Dermatology nurse prescribing in China:a Delphi method

Objectives:To identify the dermatological system drugs that may be prescribed by Chinese dermatological nurses through expert consensus.Methods:A 2-round study,consisting of 32 medical and nursing exper ts,was conducted using the Delphi method from September 2019 to June 2020.Microsoft Excel 2019 and IBM SPSS Ver.22 were used to analyze the results of the consultations.Results:A total of 63 drugs across 13 categories were identified as relevant to Chinese nurses working in dermatological departments.Among these drugs,1 drug was generally prescribed independently,17 drugs tended to be prescribed collaboratively,and 45 were prescribed either independently or in collaboration with others.Conclusions:This exper t consensus determines the prescription drugs that may be prescribed by dermatology nurses in China,which can be used as the key content of prescription drug training for dermatology nurses in future.The results of the study could provide a basis for the implementation of nurses'prescription rights in China in future and provide a reference for the formulation of relevant legislation on nurses'prescription rights.

Epidemiological Profile of Autoimmune Diseases in Thiès, Senegal: About a Descriptive Observational Study over 11 Years in 2 Internal Medicine Departments and a Dermatology Department

Introduction: Autoimmune diseases are characterized by a very large clinical polymorphism that can lead to a diagnostic wandering. So, we aimed to determine their epidemiological profile outside the context of Dakar (capital of Senegal) where the technical plateau is more elevated. Methodology: We conducted a retrospective descriptive and observational study from January 1, 2007 to December 31, 2017. All patients admitted or followed in outpatient in the Internal Medicine departments of the Saint Jean de Dieu and Regional Hospitals of Thiès as well as in the dermatology department of the CHRT (Regional Hospital Center of Thiès), and who met the MAI criteria (autoimmune diseases) have been included. The data were collected on a standardised sheet and analysed by EPI INFO version 7.2. Results: A total of 121 patients were included out of 25951 records i.e a prevalence of 0.46% in internal medicine departments. In dermatology, out of 31973 patients, 95 had MAIS (systemic autoimmune diseases): 0.29% as hospital prevalence. The average age was 40.7 years in internal medicine departments compared to 37.66 years 14.8 years in the dermatology department. Patients aged 30 to 59 years represented 57.89% of the study population. The sex ratio (H/F) was 0.3 in the internal medicine departments compared to 0.17 in the dermatology department. Circumstances of discovery were incidental in 16.52% and clinical in 3.30%. Biermer disease accounted for 29.75% of organ-specific MAI. Concerning systemic presentations, rheumatoid arthritis (RA) was present in 23.14%. Lupus was more representative in dermatology (65.2%) as well as systemic scleroderma (21%), dermatomyositis (6.3%). Cytopenia was found in 105 patients, showing in detail anemia (42.9%);leukopenia (14.8%);thrombocytopenia (2.4%). Autoantibodies were tested in 58 patients (47.9%). Skin histology was contributory in all cases of systemic scleroderma and in 5 cases of lupus. The main therapy prescribed was corticosteroid therapy alone or in combination with an immunosuppressant. Conclusion: In addition of infectious diseases, Subsaharan Africa is under the era of changing face of its epidemiology, and cardiovascular diseases shows signs of emergence, like auto-immune presentations. However, the difficult apprehension of these so subtle last diseases suggests that they are few reported. Technical tools in regions should be enhanced associated to a non-binding capacity building system targeting such diseases with an emphasis on good record keeping.

Surgical Flap and Graft Reconstruction Workshop for Dermatology Residents

Background: Traditional models for teaching surgical principles focus primarily on the apprenticeship theory;however there has been a trend in surgical education to certifying competency in a simulation environment prior to working with patients. Many surgical models emphasize learning the technical and manual dexterity skills necessary to be a surgeon, yet few focus on obtaining the theoretical and abstract skills needed for planning complex cutaneous surgical repairs with flaps and grafts. We developed and evaluated a novel surgical flaps and grafts workshop for residents through the Department of Dermatology. Methods: Participants received a 60 minute PowerPoint lecture focusing on the basic principles of cutaneous repair with flaps and grafts, with examples and explanation of each of the four main types of flaps and grafts. The participants then received nine photocopies of Mohs micrographic surgery defects with instructions to design three repairs, focusing on functional and aesthetic outcome. Hypothetical and actual repair designs were then discussed in an open forum format. Anonymous surveys administered to 11 dermatology residents assessed their knowledge level, confidence level, and likelihood of using flaps and grafts pre- and post-workshop using Likert scales. Overall experience was also assessed. A paired sample Wilcoxon Signed Rank Test was used for analysis, since the data was non-parametrically distributed. Results: There was a statistically significant increase in confidence performing flaps post workshop (p = 0.0469). There was also an increase in knowledge of flaps and grafts, confidence in planning flaps and grafts, and confidence in performing grafts post workshop, but these findings did not reach statistical significance. The workshop had no effect on expected future use of flaps and grafts. Conclusions: The surgical workshop is a novel simulation teaching tool for learning basic principles and design of flaps and grafts in cutaneous surgery.

Dermatology in the military field: What physicians should know?

In the civilian dermatological setting, the top 5 skin diseases usually seen are eczema/dermatitis, acne, benign skin tumors, viral infections and pigmentary disorders. In comparison, the top 5 skin conditions encountered in the military sector are usually fungal infections, eczema/dermatitis, insect bite reactions, bacterial infections and acne. This is not surprising as military personnel, due to the special environment and vocations they are in, are prone to getting eczema as heat, sweating and wearing of the military uniform aggravate the condition. Fungal infections are common in those who wear the army boots. Insect bite reactions are not an uncommon sight among those who have to go to the jungle regularly for outfield training. Grass allergy or intolerance, contact dermatitis or acneiform eruption due to the application of military camouflage cream on the face, contact dermatitis to insect repellents, and military uniform allergy and intolerance are amongst the commonest dermatological problems encountered in the military field, and physicians should recognize them, investigate and manage these problems accordingly. Lastly, a diagnosis not to be missed in the military field is cutaneous melioidosis, especially when a military personnel presents with a non-healing ulcer.

Presenting patterns of dermatology conditions to an Australian emergency department

BACKGROUND: Approximately 5%–8% of emergency department(ED) presentations are due to a dermatological condition.This study aimed to identify and characterise patients with skin conditions presenting to a busy ED.METHODS: A 5-year retrospective study on patients with dermatological conditions presenting to the Princess Alexandra Hospital ED in Brisbane, Australia was performed.Electronic medical records were used to compare demographics and admission status of the dermatology group and the total ED group presentations.A prospective survey was conducted on low priority triage(triage 4 and 5) patients identifying reasons presenting to the ED.RESULTS: Of a total 281,718 ED presentations, 11,748 dermatology presentations were identified between January 2012 to December 2016.Of the dermatology presentations, 41.5% were female and had an average age of 47.The most common dermatology presentations were cellulitis, abscess, rash unspecified, and ulcer.Of those admitted, 36% were female, average age was 53, mean length of stay of 294 minutes and 83.1% had an infectious aetiology.Of triage 4 and 5 presentations, 66% patients we approached had been seen by a health practitioner prior to coming to the ED.CONCLUSION: Within the population presenting with a skin related condition to the Princess Alexandra Hospital ED, characteristics associated with admission include male sex, older age, and an infectious etiology.This data may help ED clinicians decide on the discharge disposition of these patients.There may be a role for streamlined admissions for skin related infections, or improved hospital in the home services to support this group.

Prescribing Pattern for Skin Diseases in Dermatology OPD at Borumeda Hospital, North East, Ethiopia

Introduction: Skin diseases are the major contributors of disease burden in society. Dermatological therapy ultimate goal is achieved by administering the safest and least number of drugs. The problem gets compounded with the inappropriate and irrational use of medicines. Therefore, periodic prescription audit in the form of prescribing patterns is away to improve irrational prescription. The objective of this study to assess the prescription patterns of dermatological agents in Borumeda hospital. Method: Hospital based retrospective cross sectional study in which prescribing patterns of dermatological agents are assessed. A total of 385 samples of patient record prescription from November/1/2016 to December/30/2016, and the sample were selected by systematic random sampling technique. Sample prescriptions were reviewed using structural data collection format. The Collected data was analyzed by using SPSS version 20. Result: Regarding rout of administration, the maximum number of drugs was prescribed topically (66.2%). Topical steroids were the most commonly prescribed drugs (25.3%). Use of generic prescribing in single drug prescribing was 81.7%. The prevalence of atopic dermatitis was higher (26.3%, 20.8%) in both male and female respectively followed by scabies in male with 12.2% and Acne vulgaris (12.9%) in female. Number of drugs per prescription was higher (2.46) than WHO standard (Conclusion: The current study reveals that topical corticosteroids were commonly prescribed drugs in the dermatology unit and the prescribing practice imitates incidence of polypharmacy.

Nursing Care of Stevens Johnson Syndrome and Toxic Epidermal Necrolysis: Case Study of Dermatology Unit of Referral Hospital, Kenya

Introduction: Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are adverse reaction to drugs whose manifestation affect the skin and mucous membranes whose outcomes may be life threatening and fatal. Supportive management has been proven to be the mainstay with well executed nursing care resulting in quality clinical outcomes. The aim was to evaluate the nursing care interventions in management of patients with SJS/TEN in the dermatology unit. Methods: Qualitative design was used, data were collected through observation of nursing care activities, informant interviews and focus group discussion with the nurses. Qualitative data were recorded in audio tapes and transcribed. Qualitative content analysis was used for the analysis of the transcribed texts. Study was approved by KNH/ERC and informed written consent from participants. Funding was obtained from KNH through the Research and Programs department. Findings: 20 nurses participated in the study. The commonest nursing care interventions were described as routine tasks initiated at clinical diagnosis and routinely performed. They include aggressive skin care, wound care, mucosal and eye care, infection surveillance and prevention practices and general patient monitoring for complications. Skin and wound care were most challenging part of nursing care due to severe erosion or exfoliation. Nurses do not use any specific guidelines of care but consider their role a key in quality outcomes for patients with SJS/TEN in this hospital.

Integrated Business Intelligent System for E-Health: A Case for Dermatology Diseases

In the current era, information technology has boosted every field of life either business industry or healthcare to integrate the internal processes of it. Due to the demand of managing huge data related to these fields numerous information systems play different roles in making the organizational processes robust and up to date. This paper discusses the integrated business intelligence implication specifically for healthcare to provide the fast and precise information on time. Therefore, this paper discusses the idea of building intelligent system based on Enterprise Resource Planning (ERP) databases using exclusively for dermatology diseases by applying data mining techniques. Firstly, classification mining has been applied for categorization data based on patient’s record. Then rules and patterns generated from the categorized data related to dermatology diseases, symptoms and treatments. The proposed system will retrieve the corresponding information related to the given symptoms along with medication and complete treatment. This research aims to integrate different ERP processes with centralized ERP database to provide business intelligence effectively for the dermatologists. The paper has provided with the comprehensive conceptual framework and each step has been discussed in detail.

Dermatology Procedural and Surgical Skills Workshop for Medical and Physician Assistant Students

Background: Evidence indicating the limited amount of hands-on experience in the current era of medical training has raised concern regarding students’ development and potential deficiencies in the performance of basic procedural skills. Studies have demonstrated the value of surgical workshops for medical students;however evaluation of improved student performance during future clerkships or residencies has yet to be assessed. We initiated and evaluated a resident-led surgical skills workshop for students through the Department of Dermatology. Methods: Participants received instructions on surgical tools/techniques followed by hands-on practice. Anonymous surveys administered to 24 medical and physician assistant students assessed their skill level, confidence level, and likelihood of using surgical skills in future practice preand post-workshop using a 1 - 5 Likert scale. Overall experience was also assessed. Non-parametric bivariate tests were used for analysis to account for non-normal distribution of the data. Results: There was a statistically significant change in skill (p = 0.0001) and confidence (p = 0.0001) level post workshop. There was no significant difference in utility. There were also no statistically significant differences based on the year of medical student training, medical student versus physician assistant student responses, or number of procedures performed prior to the workshop. Estimated cost per participant was $5.65. Conclusions: Research supports our finding that workshop learning experiences increase students’ ability to perform common procedural skills, their confidence, and desire to practice such skills. Further studies are necessary to determine the impact of these skills workshops on long-term clinical performance in future clerkships and residencies.

Dermatology Resident Generated Textbook Questions as a Resident-Centered Educational Strategy

Background: Textbook conferences are widely used by dermatology residency programs in the United States to provide educational exposure to the specialty. Typically an entire textbook is reviewed each academic year. However, residents may be uncertain about mastery of the assigned readings. Since most dermatology textbooks do not provide questions about the material presented at the end of each chapter, an innovative senior resident from our program wrote questions about each chapter and offered them to the other residents prior to scheduled discussions of the assigned materials. Methods: A pilot study for resident generated quizzes about assigned textbook reading in general dermatology was developed, implemented, and assessed by anonymous completion of a Likert Scale by participants. Results: Participants indicated that quizzes better prepared them for the annual dermatology in-service examination and they thought that the additional creation of quiz materials in the subspecialty areas of dermatopathology and dermatologic surgery would be useful. Conclusion: Resident generated quizzes are a novel approach to the learning environment during dermatology residency for residency programs and may be useful for other residency programs that utilize textbook conferences. Additional research is needed.

Fecal microbiota transplant for more than Clostridioides difficile: Dermatology a new frontier

Fecal microbiota transplant(FMT)has quickly become popular in research not only for recurrent Clostridioides difficile infections but for other chronic conditions as well.Recent,small dermatologic studies have reported improvements in inflammatory skin conditions in individuals treated with FMT,but larger studies are needed to clarify this possible relationship between the skin and the gut microbiome.We conducted a single-center,retrospective chart review to assess changes in acne,dermatitis herpetiformis and/or celiac disease,eczema,and psoriasis.Due to the retrospective nature of this study and the limitations of the current electronic medical record,we were unable to adequately assess cases of these diseases in relation to FMT.However,this study informs us that improvements in retrospective data are needed to formally evaluate this possible association.The better,but more cumbersome,study design would be a prospective,observational study.We encourage others to pursue further interdepartmental research on the influence of the gut microbiome on inflammatory skin diseases.

Impact of Fluorescent Light Energy on the Quality of Life of Dogs with Dermatologic Disease and Their Owners

Background: Quality of life (QoL) is a term used to evaluate general well-being, and it is defined as ‘the degree to which an individual enjoys his or her life. Within the realm of medicine, the evaluation of QoL frequently involves examining how disease exerts a detrimental impact, diminishing the enjoyment and fulfilment experienced by the individual. Dermatological diseases have been found to exert a substantial negative influence on the QoL of dogs and their owners due to nuisance and stress related to the disease but also due to the caregiver burden. In the management of bacterial skin infections, topical therapy is commonly administered alongside systemic antibiotics. Nonetheless, the protracted duration of treatment and difficulties in ensuring owner compliance can introduce a significant caregiver burden, potentially exacerbating the challenges associated with these conditions. Purpose: This study aimed to evaluate the impact on the quality of life (QoL) of dogs with dermatologic diseases after fluorescent light energy (FLE) treatment. Methods: The study was an open, prospective, multicentric clinical trial that included dogs with various dermatological conditions. The dogs received FLE treatment once weekly until the clinical resolution was achieved. Owners completed a validated questionnaire to assess the QoL of their dogs before and after therapy. Results: Thirty-five dogs with deep pyoderma, interdigital furunculosis, pyotraumatic dermatitis, wounds and perianal fistulas were included. All dogs received two sessions of fluorescent light energy once a week. Median treatment duration was 9 weeks for perianal fistula, 7 weeks for interdigital furunculosis, 5 weeks for deep pyoderma, 3 weeks for wounds and 1.5 weeks for pyotraumatic dermatitis. Complete remission was noted in 86% of dogs, and 14% showed an improvement but partial remission. The majority of owners reported a positive impact on their dogs’ QoL after therapy, and 74% of the dogs showed at least a 50% reduction in QoL scores. Conclusion: Fluorescent light energy has been shown to exert beneficial effects on the healing of dermatological diseases and the quality of life (QoL) in dogs and their owners, whether used as a standalone treatment or in combination with standard care therapies. Additionally, it was well-tolerated by the dogs. This study emphasizes the significance of considering both the owner’s and dog’s QoL when evaluating the therapeutic efficacy of dermatological treatments.

Research progress on the application of microneedle transdermal drug delivery system in dermatology

Transdermal drug delivery systems(TDDs)have the advantages on good local targeting,controlled and sustainable drug delivery.Hoewever,the stratum corneum,as the main skin barrier,severely limits the transdermal penetration of drugs and reduces bioavailability,which also limits their application.Microneedles(MNS)penetrate the stratum corneum and create several reversible microchannels in a minimally invasive manner to significantly improve the penetration of therapeutic agents,and are considered a milestone for effective transdermal drug delivery.As an emerging drug delivery modality,microneedle transdermal drug delivery systems have the advantages of being minimally invasive,safe,efficient,economical and convenient.In addition to the extensive research on microneedles for improving transdermal drug delivery,there is a growing interest in using them to manage and treat dermatological conditions.Being the largest organ in the human body,the skin acts as a barrier between the body and the external environment,while having an immense influence on appearance and self-confidence.Indeed,there is now a considerable body of evidence on how dermatological conditions can lead to psychological problems and a reduced quality of life.The utilisation of microneedle transdermal drug delivery systems for the management and treatment of dermatological conditions is of great therapeutic and commercial value.The principleof microneedle transdermal drug delivery systems and the progress of its clinical application in dermatology are reviewed here.

中医中药治疗痤疮的研究进展

中医中药治疗痤疮疾患已有两千多年历史,具有标本兼治、内外调理、不良反应小、依赖性小等特点。本文通过查阅文献报道,对中医中药在痤疮疾病中运用的历史沿革、现代临床研究、上市产品分析等内容进行综述,追踪其历史溯源,总结其运用现状,探究中医中药治疗痤疮的优秀方法,探讨其发展方向。发现中医中药在痤疮疾病中应用广泛,治疗方法众多,有内服疗法、外用治法及特殊疗法等,有着显著疗效;但由于个体差异的存在,治疗应当根据患者的身体状况,选择合适的治疗方法。该文旨在系统阐释医家的痤疮治疗经验,为今后临床中医治疗痤疮提供参考方案。

皮肤镜在皮肤科专业学位研究生教学培训中的应用

皮肤镜诊断技术近年来发展迅速,是皮肤影像学中发展最为完善,研究也最为深入的技术和辅助诊断方法,具有便利、无创、实时和有效的特点,被誉为“皮肤科医生的听诊器”。而专业学位研究生的教学培训不同于本科生,在繁重的课业基础上,需要更快捷、准确地掌握皮肤科的疾病知识。所以,文章在目前各临床教学方法[如问题为导向式教学法(problem-based learning,PBL)、案例式教学法(case-based learning,CBL)、混合式教学等]的基础上,总结临床见习、实习及住院医师规范化培训的经验,将皮肤镜应用于皮肤科专业学位研究生的临床教学及培训当中,既可以提高皮肤科专业学位研究生的临床思维能力以及创新思维能力,也可以便于教师总结更多的教学经验,更好地为学生服务。

PBL联合DOL教学模式在皮肤科临床实习教学中的应用

目的:该研究对PBL与DOL联合教学运用于皮肤科临床实习带教方面展开探究。方法:将50名临床实习生通过随机方式平均分为观察组和对照组,观察组展开PBL联合DOL教学,对照组展开传统教学。借助学生满意度调查、mini-CEX以及认知考试成绩等对两组教学效果进行评估。结果:观察组实习生的理论知识考试得分高于对照组(P<0.05)。根据mini-CEX评价结果,观察组实习生的临床综合、组织效率、临床诊断、沟通咨询、面谈技能能力优于对照组(P<0.05)。学生问卷调查显示,观察组实习生在增加团队合作能力、临床技能提升、主动学习刺激、咨询技能提高、总体满意度方面优于对照组(P<0.05)。结论:PBL联合DOL教学有利于提高实习生临床实践能力和综合能力,可为皮肤科临床实习教学模式的改进提供参考。

融入评价的POEC教学模式在皮肤性病学教学中的应用

目的 探讨在皮肤性病学教学过程中应用融入评价的预测-观察-解释-比较(predict-observe-explaincompare,POEC)教学模式的效果。方法 选取2019年1月-2020年12月的重庆医科大学附属第二医院皮肤科的126例临床医学专业学生作为研究对象,按照随机数表法分为对照组与观察组,每组各63名。对照组采用常规模式开展教学;观察组采用融入评价的POEC教学模式进行教学,比较2组学生的理论知识考核评分以及实践考核评分、教学评价、教学满意度。结果 教学前,2组学生理论知识考核评分以及实践考核评分比较,差异无统计学意义(P> 0.05);教学后,观察组理论知识考核评分为(94.36±1.24)分,实践考核评分为(94.36±2.12)分,高于对照组的(88.21±1.56)分、(85.45±1.92)分,差异有统计学意义(P <0.001)。教学后,观察组的学习积极率为95.24%,高于对照组的79.37%,差异有统计学意义(P <0.05)。教学后,观察组学习难度降低评分为(88.54±2.34)分,学习效率提升评分为(92.62±2.24)分,注重理论和实践结合的评分为(91.12±2.14)分,高于对照组的(81.56±2.22)分、(83.21±3.13)分、(81.51±3.13)分,差异有统计学意义(P <0.001)。教学后,观察组的教学满意度为96.83%,高于对照组的79.37%,差异有统计学意义(P <0.05)。结论 在实施皮肤性病学教学时,采用融入评价的POEC教学模式,能够有效提高学生的学习成绩,激发学生的学习积极性,提升教学满意度,进而提升皮肤性病学的教学质量。

基于山东省皮肤病专科联盟早期诊断麻风三例

麻风是由麻风分枝杆菌感染所引起的一种慢性传染病,晚期可致残、毁容。进入新世纪,我国麻风进入低流行状态,但我国每年仍有近千例新发麻风患者,二级畸残者占20%以上。2017年,我院牵头成立山东省皮肤性病学专科联盟,基于此,共确诊麻风39例,诊断延迟期下降66.23个月。本文报道其中三例基于皮肤病专科联盟转诊确诊为麻风的患者。

学习心理学下问题化教学在皮肤性病学临床教学中的应用和思考

基于学习心理学,以学习条件理论和问题构成视角,分析问题化教学的条件和层级,并结合各类问题的作用特点,以皮肤性病学课程中的《带状疱疹》章节为例,进行问题化教学的课堂教学设计,旨在拓宽学生对带状疱疹的认识,并试图通过基于最小问题单元的逐层分析,从临床专业素养、医学探索、人文思政等多个维度提高学生对带状疱疹的认识。

用于皮肤病激光治疗的脉冲光热辐射模型

针对皮肤病激光治疗过程中生物组织内部温度分布与形态测量困难、医生凭借经验选取治疗参数导致疗效不佳等问题,建立了利用脉冲光热辐射法(PPTR)重建皮肤结构,并智能化选取激光参数开展辅助治疗的理论模型。采用基于自定义截断参数选取方法的截断奇异值分解法、基于L曲线法选取正则化参数的Tikhonov正则化法和给定迭代次数的共轭梯度法这3种逆算法进行仿真计算,建立误差评估函数,分析对比了不同表皮层厚度、患病层厚度及深度的重建效果,同时制作皮肤仿体进行离体实验,并以此为依据开展了鲜红斑痣临床治疗的应用研究。结果表明:3种逆算法的综合性能评价指数由高到低依次为0.066、0.082、0.126,验证了其在鲜红斑痣血管层常见深度范围内的重建效果均能保持较高精度;体外实验结果和临床应用验证了所提出的PPTR模型可用于求解表皮、病变层等组织的温升分布、厚度、位置等信息,且重建结果的精度能够满足治疗需求。该模型及研究结果可为激光治疗过程中参数的选取提供定量化指导。