Diagnostic accuracy and appropriateness of care for seborrheic keratoses

Article Abstract:

Maintaining the quality of care and preventing rising costs are currently major objectives in medicine. Quality assurance studies have concentrated on inpatient care. The performance of a physician is assessed by special committees, conferences on disease and death rates, and departmental review committees, which evaluate results from anatomic and surgical pathological studies. The accuracy of the physician's diagnosis; the appropriateness of the medical procedure; and the possible causes of unfavorable outcomes are examined. Ambulatory surgery, or operations performed on an outpatient basis, accounted for a large proportion of the 40 million visits to physicians in 1985. Most cases of ambulatory surgery involve removal of a benign or malignant skin lesion. The quality, cost, and appropriateness of care for this type of ambulatory surgery has not been extensively assessed. In this study, the diagnostic accuracy and appropriateness of treatment of seborrheic keratoses (a common, benign skin disorder) were analyzed. This skin disease is characterized by the development of keratotic, or horny skin growths, and increases with age. Seborrheic keratoses does not require surgery unless the lesions become irritated, inflamed, or cosmetically displeasing. Tissues from 527 seborrheic keratoses removed by 133 clinicians who were affiliated with four different institutions were examined. The diagnosis before surgery was correct in only 49 percent of cases, with dermatologists providing the greatest diagnostic accuracy. The correct procedure for pathological diagnosis was carried out in only 50 percent of cases. The likelihood of receiving appropriate care was eight times greater in cases in which lesions were accurately diagnosed before surgery. These findings suggest that clinicians often fail to make a correct diagnosis before removing a skin lesion. In addition, more extensive surgery than necessary is often used to confirm a diagnosis pathologically. The approach to quality assurance used in this study may be an effective and inexpensive method for monitoring the quality of ambulatory surgical care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Standards, Medical care, Quality management, Medical care quality, Surgery, Outpatient, Ambulatory surgery

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Dermatology

Article Abstract:

A review of selected studies in the field of dermatology is offered. Topics discussed include the discovery of erythromycin-resistant streptococci, the use of erythropoietin to treat uremic pruritus, prednisolone for treating skin disorders in diabetic patients, the diagnosis of cutaneous T-cell lymphoma and death rates from malignant melanomas. The monitoring of the side effects of corticosteroids and studies on the use of acyclovir to prevent herpes outbreaks are also covered.

Practice, Dermatology

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A promising step forward in psoriasis therapy

Article Abstract:

New treatments for severe psoriasis such as Raptiva should only be prescribed for patients who do not benefit from other effective treatments. Raptiva and other newer treatments are not as effective as methotrexate, cyclosporine, UV-B and psoralen plus UV-A (PUVA). They are also much more expensive than traditional treatments. In addition, there are no long-term data on their effectiveness and side effects.

United States, Product information, Editorial, Evaluation, Drug therapy, Biological products industry, Genentech Inc., Psoriasis, DNA, Raptiva (Medication)

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