Young women taking isotretinoin still conceive. Role of physicians in preventing disaster.
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QUESTION: One of my adolescent patients was prescribed isotretinoin for severe acne by a dermatologist. I was shocked to discover she does not use any means of contraception. The dermatologist insists he told her about the need for contraception. How can we do better? ANSWER: Clearly this dermatologist, like many of his colleagues, does not comply with the Pregnancy Prevention Program. Until physicians become more aware of this program, babies will continue to be born with embryopathy due to isotretinoin. (+info)
The abilities of primary care physicians in dermatology: implications for quality of care.
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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. (+info)
A large-scale evaluation of terminology integration characteristics.
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OBJECTIVE: To describe terminology integration characteristics of local specialty specific and general vocabularies in order to facilitate the appropriate inclusion and mapping of these terms into a large-scale terminology. METHODS: We compared the sensitivity, specificity, positive predictive value, and positive likelihood ratios for Automated Term Composition to correctly map 9050 local specialty specific (dermatology) terms and 4994 local general terms to UMLS using Metaphrase. Results were systematically combined among exact matches, semantic type filtered matches, and non-filtered matches. For the general set, an analysis of semantic type filtering was performed. RESULTS: Dermatology exact matches defined a sensitivity of 51% (57% for general terms) and a specificity of 86% (92% general terms). Including semantic type filtered matches increased sensitivity (75% dermatology; 88% general); as did inclusion of non-filtered matches (98% and 99%). These inclusions correspondingly decreased specificity (filtered: 82% and 74%; non-filtered: 52% and 32%). Positive predictive values for exact matches (93.0% dermatology, 97.6% general) were improved by small but significant (p < 0.001) margins by including filtered matches (95.1% dermatology, 98.4% general) but decreased with non-filtered matches (89.2% dermatology, 87.8% general). Adding additional semantic types to the filtering algorithm failed to improve the positive predictive value or the positive likelihood ratio of term mapping, in spite of a 2.3% improvement in sensitivity. CONCLUSIONS: Automated methods for mapping local "colloquial" terminologies to large-scale controlled health vocabulary systems are practical (ppv 95% dermatology, 98% general). Semantic type filtering improves specificity without sacrificing sensitivity and yields high positive predictive values in every set analyzed. (+info)
Agreement between self-assessment of melanocytic nevi by patients and dermatologic examination.
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The number of melanocytic nevi is the strongest risk factor for cutaneous melanoma. As pigmented skin lesions are visible to everybody, the question has been raised about whether people can identify themselves as being at risk for melanoma through self-counting of moles. In 1991, a total of 513 central European melanoma patients and 498 controls were asked to count the total number of nevi and the number of atypical nevi on the whole body. Whole-body examination by dermatologists followed. Agreement was assessed on categorized nevus counts by means of ordinal kappa values and log-linear modeling. Study subjects significantly underestimated the total number of melanocytic nevi (p < 0.0001). Chance-corrected overall agreement was rather poor (kappa = 0.14), and the ability to detect many existing nevi was low. Agreement was higher for atypical melanocytic nevi counts (kappa = 0.37), and the sensitivity to detect more than one atypical nevus was 0.48. Self-assessment of the number of melanocytic nevi was difficult to perform accurately, and people severely underestimated the actual number. Despite these results, people should be encouraged to perform regular skin self-examination for early detection of melanoma. (+info)
The epidemiology of atopic dermatitis at a tertiary referral skin center in Singapore.
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Atopic dermatitis is a common chronic, relapsing, pruritic ecematous skin condition with a predilection for the flexural areas and occurs in patients with a personal or family history of atopy. The aim of this study is to describe the profile of atopic dermatitis seen at the National Skin Centre in Singapore. A retrospective chart review was conducted of all the patients with atopic dermatitis seen during the first six months of 1994. There were 492 patients whose ages ranged from one month to 74 years with an equal sex ratio. The prevalence was 2%. The onset of the disease occurred before the age of 10 years in 61.2% of patients. In 13.6% of the patients, the onset was after the age of 21 years. Two hundred and fifty-four patients (52%) had "pure" atopic dermatitis without concomitant respiratory allergies. Two hundred and thirty-eight patients (48%) suffered from a "mixed" type, with 23% having allergic rhinitis, 12% having asthma and 13% having both asthma and allergic rhinitis. Two hundred and thirty-one patients (47%) had at least one first-degree family member with atropy: atopic dermatitis (17%), asthma (15%) and allergic rhinitis (15%). Most of the patients, 416 (84.5%), had subacute eczema at presentation. Ichthyosis vulgaris was present in 38 patients (8%) and pityriasis alba in 13 patients (3%). The most common infective complication was bacterial infection (impetiginized eczema, folliculitis, cellullitis) present in 95 patients (19%) followed by viral infections (eczema herpeticum, viral warts and molluscum contagiosum) in 17 patients (3%). Allergies were noted in 43 patients (9%) based on the history given. The most common was drug allergies (penicillin and co-trimoxazole) in 28 patients followed by food allergies in 11 patients. Common aggravating factors reported include heat, sweating, stress, thick clothing and grass intolerance. Most patients could be controlled with a fairly simple regimen of moisturizers, topical steroids and antibiotics for acute flares. Short courses of systemic steroids were used in 78 patients (16%). Three patients were treated with phototherapy, Two on UVAB and one on PUVA. The pattern of atopic dermatitis in Singapore is similar to that reported in the Western literature except for a lower prevalence and a significant proportion of adult onset atopic dermatitis. (+info)
Pattern of occupational allergic dermatitis in the Dermatology Clinic, Hospital Kuala Lumpur.
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A two years retrospective analysis of patients diagnosed as contact allergic dermatitis with positive patch test attending the Dermatology clinic was performed. Of the 346 patients with a positive patch test, 14% had occupational dermatitis. This condition affected mainly young and inexperienced workers. An inverse relationship was seen between age and prevalence of occupational allergic dermatitis. Allergic hand dermatitis was the commonest presentation in occupational allergic dermatitis. This was followed by dermatitis of the exposed skin (face, neck, hands and forearms). The common sensitising agents identified were rubber chemicals and nickel. The two main groups at risk were factory workers and medical personnel. The common allergens found in factory workers were epoxy resin, pewter, nickel and rubber chemicals. Exposure dermatitis occurred in patients working in the pewter industry. Two thirds of medical personnel with hand dermatitis were allergic to rubber gloves. One year follow up after patch testing showed that 19% of patients still suffered from chronic dermatitis. Dermatitis improved in 34% of patients. Forty-seven percent were cured and stopped attending the clinic after patch testing and adequate counselling. (+info)
Knowledge, attitudes, and practices regarding sexually transmitted infections among general practitioners and medical specialists in Karachi, Pakistan.
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OBJECTIVES: To determine the knowledge, attitudes, and practices regarding diagnosis and treatment of sexually transmitted infections (STIs) among specialists--that is, dermatologists, gynaecologists and urologists, and general practitioners (GPs) in Karachi, Pakistan. METHODS: Interviewers administered structured questionnaires to doctors conducting outpatient clinics at tertiary hospitals and/or private clinics in Karachi. All private clinics within a 10 km radius of the Aga Khan University, and all tertiary hospitals having more than 100 inpatient beds were included in the study. RESULTS: 100 doctors (54 specialists and 46 GPs) responded. 80 doctors reported seeing at least one STI patient/month. The most commonly diagnosed STI the doctors reported was urethritis/cervicitis syndrome. 50% of the doctors knew the recommended antibiotics for gonorrhoea though only 46% of these knew the correct dosage. Specialists were three times more likely to recognise the clinical presentation of herpes and twice as likely to treat chlamydia, syphilis, and herpes with appropriate antimicrobials than GPs. 85% of the doctors advised their STI patients regarding condom usage; 36% thought that STI patients had loose sexual morals; 43% believed STI patients were drug addicts. Over 90% of the physicians were willing to attend educational sessions and follow a national STI treatment protocol. CONCLUSION: Doctors in Karachi, especially GPs, are deficient in appropriately managing and counselling STI patients. Among the specialists, urologists and dermatologists were more likely to manage STIs correctly than gynaecologists. Karachi doctors should be educated in the correct management and counselling of STIs to prevent further spread of STIs including AIDS. (+info)
Diagnosis of skin disease by nondermatologists.
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OBJECTIVE: To determine how often primary care physicians diagnose and treat skin disease and to compare their experience with that of dermatologists. STUDY DESIGN: Retrospective review of National Ambulatory Medical Care Survey data. METHODS: We reviewed data from the 1990-1994 National Ambulatory Medical Care Survey on outpatient visits to physicians for both dermatologic and nondermatologic disorders. RESULTS: Dermatitis is the most common dermatologic problem diagnosed by internists, family physicians, and pediatricians and is the 35th, 17th, and 15th most common diagnosis made by these providers, respectively. Dermatologists had 728 and 352 office visits per year for acne and contact dermatitis, respectively, whereas internists averaged 3 and 9 visits, family physicians averaged 8 and 27 visits, and pediatricians averaged 8 and 37 visits. Overall, dermatologists spent 930 outpatient hours per year with patients with dermatologic conditions, compared with 21, 53, and 56 hours per year for internists, family physicians, and pediatricians. CONCLUSIONS: Although most visits for skin disease are managed by primary care physicians, these physicians treat few cases of individual skin conditions. The different levels of experience between dermatologists and nondermatologists may affect the quality of dermatologic care and may explain in part the greater expertise dermatologists have in diagnosing and treating skin disease. This should be considered in decisions about the delivery of dermatologic healthcare services and in planning educational programs designed to improve dermatologic care. (+info)