Online Training on Skin Cancer Diagnosis in Rheumatologists: Results from a Nationwide Randomized Web-Based Survey

International audiencePatients with inflammatory rheumatisms, such as rheumatoid arthritis, are more prone to develop skin cancers than the general population, with an additional increased incidence when receiving TNF blockers. There is therefore a need that physicians treating patients affected with inflammatory rheumatisms with TNF blockers recognize malignant skin lesions, requiring an urgent referral to the dermatologist and a potential withdrawal or modification of the immunomodulatory treatment. We aimed to demonstrate that an online training dedicated to skin tumors increase the abilities of rheumatologists to discriminate skin cancers from benign skin tumors. A nationwide randomized web-based survey involving 141 French rheumatologists was conducted. The baseline evaluation included short cases with skin lesion pictures and multiple choice questions assessing basic knowledge on skin cancers. For each case, rheumatologists had to indicate the nature of skin lesion (benign; premalignant/ malignant), their level of confidence in this diagnosis (10-points Likert scale), and the precise dermatological diagnosis among 5 propositions. Different scores were established. After randomization, only one group had access to the online formation consisting in 4 elearning modules on skin tumors, of 15 minutes each (online training group). After reevaluation, the trained and the non-trained group (control group) were compared. The primary end-point was the number of adequate diagnoses of the nature of the skin lesions. The mean number of adequate diagnosis for the benign versus premalignant/malignant nature of the lesions was higher in the online training group (13.4 vs. 11.2 points; p value <0.0001). While the other knowledge scores were also significantly higher, no statistical difference was observed on the level of self-confidence between the 2 groups. In conclusion, the online formation was effective to improve the rheumatologists' ability to diagnose skin cancer

Case-Only Designs in Pharmacoepidemiology: A Systematic Review

<div><h3>Background</h3><p>Case-only designs have been used since late 1980’s. In these, as opposed to case-control or cohort studies for instance, only cases are required and are self-controlled, eliminating selection biases and confounding related to control subjects, and time-invariant characteristics. The objectives of this systematic review were to analyze how the two main case-only designs – case-crossover (CC) and self-controlled case series (SCCS) – have been applied and reported in pharmacoepidemiology literature, in terms of applicability assumptions and specificities of these designs.</p> <h3>Methodology/Principal Findings</h3><p>We systematically selected all reports in this field involving case-only designs from MEDLINE and EMBASE up to September 15, 2010. Data were extracted using a standardized form. The analysis included 93 reports 50 (54%) of CC and 45 (48%) SCCS, 2 reports combined both designs. In 12 (24%) CC and 18 (40%) SCCS articles, all applicable validity assumptions of the designs were fulfilled, respectively. Fifty (54%) articles (15 CC (30%) and 35 (78%) SCCS) adequately addressed the specificities of the case-only analyses in the way they reported results.</p> <h3>Conclusions/Significance</h3><p>Our systematic review underlines that implementation of CC and SCCS designs needs to be more rigorous with regard to validity assumptions, as well as improvement in results reporting.</p> </div

Prescriptions médicamenteuses chez les personnes âgées en EHPAD : une étude transversale multicentrique

Objectif. Évaluer de façon rétrospective la qualité des prescriptions des résidents des établissements d’hébergement pour personnes âgées dépendantes (EHPAD) avant la diffusion d’un livret thérapeutique. Méthodes. L’étude a porté sur les prescriptions de 495 résidents de 8 EHPAD, un jour donné. Un score de conformité de prescription a été calculé par rapport au livret à partir de 6 items. Résultats. Le nombre médian de médicaments par ordonnance était de 8,5. Sur 4 311 médicaments prescrits, le score moyen de conformité de la prescription au livret thérapeutique était de 4,96 ± 0,45, (3,4 ± 1,02 pour la prescription manuscrite et 4,54 ± 0,70 pour la prescription informatisée). Parmi ces 4 311 médicaments, 939 (21,8 %) appartenaient à des classes à risque, et devraient être accompagnés d’une surveillance prescrite ; seuls 154 (16,4 %) étaient associés à une prescription de surveillance. Conclusion. Il existe un défaut dans la surveillance des médicaments appartenant aux classes à risque. L’informatisation de la prescription permet d’améliorer la conformité des prescriptions comme le montre le score de conformité

Characteristics of Exposures and Data Sources of the Studies.

a<p>Two reports used both CC and SCCS.</p>b<p>Administrative database: reimbursement database, hospital or institutional records, primary care database (THIN, GRPD).</p>c<p>Data collected for the study: self-questionnaire, diary, telephone call, web site, interview, individual health booklet.</p>d<p>Pre-existing studies: register, clinical/cohort data.</p

General Characteristics of the Studies Using Case-Crossover and/or Self-Controlled Case Series Designs.

a<p>Two reports used both CC and SCCS.</p>b<p>e.g.: bias due to fixed-confounders.</p>c<p>e.g.: suitable database, no representative control group available, necessity of easy, rapid, simple design.</p

Main Specific Methodological Points to Consider in Planning and Reporting Case-only Studies (to be considered as a complement of the STROBE Statement).

<p>Main Specific Methodological Points to Consider in Planning and Reporting Case-only Studies (to be considered as a complement of the STROBE Statement).</p

Flowchart of selected articles.

<p>Flowchart of selected articles.</p

Statistical Issues.

a<p>One report used both CC and SCCS.</p>b<p>Conditional logistic regression for the CC and conditional Poisson regression for SCCS.</p>c<p>CC: Odds Ratio, Relative risk, Rate Ratio/Incidence Rate Ratio; SCCS: Relative Risk, Relative Incidence, Incidence Rate Ratio.</p

Characteristics of Risk and Control Periods.

<p>Characteristics of Risk and Control Periods.</p

Validity Assumptions for Use of Case-Crossover and Self-Controlled Case Series Designs.

<p>Validity Assumptions for Use of Case-Crossover and Self-Controlled Case Series Designs.</p