S.F.K. Lubeek

An evidence based blunt trauma protocol

Objective Currently CT is rapidly implemented in the evaluation of trauma patients. In anticipation of a large international multicentre trial, this studys aim was to evaluate the clinical feasibility of a new diagnostic protocol, used for the primary radiological evaluation in adult blunt high-energy trauma patients, especially for the use of CT. Methods An evidence-based flow chart was created with criteria based on trauma mechanism, physical examination and laboratory analyses to indicate appropriateness of conventional radiography (CR), sonography and CT of head, cervical spine and trunk. To evaluate this protocol, the authors prospectively included 81 consecutive patients. Collected data included protocol adherence and number and type of performed CR and CT scans. The authors also determined the time needed to perform radiological investigations, adverse events in the CT room and clinically relevant missed injuries after 1-month clinical follow-up. Results There was 99% adherence to the protocol concerning CT. Seventy-nine patients (98%) received one or more CT scans: 72 (89%) had thoracoabdominal, 78 (96%) cervical spine and 54 (67%) had cranial CT. In 30 patients, one or more CT scans of body regions could be omitted. In 38%, CR was wrongly omitted or performed incorrectly at a variance with the protocol. No major adverse events occurred in the CT room and no clinically relevant injuries were missed. Conclusions The authors introduced a diagnostic protocol that seems feasible and safe for the evaluation of adult blunt high-energy trauma patients. Implementation of this protocol has the potential to reduce unnecessary radiological investigations, especially CT scans.

The Epidemiology and Clinicopathological Features of Basal Cell Carcinoma in Patients 80 Years and Older: A Systematic Review

Importance The number of very elderly (≥80 years) is rapidly growing worldwide. Basal cell carcinoma (BCC) are common in this age group and treatment is often challenging in this population. Objective Obtaining an overview of the epidemiology and clinicopathological features of BCC in the very elderly to guide clinicians and policy makers. Evidence Review A systematic review of literature was performed using PubMed, Excerpta Medica Database (EMBASE), and the Cochrane Library. Study selection, quality assessment, and data extraction was performed by 2 independent reviewers. For quality assessment (including the risk of bias) the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist was used, combined with the Quality Rating Scheme for Studies and Other Evidence. Data were described though a narrative synthesis and tabulation. Findings Of 13 628 studies identified, 83 studies were included and quality assesment was performed for 76 studies; 27 studies (representing >350 000 patients) were found that included age-specific incidence rates of BCC in the very elderly. High and increasing incidence rates of BCC in the very elderly were found ranging from 13 to 12 112 per 100 000 person-years, strongly depending on factors like study population and clinical setting. Basal cell carcinoma in the very elderly were more common in men, mostly of the nodular subtype, and located in the head and neck region. Interpretation and generalization of the data was limited by the heterogeneity of study populations, methods, and outcomes. Data concerning impact on health-related quality of life (HRQoL) and prognostication were scarce. Conclusions and Relevance The incidence of BCC among the very elderly is high and increasing. Epidemiologic and clinicopathological data from current literature provide only limited guidance in clinical decision making owing to heterogeneity and scarcity. Future research should focus more specifically on BCC in the very elderly, together with prognostication and their relation with HRQoL in both the short and longer term.

Improving Dermatological Care for Elderly People Living in Permanent Healthcare Institutions: Suggestions from Dutch Dermatologists

© 2016 The Authors. doi: 10.2340/00015555-2217 Journal Compilation

Dermatologic care of institutionalized elderly patients: a survey among dermatologists in the Netherlands

Backgrounddermatologists are expected to be increasingly confronted with institutionalized elderly patients, due to the rapidly ageing world population.Objectiveto determine the proportion of dermatologists visiting patients in nursing homes, together with the reasons for consultation, barriers to perform these visits and diagnostic and treatment patterns.Materials and Methodsa web-based questionnaire regarding dermatologic care in nursing home patients was developed by a multidisciplinary group of dermatologists, residents and elderly care physicians. A cover letter containing a link to the final questionnaire was sent by e-mail to all 661 dermatologists and dermatology residents in the Netherlands.Resultsa total of 130 eligible questionnaires were returned (19.7%). Most respondents (79.2%) never had contact with an elderly care physician concerning a nursing home patient. However, only 30.0% of the respondents ever visited a patient within a nursing home. The most common reasons for nursing home visits were cutaneous (pre)malignancies (51.4%), eczema/dermatitis (25.7%) and (pressure) ulcers (8.6%). The most important barriers mentioned to perform nursing home visits were a lack of time and indistinct and/or inadequate financial compensation. Diagnostic and treatment patterns often differed from the outpatient clinic due to various patient-related and logistic factors.Conclusionsdermatologists are frequently confronted with nursing home patients but only a minority visits patients within nursing homes. Lack of time and/or financial compensation seem important barriers.

Skin cancer care in institutionalized elderly in the Netherlands: a nationwide study on the role of nursing home physicians

on dermoscopy: observation in non-melanoma cases. An Bras Dermatol 2013; 88: 646–648. 3 Phan A, Dalle S, Marcilly MC, Bergues JP, Thomas L. Benign dermoscopic parallel ridge pattern variants. Arch Dermatol 2011; 147: 634. 4 D ıaz Moreno R, Dom ınguez-Cruz J, Zulueta T, Quintana J, Conejo-Mir J. Parallel ridge pattern due to cryotherapy treatment. JAMA Dermatol 2013; 149: 491–493. 5 Tanioka M. Benign acral lesions showing parallel ridge pattern on dermoscopy. J Dermatol 2011; 38: 41–44. 6 Tanioka M, Matsumura Y, Utani A, Tanaka M, Miyachi Y. Occupationrelated pigmented macules on the sole with parallel-ridge pattern on dermatoscopy. Clin Exp Dermatol 2009; 34: e31–e33. 7 Lacarrubba F, Dall’oglio F, Dinotta F, Micali G. Photoletter to the editor: exogenous pigmentation of the sole mimicking in situ acral melanoma on dermoscopy. J Dermatol Case Rep 2012; 6: 100–101. 8 Fukushima S, Hatta N. Atypical moles in a patient undergoing chemotherapy with oral 5-fluorouracil prodrug. Br J Dermatol 2004; 151: 698–700. 9 Egawa K, Honda Y, Inaba Y, Ono T. Pigmented viral warts: a clinical and histopathological study including human papillomavirus typing. Br J Dermatol 1998; 138: 381–389. 10 Belloni J. Photography: enhancing sensitivity by silver-halide crystal Doping. Radiat Phys Chem 2003; 67: 291–296.

Improving the applicability of guidelines on nonmelanoma skin cancer in frail older adults: a multidisciplinary expert consensus and systematic review of current guidelines.

Balancing treatment decisions in frail older adults with nonmelanoma skin cancer (NMSC) can be challenging. Clinical practice guidelines (CPGs) could provide assistance.

A retrospective study on the effectiveness of curettage and electrodesiccation for clinically suspected primary nodular basal cell carcinoma

An easy, cheap, and practical therapy for nodular basal cell carcinoma (nBCC) is curettage combined with electrodessication (C&ED).1,2 Recurrence rates for BCC after C&ED range from 1-27%, influenced by anatomic location, histopathologic growth pattern, and size.2-7 Therefore, most guidelines solely recommend C&ED as treatment in low-risk BCC, typically defined as: primary and small BCC (≤5 mm) with no clinical suspicion of infiltrative growth in low-risk areas (outside of the H-zone). This article is protected by copyright. All rights reserved.

Quality of Dutch dermatological guidelines according to AGREE II

The number of clinical practice guidelines is increasing, but their quality is variable.1 However, healthcare professionals/users should be able to rely on methodologically sound guidelines that are helpful and applicable in practice. To objectively assess (methodological) guideline quality, experts developed the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. This article is protected by copyright. All rights reserved.

Impact of High Age and Comorbidity on Management Decisions and Adherence to Guidelines in Patients with Keratinocyte Skin Cancer

Appropriate medical decision-making in patients with keratinocyte skin cancer (KSC) can be challenging, especially in those with a limited life expectancy (LEx). Treatment should be beneficial for the individual patient, the risk of both over- and under-treatment should be carefully considered, and deviation from guideline recommendations may be necessary. In this study retrospective analysis was performed to determine the influence of age and comorbidity, both factors strongly related to limited LEx, on KSC management in daily practice. After analysis of 401 patients it was found that management in patients with KSC is not influenced, or is only minimally influenced, by high age and comorbidity. Better integration of aspects related to a limited LEx in KSC management might optimize care and prevent overtreatment. Future research on the general prognostication, prediction of the patient burden caused by tumour and treatment, and time-to-benefit in KSC management is strongly recommended.

Teledermatologie binnen Nederlandse verpleeghuizen

Skin problems are common within the nursing home population and could have a significant impact on quality of life. As a form of long-distance consultation teledermatology offers several potential benefits within this frail population. In this review we discuss several aspects of teledermatology, especially in relation to the nursing home population. Several studies demonstrated that teledermatology is a cost-effective and easy-to-use consultation method, which could significantly reduce the amount of hospital visits. However, teledermatology is only used in a limited number of Dutch nursing homes in daily practice due to several factors. For the optimal implementation of teledermatological consultation there are some important logistical, legal and financial framework conditions. In conclusion, teledermatology has a lot to offer within the nursing home population and therefore teledermatology will hopefully be increasingly used in daily practice within the near future.SamenvattingHuidproblemen komen veel voor binnen de verpleeghuispopulatie en ze kunnen een aanzienlijke invloed op de kwaliteit van leven hebben. Als digitale consultatiemogelijkheid op afstand kan teledermatologie verschillende voordelen bieden binnen deze kwetsbare populatie. In dit overzichtsartikel geven wij een uiteenzetting van verschillende aspecten rondom teledermatologie, in het bijzonder binnen de verpleeghuispopulatie. Uit diverse onderzoeken blijkt dat teledermatologie een kostenefficiënte en eenvoudige consultatiemogelijkheid is, die ziekenhuisbezoek aanzienlijk kan beperken. Toch wordt teledermatologie door verschillende factoren slechts in een beperkt aantal Nederlandse verpleeghuizen in de dagelijkse praktijk gebruikt. Om een teledermatologisch consult optimaal te laten verlopen zijn er een aantal belangrijke logistieke, juridische en financiële randvoorwaarden van belang. Teledermatologie kan veel bieden binnen de verpleeghuispopulatie en we hopen dan ook dat dit in toenemende mate toegepast zal worden in de dagelijkse praktijk.AbstractSkin problems are common within the nursing home population and could have a significant impact on quality of life. As a form of long-distance consultation teledermatology offers several potential benefits within this frail population. In this review we discuss several aspects of teledermatology, especially in relation to the nursing home population. Several studies demonstrated that teledermatology is a cost-effective and easy-to-use consultation method, which could significantly reduce the amount of hospital visits. However, teledermatology is only used in a limited number of Dutch nursing homes in daily practice due to several factors. For the optimal implementation of teledermatological consultation there are some important logistical, legal and financial framework conditions. In conclusion, teledermatology has a lot to offer within the nursing home population and therefore teledermatology will hopefully be increasingly used in daily practice within the near future.