Psoriasis care consumption and expectations from a gender perspective in a psoriasis population in northern Sweden.
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The aim was to analyse use of psoriasis care and expectations from a gender perspective in a psoriasis population. The study is based on questionnaire data from 1,060 subjects. The response rate was 74%. The relation between care consumption and studied variables was measured using regression and chi-square analysis. Care consumption was strongly influenced by age, quality of life, income and joint symptoms. Men visited a dermatologist more often, while women visited a general practitioner and treated themselves topically more frequently. Important expectations among both women and men concerned the receiving of professional care and amelioration, while more women wanted to be treated politely. Expectations were fulfilled, except those regarding amelioration, especially among men. Awareness of gender differences is important among professionals. In order to decrease such differences decision-makers should provide for a maintained specialized care as well as a local health care system of high standard. (+info)
Referral pattern of skin diseases in an acute outpatient dermatological clinic in Copenhagen.
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The referral pattern of acute dermatologic conditions is not well described in either outpatients or hospitalized patients. The aim of this study is to describe in more detail the skin diseases that were referred for evaluation in an acute outpatient clinic at Bispebjerg Hospital, Copenhagen. In a 3-month period in 2003 a total of 428 consecutive new patients were referred for various skin diseases that needed subacute and acute dermatological evaluation in a university hospital setting. Referral pattern, age ratio and sex ratio were examined retrospectively. Two hundred and twenty-five (53%) of the 428 patients were referred from other hospital clinics in the local area. Sixty-six (15%) were referred from private practising dermatologists and 64 (15%) from general practitioners in the City of Copenhagen. Referral information was not noted in 35 (8%) of the 428 patients. The most prevalent diagnoses were: unspecified eczema (10.7%), drug eruptions (6.3 %), psoriasis (6.3%), atopic dermatitis (5.6%), bacterial skin infections (4.0%), inflammatory skin disorders (3.7%), seborrhoeic dermatitis (3.5%), urticaria (3.0%), seborrhoeic keratosis (3.0%), toxic contact dermatitis (2.8%), ulcus cruris (2.8%), autoimmune diseases (2.8%), malignant skin tumours (2.5%), candidiasis (2.5%), pruritus/prurigo (2.5%) and viral skin infections (2.5%). The fact that drug eruptions are one of the leading causes of acute referral conditions probably reflects the proximity to other hospital settings, where a large number of patients receive several systemic medicaments for various conditions. (+info)
Improving the classification of multiple disorders with problem decomposition.
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Differential diagnosis of multiple disorders is a challenging problem in clinical medicine. According to the divide-and-conquer principle, this problem can be handled more effectively through decomposing it into a number of simpler sub-problems, each solved separately. We demonstrate the advantages of this approach using abductive network classifiers on the 6-class standard dermatology dataset. Three problem decomposition scenarios are investigated, including class decomposition and two hierarchical approaches based on clinical practice and class separability properties. Two-stage classification schemes based on hierarchical decomposition boost the classification accuracy from 91% for the single-classifier monolithic approach to 99%, matching the theoretical upper limit reported in the literature for the accuracy of classifying the dataset. Such models are also simpler, achieving up to 47% reduction in the number of input variables required, thus reducing the cost and improving the convenience of performing the medical diagnostic tests required. Automatic selection of only relevant inputs by the simpler abductive network models synthesized provides greater insight into the diagnosis problem and the diagnostic value of various disease markers. The problem decomposition approach helps plan more efficient diagnostic tests and provides improved support for the decision-making process. Findings are compared with established guidelines of clinical practice, results of data analysis, and outcomes of previous informatics-based studies on the dataset. (+info)
Introduction to the 2005 long course.
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Dermatopathology, as with other fields of pathology, has undergone major changes in the last 25 years. Our understanding of epidermally derived neoplasms becomes far more advanced with each passing year. Evidence for this progress is readily apparent upon reviewing textbooks of dermatopathology over time and in examining the course contents of the long-course presentations at the United States-Canadian Academy of Pathology annual meetings. What was once a simple discussion of melanocytic neoplasms (thought to be a variant of sarcoma) has become a reasonably complex analysis of the histologic, immunologic, and molecular aspects of melanocytic neoplasia. Similarly, our understanding of the development of cutaneous squamous cell carcinoma is greatly enhanced. The understanding of the molecular alterations that result in full transformation offers great insight into carcinogenesis. This introductory essay briefly traces this progression in setting the stage for the series of more detailed chapters about epidermal neoplasms that follow. (+info)
Medicolegal aspects of neoplastic dermatology.
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Medical malpractice litigation is rising at an explosive rate in the US and, to a lesser extent, in Canada. The impact of medical malpractice litigation on health care costs and the cost of insurance is dramatic. Certain specialist categories are becoming uninsurable in some parts of the US, while in others, clinicians are retiring early, restricting or changing practice or changing states of residence in consequence of medical malpractice claims and of the cost and availability of insurance. This, in turn, has had the real effect of denying care to patients in some communities in the US. Some 13% of all medical malpractice claims relate to one area of neoplastic dermatopathology, specifically, melanocytic neoplasia. Certain steps can be taken by pathology laboratories to reduce, but never completely eliminate, the risk of medical malpractice claims. In this review, attention is paid to the source of medical malpractice claims and an abbreviated approach to specific strategies for risk management is presented. (+info)
Primary care and pattern of skin diseases in a Mediterranean island.
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BACKGROUND: In Greece where primary health care services are not fully developed, patients with simple or minor conditions have to attend to hospitals to be treated. We analysed the data of patients with cutaneous disorders attending the tertiary referral hospital on the Island of Crete, with the aim to identify the most common conditions that patients complain of, in order to define the areas where the education of General Practitioners in Dermatology must focus. METHODS: All patients attending the Dermatology ambulatory office in the Emergency Department of the University General Hospital of Heraklion from January 2003 to December 2003 were included in this retrospective analysis. The medical records of the patients (history, physical examination and laboratory investigations) were analysed to ascertain the diagnosis and the management of cases. All patients were evaluated by qualified dermatologists. RESULTS: A total of 3715 patients attended the Dermatology Clinic. Most patients were young adults in the age group 21-40 years (38.4%), and the male to female ratio was 1 to 1.2. Allergic skin diseases, mostly dermatitis and urticaria (35.7%) were the most common for attendance, followed by infectious diseases (26.1%) and insect bites (10.2%). Inflammatory and autoimmune disorders accounted for 7.9% of the cases. Pruritus of unknown origin was diagnosed in 6.3% of patients. Skin tumors were detected in 2.7%. The management of the vast majority of cases (85.0%) consisted of advice with or without a prescription, while only 4.8% of patients required admission. CONCLUSION: Allergic and infectious skin diseases were the most common cutaneous diseases in patients attending this tertiary University hospital, while the management of most patients did not require specialised care. On the basis of the present data, the training of primary health care providers in Dermatology should emphasize these common conditions, with the aim of improving primary care and alleviating the burden on hospital care. (+info)
Integration of basic dermatological care into primary health care services in Mali.
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OBJECTIVE: To evaluate, in a developing country, the effect of a short training programme for general health care workers on the management of common skin diseases--a neglected component of primary health care in such regions. METHODS: We provided a one-day training programme on the management of the skin diseases to 400 health care workers who worked in primary health care centres in the Bamako area. We evaluated their knowledge and practice before and after training. FINDINGS: Before training, knowledge about skin diseases often was poor and practice inadequate. We found a marked improvement in both parameters after training. We analysed the registers of primary health care centres and found that the proportion of patients who presented with skin diseases who benefited from a clear diagnosis and appropriate treatment increased from 42% before the training to 81% after; this was associated with a 25% reduction in prescription costs. Improved levels of knowledge and practice persisted for up to 18 months after training. CONCLUSIONS: The training programme markedly improved the basic dermatological abilities of the health care workers targeted. Specific training may be a reasonable solution to a neglected component of primary health care in many developing countries. (+info)
Photoprotective effect of isoflavone genistein on ultraviolet B-induced pyrimidine dimer formation and PCNA expression in human reconstituted skin and its implications in dermatology and prevention of cutaneous carcinogenesis.
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Genistein, the most abundant isoflavone of the soy derived phytoestrogen compounds, is a potent antioxidant and inhibitor of tyrosine kinase. We previously reported the antiphotocarcinogenic effects of genistein in SKH-1 murine skin, including its capacity for scavenging reactive oxygen species, inhibiting photodynamic DNA damage and downregulating UVB(ultra violet B)-induced signal transduction cascades in carcinogenesis. In this study we elucidate genistein's photoprotective efficacy within the context of full thickness human reconstituted skin relative to acute challenges with ultraviolet-B irradiation. Skin samples were pre-treated with three concentrations of genistein (10, 20 and 50 microM) 1 h prior to UVB radiation at 20 and 60 mJ/cm2. Proliferating cell nuclear antigen (PCNA) and pyrimidine dimer (PD) expression profiles were localized using immunohistochemical analysis on paraffin embedded samples 6 and 12 h post UVB exposure. Genistein dose dependently preserved cutaneous proliferation and repair mechanics at 20 and 60 mJ/cm2, as evidenced by the preservation of proliferating cell populations with increasing genistein concentrations and noticeable paucity in PCNA immunoreactivity in the absence of genistein. Genistein inhibited UV-induced DNA damage, evaluated with PD immunohistochemical expression profiles, demonstrated an inverse relationship with increasing topical genistein concentrations. Irradiation at 20 and 60 mJ/cm2 substantially induced PD formation in the absence of genistein, and a dose dependent inhibition of UVB-induced PD formation was observed relative to increasing genistein concentrations. Collectively all genistein pre-treated samples demonstrated appreciable histologic architectural preservation when compared with untreated specimens. These findings represent a critical link between our animal and cell culture studies with those of human skin and represent the first characterization of the dynamic alterations of UV-induced DNA damage and proliferating cell populations relative to pretreatment with genistein in human reconstituted skin. The implications of our findings serve as compelling validation to our conclusions that genistein may serve as a potent chemopreventive agent against photocarcinogenesis. (+info)