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Biomedical subjects

R S Kirsner

Publications and source records attributed to R S Kirsner.

At least 19 recordsLinked to original sources
PubMed2001

An update on hypercoagulable disorders.

Venous thrombosis is a cause of considerable morbidity and is often responsible for chronic venous disorders that frequently lead to visits to dermatologists and others involved in wound healing. Over the past several years, many new causes of thrombophilia have been identified and have dramatically altered the approach to patients presenting with thrombosis. Newly described abnormalities associated with thrombophilia include the syndrome of activated protein C resistance, the prothrombin 20210A mutation, hyperhomocysteinemia, and elevated levels of coagulation factors VIII and XI. Clinicians can now frequently determine causes of thromboses that have previously been deemed idiopathic.

Activated Protein C Resistance↗
PubMed2001

The primary care provider and the care of skin disease: the patient's perspective.

OBJECTIVE: To ascertain the patient's perspective on dermatologic care provided by primary care providers (PCPs) or dermatologists. DESIGN: Cross-sectional survey of patients drawn from primary care and dermatology clinics. SETTING: Academic Veterans Affairs medical center. PATIENTS: Convenience sample of patients in either a primary care or a dermatology clinic. INTERVENTION: Survey questionnaire. MAIN OUTCOME MEASURES: Patients' confidence in having their skin problems cared for by PCPs and dermatologists and satisfaction with previous care rendered. RESULTS: A total of 137 patients in the primary care clinic (group 1) and 100 patients in the dermatology clinic (group 2) participated. Patients (N = 237) expressed confidence in their PCP's ability to treat rashes (62%), diagnose skin cancer (65%), perform skin biopsies (60%), "freeze" lesions with liquid nitrogen (50%), and perform cutaneous surgery (46%). Group 2 patients were significantly less likely to have confidence in their PCP than group 1 patients for all measures other than the use of liquid nitrogen. High levels of confidence were expressed in a dermatologist's ability for all 5 measures: 92%, 91%, 92%, 83%, and 85%, respectively. Patients were more confident in dermatologists' abilities to perform these procedures compared with PCPs (P<.001 for all comparisons). Of patients previously treated for skin disorders, there was a high rate of satisfaction with the treatment rendered by PCPs (81% for group 1 and 75% for group 2) and by dermatologists (92% for group 1 and 90% for group 2). However, patient satisfaction was higher for dermatology vs primary care for the treatment of skin disease (P<.001). Direct access to dermatologists was preferred. CONCLUSIONS: Although patients have confidence in their PCP to care for their skin disease, they have greater confidence in the care provided by dermatologists. Among patients previously treated for skin disease, satisfaction was higher with care rendered by dermatologists vs PCPs. Most patients prefer direct access to dermatologists should they develop a skin problem.

Aged↗
PubMed2001

Inpatient dermatology. A prescription for survival.

Currently, only a minority of dermatologists participate in the primary hospital care of patients with severe skin disease. However, an opportunity exists to alter this course. We believe the current course is a detriment to our specialty, and as a specialists we should provide the care for the full spectrum of dermatologic diseases. Moreover, by not delivering complete dermatology care, our specialty also stands to lose respect from both our patients and peers. Our experience at UM suggests that the creation of a cadre of dermatology hospitalists at selected academic medical centers would allow improved patient hospital care, education, and research.

Clinical Protocols↗
PubMed2001

Chronic venous insufficiency and venous leg ulceration.

UNLABELLED: Venous ulcers are the most common form of leg ulcers. Venous disease has a significant impact on quality of life and work productivity. In addition, the costs associated with the long-term care of these chronic wounds are substantial. Although the exact pathogenic steps leading from venous hypertension to venous ulceration remain unclear, several hypotheses have been developed to explain the development of venous ulceration. A better understanding of the current pathophysiology of venous ulceration has led to the development of new approaches in its management. New types of wound dressings, topical and systemic therapeutic agents, surgical modalities, bioengineered tissue, matrix materials, and growth factors are all novel therapeutic options that may be used in addition to the "gold standard," compression therapy, for venous ulcers. This review discusses current aspects of the epidemiology, pathophysiology, clinical presentation, diagnostic assessment, and current therapeutic options for chronic venous insufficiency and venous ulceration. (J Am Acad Dermatol 2001;44:401-21.) LEARNING OBJECTIVE: At the conclusion of this learning activity, participants should be familiar with the 3 main types of lower extremity ulcers and should improve their understanding of the epidemiology, pathogenesis, risk factors, clinical presentation, diagnostic assessment, and current therapies for chronic venous insufficiency and venous ulcers.

Anti-Bacterial Agents↗
PubMed2001

Dermatology in primary care: Prevalence and patient disposition.

BACKGROUND: Cutaneous disease is commonly encountered in primary care. The frequency of patients presenting to primary care physicians with skin disease and their eventual disposition is not well studied. OBJECTIVE: The purpose of this study was to determine the prevalence of patients seen with skin disease in a primary care setting and the likelihood of their referral to a dermatologist. The impact the primary care provider had on the quality of skin care was also examined. METHODS: A retrospective chart review was performed of patients seen during a 2-year period at a general medicine clinic within the University of Miami and upon referral to a University of Miami dermatology office. Data were obtained on the prevalence of skin disease, dispositions of referral, diagnoses made, and procedures performed. RESULTS: During a 2-year period, 36.5% of patients who presented to their primary care physician had at least one skin problem. Of 208 patients with skin disease, in 58.7% (122/208) it was their chief complaint. A wide range of diagnoses were made by the primary care physician, with a limited number of diagnostic procedures performed. Of the 37.5% of patients referred to a dermatologist, 68% were referred on initial evaluation. Diagnoses made by the primary care physician were concordant with that made by the dermatologists 57% of the time. CONCLUSION: Patients frequently see their primary care physician for skin disease. A large percentage are referred to dermatologists, often for a biopsy of a suspect lesion, to confirm a suspected diagnosis, or to establish a diagnosis of lesions of unknown origin.

Adult↗
PubMed2001

Interpretation of cutaneous biopsy specimens: choice of pathologist by primary care practitioners.

BACKGROUND: Primary care providers (PCPs) have limited training in recognizing common skin disorders, and additional emphasis may be placed on laboratory evaluation, including skin biopsies. METHODS: Primary care providers in Miami, Fla, were surveyed regarding skin biopsy and excision practices and histologic interpretation. They then participated in an examination, using 20 high-quality color photographs of common dermatologic disorders. RESULTS: Of the 80 PCPs who participated, 42% currently do skin biopsies and consult general pathologists for interpretation. Another 20% of PCPs intend to do biopsies within the next 5 years. Only 33% prefer to have a dermatopathologist interpret histopathology. We found no correlation between PCPs' scores on diagnostic testing and whether they do skin biopsies. CONCLUSION: Nearly all PCPs doing skin biopsies in our study sample use general pathologists to interpret histopathology. The limited training in clinical dermatology of both PCPs and general pathologists may result in compromised clinical-pathologic correlation.

Biopsy↗
PubMed2001

Common bacterial skin infections.

Skin infections account for a significant portion of dermatologic disease, often resulting in or as a consequence of a disruption in the skin's integrity. This article covers the presentation, diagnosis, and treatment of the more common bacterial infections. The infections presented herein include impetigo, ecthyma, folliculitis, carbuncles/furuncles, cellulitis, toxic shock syndrome, and ecthyma gangrenosum. Once a diagnosis is made, treatment is based on the culture and antibiotic sensitivities of the offending organisms.

Anti-Bacterial Agents↗
PubMed2001

Common viral and fungal skin infections.

Skin infections account for a significant portion of dermatologic diseases, often resulting in, or as a consequence of a disruption in the skin's integrity. This paper covers the presentation, diagnosis, and treatment of the more common viral and fungal skin infections. The viral infections presented in this paper include herpes simplex virus, herpes zoster, condyloma acuminata, and molluscum contagiosum. The fungal infections presented include tinea pedis, tinea cruris, tinea capitis, tinea unguium, tinea versicolor, and candidiasis. Once a diagnosis is made, treatment with appropriate antifungal, antiviral, destructive, or immune modifying therapies can be instituted.

Candidiasis, Cutaneous↗
PubMed2000

The primary care physician and the treatment of patients with skin disorders.

Scientific advances have altered the nature of primary care medicine. Primary care providers are increasingly asked to care for a broad spectrum of common maladies, including cutaneous disease. We review studies that have compared primary care physicians with dermatologists with respect to the diagnosis and treatment of skin disorders. Though primary care providers play a crucial role in the delivery of health care, the judicious and appropriate use of dermatology consultation should be encouraged.

Clinical Competence↗
PubMed2000

Inpatient dermatology. The difficulties, the reality, and the future.

Changes in the health care delivery system have profoundly affected medical dermatology in the United States. Although a significant number of patients are still being admitted for skin and skin-related disorders, only a minority are now admitted by dermatologists. An analysis of the mechanics of such a change and a national perspective is presented.

Delivery of Health Care↗
PubMed2000

The effect of health care delivery systems on admission to and treatment at an inpatient dermatology unit.

The University of Miami Department of Dermatology has maintained an active inpatient unit. Analysis of data from a 12 month period from 1995-1996 showed 562 admissions. Cutaneous lymphoma, psoriasis, and chronic wounds accounted for over half the admissions. Most patients were insured by a fee-for-service system, and compared to patients insured by managed care systems or patients who were indigent, fee-for-service patients had the shortest length of stay. Using a case mix severity index, indigent patients had the greatest disease severity followed by fee-for-service patients. Patients enrolled in managed care systems had the least severity suggesting that factors other than disease severity alone may play a role in determining why patients are admitted.

Adult↗
PubMed2000

Treatment of patients hospitalized for psoriasis.

Life quality of patients with severe forms of psoriasis can be greatly improved with an appropriate inpatient therapy. In an effort to better understand how to treat this disorder, this article explores several aspects of inpatient treatment for severe psoriasis. Special attention is given to the Goeckerman regimen, combination therapies, and some innovative approaches that may shorten the hospital stay and prolong the remission periods of the disease.

Hospitalization↗
PubMed2000

Stasis in venous ulcers: a misnomer that should be abandoned.

Leg ulcerations secondary to chronic venous insufficiency have been termed 'stasis ulcers.' This is based on an original idea proposed by Homans in 1917. However, since then data has been generated suggesting in fact 'stasis' does not occur. In this paper, we review the information that has accumulated, refuting the concept of stasis. We suggest that the term 'stasis ulcer' is a misnomer, and should be abandoned.

Humans↗
PubMed2000

Sustained improvement of the quality of life of patients with psoriasis after hospitalization.

Psoriasis is a chronic, recurrent, and often disfiguring skin disease that may significantly affect patients' quality of life. Treatment of psoriasis, including hospitalization, has been shown to improve quality of life. A pilot study of 15 consecutive inpatients and 7 consecutive outpatients with psoriasis were asked to complete the Dermatology Life Quality Index (DLQI) before treatment and 3 months later. Hospitalized patients also completed the DLQI 1 week after discharge. Statistical analysis using t tests compared pretreatment and posttreatment DLQI scores as well as improvement of inpatients versus outpatients. Baseline DLQI scores for hospitalized patients were significantly higher (greater impairment of life quality) compared with oupatients' quality of life. After discharge, hospitalized patients' quality of life had significantly improved at 1 week and remained improved at 3 months.

Adult↗