Assuntos
Estética , Ética Médica , Dermatopatias/terapia , Idoso , Idoso de 80 Anos ou mais , Beneficência , Humanos , Autonomia PessoalRESUMO
INTRODUCTION: Touch is essential for dermatologists. Differences in practice, such as whether or not to wear examination gloves, may be seen among dermatologists. To investigate this approach and its associated factors, we conducted a national survey to study hygiene measures and the wearing of gloves among dermatologists, e.g. wearing a coat, hand washing between patient visits, hand shaking and past history of infectious disease transmitted by patients. The context and circumstances in which gloves were worn was studied. RESULTS: Four hundred and seventy-four dermatologists responded to the survey (median age: 52 years). Most dermatologists reported wearing examination gloves as follows: always (21%, n=99), occasionally (76%, n=359), never (3%, n=13). Most physicians reported wearing a coat (91%, n=419) and routinely washing their hands after examination (53%, n=241). A minority of physicians reported shaking hands (36%, n=163). A significant number of dermatologists reporting that they wore examination gloves were younger and female, and these practitioners also washed their hands more frequently. The most common reason cited by dermatologists wearing gloves "occasionally" was patient hygiene (71%, n=256) rather than infectious skin disease (52%, n=186). This practice was ascribable more to concerns by dermatologists about protecting themselves (78%, n=270) rather than protecting patients (51%, n=169). Finally, it was felt that wearing gloves impaired neither the quality of clinical examination (52%, n=173) nor relations with patients (49%, n=160). CONCLUSION: Although wearing gloves is not recommended for examining unbroken skin, most of the respondents reported wearing examination gloves during their consultations. Wearing of gloves was associated with more frequent hygiene measures (hand washing, no handshaking) and was based on concern for self-protection.
Assuntos
Infecção Hospitalar/prevenção & controle , Dermatologistas/estatística & dados numéricos , Desinfecção das Mãos , Roupa de Proteção/estatística & dados numéricos , Adulto , Idoso , Feminino , França/epidemiologia , Luvas Protetoras/estatística & dados numéricos , Fidelidade a Diretrizes , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Understanding patients' expectations with regard to medical care is critical as it guarantees an efficient therapeutic process. Our aim was to determine outpatients' expectations concerning clinical encounters in a dermatology clinic and to study how these matched the opinions of dermatologists regarding them. PATIENTS AND METHODS: Consecutive outpatients consulting in five dermatology centres in the Paris suburbs between February 2013 and March 2013 were prospectively included. For this pilot cross-sectional study, we used two standardized forms to collect data from patients and dermatologists. Patients' answers were compared to those of their dermatologist, and the degree of matching was calculated to assess the ability of dermatologists to accurately identify their patients' expectations. RESULTS: Two hundred and sixty-five patients were included, with a median age of 41 years (interquartile range: 25; 62), of whom 166 were women (65.4%). Patient's principal expectations concerned diagnosis (51.7%) and medication (40.8%), with 32.1% of patients requiring reassurance. The rates of matching between patients' and dermatologists' answers ranged from 33.3% to 65.7% according to the type of expectations. The highest rate concerned expectation with regard to medications, being only 52.6% and 58.8%, respectively for expectations regarding diagnosis and the need for reassurance. CONCLUSION: This study highlights the need for improved identification of outpatient expectations in dermatology consultations.
Assuntos
Visita a Consultório Médico , Pacientes Ambulatoriais , Satisfação do Paciente , Qualidade de Vida , Dermatopatias/diagnóstico , Dermatopatias/psicologia , Adulto , Dermatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Paris/epidemiologia , Satisfação do Paciente/estatística & dados numéricos , Projetos Piloto , Estudos Prospectivos , Dermatopatias/tratamento farmacológico , Dermatopatias/epidemiologia , Inquéritos e QuestionáriosAssuntos
Relações Médico-Paciente/ética , Recusa em Tratar/ética , Acitretina/uso terapêutico , Adulto , Anticorpos Monoclonais/economia , Anticorpos Monoclonais/uso terapêutico , Criança , Comportamento de Escolha , Contraindicações , Técnicas Cosméticas/ética , Eritroceratodermia Variável/tratamento farmacológico , Feminino , Humanos , Ácido Hialurônico/uso terapêutico , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Relações Interprofissionais/ética , Ipilimumab , Falência Renal Crônica/cirurgia , Transplante de Rim , Melanoma/tratamento farmacológico , Melanoma/etiologia , Melanoma/secundário , Complicações Pós-Operatórias/etiologia , TatuagemAssuntos
Enganação , Relações Médico-Paciente/ética , Revelação da Verdade/ética , Adolescente , Adulto , Atitude Frente a Saúde , Confidencialidade/ética , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/psicologia , Ginecologia , Humanos , Pessoa de Meia-Idade , Neurofibromatoses/genética , Neurofibromatoses/psicologia , Relações Pais-Filho , Relações Profissional-Família/éticaRESUMO
Human immunodeficiency virus (HIV)-related CD8+ cutaneous pseudolymphoma (CD8+ cytotoxic T cell skin infiltrative disease) is an inflammatory process resulting from a massive infiltration of the skin by activated, oligoclonal, HIV-specific, cytotoxic T lymphocytes. Usually, CD8+ cutaneous pseudolymphoma affects patients with a deep immunosuppression, and is rare in patients with mild immunosuppression. In deeply immunocompromised patients, highly active antiretroviral therapy (HAART) is considered as the first-line treatment. In contrast, the choice of therapy in moderately immunocompromised patients and/or patients already receiving HAART remains nonconsensual. We report a case of HIV-related CD8+ cutaneous pseudolymphoma in a moderately immunocompromised patient who was successfully and safely treated with methotrexate. We review the literature on HIV-related CD8+ pseudolymphoma and the use of methotrexate in HIV-positive patients.