RESUMO
BACKGROUND: Family medicine physicians play a pivotal role in the prevention and early detection of skin cancer. Our objective was to evaluate how family physicians believe their postgraduate training in skin cancer screening and prevention has prepared them for independent practice and to assess the need for enhanced skin lesion teaching in a family medicine residency setting. METHODS: A descriptive, cross-sectional survey investigating provider demographics, confidence in providing dermatological care, residency training, current medical practice, and skin cancer prevention beliefs was mailed to all family medicine physicians in the state of Iowa as listed in the Iowa Academy of Family Physicians annual directory in 2006 (N = 1069). RESULTS: A total of 575 family medicine physicians completed the survey for an overall response rate of 53.8%. Overall, family medicine physicians reported feeling confident in their ability to diagnose skin lesions (83.2%), differentiate between benign and malignant lesions (85.3%), and perform a biopsy of a lesion (94.3%). Only 65% of surveyed physicians felt that their residency program adequately trained them in diagnosing skin lesions and 65.7% of physicians agree that they could have benefited from additional training on skin lesions during residency training. Nearly 90% of clinicians surveyed believe that skin cancer screenings are the standard of care; however, only 51.8% perform skin cancer screening examinations during adult health maintenance visits more than 75% of the time. The primary reason listed by respondents who said they do not routinely perform skin cancer screenings was inadequate time (68.2%). CONCLUSION: Family medicine physicians in the state of Iowa are confident in evaluating skin lesions. However, they reported a need for additional enhanced, targeted skin lesion education in family medicine residency training programs. Physicians believe that skin cancer screening examination is the standard of care, but find that inadequate time increasingly hinders skin cancer screening during routine health maintenance examinations.
RESUMO
Subcutaneous nodules of the scalp are common and usually benign. We describe a case that presented as a probable inclusion cyst or lipoma of the scalp that was discovered to be a benign osteolytic fibrohistiocytic lesion of the frontoparietal skull. This ultimately was successfully treated by neurosurgery with a craniectomy, tumor excision, and reconstructive cranioplasty.
Assuntos
Histiocitoma Fibroso Benigno/patologia , Osteólise/etiologia , Couro Cabeludo/patologia , Neoplasias Cranianas/patologia , Feminino , Histiocitoma Fibroso Benigno/complicações , Histiocitoma Fibroso Benigno/cirurgia , Humanos , Pessoa de Meia-Idade , Neoplasias Cranianas/complicações , Neoplasias Cranianas/cirurgiaAssuntos
Diabetes Mellitus/terapia , Garantia da Qualidade dos Cuidados de Saúde , Indicadores de Qualidade em Assistência à Saúde , Pressão Sanguínea , Diabetes Mellitus/sangue , Diabetes Mellitus/fisiopatologia , Diabetes Mellitus Tipo 2 , Registros Eletrônicos de Saúde , Retroalimentação , Hemoglobinas Glicadas/metabolismo , Humanos , Satisfação do Paciente , Garantia da Qualidade dos Cuidados de Saúde/tendências , Qualidade de VidaAssuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Algoritmos , Biguanidas/efeitos adversos , Biguanidas/uso terapêutico , Diabetes Mellitus Tipo 2/terapia , Quimioterapia Combinada , Humanos , Hipoglicemiantes/efeitos adversos , Insulina/efeitos adversos , Insulina/uso terapêutico , Compostos de Sulfonilureia/efeitos adversos , Compostos de Sulfonilureia/uso terapêutico , Tiazolidinedionas/efeitos adversos , Tiazolidinedionas/uso terapêuticoAssuntos
Haloperidol/efeitos adversos , Internet , Acetaminofen/administração & dosagem , Acetaminofen/efeitos adversos , Administração Oral , Adulto , Azepinas/administração & dosagem , Azepinas/efeitos adversos , Codeína/administração & dosagem , Codeína/efeitos adversos , Combinação de Medicamentos , Distonia/etiologia , Feminino , Haloperidol/administração & dosagem , Humanos , Preparações Farmacêuticas , Comprimidos , Estados Unidos , United States Food and Drug AdministrationRESUMO
Combined treatment with psychotherapy or psychiatric consult and drug therapy has shown better response in several studies than either therapy alone. Although not proven by clinical trials, selecting a medication by matching its side-effect profile to patient characteristics is supported by case reports and likely enhances compliance. Patients who do not improve with initial therapy often benefit from being switched to another class of antidepressants, or having a drug from another class added to their therapy.