Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
School of Medicine, University of California, San Francisco.
JAMA Dermatol. 2019 Dec 1;155(12):1410-1415. doi: 10.1001/jamadermatol.2019.3064.
Emerging efforts to recognize and combat medical overuse are important solutions to mitigate patient morbidity from unnecessary health care interventions.
To identify and highlight important original investigations on medical overuse in dermatology from 2017 to 2018.
The PubMed and Embase databases coupled with articles published in 8 major dermatology and medical journals from January 1, 2017, to December 31, 2018, were searched to identify articles related to medical overuse in dermatology.
Of 1941 candidate articles identified through the database search and 41 through the manual journal review, 38 were deemed relevant to medical overuse in dermatology by 2 independent reviewers. Twenty-eight of these articles were determined to be high priority based on scoring for quality of methods, magnitude of clinical effect, and number of patients potentially affected. After expert reviewer scoring, 10 articles were selected for analysis based on highest scores and greatest clinical significance. Selected articles covered topics such as dermatology consultation for cellulitis, management of dysplastic nevi, prognostic utility of sentinel lymph node biopsy, laboratory monitoring for terbinafine and isotretinoin, and safe medication prescribing. For cellulitis management, dermatology consultation is important for reducing misdiagnosis, unnecessary hospitalization, and inappropriate use of antibiotics. Findings related to common dermatologic procedures revealed that clinical observation is safe for dysplastic nevi and that sentinel lymph node biopsy may not have prognostic utility over Breslow thickness. In monitoring for terbinafine and isotretinoin, patient education on clinical symptoms is likely more effective than standard laboratory test result monitoring. Finally, dermatologists should reconsider the use of cyclosporine in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis and reevaluate the use of perioperative narcotics for patients.
This review notes actionable, evidence-based practices to reduce medical overuse in dermatology. This work may help to facilitate management changes to emphasize high-value care in dermatology while promoting awareness and further evaluation of overuse in medicine.
识别和打击医疗过度的新兴努力是减轻不必要的医疗干预对患者发病率的重要解决方案。
确定和突出 2017 年至 2018 年皮肤科过度医疗的重要原始研究。
通过 PubMed 和 Embase 数据库以及 2017 年 1 月 1 日至 2018 年 12 月 31 日 8 种主要皮肤科和医学期刊上发表的文章进行搜索，以确定与皮肤科过度医疗相关的文章。
通过数据库搜索确定了 1941 篇候选文章，通过手动期刊审查确定了 41 篇，由 2 位独立审查员确定了 38 篇与皮肤科过度医疗相关的文章。其中 28 篇文章根据方法质量、临床效果大小和潜在受影响患者数量进行评分，被认为是高度优先事项。经过专家审查员评分，根据最高得分和最大临床意义选择了 10 篇文章进行分析。选定的文章涵盖了皮肤科对蜂窝织炎的咨询、发育不良痣的管理、前哨淋巴结活检的预后效用、特比萘芬和异维 A 酸的实验室监测以及安全药物处方等主题。在蜂窝织炎管理方面，皮肤科咨询对于减少误诊、不必要的住院治疗和不适当使用抗生素非常重要。与常见皮肤科程序相关的发现表明，临床观察对于发育不良痣是安全的，并且前哨淋巴结活检可能不如 Breslow 厚度具有预后效用。在监测特比萘芬和异维 A 酸时，患者对临床症状的教育可能比标准实验室检测结果监测更有效。最后，皮肤科医生应该重新考虑在 Stevens-Johnson 综合征和中毒性表皮坏死松解症患者中使用环孢素，并重新评估围手术期麻醉药物在患者中的使用。
本综述指出了减少皮肤科过度医疗的可操作、基于证据的实践。这项工作可能有助于促进皮肤科高价值护理管理的改变，同时提高对过度医疗的认识，并进一步评估医学中的过度医疗。
