Educational conferences in dermatology residency programs.

To characterize conferences in dermatology residency programs, we surveyed directors and chief residents. Most respondents thought their amount of conference time was just right (7-8 hours/wk); they also identified grand rounds, dermatopathology, and clinical images as best implemented, whereas journal club and basic science needed most improvement. By contrast, respondents diverged regarding conferences they wanted to establish; directors identified research and basic science, whereas chief residents listed pediatrics and surgery.

Advances in the management of psoriasis: monoclonal antibody therapies.

Psoriasis is a common skin disorder characterized by erythematous, scaling plaques. Until recently, therapies for this disease have been aimed at reducing keratinocyte proliferation. We have learned that psoriasis is not primarily a disorder of keratinocyte hyperproliferation, but is an inflammatory disease. This knowledge, especially our current understanding of the role of activated T cells in psoriasis, has led to new therapeutic options and new areas of research. Immunosuppressive agents such as cyclosporine have proven very useful in the treatment of psoriasis, but their use is limited by toxicity. Monoclonal antibodies directed against key components of the inflammatory process have been studied in an attempt to produce safer, more selective immunosuppressive agents. This review summarizes much of the available literature describing the use of monoclonal antibodies in the treatment of psoriasis.

Removal of keratinous and pilar cysts with the punch incision technique: analysis of surgical outcomes.

BACKGROUND: The removal of keratinous and pilar cysts by the punch incision technique is an alternative to traditional excision methods. It is easy to perform with commonly available instruments, and quick. Faster healing and less scarring are advantages because of the small opening through which the cysts are removed. No previous studies have documented recurrence rates of cysts removed by this technique or the recurrence rates following either traditional excision surgery or other alternative minimal excision techniques. We provide data demonstrating that the removal of keratinous and pilar cysts by the punch incision technique is a viable option with an acceptably low recurrence rate. OBJECTIVE: To evaluate the overall recurrence rates of keratinous and pilar cysts removed by the punch incision technique and rates of recurrence by location and using other cyst characteristics. METHODS: A preliminary retrospective chart review of cysts removed exclusively by the punch incision technique from 1989 to 1998 was performed. The rate of cyst recurrence and average time to patient-initiated follow-up visit for evaluation and removal were determined. In a second study, a survey requested information on the presence of cyst recurrence. This was mailed to all 646 patients who had cysts removed by the punch incision technique from 1989 to 1998 to evaluate possible cyst recurrence in patients who did not choose to follow-up at the office. Statistical analysis was performed to determine the overall recurrence rates and recurrence rates based on location and other cyst characteristics. RESULTS: Preliminary chart review revealed a recurrence rate of 3.6%, with a mean time to patient-initiated follow-up of 79.3 weeks. In the second study, an analysis of cyst recurrence rates in patients returning the survey revealed an 8.3% recurrence rate. Subanalysis revealed a trend showing that inflamed cysts had a lower recurrence rate. Another trend noted was that cysts removed from the back and ear had the highest recurrence rates (13.8 and 13.0%, respectively) compared to those removed from other locations. Most cysts (54.5%) recurred within the first year after punch incision removal. CONCLUSION: This is the first study to document recurrence rates using the punch incision technique for removal of epithelial cysts. Though most recurrences occur within the first year, there is a delay in patients reporting to their doctors for reexcision, perhaps because recurrent cysts are often asymptomatic. Studies to determine the recurrence rates for cyst excision using other techniques should be performed. The punch incision technique, when properly performed, is a satisfactory removal method with a recurrence rate of less then 10%.

Use of the alexandrite laser for treatment of seborrheic keratoses.

BACKGROUND: Seborrheic karatoses are benign lesions that are easily irritated and often cosmetically objectionable. Liquid nitrogen cryotherapy and other surgical methods are useful in treating these lesions, but are difficult to tolerate in patients who have large numbers of lesions requiring treatment. The alexandrite laser was used in one patient to quickly and efficiently destroy hundreds of seborrheic keratoses. The treatment was tolerable and excellent cosmetic results were achieved.

Capitation payment, length of visit, and preventive services: evidence from a national sample of outpatient physicians.

OBJECTIVE: To test the hypothesis that capitation payment to physicians reduces the length of physician-patient encounters but increases use of preventive and health counseling services. STUDY DESIGN: Cross-sectional analysis of data from the National Ambulatory Medical Care Survey of outpatient physicians and their office staff (1997 and 1998). PATIENTS AND METHODS: A random national sample of 46,320 ambulatory care visits was used. Weight-adjusted multivariate regression techniques were utilized to examine the effects of capitation on duration of physician visit and number of preventive and health counseling services. RESULTS: Physicians spent 5.6% less time (P < .01) with patients in capitated plans than with those in noncapitated plans. The effect of payment method on length of visit was 3.5 times stronger among physicians receiving only capitated payment, compared with physicians receiving only noncapitated payment. Patients in capitated plans were 17% more likely to receive health counseling services (P < .01) than patients in noncapitated plans. Patients under capitation were 3% more likely to receive preventive services compared to patients in non-health maintenance organizations, noncapitated plans (P < .05). CONCLUSIONS: Capitation is associated with a modest decrease in the amount of time physicians spend with their patients and with increased receipt of preventive and health counseling services, on average. These trends are driven by physicians who receive capitated payment predominantly. Physicians with a mix of patients from capitated and noncapitated plans spend approximately equal time with each type of patient, which reflects an ethic of impartiality in medical judgment.