Evolution of Telehealth in Ambulatory Psychiatry: A One Year Perspective.

Under the direction of the leadership at our medical center, beginning March 16, 2020, all non-urgent in-person ambulatory visits were to be limited, either rescheduled or performed virtually, as the hospital braced for the surge of COVID-19 patients. The outpatient psychiatry department quickly transitioned to a telehealth model. This paper details our actions taken to implement this plan, reflections on our experience one year later, and areas for future study. On the one-year anniversary of our department implementing remote care practices around COVID-19, we reflect on lessons learned in the transition and maintenance phases of the last 12 months. Reflecting on next steps as a face-to-face care becomes more possible, we share three core factors in our decision making and research opportunities to better quantify the impact of telehealth in 2021 and beyond.

Tinea capitis caused by dermatophytes: a 15-year retrospective study from a Mississippi Dermatology Clinic.

Tinea capitis is a highly contagious disorder occurring predominantly in children. Presentation is variable and, as such, mycologic confirmation of dermatophyte infection would be useful in targeting specific therapy and implementing preventive measures to interrupt spread of infection. This retrospective study was performed at an outpatient dermatology clinic in Jackson, Mississippi, over a 15-year period (1983-1998). Dermatophyte infections were confirmed using scalp scrapings cultured on Mycosel Agar containing cycloheximide and chloramphenicol. Cultures were performed on 1220 patients of all ages presenting with signs and symptoms suggestive of tinea capitis. Of the total patients meeting the inclusion criteria, 66% were younger than 13 years. Overall, 39% (478/1220) had positive cultures for dermatophytes, with black individuals having the highest percentage of positive cultures (87% [414/478]). In addition to a review of findings, we examine the impact of a cultural diagnosis of dermatophyte infection on the treatment and prevention of this highly contagious infection.

Patient safety: Part I. Patient safety and the dermatologist.

UNLABELLED: Congress is grappling with ways to fund health care in the future. Much of the focus rests on paying physicians for their patients' outcomes, rather than the current system of payment for services provided during each visit. The years ahead will be years of change for American health care, with an increasing emphasis on the comparison of patient outcomes and measures of quality. Patient safety initiatives will be an integral part of the overall strategy to improve American health care. Part one of this two-part series on patient safety examines what we know about patient safety in dermatology, including data from medicolegal claims and published data on patient safety in the setting of office-based surgery. The article also focuses on how medical societies, payers, the US government, and the Board of Medical Specialties are responding to calls for accountability and improvements in patient safety. LEARNING OBJECTIVES: After completing this learning activity, participants should be able to identify risks to patient safety based on an understanding of the major causes of legal claims against dermatologists, use published patient safety data to improve the practice of office surgery, and be able to improve patient safety through an understanding of requirements for maintenance of certification.

Effect of a single course of isotretinoin therapy on bone mineral density in adolescent patients with severe, recalcitrant, nodular acne.

BACKGROUND: Adverse changes in bone have been reported for patients undergoing high-dose, long-term (several years) isotretinoin therapy for disorders of cornification. The effect of short-term (4-5 months) therapy at the lower dose recommended for acne on bone development in younger, growing adolescent (12-17 years) patients has not been well studied. OBJECTIVE: The purpose of the study was to evaluate the effect of a standard, single course of isotretinoin (Accutane) therapy on bone mineral density (BMD) of the lumbar spine and hip in adolescents ages 12 to 17 years with severe, recalcitrant, nodular acne. METHODS: In this open-label, multicenter study, 217 adolescents (81 girls) with severe, recalcitrant, nodular acne were enrolled and treated with isotretinoin twice daily with food at the recommended total dose of approximately 1 mg/kg for 16 to 20 weeks. BMD in the lumbar spine and hip was measured at baseline and at the end of therapy by dual energy radiograph absorptiometry. RESULTS: There was no clinically significant mean change in BMD measured at the lumbar spine (+1.4%, range: -4.9% to +12.3%) or total hip (-0.26%, range: -11.3% to +15.0%). Hyperostosis was not observed in any patient. Typical efficacy expected in the treatment of acne was observed. CONCLUSIONS: A 16- to 20-week course of isotretinoin treatment at the recommended dose for severe acne has no clinically significant effect on lumbar spine and total hip BMD in the adolescent (12-17 years) population.

Managing simple chronic paronychia and onycholysis with ciclopirox 0.77% and an irritant-avoidance regimen.

Dermatologists and other physicians frequently encounter simple chronic paronychia and onycholysis. In addition to strict avoidance of contact irritants, a broad-spectrum topical antifungal agent has been recommended. We conducted an examination of treatment with this type of agent and an assessment of the efficacy of ciclopirox 0.77% topical suspension in combination with a strict irritant-avoidance regimen. Early results of a pilot study (N = 44) using ciclopirox 0.77% topical suspension in patients diagnosed with simple chronic paronychia and/or onycholysis show excellent therapeutic outcomes of a combined regimen of a broad-spectrum topical antifungal agent such as ciclopirox and contact-irritant avoidance in this patient population.