Wound care practices following in-office cutaneous surgery among family physicians in Canada.

OBJECTIVE: Family physicians (FPs) in Canada routinely perform in-office cutaneous surgery. There is strong evidence to support a moist wound healing environment, resulting in faster healing times and improved cosmesis. However, the wound care practices of FPs have not been previously studied. We aimed to examine the postoperative wound care practices of FPs after in-office cutaneous surgery. METHOD: An online survey was distributed to Canadian FPs to determine post-surgical wound care practices. The survey examined moist versus dry wound healing and the reasons for these recommendations were explored. Additional wound care practices were also studied. Appropriate statistical analyses were undertaken. RESULTS: A total of 573 (91.5%) FPs completed the survey. Just under half (49.2%) of FPs recommended moist wound healing to their patients, while the remaining respondents (50.8%) recommended dry wound healing. The most endorsed reason for both moist and dry wound care recommendations was prior training (63.1% and 65.3%, respectively). Most physicians (57.2%) recommended the use of a cream or ointment postoperatively. While there appeared to be consensus on recommending sun avoidance after cutaneous surgery (77.7%), additional wound care practices varied, including: the use of dressings; cleansing practices; smoking cessation; reduction in physical activity; photoprotection; water exposure; and scar treatment/cosmetic use. CONCLUSION: Almost half of FPs in Canada responding to the survey did not recommend moist wound healing despite strong evidence to support this practice. We also noted a diverse range of postoperative wound care practices after in-office cutaneous surgery. Therefore, these results highlight a critical need for consistent wound care recommendations following cutaneous surgery for FPs in Canada.

Noninfectious Granulomas: A Sign of an Underlying Immunodeficiency?

Primary immunodeficiency disorders, such as ataxia-telangiectasia (A-T), may rarely be associated with cutaneous granulomas without an identifiable infection. The authors report a case of a 3-year-old boy with A-T who presented with two persistent ulcerated erythematous nodules. Histopathology was consistent with a granulomatous process secondary to A-T, without an infectious origin. Partial improvement was noted with clobetasol propionate 0.05% cream applied twice daily under occlusion. Of note, the presence of multiple noninfectious granulomas in a child may be the initial sign of an immune deficiency and should alert the astute clinician to investigate for an underlying primary immunodeficiency. Herein, the authors discuss the associations of noninfectious granulomas and primary immunodeficiency disorders and present management options for these difficult-to-treat lesions.

Predictors of Well-Being in Resident Physicians: A Descriptive and Psychometric Study.

BACKGROUND: It is important to describe the characteristics of well-being in resident physicians to develop resident wellness initiatives in postgraduate medical education. OBJECTIVE: To characterize the predictors of well-being in resident physicians by assessing personal and work-related burnout, work dissatisfaction, nutritional needs while on call, and sleep needs while on call. METHODS: We set up an online survey in 2012 to collect data from current residents at the University of Calgary in Canada. The WHO-Five Well-Being Index, personal and work-related subscales of the Copenhagen Burnout Inventory, questions on work dissatisfaction, as well as sleep and nutrition management needs while on call, were used in the survey. Descriptive statistics, univariate analysis, and linear regression were applied to the data. RESULTS: The survey response rate was 45% (317 of 706) of eligible residents, with a mean age of 30.9 years (SD  =  4.3). Fifty-three percent (168 of 317) of residents had a well-being score of 13 or less, indicating poor mental well-being. There were significant differences between men and women with respect to personal burnout (47.9 versus 54.2, P  =  .002) and work-related burnout (46.4 versus 50.4, P  =  .008). The only significant predictors of well-being overall were personal burnout and work dissatisfaction. CONCLUSIONS: Survey results suggest that a high proportion of residents at this institution have low well-being. This study did not find work-related burnout to be a significant predictor of well-being, after adjustment for other variables.

Allergic contact dermatitis to medical equipment in a non-health care worker caring for a disabled spouse.

BACKGROUND: Allergic contact dermatitis (ACD) to rubber accelerators is a common occurrence, especially in health care workers, but the risks in family caregivers are not as well documented. OBJECTIVE: To document a case of a 66-year-old woman who developed recurrent, extensive flares of ACD from contact with rubber accelerators through caregiving. METHOD AND RESULTS: Patch testing revealed a positive reaction to two common rubber accelerators: carba mix (3+) and thiuram mix (3+). The patient described caring for her disabled husband, which involved handling rubberized medical equipment. CONCLUSION: Physicians should appreciate ACD in non-health care workers caused by rubber accelerators found in medical equipment. Individuals providing care for sick or elderly relatives should be further questioned on exposure to a hospital environment and contact with medical equipment.

Annular elastolytic giant cell granuloma associated with temporal arteritis leading to blindness.

BACKGROUND: Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous disorder characterized by giant cells in the dermis phagocytosing damaged elastin fragments. OBJECTIVE: We report a case of a 71-year-old man presenting with erythematous plaques in predominantly sun-exposed areas. METHOD: A diagnosis of AEGCG was made based on the clinical and histologic picture, and treatment with systemic steroids was initiated. However, while tapering the steroid dose, the patient developed a radiating headache that progressed to temporal arteritis and eventual blindness in the right eye. CONCLUSION: There have been only two previous case reports presenting an association between AEGCG and temporal arteritis. This report explores AEGCG and its possible relationship to temporal arteritis along with possible treatment regimens cited in the current literature.

Teaching dermatology to Canadian undergraduate medical students.

BACKGROUND: The Canadian dermatology undergraduate curriculum was reviewed in 1983, 1987, and 1996. All surveys revealed the limited amount of time dedicated to dermatology in the undergraduate curriculum. OBJECTIVE: This survey was designed to obtain current information regarding undergraduate dermatology teaching in Canadian medical schools. METHODS: A survey was sent electronically to all undergraduate dermatology curriculum coordinators at each of the 17 Canadian medical schools. RESULTS: Between 1996 and 2008, the average number of hours of dermatology teaching has increased by 7 hours to 20.5 ± 17.2 hours. Again, most of the teaching is performed in the preclinical years. The majority of schools would like to have more time dedicated to dermatology teaching; however, many schools cited a restriction in the number of dermatology faculty members, with an average of 7.8 ± 7 dermatologists, as a barrier to education delivery. CONCLUSION: It is important to have dermatology included throughout the undergraduate medical curriculum because most dermatologic problems are seen by nondermatologists. Respondents at each school believed that there may be value in moving toward a national strategy for dermatology curriculum changes, and this can ensure both uniformity and consistency within Canada.