Maternal and neonatal outcomes of births to women with psoriasis: a population-based cohort of 13 million births.

PURPOSE: Psoriasis is a common auto-immune disease affecting the skin and joints for which the current literature remains limited and contradictory in the context of pregnancy. The purpose of our study was to evaluate the association between psoriasis in pregnancy and maternal and newborn outcomes. METHODS: A population based retrospective cohort study was conducted using the 1999-2015 United States' Healthcare Cost and Utilization Project Nationwide Inpatient Sample. ICD-9 codes were used to identify delivery admissions to women with or without psoriasis, as well as maternal and fetal outcomes. Adjusting for baseline characteristics, multivariate logistic regression models were performed to estimate the effects of psoriasis on maternal and newborn outcomes. RESULTS: The cohort consisted of 3737 women with psoriasis, among a total of 13,792,544 pregnancy admissions in US hospitals between the years 1999 and 2015, for a period prevalence of 27.1 cases per 100,000 pregnant women. Psoriasis was associated with preeclampsia, OR 1.4 (95% CI 1.2-1.6), gestational diabetes, 1.27 (1.13-1.42), myocardial infarction, 13.4 (3.3-54.6), chorioamnionitis, 1.3 (1.0-1.6), delivery by cesarean section, 1.2 (1.1-1.3), anemia, 1.74 (1.18-2.57), and requiring blood transfusions, 1.4 (1.0-1.8). Their newborns were at higher risk of being born preterm, 1.2 (1.1-1.4), congenital anomalies, 1.7 (1.2-2.4), and intra-uterine growth restriction, 1.5 (1.2-1.7). CONCLUSION: Women with psoriasis and their newborns appear more prone to adverse outcomes of pregnancy. It would be prudent for these women to be followed closely during pregnancy by their obstetrical caregiver and dermatologist. Further investigation is warranted regarding the management of psoriasis during pregnancy.

Mandate to evaluate robotic surgery implementation: a 12-year retrospective analysis of impact and future implications.

The introduction of robotic surgery in hospitals has raised much debate given the various effects on care, costs, education and medical advancement. Purchasing discussions are often approached with more questions than answers and there is a need for reports that provide a case for whether or not such technologies are advantageous from multiple perspectives, and offer insights into ways such devices can be introduced into a hospital setting. This report provides an evidence-based review of a university-affiliated tertiary care hospital's 12-year experience with robotic surgery in gynecologic oncology and delves into the various takeaways and challenges of implementing robotic surgery. Key findings were that robotic surgery significantly reduced complication rates, lengths of hospital stays for patients and overall hospital costs. Key obstacles were large upfront costs and the need for significant leadership and collaboration. Ongoing challenges to evaluating robotics include assessing long-term survival data, making comparisons with concurrently changing hospital conditions and determining how data can be generalized to other departments and institutions.

Vulvar swelling and the timely diagnosis of Crohn's disease: A case report.

Children with vulvar swelling often present to multiple physicians and face a prolonged period of ambiguity and extraneous treatments. Here, we report a case of an 8-year-old girl who presented to the dermatology clinic with a 2-month history of vulvar swelling and was ultimately diagnosed with Crohn's disease. Although extra-intestinal manifestations are common in inflammatory bowel diseases, they rarely present before an existing diagnosis. This report highlights this potential early manifestation and demonstrates how timely diagnosis leads to improved outcomes for patients, their families, and healthcare systems.

Artificial Intelligence Applications in Dermatology: Where Do We Stand?

Artificial intelligence (AI) has become a progressively prevalent Research Topic in medicine and is increasingly being applied to dermatology. There is a need to understand this technology's progress to help guide and shape the future for medical care providers and recipients. We reviewed the literature to evaluate the types of publications on the subject, the specific dermatological topics addressed by AI, and the most challenging barriers to its implementation. A substantial number of original articles and commentaries have been published to date and only few detailed reviews exist. Most AI applications focus on differentiating between benign and malignant skin lesions, however; others exist pertaining to ulcers, inflammatory skin diseases, allergen exposure, dermatopathology, and gene expression profiling. Applications commonly analyze and classify images, however, other tools such as risk assessment calculators are becoming increasingly available. Although many applications are technologically feasible, important implementation barriers have been identified including systematic biases, difficulty of standardization, interpretability, and acceptance by physicians and patients alike. This review provides insight into future research needs and possibilities. There is a strong need for clinical investigation in dermatology providing evidence of success overcoming the identified barriers. With these research goals in mind, an appropriate role for AI in dermatology may be achieved in not so distant future.

Optimizing smartphone intervention features to improve chronic disease management: A rapid review.

While there are an increasing number of mobile health applications to facilitate self-management in patients with chronic disease, little is known about which application features are responsible for impact. The objective was to uncover application features associated with increased usability or improved patient outcomes. A rapid review was conducted in MEDLINE for recent studies on smartphone applications. Eligible studies examined applications for adult chronic disease populations, with self-management content, and assessed specific features. The features studied and their impacts on usability and patient outcomes were extracted. From 3661 records, 19 studies were eligible. Numerous application features related to interface (e.g. reduced number of screens, limited manual data entry) and content (e.g. simplicity, self-tracking features) were linked to improved usability. Only three studies examined patient outcomes. Specific features were shown to have a higher impact. Implementing them can improve chronic disease management and reduce app development efforts.