Fiabilidad de una aplicación de ayuda a la toma de decisiones terapéuticas en el paciente con psoriasis (MDi Psoriasis(R)) / Reliability of the MDi Psoriasis(R) application to aid therapeutic decision-making in psoriasis

Introducción: Las decisiones terapéuticas en el paciente con psoriasis están influidas por factores de la enfermedad (gravedad, localización, etc.), de las comorbilidades y de otras circunstancias demográficas y clínicas asociadas. Objetivo: Evaluar la fiabilidad de una aplicación móvil, MDi-Psoriasis(R), como instrumento de ayuda al dermatólogo en la toma de decisiones terapéuticas en pacientes con psoriasis moderada-grave. Método: Estudio de concordancia interobservador entre las recomendaciones terapéuticas emitidas por un grupo de expertos y MDi-Psoriasis(R) sobre 10 casos clínicos complejos de psoriasis moderada-grave. Para cada uno de los casos los expertos fueron preguntados por el tratamiento más adecuado, posible y no adecuado. Los mismos 10 casos clínicos fueron sometidos a la aplicación MDi-Psoriasis(R) y se calcularon las concordancias interobservador pareada (kappa de Cohen) y múltiple (kappa de Fleiss), y el porcentaje de acuerdo entre las recomendaciones. Resultados: Sobre un total de 1.210 observaciones el porcentaje promedio de acuerdo fue del 51,3% (IC 95%: 48,5-54,1%), con una concordancia pareada de kappa = 0,29 y múltiple de kappa = 0,28. El acuerdo promedio entre pares de observadores, sin MDi-Psoriasis(R), fue del 50,5% (IC 95%: 47,6-53,5%). La concordancia pareada entre las recomendaciones emitidas por MDi-Psoriasis(R) y la opinión mayoritaria de los expertos fue de kappa = 0,44, con un acuerdo del 68,2%. Conclusiones: MDi-Psoriasis(R) puede emitir recomendaciones comparables a las emitidas por un experto en psoriasis (AU)

Background: Therapeutic decisions in psoriasis are influenced by disease factors (e.g., severity or location), comorbidity, and demographic and clinical features. Objective: We aimed to assess the reliability of a mobile telephone application (MDi-Psoriasis) designed to help the dermatologist make decisions on how to treat patients with moderate to severe psoriasis. Method: We analyzed interobserver agreement between the advice given by an expert panel and the recommendations of the MDi-Psoriasis application in 10 complex cases of moderate to severe psoriasis. The experts were asked their opinion on which treatments were most appropriate, possible, or inappropriate. Data from the same 10 cases were entered into the MDi-Psoriasis application. Agreement was analyzed in 3 ways: paired interobserver concordance (Cohen's κ), multiple interobserver concordance (Fleiss's κ), and percent agreement between recommendations. Results: The mean percent agreement between the total of 1210 observations was 51.3% (95% CI, 48.5-54.1%). Cohen's κ statistic was 0.29 and Fleiss's κ was 0.28. Mean agreement between pairs of human observers only, excluding the MDi-Psoriasis recommendations, was 50.5% (95% CI, 47.6-53.5%). Paired agreement between the recommendations of the MDi-Psoriasis tool and the majority opinion of the expert panel (Cohen's κ) was 0.44 (68.2% agreement). Conclusions: The MDi-Psoriasis tool can generate recommendations that are comparable to those of experts in psoriasis (AU)

Reliability of the MDi Psoriasis® Application to Aid Therapeutic Decision-Making in Psoriasis. / Fiabilidad de una aplicación de ayuda a la toma de decisiones terapéuticas en el paciente con psoriasis (MDi Psoriasis®).

BACKGROUND: Therapeutic decisions in psoriasis are influenced by disease factors (e.g., severity or location), comorbidity, and demographic and clinical features. OBJECTIVE: We aimed to assess the reliability of a mobile telephone application (MDi-Psoriasis) designed to help the dermatologist make decisions on how to treat patients with moderate to severe psoriasis. METHOD: We analyzed interobserver agreement between the advice given by an expert panel and the recommendations of the MDi-Psoriasis application in 10 complex cases of moderate to severe psoriasis. The experts were asked their opinion on which treatments were most appropriate, possible, or inappropriate. Data from the same 10 cases were entered into the MDi-Psoriasis application. Agreement was analyzed in 3 ways: paired interobserver concordance (Cohen's κ), multiple interobserver concordance (Fleiss's κ), and percent agreement between recommendations. RESULTS: The mean percent agreement between the total of 1210 observations was 51.3% (95% CI, 48.5-54.1%). Cohen's κ statistic was 0.29 and Fleiss's κ was 0.28. Mean agreement between pairs of human observers only, excluding the MDi-Psoriasis recommendations, was 50.5% (95% CI, 47.6-53.5%). Paired agreement between the recommendations of the MDi-Psoriasis tool and the majority opinion of the expert panel (Cohen's κ) was 0.44 (68.2% agreement). CONCLUSIONS: The MDi-Psoriasis tool can generate recommendations that are comparable to those of experts in psoriasis.

Biopsia selectiva del ganglio centinela de localización axilar. Video quirúrgico / Axillary Sentinel Lymph Node Biopsy: Video of the Surgical Procedure

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Rendimiento de la tomografía computarizada en la estadificación basal del paciente con melanoma / Yield of Computed Tomography at Baseline Staging of Melanoma

INTRODUCCIÓN: Las recomendaciones actuales de pruebas de imagen en la estadificación basal del paciente con melanoma cutáneo primario se limitan a los estadios tumorales de riesgo elevado (T4b). OBJETIVO: Evaluar la frecuencia y el rendimiento de la tomografía computarizada (TC) para la estadificación basal del paciente con melanoma cutáneo primario y la tipología y la frecuencia de los incidentalomas identificados. MATERIAL Y MÉTODOS: Estudio transversal sobre pacientes con melanoma cutáneo de estadio Tis-T4bN0M0 atendidos entre 2008 y 2014 en una Unidad de Melanoma. Se revisaron las TC realizadas como parte del estudio de estadificación basal para obtener la frecuencia de TC positiva, incidentalomas, coste unitario de la detección de metástasis y factores asociados a la realización de TC. RESULTADOS: Sobre un total de 419 pacientes incluidos se realizó TC basal en el 73,99% de los pacientes (n=310TC. Tis=17, T1=137, T2=71, T3=48, T4=37), de las que el 81,61% fueron negativas y el 18,06% presentaron incidentalomas. En 2 pacientes (0,64%) se identificaron segundas neoplasias primarias y en un paciente, metástasis de melanoma (0,32%). El coste asociado a la identificación de metástasis fue de 71.234,90 €/metástasis. El estadio T2 (OR = 8,73) y la edad < 70 años (OR = 3,53) se asociaron con mayor probabilidad de solicitud de TC; la exéresis del tumor primario en la Unidad de Melanoma (OR=0,08) se asoció con menor probabilidad de solicitud de TC. CONCLUSIONES: Los resultados obtenidos en esta serie confirman las recomendaciones actuales que restringen la indicación de la TC de estadificación basal a los escenarios de alto riesgo de enfermedad metastásica (estadiosIIC-III)

BACKGROUND: Current guidelines call for baseline imaging only for very high-risk (T4b) primary cutaneous melanomas. OBJECTIVES: To estimate the frequency of computed tomography (CT) at baseline staging of primary cutaneous melanoma and the diagnostic yield of CT; and to describe the types and frequencies of incidentaloma findings. MATERIAL AND METHODS: Cross-sectional study of cutaneous melanoma cases (tumor classifications Tis to T4bN0M0) attended between 2008 and 2014 in a specialized melanoma unit. Reports of CT scans performed during baseline staging were reviewed to determine the frequency of positive scan results, incidentaloma findings, unit cost for detection of metastasis, and factors associated with the decision to order CT. RESULTS: CT results were available for 310 of the 419 patients included (73.99%). The tumor classifications were as follows: Tis, 17; T1, 137; T2, 71; T3, 48; and T4, 37. The CT results were negative in 81.61%, and incidentalomas were found in 18.06%. Additional primary tumors were found in 2 patients (0.64%), and metastasis was identified in one patient (0.32%). The cost of finding the case of metastasis was €71,234.90. A T2 tumor classification (odds ratio [OR], 8.73) and age under 70 years (OR, 3.53) were associated with greater likelihood of CT being ordered. Excision of the primary tumor in the melanoma unit (OR, 0.08) was associated with less likelihood of ordering CT. CONCLUSIONS: The results for this patient series support current recommendations restricting CT at baseline to cases where there is high risk of metastasis (stagesIIC-III)

Yield of Computed Tomography at Baseline Staging of Melanoma.

BACKGROUND: Current guidelines call for baseline imaging only for very high-risk (T4b) primary cutaneous melanomas. OBJECTIVES: To estimate the frequency of computed tomography (CT) at baseline staging of primary cutaneous melanoma and the diagnostic yield of CT; and to describe the types and frequencies of incidentaloma findings. MATERIAL AND METHODS: Cross-sectional study of cutaneous melanoma cases (tumor classifications Tis to T4bN0M0) attended between 2008 and 2014 in a specialized melanoma unit. Reports of CT scans performed during baseline staging were reviewed to determine the frequency of positive scan results, incidentaloma findings, unit cost for detection of metastasis, and factors associated with the decision to order CT. RESULTS: CT results were available for 310 of the 419 patients included (73.99%). The tumor classifications were as follows: Tis, 17; T1, 137; T2, 71; T3, 48; and T4, 37. The CT results were negative in 81.61%, and incidentalomas were found in 18.06%. Additional primary tumors were found in 2 patients (0.64%), and metastasis was identified in one patient (0.32%). The cost of finding the case of metastasis was €71,234.90. A T2 tumor classification (odds ratio [OR], 8.73) and age under 70 years (OR, 3.53) were associated with greater likelihood of CT being ordered. Excision of the primary tumor in the melanoma unit (OR, 0.08) was associated with less likelihood of ordering CT. CONCLUSIONS: The results for this patient series support current recommendations restricting CT at baseline to cases where there is high risk of metastasis (stagesiiC-iii).

Cicatriz hipértrofica y queloide después de la aplicación de imiquimod 5% crema. A propósito de 2 casos / Utilidad de la ecografía cutánea en el diagnóstico de las complicaciones por materiales de relleno The Utility of Skin Ultrasound for the Diagnosis of Complications of Tissue Filler Materials

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