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PubMed2002

Handwashing patterns in two dermatology clinics.

BACKGROUND: The hands of health care workers are a major source of nosocomial infection. Studies conducted mainly in intensive-care units and emergency departments have shown low compliance with hand hygiene recommendation. OBJECTIVE: To study hand hygiene practices in outpatient dermatology clinics in Israel. METHODS: The fingers of 13 dermatologist physicians were sampled for bacterial cultures and their hand hygiene practices were monitored by two observers. In addition, 51 dermatologists attending a professional conference completed a questionnaire on hand hygiene practice. RESULTS: All the physicians' hands were found to be contaminated. Staphylococcus aureus was isolated in 9 cases (69.2%), a methicillin-resistant S. aureus in 1 (7.7%). Monitoring revealed 555 opportunities for handwashing; the average compliance was 31.4%. In the questionnaire, the main reasons given for poor hand hygiene were excessive work schedule (58%), lack of awareness (35.3%), reaction to disinfectants (17.7%) and lack of readily available facilities (15.7%). CONCLUSION: The hands of dermatologists are frequently colonized with microbial pathogens, but compliance with hand hygiene practice recommendations is low, despite a fairly high awareness of the importance. An active educational infection control program should be introduced in dermatology clinics.

Ambulatory Care Facilities↗
PubMed2005

HIV dermatology in Switzerland--from the beginning to the present.

The panendemic of HIV has markedly influenced the dermatology of our generation. This new infection produced atypical manifestations of known dermatological diseases. And beyond that, mucocutaneous diseases emerged, which had not yet been described. Classical epidemiological studies concluded that clustering of AIDS cases could be explained only if AIDS was an infection transmitted by sexual activity or blood. Switzerland was hit early on by the HIV epidemic, and Theo Rufli, the leading expert on sexually transmitted diseases in our country, was involved from the beginning. He contributed with his team to a better delineation of the cutaneous manifestations of HIV infection by directing one of the largest prospective studies on the natural course of cutaneous manifestations of HIV. In addition, he participated in studies which documented new skin diseases in HIV-infected patients. From the very beginning of the epidemic in Switzerland, Theo Rufli founded an organization which helped patients cope with their diagnosis. In Basel, an anonymous consultation facility was established. Theo Rufli also strongly supported the 'Stop AIDS' campaign. This review looks back on the history of HIV in Switzerland and especially in Basel.

Dermatology↗
PubMed1995

Development of a dermatological image atlas with worldwide access for the continuing education of physicians.

We constructed a dermatological image database as a telemedicine tool for clinical, histopathological and scientific use. The database contained about 1300 clinical images from the 40,000 slides in our archive, to provide a general overview of dermatological diseases and to cover basic student education. Some of the images were made available on the Internet through the World Wide Web system in the middle of 1994. This paper describes the architecture and components of the image database, which was designed for international access and submission of data. It allowed combined searches according to diagnosis, location and appearance of skin lesions, as well as on-screen visualization of the resulting images.

Computer Communication Networks↗
PubMed2005

Minimal important difference (MID) of the Dermatology Life Quality Index (DLQI): results from patients with chronic idiopathic urticaria.

BACKGROUND: The Dermatology Quality Life Index (DLQI) has seen widespread use as a health-related quality of life measure for a variety of dermatological diseases. The purpose of this study was to estimate the minimal important difference (MID) on the DLQI for patients with chronic idiopathic urticaria (CIU). METHODS: Data from 2 Phase III clinical trials of patients (N = 476 for Study A; N = 468 for Study B) with CIU were analyzed separately to estimate the MID for the DLQI for these populations. Both distributional based and anchor based approaches were used for deriving estimates. The anchor based approach relied upon patient self assessments of pruritus severity; the distributional based approaches relied upon estimating the standard error of measurement, as well as one-half the standard deviation of the DLQI from each study. RESULTS: The distributional approaches resulted in estimates of MID ranging from 2.24 to 3.10 for the two studies. The anchor based approach resulted in estimates of 3.21 and 2.97 for the two studies. CONCLUSION: An MID for the DLQI in the range of 2.24 to 3.10 is recommended in interpreting results for patients with CIU.

Adolescent↗
PubMed2001

A cost study of teleconsultation for primary-care ophthalmology and dermatology.

Teleconsultations were performed between a health centre in a small Finnish town and a university hospital 55 km away. Telemedicine consultations were carried out with a total of 42 patients suffering from various eye and skin disorders. We evaluated the costs of the teleconsultations in the health centre and the conventional alternative of the patient travelling to the hospital. The cost of conventional consultations, which was not affected by the patient workload, was EU126 per patient for ophthalmology and EU143 per patient for dermatology. The cost of the teleconsultations per patient decreased as the number of patients increased. There were cost savings in relation to teleconsultations when the annual numbers of patients were more than 110 in ophthalmology and 92 in dermatology. Benefits and savings achieved through teleconsultations mainly consisted of reduced transportation costs and reduced paperwork both at the health centre and at the university hospital, as well as time savings for the patient. Another important benefit was improved medical education. The present study shows that teleconsultations can be performed in a cost-effective way in a relatively small health centre.

Cost-Benefit Analysis↗
PubMed2003

Dermatologic and nondermatologic uses of thalidomide.

OBJECTIVE: To review published data on thalidomide, with emphasis on current knowledge about mechanism of action, new and/or potential dermatologic and nondermatologic therapeutic applications, well-known and emerging adverse effects, and current indications for its safe use. DATA SOURCES: Review articles, in vitro research studies, references from retrieved articles, case reports, and clinical trials were identified from a computerized literature search using MEDLINE and OVID (1966-January 2003) and on the Cochrane Clinical Trials Register (January 2003). Information available from meetings' abstract books, Internet, or pharmaceutical companies was also considered. STUDY SELECTION AND DATA EXTRACTION: All articles identified as relevant, including those from non-English literature, were considered in an attempt to provide to the reader both the theoretical basis and practical guidelines for thalidomide pharmacotherapy. DATA SYNTHESIS: Thalidomide has hypnosedative, antiangiogenic, antiinflammatory, and immunomodulatory properties. Moreover, it has been shown to selectively inhibit the production of tumor necrosis factor-alpha and reduce the expression of various integrin receptors on the membrane of leukocytes and other cell types in a dose-dependent fashion. Controlled trials demonstrated the efficacy of thalidomide in a number of diseases, including erythema nodosum leprosum, lupus erythematosus, aphthosis, graft-versus-host disease, prurigo nodularis, and actinic prurigo. Single case reports or studies in small series have also suggested a possible role for thalidomide in numerous other dermatologic and nondermatologic disorders. Possibly severe and sometimes irreversible risks related to the clinical use of thalidomide include teratogenicity and neurotoxicity. CONCLUSIONS: Although teratogenicity and neurotoxicity are significant adverse effects requiring cautious use, thalidomide is an effective therapeutic modality in a variety of difficult-to-treat disorders and, providing careful selection of patients, should offer an acceptable risk-to-benefit ratio.

Angiogenesis Inhibitors↗
PubMed2005

Methods for gene expression profiling in dermatology research using DermArray nylon filter DNA microarrays.

Here we present methods of gene expression profiling using nylon filter deoxyribonucleic acid (DNA) microarrays and radiolabeled and nonradiolabeled hybridization probes. DermArray(R) nylon filter DNA microarrays were designed specifically for use in dermatology research. A patent-pending method was used to select approx 4400 highly informative, sequence-verified human cDNA clones for this DNA micro array. Using DermArray(R) filters, biomarkers have been discovered for normal and pathologic cells from skin, and for responses to dermatologic drugs. As an example, gene expression profiling was performed with hydroquinone-treated SKMel-28 cells, a melanoma cell line. Also included are the methods for bioinformatic analysis using Pathwaystrade mark software.

Computational Biology↗
PubMed2005

Current use of anti-infectives in dermatology.

Dermatologic diseases encompass a broad category of pathologic situations. Infection remains a significant aspect of the pathology faced in patient encounters, and it is natural to expect that anti-infectives play a major element in the armamentarium utilized by dermatologists. Aside from the treatment of the classic bacterial and fungal infections, there are now new uses for antiviral agents to help suppress recurrent disease, such as herpes simplex. There is also the novel approach of using anti-infectives, or agents that have been thought to have antimicrobial activity, to treat inflammatory diseases. This review describes anti-infectives, beginning with common antibiotics used to treat bacterial infections. The discussion will then cover the current use of antivirals. Finally, the description of antifungals will be separated, starting with the oral agents and ending with the topical antimycotics. The use of anti-infectives in tropical dermatology has been purposefully left out, and perhaps should be the subject of a separate review. Cutaneous bacterial infections consist chiefly of those microorganisms that colonize the skin, such as species of staphylococcus and streptococcus. Propionibacterium acnes and certain other anaerobes can be involved in folliculitis, pyodermas and in chronic conditions such as hidradenitis suppurativa.

Anti-Infective Agents↗
PubMed2006

Drug dosage in the elderly: dermatological drugs.

Drug pharmacokinetics and pharmacodynamics may be altered in the elderly. An important contribution is made by decreased renal function, but biotransformation in the liver may also play a role. Commonly prescribed dermatological drugs such as methotrexate and cetirizine are likely to be eliminated more slowly in the elderly and potentially hepatotoxic drugs such as itraconazole and acitretin should be used with caution. Altered drug distribution as a result of body composition changes can lead to prolonged half-life or higher plasma concentrations of many drugs. Higher prevalence of adverse drug reactions and multidrug regimens, and large interindividual variability in drug response make drug dosage and administration in the elderly challenging. New immunobiological agents such as alefacept, efalizumab and etanercept, which are approved for treatment of psoriasis, seem to be as well tolerated in the elderly as in younger patients. A recommended approach when prescribing drugs to the elderly would be to start with a small initial dose and to reduce the number of drugs administered simultaneously. It is crucial to simplify the drug regimen as much as possible in order to enhance drug management in the elderly. To improve pharmacotherapy in the elderly, we review age-related changes in pharmacokinetics that are likely to play a role in dermatological practice.

Aged↗
PubMed2004

Pimozide in dermatologic practice: a comprehensive review.

Pimozide is an antipsychotic drug of the diphenylbutylpiperidine class. In the US, it is FDA-approved only as a backup treatment for Gilles de la Tourette syndrome, although it has been used in other countries for many years as a treatment for schizophrenia. In the past 20 years, pimozide has been found to be especially efficacious in the treatment of monosymptomatic hypochondriacal psychoses and is used by psychiatrists and dermatologists for this off-label purpose. In particular, pimozide is considered the treatment of choice for delusions of parasitosis. In addition, pimozide has been found to be efficacious in the treatment of body dysmorphic disorder, metastatic melanoma, trichotillomania, and trigeminal and postherpetic neuralgia. This review aims to familiarize physicians, especially dermatologists, on the uses of pimozide in dermatologic practice. A review of the literature was performed and the relevant information synthesized to give a complete overview of the drug and its therapeutic uses in dermatology.

Antipsychotic Agents↗
PubMed2006

Clonal spread of Staphylococcus aureus with reduced susceptibility to oxacillin in a dermatological hospital unit.

In November 2000, we became aware of isolates of Staphylococcus aureus with borderline resistance to oxacillin (BORSA) from patients in the Department of Dermatology, Aarhus University Hospital. The objective was to describe the isolates phenotypically and genotypically and to assess possible transmission routes in order to intervene and prevent further spread. Clonality of the isolates was confirmed by pulsed field gel electrophoresis. Several breaches in infection control procedures were revealed suggesting both direct and indirect transmission between patients. Defective skin barriers, high carrier rates of S. aureus in dermatological patients and high consumption rates of dicloxacillin in the department might facilitate transmission. Following improvement of the general infection control measures, and after reassessment of the antibiotic policy in the department, the outbreak has disappeared.

Adult↗
PubMed2000

The archives of the Canadian Dermatology Association.

This article describes some details of the archival material of the Canadian Dermatology Association (CDA). Covering its 75 years of existence, these archives consist of seven items: (1) 38 volumes of bound archives; (2) tri-annual issues since 1975 of the CDA Journal/Bulletin (a socio-political historical newsletter); (3) members' files containing extensive biographical material; (4) a collection of 150 books and other pamphlets; (5) since 1995, the scientific peer-reviewed official journal of the CDA (Journal of Cutaneous Medicine and Surgery); (6) a sporadic collection of photographs, meeting tape recordings, and protocols of patient presentations at the annual meetings; and (7) a miscellany of historical articles on Canadian dermatologists, dermatology published in older medical Journals, and two books published separately.

Archives↗
PubMed1996

Development of specialist dermatology nurse prescribing.

In 1993, nurses on the dermatology unit at the Cumberland Infirmary, Carlisle, undertook a prescribing trial in order to assess and evaluate the accuracy and safety of nurse prescribing in this specialty. The aim was to demonstrate a positive outcome with evidence which would provide a sound, logical argument to explore the legal right of experienced dermatology nurses to prescribe where necessary within the unit. Five nurses and three senior house officers (SHOs) took part in the study which compared their theoretical prescriptions for treatment with two consultants who actually prescribed. Sixty one per cent of treatment prescribed by the SHOs was of the same type and potency as the consultants' choice. Nursing staff, however, accurately prescribed 80 per cent of the topical treatment the patients received. The authors conclude that nurses should be given more prescribing rights.

Consultants↗
PubMed2004

How dermatology units can improve psychological wellbeing.

BACKGROUND: Skin conditions can result in many complex emotional and social problems. Psychological factors have long been associated with the onset, maintenance and exacerbation of many cutaneous disorders. CONCLUSION: This article is based on experience gained from contact with patients while on clinical placement at a specialist dermatology unit. It aims to assist nurses to understand the diverse ways in which stressors, coping strategies, acceptance, adaptation and compliance affect skin conditions. It will stimulate the reader to think about the psychological effect of skin conditions on everyday life and explore the advantages of specialised dermatology care in addressing the emotional problems of patients with such conditions.

Adaptation, Psychological↗
PubMedDate not supplied

General practitioners with a special interest in dermatology--the dermatologist's perspective.

The NHS plan promises the creation of general practitioners with a specialist interest (GPSIs) who will be able to provide an alternative referral resource for primary care. At present, only the specialties of orthopaedics, ophthalmology, ENT and dermatology, which have the longest waiting times for outpatient appointments, have been earmarked for GPSIs. The British Association of Dermatologists has examined, investigated and piloted several such schemes for dermatology provision. This paper summarises its principal conclusions.

Attitude of Health Personnel↗
PubMed1997

The abilities of primary care physicians in dermatology: implications for quality of care.

Quality of care in medicine has become an increasingly important issue as the nature of healthcare delivery has changed. Many managed care systems rely on the primary care physician to serve as a gatekeeper, thereby limiting access to specialist care. Controversy has arisen regarding the abilities of primary care physicians in one such specialty: dermatology. We reviewed the many studies conducted in the United States evaluating primary care physicians' abilities in dermatology. Despite inherent flaws in many of the studies, one can conclude that primary care providers are inferior to dermatologists in the diagnosis and treatment of skin disease. Whether these process-based data predict outcome is not known.

Clinical Competence↗
PubMed1999

[Teledermatology--importance of telemedicine and dermatology].

Due to a constantly improving technology the transfer of clinical images associated with histological images represents the actual answer to the expectation of Dermatologists. The authors give their personal experience regarding the use of telemedicine in Dermatology: discussion of clinical cases, histopathological presentation, diagnostic assistance, follow-up of patients, teaching, and research. Perspectives and development offered by telemedicine as well as the advantages of patient care, and of presenting research topics are mentioned. Also aspects which have to be clarified before telemedicine takes up are presented: as far as that goes for practicing Medicine and Dermatology, technical applicability, credibility, acceptance, confidence and responsibility.

Dermatology↗
PubMed1998

Dermatology nurse certified--now what does that mean?

What is certification and what does it mean to professionalization of dermatology nursing? The certification process is explored through one personal experience. Some discussion of the Dermatology Nurses Association's role in professionalism is included.

Certification↗