Characterization of the 2016-2017 dermatology standardized letter of recommendation

© 2018 Matrix Medical Communications. All rights reserved. Objective: We aimed to analyze the reformatted standard letter of recommendation (SLOR) for dermatology residents to examine trends in grading and content based on the positions of the letter writers, their backgrounds, and their relationship with the applicant, as well as to evaluate the SLOR\u27s ability to discriminate applicants. Design: This was a retrospective characterization study of dermatology SLORs from the 2016-17 application cycle. Setting: We examined SLORs received by The Ohio State University, the University of Oklahoma, and Hofstra University Northwell Health dermatology residency programs. Participants: We included dermatology residency applicants and their letter writers from the 2016-17 application cycle. Results: A total of 141 SLORs were analyzed from 115 applicants. SLORs demonstrated grade inflation from letter writers of all backgrounds. Ratings for research potential and inquisitive nature were significantly lower than ratings for other categories. Letter writers with limited clinical and research contact graded applicants significantly lower than did writers who had more extensive contact. Word boxes were underutilized. Conclusion: The dermatology SLOR is useful in differentiating applicants, and ratings correlate with the relationships that letter writers have with their applicants. Residency programs should be aware of these findings when evaluating letters of recommendation for applicants

Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease.

BACKGROUND:Patient outcomes are improved when dermatologists provide inpatient consults. Inpatient access to dermatologists is limited, illustrating an opportunity to utilize teledermatology. Little is known about the ability of dermatologists to accurately diagnose and manage inpatients using teledermatology, particularly utilizing non-dermatologist generated clinical data. METHODS:This prospective study assessed the ability of teledermatology to diagnose and manage 41 dermatology consults from a large urban tertiary care center utilizing internal medicine referral documentation and photos. Twenty-seven dermatology hospitalists were surveyed. Interrater agreement was assessed by the kappa statistic. RESULTS:There was substantial agreement between in-person and teledermatology assessment of the diagnosis with differential diagnosis (median kappa = 0.83), substantial agreement in laboratory work-up decisions (median kappa = 0.67), almost perfect agreement in imaging decisions (median kappa = 1.0), and moderate agreement in biopsy decisions (median kappa = 0.43). There was almost perfect agreement in treatment (median kappa = 1.0), but no agreement in follow-up planning (median kappa = 0.0). There was no association between raw photo quality and the primary plus differential diagnosis or primary diagnosis alone. LIMITATIONS:Selection bias and single-center nature. CONCLUSIONS:Teledermatology may be effective in the inpatient setting, with concordant diagnosis, evaluation, and management decisions

Dark-field tomography of an attenuating object using intrinsic x-ray speckle tracking.

Purpose: We investigate how an intrinsic speckle tracking approach to speckle-based x-ray imaging is used to extract an object's effective dark-field (DF) signal, which is capable of providing object information in three dimensions. Approach: The effective DF signal was extracted using a Fokker-Planck type formalism, which models the deformations of illuminating reference beam speckles due to both coherent and diffusive scatter from the sample. Here, we assumed that (a) small-angle scattering fans at the exit surface of the sample are rotationally symmetric and (b) the object has both attenuating and refractive properties. The associated inverse problem of extracting the effective DF signal was numerically stabilized using a "weighted determinants" approach. Results: Effective DF projection images, as well as the DF tomographic reconstructions of the wood sample, are presented. DF tomography was performed using a filtered back projection reconstruction algorithm. The DF tomographic reconstructions of the wood sample provided complementary, and otherwise inaccessible, information to augment the phase contrast reconstructions, which were also computed. Conclusions: An intrinsic speckle tracking approach to speckle-based imaging can tomographically reconstruct an object's DF signal at a low sample exposure and with a simple experimental setup. The obtained DF reconstructions have an image quality comparable to alternative x-ray DF techniques

Investing in the future of inpatient dermatology: The evolution and impact of specialized dermatologic consultation in hospitalized patients

© 2018 Quadrant Healthcom Inc. All right reserved. Inpatient dermatology has transitioned from units that admitted and cared for patients with chronic dermatoses to consultative services that provide a wide breadth of care, leading to a paradigm shift in the role and impact of dermatologists in the inpatient setting. Consultative dermatology provides a distinct and essential service in the care of hospitalized patients, leading to improved care quality along with reductions in inappropriate health care spending

Real-world risk of new-onset inflammatory bowel disease among patients with psoriasis exposed to interleukin 17 inhibitors

© 2020 American Academy of Dermatology, Inc. Background: Information on the real-world risk of inflammatory bowel disease (IBD) among patients with psoriasis exposed to interleukin-17 inhibitor (IL-17i) is limited. Objective: To compare IBD risk in patients with psoriasis with and without IL-17i exposure. Methods: Retrospective cohort analysis of patients with psoriasis with and without IL-17i exposure identified by using electronic health records data. Primary outcomes were 6-month and 1-year IBD incidence. Results: Crude 6-month IBD incidence was 0.16% (3/1821) among patients with psoriasis exposed to any IL-17i, 0.24% (3/1246) among those exposed to secukinumab alone, and 0.11% (239/213,060) among those unexposed. Crude 1-year IBD incidence was 0.27% (5/1821) among IL-17i–exposed patients with psoriasis, 0.32% (4/1246) among those exposed to secukinumab alone, and 0.19% (412/213,060) among those unexposed. In adjusted analysis, there was no significant difference in odds of developing IBD at 6 months (odds ratio, 1.42; 95% confidence interval, 0.45-4.43) and 1 year (odds ratio, 1.37; 95% confidence interval, 0.57-3.33) between exposed and unexposed patients with psoriasis. Similarly, there was no significant difference in odds of developing IBD at 6 months and 1 year between secukinumab-exposed and -unexposed patients with psoriasis. Limitations: Analysis may have been limited by the low number of outcome events. Conclusion: The incidence of IBD among patients with psoriasis exposed to IL-17i is low, and the risk appears similar to that for unexposed patients with psoriasis

Prevalence estimates for pemphigoid in the United States: A sex-adjusted and age-adjusted population analysis

© 2018 American Academy of Dermatology, Inc. Background: The burden of the pemphigoid group of autoimmune blistering diseases is poorly understood. Objective: To estimate standardized overall and sex-specific, age-specific, and race-specific prevalence estimates for pemphigoid among adults in the United States. Methods: Cross-sectional analysis of electronic health records data for a demographically heterogeneous population-based sample of \u3e55 million patients across all 4 census regions. Results: Overall pemphigoid prevalence was 0.012%, or 12 pemphigoid patients/100,000 adults. Prevalence of pemphigoid among those aged ≥60 years was 0.038%, or 37.7 cases/100,000 adults. Prevalence increased ∼2-fold within each successive age group and was highest among patients aged ≥90 years (123.6 [95% CI 115.2-132.5] cases/100,000 adults). Adjusted prevalence in women was 12.7 (95% CI 12.3-13.2) cases/100,000 adults, slightly more than that in men (11.0 [95% CI 10.5-11.6] cases/100,000 adults). Adjusted prevalences were similar for blacks (15.4 [95% CI 14.0-17.0] cases/100,000 adults) and whites (13.5 [95% CI 13.0-13.9] cases/100,000 adults). Limitations: Analysis of electronic health data might result in disease misclassification. Conclusion: Pemphigoid is rare in the United States. Patients aged ≥60 years comprise the majority of cases

Prevalence estimates for pyoderma gangrenosum in the United States: An age- and sex-adjusted population analysis

© 2019 American Academy of Dermatology, Inc. Background: The disease burden of pyoderma gangrenosum (PG) is poorly understood. Objective: To determine standardized overall and age-, sex-, and race-specific prevalence estimates for PG among adults in the United States. Methods: Cross-sectional analysis of 1971 patients with PG identified using electronic health records data from a diverse population-based sample of more than 58 million patients. Results: The age- and sex-standardized prevalence of PG among the study population was 0.0058%, or 5.8 PG cases (95% confidence interval [CI], 5.6-6.1) per 100,000 adults. Adjusted prevalence was nearly twice as high among women (7.1 cases [95% CI, 6.7-7.5] per 100,000) than men (4.4 cases [95% CI, 4.0-4.7] per 100,000). Patients between the ages of 70 and 79 years had the highest standardized prevalence (9.8 cases [95% CI, 8.8-10.9] per 100,000), with patients aged ≥50 years representing nearly 70% of all PG cases. Standardized prevalence was similar among white and African American patients. The female-to-male ratio of PG was \u3e1.8 across all age groups. Limitations: Analysis of electronic health records data may result in misclassification bias. Conclusion: PG is a rare disease that most commonly affects women and those aged ≥50 years

Cutaneous immune-related adverse events to checkpoint inhibitors

© 2020 Elsevier Inc. The development of immunotherapy has led to a paradigm shift in the treatment of both solid and hematologic malignancies. As immunomodulatory therapies are employed with increasing frequency, a greater number of immune-related adverse reactions are being reported, and the majority of these involve the skin. As a result, dermatologists are increasingly becoming involved in the management of these cutaneous adverse reactions—often providing critical recommendations regarding ongoing cancer treatment. Cutaneous immune-related adverse reactions can vary significantly from patient to patient, making early recognition and timely intervention imperative to mitigate associated morbidity and potential treatment interruption. Although there is considerable overlap in the cutaneous adverse events caused by these immune checkpoint inhibitors, specific eruptions are characteristically associated with particular checkpoint inhibitors. In addition, a patient\u27s comorbidities or immune status can play a significant role in the presentation and management of such adverse reactions. This review characterizes and provides management guidelines for the various cutaneous toxicities associated with checkpoint inhibitor therapy, including CTLA-4 inhibitors, PD-1 inhibitors, and PD-L1 inhibitors. © 2020 Elsevier Inc. All rights reserved