Amit Garg

Modern Moulage: Evaluating the Use of 3-Dimensional Prosthetic Mimics in a Dermatology Teaching Program for Second-Year Medical Students

OBJECTIVES To evaluate the effectiveness of a teaching method that uses 3-dimensional (3D) silicone-based prosthetic mimics of common serious lesions and eruptions and to compare learning outcomes with those achieved through the conventional method of lectures with 2-dimensional (2D) images. DESIGN Prospective and comparative. SETTING University of Massachusetts Medical School. PARTICIPANTS Ninety second-year medical students. INTERVENTION A 1-hour teaching intervention using a lecture with 2D images (2D group) or using 3D prosthetic mimics of lesions and eruptions (3D group). MAIN OUTCOME MEASURES Mean scores in the domains of morphology, lesion and rash recognition, lesion and rash management, and overall performance assessed at baseline, immediately after, and 3 months after each groups respective teaching intervention. RESULTS Immediately after the teaching intervention, the 3D group had significantly higher mean percentage scores than did the 2D group for overall performance (71 vs 65, P = .03), lesion recognition (65 vs 56, P = .02), and rash management (80 vs 67, P = .01). Three months later, the 3D group still had significantly higher mean percentage scores than did the 2D group for lesion recognition (47 vs 40, P = .03). The 3D group better recognized lesions at 3 months compared with at baseline, whereas the 2D group was no better at recognizing lesions at 3 months compared with at baseline. CONCLUSIONS Despite limited curricular time, the novel teaching method using 3D prosthetic mimics of lesions and eruptions improves immediate and long-term learning outcomes, in particular, lesion recognition. It is also a preferred teaching format among second-year medical students.

Sex- and Age-Adjusted Population Analysis of Prevalence Estimates for Hidradenitis Suppurativa in the United States

Importance The true prevalence of hidradenitis suppurativa (HS) is unknown. Objective To establish standardized overall and group-specific prevalence estimates for HS in the United States. Design, Setting, and Participants This retrospective analysis included a demographically heterogeneous population-based sample of more than 48 million unique patients across all US census regions. As of October 27, 2016, a total of 47 690 patients with HS were identified using electronic health record data. Main Outcomes and Measures Standardized overall point prevalence for HS and sex-, age-, and race-specific prevalence estimates of HS in the general US population. Results Of the 47 690 patients with HS (26.2% men and 73.8% women), the overall HS prevalence in the US population sample was 0.10%, or 98 per 100 000 persons (95% CI, 97-99 per 100 000 persons). The adjusted prevalence in women was 137 per 100 000 (95% CI, 136-139 per 100 000), more than twice that of men (58 per 100 000; 95% CI, 57-59 per 100 000; P < .001). The prevalence of HS was highest among patients aged 30 to 39 years (172 per 100 000; 95% CI, 169-275 per 100 000) compared with all other age groups (range, 15-150 per 100 000; P < .001). Adjusted HS prevalences among African American (296 per 100 000; 95% CI, 291-300 per 100 000) and biracial (218 per 100 000; 95% CI, 202-235 per 100 000) patients were more than 3-fold and 2-fold greater, respectively, than that among white patients (95 per 100 000; 95% CI, 94-96 per 100 000; P < .001). Conclusions and Relevance Hidradenitis suppurativa is an uncommon, but not rare, disease in the United States that disproportionately affects female patients, young adults, and African American and biracial patients.

Composite Measures in Psoriatic Arthritis: GRAPPA 2008

At the 2008 annual meeting of GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) in Leeds, UK, members discussed the value and current status of composite measures for the assessment of psoriatic arthritis (PsA). In plenary presentations, examples of composite measures developed for rheumatoid arthritis (RA) and ankylosing spondylitis (AS) were reviewed, followed by a presentation of the assessment of disease activity in systemic lupus erythematosus. Three recently devised composite methods of assessing activity or response in PsA also were presented. Considerable discussion followed in breakout groups, and members agreed that a new composite measure specifically for PsA is necessary. The composite measure should include components that encompass the spectrum of psoriatic disease, i.e., in addition to assessment of peripheral joints, it should include assessment of sacroiliitis, spondylitis, enthesitis, and dactylitis, as well as skin and nail disease.

Recognizing psoriatic arthritis in the dermatology clinic

Dermatologists care for patients with psoriasis in whom there exists an inherent risk of psoriatic arthritis, a condition with potential for causing joint damage and subsequent disability. Most patients have psoriasis for years before the development of psoriatic arthritis, and there may be a significant proportion of psoriasis patients with joint involvement that are cared for by the dermatologist. With the absence of a diagnostic measure, the criterion standard for recognizing or monitoring psoriatic arthritis remains the clinical assessment. Recognition of psoriatic arthritis in the psoriasis patient--and the dermatologists ability to differentiate it from other types of arthritis--provide an opportunity to improve patient outcomes through early recognition and facilitation of intervention in collaboration with a rheumatologist.

The international dermatology outcome measures group: Formation of patient-centered outcome measures in dermatology

As quality standards are increasingly in demand throughout medicine, dermatology needs to establish outcome measures to quantify the effectiveness of treatments and providers. The International Dermatology Outcome Measures Group was established to address this need. Beginning with psoriasis, the group aims to create a tool considerate of patients and providers using the input of all relevant stakeholders in assessment of disease severity and response to treatment. Herein, we delineate the procedures through which consensus is being reached and the future directions of the project.

Incidence of hidradenitis suppurativa in the United States: A sex- and age-adjusted population analysis

Background The true incidence of hidradenitis suppurativa (HS) is unknown. Objective To determine standardized incidence estimates for HS in the United States. Methods We used a retrospective cohort analysis, including incident HS cases identified using electronic health records data for a demographically heterogeneous population‐based sample of >48 million unique patients across all 4 census regions. We calculated standardized 1‐ and 10‐year cumulative incidences for the overall population and for sex‐, age‐, and race‐specific groups. Results There were 5410 new HS diagnoses over a 1‐year period, with an incidence of 11.4 (95% confidence interval [CI], 11.1‐11.8) cases per 100,000 population. One‐year incidence in women was 16.1 (95% CI, 15.5‐16.6) per 100,000, more than twice that of men [6.8 (95% CI, 6.5‐7.2) per 100,000; P < .0001]. Age group–specific incidence was highest among patients 18 to 29 years of age [22.0 (95% CI, 21.0‐23.2) per 100,000]. Incidence among African Americans [30.6 (95% CI, 29.1‐32.2) per 100,000] was >2.5 times that of whites [11.7 (95% CI, 11.3‐12.2) per 100,000; P < .0001]. The average annual overall incidence over 10 years was 8.6 (95% CI, 8.6‐8.7) per 100,000 population. Limitations The use of deidentified claims prevented validation for a larger case subset. Conclusion HS incidence has increased over the past decade and disproportionately involves women, young adults, and African Americans.

Imaging in Psoriasis and Psoriatic Arthritis: GRAPPA 2008

At the 2008 meeting of GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis), the primary focus of the imaging session was the enthesis. Presentations from Dennis McGonagle (Leeds, UK), Richard Hodgson (Leeds, UK), and Paolo Gisondi (Verona, Italy) elaborated on this theme and prepared the meeting attendees for group discussions of further work in this area. Imaging, notably magnetic resonance imaging (MRI) and ultrasonography, provides evidence of pathological change at the enthesis in psoriatic arthritis (PsA). Further, imaging abnormalities are found at sites that are asymptomatic in both PsA and psoriasis. The role of newer imaging modalities, such as ultra-short echo time (UTE) MRI, is promising but remains to be fully elucidated. The implication of these findings in relation to subclinical and predisease status is intriguing and requires further study in longitudinal studies. Further work is also required to examine the proposed common biomechanical basis between joint and skin, the mechanism of the resulting inflammation, and how these mechanisms differ from those seen in rheumatoid arthritis.

Protocol for the development of a core domain set for hidradenitis suppurativa trial outcomes

Introduction Randomised controlled trials (RCTs) should have well-defined primary and secondary outcomes to answer questions generated by the main hypotheses. However, for the chronic, inflammatory skin disease hidradenitis suppurativa (HS), the reported outcome measures are numerous and diverse. A recent systematic review found a total of 30 outcome measure instruments in 12 RCTs. This use of a broad range of outcome measures can increase difficulties in interpretation and comparison of results and may potentially obstruct appropriate evidence synthesis by causing reporting bias. One strategy for dealing with these problems is to develop a core outcome set (COS). A COS is a list of outcomes that are meant as mandatory and should be measured and reported in all clinical trials. The aim of this study is to develop a COS for the management of HS. Method and analysis An international steering group of researchers, clinicians and a patient research partner will guide the COS development. 6 stakeholder groups are involved: patients, dermatologists, surgeons, nurses, industry representatives and drug regulatory authorities. A 1:1 ratio of patients:healthcare professionals is aimed for. The initial list of candidate items will be obtained by combining three data sets: (1) a systematic review of the literature, (2) US and Danish qualitative interview studies involving patients with HS and (3) an online healthcare professional (HCP) item generation survey. To reach consensus on the COS, 4 anonymous online Delphi rounds are then planned together with 2 face-to-face consensus meetings (1 in Europe and 1 in the USA) to ensure global representation. Ethics and dissemination The study will be performed according to the Helsinki declaration. All results from the study, including inconclusive or negative results, will be published in peer-reviewed indexed journals. The study will involve different stakeholder groups to ensure that the developed COS will be suitable and well accepted.

Validation of a Case-Finding Algorithm for Hidradenitis Suppurativa Using Administrative Coding from a Clinical Database

Background: Requisite to the application of clinical databases for observational research in hidradenitis suppurativa (HS) is the identification of an accurate case cohort. Objective: To assess the validity of utilizing administrative codes to establish the HS cohort from a large clinical database. Methods: In this retrospective study using chart review as the reference standard, we calculated several estimates of the diagnostic accuracy of at least 1 ICD-9 code for HS. Results: Estimates of the diagnostic accuracy of at least 1 ICD-9 code for HS include sensitivity 100% (95% CI 98-100), specificity 83% (95% CI 77-88), positive predictive value 79% (95% CI 72-85), negative predictive value 100% (95% CI 98-100), accuracy 90% (95% CI 86-93), and kappa statistic 79% (95% CI 73-86). Conclusion: The case-finding algorithm employing at least 1 ICD-9 code for HS provides balance in achieving accuracy and adequate power, both necessary in the evaluation of a less common disease and its potential association with uncommon or even rare events.

The international dermatology outcome measures initiative as applied to psoriatic disease outcomes: A report from the GRAPPA 2013 meeting

In the United States, access to care is the number one issue facing our patients with dermatological conditions. In part, this is because we do not have outcome measures that are useful in clinical practice and available in databases where payers and governmental agencies can compare the performance of physicians and treatments. There is a growing recognition that insufficient attention has been paid to the outcomes measured in clinical trials and subsequently in clinical practice. The International Dermatology Outcome Measures group includes all willing stakeholders: patients, physicians, payers, and pharmaceutical scientists. As reported herein, the group’s goal is to develop outcome measures in dermatology that address the needs of all involved.