hared decision-making (SDM) is a formal process of consensus building between health care professionals and patients to select treatment plans based on the best medical evidence and the patient's values. Shared decision-making has been reported to improve patient knowledge, satisfaction, and adherence to treatment. 1 Active collaboration between patient and the clinician is important based on the premises that patients will better adhere to treatment if they understand and agree to its use. Shared decision-making is a measure of high-quality decisionmaking and has been incorporated into reimbursement by payers and legislation of health care models. [2][3][4] Shared decision-making has been broadly applied to medical and surgical specialties since it was first defined in 1982. 5 Shared decisionmaking is particularly relevant in complex, preference-sensitive de-cision-making when there are several medically reasonable alternatives. 6 Fields such as palliative care, oncology, and cardiology have been leaders in the implementation of SDM. [7][8][9][10][11] In addition, the Centers for Medicare & Medicaid Services Innovation Center has developed payment models to encourage clinicians to use patient decision support tools aimed to improve individual understanding of medical options as well as requiring SDM for payment of procedures. 2 Dermatologists and patients co-manage complex chronic conditions with medical, economic, and quality-of-life implications. Decision tools, also known as patient decision aids (PDAs), provide detailed and balanced, evidence-based information about varying treatment options and can therefore be used before, during, or after a clinic visit. 12,13 These tools can be used by the patient before IMPORTANCE Shared decision-making (SDM) can improve the quality of care for patients. The extent to which this tool has been used and the evidence supporting its use in dermatology have not been systematically examined.OBJECTIVE To perform a scoping review of the literature regarding SDM in dermatology.
Atopic dermatitis is a chronic inflammatory skin condition that affects approximately 18 million people in the United States. Assessing the extent and severity of atopic dermatitis is critical for determining baseline disease burden and treatment effectiveness for both investigators and clinicians. Considerable efforts over the past several decades have been made in developing a highly validated instrument called the Eczema Area and Severity Index (EASI). Although several guides exist for the EASI, questions continue to arise regarding its use and interpretation. This review was developed to serve as the definitive guide for the EASI and to address commonly asked questions.
Effective treatment of atopic dermatitis is complicated due to its chronic nature, multifaceted pathophysiology, and variable clinical manifestations. The success of dupilumab confirms the importance of type 2 cytokines in the patho physiology of atopic dermatitis. Besides type 2 cytokines, certain phenotypes of atopic dermatitis may be driven by additional cytokine pathways. However, data to date at tempting to target specific cytokines outside of the type 2 axis have been largely unsuccessful. Further data using largescale and longterm clinical trials are needed in order to create tailored and personalized treatments for atopic dermatitis.Atopic dermatitis (AD) is a chronic, inflammatory cutaneous disease that is characterized by complex immune dysregulation and skin barrier dysfunction with a wide variety of clinical phenotypes. Until recently, conventional therapeutic modalities for AD remained rather non-specific despite AD's complex etiology. Failing to take into account the underlying inflammatory pathways led to treatments with inadequate efficacy or unacceptable long-term toxicities. We are currently in the midst of a therapeutic renaissance in AD. Recent progress in molecular medicine provides us a better understanding of the AD pathogenesis, suggesting a dominant helper T cell (Th) 2/Th22 response with a varying degree of Th1/Th17 overexpression. Targeted therapeutic agents including biologics and small molecule inhibitors in development hold promises for more effective and safer therapeutic approaches for AD. A better understanding of individual differences amongst AD patients will allow for a more tailored approach in the future. This review aims to cover the most promising emerging therapies in the field of atopic dermatitis utilizing recently published manuscripts and up-todate conference abstracts and presentations.
Objectives: Nerve transfer (NT) and free gracilis muscle transfer (FGMT) are procedures for reanimation of the paralyzed face. Assessing the surgical outcomes of these procedures is imperative when evaluating the effectiveness of these interventions, especially when establishing a new center focused on the treatment of patients with facial paralysis. We desired to discuss the factors to consider when implementing a facial nerve center and the means by which the specialist can assess and analyze outcomes. Methods: Patients with facial palsy secondary to multiple etiologies, including cerebellopontine angle tumors, head and neck carcinoma, and trauma, who underwent NT or FGMT between 2014 and 2019 were included. Primary outcomes were facial symmetry and smile excursion, calculated using FACE-gram and Emotrics software. Subjective quality of life outcomes, including the Facial Clinimetric Evaluation (FaCE) Scale and Synkinesis Assessment Questionnaire (SAQ), were also assessed. Results: 14/22 NT and 6/6 FGMT patients met inclusion criteria having both pre-and postoperative photo documentation. NT increased oral commissure excursion from 0.4 mm (SD 5.3) to 2.9 mm (SD 6.8) ( P = 0.05), and improved symmetry of excursion ( P < 0.001) and angle ( P < 0.001). FGMT increased oral commissure excursion from −1.4 mm (SD 3.9) to 2.1 mm (SD 3.7), ( P = 0.02), and improved symmetry of excursion ( P < 0.001). FaCE scores improved in NT patients postoperatively ( P < 0.001). Conclusions: Measuring outcomes, critical analyses, and a multidisciplinary approach are necessary components when building a facial nerve center. At our emerging facial nerve center, we found NT and FGMT procedures improved smile excursion and symmetry, and improved QOL following NT in patients with facial palsy secondary to multiple etiologies.
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