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PubMed2001

[Psychosomatic dermatology in Germany: a survey of 69 dermatologic clinics].

BACKGROUND AND OBJECTIVE: A questionnaire study of German dermatological clinics was designed to show the situation and development of psychosomatic dermatology 10 years after a similar study. PATIENTS/METHODS: A questionnaire was sent to 170 dermatological clinics. 76 were send back; 69 of them (40.6%) were evaluable. The questionnaires were mostly answered by the heads of the dermatological clinics (38/69 = 55.1%). RESULTS: Nearly 85% of the dermatological clinics answered that they take psychosomatic aspects into consideration in the therapy. 5.1% of the dermatologists working in clinics have additional psychotherapeutic certification. The improvement of coping behaviour seems to be the main goal of psychosomatic interventions. The importance of psychic factors increased in the last 10 years in comparison to a former study in regard to most of the dermatological diseases. CONCLUSIONS: Psychosomatic aspects seem to be an obligatory part of inpatient dermatological therapy. The frequency of some diseases was underestimated in comparison with results from literature.

Behavior Therapy↗
PubMed1983

Continuing education in pediatric dermatology: the role of pediatric and dermatologic journals.

To summarize the quantity, quality, and subject matter of articles pertaining to pediatric dermatology in current pediatric and dermatologic journals, 2,010 articles published in 1981 in 9 clinical journals were reviewed. Of articles in the pediatric journals, 4% had a primary dermatologic focus, and another 6% had a secondary dermatologic focus. Of the clinical articles in the dermatologic journals, 15% concerned only pediatric patients, and an additional 18% involved both pediatric and adult patients. The great majority of pediatric (65%) and dermatologic (83%) articles concerning pediatric dermatology were case reports, with lesser proportions of research reports and review articles. There was a relative scarcity of prospective clinical studies describing either the natural course of pediatric skin diseases or the effects of various therapies upon these diseases. Frequent topics of articles in both types of specialty journals included cutaneous manifestations of systemic disease, hereditary skin disorders, and bacterial skin infections. It is hoped that interest in this important field will promote mutually beneficial collaboration between pediatricians and dermatologists in the areas of patient care and clinical research.

Dermatology↗
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↗
PubMed2006

Errors in the Archives of Dermatology and the Journal of the American Academy of Dermatology from January through December 2003.

OBJECTIVE: To assess the frequency of statistical errors in the dermatology literature. DESIGN: Original studies published in the Archives of Dermatology and the Journal of the American Academy of Dermatology from January through December 2003 were analyzed for correctness of statistical methods and reporting of the results. RESULTS: Of 364 studies published, 155 included statistical analysis. Of these, 59 (38.1%) contained errors in the methods or omissions in reporting of the statistical results. Fourteen percent of the articles with statistical analysis contained errors in the methods used (considered to be more significant errors), 26.5% contained errors in the presentation of the results, and 2.6% contained errors in both. CONCLUSIONS: The misuse of statistical methods is prevalent in the dermatology literature, and the appropriate use of these methods is an integral component of all studies. Readers should critically analyze the methods and results of studies published in the dermatology literature.

Bibliometrics↗
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↗
PubMed2006

Need and greed in dermatology: disease and outcome measures in dermatological healthcare planning.

Assessing dermatological needs in the population and our ability to meet them is a challenge. The choice of outcome measures is central in dermatological healthcare planning. The concept of ill health and its relationship to dermatological outcome measures is described. Outcome measures used should provide information on these issues in order to gain insight into genuine needs and illness behavior in the population and to ensure quality of healthcare. Nevertheless, the dilemma of assigning priorities in healthcare planning remains; outcome measures in dermatology should be perceived as appropriate by patients as well as by caregivers and policy makers. It is important to stimulate research to develop and refine person-focused outcome measures. Their use is essential to assess dermatological health needs and to understand illness behavior. The information they can provide can enable provision and evaluation of healthcare quality and contribute to the challenge of making appropriate priority decisions in healthcare.

Attitude to Health↗
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↗
PubMed2004

The Canadian Dermatology Workforce Survey: implications for the future of Canadian dermatology--who will be your skin expert?

OBJECTIVE: To survey Canadian dermatologists for specialty-specific physician resource information including demographics, workload and future career plans. BACKGROUND AND METHODS: In 2001, the Canadian Dermatology Association (CDA) surveyed 555 dermatologists in Canada to gain specialty-specific physician resource information. Three hundred and seventy-one dermatologists (69%) provided information about themselves, their workloads and their future career goals. RESULTS: The average Canadian dermatologist is 52 years old and 35% of practicing dermatologists are over the age of 55. Eighty-nine percent of dermatologists practice in an urban setting, 19% include practice in a rural setting while less than 0.5% practice in remote areas. Canadian dermatologists spend 61% of their clinical time providing services in Medical Dermatology. Within 5 years, 50% of dermatologists reported that they plan to reduce their practices or retire. CONCLUSION: The Canadian Dermatology Workforce Survey provides a snapshot of the current practice of dermatology in Canada. It also serves to highlight the critical shortage of dermatologists, which will continue to worsen without immediate, innovative planning for the future.

Adult↗
PubMed2003

[Cosmetic dermatology in German dermatology departments--outcome of a national survey].

The demand for non-surgical cosmetic treatments has grown considerably in recent years. It appears German dermatology departments now also increasingly seem to offer many of these methods. In 2001 we evaluated the use of different non-surgical cosmetic techniques in German dermatology departments through means of a national questionnaire. Information was requested from 85 departments, of which 63.5% responded. The outcome revealed that 96.3% of the participating departments have lasers at their disposal to treat cosmetic skin lesions, 79.6% carry out injections with botulinum toxin, 59.3% perform chemical peels and 37% perform tissue augmentation with injectable fillers. Overall, the ratio between desired and adverse effects as well as the economic benefit of all evaluated methods was judged as positive by the interviewees. In a comparison of all evaluated modalities, the therapeutic index was considered most favourable with botulinum toxin and most unfavourable with injectable filling agents. With regard to cost-effectiveness, soft tissue augmentation was judged best, while chemical peels alongside lasers were regarded as least advantageous in this respect. Further evaluated topics were indications, substances, organisation and other issues. In summary the survey confirmed that a large number of German dermatology departments employ non-surgical cosmetic procedures matching the international upward trend of cosmetic dermatology.

Cosmetic Techniques↗