Assessing Skin Biopsy Rates for Histologic Findings Indicative of Nonpathological Cutaneous Disease.

BACKGROUND: Recent increase in skin biopsies has been attributed to an epidemic of skin cancer. This may be avoidable, with potential savings. OBJECTIVE: To determine whether the increase in skin biopsies is attributable to increasing frequency of biopsies associated with histology lacking pathological cutaneous disease. Pathological cutaneous disease was defined as (1) a malignancy, precancerous lesion, or lesion of uncertain behavior; or (2) disease symptomatic or associated with adverse quality of life impact. PATIENTS AND METHODS: Retrospective cohort study, 2006 to 2013 of dermatology practice serving Florida and Ohio. Data were a consecutive sample of skin biopsies for diagnosis of dermatologic disease. RESULTS: A total of 267,706 biopsies by an average of 52 providers per month from January 06 to December 13 were analyzed. Number of biopsies per visit increased 2% per year (RR: 1.02, CI: 1.00-1.04). Likelihood of biopsy associated with histology indicative of nonpathological cutaneous disease did not increase over time (OR: 0.99, CI: 0.95-1.03, p = .6302). CONCLUSION: Rates of biopsies associated with nonpathological cutaneous disease is not increasing. Overall biopsy rates per visit have gradually increased; this seems attributable to greater rates of detection of pathological dermatologic disease.

Student Perceptions of College-Readiness, College Services and Supports, and Family Involvement in College: An Exploratory Study.

Although increasing numbers of students with disabilities are attending college, they graduate at lower rates compared to students without disabilities. In order to understand how to effectively prepare students with disabilities and provide meaningful support to college students with disabilities, we investigated the experiences of students registered with the disability service office at a public university located in the eastern region of the U.S. to learn about (a) the degree to which they felt prepared to enter college, (b) the disability-related services they received in college, (c) their perspectives of services received, (d) suggestions for improving services, and (e) their perspectives family involvement in college. We report mixed-methods findings from participants and provide implications for policy and practice.

Does the epidemiologic paradox hold in the presence of risk factors for low birth weight infants among Mexican-born women in Colorado?

OBJECTIVES: To test whether foreign-born status confers a protective effect against low birth weight (LBW) outcomes among Mexican-origin women in Colorado. METHODS: Retrospective cohort study utilizing Colorado birth records from 1989-2004 for multivariate logistic regression analysis. The study population was 66,422 U.S.-born women of Mexican origin (USB) and 85,000 Mexican-born (MB) women with singleton births. RESULTS: Mexican-born women had 24.9% lower odds of LBW (OR 0.751 95% CI 0.782) than USB women. Mexican-born women had a higher prevalence of risk factors for LBW than their USB counterparts (anemia, cardiac disease, hypertension, inadequate prenatal care, less than high school education). After adjusting for these risk factors, MB women had 22.5% lower odds of having LBW infants than USB women (OR 0.775, 95% CI 0.73-0.81). CONCLUSIONS: This study supports the epidemiologic paradox of LBW; despite higher prevalence of risk factors, foreign-born status confers an overall protective effect against low birth weight outcomes.

Benchmarking US Department of Veterans Affairs dermatologic services: results from a national survey.

BACKGROUND: How well Department of Veterans Affairs (VA) dermatology services provide clinical care, medical education, and innovative research is a largely unexplored topic in the literature. OBJECTIVE: We sought to benchmark VA dermatology services by surveying VA dermatologists about their environment, resources, and the pros and cons of working in the VA. METHODS: Printed surveys were mailed to VA dermatologists and responses were compiled and analyzed. RESULTS: Of 105 dermatology services surveyed, 48% returned surveys completed by board-certified dermatologists (n = 50); 20 surveys completed by nondermatologists were excluded from the analysis. Most services trained dermatology residents (72%) and medical students (80%). One third of services reported significant research involvement. Qualitative analysis revealed the academic environment, patient population, and decreased business management responsibilities as the 3 most commonly cited advantages to VA employment. The most commonly listed disadvantages included low salaries, bureaucracy, and lack of resources. LIMITATIONS: The survey data were self-reported and not independently verified. Not all services returned the survey. CONCLUSIONS: Outpatient VA dermatology services accomplish significant primary care and preventive services (eg, sun safety counseling, skin cancer screening, and treatment). However, the small number of dedicated dermatology services, their irregular geographic distribution, and the lack of staffing and resources may adversely affect optimal patient care. Dermatologist responses regarding the positive and negative aspects of working in the VA system may lead to improved management strategies to better retain and recruit dermatologists to provide patient care, medical education, and medical research despite dramatically lower dermatologist salaries within the VA system compared with private practice.

Outpatient Follow-up and Secondary Prevention for Melanoma Patients.

Health care providers and their patients jointly participate in melanoma prevention, surveillance, diagnosis, and treatment. This paper reviews screening and follow-up strategies for patients who have been diagnosed with melanoma, based on current available evidence, and focuses on methods to assess disease recurrence and second primary occurrence. Secondary prevention, including the roles of behavioral modification and chemoprevention are also reviewed. The role of follow-up dermatologist consultation, with focused physical examinations complemented by dermatoscopy, reflectance confocal microscopy, and/or full-body mapping is discussed. Furthermore, we address the inclusion of routine imaging and laboratory assessment as components of follow-up and monitoring of advanced stage melanoma. The role of physicians in addressing the psychosocial stresses associated with a diagnosis of melanoma is reviewed.

US dermatology residents' satisfaction with training and mentoring: survey results from the 2005 and 2006 Las Vegas Dermatology Seminars.

OBJECTIVE: To evaluate residents' satisfaction with dermatology training and mentorship. DESIGN: Written survey. SETTING: The Las Vegas Dermatology Seminar in 2005 and 2006. PARTICIPANTS: Graduating dermatology residents in the United States. MAIN OUTCOME MEASURES: Satisfaction with and importance of 26 training components, overall training satisfaction, satisfaction with availability and quality of mentors, and time spent outside the clinics and classroom with mentors. RESULTS: Of dermatology residents attending the 2005 and 2006 seminars, 57 (50%) and 49 (54%), respectively, completed the survey. In 2006, 38 more surveys were received by mail, for a combined total of 144 respondents. In 2005 and 2006, respectively, 44 (77%) and 66 (76%) residents scored training at or above 7 on a 10-point rating scale. Residents were most satisfied with peer teaching, medical dermatology training, pathology slide sessions, and live patient conferences and least satisfied with business management and dermoscopy training. Discrepancies between perceived importance and satisfaction were greatest for business management, time for independent study, and responsiveness to resident input. Residents spending 30 minutes (the median) or more per month outside of clinics and the classroom with someone they defined as a mentor reported higher training satisfaction (8.0 vs 7.2; P = .02). Resident-perceived program mentor availability (P = .001 in 2005, P=.002 in 2006) and quality (P =.002 in 2005, P < or = .001 in 2006) were also associated with increased overall training satisfaction. CONCLUSIONS: Of 26 training components, residents were most dissatisfied with business management training. Resident training satisfaction was associated with program mentor availability and quality, as well as time spent with mentors.