[Telemedical aftercare of patients with skin diseases]. / Telemedizinische Nachsorge von Patient*innen mit Hauterkrankungen.

BACKGROUND: Improved technologies, an increased need for medical healthcare as well as the shortage of specialist personnel lead to a growing importance of telemedical applications. Dermatology is especially suitable for telemedical applications because of the visual appearance of skin diseases. This can contribute to optimizing the care and aftercare of patients with skin diseases. OBJECTIVE: An analysis of patient satisfaction with teledermatological aftercare at the University Hospital Greifswald using the teledermatological application Mobil Skin® (Infokom, Neubrandenburg, Germany) was carried out. Factors that influence patient satisfaction and the suitability of the teledermatological aftercare for different skin diseases were also analyzed. MATERIAL AND METHODS: The evaluation of standardized questionnaires, analysis of demographic data of the patient collective and analysis of usage data concerning the teledermatological system Mobil Skin® were carried out. RESULTS: A total of 91 out of 118 telemedically treated patients participated in the survey. The majority of the patients reported a high degree of satisfaction with the teledermatological aftercare. Patient satisfaction was independent of where the patients lived (minor center or middle center/main center). Patient satisfaction correlated with the frequency of use and the number of answers received through the teledermatological system. The aftercare with the teledermatological system Mobil Skin® was suitable for all diagnosis groups surveyed. Both older and younger patients as well as children benefited from this kind of aftercare.

[Influence of nutrition, common autoimmune diseases and smoking on the incidence of foot mycoses]. / Einfluss von Ernährung, autoimmunen Volkskrankheiten und Rauchen auf die Erkrankungshäufigkeit von Fußmykosen.

BACKGROUND: Foot mycoses, including onychomycoses, are worldwide infectious diseases. As part of a regional survey using randomly selected residents of in Mecklenburg-Western Pomerania, we investigated the impact of dietary habits, the presence of most frequent autoimmune diseases and current smoking on fungal skin infections in order to reveal potential new risk factors to elucidate potential preventive interventions. OBJECTIVES: The identification of potential new factors that influence the development of mycosis was performed in order to derive possible preventive measures. METHODS: In the Study of Health in Pomerania (SHIP) in Mecklengburg-Western Pomerania, 2523 inhabitants were examined for mycotic lesions and asked about nutritional habits, the presence of atopic dermatitis, allergic rhinitis, psoriasis and smoking habits. RESULTS: In all, 8% of probands were diagnosed with mycosis, 6.5% onychomycosis, 3.7% tinea pedis and 0.2% tinea corporis. Psoriasis, allergic rhinitis and atopic dermatitis and frequent consumption of cooked potatoes, oatmeal and corn flakes, cereals, pasta and rice were significantly associated with tinea pedis. Onychomycosis was positively associated with consumption of cooked potatoes. Cigarette consumption proved protective for tinea pedis and dermatophyte colonization. CONCLUSIONS: The autoimmune disorders psoriasis and atopic dermatitis and allergic rhinitis seem to predispose to foot mycosis. Recalcitrant mycosis should raise the question of diets high in carbohydrates. Nicotine abuse seems to protect against skin mycosis and colonization.

[Teledermatology for emergency patient care : Two-year experience with teledermatological emergency care]. / Teledermatologie zur notfallmedizinischen Patientenversorgung : Zweijahreserfahrungen mit teledermatologischer Notfallversorgung.

BACKGROUND: Internationally telemedicine has become an important element of health care. Up to now it plays, however, a minor role in the German health care system. Taking skin diseases as an example we examined over a 2­year period whether teledermatology is appropriate to care for patients presenting to the emergency department (ED) with symptomatic skin diseases. METHODS: During 2016 and 2017, 190 patients aged between 18 and 88 years with skin diseases who presented to the ED of the University Medicine Greifswald (UMG) were cared for by a core team consisting of surgeons who were supported by the on-call dermatologist of the UMG via teledermatology (mSkin Doctor®, InfoKom, Neubrandeburg, Germany). Patients presented nearly exclusively outside the regular working hours: 59% on weekends and public holidays, 39% after 4 p.m. on working days. Furthermore, 33% of patients came from rural areas (<10,000 inhabitants), 41% from regional centres or mid-sized centres. Patients travelled 23 km (median) from their homes to the emergency department. RESULTS: In all, 59 of the 190 patients immediately assessed the teledermatology-based care they received in the emergency department: 76% of the patients felt that they had received adequate care, 81% trusted the medical decisions. The teledermatologically based care outside normal working hours was deemed appropriate by 68% of the patients; 32% of the patients, however, wanted the dermatologist to be present at any time at day and night. CONCLUSION: Patients with skin diseases were cared for safely by the core team of the ED which was supported by the on-call dermatologist via teledermatology. The use of teledermatology within the context of emergency-based care has gained a high degree of patients' acceptance and confidence.

Long-term outcome of open surgery in CVI patients concerning postoperative complications, perioperative hemodynamics and clinical efficacy, Part II1.

BACKGROUND: Chronic venous disease (CVD) is extremely common worldwide with prevalence increasing with age. It is associated with a reduced quality of life, particularly in relation to pain, physical function and mobility. Symptomatic chronic venous insufficiency (CVI) with venous ulcer at its' endpoint, indicates interventional surgery to cure venous reflux therewith promoting wound healing and preventing recurrence. In this retrospective, single-centre, consecutive case-control study in a single patient population of a university clinic in northern Germany a holistic evaluation of varicose vein surgeries has been undertaken. Part I covered postoperative complications in relation to co-morbidities, co-medication and clinical presentation. Part II of this article presents now the hemodynamic results in relation to the perioperative evolution of CVI specific symptoms. METHODS: Records of n = 429 (467 extremities) patients from 2009-2013 treated with open surgery were analysed with regards to perioperative hemodynamics. Evolution of CVI symptomology was accessed postoperatively with the help of a questionnaire and patient records in the case of complication development. Venous hemodynamics was analysed in the whole patient population and with regards to complication subgroups: no events (NE), neglectable adverse events (NAE) and non-neglectable adverse events (NNAE). RESULTS: Postoperatively, patients' CVI-symptoms like pain (p < 0.001), swelling (p < 0.001) and itching (p = 0.003) significantly improved. The venous refill time and venous pump capacity improved significantly after open vein surgery (p < 0.05). Regardless of the development of postoperative complications there was a significant improvement of venous function at 6 weeks- and one-year postoperative in follow-up (p < 0.05). Symptom regression was strongly correlated with hemodynamic improvement. CONCLUSION: A significant improvement of patients' symptoms was achieved by means of open-surgery, regardless of postoperative complication development. This was in accordance with the improvement of venous hemodynamics. A strong correlation between symptom regression and improvement in venous hemodynamics could be proven.

[Importance of modern treatment procedures for infected and colonized wounds in dermatology]. / Stellenwert moderner physikalischer Behandlungsverfahren bei infizierten und kolonisierten Wunden in der Dermatologie.

In the coming years increasing numbers of patients with chronic ulcers and tumor wounds are to be expected, both of which are typically multifaceted diseases requiring complex and increasingly long-term ambulatory therapy. Therefore, in recent years special medical emphasis has been placed on efficacious therapies with good tolerability and also suitability regarding feasibility for outpatient treatment. Some of these methods, such as cold plasma therapy, extracorporeal shock wave therapy (ESWT), water-filtered infrared therapy (wIRA), electrostimulation (ES) and low level laser therapy (LLLT) have a good chance of success when applied as an adjuvant method in the multimodal treatment concept for patients with recalcitrant wounds. All of these methods have at least indirect antimicrobial properties which can be advantageous in cases of microbial infiltration of wounds. As for all other methods for treating recalcitrant wounds, the promising application of the aforementioned methods requires great expertise in wound healing together with a broad and continuous interdisciplinary diagnostics and therapy (wound center).

[Microbial stress of skin and wounds in clinical aspects and practice. Between search and destroy and monitor and relax]. / Mikrobielle Belastung von Haut und Wunden in Klinik und Praxis. Zwischen "Search and Destroy" und "Monitor and Relax".

The antibiotic treatment of microbial pathogens of the skin and wounds could so far not fulfil the expectations of an effective and permanent elimination of pathogens so that local treatment with antiseptic agents as a flanking measure to wound cleansing and debridement has become increasingly more established. Because an antiseptic treatment does not actually represent a treatment of infections, the current antimicrobial treatment strategy for infections in skin and wound areas consists of combined antibiotic and flanking antiseptic administration following debridement. However, the combined therapy is not always successful. There is an urgent need for new forms of therapy particularly to combat multiresistant pathogens in biofilms in infections of chronic and other complicated wounds.