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Technostress: The impact of technology on Italian dermatologists' burnout. 技术压力:技术对意大利皮肤科医生职业倦怠的影响。
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-11-01 Epub Date: 2024-06-24 DOI: 10.1111/ajd.14341
Vincenzo Picone, Cataldo Patruno, Vincenzo Greco, Alessia Spignese, Luigi Coronella, Maddalena Napolitano

Dermatologists' burnout is a growing phenomenon. During the last years, an important role on medical stress is played by the ever-increasing use of common technological devices (smartphones, smartwatches, PCs and tablets). The aim of the study was to investigate whether digital technology use causes burnout among Italian dermatologists, using a survey conducted among a group of Italian dermatologists. The final sample contained 194 responses valid for analysis. A positive and significant relationship between technostress, assessed through Technostress Inventory and burnout, assessed through Maslach Burnout Inventory, among Italian dermatologists was found. Our data seems suggesting a close relationship between technostress and dermatologist burnout.

皮肤科医生的职业倦怠现象日益严重。在过去几年中,越来越多地使用普通技术设备(智能手机、智能手表、个人电脑和平板电脑)对医疗压力起到了重要作用。本研究旨在通过对一组意大利皮肤科医生进行调查,研究数字技术的使用是否会导致意大利皮肤科医生的职业倦怠。最终样本中有 194 份有效回复可供分析。研究发现,在意大利皮肤科医生中,通过技术压力量表评估的技术压力与通过马斯拉赫职业倦怠量表评估的职业倦怠之间存在积极而重要的关系。我们的数据似乎表明,技术压力与皮肤科医生的职业倦怠之间存在密切关系。
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引用次数: 0
Comment on 'Dupilumab for atopic dermatitis in metastatic cancer'. 就 "杜匹单抗治疗转移性癌症特应性皮炎 "发表评论。
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-15 DOI: 10.1111/ajd.14351
Luca Potestio, Cataldo Patruno, Maddalena Napolitano
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引用次数: 0
Evaluation of serial QuantiFERON-TB Gold in tube test results and tuberculosis infection status in patients with psoriasis receiving anti-IL-17 treatment (secukinumab and ixekizumab): Real-world data from a tuberculosis-endemic country. 评估接受抗IL-17治疗(secukinumab和ixekizumab)的银屑病患者的系列QuantiFERON-TB Gold试管内检测结果和结核感染状况:来自结核病流行国家的真实数据。
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-01 DOI: 10.1111/ajd.14340
Ece Erbağcı, Sema Koç Yıldırım, Fatma Aslı Hapa

Background: In comparison with TNF-α inhibitors, anti-IL-17A agents are considered to have a lower risk of active tuberculosis (TB) or latent TB infection (LTBI) reactivation.

Methods: In this study, we aimed to evaluate the TB infection status and serial QuantiFERON-TB-Gold in tube test (QFT) results of psoriasis patients using IL-17 inhibitors (secukinumab [SEC] and ixekizumab [IXE]) in a real-world setting from a tuberculosis-endemic country. Patients who used an anti-IL-17 agent for at least 3 months in our follow-up were included in the study. Patients' clinical and demographic features, baseline QFT results and latest QFT results (if any), and TB infection status were noted from the past medical records.

Results: A total of 717 patients, of whom 333 (46.4%) were female, were included in the study. The cumulative exposure time to an anti-IL-17 agent was 14,147 patient-months, 9743 patient-months for SEC and 4404 patient-months for IXE. Also, 459 (SEC = 305/IXE = 154) patients used an anti-IL-17 agent for ≥ 12 months. Of these, 125 had positive baseline QFT results. In all, 334 had negative baseline QFT results. The latest QFT result of 309 was also negative (persistent seronegative group). During follow-up, the QFT results of 10 patients changed from negative to positive (positive seroconversion group). Seven of them were using SEC and three were using IXE, respectively. No case of active TB infection was detected.

Conclusion: In our study, the positive seroconversion rate of 10/334 seems high, but this did not translate to active disease. However, closer monitoring may be required, especially in patients with advanced age, the presence of PsA, long disease duration and long anti-IL-17 treatment duration.

背景:与 TNF-α 抑制剂相比,抗 IL-17A 药物被认为具有较低的活动性肺结核(TB)或潜伏肺结核感染(LTBI)再活化风险:在本研究中,我们旨在评估结核病流行国家使用 IL-17 抑制剂(secukinumab [SEC] 和 ixekizumab [IXE])的银屑病患者的结核病感染状况和连续 QuantiFERON-TB-Gold 管内试验(QFT)结果。在我们的随访中,使用抗IL-17药物至少3个月的患者被纳入研究范围。患者的临床和人口学特征、基线 QFT 结果和最新 QFT 结果(如有)以及结核病感染状况均来自既往病历:研究共纳入了 717 名患者,其中 333 人(46.4%)为女性。抗IL-17制剂的累计暴露时间为14147个患者月,其中SEC为9743个患者月,IXE为4404个患者月。此外,459 名(SEC = 305/IXE = 154)患者使用抗 IL-17 药物的时间≥ 12 个月。其中 125 人的基线 QFT 结果为阳性。总共有 334 人的基线 QFT 结果为阴性。309 人的最新 QFT 结果也为阴性(血清持续阴性组)。在随访期间,10 名患者的 QFT 结果由阴性转为阳性(血清转换阳性组)。其中 7 人使用 SEC,3 人使用 IXE。没有发现活动性肺结核感染病例:在我们的研究中,10/334 的血清转换阳性率似乎很高,但这并没有转化为活动性疾病。然而,可能需要进行更密切的监测,尤其是对于高龄、存在 PsA、病程长和抗 IL-17 治疗时间长的患者。
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引用次数: 0
Prospective evaluation of the store-and-forward teledermatology service (eConsult) delivery at Townsville Hospital: A pilot study. 对汤斯维尔医院提供的存储转发远程皮肤科服务(eConsult)进行前瞻性评估:试点研究。
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-10-30 DOI: 10.1111/ajd.14371
Celine Jessica Lee, Rebecca Evans, Aaron Boyce

Background: The shortage of dermatologists in rural and regional Australia is acutely felt in north Queensland where the population experiences a leading burden of skin cancer and tropical dermatoses. Store-and-forward teledermatology (SAFT) is recognised as a potential solution to improve accessibility of dermatology specialist care in rural communities. eConsult (a SAFT service) was piloted for the broader Townsville community in 2022. Evaluation was necessary to ensure wider implementation would meet stakeholder needs and improve patient care.

Objective: To evaluate clinician perspectives and use of eConsult within the Townsville Hospital and Health service catchment over the pilot period (up to 9 months).

Methodology: Pre-engagement interviews with clinicians assessed their management of dermatoses and service expectations prior to eConsult usage. eConsult referrals identified case characteristics, outcomes and uptake of the service amongst clinicians. Post-engagement interviews assessed clinician perceptions and their suggestions for the service at the conclusion of the pilot period.

Results: In total, 24 and 17 clinicians participated in the pre- and post-engagement interviews respectively, and 38 referrals were submitted by clinicians. The service assisted diagnosis and management of non-urgent skin conditions for any age group. Clinicians generally had positive perceptions and appreciated timely access to local specialist advice. This study suggests a SAFT service can improve access to dermatology specialist opinion and increase management of dermatoses in primary care.

Conclusions: Establishing sustainable teledermatology services with strong engagement from users is important for accessible care. Future research may investigate similar SAFT models involving more specialists and assess long-term cost-effectiveness.

背景:澳大利亚农村和地区皮肤科医生短缺的问题在昆士兰北部尤为突出,那里的居民主要罹患皮肤癌和热带皮肤病。存储转发远程皮肤病学(SAFT)被认为是改善农村社区皮肤病专科护理可及性的潜在解决方案。2022 年,eConsult(SAFT 服务)在更广泛的汤斯维尔社区进行了试点。有必要进行评估,以确保更广泛的实施能够满足利益相关者的需求并改善患者护理:评估试点期间(长达 9 个月)汤斯维尔医院和卫生服务范围内临床医生对 eConsult 的看法和使用情况:方法:对临床医生进行参与前访谈,评估他们在使用 eConsult 之前对皮肤病的管理和服务期望。参与后访谈评估了临床医生的看法以及他们在试点期结束后对服务的建议:共有 24 名和 17 名临床医生分别参加了参与前和参与后访谈,临床医生共提交了 38 份转介报告。该服务可协助诊断和处理任何年龄组的非急症皮肤病。临床医生普遍对该服务持积极态度,并对及时获得当地专家建议表示赞赏。这项研究表明,SAFT 服务可以改善皮肤病专家意见的获取途径,并提高基层医疗机构对皮肤病的管理水平:结论:建立可持续的远程皮肤科服务,并让用户积极参与其中,对于实现无障碍医疗非常重要。未来的研究可能会调查涉及更多专家的类似 SAFT 模式,并评估长期成本效益。
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引用次数: 0
Predictors of wound healing after surgical deroofing in Hidradenitis Suppurativa. 化脓性扁桃体炎手术切除后伤口愈合的预测因素
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-10-30 DOI: 10.1111/ajd.14375
James Pham, Tara Sholji, Lauren Guttman, Timothy Allan, John W Frew

Background/objectives: Surgical deroofing is an essential part of ongoing management of Hidradenitis Suppurativa, including persistent lesions non-responsive to medical therapy. The variables associated with delayed wound healing after surgical deroofing are contradictory within the literature due to the inclusion of heterogeneous surgical intervention methods. We aimed to assess the predictors of time to wound healing after surgical deroofing in HS.

Methods: Patients who underwent in-office surgical deroofing between 2020 and 2024 at a single tertiary HS referral centre were included in analysis. Demographic, disease and blood variables were collected as per standard of care. Statistical analysis was performed using univariate correlation, with multiple regression performed to explore the interactions between variables and identify variables predictive of time to wound healing.

Results: A total of 270 individuals were included in the analysis. The median time to wound healing was 9.6 weeks with a range from 4 to 22 weeks. Kaplan-Meier curves demonstrated significant differences with the log rank test when comparing biologic use versus no use, normal versus abnormal CRP and normal versus abnormal haemoglobin. Cox regression analysis identified biologic use with a significant hazard ratio compared to no biologic therapy (HR = 2.512, p < 0.0001) along with baseline CRP (HR = 0.968, p < 0.0001) and baseline haemoglobin (HR = 1.052, p < 0.001).

Conclusions: Time to wound healing after in-office deroofing can be decreased with prior biologic therapy and markers of systemic inflammation in blood are also significantly associated with delays in healing. This correlates well with the existing literature promoting concurrent medical and surgical therapy to improve patient outcomes in HS.

背景/目的:手术切除是持续治疗扁平苔藓(包括对药物治疗无反应的顽固性病变)的重要组成部分。由于采用了不同的手术干预方法,与手术切除后伤口延迟愈合相关的变量在文献中存在矛盾。我们旨在评估HS手术切除后伤口愈合时间的预测因素:分析对象包括2020年至2024年期间在一家三级HS转诊中心接受诊室内手术切除的患者。按照护理标准收集人口统计学、疾病和血液变量。采用单变量相关性进行统计分析,并进行多元回归以探讨变量之间的相互作用,确定可预测伤口愈合时间的变量:共有 270 人被纳入分析。伤口愈合时间的中位数为 9.6 周,范围从 4 周到 22 周不等。使用生物制剂与不使用生物制剂、CRP 正常与异常、血红蛋白正常与异常进行比较时,Kaplan-Meier 曲线显示出对数秩检验的显著差异。Cox 回归分析表明,使用生物制剂与不使用生物制剂相比具有显著的危险比(HR = 2.512,p 结论):使用生物制剂治疗可缩短诊室脱毛后的伤口愈合时间,血液中的全身炎症指标与伤口愈合延迟也有显著相关性。这与现有文献中提倡同时进行药物和手术治疗以改善 HS 患者预后的观点不谋而合。
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引用次数: 0
Perspectives on oral benzodiazepine use for anxiety in Mohs micrographic surgery: A response to the Australian survey. 莫氏显微摄影手术中口服苯并二氮杂卓治疗焦虑症的观点:对澳大利亚调查的回应。
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-10-29 DOI: 10.1111/ajd.14378
Ching Ching Hsieh, Lien-Chung Wei

This letter responds to the recent Australian survey by Harris and Lee (Australas J Dermatol, 2024, doi: 10.1111/ajd.14361) on the use of oral benzodiazepines for anxiety management in Mohs micrographic surgery (MMS). While commending the authors' efforts, we provide additional perspectives on current practices, recent evidence and safety considerations. We highlight the alignment with U.S. practices, discuss a recent randomized controlled trial supporting diazepam's efficacy and emphasize the importance of non-pharmacological interventions. The letter also addresses the need for flumazenil availability and calls for standardized guidelines and further research to optimize patient care in MMS.

这封信是对 Harris 和 Lee 最近在澳大利亚进行的一项调查(Australas J Dermatol, 2024, doi: 10.1111/ajd.14361)的回应,该调查涉及在莫氏微创手术 (MMS) 中使用口服苯二氮卓类药物控制焦虑。在对作者的努力表示赞赏的同时,我们对当前的实践、最新的证据和安全考虑提供了更多的视角。我们强调了与美国实践的一致性,讨论了最近一项支持地西泮疗效的随机对照试验,并强调了非药物干预的重要性。信中还提到了提供氟马西尼的必要性,并呼吁制定标准化指南和开展进一步研究,以优化对 MMS 患者的护理。
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引用次数: 0
Real-world data on the efficacy and safety of hedgehog pathway inhibitors in patients with basal cell carcinoma: Experience of a tertiary Australian centre. 刺猬通路抑制剂对基底细胞癌患者疗效和安全性的真实数据:澳大利亚一家三级医疗中心的经验。
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-10-25 DOI: 10.1111/ajd.14373
K Truong, M Peera, R Liu, M Wijaya, M Jones-Caballero, R Ruiz Araujo, P Fernandez-Penas

Background: Basal cell carcinomas (BCCs) are the most common cancers worldwide. Although most BCCs are amenable to local treatment, there are limited therapeutic options for surgically unresectable locally advanced and metastatic BCCs. Activation of the sonic hedgehog signalling pathway plays a significant role in the development of most BCCs. Hedgehog pathway inhibitors (HPIs) can be used to inhibit this pathway. Efficacy and safety data on HPI use in Australia is scarce.

Objectives: This study aims to present the effectiveness and safety of HPI at a tertiary dermatology referral centre.

Methods: We conducted a retrospective analysis of the clinical charts of all patients with BCC treated with an HPI at a tertiary Dermatology referral centre in New South Wales, Australia from 1 January 2016 to 1 July 2023.

Results: Twenty-three patients with BCCs were treated with an HPI; 11 locally advanced, 8 multiple, 3 basal cell naevus syndrome and 1 metastatic. All patients were of Caucasian background, with a median age of 56. Across 41 treatment cycles, the median treatment duration was 4 months. The overall response rate (ORR) was 20/23 (87%) and complete response (CR) rate was 9/23 (39%); patients treated with sonidegib achieved an ORR of 11/12 (92%) and CR of 4/12 (33%), and vismodegib-treated patients achieved an ORR of 9/11 (82%) and CR of 5/11 (45%). Patients who responded to HPI treatment also responded to a subsequent HPI rechallenge. Common treatment emergent adverse events (TEAEs) included muscle spasms, dysgeusia and alopecia. Dysgeusia was more frequent with vismodegib than sonidegib (p = 0.0001). There was no evidence to suggest a difference in other TEAEs between the two HPIs. Four treatment cycles were stopped due to grade 3 muscle spasm.

Conclusions: In our cohort of 23 patients being treated with HPI, the ORR was 87% and CR was 39%. All patients who experienced TEAEs and had a drug holiday successfully responded to HPI rechallenge. TEAEs, particularly muscle spasms, are common reasons for treatment cessation. Clinicians should implement strategies to mitigate TEAE to improve drug survivability.

背景:基底细胞癌(BCC基底细胞癌(BCC)是全球最常见的癌症。虽然大多数 BCC 适合局部治疗,但对于无法通过手术切除的局部晚期和转移性 BCC,治疗方案十分有限。声刺猬信号通路的激活在大多数 BCC 的发展过程中起着重要作用。刺猬通路抑制剂(HPIs)可用于抑制这一通路。在澳大利亚使用HPI的有效性和安全性数据很少:本研究旨在介绍一家三级皮肤病转诊中心使用 HPI 的有效性和安全性:我们对澳大利亚新南威尔士州一家三级皮肤科转诊中心2016年1月1日至2023年7月1日期间所有接受HPI治疗的BCC患者的临床病历进行了回顾性分析:23 名 BCC 患者接受了 HPI 治疗;其中 11 名局部晚期患者、8 名多发性患者、3 名基底细胞痣综合征患者和 1 名转移性患者。所有患者均为白种人,中位年龄为 56 岁。在41个治疗周期中,中位治疗时间为4个月。总反应率(ORR)为20/23(87%),完全反应率(CR)为9/23(39%);接受索尼替吉治疗的患者的ORR为11/12(92%),CR为4/12(33%);接受维斯替吉治疗的患者的ORR为9/11(82%),CR为5/11(45%)。对HPI治疗有反应的患者对随后的HPI再挑战也有反应。常见的治疗突发不良事件(TEAEs)包括肌肉痉挛、肢体运动障碍和脱发。与索尼替吉相比,vismodegib更容易出现消化不良(p = 0.0001)。没有证据表明两种 HPI 在其他 TEAEs 方面存在差异。四个治疗周期因3级肌肉痉挛而停止:在我们使用HPI治疗的23例患者中,ORR为87%,CR为39%。所有出现 TEAEs 和休药期的患者都对 HPI 再治疗成功做出了反应。TEAEs,尤其是肌肉痉挛,是停止治疗的常见原因。临床医生应采取策略减轻 TEAE,以提高药物的存活率。
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引用次数: 0
Pyodermatitis vegetans confined to the umbilicus: Report of 2 cases. 局限于脐部的植物性热皮炎:2例报告。
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-10-22 DOI: 10.1111/ajd.14376
Natsuko Matsumura, Tomoko Hiraiwa, Toshiyuki Yamamoto

Pyodermatitis pyostomatitis vegetans is a rare variant of neutrophilic disorders, affecting the intertriginous areas such as axilla and groin, umbilicus, as well as the oral mucosa. We herein describe 2 female patients, in both of whom the umbilicus was restrictedly involved.

植物性脓皮炎是中性粒细胞性疾病的一种罕见变异型,可累及腋窝、腹股沟、脐部等三叉神经间隙部位以及口腔黏膜。我们在此描述了两名女性患者,她们的脐部都受到了局限性的影响。
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引用次数: 0
Special sites in atopic dermatitis: Effectiveness of dupilumab on the hands in a single-centre study on 485 patients. 特应性皮炎的特殊部位:在一项针对 485 名患者的单中心研究中,杜必鲁单抗对手部的疗效。
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-10-21 DOI: 10.1111/ajd.14372
Gabriele Perego, Italo Francesco Aromolo, Francesca Barei, Martina Zussino, Luca Valtellini, Angelo Valerio Marzano, Silvia Mariel Ferrucci
{"title":"Special sites in atopic dermatitis: Effectiveness of dupilumab on the hands in a single-centre study on 485 patients.","authors":"Gabriele Perego, Italo Francesco Aromolo, Francesca Barei, Martina Zussino, Luca Valtellini, Angelo Valerio Marzano, Silvia Mariel Ferrucci","doi":"10.1111/ajd.14372","DOIUrl":"https://doi.org/10.1111/ajd.14372","url":null,"abstract":"","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treatment with risankizumab for nivolumab-induced psoriasis in a patient with metastatic clear cell renal carcinoma. 用利桑珠单抗治疗一名转移性透明细胞肾癌患者的 nivolumab 引起的银屑病。
IF 2.2 4区 医学 Q2 DERMATOLOGY Pub Date : 2024-10-12 DOI: 10.1111/ajd.14368
Paulo Ricardo Criado, Luiza Keiko M Oyafuso, Andreia Costa, Natasha Maia Pansani E Arantes, Suelen Patricia Dos Santos Martins, Tiago Torres
{"title":"Treatment with risankizumab for nivolumab-induced psoriasis in a patient with metastatic clear cell renal carcinoma.","authors":"Paulo Ricardo Criado, Luiza Keiko M Oyafuso, Andreia Costa, Natasha Maia Pansani E Arantes, Suelen Patricia Dos Santos Martins, Tiago Torres","doi":"10.1111/ajd.14368","DOIUrl":"https://doi.org/10.1111/ajd.14368","url":null,"abstract":"","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Australasian Journal of Dermatology
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