieth century, it had evolved as both a clinical and investigational department at the forefront of both dermatology and syphilology. Today, it excels in both clinical and research areas and is on the cutting edge in dermatologic surgery.

Dermatology↗

Diagnostic accuracy and appropriateness of general practitioner referrals to a dermatology out-patient clinic.

A study was undertaken of new referrals by GPs to a dermatology clinic in a district general hospital over a 6-month period. Six hundred and eighty-six consecutive referrals to one consultant were analysed for diagnostic accuracy and requirement for referral. Only 47% of referral letters contained the correct diagnosis. Viral warts and psoriasis were best diagnosed (82 and 78%, respectively), but seborrhoeic warts and dermatofibromas caused difficulty (22 and 19%, respectively). Cutaneous malignancy was correctly diagnosed in 45% of referrals, and eczema, the commonest condition referred, in 54% of cases. Sixty-eight percent of referrals required hospital-based facilities for diagnosis (31%) or treatment/management (37%). Twenty-one per cent of patients referred attended for once-only visits, requiring no specialized diagnostic or therapeutic procedures. Such referrals should decrease with improved GP education. Eleven percent of referrals were for minor surgical procedures such as curettage, shave biopsy, or cryotherapy and would become unnecessary if such facilities were available in the community. Our data demonstrate the potential for management of up to one-third of current dermatological referrals within the community by improving education of GPs and providing appropriate facilities within the community. However, over two-thirds of patients required hospital facilities, a finding of considerable relevance to the future location of dermatological services.

Dermatology↗