In Reply: The Only Thing We Have to Blame Is Blame Itself

Publication date: Available online 8 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jason Dean, Michael C. Shapiro, Andrew R. Salama




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Severity strata for EASI, mEASI, oSCORAD, SCORAD, ADSI and BSA in adolescents and adults with atopic dermatitis

Abstract

Background

Scoring systems for assessing the signs of atopic dermatitis (AD) are complex and difficult to interpret. Severity strata are helpful to properly interpret these assessments. We sought to confirm previously reported strata for Eczema Area and Severity Index (EASI), Scoring AD (SCORAD) and objective component of SCORAD (oSCORAD) and develop strata for the modified EASI (mEASI), Atopic Dermatitis Severity Index (ADSI) and body surface (BSA) for use in adults with AD.

Methods

Skin-examination was performed in 673 adolescents and adults (age ≥13 years) with diagnosed AD in a dermatology practice setting. Strata were selected using an anchoring approach based on a 4-point Investigator's Global Assessment of severity (clear of active skin lesions, mild, moderate or severe disease).

Results

We determined potential severity strata for EASI (0=clear, 0.1-5.9=mild, 6.0-22.9=moderate, 23.0-72=severe; kappa=0.694), mEASI (0-0.9=clear, 1-8.9=mild, 9.0-29.9=moderate, 30.0-90=severe; kappa=0.71), oSCORAD (0-7.9=clear, 8.0-23.9=mild, 24.0-37.9=moderate, 38.0-83=severe; kappa=0.70), SCORAD (0-9.9=clear, 10.0-28.9=mild, 29.0-48.9=moderate, 49.0-103=severe; kappa=0.68), ADSI (0-1.9=clear, 2-5.9=mild, 6.0-8.9=moderate and 9.0-15=severe; kappa=0.55), and BSA (0=clear, 0.1-15.9=mild, 16.0-39.9=moderate, 40.0-100=severe; kappa=0.656). oSCORAD >0 were found in clear skin due to the presence of xerosis, which is scored in oSCORAD. Similarly, SCORAD >0 were found in clear skin due to the scoring of xerosis, pruritus and sleeplessness. Similarly, mEASI and ADSI scores >0 occurred in patients with clear skin due to scoring of pruritus.

Conclusions

We recommend using these strata for interpretation of their respective measures in clinical trials of AD. There are important differences between the 5 assessments, which profoundly impact the interpretation of their scores.

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Sirolimus therapy for children with problematic Kaposiform haemangioendothelioma and tufted angioma

Abstract

Kaposiform haemangioendothelioma (KHE) and tufted angioma (TA) are rare vascular tumours that typically present during infancy or childhood. Originally regarded as distinct lesions, they are now considered as part of a spectrum. Presentation is usually as an enlarging, tender, blue or red mass. Both KHE and TA may be associated with Kasabach-Merritt Phenomenon (KMP), a severe haemorrhagic state arising from intralesional platelet trapping, microangiopathic haemolytic anaemia, and consumptive coagulopathy.

This article is protected by copyright. All rights reserved.

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Treatment satisfaction and need for shared decision-making in patients with psoriasis from Peru

Abstract

psoriasis is reported by the World Health Organization as a chronic skin disease with an elevated physical, emotional and socioeconomic burden. However, this burden is underestimated in developing countries, such as Peru, due the lack of epidemiological research in dermatology. This uncertainty hinders the development of appropriate patient-centered health care that prevent patients from unnecessary suffering.

This article is protected by copyright. All rights reserved.

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I strongly recommend that all practicing physicians consider such a list, and review it occasionally. I wish for the judgement to know what is best for my patients and to weigh the merits of interventions; surgically, medically, and radiotherapeutically. I wish that I can master the complexities of the practice of medicine and be worthwhile as a physician. I wish for the honesty and integrity to objectively assess my competencies and fallibilities. I wish for the intellectual drive to maintain currency of knowledge. I wish for the wisdom to assess and maintain appropriate costs for medical care. I wish for the integrity to avoid marketing my skills and accomplishments unrealistically and erroneously. I wish for the compassion that allows me to separate my personal problems from the needs of the patients that I serve. I wish for the courage to challenge the wisdom of those that create policies and regulations that fail to consider the full dimension and scope of medical care. Please p

Brazilian Journal of Otorhinolaryngology

Print version ISSN 1808-8694

On-line version ISSN 1808-8686

Braz. j. otorhinolaryngol. vol.83 no.2 São Paulo 

http://dx.doi.org/10.1016/j.bjorl.2017.01.001 

EDITORIAL

Ethics in the twenty first century otolaryngology☆

Charles W. Cummings1 

1Johns Hopkins University, Baltimore, USA. E-mail: ccumming@jhmi.edu

In the United States, the climate of the practice of Medicine is in transition and under siege by policy revisionists and governmental/political opportunists. Regulatory and legislative hubris has enshrouded the medical arena through formulaic dictums and onerous regulations oft times constructed by individuals who have no clinical experience or knowledge. The art of Medicine is being dismantled by emphasis on outcomes based solely on statistical evidence, with no concern for the human variables. Objective analysis is not inherently bad provided the personal and social factors are properly emphasized in the analysis. Freedom to make clinical decisions MUST be preserved for optimal care.

This phenomenon exerts undue pressure on the clinician leading to professional frustration and anemia of job satisfaction. Also, the environment which enables the best of care is further challenged and compromised.

Never the less, we, as physicians, must continue to acknowledge our calling and respond to the gifts of our profession. It seems appropriate to review the commitments that we have made to ourselves and our patients. Over the years, I have created a wish list concerning the way I want to conduct myself to satisfy my professional goals. What follows are those wishes. I strongly recommend that all practicing physicians consider such a list, and review it occasionally.

I wish for the judgement to know what is best for my patients and to weigh the merits of interventions; surgically, medically, and radiotherapeutically.

I wish that I can master the complexities of the practice of medicine and be worthwhile as a physician.

I wish for the honesty and integrity to objectively assess my competencies and fallibilities.

I wish for the intellectual drive to maintain currency of knowledge.

I wish for the wisdom to assess and maintain appropriate costs for medical care.

I wish for the integrity to avoid marketing my skills and accomplishments unrealistically and erroneously.

I wish for the compassion that allows me to separate my personal problems from the needs of the patients that I serve.

I wish for the courage to challenge the wisdom of those that create policies and regulations that fail to consider the full dimension and scope of medical care.

Please preserve the art of Medicine. We must steward our wonderful calling.

☆Please cite this article as: Cummings CW. Ethics in the twenty first century otolaryngology. Braz J Otorhinolaryngol. 2017;83:119.2

Conflicts of interest

The author declares no conflicts of interest.

© 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda.

 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

 

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Regional anaesthesia for ophthalmic surgery

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Acute respiratory distress syndrome

<span class="paragraphSection"><div class="boxedTextSection">Key points<ul><li class="bullet">Acute respiratory distress syndrome (ARDS) is commonly encountered in the critical care population and is associated with a high mortality of between 27% and 45%.</li><li class="bullet">ARDS is diagnosed according to the Berlin definition and is characterized as mild, moderate, or severe depending on the <span style="font-style:italic;">P</span>a<span style="text-transform:lowercase;font-variant:small-caps;">O</span>₂/<span style="font-style:italic;">FI</span><span style="text-transform:lowercase;font-variant:small-caps;">O</span>₂ ratio.</li><li class="bullet">Accepted management strategies include lung protective ventilation with tidal volumes limited to 6 ml kg⁻¹, positive end expiratory pressure increasing in line with oxygen requirement, and prone positioning in severe cases.</li><li class="bullet">Steroids, statins, inhaled nitric oxide, and high-frequency oscillation ventilation do not have a role in the routine management of adults with ARDS.</li><li class="bullet">Adverse functional and neuropsychological outcomes are increasingly recognized in long-term ARDS survivors.</li></ul></div></span>

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