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PubMed1999

The changing status of inpatient dermatology at American academic dermatology programs.

BACKGROUND: Changes in health care delivery financing such as the adoption of the diagnosis-related groups (DRG) in 1983 has affected inpatient services of dermatology programs across the United States. OBJECTIVE: The purpose of this study was to define the present status of inpatient dermatology at academic medical centers compared with 1982. METHODS: Questionnaires inquiring about the state of inpatient service were sent to the chairpersons of each dermatology residency program in the United States. RESULTS: Of the 71 programs responding, 79% reported a reduction in inpatient activity. Nearly half of the dermatology programs with dedicated dermatology beds in 1982 reported not continuing to have these in 1997 (41 to 24). The average number of patients admitted for skin disease decreased from 1 19 in 1982 to 36.5 in 1997, and the average daily census decreased from 8.9 to 2.2. CONCLUSION: There has been a decline in the number of patients hospitalized by academic dermatology departments and a shift of some patients hospitalized to beds where the attending is other than a dermatologist.

Academic Medical Centers↗
PubMed1980

The making of dermatologic surgeons. The first decade of the American Society for Dermatologic Surgery.

The history of the American Society for Dermatologic Surgery is traced from its inception in 1970 to the present. Its positive influence on all aspects of dermatology has been demonstrated by the inclusion of dermatologic surgery in dermatologic residency programs and the annual meetings of the American Academy of Dermatology. Other related surgical societies, both national and international, have also been formed following the example of the American Society for Dermatologic Surgery.

Dermatology↗
PubMed1990

The new dermatology. Implications for the dermatologist and for dermatological training.

The advent of new drugs including 'over the counter' (OTC) drugs, the increasingly aged population with its special requirements for skin care, and environmental and occupational factors will affect the nature of future dermatological practice in developed countries. The role of sub-specialists is likely to increase, and the case for expansion of the dermatological consultant grade is debatable. Consultant training should place more emphasis on highly specialised training in specific areas, including occupational dermatoses, environmental dermatology, dermatopharmacology, dermatological surgery and dermato-oncology. A strategy for dermatological research in Europe needs to be established which is based upon fewer, larger groups of a multi-disciplinary character. Corporate support could well help achieve this aim.

Aged↗
PubMed2000

The roles of the pharmaceutical industry and drug development in dermatology and dermatologic health care.

Drug development is becoming shorter, more high-tech and strategic, more costly, and more complicated. The pharmaceutical, biotech, and cosmetic companies, along with regulatory agencies such as the FDA, are struggling to cope with and master the scientific, medical, and economic implications of this new environment. There are rapidly growing new classes of drugs, including biologicals, genomics, antibodies, and novel receptor-ligand antagonists. Dermatologic drug development has several idiosyncrasies, including the vehicle in topical drugs. Development for dermatology is much cheaper than for other therapeutic areas but also generates much less sales. The pharmaceutical industry's search for blockbusters threatens to leave dermatology without access to these new technologies, therapeutic modalities, and drug classes. The pharmaceutical industry is interested, invested, and intertwined, at many different levels, in the efforts and practices of academic dermatology, dermatology specialty organizations, and clinical dermatologists.

Cosmetics↗
PubMed2004

The International Foundation for Dermatology: an exemplar of the increasingly diverse activities of the International League of Dermatological Societies.

The International Foundation of Dermatology (IFD) was established by the International League of Dermatology Societies to promote the care of skin disease in the developing world. Starting from an initial base of the Regional Dermatology Training Centre in Tanzania it has successfully trained a cadre of clinical officers and dermatology residents from different African countries. It has now broadened this approach to an assessment of the effectiveness of focused training in Mali. The IFD is also completing a global assessment of dermatological needs in developing countries with a view to establishing guidelines and programmes for the control of common skin diseases. An ongoing strategy has been to work with other agencies to help ease the burden of other endemic tropical diseases that affect the skin; preventing the development of elephantiasis in filarial lymphoedema has been one such project implemented through a programme of skin hygiene.

Dermatology↗
PubMed1998

Digital images in dermatology and the Dermatology Online Atlas on the World Wide Web.

The digital revolution opens new ways of storing, retrieving and distributing images. The informativeness of digital images of dermatological conditions as compared to conventional photographs and slides has proven to be statistically similar; in many cases, digital images may even substitute for dermatologic physical examination. Current developments in high-speed, high-capacity international networks and the growing popularity of the World Wide Web are converging in ways that have great potential for enhancing access to biomedical information, including medical images. However, lack of metainformation and indexing services specialised in retrieving images makes finding images--as opposed to textual information--on the Web difficult. To provide an image collection and entry point into dermatological resources on the World Wide Web, we have developed an image database (Dermatological OnlIne Atlas--DOIA). The database, which is freely available on the Internet at http://dermis.net, contains about 3,000 clinical images covering more than 600 dermatological diagnoses. It is designed for worldwide use; international submissions are encouraged. It serves as a teaching tool for medical students, doctors and patients, assists professional users by being an easy gateway to other databases such as MEDLINE, PDQ, and OMIM and serves as a platform for conducting research by means of administering Internet surveys to users. We conclude that an online image atlas has multiple educational, clinical, and research applications.

Anatomy, Artistic↗
PubMed1990

Learning dermatology on a dermatology elective.

The format of the 4-week dermatology elective rotation at the University of Florida is presented. A 20-item case example slide test was given as a pre-test and as a post-test to 12 internal medicine residents and 41 fourth-year medical students during the elective. Results indicate that the residents (48% correct) and students (46% correct) did not differ in their recognition abilities for common dermatoses at the beginning of the elective. Both groups improved their scores significantly at the end of the dermatology elective (residents, 87% correct; students, 82% correct). These results indicate the usefulness of a dermatology elective program in improving dermatologic skills and of a clinical pre- and post-test approach for the crude assessment of such acquired knowledge for both rotating students and residents. This feedback can be helpful in modifying teaching programs for dermatology educators.

Curriculum↗
PubMed2004

Psychological symptoms and quality of life of dermatology outpatients and hospitalized dermatology patients.

The aim of the investigation was to compare psychological symptoms and health-related quality of life of dermatology patients and healthy controls. The sample consisted of 333 consecutively recruited patients from four dermatology outpatient clinics, 172 hospitalized dermatological patients from two university hospitals and 293 matched healthy controls. All patients and controls completed Beck's Depression Inventory, the Brief Symptom Inventory and the Dermatology Life Quality Index. Hospitalized patients were more distressed than outpatients and healthy controls and reported greater impairment of disease-related quality of life than outpatients. More hospitalized patients had suicidal thoughts and were characterized as having severe to moderate depression compared with outpatients and controls. Female patients and younger patients were generally more distressed than male patients and older patients, and patients with atopic dermatitis and psoriasis were more distressed than patients with urticaria and eczemas. Disease-related impairment of quality of life was the main predictor of psychological symptoms, when controlling for diagnosis, age, gender, disease duration and disease severity. Although older age was associated with fewer psychological symptoms, our data suggest that skin disease affects quality of life equally in young and older patients. The findings highlight the importance of recognizing disease-related psychological problems and possible psychiatric comorbidity of dermatology patients, especially among patients with atopic dermatitis and psoriasis.

Age Factors↗
PubMed1999

Current issues in dermatologic office-based surgery. The American Academy of Dermatology Joint AAD/ASDS Liaison Committee.

Dermatologists and dermatologic surgeons have played major roles in the development and refinement of many office-based cutaneous surgical procedures. The comprehensive scientific education in the structure and function of skin that dermatologists receive during formal residency training programs has contributed directly to these advances. This long tradition of comprehensive training and strong basic research activities in skin biology has supported a scholarly approach to cutaneous surgery. As a result, many pioneering cutaneous surgical techniques have been created by dermatologists and dermatologic surgeons. One example of this creativity can be seen in the field of laser surgery where techniques to effectively treat tattoos, benign pigmented lesions, port-wine stains and other vascular conditions, premalignant and malignant skin lesions, wrinkles and sun-damaged skin, and excess or unwanted hair were developed by dermatologists. Some of the most innovative procedures, like tumescent liposuction, have focused primarily on improving patient safety while preserving the highest standards of care. Virtually every aspect of cutaneous surgery, including Mohs micrographic surgery for the treatment of skin cancers, hair replacement surgery, sclerotherapy of leg veins, the correction of scars and sun-damaged skin with the injection of filler materials, dermabrasion or chemical peels, and new anesthesia techniques, have been favorably impacted by the unique education and skills of many dermatologists and dermatologic surgeons. This article reviews the important historic role that has been played by dermatologists and dermatologic surgeons in developing and improving outpatient cutaneous surgical procedures and examines current issues and future directions in credentialing, privileging, and accreditation.

Ambulatory Surgical Procedures↗
PubMed2000

[Implicit personality theories in dermatology. An empirical study on the image that physicians have of patients of diverse dermatologic diagnosis groups].

BACKGROUND AND OBJECTIVE: Studies about the personality of dermatological patients are numerous. The results are inconsistent and peculiarities of the personality are rarely confirmed. Contrary to the usual procedure, this study asks for the impressions physicians have about their patients. PATIENTS/METHODS: To elicit associations dependent on a dermatological diagnosis, 27 physicians filled in a three-dimensional differential asking for their impressions about patients with atopic dermatitis, leg ulcer, malignant melanoma, or psoriasis vulgaris in order to quantify these impressions. RESULTS: The dimension valence (good-bad) did not differ between the groups. The dimensions of excitation (active-passive) and potency (strong-weak) showed the biggest differences between patients with atopic dermatitis and ulcus cruris. The latter get significantly lower values on both dimensions. The correlations between the impression and the duration of employment in dermatology were low. CONCLUSIONS: In our opinion it is necessary to raise the impression of medical personal about their patients because these impressions affect the interaction of the personal with the patient.

Dermatitis, Atopic↗
PubMed1992

Photographic utilization in dermatology clinics in the United States: a survey of university-based dermatology residency programs.

BACKGROUND: Photography has recently been introduced as an adjunct to the clinical management of patients with the dysplastic nevus syndrome (DNS). OBJECTIVE: Our purpose was to evaluate the methods used and the extent of clinical photography in dermatology residency programs in the United States. METHODS: Nonmilitary accredited dermatology residency programs in the United States were surveyed (73% response rate) regarding utilization and technical aspects of clinical photography. RESULTS: Forty-one percent of respondents used photography for the clinical management of 90% or more of patients with DNS. Twenty-four percent of respondents used photography for the clinical management of all patients with DNS. Eighty-one percent of respondents used slides, and 62% utilized total body photographs. The median number of photographs taken for a patient with DNS was 20. CONCLUSION: Dermatologic photography has been widely adopted for the clinical management of patients with DNS. Failure of the health insurance industry to recognize the value of this procedure may result in its underutilization.

Dermatology↗
PubMed1989

[Dermatology in Prague and the 1st Congress of the German Dermatology Society 1889].

Around 1900, dermatology as practised in Prague formed a link between Austria and Germany. The Congress of the German Dermatological Society held in 1889 in Prague was the first highlight of this connection. The topics and contents of the papers are characterized. The development of the dermatological clinics in Prague is described and their directors and research emphases are listed.

Czechoslovakia↗
PubMed2002

[Prevalence of psychosomatic disorders in dermatologic patients. Experiences in 2 dermatology clinics with a liaison therapy model].

INTRODUCTION: The prevalences and differences of biopsychosocial disorders were investigated in the dermatologic clinics of Erfurt and Giessen, where a liaison-therapy model has been established. Different dermatological diseases were compared by a variety of psychological tests, and patients with the same diagnosis were compared between the two clinics. PATIENTS AND METHODS: We examined 406 patients for psychosomatic problems with diagnostic interviews and psychometric tests. The coping of skin disease questionnaire (CSD) and the Symptom Checklist (SCL-90R) served as diagnostic measures. Between 1995-2000, 71 patients were seen in Erfurt and 335 in Giessen. The distribution of skin diseases and the psychosomatic disorders are shown by ICD-10 diagnoses. RESULTS: The comparison of an East and a West German city showed no significant differences in the whole group or the parallel groups using the CSD and SCL-90R. There was only a tendency to a greater reduction of quality of life in Erfurt. Patients with glossodynia evaluated themselves in all psychometric tests as very "normal". By contrast, patients suffering from alopecia and acne felt very helpless and seemed to have a need of greater psychosocial care. CONCLUSIONS: The biopsychosocial characteristics of the patients treated in the dermato-psychosomatic units in Erfurt and Giessen show no significant differences. Patients with diseases such as alopecia and acne are underestimated in regard to the need for additional psychosocial care. The liaison therapy model is an effective approach to diagnose psychosomatic-dermatological disorders and decide if further psychosomatic treatment is indicated.

Adolescent↗
PubMed1991

Dermatology residency training in 1932 versus dermatology residency training in 1990.

Dermatologic training programs and patient care in 1932 are compared with patient care, research, and residency training programs in 1990. The changes are due to development of newer diagnostic procedures and therapeutic agents, emergence of dermatopharmacology programs, research conducted by and supported by the pharmaceutical industry, and support of cutaneous research by the government. The excellence of teaching and patient care in 1932 was due to the "giants" who created interest in dermatology and by their dedication and ingenuity managed recalcitrant dermatoses without presently available drugs, chemotherapeutic agents, diagnostic techniques, basic information, and advances in cutaneous surgery.

Dermatology↗
PubMed2000

Dermatology practice management enhancement: implications for dermatology in the age of managed care.

Health care delivery in the United States has changed dramatically during the past 10 years. Dermatologists are faced with challenging changes in the way they learn new skills, practice, and provide dermatologic care. Dermatologists can survive and flourish in this environment if they learn proper management and enhancement skills. These skills include proper coding and documentation, regulatory compliance, and new levels of practice effectiveness and efficiency. Dermatologists can offer also the benefit of cosmetic procedures and ethical office-based dispensing to their patients. Greater future unification of this specialty will allow dermatology to flourish and show its need, efficiency, and cost-effectiveness.

Cosmetics↗