A proposed scoring system for assessing the severity of actinic keratosis on the head: actinic keratosis area and severity index

Background: Actinic keratosis (AK) severity is currently evaluated by subjective assessment of patients. Objectives: To develop and perform an initial pilot validation of a new easy-to-use quantitative tool for assessing AK severity on the head. Methods: The actinic keratosis area and severity index (AKASI) for the head was developed based on a review of other severity scoring systems in dermatology, in particular the psoriasis area and severity index (PASI). Initial validation was performed by 13 physicians assessing AK severity in 18 AK patients and two controls using a physician global assessment (PGA) and AKASI. To determine an AKASI score, the head was divided into four regions (scalp, forehead, left/right cheek ear, chin and nose). In each region, the percentage of the area affected by AKs was estimated, and the severities of three clinical signs of AK were assessed: distribution, erythema and thickness. Results: There was a strong correlation between AKASI and PGA scores (Pearson correlation coefficient: 0.86). AKASI was able to discriminate between different PGA categories: mean (SD) AKASI increased from 2.88 (1.18) for ‘light’ to 5.33 (1.48) for ‘moderate’, 8.28 (1.89) for ‘severe’, and 8.73 (3.03) for ‘very severe’ PGA classification. The coefficient of variation for AKASI scores was low and relatively constant across all PGA categories. Conclusions: Actinic keratosis area and severity index is proposed as a new quantitative tool for assessing AK severity on the head. It may be useful in the future evaluation of new AK treatments in clinical studies and the management of AK in daily practice

Ustekinumab: differential use in psoriasis

Chronic plaque psoriasis is a systemic disease affecting over 3% of the population, and many patients are unsatisfied with their current treatment regimen. With advances in understanding of the pathophysiology of psoriasis, new therapeutic options are being developed. The newest of these agents, ustekinumab, offers patients rapid results and the convenience of four annual subcutaneous doses, with efficacy and safety profiles comparable with those of other biologics. However, ustekinumab has been on the market in the US for less than 2 years and will require years of extensive use before the full adverse event profile is fully understood. The purpose of this paper is to summarize the treatment options currently available for psoriasis, with an emphasis on ustekinumab in order to give prescribers an overview of the available data and allow them to make educated and informed prescribing decisions

Resident perceptions of the resident assistant position at Iowa State University

Each semester, each resident assistant is evaluated by tlieir house members, their hall director, and themselves. Feedback from residents is given to resident assistants so that the RAs might utilize the information to improve the quality of their work and to become more aware of the residents' needs and wants. Although this information is received from approximately 30 percent of all residents each semester, the information cannot be used to evaluate the resident assistant position campus-wide because the evaluation forms are not uniform, a condition which makes cross-comparisons difficult. Therefore, this study is needed to assess the views of the residents across campus about the resident assistant position in order that the Department of Residence can provide services which better meet students' desires. This study will not attempt to determine which roles of the resident assistant have the greatest impact on residents. Rather, it will focus on the direct opinions of residents about the relative importance of the current job description components and changes that they feel should be made to the position

Time needed to schedule dermatological consultations in Brazil

BACKGROUND: It is not clear what the population's demand for dermatologists is, nor how many professionals are needed in order to provide adequate care in this area of expertise. Knowledge of the flow of patients at dermatological clinics throughout the country allows for the formation of expansion and distribution policies regarding professionals, and provides backing for the decision to increase medical residency places. OBJECTIVES: To evaluate the time it takes to schedule a private dermatological consultation in Brazil, and other factors concerning consultations. METHODS: Survey with a random sample of 14% of Brazilian dermatologists, simulating the scheduling of emergency clinical and cosmetic consultations, and botulinum toxin procedures. Also, details relating to cost and professionals, were studied. Data were adjusted for each region of the country. RESULTS: A total of 873 dermatologists were evaluated. Full SBD members represented 85%, and 66% were women. The median time to schedule a consultation ranged from 6 (out-of-pocket payment) to 7 (medical insurance) consecutive working days. Times varied depending on the region. A multivariate analysis showed that out-of-pocket consultations and procedures were scheduled sooner than with medical insurance, regardless of whether they were clinical or cosmetic. CONCLUSION: The characteristics of dermatologists are varied throughout regions of the country. Private consultations and procedures are scheduled sooner than with insurance companies

Book review: Seminal educational psychology works for teaching and learning

Dr. Katie Uhlenhake reviews Paul A. Kirschner and Carl Hendrick’s “How Learning Happens” (2020). She offers a glowing review of this compiled resource of the most seminal works from educational psychology as they address teaching and learning in the current pandemic moment

Optimal treatment of actinic keratoses

Elizabeth E UhlenhakeDepartment of Dermatology, Wayne State University School of Medicine, Detroit, MI, USAAbstract: The most compelling reason and primary goal of treating actinic keratoses is to prevent malignant transformation into invasive squamous cell carcinoma, and although there are well established guidelines outlining treatment modalities and regimens for squamous cell carcinoma, the more commonly encountered precancerous actinic lesions have no such standard. Many options are available with variable success and patient compliance rates. Prevention of these lesions is key, with sun protection being a must in treating aging patients with sun damage as it is never too late to begin protecting the skin.Keywords: actinic keratosis, photodynamic therapy, topical chemotherapy, field therapyA Letter to the Editor has been received and published for this article

Staying healthy to be indispensable for the long-term

Bovine veterinarians must perform very physically challenging tasks, and often disregard simple injury prevention techniques due to such things as a lack of knowledge, prioritizing the animals over themselves, and/ or not taking the time to consider options. Applying basic principles of body mechanics while performing essential duties could assist with decreasing stress on their bodies and prevent or at least delay the onset of pain or other symptoms. Additional knowledge regarding topics such as good posture, sleep positioning, and basic orthopedic care, including stretching, could improve the health of the veterinarian, allowing them to continue providing veterinary care while also being able to participate with activities outside of work as desired. A physical therapist spent significant time with a group of bovine veterinarians providing individual examinations and observing job tasks in a wide range of environments. To be indispensable for the long-term, bovine veterinarians must become more aware of HUMAN injury prevention and treatment options for themselves.</jats:p