Exposure to teledermatology and resident preparedness for future practice: results of a national survey

Teledermatology (TD) is an emerging modality for providing remote dermatologic care with high diagnostic and management 25 concordance compared to face-to-face clinic dermatology. TD training among dermatology residency programs in the United 26 States has not been characterized. We disseminated a survey to all dermatology residents at ACGME accredited programs in the 27 United States to explore the prevalence and distribution of TD training and trainee perceptions of TD. One hundred out of a 28 potential 1170 responses (RR 8.5%) were collected from residents in every geographic location from all years in training: 67/100 29 of residents reported that TD was practiced at their institutions, although at these sites only 21/100 residents participated in 30 clinical sessions. Residents with TD exposure were more likely to feel comfortable managing a TD consult after residency 31 (p<0.001), but were not more likely to incorporate teledermatology into their future plans. Results of this study provide insight 32 into the impact of TD exposure on resident perceptions of TD and demonstrate the need for expanding TD training across all 33 dermatology residency programs

Impact of medical scribes on dermatology trainee and attending experience

Background: Medical scribe integration into academic dermatology practices results in decreased attending documentation time, improved physician efficiency, and positive patient satisfaction. However, scribes' impact on dermatology education has not been explored. Methods: We conducted a cross-sectional survey at the Brigham and Women's Hospital Dermatology Department and its associated residency program assessing trainee and attending perceptions of scribe impact on documentation time, teaching time, and quality of teaching. Results: Thirty-nine surveys (67% of eligible population) were analyzed. The majority of faculty and trainees perceived that scribes decreased documentation time (92% attendings, 88% trainees), increased attendings' direct teaching time (57% attendings, 76% trainees), increased attending availability to answer questions (57% attendings, 68% trainees), and improved overall education (57% attendings, 80% trainees). Trainees generally perceived educational benefits of scribes more strongly than attendings. Trainees and attendings had discordant views regarding number of patients that the trainee sees (29% attendings, 72% trainees, P<0.05) and the amount of supervision provided for procedures (43% attendings, 56% trainees). Conclusions: The positive impact of scribes on dermatology education is consistent with results in other disciplines. Although hospitals typically invest in scribes to increase physician efficiency, this study suggests that scribes can also improve the educational experience

Giant Pyogenic Granuloma in a Patient with Chronic Lymphocytic Leukemia

Pyogenic granuloma, also known as lobular capillary hemangioma, is a common benign vascular proliferative lesion that can present at any age on the skin or mucous membranes. Most lesions do not exceed 2 cm, but there are a handful of giant cutaneous pyogenic granulomas that have been reported, often in individuals with underlying immune dysfunction. Here, we report the first giant pyogenic granuloma in a patient with a hematological malignancy, chronic lymphocytic leukemia

Estimated Cost of Emergency Sunburn Visits—Validation of ICD-9-CM Search Criteria

To the Editor We applaud the evaluation by Guy and colleagues of costs for sunburn-associated visits to US emergency departments. Their analysis was performed using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) primary and secondary billing codes for sunburn (692.71, 692.76, and 692.77) in discharge records from the National Emergency Department Sample database

Medicare Part D Payments for Topical Steroids

Question What are the trends, drivers, and potential modifiers of Medicare spending on topical steroids? Findings In this retrospective analysis of Medicare Part D claims data between 2011 and 2015, Medicare spent $2.3 billion on topical steroids; spending increased 226.5$944.8 million. Meaning Medicare spending on topical steroids continues to rise, largely owing to increased medication costs for generic drugs; encouraging physicians to prescribe the cheapest topical steroids within a given potency group may decrease health care expenditures without compromising patient outcomes

Low Usefulness of Potassium Monitoring Among Healthy Young Women Taking Spironolactone for Acne

Importance Spironolactone has been shown to be an effective treatment option for hormonally mediated acne but can cause hyperkalemia. The prevalence of hyperkalemia among healthy young women taking spironolactone for acne is unclear. Objective To measure the rate of hyperkalemia in healthy young women taking spironolactone for acne or for an endocrine disorder with associated acne. Design, Setting, and Participants Retrospective study of healthy young women taking spironolactone for acne. Data from December 1, 2000, through March 31, 2014, were obtained from a clinical data repository. Outpatient data were collected from 2 tertiary care centers in the United States. We analyzed rates of hyperkalemia in 974 healthy young women taking spironolactone for acne. We also analyzed 1165 healthy young women taking and not taking spironolactone to obtain a profile for the baseline rate of hyperkalemia in this population. Exclusion criteria were cardiovascular disease, renal failure, and the use of medications that affect the renin-angiotensin-aldosterone system. Main Outcomes and Measures The rate of hyperkalemia in healthy young women taking spironolactone for acne was calculated. Secondary measures included spironolactone prescriber profiles and potassium monitoring practices. Results There were 13 abnormal serum potassium measurements in 1802 measurements obtained among young women receiving spironolactone therapy, yielding a hyperkalemia rate of 0.72%, equivalent to the 0.76% baseline rate of hyperkalemia in this population. Repeat testing in 6 of 13 patients demonstrated normal values, suggesting that these measurements may have been erroneous. In the remaining 7 patients, no action was taken. Conclusions and Relevance The rate of hyperkalemia in healthy young women taking spironolactone for acne is equivalent to the baseline rate of hyperkalemia in this population. Routine potassium monitoring is unnecessary for healthy women taking spironolactone for acne

DeepAngle: Fast calculation of contact angles in tomography images using deep learning

DeepAngle is a machine learning-based method to determine the contact angles of different phases in the tomography images of porous materials. Measurement of angles in 3--D needs to be done within the surface perpendicular to the angle planes, and it could become inaccurate when dealing with the discretized space of the image voxels. A computationally intensive solution is to correlate and vectorize all surfaces using an adaptable grid, and then measure the angles within the desired planes. On the contrary, the present study provides a rapid and low-cost technique powered by deep learning to estimate the interfacial angles directly from images. DeepAngle is tested on both synthetic and realistic images against the direct measurement technique and found to improve the r-squared by 5 to 16% while lowering the computational cost 20 times. This rapid method is especially applicable for processing large tomography data and time-resolved images, which is computationally intensive. The developed code and the dataset are available at an open repository on GitHub (https://www.github.com/ArashRabbani/DeepAngle)

A national survey of residents in combined Internal Medicine and Dermatology residency programs: educational experience and future plans.

IMPORTANCE: In response to a perceived erosion of medical dermatology, combined internal medicine and dermatology programs (med/derm) programs have been developed that aim to train dermatologists who take care of medically complex patients. Despite the investment in these programs, there is currently no data with regards to the potential impact of these trainees on the dermatology workforce. OBJECTIVE: To determine the experiences, motivations, and future plans of residents in combined med/derm residency programs. DESIGN, SETTING, AND PARTICIPANTS: We surveyed residents at all United States institutions with both categorical and combined training programs in spring of 2012. Respondents used visual analog scales to rate clinical interests, self-assessed competency, career plans, and challenges. MAIN OUTCOMES AND MEASURES: The primary study outcomes were comfort in taking care of patients with complex disease, future practice plans, and experience during residency. RESULTS: Twenty-eight of 31 med/derm residents (87.5%) and 28 of 91 (31%) categorical residents responded (overall response rate 46%). No significant differences were seen in self-assessed dermatology competency, or comfort in performing inpatient consultations, cosmetic procedures, or prescribing systemic agents. A trend toward less comfort in general dermatology was seen among med/derm residents. Med/derm residents were more likely to indicate career preferences for performing inpatient consultation and taking care of medically complex patients. Categorical residents rated their programs and experiences more highly. CONCLUSIONS AND RELEVANCE: Med/derm residents have stronger interests in serving medically complex patients. Categorical residents are more likely to have a positive experience during residency. Future work will be needed to ascertain career choices among graduates once data are available

Use of active comparator tirals in dermatology: A repeated cross-sectional analysis

Introduction: Spending on medications is expected to grow to $420 billion in 2023, largely driven by introduction of new branded products. While new branded medications can transform how physicians care for patients, others may not offer meaningful benefit over existing less costly alternatives. As additional new products are approved, the need to include active comparators in dermatologic clinical trials is particularly important to guide clinical decision making. Methods: To evaluate the trends in the use of active comparator trials designs, topical medications approved between January 2002 and December 2020 were identified through the 2020 Food and Drug Administration (FDA) Orange Book. For each medication, ClinicalTrials.gov was used to identify associated Phase II, III, and IV clinical trials. The frequency of active comparator was determined based on clinical indication and clinical trial phase. A logistic regression was performed to analyze the prevalence of active comparators between the study interval. Results: 177 trials met the inclusion criteria. Between 2002 and 2020, there was a decrease in the percentage of clinical trials for acne, psoriasis, and eczema that included an active comparator (-2.5% per year; 95% CI 0.9-4.2%). Phase II studies were most likely to include an active comparator (71%), while phase III studies were least likely (32%). Conclusion: Although there is a greater need for comparative effectiveness data in the setting of a growing number of available treatments, our results highlight that use of active comparator trials is decreasing over time, which will hinder comparative effectiveness research

Homebound patients’ perspectives on technology and telemedicine: A qualitative analysis

Telemedicine holds promise in bridging the gap between homebound patients and high quality health care, but uptake of such technology remains limited. Qualitative interviews conducted with 17 homebound patients found two major barriers to telemedicine. First, participants who lack familiarity with technology are hesitant about telemedicine, as baseline use of technology in the home is limited, participants did not feel capable of learning, and the advantages of telemedicine were unclear. Second, homebound patients place a high value on in- office visits due to therapeutic benefit, face-to-face communication, and the social aspect of medical appointments