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At least 793 records · Page 44Linked to original sources
PubMed2005

The rise of the generic drug market and its implications for dermatology.

BACKGROUND: Recent data from the pharmaceutical industry suggest that generic medications are occupying an increasing percentage of the prescription drug market. OBJECTIVE: The objective of this paper was to review the trends in branded and generic dermatological and overall medications in the United States. METHODS: A thorough literature search of research papers for the period 1990-2003 was performed. In addition, we utilized data from a number of medical databases to obtain and compare information on the manufacturing, production, patents and prescription of branded and generic drugs. RESULTS: Two of the top 10 drugs used exclusively for dermatological conditions prescribed in 2003 were generics. For all drugs, the number of generic equivalents increased from 2 (in 1990) to 6 (in 2003) of the top 10 prescription drugs. CONCLUSIONS: The economic, social and scientific implications of the rising prominence of generic drugs are incredibly complex. Dermatologists, pharmacists, pharmacy benefit managers, and health policy makers should consider medication decisions carefully.

Dermatologic Agents↗
PubMed2004

Nonphysician practice of dermatologic surgery: the Texas perspective.

BACKGROUND: Increases in complications resulting from the nonphysician practice of dermatologic procedures have been reported nationally. This investigation was initiated owing to growing concern regarding the nonphysician practice of medicine in Texas. OBJECTIVE: The objective was to survey dermatologists in Texas to determine the number of patients seeking corrective treatment owing to complications from dermatologic procedures performed by nonphysicians. METHODS: A total of 488 dermatologists in Texas were surveyed and seven patients who experienced complications were interviewed by phone. RESULTS: Nearly 53% of responding physicians noted increased complications resulting from nonphysician practice of medicine. Approximately 33% of responding physicians reported that complications were known to have occurred in the absence of an on-site supervising physician. CONCLUSION: The increase in the number of complications owing to nonphysician practice of medicine in Texas mirrors the increases that have been reported nationally. The serious complications reported underscore the need for improved awareness and regulatory changes by state boards of medicine.

Clinical Competence↗
PubMed1963

Current concepts in dermatology. I.

Some of the more recent advances and newer concepts about certain dermatological conditions are presented. Untoward reactions to drugs, whether to systemic or topical agents, are discussed in detail; emphasis is placed on their frequency and on the diversity of clinical findings. In the management of certain skin tumours (hemangiomas and melanocytic nevi) it is essential that the natural history of the lesion be considered. It is generally agreed that the answer to the problem of staphylococcal infection of the skin will be found in the host rather than the staphylococcus. Keratoacanthoma is a pseudocarcinoma of unknown etiology and sometimes gives rise to considerable difficulty in diagnosis. Diffuse alopecia in women is now a common dermatological problem, the cause of which is unknown. The hair loss associated with it is not permanent.

Alopecia↗
PubMedDate not supplied

Focus on: information technology. Online drug information for dermatology patients.

Information about medications appropriate for dermatologists and patients with skin diseases is readily available on the Internet. Authoritative educational material is supplied by academic dermatologic associations and institutions and distributed by independent websites, large health portals, and search directories. Although it is easy to find excellent dermatological drug information, the World Wide Web is dynamic and unmoderated, and patients can be misled or exploited by inaccurate or fraudulent websites. Health on the Net and other organizations have developed ethical principles to aid consumers and evaluate the quality of health-related information.

Databases, Factual↗
PubMed1975

The importance of being visually literate. Observations on the art and science of making a morphological diagnosis in dermatology.

Morphology (or living gross pathology) is being neglected in contemporary dermatology. It is high time for a renaissance of the teaching of the art and science of seeing, so that students, residents, and physicians can learn about basic morphological changes in the skin, the raison d'etre of the speciality of dermatology. How do we see? How can what we see be recorded? What do these recordings tell us when applied to morphological diagnosis? Basing my arguments on the studies of Thomas and others, I will discuss the significance of how much a physician actually sees, the effect of certain emotional states and blind spots, the ability to synthesize visually, and the influence of prior knowledge.

Dermatology↗
PubMed1994

Managed care in California. Daunting new realities for dermatology and academic medicine.

Managed care is the predominant method of health care delivery in Sacramento, Calif; the effect on our academic medical center is profound. The lessons we are learning in the development of a university-based health care network have applicability to dermatology. The future of dermatology demands that all practicing dermatologists have an understanding of the challenges and that they participate in the design of appropriate cost-effective strategies for the future.

Academic Medical Centers↗
PubMed1996

The future of Medicare. Their plans, your practice, Medicare reform, and how it will affect the practice of dermatology.

The future of Medicare will be determined by patient demands, government action, and physician reactions. The federal government has always had the authority to design the Medicare program, but in the past physicians have had control over its implementation. While it is impossible to accurately predict the future, past and present reform efforts shed considerable light on directions the Medicare program will take and the impact Medicare will have on the science and practice of dermatology. It is important to understand these historic trends and the changes they foster to position ourselves to avoid threats and benefit from opportunities that will arise for the science and practice of dermatology.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1998

On the importance of the clinician-educator. Dermatology fellowship for academic clinician teachers.

Within each academic dermatology department there usually exists one clinician who is viewed as the "gold standard" against which diagnostic and therapeutic acumen are measured. As a patient with a puzzling disorder is discussed at rounds, it is to this master that the final word falls, whose recommendation for treatment gets the nod; it is to his or her words that people remain quiet and listen intently. They are commonly also the leading teachers in the medical centers, passing on to succeeding generations the factual knowledge, spiced with bits of philosophy, ethics, and anecdote, that helps to ensure the development of dermatology residents into superb practitioners. They are often the ones most responsible for generating medical student interest in our specialty. Such individuals in our current lingo are "clinician-educators," the rock residents depend on to provide role models to emulate in the diagnosis, care, and treatment of our patients and to whom the community looks to for help in caring for their patients with the most difficult diagnoses.

Academic Medical Centers↗
PubMed1998

Intra-incisional prophylactic antibiotics for dermatologic surgery.

OBJECTIVE: To determine the efficacy of intra-incisional antibiotics in decreasing the risk of wound infections in cutaneous surgery. DESIGN: Prospective, blinded, randomized, placebo-controlled trial conducted during an 8-month period. SETTING: A private practice Mohs micrographic surgery referral center. PATIENTS: Seven hundred ninety consecutive patients referred for Mohs surgery or other dermatologic surgery were randomized to receive anesthesia either with study compound or placebo. The 2 groups were equivalent with respect to age and sex distribution and the lesions treated were similar in character. No patients were withdrawn for adverse effects. INTERVENTIONS: Patients received local anesthesia before surgery with either buffered lidocaine hydrochloride or a solution consisting of nafcillin sodium in buffered lidocaine. MAIN OUTCOME MEASURES: All surgical wounds were evaluated in a blinded fashion at the time of suture removal (5-7 days) and scored according to a standardized assessment chart based on erythema, edema, and the presence of purulent discharge. RESULTS: Seven hundred ninety consecutive patients with 908 surgical wounds were enrolled in this study. A total of 12 wound infections were recorded. Eleven (2.5%) of these occurred in the control group, while only 1 (0.2%) occurred in the nafcillin group. This difference was highly significant (P = .003). Observers were blinded to patient groupings particularly for surgical wound scoring. CONCLUSIONS: This study offers strong supporting data for the use of a single intra-incisional dose of an antibiotic administered immediately before dermatologic surgery. The use of nafcillin and buffered lidocaine solution is inexpensive, safe, convenient, and effective.

Aged↗
PubMed1998

Interactive mechanisms for teaching dermatology to medical students.

OBJECTIVES: To develop interactive teaching mechanisms for an "Introduction to Dermatology" course for medical students and to compare the effectiveness and impact of these mechanisms on learning. DESIGN: Survey and before-after trial. SETTING: Medical school. PARTICIPANTS: Second-year medical students (approximately 200 per year). MAIN OUTCOME MEASURES: The teaching mechanisms were evaluated through responses to questionnaire-based course evaluations (survey). The impact of the CD-ROM program was assessed by performance in Kodachrome slide-based multiple choice examinations (before-after trial). RESULTS: Overall the course was highly rated and among its components, the live-patient sessions, the CD-ROM program, and the poster exhibit were rated most effective. There was no difference in the examination performance of students who took the course before and after inclusion of the CD-ROM program. High-scoring students attended a significantly greater number of lectures in comparison with low-scoring students. CONCLUSIONS: The 3 teaching mechanisms judged by students to be most effective were also the most visual and interactive, suggesting that these attributes are critical to learning dermatology. On the other hand, addition of the CD-ROM program failed to produce differential improvement in short-term cognitive skills.

Adult↗
PubMed1998

Reports by patients and dermatologists of skin cancer preventive services provided in dermatology offices.

OBJECTIVE: To learn how often patients receive skin cancer preventive services in dermatologists' offices. DESIGN: Survey of dermatology patients and dermatologists. SETTING: Dermatology practices of full-and part-time faculty at a midwestern medical school. PARTICIPANTS: Patients were randomly selected from clinical sessions of 11 dermatologists. Of 200 patients enrolled, 162 (81%) responded to the survey. Ten (91%) of the dermatologists responded, and 4 additional dermatologists from the faculty were also surveyed. MAIN OUTCOME MEASURES: Patients' and dermatologists' reports of the provision of skin cancer prevention counseling and screening for skin cancer. RESULTS: Most patients (93%) had been informed about the risks of sun exposure, but for only 27% was a dermatologist the main source of information. Although 76% of patients had seen a dermatologist at least twice in the last 5 years, only 34% reported that they had ever received a total-body screening examination for skin cancer. Most patients (55%) would like to learn more about skin cancer prevention, and responded that they would learn best from a brochure (43%) or from a dermatologist (42%). All dermatologists believed that some skin cancer preventive services should be provided to each patient, but they varied widely in the proportion of their white adult patients to whom they provided such services. For example, with respect to counseling about sunscreens, the same number of dermatologists (4 [29%]) responded that they counsel 25% or less of their patients, and more than 75% of their patients. CONCLUSION: There is wide variation in how often skin cancer preventive services are provided in dermatologists' offices.

Adult↗
PubMed2002

Clindamycin for intraincisional antibiotic prophylaxis in dermatologic surgery.

OBJECTIVE: To assess the efficacy of intraincisional clindamycin therapy as an alternative to nafcillin treatment in decreasing the risk of postoperative wound infections in dermatologic surgery. DESIGN: Prospective, double-blinded, randomized, placebo-controlled trial conducted over a 7-month period. SETTING: Three private practice Mohs micrographic surgery referral centers. PATIENTS: A total of 1030 consecutive patients who underwent Mohs micrographic surgery with subsequent reconstruction. INTERVENTIONS: Prior to reconstruction, patients were randomly assigned to receive either intraincisional buffered lidocaine with epinephrine containing clindamycin or buffered lidocaine with epinephrine without clindamycin. Nurses and physicians who scored the wound at follow-up were blinded to the treatment conditions. MAIN OUTCOME MEASURES: Surgical wounds evaluated at the time of suture removal were scored according to a standardized assessment based on erythema, edema, and the presence of purulent discharge. Wounds scored 4 or higher were considered to be infected. Bacterial cultures obtained when indicated were also compared. RESULTS: Of the 1172 surgical wounds included in the study, 29 had wound scores of 4 or higher, 6 in the study group and 23 in the control group (P =.001, Fisher exact test). Of these 29, 18 had culture-positive infections. Four of these occurred in the study group, and 14 occurred in the control group (P =.02, Fisher exact test). CONCLUSIONS: The results of this study further support the efficacy of single-dose preoperative intraincisional antibiotic treatment for dermatologic surgery. With the relatively high prevalence of patient-reported penicillin allergies, buffered lidocaine containing clindamycin offers an inexpensive, safe, convenient, and effective alternative.

Adult↗
PubMed2004

Photographic images, digital imaging, dermatology, and the law.

BACKGROUND: Patient photographic images play an important role in dermatological record keeping and training. An assessment of the legal implications of image taking is necessary to use images properly. OBSERVATIONS: Images are parts of the medical record and must be treated with the same care as written medical records. Because multiple digital images are sometimes taken and digital images can be easily manipulated, they present novel issues in this regard. Images can be used as evidence in court. Issues regarding digital images include (1). authentication, (2). manipulation, (3). audit trail verification, and (4). data compression. The Health Information Portability and Accountability Act requires that health care providers control and track those who have access to identifiable digital medical information. This should facilitate the use of digital images as evidence because the provenance of digital images can be established. The Health Information Portability and Accountability Act covers the use and disclosure of protected health information, such as "full-face photographic images and any comparable images." To publish identifiable digital images (images of the face), it seems prudent for patients to waive in writing their rights to this protected health information. Conclusion Images will continue to enhance dermatological care, and understanding and accounting for the legal underpinnings of their use is prudent.

Confidentiality↗
PubMed2005

Ultrasound scanning in dermatology.

In recent years, ultrasound scanning has become an important diagnostic tool in dermatology. It is easy to use, completely safe, and provides important diagnostic information. There are 2 basic types of ultrasonography with dermatologic applications. The best established is 20-MHz scanning, which can be used to measure tumor thickness and/or skin thickness when treating inflammatory diseases such as scleroderma or psoriasis. Real-time sonography with 7.5- to 10-MHz probes has assumed an increasingly important role, since it is used to search for and image lymph nodes and subcutaneous tumors in a variety of clinical settings, including preoperative staging and follow-up of melanoma. Ultrasonography is capable of revealing the 3-dimensional size and outline of subcutaneous lesions, for example, lymph nodes, subcutaneous tumor masses or hematomas, and their relation to adjacent vessels. Moreover, information about the lesion quality (solid, cystic, and combined) and the inner structure (homogeneous, inhomogeneous, hypoechoic, hyperechoic, calcification foci, and necroses) can be obtained. All this information can be combined to help distinguish between benign and malignant lymphadenopathy and to determine the malignant potential of a subcutaneous lesion. In addition to conventional B-mode sonography, newer ultrasound techniques such as native and signal-enhanced color Doppler sonography can be used to assess peripheral lymph nodes.

Dermatology↗
PubMed2001

Cryogen spray cooling in laser dermatology: effects of ambient humidity and frost formation.

BACKGROUND AND OBJECTIVE: Dynamics of cryogen spray deposition, water condensation and frost formation is studied in relationship to cooling rate and efficiency of cryogen spray cooling (CSC) in combination with laser dermatologic surgery. STUDY DESIGN/MATERIALS AND METHODS: A high-speed video camera was used to image the surface of human skin during and after CSC using a commercial device. The influence of ambient humidity on heat extraction dynamics was measured in an atmosphere-controlled chamber using an epoxy block with embedded thermocouples. RESULTS: A layer of liquid cryogen may remain on the skin after the spurt termination and prolong the cooling time well beyond that selected by the user. A layer of frost starts forming only after the liquid cryogen retracts. Condensation of ambient water vapor and subsequent frost formation deposit latent heat to the target site and may significantly impair the CSC cooling rate. CONCLUSIONS: Frost formation following CSC does not usually affect laser dosage delivered for therapy of subsurface targets. Moreover, frost formation may reduce the risk of cryo-injury associated with prolonged cooling. The epidermal protection during CSC assisted laser dermatologic surgery can be further improved by eliminating the adverse influence of ambient humidity.

Aerosol Propellants↗
PubMed1983

Research and development of additional aids for dermatologic and plastic surgery.

Increasing numbers of accessories continue to be found to make laser surgery more effective for dermatologic and plastic surgery. Argon laser surgery aids are available to increase the dilatation of the superficial vessels and to localize increasing numbers of red cell masses. Laser probes for intravascular thrombogenesis and thrombolysis have now been adapted for intradermal and deep dermal tissues and for cardiology. Studies on laser effects on platelets and heat transmission and thromboembolic phenomena are lacking. Investigative studies are developing for laser fiber optic probes for laser-induced fluorescence, not only for oncology, but also for studies of metabolism of tissues and also for spectroscopy. The use of different wavelengths and shorter pulses, more flexible fiber-optics transmission for all laser systems, combinations of laser systems into a single operating probe, as well as the increased use of lasers for diagnosis and treatment will all stimulate the development of new aids for laser surgery. Cooperative programs developed jointly by dermatologic and plastic surgeons will make for great progress in skin and soft-tissue laser surgery.

Dermatologic Surgical Procedures↗
PubMed2005

[Use of phytopharmaceutical agents in dermatology. Indications, therapeutic approaches and side effects].

In the recent years there has been increasing interest in herbal therapy including its use for treatment of dermatologic disorders. In Germany, a regulatory authority known as "Commission E" performed an extensive review of common phytotherapeutic (1987-1995) agents indicating quality of evidence, clinical efficacy and therapeutic usefulness producing a "positive monograph" indicating agents supported by evidence and likely to be useful. This article explores the therapeutic use of several of these and other currently popular plants suitable for dermatologic indications; therapeutic hints including phytotherapeutic products and formulations are given and side effects, in particular toxic and allergic skin reactions, are discussed.

Dermatology↗
PubMed2006

[Tasks and function of the German Medical Review Board of the Statutory Health Insurance (MDK). Latest aspects in dermatology in view of social medicine].

The German Medical Review Board of the Statutory Health Insurance (MDK) is a sociomedical service for impartial medical opinion and consultation. Together with the statutory health insurance companies it takes part in shaping the public health care system. Many recent developments are changing the german health insurance system. This article illustrates the complex sociomedical framework of MDK's activities in relation to current issues in dermatology. The article focuses on: new diagnostic and therapeutic methods, drugs (off-label-use), out-patient and in-patient dermatological rehabilitation and hospital treatment.

Dermatology↗