JAMA dermatologyPub Date : 2024-12-23DOI: 10.1001/jamadermatol.2024.5567
Anna Brinks, Carli Needle, Kristen Lo Sicco
{"title":"Methotrexate and Interstitial Lung Disease.","authors":"Anna Brinks, Carli Needle, Kristen Lo Sicco","doi":"10.1001/jamadermatol.2024.5567","DOIUrl":"https://doi.org/10.1001/jamadermatol.2024.5567","url":null,"abstract":"","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA dermatologyPub Date : 2024-12-23DOI: 10.1001/jamadermatol.2024.5286
Lauren A V Orenstein, John S Barbieri, Meron Siira, Ethan Borre, Krittin J Supapannachart, Eric Viera, Courtney Ann Prestwood, Robert Swerlick, Rachel E Patzer, Suephy C Chen
{"title":"Outpatient Dermatology Productivity Measures by Patient Race, Sex, and Age.","authors":"Lauren A V Orenstein, John S Barbieri, Meron Siira, Ethan Borre, Krittin J Supapannachart, Eric Viera, Courtney Ann Prestwood, Robert Swerlick, Rachel E Patzer, Suephy C Chen","doi":"10.1001/jamadermatol.2024.5286","DOIUrl":"https://doi.org/10.1001/jamadermatol.2024.5286","url":null,"abstract":"<p><strong>Importance: </strong>Clinical productivity measures may incentivize clinical care to specific patient populations and thus perpetuate inequitable care. Before the 2021 Medicare physician fee schedule changes, outpatient dermatology encounters for patients who were younger, female, and races other than White systematically generated fewer work relative value units (wRVUs).</p><p><strong>Objective: </strong>To examine the association of patient race, age, and sex with wRVUs generated by outpatient dermatology encounters after 2021.</p><p><strong>Design, setting, and participants: </strong>This multi-institutional cross-sectional study evaluated demographic and billing data for outpatient dermatology encounters across 3 academic dermatology practices. The study compared wRVUs generated by outpatient general dermatology encounters in 6-month periods before and after the 2021 fee schedule updates (March 1 to August 31, 2019, and March 1 to August 31, 2021). Eligibility required an age of 18 years or older and available age, race, and sex data. Data analysis was performed from September 2022 to March 2024.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was wRVUs generated per encounter.</p><p><strong>Results: </strong>This study included 89 656 encounters (47 607 before the 2021 Medicare physician fee schedule update and 42 049 after the update). Across all encounters, the mean (SD) patient age was 56.3 (17.8) years; 55 460 encounters (61.9%) were with female patients and 34 196 (38.1%) were with male patients; and 3457 encounters (3.9%) were with Asian patients, 10 478 (11.7%) with Black patients, 72 894 (81.3%) with White patients, and 2287 (3.2%) with patients of other race or ethnicity (Latino and multiracial). The mean (SD) wRVUs per outpatient dermatology encounter was 1.44 (0.88) before the update and 1.80 (0.99) after (P < .001). After 2021, adjusted analyses demonstrated significantly fewer wRVUs per encounter for female (β, -0.11; 95% CI, -0.13 to -0.10) compared with male patients, and for younger (β, 0.04 [95% CI, 0.04 to 0.05] per 10-year increase in age) compared with older patients. After the update, compared with White patients, visits with Asian patients generated fewer wRVUs (β, -0.12; 95% CI, -0.17 to -0.08) as did visits with Black patients (β, -0.14; 95% CI, -0.17 to -0.11), both statistically significant reductions compared with prior comparisons (P < .001 for both). After 2021, mediation analysis identified that premalignant destructions and biopsies mediated many of the remaining differences in wRVU generation by patient age, race, and sex.</p><p><strong>Conclusions and relevance: </strong>This study found that after the 2021 Medicare fee schedule updates, there was a persistent, albeit reduced, gap between wRVU productivity in outpatient dermatology visits for Asian and Black compared with White patients. These persisting differences were attributable to skin biopsies and cryotherapy of premal","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA dermatologyPub Date : 2024-12-18DOI: 10.1001/jamadermatol.2024.5129
Kristy K Broman, Qingrui Meng, Anna Holmqvist, Nora Balas, Joshua Richman, Wendy Landier, Lindsey Hageman, Elizabeth Ross, Alysia Bosworth, Hok Sreng Te, Britany Hollenquest, F Lennie Wong, Ravi Bhatia, Stephen J Forman, Saro H Armenian, Daniel J Weisdorf, Smita Bhatia
{"title":"Incidence of and Risk Factors for Cutaneous Malignant Neoplasms After Blood or Marrow Transplant.","authors":"Kristy K Broman, Qingrui Meng, Anna Holmqvist, Nora Balas, Joshua Richman, Wendy Landier, Lindsey Hageman, Elizabeth Ross, Alysia Bosworth, Hok Sreng Te, Britany Hollenquest, F Lennie Wong, Ravi Bhatia, Stephen J Forman, Saro H Armenian, Daniel J Weisdorf, Smita Bhatia","doi":"10.1001/jamadermatol.2024.5129","DOIUrl":"https://doi.org/10.1001/jamadermatol.2024.5129","url":null,"abstract":"<p><strong>Importance: </strong>Cutaneous malignant neoplasms are the most common subsequent neoplasm after blood or marrow transplant (BMT), but a full assessment among survivors is lacking.</p><p><strong>Objective: </strong>To identify risk factors for subsequent cutaneous malignant neoplasms using the BMT Survivor Study (BMTSS).</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included patients who underwent transplant from 1974 to 2014 at City of Hope, University of Minnesota, or University of Alabama at Birmingham and survived 2 years or longer, as well as a comparison cohort of siblings. Both groups completed the BMTSS survey. Data analysis took place from October 2022 to October 2024.</p><p><strong>Exposures: </strong>Demographics, pre-BMT and BMT-related therapeutic exposures, chronic graft-vs-host disease (cGVHD), and posttransplant immunosuppression.</p><p><strong>Main outcomes and measures: </strong>Incident cutaneous malignant neoplasms (basal cell carcinoma [BCC], squamous cell carcinoma [SCC], and melanoma) after BMT. Exposures were evaluated for association with subsequent neoplasms using proportional subdistribution hazards models (reported as subdistribution hazard ratio [SHR] and 95% CI).</p><p><strong>Results: </strong>Among the 3880 BMT survivors (median [range] age at BMT, 44.0 [0-78.0] years; 2165 [55.8%] male; 190 [4.9%] Black, 468 [12.1%] Hispanic, 2897 [74.7%] non-Hispanic White, and 325 [8.4%] of other race [including Asian and Pacific Islander] and multiracial) who were followed up for a median (range) of 9.5 (2.0-46.0) years, 605 developed 778 distinct cutaneous neoplasms (BCC, 321; SCC, 231; melanoma, 78; and unknown type, 148). The 30-year cumulative incidence of any cutaneous malignant neoplasm was 27.4% (BCC, 18.0%; SCC, 9.8%; and melanoma, 3.7%). Seventy-year cumulative probabilities of BCC, SCC, and melanoma were considerably higher in BMT survivors than siblings (18.1% vs 8.2%, 14.7% vs 4.2%, and 4.2% vs 2.4%, respectively). Among BMT survivors, risk factors for subsequent cutaneous malignant neoplasms included age of 50 years and older at BMT (BCC: SHR, 1.76; 95% CI, 1.36-2.29; SCC: SHR, 3.37; 95% CI, 2.41-4.72), male sex (BCC: SHR, 1.39; 95% CI, 1.10-1.75; SCC: SHR, 1.85; 95% CI, 1.39-2.45), pre-BMT monoclonal antibody exposure (BCC: SHR, 1.71; 95% CI, 1.27-2.31), allogeneic BMT with cGVHD (BCC: SHR, 1.48; 95% CI, 1.06-2.08; SCC: SHR, 2.61; 95% CI, 1.68-4.04 [reference: autologous BMT]), post-BMT immunosuppression (BCC: SHR, 1.63; 95% CI, 1.24-2.14; SCC: SHR, 1.48; 95% CI, 1.09-2.02; melanoma: SHR, 1.90; 95% CI, 1.16-3.12), and transplant at City of Hope (BCC: SHR, 3.55; 95% CI, 2.58-4.89; SCC: SHR, 3.57; 95% CI, 2.34-5.47 [reference: University of Minnesota]) or University of Alabama at Birmingham (BCC: SHR, 2.35; 95% CI, 1.35-4.23; SCC: SHR, 2.63; 95% CI, 1.36-5.08 [reference: University of Minnesota]). Race and ethnicity other than non-Hispanic White were protective ","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA dermatologyPub Date : 2024-12-18DOI: 10.1001/jamadermatol.2024.5044
Dorian Kern, Brjánn Ljótsson, Louise Lönndahl, Erik Hedman-Lagerlöf, Olof Molander, Björn Liliequist, Maria Bradley, Nils Lindefors, Martin Kraepelien
{"title":"Self-Guided vs Clinician-Guided Online Cognitive Behavioral Therapy for Atopic Dermatitis: A Randomized Clinical Trial.","authors":"Dorian Kern, Brjánn Ljótsson, Louise Lönndahl, Erik Hedman-Lagerlöf, Olof Molander, Björn Liliequist, Maria Bradley, Nils Lindefors, Martin Kraepelien","doi":"10.1001/jamadermatol.2024.5044","DOIUrl":"https://doi.org/10.1001/jamadermatol.2024.5044","url":null,"abstract":"<p><strong>Importance: </strong>Clinician-guided online self-help based on cognitive behavioral therapy (CBT) has been shown to be effective at decreasing symptom severity for people with atopic dermatitis (AD). A brief online self-guided CBT intervention could be more cost-effective and allow for easy implementation and broader outreach compared with more comprehensive clinician-guided interventions.</p><p><strong>Objective: </strong>To investigate whether a brief online self-guided CBT intervention is noninferior to a comprehensive online clinician-guided CBT treatment.</p><p><strong>Design, setting, and participants: </strong>This single-blind randomized clinical noninferiority trial was conducted at Karolinska Institutet, Stockholm, Sweden. Adult individuals with AD were enrolled from November 2022 to April 2023. The last postintervention data were collected in December 2023.</p><p><strong>Interventions: </strong>Participants randomized to the self-guided group had access to a self-guided online CBT intervention for 12 weeks without clinician support. Participants randomized to the clinician-guided group received online CBT for 12 weeks.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was change in score from baseline to postintervention to 12-week follow-up on the self-reported Patient-Oriented Eczema Measure (POEM). The predefined noninferiority margin was 3 points on POEM.</p><p><strong>Results: </strong>Of 168 randomized participants, 142 (84.5%) were female, and the mean (SD) age was 39 (10.5) years. A total of 86 participants were randomized to the self-guided group and 82 were randomized to the clinician-guided group. A total of 151 (90.0%) completed the main outcome postintervention assessment. Postintervention, the clinician-guided group had improved 4.20 points (95% CI, 1.94-6.05) on POEM and the self-guided group improved 4.60 points (95% CI, 2.57-6.64), corresponding to an estimated mean difference in change of 0.36 points (1-sided 97.5% CI, -∞ to 1.75), which was below the noninferiority margin of 3 points. No serious adverse events were reported. In the clinician-guided group, clinicians spent a mean (SD) of 36.0 (33.3) minutes (95% CI, 29.2-41.7) on treatment guidance and 14.0 (6.0) minutes (95% CI, 12.9-15.6) on assessments compared to 15.8 (6.4) minutes on assessments in the self-guided group.</p><p><strong>Conclusions and relevance: </strong>In this randomized clinical noninferiority trial, a brief self-guided CBT intervention was noninferior to clinician-guided CBT. Given the limited clinical resources required to deliver self-guided CBT, this treatment might be a promising means to disseminate evidence-based psychological treatment for patients with AD.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT05517850.</p>","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA dermatologyPub Date : 2024-12-18DOI: 10.1001/jamadermatol.2024.5125
María Colmenero-Sendra, Javier Del Boz-González, Mercè Grau-Pérez, Ricardo Ruiz-Villaverde, Miguel Ángel Descalzo-Gallego, Ignacio García-Doval, Eulalia Baselga Torres
{"title":"Interobserver and Intraobserver Agreement on the Treatment of Infantile Hemangiomas.","authors":"María Colmenero-Sendra, Javier Del Boz-González, Mercè Grau-Pérez, Ricardo Ruiz-Villaverde, Miguel Ángel Descalzo-Gallego, Ignacio García-Doval, Eulalia Baselga Torres","doi":"10.1001/jamadermatol.2024.5125","DOIUrl":"https://doi.org/10.1001/jamadermatol.2024.5125","url":null,"abstract":"<p><strong>Importance: </strong>Although clinical practice guidelines exist for the treatment of infantile hemangiomas (IHs), recommendations are heterogeneous, and wide practice variations in IH management have been reported.</p><p><strong>Objective: </strong>To analyze the degree of agreement in treatment choices for IH among pediatric dermatologists in North America and Europe and assess whether there are differences across IH risk categories.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional interrater and intrarater agreement study was conducted through a survey based on the Spanish Academy of Dermatology and Venereology IH prospective cohort. The survey used 50 vignettes of IH cases that were randomly selected from the cohort. It was administered twice in 2023, 1 month apart, to allow for interrater and intrarater agreement assessments. Data were analyzed in January 2024. The study involved pediatric dermatologists from North America (via the Pediatric Dermatology Research Alliance) and Europe (via the European Society of Pediatric Dermatologists).</p><p><strong>Exposures: </strong>Participants were asked to choose 1 of 3 treatment options (propranolol, topical timolol, or observation) for each vignette.</p><p><strong>Main outcome and measure: </strong>The primary outcome was the interrater agreement in treatment choices for IH cases, measured using κ statistics (Gwet AC1 coefficient).</p><p><strong>Results: </strong>The global interobserver agreement among 90 pediatric dermatologists was fair (AC1, 0.38; 95% CI, 0.29-0.46). In North America (45 pediatricians), agreement was moderate (AC1, 0.41; 95% CI, 0.33-0.49), while in Europe (45 pediatricians) it was fair (AC1, 0.37; 95% CI, 0.28-0.46). The degree of agreement varied depending on the risk category of IH, with excellent agreement in high-risk IH and only moderate agreement in intermediate-risk and low-risk IHs. Propranolol was predominantly chosen for high-risk IH, while observation was most frequent for low-risk IH (55.9%). The second survey had 61 respondents, with no significant intrarater differences.</p><p><strong>Conclusions and relevance: </strong>The results of this survey study suggest that there is an important variability in the treatment of intermediate-risk and low-risk IH. The study findings support the need for more evidence regarding the role of topical timolol in IH treatment, which may help harmonize treatment approaches and improve consistency in IH management globally.</p>","PeriodicalId":14734,"journal":{"name":"JAMA dermatology","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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