Consensus document on the evaluation and treatment of moderate-to-severe psoriasis: Psoriasis Group of the Spanish Academy of Dermatology and Venereology.

Psoriasis is a highly prevalent disease with a major impact on quality of life; therefore, appropriate patient management is mandatory. Given that many issues in psoriasis are controversial and not clearly defined by evidence-based medicine, management of psoriasis is very variable. Expert consensus can generate practical guidelines for optimization of patient care. Much has changed since 2009, when the Consensus Document on the Evaluation and Treatment of Moderate to Severe Psoriasis was published by the Spanish Psoriasis Group (GEP) of the Spanish Academy of Dermatology and Venereology (AEDV). The objective of the present consensus document is to provide the dermatologist with updated recommendations for the evaluation and treatment of patients with moderate-to-severe plaque psoriasis. All active members of the GEP of the AEDV were invited to participate in the survey. The final group comprised 46 members from various areas of Spain and with substantial experience in managing psoriasis. A 3-round Delphi process was used to reach consensus. Consistent agreement and consistent disagreement (consensus) required the achievement of at least two of the following three criteria: Criterion 1, which was based on the position occupied by the mean on a scale of 1-9 and an SD <2; Criterion 2, which was based on the median and interquartile range (IQR) on a scale of 1-9; Criterion 3, which considered the percentage of the voting experts on a scale of 1-9. The items studied were definition of severity, therapeutic objectives, indications for systemic treatment and biologic therapy, induction and maintenance periods, therapeutic failure, loss of response, relapse and rebound, continuous and intermittent therapy, screening of patients before treatment, adherence to therapy, follow-up of treatment outcome, combination of drugs, transitioning and associated comorbidities. Consistent agreement or disagreement (consensus) was achieved for 198 items (agreement, 3 criteria 146 items, 2 criteria 43 items; disagreement, 3 criteria 9 items, 2 criteria 0 items) based on the criteria described above. Completion of the Delphi consensus process enabled a broad and experienced group of Spanish psoriasis experts to provide useful and practical guidelines for the management and treatment of patients with moderate-to-severe psoriasis, particularly in areas where evidence is lacking.

Measurement of health-related quality of life in dermatological research and practice: outcome of the EADV Taskforce on Quality of Life.

In the last decade, the importance of the measurement of health-related quality of life (HRQoL) has grown significantly. Today, HRQoL measurement is generally considered to be important in clinical trials, in the assessment of disease severity, in patient management and in the field of health economics. Therefore, a good understanding of the concept of HRQoL and its measurement instruments is a prerequisite for both researchers and clinicians. The European Academy for Dermatology and Venereology (EADV) Taskforce on Quality of Life encourages the application of HRQoL instruments in research and clinical practice, and with this manuscript, the Taskforce aims to contribute to the quality of this application. In dermatology, a large number of HRQoL instruments exist and herewith, we summarize the most commonly used generic and dermatology-specific HRQoL instruments. Information is given on the most important psychometric characteristics of these instruments, including: scale structure, reliability, validity and responsiveness. Furthermore, a flow chart is provided to support researchers and clinicians in selecting an existing instrument or, in case an appropriate instrument does not exist, in finding alternative solutions. The present manuscript is the first of a series of manuscripts to be written on behalf of the EADV Taskforce on Quality of Life, aiming to contribute to the scientific knowledge and measurement of patient reported outcomes in dermatological research and practice.

[Telemedicine: opinions of dermatovenerologist and patient].

The article presents the results of the survey of the dermatovenereologists and patients to explore their attitude to the telemedicine consultations. It is found that most of the dermatovenereologists have the positive attitude towards telemedicine consultations. From the perspective of patients using telemedicine technology is likely to breach the protection of personal privacy.

[Consultative dermatovenereologic help in multi-profile hospital based on internet technologies].

The authors of this article presented the organizational aspects of dermatovenereologic help in multiphasic hospital on the basis of IT. The scheme of web-consultation is developed. This scheme can bring dermatovenereologic help in outlying garrison and reduce the expenses of delivering of such help.

Health needs and service use of parlour-based prostitutes compared with street-based prostitutes: a cross-sectional survey.

OBJECTIVES: To compare the health needs of prostitutes (sex workers) working in massage parlours with that of those working on the streets. DESIGN: Cross-sectional survey. SETTING: Inner city, UK. POPULATION: Women aged 16 years and older selling sex in massage parlours. METHODS: Interviewer-administered questionnaires were undertaken with 71 parlour workers, and results were compared with our previous findings for street sex workers. MAIN OUTCOME MEASURES: Self-reported experiences of health and service use. RESULTS: In comparison with street sex workers, parlour sex workers were less likely to report chronic (43/71 versus 71/71; P < 0.001) and acute (10/71 versus 35/71; P < 0.001) illnesses but more likely to be registered with a GP (67/71 versus 59/71; P = 0.06). They were more likely than street sex workers to have been screened for sexually transmitted infections in the previous year (49/71 versus 33/71; P = 0.011) and more likely to use contraception in addition to condoms (34/71 versus 8/71; P < 0.001). They were less likely to be overdue for cervical screening (5/46 versus 19/48; P = 0.001), and more of those booked for antenatal care in the first trimester attended all follow-up appointments (28/37 versus 14/47; P < 0.001). Fewer parlour sex workers used heroin (4/71 versus 60/71; P < 0.001), crack cocaine (5/71 versus 62/71; P < 0.001) or injected drugs (2/71 versus 41/71 versus; P < 0.001) They reported fewer episodes of intercourse per week (mean 14 versus 22; P < 0.001) with fewer different men (mean 11 versus 19; P < 0.001), less of whom were new (mean 8 versus 13; P < 0.001). CONCLUSIONS: The two groups had very different health experiences, risk-taking behaviour and use of services. To be effective in improving health, different types of service delivered in different settings for different groups are required.

Fear of venepuncture as a barrier to testing for blood-borne infection and use of an oral fluid test as an alternative to venepuncture in a genitourinary medicine clinic.

OBJECTIVE: A survey of 505 consecutive patients attending a UK genitourinary medicine clinic (GUM) included a psychometric tool to compute a fear of venepuncture (FOV) score, responses to the offer of venepuncture and to alternative testing. METHOD: An oral fluid test (OFT) was available to test for blood-borne infection (BBI). Completed fear scores were provided by 299 (59%) patients routinely offered venepuncture, of whom 72 (24%) who did not have venepuncture had higher fear scores compared with 227 (76%) who had venepuncture (p<0.001). RESULTS: Both FOV and female sex were independent predictors of not having venepuncture. CONCLUSIONS: FOV is an important barrier to uptake of venepuncture. FOV may not always be recognised by health carers. OFT is an acceptable alternative test for some patients with needle aversion who decline venepuncture.

[Contribution of Academician D. K. Zabolotnyi to the development of venereology (to 140th aniversary of birthday and 100th aniversary of opening of the first Syphilology Laboratory in Russia)].

The Contribution of D. K. Zabolotnogo to the development of venerology is discussed in the article. Numerous scientific papers of D. K. Zabolotnogo are dedicated to aetiology, pathogenesis, epidemiology and prophylactics of three infections: pestilence, cholera and syphilis.

A care package for managing female sexual assault in genitourinary medicine.

This paper describes the development of a designated in-house service for the management of adult female victims of sexual assault within the Department of Genitourinary Medicine (GUM) at St Mary's Hospital, London. This was set up in 1994 as a need was identified by medical, nursing, psychological and health advising staff for an appropriate streamlined service which would provide comprehensive sexual health screening, psychological support and therapy and adequate medico-legal documentation within the limitations of a busy GUM clinic. A structured package of care consisting of medical and psychological protocols with training for relevant staff and a specialist in-house referral clinic was introduced. Fifty-four patients were seen during the first 17 months of the service, the notes of 48 of these were examined and relevant epidemiological and audit data are presented here. By auditing the quality of documentation before and after the introduction of the protocols specifically looking at the appropriateness and comprehensiveness of the sexually transmitted diseases screen and the medico-legal documentation it was clear that the quality of care to these patients was improved. We present here the development of these protocols, a detailed description of the protocols themselves and the method of their implementation.