Impact of medical scribes on physician and patient satisfaction in dermatology.

Physician burnout and its association with the use of electronic health records (EHRs) is well known. The impact of scribes for academic dermatologists and their patients needs to be explored. As physician burnout increases, system-based solutions are needed. To assess the impact of a scribe on physician and patient satisfaction at an academic dermatology clinic. Prospective, pre-post-pilot intervention study. During the pilot intervention, clinicians had clinic sessions with and without a scribe. We assessed changes in (1) clinician satisfaction and burnout, (2) time spent on EHR, and (3) patient satisfaction. An electronic 7-item baseline survey, 23-item mid-study survey, and a 22-item end-of-study survey to assess clinician burnout and feedback on satisfaction with medical scribes. A 19-item post visit satisfaction survey was given to patients. EHR was queried to compare amount of time spent on EHR, closure of charts, and number of patients seen during scribe coverage and at baseline. Of the six clinicians, 100% felt that there was value to scribe support. Physician burnout was low at baseline and did not change post-pilot. Active documentation time, on average, decreased by 67% per patient with a 28% increase in patients seen per clinic. Over 88% of patients disagreed with the statement, "I was uncomfortable disclosing personal information when a scribe was present" (p < 0.001). In an academic dermatology and Mohs surgery setting, medical scribes increased clinician satisfaction without compromising patient satisfaction.

Palliative effect of capecitabine and cetuximab for refractory metastatic squamous cell carcinoma of the perineum in epidermodysplasia verruciformis.

A teenage girl presented with multiple warty skin lesions and had a diagnosis of epidermodysplasia verruciformis made several years later. Later in life she presented with an extensive SCC in situ in her gluteal crease that was surgically resected with wide margins. Despite this treatment, the lesion recurred with extension onto her lower back. Biopsies at the time confirmed SCC in situ of the perianal tissue and invasive SCC above her gluteal cleft.

Bed bugs.

The term bed bug is applied to 2 species of genus Cimex: lectularius describes the common or temperate bed bug, and hemipterus its tropical cousin. Cimex lectularius is aptly named; its genus and species derive from the Latin words for bug and bed, respectively. Though the tiny pest is receiving increased public attention and scrutiny, the bed bug is hardly a new problem.

A survey of dermatology resident education in cosmetic procedures.

BACKGROUND: The demands for cosmetic procedures are increasing. Dermatologists perform many of these procedures, therefore adequate education and training during residency is important. Surveys demonstrate dermatology residents desire more training even while faculty members believe this has already become a more prominent feature of resident education. OBJECTIVE: We sought to assess the time and methods dedicated to education and training of cosmetic procedures in dermatology residency. METHODS: A 26-question survey was developed and electronically distributed in May 2010 to dermatology program directors via the Association of Professors of Dermatology list-serve with their approval. Program directors were asked to forward the e-mail to their instructors of cosmetic/procedural dermatology, and chief residents. Responses were anonymous. RESULTS: A total of 86 responses were collected. In all, 67% (n = 54) of respondents had formal lectures focusing on cosmetic dermatology. Lecture topics reported by more than 50% of respondents included botulinum toxin injection, lasers, soft tissue augmentation, chemical peels, and sclerotherapy. Topics such as dermabrasion, liposuction, and scar revision were less commonly taught. The most commonly encountered and performed procedures were botulinum toxin injection and lasers (100%, n = 86); 98.8% (n = 85) encounter soft tissue augmentation and 95.4% (n = 82) encounter both chemical peels and sclerotherapy. Resident experience performing procedures as the first assistant or as the first surgeon varied widely. LIMITATIONS: The limitations of this study are that the data were subjectively reported so results may differ from the true amount of time spent in any activity. The data may be biased by the population that responded as they may have strong opinions supporting or opposing training in cosmetic procedures. The data also may have been skewed by the small percentage of participants who were instructors of cosmetic dermatology (21%), chief residents (20%), and others respondents (8% total). CONCLUSION: The results demonstrate the variability of training in cosmetic procedures. The challenge for programs is to find the balance between insufficiency and overemphasis. The results of this study will hopefully assist programs in determining the quantity and methods of resident training in cosmetic procedures.

Irritant contact dermatitis to the brown marmorated stink bug, Halyomorpha halys.

The brown marmorated stink bug, Halyomorpha halys, is native to Asia (China, Taiwan, Japan, and the Korean peninsula). It was first found in Allentown, Pa, in 1996 and has since spread across wide areas of the Eastern United States. As of October 2010, at least 26 states have reported the presence of the brown marmorated stink bug. It is considered an invasive species, and to the best of scientific knowledge, it was accidently introduced into the United States through transportation of goods from Asia. To date, no reports of human disease have been published in the literature. Fruit crop workers have complained of a slight allergic reaction to the chemicals released by the bug.

Ileocecal adenocarcinoma and ureteral transitional cell carcinoma with multiple sebaceous tumors and keratoacanthomas in a case of muir-torre syndrome.

Cutaneous neoplasms including sebaceous tumors, keratoacanthomas, and basal cell carcinomas with sebaceous differentiation can be markers of internal malignancy associated with the Muir-Torre Syndrome (MTS). We report a 56-year-old man with a diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC) and ureteral transitional cell carcinoma who subsequently developed two sebaceous gland neoplasms and several keratoacanthomas, leading to the diagnosis of MTS. Our case highlights the clinical advantages of immunohistochemistry (IHC) in identifying mutations in the mismatch repair (MMR) genes responsible for both HNPCC and MTS. The importance of continued clinical suspicion in the dermatological assessment of patients with sebaceous neoplasms is emphasized.

Treatment of hidradenitis suppurativa with etanercept injection.

OBJECTIVES: To observe the effects of etanercept treatment on the cutaneous manifestations of hidradenitis suppurative (HS) and to evaluate physician and patient global assessment scores of cutaneous manifestations. DESIGN: Single-center, randomized, prospective, double-blind, placebo-controlled study. SETTING: Academic dermatology practice. PATIENTS: Twenty patients with active moderate to severe HS who fulfilled all inclusion criteria. INTERVENTION: Etanercept, 50 mg, or placebo was administered subcutaneously (SC) twice weekly for 12 weeks. After 12 weeks, all patients received open-label etanercept, 50 mg, SC twice weekly for 12 more weeks. MAIN OUTCOME MEASURES: Primary end point: physician global assessment of HS as clear or mild at week 12. Secondary end points: patient global assessment and Dermatology Life Quality Index (DLQI). RESULTS: There was no statistically significant difference among physician global assessment, patient global assessment, and DLQI at 12 or 24 weeks between treatment and placebo groups (P > .05 for all comparisons). CONCLUSIONS: Etanercept, 50 mg, SC administered twice weekly did not have significant efficacy in the improvement of HS. In light of our negative results, as well as those of previous studies, we suggest that future studies focus on other agents for the treatment of HS. Trial Registration clinicaltrials.gov Identifier: NCT00949546.

Spa contact dermatitis.

Potassium monopersulfate (MPS) is widely used in spa and pool "shock" treatments, yet contact dermatitis associated with MPS has been rarely reported. A patient presented with a generalized scattered dermatitis from the neck down that worsened after spa use. Patch testing elicited a ++ reaction to ammonium persulfate. Contact with ammonium persulfate was ruled out; however, MPS, which can cross-react with ammonium persulfate, was found to be the active ingredient in the patient's spa shock treatments. The dermatitis cleared after the patient switched to a hydrogen peroxide-based shock treatment.

Prevention of nickel release with barrier coatings.

BACKGROUND: Allergic contact dermatitis from nickel is very common in the United States. A barrier coating to be used on personal items such as snaps or watches would be of great use in preventing the consequences of nickel allergy. OBJECTIVE: To evaluate various barrier coatings and their ability to yield a negative dimethylglyoxime (DMG) test result. METHODS: Four different barrier coatings were assessed prior to soaking in saline, after soaking in saline for 2 days, and after soaking in saline for 7 days. RESULTS: Depending on the number of coatings and the time soaked in saline, the different barriers showed different efficacies in yielding a negative DMG test result. CONCLUSIONS: Nickel Guard and Beauty Secrets Hardener were most effective in yielding a negative DMG test result. Beauty Secrets Hardener was the more cost-effective choice.

The Hershey access clinic: a model for improving patient access.

BACKGROUND: When waiting times for new and return patient visits at Hershey Medical Center's Department of Dermatology approached 4 and 2 months, respectively, the Hershey access clinic was implemented to increase access for patients with acute problems. OBJECTIVE: The purpose of this study was to assess the impact of the Hershey access clinic on patient care. RESULTS: The great majority of patients were satisfied with the access clinic. However, there has been no effect on the no-show rates or patient waiting times for routine appointments. Fifty-seven percent of patients had eruptions, most commonly acne/rosacea, and 43% had neoplasms, most commonly warts. LIMITATIONS: This study was limited by the fact that it was a survey filled out by the patients after their encounter. CONCLUSION: The Hershey access clinic successfully provides acute problem-focused care, and patient satisfaction is high.

Patch-test reactions to formaldehydes, bioban, and other formaldehyde releasers.

BACKGROUND: Contact allergy to formaldehyde, Bioban, and other formaldehyde releasers and cross-reactivity between them have been reported in the literature; however, not many studies have data on this cross-reactivity. OBJECTIVE: To study (1) the rates of allergy to formaldehyde and to Bioban and other formaldehyde releasers and (2) the rates of cross-reactivity between them. METHODS: We present a retrospective chart analysis of patch-test results for all patients referred for allergic contact dermatitis testing at the Milton S. Hershey Medical Center from June 2004 to September 2005. Anyone allergic to formaldehyde, Bioban, or other formaldehyde releasers was included. Cross-reactivity between the agents was then analyzed. RESULTS: The charts of 210 patients were analyzed. Of these patients, 24 (11%) were allergic to formaldehyde, Bioban, or other formaldehyde-releasing agents. Seventeen (8.1%) of the patients were allergic to formaldehyde, 15 (7.1%) were allergic to Bioban, and 20 (9.5%) were allergic to other formaldehyde-releasing agents. Eleven (65%) of the 17 formaldehyde-allergic patients were also allergic to Bioban. Of the 20 patients allergic to formaldehyde-releasing agents, 14 (70%) were also allergic to one of the three Bioban products tested. Of the 15 patients allergic to Bioban, 11 (73%) were allergic to formaldehyde, 14 (93%) were allergic to formaldehyde-releasing agents, and 11 (73%) were allergic to both formaldehyde and formaldehyde-releasing agents. CONCLUSION: A high cross-reactivity rate between formaldehyde, Bioban, and other formaldehyde-releasing agents was found.