ABSTRACT
Provider attire has been studied as a potential vector for infectious microorganisms in the medical setting as well as a potential factor in patient satisfaction. Our objective was to determine if a change from formal attire to fitted scrubs had a measurable impact on patient satisfaction scores in an outpatient dermatology setting. We designed a 2-year retrospective cohort study of 22 providers in an outpatient dermatology setting who transitioned from formal attire to fitted scrubs and had at least 12 months of patient satisfaction scores (measured by a third-party patient satisfaction survey) before and after the change in attire. The primary outcome was statistically significant change in patient satisfaction scores before and after the institution of fitted scrubs. A total of 3511 completed surveys were evaluated from the 12 months prior to the change in attire (study period 1), and 4191 completed surveys were evaluated in 12 months after the change (study period 2). No significant change was seen in the overall survey responses. A small but statistically significant improvement was noted for several questions in study period 2, which suggested that a change from formal attire to fitted scrubs did not have a strong impact on patient satisfaction scores. Factors beyond provider attire likely have the greatest impact on patient satisfaction.
Subject(s)
Clothing , Dermatology , Health Personnel , Patient Satisfaction , Ambulatory Care , Cohort Studies , Female , Humans , Male , Professional-Patient Relations , Retrospective Studies , Surveys and QuestionnairesABSTRACT
Leg ulcerations are a common problem, with an estimated prevalence of 1% to 2% in the adult population. Venous leg ulcers are primarily treated in outpatient settings and often are managed by dermatologists. Recent advances in the diagnosis and treatment of leg ulcers combined with available evidence-based data will provide an update on this topic. A systematized approach and the judicious use of expensive advanced therapeutics are critical. Specialized arterial and venous studies are most commonly noninvasive. The ankle brachial pressure index can be performed with a handheld Doppler unit at the bedside by most clinicians. The vascular laboratory results and duplex Doppler findings are used to identify segmental defects and potential operative candidates. Studies of the venous system can also predict a subset of patients who may benefit from surgery. Successful leg ulcer management requires an interdisciplinary team to make the correct diagnosis, assess the vascular supply, and identify other modifiable factors to optimize healing. The aim of this continuing medical education article is to provide an update on the management of venous leg ulcers. Part I is focused on the approach to venous ulcer diagnostic testing.
Subject(s)
Varicose Ulcer/epidemiology , Varicose Ulcer/therapy , Wound Healing/physiology , Age Distribution , Aged , Aged, 80 and over , Biopsy, Needle , Chronic Disease , Combined Modality Therapy/methods , Disease Progression , Evidence-Based Medicine , Female , Humans , Immunohistochemistry , Incidence , Leg Ulcer/diagnosis , Leg Ulcer/epidemiology , Leg Ulcer/therapy , Male , Middle Aged , Plethysmography/methods , Prognosis , Risk Assessment , Severity of Illness Index , Sex Distribution , Treatment Outcome , Ultrasonography, Doppler, Duplex , United States/epidemiology , Varicose Ulcer/diagnosisABSTRACT
Venous leg ulcers account for approximately 70% of all leg ulcers and affect 2.2 million Americans annually. After a comprehensive patient and wound assessment, compression therapy remains the cornerstone of standard care. Adjuvant care with topical or systemic agents is used for wounds that do not heal within 4 weeks. Once healed, long-term compression therapy with stockings or surgical intervention will reduce the incidence of recurrence. This continuing medical education article aims to outline optimal management for patients with venous leg ulcers, highlighting the role of a multidisciplinary team in delivering high quality care.
Subject(s)
Varicose Ulcer/diagnosis , Varicose Ulcer/therapy , Vascular Surgical Procedures/methods , Wound Healing/physiology , Chronic Disease , Combined Modality Therapy , Compression Bandages , Electric Stimulation Therapy/methods , Female , Humans , Leg Ulcer/diagnosis , Leg Ulcer/therapy , Male , Negative-Pressure Wound Therapy/methods , Prognosis , Randomized Controlled Trials as Topic , Recurrence , Risk Assessment , Severity of Illness Index , Skin Care/methods , Treatment OutcomeSubject(s)
CREST Syndrome/pathology , CREST Syndrome/surgery , Debridement , Fingers , Humans , Male , Middle AgedSubject(s)
Drug Eruptions/etiology , Immunologic Factors/adverse effects , Interferon-beta/adverse effects , Lupus Erythematosus, Cutaneous/chemically induced , Multiple Sclerosis/drug therapy , Adult , Drug Eruptions/pathology , Female , Humans , Lupus Erythematosus, Cutaneous/pathology , Skin/pathologySubject(s)
Choristoma/etiology , Intestine, Small , Postoperative Complications/etiology , Skin Diseases/etiology , Abscess/etiology , Abscess/surgery , Adenocarcinoma/surgery , Aged , Choristoma/therapy , Colectomy , Colonic Neoplasms/surgery , Combined Modality Therapy , Curettage , Cutaneous Fistula/complications , Cutaneous Fistula/surgery , Drainage , Hernia, Ventral/etiology , Humans , Ileostomy , Intestinal Fistula/complications , Intestinal Fistula/surgery , Male , Postoperative Complications/pathology , Silver Nitrate/therapeutic use , Skin Diseases/therapy , Skin TransplantationABSTRACT
Graves' disease is an autoimmune disorder of the thyroid gland with characteristic peripheral manifestations. The most common clinical findings include ophthalmopathy in 30% of patients, dermopathy (pretibial myxedema) in 4% of patients, and thyroid acropachy in 1% of patients. The triad of exophthalmos, pretibial myxedema, and acropachy occurs in less than 1% of patients. We present a case of Graves' disease with the clinical triad of eye disease, dermopathy, and acropachy.
