ABSTRACT
Perioral dermatitis, also known as periorificial dermatitis, is characterized by a papular rash involving the perioral, perinasal and periorbital areas of the skin. There are multiple agents that may cause these lesions, with topical steroids being the most common. Inhaled steroids are rarely implicated as a cause of perioral dermatitis. Our case is illustrative because there was a clear association of perioral dermatitis with the use of inhaled steroids and a quick response to the treatment regimen, which included discontinuation of the offending agent.
Subject(s)
Albuterol/analogs & derivatives , Androstadienes/adverse effects , Anti-Asthmatic Agents/adverse effects , Asthma/drug therapy , Dermatitis, Perioral/diagnosis , Drug Eruptions/diagnosis , Administration, Inhalation , Adolescent , Albuterol/administration & dosage , Albuterol/adverse effects , Androstadienes/administration & dosage , Anti-Asthmatic Agents/administration & dosage , Clindamycin/therapeutic use , Dermatitis, Perioral/chemically induced , Dermatitis, Perioral/drug therapy , Drug Eruptions/drug therapy , Drug Eruptions/etiology , Fluticasone , Humans , Male , Metronidazole/therapeutic use , Salmeterol XinafoateSubject(s)
Molluscum Contagiosum/diagnosis , Molluscum contagiosum virus/isolation & purification , Skin Diseases, Vesiculobullous/diagnosis , Antiviral Agents/therapeutic use , Biopsy, Needle , Child , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Immunohistochemistry , Molluscum Contagiosum/drug therapy , Molluscum Contagiosum/pathology , Photography , Risk Assessment , Severity of Illness Index , Skin Diseases, Vesiculobullous/pathology , Treatment OutcomeABSTRACT
BACKGROUND: Despite the highly acclaimed psychometric features of a 360-degree assessment in the fields of economics, military, and education, there has been increased interest in developing 360-degree instruments to assess competencies in graduate medical education only in the past recent years. Most of the effort to date, however, has focused on developing instruments and testing their reliability and feasibility. Insufficient attention has gone into issues of construct validity and particularly understanding the underlying constructs on which the instruments are based as well as the phenomena that affect ratings. PURPOSE: In preparation for developing a 360-degree assessment instrument, we explored variations in evaluators' opinion type of a competent resident and offer observation about evaluator's professional background and opinions. METHOD: Evaluators from two residency programs ranked 36 opinion statements, using a relative-ranking model, based on their opinion of a competent resident. By-person factor analysis was used to structure opinion types. RESULTS: Factor analysis of 156 responses identified four factors interpreted as four different opinion types of a competent resident: (a) altruistic, compassionate healer (n = 42 evaluators), (b) scientifically grounded clinician (n = 30), (c) holistic, humanistic clinician (n = 62), and (d) patient-focused, health manager (n = 31). Although 72% of nurses/respiratory therapist evaluators expressed type C, 28% expressed other types just as often. Only 14% of evaluator physicians expressed type D, and the remainders were evenly split among the other types. CONCLUSIONS: Our evaluators in 360-degree system expressed four opinion types of a competent resident. The individual opinion and not professional background influences the characteristics an evaluator values in a competent resident. We propose that these values will have an impact on competency assessment and should be taken into account in a 360-degree assessment.
