ABSTRACT
BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.
Subject(s)
Dermatology , Humans , Spain , Cross-Sectional StudiesABSTRACT
BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.
Subject(s)
Dermatology , Humans , Spain , Cross-Sectional StudiesSubject(s)
Anti-Infective Agents, Local , Dermatitis, Allergic Contact , Child , Humans , Chlorhexidine , Patch Tests , AllergensABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Organ Transplantation/adverse effects , Immunocompetence , Melanoma/immunology , Skin Neoplasms/immunology , Retrospective Studies , Immunosuppressive Agents/adverse effects , Time Factors , Long Term Adverse EffectsABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Adalimumab/adverse effects , Mycobacterium marinum/isolation & purification , Mycobacterium Infections, Nontuberculous/microbiology , Skin Diseases, Bacterial/immunology , Mycobacterium Infections, Nontuberculous/immunology , Skin Diseases, Bacterial/microbiology , Arthritis, Rheumatoid/drug therapy , Adalimumab/therapeutic useABSTRACT
No disponible
Subject(s)
Humans , Child , Phototherapy , Skin Diseases/diagnosis , Skin Diseases/therapySubject(s)
Bowen's Disease/drug therapy , Human papillomavirus 16/drug effects , Photochemotherapy/methods , Skin Neoplasms/drug therapy , Bowen's Disease/complications , Bowen's Disease/radiotherapy , Bowen's Disease/virology , Female , Follow-Up Studies , Human papillomavirus 16/genetics , Humans , Lasers, Gas/therapeutic use , Male , Retrospective Studies , Skin Neoplasms/radiotherapy , Skin Neoplasms/virology , Treatment OutcomeABSTRACT
La escombroidosis es una causa frecuente de intoxicación alimentaria a nivel mundial que se debe a la ingesta de pescado azul contaminado con bacterias que inducen la formación de grandes cantidades de histamina. Clínicamente se manifiesta sobre todo a nivel cutáneo, en forma de flushing descendente y/o rash eritemato-urticariforme facial y en el tronco superior. Aunque habitualmente tiene un curso autolimitado y benigno, pueden existir casos de compromiso vascular, broncoespasmo y arritmias. Es importante hacer un correcto diagnóstico diferencial, entre otros con la alergia al pescado. El tratamiento se basa en la administración de antihistamínicos orales. Lo más importante es su prevención mediante una correcta refrigeración del pescado. Este trabajo es una revisión práctica de la escombroidosis orientada para su uso por el dermatólogo
Scombroid poisoning is a common cause of food poisoning worldwide. It is caused by ingestion of oily fish contaminated with bacteria that trigger the formation of high concentrations of histamine. Scombroid poisoning manifests mainly as a skin complaint (flushing that spreads downward and/or an erythematous urticarial rash affecting the face and upper trunk). Although the clinical course is usually self-limiting and benign, vascular compromise, bronchospasm, and arrhythmias have been described. It is important to establish a differential diagnosis that includes conditions such as fish allergy. Oral antihistamines are the mainstay of treatment. Scombroid poisoning is best prevented by refrigerating fish properly. The practical review of scombroid poisoning provided here is intended for dermatologists
Subject(s)
Humans , Male , Female , Food Hypersensitivity , Food Hypersensitivity/diagnosis , Food Hypersensitivity/drug therapy , Foodborne Diseases/complications , Foodborne Diseases/diagnosis , Foodborne Diseases/drug therapy , Histamine Antagonists/therapeutic use , Histamine/toxicity , Exanthema/complications , Exanthema/drug therapy , Exanthema/epidemiology , Diagnosis, Differential , PrognosisABSTRACT
Scombroid poisoning is a common cause of food poisoning worldwide. It is caused by ingestion of oily fish contaminated with bacteria that trigger the formation of high concentrations of histamine. Scombroid poisoning manifests mainly as a skin complaint (flushing that spreads downward and/or an erythematous urticarial rash affecting the face and upper trunk). Although the clinical course is usually self-limiting and benign, vascular compromise, bronchospasm, and arrhythmias have been described. It is important to establish a differential diagnosis that includes conditions such as fish allergy. Oral antihistamines are the mainstay of treatment. Scombroid poisoning is best prevented by refrigerating fish properly. The practical review of scombroid poisoning provided here is intended for dermatologists.
Subject(s)
Fishes/microbiology , Food Microbiology , Foodborne Diseases/etiology , Algorithms , Animals , Foodborne Diseases/diagnosis , Foodborne Diseases/drug therapy , Foodborne Diseases/metabolism , Histamine/biosynthesis , Histamine Antagonists/therapeutic use , HumansABSTRACT
No disponible
Subject(s)
Female , Humans , Mycosis Fungoides/complications , Mycosis Fungoides/diagnosis , Mycosis Fungoides/therapy , Brain DiseasesSubject(s)
Brain/pathology , Memory Disorders/etiology , Mycosis Fungoides/complications , Nystagmus, Pathologic/etiology , Skin Neoplasms/complications , Adrenal Cortex Hormones/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bexarotene , Carmustine/administration & dosage , Combined Modality Therapy , Cytarabine/administration & dosage , Disease Progression , Fatal Outcome , Female , Humans , Lymphoma, Large-Cell, Anaplastic/complications , Methotrexate/administration & dosage , Middle Aged , Mycosis Fungoides/drug therapy , Mycosis Fungoides/pathology , Mycosis Fungoides/radiotherapy , PUVA Therapy , Skin Neoplasms/drug therapy , Skin Neoplasms/radiotherapy , Tetrahydronaphthalenes/therapeutic useABSTRACT
El estudio del ganglio centinela (GC) en el tratamiento del melanoma requiere una estrecha colaboración entre el cirujano plástico, el dermatólogo, el especialista en Medicina Nuclear y el patólogo. Presentamos un estudio retrospectivo sobre un grupo de 123 pacientes con melanoma primario cutáneo en los que se realizó técnica de biopsia selectiva del gangliocentinela (BSGC) entre diciembre de 1999 y diciembre del 2005 en el Hospital Universitario Cruces en Barakaldo (Bizkaia, España) y describimos la evolución a largo plazo y la relación entre los resultados de la BSGC y los eventos clínicos relevantes durante el seguimiento. Fueron extirpados 294 ganglios centinela; en 15 pacientes el patólogo informó de la presencia de micrometástasis en el GC, desarrollando posteriormente metástasis a distancia el 46,6% de esos pacientes frente a un 19% en aquellos con GC negativo (p=0,021). De los 123 pacientes estudiados, 14 fallecieron por melanoma (11´4%):3 en el primer año de seguimiento, 2 en el segundo, 3 en el tercero, 2 en el cuarto y 2 en el quinto año. Nuestra experiencia confirma que la BSGC es una técnica sencilla y útil para el estadiaje del melanoma por mostrar una tendencia hacia la asociación estadística entre la positividad del GC y un peor pronóstico (AU)
The study of sentinel node (SN) in the management of melanoma requires close collaboration among plastic surgeon, dermatologist, specialist in Nuclear Medicine and pathologist. The authors present a retrospective study in a group of123 patients with primary cutaneous melanoma who consented to sentinel node biopsy (SLNB) between December1999 and December 2005 at the University Hospital Cruces (Barakaldo, Bizkaia, Spain). We describe the long-term evolution and the relation between SLNB results and relevant clinical events during follow-up. We removed 294 sentinel nodes; 15 patients had tumour in the centinela node, subsequently developed distant metastasis in 46.6%, compared with 19% in patients with negative SN (p=0.021). Of the 123 patients studied,14 died of melanoma (11´4%): 3 in the first year of follow up, 2 in the second, 3 in the third, 2 in the fourth and2 in fifth year. We corroborate that the SLNB is an easy technique and useful for staging, showing the statistic relationship between positive SN and bad prognostic (AU)
