Oct 31, 2019
How can you integrate decision-making resources into your
clinical practice? In this resident takeover of the podcast, three
dermatology residents — Dr. Daniel Mazori, Dr. Elisabeth Tracey,
and Dr. Julie Croley — discuss
clinical decision support tools such as scoring systems and
other resources available for dermatologists. These tools should be
used as a supplement, not as a substitute for one’s clinical
judgment. “The optimal treatment for patients in a complex medical
system requires not just coming to the correct diagnosis and using
your clinical judgment to make a decision but effectively
communicating that decision to the insurance companies [and] to the
primary team that’s taking care of them on the inpatient service.
... Some objective data can really be useful in those situations,”
advises Dr. Tracey.
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We bring you the latest in
dermatology news and research:
1. No tacrolimus/cancer link in atopic dermatitis in 10-year
2. PASI-75 with ixekizumab approaches 90% in pediatric psoriasis
3. NAM offers recommendations to fight clinician burnout
* * *
Things you will learn in this episode:
- Evaluate for psoriatic arthritis with the Psoriasis
Epidemiology Screening Tool (PEST).
“It’s the kind of thing that I’ll use in addition to asking a
patient with psoriasis questions about symptoms like joint pain and
morning stiffness,” Dr. Mazori says.
- Consider UpToDate.com and VisualDx.com for clinical decision support, to
formulate differential diagnoses, and as a resource for patient
education. “The other day, I had a patient who was diagnosed with
scabies,” Dr. Tracey explains. “We were counseling the patient on
how to decontaminate their environment. I wanted to get the exact
number of hours their belongings needed to be in a plastic bag or
how to wash their clothes. So, we went on UpToDate and read it
together in the clinic.”
- The SCORTEN
system predicts hospital mortality from Stevens-Johnson
syndrome/toxic epidermal necrolysis and is useful for the primary
team. “I’ve found it useful ... as a measure of risk to communicate
to the primary team, even the patient’s family,” Dr. Mazori says.
But the SCORTEN isn’t perfect. “There are studies that have found
it can overestimate or underestimate mortality,” he warns.
- To differentiate cellulitis from pseudocellulitis in adult
patients, consider the ALT-70 score.
“It gives me an objective measure of risk to communicate to the
primary team in support of one diagnosis or another in addition to
my clinical judgment,” advises Dr. Mazori.
- The Mohs Appropriate Use Criteria (AUC) helps
guide decision making for Mohs micrographic surgery, but it has
been scrutinized for classifying most primary superficial basal
cell carcinomas as appropriate for treatment, omitting important
European trials, and for having ratings that are based on expert
opinion rather than evidence.
- The MyDermPath+
app can assist clinicians in forming differentials based on
Hosts: Elizabeth Mechcatie, Terry Rudd
Guests: Daniel R. Mazori, MD (State University
of New York Downstate Medical Center); Elisabeth
(Libby) Tracey, MD (Cleveland Clinic Foundation);
Julie Ann Amthor Croley, MD (University of Texas Medical Branch
Show notes by: Jason Orszt, Melissa Sears,
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