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Xu KR, Onamusi T, Vasquez R, Glass DA, Carroll BT. Barriers to Health Literacy in Skin Bleaching: A Cross-Sectional Study of Reddit Discussion Posts. Dermatol Surg 2024:00042728-990000000-00809. [PMID: 38770929 DOI: 10.1097/dss.0000000000004241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Katie R Xu
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Toluwalashe Onamusi
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Rebecca Vasquez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Donald A Glass
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bryan T Carroll
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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2
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Sax JL, McFarland CD, Carroll BT. Limitations of the Commercially Available Gene Expression Test in Predicting Cutaneous Squamous Cell Carcinoma Metastasis and Clinical Outcomes. J Am Acad Dermatol 2024:S0190-9622(24)00746-1. [PMID: 38762012 DOI: 10.1016/j.jaad.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 04/17/2024] [Accepted: 05/03/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Clinical genetic tests are integral to healthcare decision-making. However, the unclear regulatory framework, especially regarding products that evade stringent FDA oversight, may compromise test validity and transparency. OBJECTIVE To critically evaluate the DecisionDx® cutaneous squamous cell carcinoma test by Castle Biosciences for its dataset biases, gene panel selection, and reported accuracy metrics, providing insight into broader challenges in the clinical genetic testing landscape. METHODS Independent analyses of the DecisionDx®-SCC 40-GEP test data from Castle Biosciences were conducted. These included comparisons to clinical genetic testing standards, analysis of prevalence metrics against national cSCC rates, gene ontology of 34 genes for cSCC associations, and evaluation of accuracy metrics. RESULTS The DecisionDx®-SCC met 11 of 44 CDC's ACCE criteria for clinical genetic testing. Its dataset showed a metastasis prevalence higher than the national average. Out of 34 genes, 15 had known associations with cSCC. Inconsistencies in accuracy metrics presentation were noted, particularly in moderate and high-risk stratifications. CONCLUSION Analysis of DecisionDx®-SCC indicates potential biases and ambiguities, exacerbated by differences between FDA and CLIA standards. This highlights the need for systematic validation and a unified regulatory approach, stressing the necessity for precise and dependable genetic testing in patient care.
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Affiliation(s)
- Joel L Sax
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, 44106, USA
| | - Christopher D McFarland
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, 44106, USA
| | - Bryan T Carroll
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio, 44106, USA; Department of Dermatology, University Hospitals, Cleveland, Ohio, 44145, USA.
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3
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Savage KT, Chen J, Schlenker K, Pugliano-Mauro M, Carroll BT. Geriatric Dermatologic Surgery Part II: Peri and intraoperative considerations in the geriatric dermatologic surgery patient. J Am Acad Dermatol 2024:S0190-9622(24)00546-2. [PMID: 38580086 DOI: 10.1016/j.jaad.2024.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/12/2024] [Accepted: 02/28/2024] [Indexed: 04/07/2024]
Abstract
Geriatric patients compose a growing proportion of the dermatologic surgical population. Dermatologists and dermatologic surgeons should be cognizant of the unique physiologic considerations that accompany this group to deliver highly effective care. The purpose of this article is to discuss the unique preoperative, intraoperative, and postoperative considerations geriatric patients present with to provide goal-concordant care. Preoperative considerations include medication optimization and anxiolysis. Intraoperative considerations such as fall-risk assessment and prevention, sundowning, familial support, and pharmacologic interactions will be discussed. Lastly, effective methods for optimizing post-operative wound care, home care, and follow up are reviewed.
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Affiliation(s)
- Kevin T Savage
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeffrey Chen
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - Bryan T Carroll
- Department of Dermatology, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA; Adjunct Professor, Department of Pharmacology, University of Pittsburgh, Pittsburgh, PA, USA.
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4
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Savage KT, Chen J, Schlenker K, Pugliano-Mauro M, Carroll BT. Geriatric Dermatologic Surgery Part I: Frailty assessment and palliative treatments in the geriatric dermatology population. J Am Acad Dermatol 2024:S0190-9622(24)00545-0. [PMID: 38580087 DOI: 10.1016/j.jaad.2024.02.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/12/2024] [Accepted: 02/28/2024] [Indexed: 04/07/2024]
Abstract
Longer life expectancy and increasing keratinocyte carcinoma incidence contribute to an increase in geriatric patients presenting for dermatologic surgery. Unique considerations accompany geriatric patients including goals of care, physiologic changes in medication metabolism, cognitive decline, and frailty. Limited geriatric training in dermatology residency has created a knowledge gap and dermatologic surgeons should be familiar with challenges facing older patients to provide interventions more congruent with goals and avoid overtreatment. Frailty assessments including the Geriatric 8 and Karnofsky Performance Scale are efficient tools to identify patients who are at risk for poor outcomes and complications. When frail patients are identified, goals of care discussions can be aided using structured palliative care frameworks including the 4Ms, REMAP, and Serious Illness Conversation Guide. Most geriatric patients will tolerate standard of care treatments including invasive modalities like Mohs surgery and excision. However, for frail patients, non-standard treatments including topicals, energy-based devices, and intralesional chemotherapy may be appropriate options to limit patient morbidity while offering reasonable disease control.
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Affiliation(s)
- Kevin T Savage
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeffrey Chen
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - Bryan T Carroll
- Department of Dermatology, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA; Adjunct Professor, Department of Pharmacology, University of Pittsburgh, Pittsburgh, PA, USA.
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5
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Pisano C, Leitenberger JJ, Pugliano-Mauro M, Carroll BT. Updates in Skin Cancer in Transplant Recipients and Immunosuppressed Patients: Review of the 2022-2023 Scientific Symposium of the International Immunosuppression and Transplant Skin Cancer Collaborative. Transpl Int 2024; 37:12387. [PMID: 38562207 PMCID: PMC10982388 DOI: 10.3389/ti.2024.12387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
The International Immunosuppression and Transplant Skin Cancer Collaborative (ITSCC) and its European counterpart, Skin Care in Organ Transplant Patients-Europe (SCOPE) are comprised of physicians, surgeons, and scientist who perform integrative collaborative research focused on cutaneous malignancies that arise in solid organ transplant recipients (SOTR) and patients with other forms of long-term immunosuppression. In October 2022, ITSCC held its biennial 4-day scientific symposium in Essex, Massachusetts. This meeting was attended by members of both ITSCC and SCOPE and consisted of specialists including Mohs micrographic and dermatologic oncology surgeons, medical dermatologists, transplant dermatologists, transplant surgeons, and transplant physicians. During this symposium scientific workshop groups focusing on consensus standards for case reporting of retrospective series for invasive squamous cell carcinoma (SCC), defining immunosuppressed patient status for cohort reporting, development of multi-institutional registry for reporting rare tumors, and development of a KERACON clinical trial of interventions after a SOTRs' first cutaneous SCC were developed. The majority of the symposium focused on presentation of the most up to date research in cutaneous malignancy in SOTR and immunosuppressed patients with specific focus on chemoprevention, immunosuppression regimens, immunotherapy in SOTRs, spatial transcriptomics, and the development of cutaneous tumor registries. Here, we present a summary of the most impactful scientific updates presented at the 2022 ITSCC symposium.
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Affiliation(s)
- Catherine Pisano
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Justin J. Leitenberger
- Department of Dermatology, Oregon Health & Science University, Portland, OR, United States
| | - Melissa Pugliano-Mauro
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Bryan T. Carroll
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
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6
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Mahlberg SJ, Sarac R, Carroll BT. Efficient suturing in herniating adipose with an assistant's technique of tissue displacement. J Am Acad Dermatol 2024; 90:e66. [PMID: 36191685 DOI: 10.1016/j.jaad.2022.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Scott J Mahlberg
- Department of Dermatology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio.
| | - Rebecca Sarac
- Department of Dermatology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Bryan T Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
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7
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Wei AH, Zheng DX, Cullison CR, Scott JF, Carroll BT. Incidence and characteristics of acral lentiginous melanoma in Asian Americans and Pacific Islanders. J Am Acad Dermatol 2024; 90:374-376. [PMID: 37734664 DOI: 10.1016/j.jaad.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Angela H Wei
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
| | - David X Zheng
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Christopher R Cullison
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bryan T Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
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8
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Ouyang K, Gamal A, Wilkowski CM, Mahlberg SJ, Carroll BT. Microbial Contamination of Smart Watches in Dermatologic Surgeries: A Cross-Sectional Study. Dermatol Surg 2024; 50:192-193. [PMID: 37890019 PMCID: PMC10873120 DOI: 10.1097/dss.0000000000003998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Affiliation(s)
- Kelsey Ouyang
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH
| | - Ahmed Gamal
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | | | - Scott J. Mahlberg
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Bryan T. Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
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9
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Wilkowski CM, Maytin AK, Klatzky RL, Carroll BT. A pilot study comparing the user preference of different forms of mechanical vibration. Arch Dermatol Res 2024; 316:69. [PMID: 38197978 DOI: 10.1007/s00403-023-02797-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 01/11/2024]
Affiliation(s)
| | | | - Roberta L Klatzky
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Bryan T Carroll
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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10
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Kim U, Hoehn RS, Schwartz GK, Cullen J, Bordeaux JS, Mangla A, Carroll BT. Evaluating disruptions in melanoma diagnosis resulting from the COVID-19 pandemic from a community-based perspective. J Am Acad Dermatol 2024; 90:147-150. [PMID: 37666421 DOI: 10.1016/j.jaad.2023.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Affiliation(s)
- Uriel Kim
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
| | - Richard S Hoehn
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Gary K Schwartz
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Jennifer Cullen
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Jeremy S Bordeaux
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Ankit Mangla
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Division of Hematology and Oncology, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Bryan T Carroll
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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11
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Reddy HA, Maytin A, DeMeo D, Wilkowski C, Carroll BT. Response to "Role of Health Literacy Screening in Clinical Practice". J Am Acad Dermatol 2024; 90:e41. [PMID: 37751778 DOI: 10.1016/j.jaad.2023.08.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 09/28/2023]
Affiliation(s)
- Haarika A Reddy
- Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Alexander Maytin
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Dustin DeMeo
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Bryan T Carroll
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals, Cleveland, Ohio
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12
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Kim U, Koroukian S, Rose J, Hoehn RS, Carroll BT. US Cancer Detection Decreased Nearly 9 Percent During The First Year Of The COVID-19 Pandemic. Health Aff (Millwood) 2024; 43:125-130. [PMID: 38190599 DOI: 10.1377/hlthaff.2023.00767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
We investigated the impact of the COVID-19 pandemic on cancer detection, using data from the Surveillance, Epidemiology, and End Results Program, which recently released data through the first year of the pandemic (2020). Across all cancer sites, cancer incidence fell by 8.7 percent. The most common cancers that experienced the largest disruptions were lung and bronchus, melanoma of the skin, and thyroid cancer.
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Affiliation(s)
- Uriel Kim
- Uriel Kim , Case Western Reserve University, Cleveland, Ohio
| | | | - Johnie Rose
- Johnie Rose, Case Western Reserve University
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13
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Onamusi TA, Wilkowski CM, Curtis KK, Kumar Y, Sharma TR, Carroll BT. Identifying sunscreen deserts in Cuyahoga County. Arch Dermatol Res 2023; 316:32. [PMID: 38064018 DOI: 10.1007/s00403-023-02778-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/16/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023]
Abstract
Low sunscreen use in patients of color (POC) is multifactorial and could be partially attributable to lack of access or the lack of knowledge about its use beyond skin cancer prevention. Dyschromia is among the top diagnoses for POC and sunscreen is first-line management. POC and lower socioeconomic status often face health disparities and are susceptible to having difficulty accessing food, health care, and medication. We look to see if they extend to sunscreen access by evaluating physical retailers. This study investigated sunscreen access by identifying potential sunscreen deserts and characterizing sunscreen availability and affordability in Cuyahoga County, Ohio. Sunscreen deserts were defined as census tracts that were both low-income and low-access, adapted from the definition of food deserts. Google Maps search of "sunscreen" and "sunscreen store" in Cuyahoga County identified sunscreen retailers to geocode addresses. Total number and average cost of sunscreens were collected for each retailer and compared by community type. Fisher exact test, analysis of variance, and logistic regression were used for analysis. One hundred forty-six retailers were included in analysis of four hundred twenty-one census tracts in the county. Sixty-seven tracts met the definition of sunscreen desert. Majority White tracts were less likely to be deserts and had more sunscreen formulations, than Majority Black tracts (p < 0.001). The majority of sunscreen deserts were in predominantly black communities, which had fewer stores and sunscreen formulations available. These findings indicate a lack of sunscreen available to a demographic of patients that could benefit from increased access, as it would help manage hyperpigmentation.
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Affiliation(s)
- Toluwalashe A Onamusi
- Department of Dermatology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Caroline M Wilkowski
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kristen K Curtis
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Yash Kumar
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Timmie R Sharma
- Department of Dermatology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Bryan T Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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14
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Govas P, Ha MV, Wessel CB, Hurst A, Gordon BR, Carroll BT. Reported Outcome Measures in Mohs Micrographic Surgery in Studies With Defined Techniques for Embedding and Processing of Tissue: A Systematic Review. Dermatol Surg 2023; 49:1116-1121. [PMID: 37962132 DOI: 10.1097/dss.0000000000004013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) is a technique that combines surgical excision and histologic evaluation to achieve higher cure rates for skin cancer than traditional surgical excision. Competing performance measures have fostered numerous histologic techniques for MMS. OBJECTIVE To analyze differences in primary outcomes in the published literature regarding the technique of tissue processing and embedding during the MMS process. METHODS A systematic review was performed of the published literature in MEDLINE, PubMed, Embase, and Cochrane library that included a description of the manipulation of tissue during the grossing and embedding steps of MMS. RESULTS Inclusion criteria were met by 61 articles. Of these studies, the cure/recurrence rate was assessed in 1 article (1.6%), tissue conservation was assessed in 47 (77%), time-saving was assessed in 35 (57%), cost-saving was assessed in 6 (10%), and decreased artifact were assessed in 20 (33%). CONCLUSION There is a lack of standardization for assessing clinical outcomes in the published literature regarding MMS process techniques. Cure is a critical outcome in studies comparing MMS processing methodologies.
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Affiliation(s)
- Panayiota Govas
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Megan V Ha
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Charles B Wessel
- University of Pittsburgh, Health Sciences Library System, Pittsburgh, Pennsylvania
| | - Anne Hurst
- Atlantic Skin Cancer Surgery, Virginia Beach, Virginia
| | - Beth R Gordon
- Department of Internal Medicine, NYU Langone Health, New York, New York
| | - Bryan T Carroll
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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15
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Ha MV, McCormick TS, Salem I, Al-Shakhshir H, Ghannoum MA, Carroll BT. Skin and gut microbial associations with squamous cell carcinoma in solid organ transplant recipients. Arch Dermatol Res 2023; 315:2709-2713. [PMID: 37278910 DOI: 10.1007/s00403-023-02644-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 04/25/2023] [Accepted: 05/17/2023] [Indexed: 06/07/2023]
Abstract
Solid organ transplant recipients (SOTRs) are burdened with a significantly higher risk of squamous cell carcinoma (SCC) compared to the general population. Accumulating evidence suggests the potential influence of microbial dysbiosis on transplant outcomes. Based on these observations, we sought to identify differences in the cutaneous and gut microbiomes of SOTRs with and without a history of SCC. This case-control study collected and analyzed non-lesional skin and fecal samples of 20 SOTRs > 18 years old with either ≥ 4 diagnoses of SCC since most recent transplant (n = 10) or 0 diagnoses of SCC (n = 10). The skin and gut microbiomes were investigated with Next-Generation Sequencing, and analysis of variance (ANOVA) followed by Tukey pairwise comparison procedure was used to test for differences in taxonomic relative abundances and microbial diversity indices between the two cohorts. Analyses of the skin microbiome showed increased bacterial and reduced fungal diversity in SOTRs with a history of SCC compared to SOTRs without a history of SCC (bacterial median Shannon diversity index (SDI) = 3.636 and 3.154, p < 0.05; fungal SDI = 4.474 and 6.174, p < 0.05, respectively). Analyses of the gut microbiome showed reduced bacterial and fungal diversity in the SCC history cohort compared to the SCC history-negative cohort (bacterial SDI = 2.620 and 3.300, p < 0.05; fungal SDI = 3.490 and 3.812, p < 0.05, respectively). The results of this pilot study thus show a trend toward the bacterial and fungal communities of the gut and skin being distinct in SOTRs with a history of SCC compared to SOTRs without a history of SCC. It furthermore demonstrates the potential for microbial markers to be used in the prognostication of squamous cell carcinoma risk in solid organ transplant recipients.
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Affiliation(s)
- Megan V Ha
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- Department of Dermatology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 3500, Cleveland, OH, 44106, USA.
| | - Thomas S McCormick
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Iman Salem
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Hilmi Al-Shakhshir
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Mahmoud A Ghannoum
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 3500, Cleveland, OH, 44106, USA
| | - Bryan T Carroll
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 3500, Cleveland, OH, 44106, USA
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16
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Decosma L, Kumar Y, McCormick TS, Carroll BT. Do Indoor LED Grow Lights Emit Sufficient UV Irradiation to Pose an Increased Skin Cancer Risk? Dermatol Surg 2023; 49:1041-1042. [PMID: 37643237 DOI: 10.1097/dss.0000000000003911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Lorvens Decosma
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Yash Kumar
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Thomas S McCormick
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Bryan T Carroll
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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17
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Reddy HA, Maytin A, DeMeo D, Wilkowski CM, Carroll BT. Health literacy screening tools to identify patients at risk of misunderstanding wound care instructions after dermatologic surgery. J Am Acad Dermatol 2023; 89:837-839. [PMID: 37321480 DOI: 10.1016/j.jaad.2023.05.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/25/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Haarika A Reddy
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Alexander Maytin
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Dustin DeMeo
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Caroline M Wilkowski
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Bryan T Carroll
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals, Cleveland, Ohio
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18
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DeMeo D, Reddy HA, Cowden MP, Maytin AK, Carroll BT. Readability of iPledge materials for isotretinoin education in English and Spanish. Arch Dermatol Res 2023; 315:2175-2178. [PMID: 36918437 DOI: 10.1007/s00403-023-02598-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 12/29/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023]
Abstract
iPledge is a program meant to reduce the incidence of pregnancy in patients using isotretinoin, a teratogenic acne medication. Adherence to the iPledge program is essential in preventing pregnancy complications among isotretinoin users. We present an analysis of the readability of both English and Spanish patient education materials published by iPledge. Readability grade levels for twelve iPledge documents were compared using both Lexile and graph-based methods (English: Fry; Spanish: Gilliam-Peña-Mountain). In both English and Spanish, aggregate Lexile grade levels are written below the 6th grade level; however, approximately one-third of pages are written above the 6th grade level. Aggregate graph-based grade levels are written above the 6th grade level as well. This suggests that iPledge materials should be rewritten at a lower grade level. Doing so may allow more patients to understand and utilize the important information presented in iPledge.
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Affiliation(s)
- Dustin DeMeo
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Haarika A Reddy
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Mary P Cowden
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Alexander K Maytin
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Bryan T Carroll
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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19
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Rao EM, Maden AR, Hill ST, Carroll BT. How We Do It: Subsection Grossing for Partial- to Full-Thickness Sections of the Nasal Ala During Mohs Micrographic Surgery. Dermatol Surg 2023; 49:805-806. [PMID: 37249517 DOI: 10.1097/dss.0000000000003845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Elizabeth M Rao
- University Hospitals Cleveland Medical Center, Department of Dermatology, Cleveland, Ohio
| | - Angel R Maden
- University Hospitals Cleveland Medical Center, Department of Dermatology, Cleveland, Ohio
| | - Sheena T Hill
- University Hospitals Cleveland Medical Center, Department of Dermatology, Cleveland, Ohio
| | - Bryan T Carroll
- University Hospitals Cleveland Medical Center, Department of Dermatology, Cleveland, Ohio
- †Case Western Reserve University School of Medicine, Cleveland, Ohio
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20
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Govas P, Ramanathan D, Ketchum A, Carroll BT. Levels of Evidence Within Dermatology: Bibliometric Trends Compared With General Medicine and General Surgery From 2008 to 2017. Dermatol Surg 2023; 49:631-633. [PMID: 37011020 DOI: 10.1097/dss.0000000000003786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Affiliation(s)
- Panayiota Govas
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Diya Ramanathan
- Department of Dermatology, University Hospitals of Cleveland, Cleveland, Ohio
| | - Andrea Ketchum
- University of Pittsburgh, Health Sciences Library System, Pittsburgh, Pennsylvania
| | - Bryan T Carroll
- Department of Dermatology, University Hospitals of Cleveland, Cleveland, Ohio
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
- Department of Pharmacology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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21
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Eley SJ, Carroll BT. Intralesional Triamcinolone Acetonide Injection of Keloid Resulting in Copious Purulence. Dermatol Surg 2023; 49:628-629. [PMID: 37040533 DOI: 10.1097/dss.0000000000003795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- Sarah J Eley
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Bryan T Carroll
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
- Department of Dermatology, University Hospitals, Cleveland, Ohio
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22
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Fane LS, Maden AR, Hill ST, Wilkowski CM, Carroll BT. Mohs Surgery on the Complex Contours of the Ear Optimized With Coordinated Subdivision to Isolate Sections With Single Curves. Dermatol Surg 2023; 49:621-623. [PMID: 37027239 DOI: 10.1097/dss.0000000000003797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Lauren S Fane
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Angel R Maden
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sheena T Hill
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Bryan T Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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23
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Cwalina TB, Jella TK, Tripathi R, Carroll BT. Financial stress among skin cancer patients: a cross-sectional review of the 2013-2018 National Health Interview Survey. Arch Dermatol Res 2023; 315:1003-1010. [PMID: 35192005 PMCID: PMC8861625 DOI: 10.1007/s00403-022-02330-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 11/12/2022]
Abstract
Financial stress among skin cancer patients may limit treatment efficacy by forcing the postponement of care or decreasing adherence to dermatologist recommendations. Limited information is available quantifying the anxiety experienced by skin cancer patients from both healthcare and non-healthcare factors. Therefore, the present study sought to perform a retrospective cross-sectional review of the 2013-2018 cycles of the National Health Interview Survey (NHIS) to determine the prevalence, at-risk groups, and predictive factors of skin cancer patient financial stress. Survey responses estimated that 11.45% (95% Cl 10.02-12.88%) of skin cancer patients experience problems paying medical bills, 20.34% (95% Cl 18.97-21.71%) of patients worry about the medical costs, 13.73% (95% Cl 12.55-14.91%) of patients worry about housing costs, and 37.48% (95% Cl 35.83-39.14%) of patients worry about money for retirement. Focusing on at-risk groups, black patients, uninsured patients, and patients with low incomes (< 200% poverty level) consistently experienced high rates of financial stress for each of the four measures. Multivariable logistic regression revealed low education, lack of insurance, and low income to be predictive of financial stress. These findings suggest that a considerable proportion of skin cancer patients experience financial stress related to both healthcare and non-healthcare factors. Where possible, the additional intricacy of treating patients at risk of high financial stress may be considered to optimize patient experience and outcomes.
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Affiliation(s)
- Thomas B Cwalina
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- Department of Dermatology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Tarun K Jella
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Raghav Tripathi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
- The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Bryan T Carroll
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
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24
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Mazmudar RS, Vaccarello A, Onamusi T, Sarfo A, Sharma T, Carroll BT. Availability and content of diversity, equity, and inclusion information on dermatology residency program websites. J Am Acad Dermatol 2023; 88:891-893. [PMID: 36244553 DOI: 10.1016/j.jaad.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Rishabh S Mazmudar
- Department of Internal Medicine, The MetroHealth System/Case Western Reserve University, Cleveland, Ohio.
| | - Annalise Vaccarello
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Toluwalashe Onamusi
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Akua Sarfo
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Timmie Sharma
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Bryan T Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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25
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Wilkowski C, Maden AR, Cassidy Z, Carroll BT. A Hybrid Heat Sink and Glass Slide Method for Challenging Mohs Tissue Embedding. Dermatol Surg 2023; 49:524-525. [PMID: 36946650 DOI: 10.1097/dss.0000000000003759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Affiliation(s)
| | - Angel R Maden
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Zipporah Cassidy
- Skin Cancer Center of Fairfield County, Dermatology Physicians of CT, Norwalk, Connecticut
| | - Bryan T Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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26
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Narang J, Zheng DX, Xu JR, Vaccarello A, Mulligan KM, Carroll BT, Sharma TR. Estimating carbon emission and cost savings from virtual dermatology residency interviews. J Am Acad Dermatol 2023; 88:676-678. [PMID: 35803404 PMCID: PMC9813268 DOI: 10.1016/j.jaad.2022.06.1197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/20/2022] [Accepted: 06/29/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Jatin Narang
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - David X Zheng
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - James R Xu
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Annalise Vaccarello
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Kathleen M Mulligan
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Bryan T Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Timmie R Sharma
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
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27
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Rao EM, Lawrence MM, Hayek SM, Klatzky RL, Carroll BT. Assessing sensory hypersensitivity in interventional pain patients: a pilot study. Reg Anesth Pain Med 2023:rapm-2022-103972. [PMID: 36635044 DOI: 10.1136/rapm-2022-103972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Affiliation(s)
- Elizabeth Marley Rao
- Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Melinda M Lawrence
- Division of Pain Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Anesthesiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Salim M Hayek
- Division of Pain Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Anesthesiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Roberta L Klatzky
- Department of Psychology, Human Computer Interaction Institute, Neuroscience Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Bryan T Carroll
- Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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28
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Eley SJ, DeMeo DP, Korman NJ, Carroll BT. Equity in the usage of biologics for psoriasis in the working poor. Arch Dermatol Res 2022; 315:1029-1031. [PMID: 36307556 DOI: 10.1007/s00403-022-02410-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 10/13/2022] [Indexed: 11/02/2022]
Abstract
Biologic therapy often produces excellent outcomes for psoriasis; however, their high cost may create a barrier to appropriate usage, especially in the working poor population. This study defines working poor as income below 150% of the federal poverty level and holding or seeking work at least half a year. Our study aims to identify gaps in access to biologic therapy for psoriasis based on working poor status. This retrospective cross-sectional study was conducted utilizing data from the Medical Expenditure Panel Survey (MEPS) from 2007 to 2018. Patients were stratified into working poor (57,091), non-working poor (43,421), and non-poor (693,841) groups for analysis. In univariate analysis, WP (4.0%, ph p = 0.003) and NWP (2.8%, ph p = 0.006) were less likely to use biologics than NP (15.8%) (X2 p < 0.001). A binary logistic regression showed that WP vs. NP status (OR 0.27, p = 0.05), female vs. male sex (OR 0.55, p = 0.05), Black vs. White race (OR 0.14, p = 0.02), and Medicare vs. private insurance (OR 0.09, p = 0.03) had lower odds of using biologics. After correcting for age, sex, race, and insurance, WP confers an independent risk factor to lower biologic prescriptions. The high cost of biologics in the setting of financial barriers for some patients should be considered by physicians prescribing biologic therapy for psoriasis.
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29
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Ramanathan D, Govas P, Ketchum A, Carroll BT. 34860 Levels of evidence within dermatology; bibliometric trends compared with general medicine and general surgery from 2008-2017: A bibliometric systematic review. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Reddy H, Russell E, DeMeo D, Xu V, Goel M, Lehman JF, Carroll BT. 34804 Patient attitudes toward digital surveillance research after Mohs micrographic surgery. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Barzallo DK, DeMeo D, Carroll BT. 32316 Five-year cancer-specific survival for melanoma in LEP: An analysis of the SEER database. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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32
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Garcia E, Younis J, Carroll BT, Glass DA. 35339 Comparative analysis of social media sentiment between keloids and psoriasis: A prospective observational study. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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33
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Ning AY, Levoska MA, Zheng DX, Carroll BT, Wong CY. Treatment Options and Outcomes for Squamous Cell Carcinoma of the Nail Unit: A Systematic Review. Dermatol Surg 2022; 48:267-273. [PMID: 34889218 DOI: 10.1097/dss.0000000000003319] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nail squamous cell carcinoma (nSCC) is the most common nail unit malignancy. However, no studies to date have evaluated treatment options for nSCC based on recurrence data while controlling for invasion. OBJECTIVE To identify temporal trends in nSCC treatment modalities and compare treatment outcomes based on invasion. METHODS AND MATERIALS The authors performed a systematic review of articles published on PubMed, MEDLINE, and Scopus from inception to April 2020 reporting treatment of nSCC. The primary outcome was disease recurrence. RESULTS Reports of nSCC treatments have increased in the past decade. Mohs micrographic surgery (MMS) is the most common treatment reported overall. The lowest recurrence rates for in situ nSCC were seen with wide surgical excision (WSE) and MMS. For invasive disease, the recurrence rates were lowest with amputation, MMS, and WSE. CONCLUSION Complete surgical excision of nSCC with either WSE or MMS is associated with lower recurrence rates than limited excision and nonsurgical therapies, regardless of degree of invasion. The prognostic significance of in situ versus invasive disease remains unclear. Confirmation of complete excision may improve outcomes. Digital amputation is indicated for nSCC with bone invasion. Prospective studies and randomized controlled trials are needed to directly compare surgical modalities for nSCC.
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Affiliation(s)
- Anne Y Ning
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Melissa A Levoska
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - David X Zheng
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Bryan T Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Christina Y Wong
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
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34
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Govas P, Ketchum A, Kazi R, Gordon BR, Carroll BT. Pain Intensity Assessment Scales for Dermatologic Surgery Patients: A Systematic Review. Dermatol Surg 2022; 48:232-238. [PMID: 34923536 DOI: 10.1097/dss.0000000000003353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pain assessment plays an important role in dermatologic surgery. The numeric rating scale (NRS), visual analog scale (VAS), verbal rating scale (VRS), and Faces Pain Scale (FPS) are commonly used scales for pain measurement. Conflicting evidence exists regarding the use of each. Prompt pain recognition and treatment during procedures result in higher patient satisfaction. OBJECTIVE Determine the most applicable scale for acute pain measurement in dermatologic surgery. MATERIALS AND METHODS This systematic review was performed in accordance with PRISMA-Supplemental Digital Content 4, http://links.lww.com/DSS/A976 (PROSPERO; CRD42018091058). PubMed, Cochrane, EMBASE, Scopus, and Web of Science were searched between April 24, 2018, and May 06, 2018. The search query consisted of pain, pain measurement (NRS, VAS, VRS, and FPS), and assessment/comparison. The inclusion criteria included English language literature with primary/secondary outcome objectives directly comparing ≥2 pain scales in acute pain (age: 13+). Study end points included interscale correlations, patient preferences, provider preferences, study author recommendations, and failure rates. RESULTS Eight hundred seven studies were retrieved: A total of 42 studies were included. The visual analog scale (n = 42) was most studied, followed by NRS (n = 29), VRS (n = 27), and FPS (n = 11). 93.1% studies showed a high statistical correlation between VAS and NRS. Patients preferred NRS (n = 8/11), followed by FPS (n = 3/11), VRS (n = 2/11), and VAS (n = 1/11). Study authors recommended NRS/VAS (n = 8/19), VRS (n = 6/19), and FPS (n = 1/19). Providers preferred NRS (n = 2/3) and VRS (n = 1/3). The visual analog scale had the highest failure rate (n = 11/12). CONCLUSION The numeric rating scale is most applicable for dermatologic surgery because of reported patient and provider preferences, lowest failure rates, and most frequent study author recommendations.
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Affiliation(s)
- Panayiota Govas
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Andrea Ketchum
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rashek Kazi
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Beth R Gordon
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bryan T Carroll
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
- Department of Dermatology, University Hospitals of Cleveland, Cleveland, Ohio
- Department of Pharmacology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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35
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Massey PR, Schmults CD, Li SJ, Arron ST, Asgari MM, Bavinck JNB, Billingsley E, Blalock TW, Blasdale K, Carroll BT, Carucci JA, Chong AH, Christensen SR, Chung CL, DeSimone JA, Ducroux E, Escutia-Muñoz B, Ferrándiz-Pulido C, Fox MC, Genders RE, Geusau A, Gjersvik P, Hanlon AM, Harken EBO, Hofbauer GF, Hopkins RS, Leitenberger JJ, Loss MJ, Del Marmol V, Mascaró JM, Myers SA, Nguyen BT, Oliveira WRP, Otley CC, Proby CM, Rácz E, Ruiz-Salas V, Samie FH, Seçkin D, Shah SN, Shin TM, Shumack SP, Soon SL, Stasko T, Zavattaro E, Zeitouni NC, Zwald FO, Harwood CA, Jambusaria-Pahlajani A. Consensus-Based Recommendations on the Prevention of Squamous Cell Carcinoma in Solid Organ Transplant Recipients: A Delphi Consensus Statement. JAMA Dermatol 2021; 157:1219-1226. [PMID: 34468690 PMCID: PMC9937447 DOI: 10.1001/jamadermatol.2021.3180] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE There is a paucity of evidence to guide physicians regarding prevention strategies for cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs). OBJECTIVE To examine the development and results of a Delphi process initiated to identify consensus-based medical management recommendations for prevention of CSCC in SOTRs. EVIDENCE REVIEW Dermatologists with more than 5 years' experience treating SOTRs were invited to participate. A novel actinic damage and skin cancer index (AD-SCI), consisting of 6 ordinal stages corresponding to an increasing burden of actinic damage and CSCC, was used to guide survey design. Three sequential web-based surveys were administered from January 1, 2019, to December 31, 2020. Pursuant to Delphi principles, respondents thoroughly reviewed all peer responses between rounds. Supplemental questions were also asked to better understand panelists' rationale for their responses. FINDINGS The Delphi panel comprised 48 dermatologists. Respondents represented 13 countries, with 27 (56%) from the US. Twenty-nine respondents (60%) were Mohs surgeons. Consensus was reached with 80% or higher concordance among respondents when presented with a statement, question, or management strategy pertaining to prevention of CSCC in SOTRs. A near-consensus category of 70% to less than 80% concordance was also defined. The AD-SCI stage-based recommendations were established if consensus or near-consensus was achieved. The panel was able to make recommendations for 5 of 6 AD-SCI stages. Key recommendations include the following: cryotherapy for scattered actinic keratosis (AK); field therapy for AK when grouped in 1 anatomical area, unless AKs are thick in which case field therapy and cryotherapy were recommended; combination lesion directed and field therapy with fluorouracil for field cancerized skin; and initiation of acitretin therapy and discussion of immunosuppression reduction or modification for patients who develop multiple skin cancers at a high rate (10 CSCCs per year) or develop high-risk CSCC (defined by a tumor with approximately ≥20% risk of nodal metastasis). No consensus recommendation was achieved for SOTRs with a first low risk CSCC. CONCLUSIONS AND RELEVANCE Physicians may consider implementation of panel recommendations for prevention of CSCC in SOTRs while awaiting high-level-of-evidence data. Additional clinical trials are needed in areas where consensus was not reached.
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Affiliation(s)
- Paul R. Massey
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chrysalyne D. Schmults
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sara J. Li
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah T. Arron
- Sarah Arron MD, A Professional Corporation, San Mateo, California
| | - Maryam M. Asgari
- Department of Dermatology, Massachusetts General Hospital, Boston,Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
| | | | | | - Travis W. Blalock
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Katie Blasdale
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Bryan T. Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - John A. Carucci
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Alvin H. Chong
- Skin Health Institute, Victoria, Australia,Department of Medicine (Dermatology), St Vincent’s Hospital Clinical School, The University of Melbourne, Victoria, Australia
| | - Sean R. Christensen
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Christina Lee Chung
- Montgomery Dermatology, King of Prussia, Pennsylvania,Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | | | - Emilie Ducroux
- Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
| | | | - Carla Ferrándiz-Pulido
- Department of Dermatology, Hospital Universitari Vall d’Hebron, Barcelona, Spain,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matthew C. Fox
- Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin
| | - Roel E. Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexandra Geusau
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Petter Gjersvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Allison M. Hanlon
- Department of Dermatology, Vanderbilt University, Nashville, Tennessee
| | | | | | - R. Samuel Hopkins
- Department of Dermatology, Oregon Health and Science University, Portland
| | | | - Manisha J. Loss
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Veronique Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - José M. Mascaró
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sarah A. Myers
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Bichchau T. Nguyen
- Department of Dermatology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts,Department of Dermatology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Walmar R. P. Oliveira
- Department of Dermatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Clark C. Otley
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Charlotte M. Proby
- Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Emőke Rácz
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Veronica Ruiz-Salas
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Faramarz H. Samie
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Deniz Seçkin
- Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Syed N. Shah
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Thuzar M. Shin
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | | | - Seaver L. Soon
- Scripps Green Hospital, Private Practice (The Skin Clinic MD), San Diego, California
| | - Thomas Stasko
- Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Elisa Zavattaro
- Dermatology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Nathalie C. Zeitouni
- Medical Dermatology Specialists, Phoenix, Arizona,Division of Dermatology, University of Arizona College of Medicine, Phoenix
| | - Fiona O’Reilly Zwald
- Piedmont Healthcare, Atlanta, Georgia,O’Reilly Comprehensive Dermatology Inc, Atlanta, Georgia,Mount Vernon Medical Center, Atlanta, Georgia
| | - Catherine A. Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, United Kingdom,The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Russell ER, Tripathi R, Carroll BT. Emergency department utilization for impetigo among the pediatric population: A retrospective study of the national emergency department sample 2013-2015. Pediatr Dermatol 2021; 38:1111-1117. [PMID: 34338362 DOI: 10.1111/pde.14729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite the large burden of impetigo in childhood and high frequency of pediatric emergency department (ED) visits for skin conditions, limited information exists on the use of EDs for impetigo among US children. OBJECTIVE Our study aimed to generate national estimates of ED utilization and to identify sociodemographic predictors of impetigo-related ED visits. METHODS This was a retrospective, cross-sectional study of children ages 1-17 presenting to EDs with a primary diagnosis of impetigo using years 2013-2015 of the Nationwide Emergency Department Sample. RESULTS Impetigo accounted for 163 909 of the 71 488, 511 pediatric ED visits and was the fourth most common presenting skin diagnosis. Controlling for sociodemographic factors, patients presenting to the ED with impetigo were most likely to be 6-11 years old, male, and from lower-income quartiles. Patients were most likely to be uninsured and most likely to present on weekends in the summer. CONCLUSION This study provided national-level estimates of ED use for impetigo among US children. Ultimately, the identification of factors associated with increased ED utilization may help in developing targeted interventions to reduce the use of emergency care for impetigo.
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Affiliation(s)
- Emma R Russell
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Raghav Tripathi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Bryan T Carroll
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center Department of Dermatology, Cleveland, OH, USA
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Narang J, Kalra M, Zheng DX, Russell ER, Obi E, Carroll BT, Sharma TR. 28420 Predictors of postresidency publication quantity and quality in dermatologists. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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38
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Narang J, Eversman A, Kalra M, Morgan F, Obi E, Russell ER, Wei AH, Zheng DX, Osei-Koomson W, Carroll BT, Sharma TR. 28400 Retrospective analysis of dermatology residency applicant’s research output from 2007-2018. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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39
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Ha MV, Salem I, Ghannoum M, Carroll BT. 26555 Characterizing the skin and fecal microbiome in solid organ transplant recipients. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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40
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Eversman A, Narang J, Zheng DX, Wei AH, Russell ER, Osei-Koomson W, Obi E, Morgan F, Kalra M, Nowacki AS, Carroll BT, Sharma TR. Factors associated with matching into research-focused dermatology residency programs. Arch Dermatol Res 2021; 314:991-994. [PMID: 34424403 DOI: 10.1007/s00403-021-02271-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022]
Abstract
Although dermatology is one of the most competitive specialties to match into, there is limited transparency in the residency match process. In this retrospective cohort study of 2234 allopathic medical graduates, we identify applicant characteristics associated with matching into research oriented dermatology programs. Many of the statistically significant variables in our study, including PhD/MD status, graduating from a Top-25 NIH funded medical school, increasing total number of pre-residency publications (PRPs), and increasing number of high-impact PRPs, correlate with future academic employment. Although literature shows an association between an increasing number of first author PRPs and future academic employment, we did not find number of first or last author PRPs to be predictive of matching into a research oriented residency program. A more comprehensive evaluation of an applicant's research output, considering both the final products of an applicant's research endeavors and an applicant's role in various projects, may better approximate an applicant's commitment to academics.
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Affiliation(s)
- Anna Eversman
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jatin Narang
- Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, OH, USA
| | - David X Zheng
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Angela H Wei
- Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, OH, USA
| | - Emma R Russell
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Wilhemina Osei-Koomson
- Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, OH, USA
| | - Elizabeth Obi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Frederick Morgan
- Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, OH, USA
| | - Mehak Kalra
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Amy S Nowacki
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Bryan T Carroll
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Dermatology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Timmie R Sharma
- Case Western Reserve University School of Medicine, Cleveland, OH, USA. .,Department of Dermatology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
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41
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Govas P, Ramanathan D, Ketchum A, Carroll BT. Systematic Review reporting quality within Dermatology; Bibliometric Trends compared with General Medicine and General Surgery from 2008-2017. J Am Acad Dermatol 2021; 87:225-228. [PMID: 34403704 DOI: 10.1016/j.jaad.2021.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Panayiota Govas
- University of Pittsburgh School of Medicine, Department of Dermatology, Pittsburgh, PA.
| | - Diya Ramanathan
- University Hospitals of Cleveland, Department of Dermatology, Cleveland, OH
| | - Andrea Ketchum
- University of Pittsburgh, Health Sciences Library System, Pittsburgh, PA
| | - Bryan T Carroll
- University Hospitals of Cleveland, Department of Dermatology, Cleveland, OH; Case Western Reserve University, Department of Dermatology, Cleveland, OH; University of Pittsburgh School of Medicine, Department of Pharmacology, Pittsburgh, PA
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Ha MV, Mazmudar RS, Carroll BT. Internet searches for Black dermatologists during the social justice movement of 2020. J Am Acad Dermatol 2021; 87:178-180. [PMID: 34293389 DOI: 10.1016/j.jaad.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/24/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Megan V Ha
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Rishabh S Mazmudar
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Bryan T Carroll
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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43
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Ramanathan D, Chu S, Prendes M, Carroll BT. Validated Outcome Measures and Postsurgical Scar Assessment Instruments in Eyelid Surgery: A Systematic Review. Dermatol Surg 2021; 47:914-920. [PMID: 33988553 DOI: 10.1097/dss.0000000000003077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Determining which postsurgical scar assessment instruments, if any, cover important eyelid outcome measures can either attest to the strength of one or more instruments or reveal the need for a more comprehensive scale. OBJECTIVE To systematically review validated outcome measures after eyelid surgery and postsurgical scar assessment tools to see whether any individual or combination of 2 assessment tools encompass all relevant, validated eyelid outcome measures. METHODS Systematic reviews of validated eyelid outcome measures and postsurgical scar assessment tools were conducted using PubMed/MEDLINE and Ovid. Outcome measure papers that met inclusion criteria were sorted into 8 categories: Patient Subjective, Visual Function, Mechanical Function, Daily Activities, Adverse Effects, Aesthetic Quantitative: Clinical Measurements, Aesthetic Qualitative: Global, and Aesthetic Qualitative: Specific. Outcome measure papers were categorized into tiers of evidence support, and assessment tools were evaluated based on which outcome measures each covered. RESULTS No one or combination of 2 assessment tools covered all selected eyelid outcome measures. Although measures related to the subjective patient experience were included in several of the assessment scales, none covered measures of visual function or eyelid-specific clinical measurements. CONCLUSION There is currently no existing postsurgical scar assessment instrument that covers all important eyelid-specific outcome measures.
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Affiliation(s)
- Diya Ramanathan
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sherman Chu
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Northwest, Lebanon, Oregon
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Mark Prendes
- Department of Ophthalmology and Visual Sciences, University Hospitals, Case Western
- Reserve University School of Medicine, Cleveland, Ohio
| | - Bryan T Carroll
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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44
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Chu S, Ramanathan D, Thuener JE, Carroll BT. Validated Outcome Measures and Postsurgical Scar Assessment Instruments in Auricular Surgery: A Systematic Review. Dermatol Surg 2021; 47:921-925. [PMID: 34081048 DOI: 10.1097/dss.0000000000003095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The utilization of an assessment instrument that successfully analyzes validated outcome measures for auricular surgery is important for advancing evidence-based medicine. OBJECTIVE To systematically review postsurgical scar assessment instruments and outcome measures after auricular surgery to assess if any individual or combination of 2 assessment instruments encompass all relevant, validated auricular outcome measures. METHODS Two systematic reviews were conducted using the PubMed/MEDLINE and Ovid databases: one for postauricular surgical outcome measures and another for postsurgical scar assessment instruments. Auricular outcome measure articles were selected for inclusion if they included at least one auricular-specific validated outcome measure, and assessment tool articles were included if they referenced one or more specific tool(s) specifically designed to assess postsurgical scars. Assessment tools were evaluated based on which outcome measures each covered. RESULTS There was no single postsurgical scar assessment instrument or combination of 2 instruments that covered all outcome measures within the 5 different categories (psychosocial well-being, functional, objective appearance, subjective appearance, and clinical-related outcomes) after auricular surgery. None of the instruments measured functional outcomes, such as the ability to wear glasses and hearing outcomes. CONCLUSION There is currently no existing postsurgical scar assessment instrument that covers all outcome measures after auricular surgery.
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Affiliation(s)
- Sherman Chu
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Northwest, Lebanon, Oregon
| | - Diya Ramanathan
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jason E Thuener
- Department of Otolaryngology, Head, and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Department of Otolaryngology, Head, and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Bryan T Carroll
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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45
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Narang J, Eversman A, Kalra M, Morgan F, Obi E, Russell ER, Wei AH, Zheng DX, Osei-Koomson W, Nowacki AS, Carroll BT, Sharma TR. Trends of Research Output of Allopathic Medical Students Matching Into Dermatology, 2007-2018. JAMA Dermatol 2021; 157:2781296. [PMID: 34132741 PMCID: PMC8209568 DOI: 10.1001/jamadermatol.2021.2000] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/25/2021] [Indexed: 11/14/2022]
Abstract
IMPORTANCE According to the National Residency Matching Program's biennial Charting Outcomes in the Match (NRMP ChOM) reports, the mean number of research items of matched allopathic dermatology applicants has nearly tripled since 2007, rising from 5.7 to 14.7. Research items are self-reported by applicants and serve as an approximation of research output. Because the NRMP research items field is unverified and reported as an aggregate of several different research pursuits, it may not be an accurate representation of applicant research output. OBJECTIVE To determine if the rise in NRMP-reported data is associated with a rise in verifiable, indexed publications from matched allopathic dermatology applicants from 2007 to 2018. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study including a bibliometric analysis on accepted applicant research output among 2234 matched allopathic dermatology applicants, with a total of 6229 publications, in dermatology residency programs for the years 2007, 2009, 2011, 2014, 2016, and 2018. MAIN OUTCOME AND MEASURES The primary outcomes were the mean number of peer-reviewed indexed publications and mean number of NRMP ChOM research items. Secondary outcomes assessed the quality of indexed publications by analyzing article type and journal of publication. RESULTS From 2007 to 2018, the mean number of indexed publications per matched dermatology applicant increased from 1.6 to 4.7 (203% increase). Indexed publications consistently compose a minority of NRMP ChOM research items (28.8% across the 6 years of the study). Nonindexed research items increased at more than double the rate of indexed publications. Bibliometric analysis showed that all other types of publications are increasing at a rate of 6 to 9 times that of basic science publications, dermatology-related publications increased at 5 times the rate of non-dermatology publications, and publications in lower-impact factor dermatology journals increased at 4 times the rate of publications in higher-impact factor dermatology journals. CONCLUSIONS AND RELEVANCE This cross-sectional study provides data on the research output of matched dermatology applicants. Indexed publications compose a minority of NRMP research items. Medical student self-reports of research output may emphasize research quantity over quality.
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Affiliation(s)
- Jatin Narang
- Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, Ohio
| | - Anna Eversman
- Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Mehak Kalra
- Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Frederick Morgan
- Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, Ohio
| | - Elizabeth Obi
- Case Western Reserve School of Medicine, Cleveland, Ohio
| | | | - Angela H. Wei
- Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, Ohio
| | - David X. Zheng
- Case Western Reserve School of Medicine, Cleveland, Ohio
| | | | - Amy S. Nowacki
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Bryan T. Carroll
- Case Western Reserve School of Medicine, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Timmie R. Sharma
- Case Western Reserve School of Medicine, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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46
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Zheng DX, Jella TK, Levoska MA, Ning AY, Cullison CR, Carroll BT, Scott JF. Workforce geography of older dermatologists during the COVID-19 pandemic. Dermatol Ther 2021; 34:e14917. [PMID: 33629446 PMCID: PMC7995123 DOI: 10.1111/dth.14917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/21/2021] [Accepted: 02/19/2021] [Indexed: 12/01/2022]
Affiliation(s)
- David X Zheng
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Tarun K Jella
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Melissa A Levoska
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Anne Y Ning
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Christopher R Cullison
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Bryan T Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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47
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Narang J, Morgan F, Eversman A, Kalra M, Osei-Koomson W, Obi E, Russell ER, Wei AH, Zheng DX, Carroll BT, Sharma TR. Trends in geographic and home program preferences in the dermatology residency match: A retrospective cohort analysis. J Am Acad Dermatol 2021; 86:645-647. [PMID: 33581188 DOI: 10.1016/j.jaad.2021.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Jatin Narang
- Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, Ohio
| | - Frederick Morgan
- Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, Ohio
| | - Anna Eversman
- Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Mehak Kalra
- Case Western Reserve School of Medicine, Cleveland, Ohio
| | | | - Elizabeth Obi
- Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Emma R Russell
- Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Angela H Wei
- Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, Ohio
| | - David X Zheng
- Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Bryan T Carroll
- Case Western Reserve School of Medicine, Cleveland, Ohio; University Hospitals Cleveland Medical Center Department of Dermatology, Cleveland, Ohio
| | - Timmie R Sharma
- Case Western Reserve School of Medicine, Cleveland, Ohio; University Hospitals Cleveland Medical Center Department of Dermatology, Cleveland, Ohio.
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48
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Donigan JM, Srivastava D, Maher I, Abdelmalek M, Bar AA, Blalock TW, Bordeaux JS, Brodland DG, Carroll BT, Council ML, Duffy K, Fathi R, Golda N, Johnson-Jahangir H, Konda S, Leitenberger JJ, Moye M, Nelson JL, Patel VA, Shaffer JJ, Soltani-Arabshahi R, Tristani-Firouzi P, Tschetter AJ, Nijhawan RI. Opioid Prescribing Recommendations After Mohs Micrographic Surgery and Reconstruction: A Delphi Consensus. Dermatol Surg 2021; 47:167-169. [PMID: 32769528 DOI: 10.1097/dss.0000000000002551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prescription opioids play a large role in the opioid epidemic. Even short-term prescriptions provided postoperatively can lead to dependence. OBJECTIVE To provide opioid prescription recommendations after Mohs micrographic surgery (MMS) and reconstruction. METHODS This was a multi-institutional Delphi consensus study consisting of a panel of members of the American College of Mohs Surgery from various practice settings. Participants were first asked to describe scenarios in which they prescribe opioids at various frequencies. These scenarios then underwent 2 Delphi ratings rounds that aimed to identify situations in which opioid prescriptions should, or should not, be routinely prescribed. Consensus was set at ≥80% agreement. Prescription recommendations were then distributed to the panelists for feedback and approval. RESULTS Twenty-three Mohs surgeons participated in the study. There was no scenario in which consensus was met to routinely provide an opioid prescription. However, there were several scenarios in which consensus were met to not routinely prescribe an opioid. CONCLUSION Opioids should not be routinely prescribed to every patient undergoing MMS. Prescription recommendations for opioids after MMS and reconstruction may decrease the exposure to these drugs and help combat the opioid epidemic.
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Affiliation(s)
| | - Divya Srivastava
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas
| | - Ian Maher
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Mark Abdelmalek
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Anna A Bar
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | | | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - David G Brodland
- Zitelli & Brodland, P.C. Skin Cancer Center, Pittsburgh, Pennsylvania
- Zitelli & Brodland, P.C. Skin Cancer Center, Clairton, Pennsylvania
- Departments of Dermatology, Otolaryngology, and Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bryan T Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Martha Laurin Council
- Division of Dermatology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Keith Duffy
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Ramin Fathi
- Phoenix Surgical Dermatology Group, LLC, Phoenix, Arizona
| | - Nicholas Golda
- Department of Dermatology, University of Missouri, Columbia, Missouri
| | | | - Sailesh Konda
- Department of Dermatology, University of Florida, Gainesville, Florida
| | | | - Molly Moye
- Forefront Dermatology, Louisville, Kentucky
| | - Jenny L Nelson
- Avera Medical Group Dermatology Sioux Falls, Sioux Falls, South Dakota
| | - Vishal A Patel
- Department of Dermatology, The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
| | | | - Razieh Soltani-Arabshahi
- Department of Dermatology, University of Southern California Keck School of Medicine, Los Angeles, California
| | | | | | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas
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Jackson Cullison SR, Govas P, Carroll BT. Pearls for securing the pinch-and-slide suture technique for high-tension closures. J Am Acad Dermatol 2020; 87:e5-e7. [PMID: 32682888 DOI: 10.1016/j.jaad.2020.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 06/30/2020] [Accepted: 07/08/2020] [Indexed: 11/25/2022]
Affiliation(s)
| | - Panayiota Govas
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bryan T Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Govas P, Kazi R, Slaugenhaupt RM, Carroll BT. Effect of a Vibratory Anesthetic Device on Pain Anticipation and Subsequent Pain Perception Among Patients Undergoing Cutaneous Cancer Removal Surgery: A Randomized Clinical Trial. JAMA FACIAL PLAST SU 2020; 21:480-486. [PMID: 31513234 DOI: 10.1001/jamafacial.2019.0733] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Vibration has been shown to decrease injection site pain in patients; however, to date, this effect has not been assessed for patients who catastrophize pain (ie, patients who anticipate a higher pain level). The anticipation of a pain score greater than 4 on the 11-point Numeric Rating Scale (NRS) has been associated with an increase in a patient's perception of procedural pain. Objective To assess the efficacy of vibration during cutaneous anesthetic injection for dermatologic surgery for patients who catastrophize pain (NRS score >4) and patients who do not (NRS score ≤4). Design, Setting, and Participants Randomized, parallel-group clinical trial from June 19 to September 4, 2018, at a tertiary dermatologic surgery clinic among 87 adults undergoing cutaneous cancer removal surgery. Patients completed a preprocedural questionnaire detailing their baseline pain, anticipated pain, and drug use. Analysis was performed on an intent-to-treat basis. Interventions Use of a vibratory anesthetic device (VAD) on the treatment site prior to anesthetic injection in the on (VAD ON) or off (VAD OFF) mode. Main Outcomes and Measures Pain was reported using the 11-point NRS (where 0 indicates no pain and 11 indicates the worst pain imaginable). A minimum clinically important difference of 22% or more and a substantial clinically important difference of 57% or more were used to assess the efficacy of vibration in patient-reported NRS score during anesthetic injection (iNRS score). Results A total of 87 patients were included, with 101 unique events reported (among the unique events, 37 were reported in women and 64 were reported in men; mean [SD] age, 66.0 [11.3] years). The mean (confidence level [CL]) iNRS score for patients who catastrophized pain was 2.27 (0.66) compared with 1.44 (0.39) for patients who did not (P = .03). A 38.9% decrease in mean (CL) iNRS score was reported with VAD ON compared with VAD OFF in all participants (1.24 [0.38] vs 2.04 [0.54]). Patients who catastrophized pain reported a 25.5% decrease in mean (CL) iNRS score with VAD ON vs VAD OFF (1.91 [0.99] vs 2.57 [0.98]), and patients who did not reported a 79.4% decrease (1.02 [0.40] vs 1.84 [0.66]). VAD ON was the only statistically significant variable to affect iNRS score (F statistic, 2.741; P = .03). Conclusions and Relevance This trial demonstrates that those who catastrophize pain prior to a procedure report a higher perceived level of pain. The application of vibration during local anesthetic injection resulted in a minimum clinically important difference in pain level for patients who catastrophize pain and a substantial clinically important difference in pain level for patients who do not. Level of Evidence 2. Trial Registration ClinicalTrials.gov identifier: NCT03467685.
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Affiliation(s)
- Panayiota Govas
- Department of Dermatology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rashek Kazi
- Department of Dermatology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Bryan T Carroll
- Department of Dermatology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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