Effects of an optional clinical skills laboratory on surgical performance of third-year veterinary students.

OBJECTIVE: To determine whether addition of an optional clinical skills laboratory (OCSL) to the traditional surgery curriculum would affect total surgery time or incision closure time in veterinary students performing ovariohysterectomy of a dog during a third-year surgery course. DESIGN: Retrospective and prospective study of veterinary student attendance at OCSL sessions and student performance during the third-year surgery course. SAMPLE: Students from the classes of 2012, 2013, and 2014 at the Washington State University College of Veterinary Medicine. PROCEDURES: For all students, total surgery time and incision closure time were recorded when students performed an ovariohysterectomy of a dog during their third-year live-animal surgery course. Times were analyzed to identify differences among classes and determine whether times were associated with number of OCSL sessions attended, previous experience performing ovariohysterectomies, or enrollment in an elective clinical skills course. RESULTS: Total surgery and incision closure times were not significantly different between students in the class of 2012 (no access to the OCSL prior to the third-year surgery course) and students in the class of 2013 (ie, access to 4 OCSL sessions during the spring semester prior to the third-year surgery course). However, times were significantly shorter for students in the class of 2014 (ie, students who had access to OCSL sessions during the 3 semesters prior to the third-year surgery course) than for students in the other 2 classes. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that attendance in the OCSL sessions was associated with improvements in surgical performance, as reflected in faster total surgery and incision closure times while performing an ovariohysterectomy during the third-year surgery course.

Incidence estimate of nonmelanoma skin cancer in the United States, 2006.

OBJECTIVES: To estimate the incidence of nonmelanoma skin cancer (NMSC) in the US population in 2006 and secondarily to indicate trends in numbers of procedures for skin cancer treatment. DESIGN: A descriptive analysis of population-based claims and US Census Bureau data combined with a population-based cross-sectional survey using multiple US government data sets, including the Centers for Medicare and Medicaid Services Fee-for-Service Physicians Claims databases, to calculate totals of skin cancer procedures performed for Medicare beneficiaries in 1992 and from 1996 to 2006 and related parameters. The National Ambulatory Medical Care Service database was used to estimate NMSC-related office visits. We combined these to estimate totals of new skin cancer diagnoses and affected individuals in the overall US population. RESULTS: The total number of procedures for skin cancer in the Medicare fee-for-service population increased by 76.9% from 1 158 298 in 1992 to 2 048 517 in 2006. The age-adjusted procedure rate per year per 100 000 beneficiaries increased from 3514 in 1992 to 6075 in 2006. From 2002 to 2006 (the years for which the databases allow procedure linkage to patient demographics and diagnoses), the number of procedures for NMSC in the Medicare population increased by 16.0%. In this period, the number of procedures per affected patient increased by 1.5%, and the number of persons with at least 1 procedure increased by 14.3%. We estimate the total number of NMSCs in the US population in 2006 at 3 507 693 and the total number of persons in the United States treated for NMSC at 2 152 500. CONCLUSIONS: The number of skin cancers in Medicare beneficiaries increased dramatically over the years 1992 to 2006, due mainly to an increase in the number of affected individuals. Using nationally representative databases, we provide evidence of much higher overall totals of skin cancer diagnoses and patients in the US population than previous estimates. These data give the most complete evaluation to date of the underrecognized epidemic of skin cancer in the United States.

Generalized granuloma annulare as an initial manifestation of chronic myelomonocytic leukemia: a report of 2 cases.

Granuloma annulare is a dermatologic condition of unknown etiology that has been associated with systemic diseases and reported to be a paraneoplastic manifestation. Two patients with generalized granuloma annulare as an initial manifestation of chronic myelomonocytic leukemia are herein described. We suggest that chronic myelomonocytic leukemia should be added to the list of systemic diseases associated with generalized granuloma annulare.

Transcending the language barrier--creation of a multilingual dermatology website.

In a linguistically diverse society, healthcare professionals must overcome the daunting task of effectively communicating with patients who speak a different language. In effort to aid healthcare professionals and their patients, an on-line dermatology patient education resource was created with links to various skin related topics in over 30 languages. The development of the on-line resource, key features of the information available on the website, and limitations experienced during its creation are discussed in the article.

Common skin disorders seen in the migrant farmworker health care clinic setting.

BACKGROUND: Skin diseases are common occupational illnesses for farmworkers. Migrant farmworkers commonly access rural health clinics for diagnosis and treatment of skin disease. PURPOSE: To assess common skin conditions of migrant farmworkers treated in rural clinics and to describe effective and economic management of these conditions. METHODS: Seventy-nine farmworkers with a skin condition were seen as patients at 4 clinics in eastern North Carolina. A list of the most common conditions encountered was compiled and treatment methods were found in the literature. RESULTS: Twenty-three common conditions were identified. The most common conditions were contact dermatitis, melasma, tinea, seborrheic keratoses, and impetigo. A table of treatment recommendations was composed that can be used by clinicians in this setting. CONCLUSIONS: Generally, the most common skin conditions seen in the migrant farmworker population in eastern North Carolina are similar to conditions found in the general population.

Impact of obesity and smoking on psoriasis presentation and management.

OBJECTIVE: To study the impact of obesity and smoking on psoriasis. DESIGN: Cross-sectional study. SETTING: University of Utah Department of Dermatology clinics. PATIENTS: A case series of patients with psoriasis enrolled in the prospective Utah Psoriasis Initiative (UPI) (which carefully performs phenotyping of patients with psoriasis) was compared with 3 population databases: the Behavioral Risk Factor Surveillance System of the Utah population, the 1998 patient-member survey from the National Psoriasis Foundation, and 500 adult patients who attend our clinics and do not have psoriasis (non-psoriatic population). RESULTS: The prevalence of obesity in patients within the UPI population was higher than that in the general Utah population (34% vs 18%; P<.001) and higher than that in the non-psoriatic population attending our clinics. Assessment of body image perception with a standardized diagram in the UPI group resulted in the median body image score of normal weight at 18 years of age and the onset of psoriasis, but it changed to overweight at the time of enrollment in the UPI. Thus, obesity appears to be the consequence of psoriasis and not a risk factor for onset of disease. We did not observe an increased risk for psoriatic arthritis in patients with obesity; furthermore, obesity did not positively or negatively affect the response or the adverse effects of topical corticosteroids, light-based treatments, and systemic medications. The prevalence of smoking in the UPI population was higher than in the general Utah population (37% vs 13%; P<.001) and higher than in the non-psoriatic population (37% vs 25%; P<.001). We found a higher prevalence of smokers in the obese population within the UPI than in the obese population within the Utah population (25% vs 9%; P<.001). CONCLUSIONS: Patients with psoriasis attending the University of Utah Dermatology Clinics were more likely to be obese and to smoke compared with non-psoriatic patients and more likely to be obese compared with other large cohorts with psoriasis. Smoking appears to have a role in the onset of psoriasis, but obesity does not. The high prevalence of obesity and smoking in a psoriasis cohort has not been previously noted; if confirmed, it supports the prediction that a significant portion of patients with psoriasis will have the comorbid conditions and public health issues of those with obesity and smoke.

The effect of lens edge design versus anterior capsule overlap on posterior capsule opacification.

PURPOSE: To determine whether lens edge design or anterior capsule overlap on the intraocular lens (IOL) has greater effect on posterior capsule opacification (PCO). DESIGN: Retrospective cohort clinical study. METHODS: Retrospective. SETTING: Academic clinical practice. PATIENT POPULATION: The patient population consisted of 259 uncomplicated surgical patients (259 eyes) with no confounding comorbidity and at least 1 year of follow-up after surgical placement of a silicone or hydrophobic acrylic lens. OBSERVATION PROCEDURES: Digital retroilluminated photographs were taken to ascertain PCO, anterior capsular opacification (ACO), previous neodymium:YAG capsulotomy and degree of anterior capsule overlap on the IOL optic. MAIN OUTCOME MEASURES: PCO, ACO, YAG capsulotomy rate, and anterior capsule overlap on the IOL optic. RESULTS: One hundred forty-eight digital images (74 silicone and 74 acrylic) were measurable for both anterior capsule overlap and PCO. Complete 360 degrees of anterior capsule overlap on the IOL was associated with decreased PCO (P = <.001). A significant negative correlation was found between the degree of anterior capsule overlap and PCO (P = <.001). Evaluation of PCO, and YAG capsulotomy rates were similar between acrylic and silicone lenses. Minimal anterior capsule overlap may also be associated with PCO prevention. CONCLUSIONS: Implanting a lens with complete anterior capsule overlap on the IOL was found to significantly reduce PCO, which advantage appeared to be greater than PCO prevention by a truncated, sharp edge IOL design.

A clinical comparison of single-piece and three-piece truncated hydrophobic acrylic intraocular lenses.

PURPOSE: To determine the clinical differences between three-piece (3P) and single-piece (SP) truncated hydrophobic acrylic intraocular lenses (IOL). DESIGN: Retrospective cohort clinical study. METHODS: The setting was an academic clinical practice. The patient population consisted of subjects without confounding comorbidity that could effect central vision with at least 1-year follow-up after uncomplicated surgical placement of 3P or SP IOLs in the capsular bag and at least 20/25 best-corrected postoperative vision documented. Observation procedures were as follows: logarithm of the minimal angle of resolution (LogMAR) visual acuity (uncorrected and best corrected), digital retroillumination photographs to ascertain posterior capsular opacification (PCO), anterior capsular opacification (ACO), IOL centration, and refractive stability by comparing this refraction with the early postoperative refraction. Patients completed a dysphotopsia questionnaire. Main outcome measures were as follows: LogMAR visual acuity (uncorrected and best corrected), PCO, ACO, IOL centration, refractive stability, and dysphotopsia outcomes comparing 3P and SP. RESULTS: Seventy-five patients were enrolled (36 3P and 39 SP). Corrected and uncorrected visual acuity, refractive stability, and IOL centration were similar. Single piece truncated hydrophobic acrylic intraocular lenses had more PCO (P =.013), less ACO (P =.001), less central flash looking at a peripheral light (P =.044), and less unwanted images to the side of a light source (P =.025) . CONCLUSIONS: Although similar in centration and refractive stability, SP has more PCO, less ACO, and less dysphotopsia than 3P.