11 research outputs found
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Assessment of risk and use of prophylaxis for glucocorticoidinduced-osteoporosis among dermatologists in the Pacific Northwest: a survey study
Objective: Exposure to even physiologic doses of glucocorticoids can reduce one's bone mass and increase risk for osteoporotic fracture. There currently exists a wide variation in clinician approach to the assessment and management of glucocorticoid-induced osteoporosis (GIO). Our objectives were to characterize Pacific Northwest dermatology providers' general practices, assessment of risk for GIO, and preferred GIO prophylaxis measures by way of survey. To identify whether knowledge deficits exist with respect to preventing and managing GIO in dermatology patients.Design: A self-administered, 22-question survey was sent electronically to respondent population. Surveyed population composed of 392 dermatology providers of the Washington State Dermatology Association and Oregon Dermatology Society registries. Survey responses were collected anonymously via Catalyst WebQ.Results: Respondents over-estimated fracture risk and reported they would prescribe antiresorptive medications at a less-than-adequate rate. When given clinical scenarios and asked to assess risk of major osteoporotic fracture, respondents frequently overestimated risk compared to that estimated by the FRAX tool (67%-71%). When asked directly if one would prescribe bisphosphonates as GIO prophylaxis for a high-risk patient, only 49% responded always/almost always.Conclusions: This study suggests that a knowledge deficit exists within dermatology with respect to prevention and screening of GIO. The resultant practice gap is likely contributing to morbidity and mortality for dermatology patients requiring chronic glucocorticoid use for dermatologic disorders. Provider variability in practices suggests that dermatology could benefit from additional education in assessment and treatment of GIO, as well as a clear set of guidelines for GIO management
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Assessment of risk and use of prophylaxis for glucocorticoidinduced-osteoporosis among dermatologists in the Pacific Northwest: a survey study
Objective: Exposure to even physiologic doses of glucocorticoids can reduce one's bone mass and increase risk for osteoporotic fracture. There currently exists a wide variation in clinician approach to the assessment and management of glucocorticoid-induced osteoporosis (GIO). Our objectives were to characterize Pacific Northwest dermatology providers' general practices, assessment of risk for GIO, and preferred GIO prophylaxis measures by way of survey. To identify whether knowledge deficits exist with respect to preventing and managing GIO in dermatology patients.Design: A self-administered, 22-question survey was sent electronically to respondent population. Surveyed population composed of 392 dermatology providers of the Washington State Dermatology Association and Oregon Dermatology Society registries. Survey responses were collected anonymously via Catalyst WebQ.Results: Respondents over-estimated fracture risk and reported they would prescribe antiresorptive medications at a less-than-adequate rate. When given clinical scenarios and asked to assess risk of major osteoporotic fracture, respondents frequently overestimated risk compared to that estimated by the FRAX tool (67%-71%). When asked directly if one would prescribe bisphosphonates as GIO prophylaxis for a high-risk patient, only 49% responded always/almost always.Conclusions: This study suggests that a knowledge deficit exists within dermatology with respect to prevention and screening of GIO. The resultant practice gap is likely contributing to morbidity and mortality for dermatology patients requiring chronic glucocorticoid use for dermatologic disorders. Provider variability in practices suggests that dermatology could benefit from additional education in assessment and treatment of GIO, as well as a clear set of guidelines for GIO management
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A virtual faculty exchange program enhances dermatology resident education in the COVID-19 era: a survey study
One of the many consequences of the COVID-19 pandemic was the cancelation of the 2020 American Academy of Dermatology Annual Meeting. This conference historically features lectures from world-renowned experts in all areas of dermatology, thus providing an important educational experience for dermatology residents. We hypothesized that the cancellation of this meeting produced a substantial educational loss for dermatology residents. To mitigate this impact, we developed a virtual faculty exchange program and surveyed dermatology residents' perspectives on its implementation. All participating residents found the virtual faculty exchange useful and would recommend it to other residents/programs. Moreover, all residents wanted to participate in more faculty exchange sessions as well as incorporate them throughout the academic year. Additionally, this educational program eliminated the potential cost of >$15,000 in flights and >24 metric tons of carbon emissions. This virtual faculty exchange program is a viable tool to enhance dermatology resident education in the COVID-19 era
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A national survey comparing practice patterns and residency training satisfaction for categorical dermatology versus combined internal medicine and dermatology trained physicians
Combined internal medicine and dermatology (med-derm) training programs were created to advance complex medical dermatology and inpatient dermatology care. A prior study demonstrated that compared to categorical dermatology residents, med-derm residents had less program satisfaction, yet indicated a stronger desire to pursue careers in academia. No follow-up data on practice patterns after training has been reported. We aimed to characterize differences in residency program satisfaction and practice patterns between physicians trained in categorical dermatology compared to med-derm residency programs. We surveyed physicians who graduated from combined med-derm programs along with their counterparts, from six institutions, that either currently or historically had a combined med-derm training, from 2008-2017. Fifty-five percent of med-derm and forty-one percent of categorical-trained physicians responded. The practice patterns between the two groups were similar. A quarter of med-derm physicians continued to provide general internal medicine services. Categorical trained physicians were significantly more satisfied with their training (P=0.03) and performed more excisions on the head/neck (P=0.02). The combined graduates had significantly greater confidence in multidisciplinary care (P=0.003), prescribed more biologic (P<0.001) and non-biologic immunosuppressive agents (P=0.002), and volunteered more for the underserved patients in their communities (P=0.04). Although few differences in overall practice patterns between categorical and med-derm trained graduates were appreciated, med-derm graduates seem more comfortable with multidisciplinary care and may care for more medically complex patients requiring immunosuppression
Evaluation of Reliability, Validity, and Responsiveness of the CDASI and the CAT-BM
To properly evaluate therapies for cutaneous dermatomyositis (DM), it is essential to administer an outcome instrument that is reliable, valid, and responsive to clinical change, particularly when measuring disease activity. The purpose of this study was to compare two skin severity DM outcome measures, the Cutaneous Disease and Activity Severity Index (CDASI) and the Cutaneous Assessment Tool—Binary Method (CAT-BM), with the Physician Global Assessment (PGA) as the “gold standard”. Ten dermatologists evaluated 14 patients with DM using the CDASI, CAT-BM, and PGA scales. Inter- and intra-rater reliability, validity, responsiveness, and completion time were compared for each outcome instrument. Responsiveness was assessed from a different study population, where one physician evaluated 35 patients with 110 visits. The CDASI was found to have a higher inter- and intra-rater reliability. Regarding construct validity, both the CDASI and the CAT-BM were significant predictors of the PGA scales. The CDASI had the best responsiveness among the three outcome instruments examined. The CDASI had a statistically longer completion time than the CAT-BM by about 1.5minutes. The small patient population may limit the external validity of the findings observed. The CDASI is a better clinical tool to assess skin severity in DM