This document provides an overview and agenda for a learning community on basic dermatology care in the pediatric medical home. It lists the faculty for the program and discloses no financial conflicts of interest. The schedule outlines topics covered on atopic dermatitis, acne, warts/molluscum, and a wrap-up session. It encourages completion of coursework like case reviews and process maps. The webinar covers treatment of common conditions like atopic dermatitis and acne, addressing complications, and answering questions from participants. Process map presenters then share examples from their own practices.
Antimicrobial resistance is one of the biggest threats to human health and is rising to dangerously high levels in all parts of the world. Anyone, of any age, in any country, could be impacted. While it's normal for microbes to develop resistance to drugs, the way antimicrobials are currently being used is accelerating the process, and as a result common infections and minor injuries are becoming an increasingly greater threat to our well-being. Organizations from across the world are taking action and making progress on this issue, but is there anything patients, their families and patient advisors can do to help?
See the full presentation here: https://goo.gl/AYCsdd
Antimicrobial resistance is one of the biggest threats to human health and is rising to dangerously high levels in all parts of the world. Anyone, of any age, in any country, could be impacted. While it's normal for microbes to develop resistance to drugs, the way antimicrobials are currently being used is accelerating the process, and as a result common infections and minor injuries are becoming an increasingly greater threat to our well-being. Organizations from across the world are taking action and making progress on this issue, but is there anything patients, their families and patient advisors can do to help?
See the full presentation here: https://goo.gl/AYCsdd
Antimicrobial resistance is one of the biggest threats to human health and is rising to dangerously high levels in all parts of the world. Anyone, of any age, in any country, could be impacted. While it's normal for microbes to develop resistance to drugs, the way antimicrobials are currently being used is accelerating the process, and as a result common infections and minor injuries are becoming an increasingly greater threat to our well-being. Organizations from across the world are taking action and making progress on this issue, but is there anything patients, their families and patient advisors can do to help?
See the full presentation here: https://goo.gl/AYCsdd
Antimicrobial resistance is one of the biggest threats to human health and is rising to dangerously high levels in all parts of the world. Anyone, of any age, in any country, could be impacted. While it's normal for microbes to develop resistance to drugs, the way antimicrobials are currently being used is accelerating the process, and as a result common infections and minor injuries are becoming an increasingly greater threat to our well-being. Organizations from across the world are taking action and making progress on this issue, but is there anything patients, their families and patient advisors can do to help?
See the full presentation here: https://goo.gl/AYCsdd
Bringing Basic Concussion and Orthopedic Care to the Pediatric Medical Home K...ppochildrens
This session occurred on 2/24/2016 and is the 4th Didactic session of the Concussion/Ortho LC. This session focused on the Knee and our speaker was Dr. Heyworth from Boston Children's.
The contents :
Skin over view
Types of skin lesions
Hypersensitivity reactions and the skin
Eczema over view
Approach to a Skin Rash
Atopic dermatitis
MCQ Questions
Summary of updated information about the disease of Atopic dermatitis, aetiology, immunopathogenesis, main clinical features and dianostic criteria, concepts of managemnt of Atopic dermatitis including newest treatment trends.
26 Disruptive & Technology Trends 2016 - 2018Brian Solis
Introducing the “26 Disruptive Technology Trends for 2016 – 2018.” In this report, we’ll explore some of the disruptive trends that are affecting pretty much everything over the next few years at least those that I’m following. It’s not just tech, though. The report is organized by socioeconomic and technological impact.
Obviously, this is not an exhaustive list of every technology and societal trend bringing about disruption on planet Earth. What follows thought definitely affects the evolution of digital Darwinism, the evolution of society and technology and its impact on behavior, expectations and customs.
GR AFHS Skin Infection-final 9-23 wo CE for ho.pptxAFHSResources
The learning outcome for this activity: Participants will have increased knowledge and ability to apply the Age-Friendly 4Ms Framework to older adult patients presenting with a skin infection in a convenient care setting.
Bringing Basic Concussion and Orthopedic Care to the Pediatric Medical Home K...ppochildrens
This session occurred on 2/24/2016 and is the 4th Didactic session of the Concussion/Ortho LC. This session focused on the Knee and our speaker was Dr. Heyworth from Boston Children's.
The contents :
Skin over view
Types of skin lesions
Hypersensitivity reactions and the skin
Eczema over view
Approach to a Skin Rash
Atopic dermatitis
MCQ Questions
Summary of updated information about the disease of Atopic dermatitis, aetiology, immunopathogenesis, main clinical features and dianostic criteria, concepts of managemnt of Atopic dermatitis including newest treatment trends.
26 Disruptive & Technology Trends 2016 - 2018Brian Solis
Introducing the “26 Disruptive Technology Trends for 2016 – 2018.” In this report, we’ll explore some of the disruptive trends that are affecting pretty much everything over the next few years at least those that I’m following. It’s not just tech, though. The report is organized by socioeconomic and technological impact.
Obviously, this is not an exhaustive list of every technology and societal trend bringing about disruption on planet Earth. What follows thought definitely affects the evolution of digital Darwinism, the evolution of society and technology and its impact on behavior, expectations and customs.
GR AFHS Skin Infection-final 9-23 wo CE for ho.pptxAFHSResources
The learning outcome for this activity: Participants will have increased knowledge and ability to apply the Age-Friendly 4Ms Framework to older adult patients presenting with a skin infection in a convenient care setting.
"Quality in action...for every patient, every time" by Derek FeeleyNHSScotlandEvent
n this opening plenary session of the NHSScotland Event 2011, Derek Feely talks about progress on quality. Along with Jason Leitch, Derek reflects on some of the challenges facing the service and how NHSScotland would respond. He also celebrates some of the successes over the last year across NHSScotland.
The learning outcome for this activity: Participants will have increased knowledge of using the Age-Friendly 4Ms Framework while caring for an older adult patient with Diabetes Mellitus in a convenient care setting.
The learning outcome for this activity: Participants will have increased knowledge and ability to apply the Age-Friendly 4Ms Framework in managing polypharmacy in the older adult patient seen in a convenient care setting.
For more information contact: Slideshare@marcusevans.com
Presentation delivered by Donna Medina, Regional Director,OSF Hospice and Homecare Foundation at the marcus evans Home Care Leadership Summit held on July 13 & 14 2015 in Palm Beach FL.
GR AFHS Geriatric Syndromes- HO Version wo CE.pptxAFHSResources
The learning outcome for this activity: Participants will have increased knowledge of applying the Age-Friendly 4Ms Framework while caring for an older adult patient experiencing elements of Geriatric Syndrome in a convenient care setting.
The goal for this activity is to increase the participant’s knowledge and ability to apply the Age-Friendly 4Ms Framework when caring for older adults (65 and up) with Cerumen Impaction in a convenience care setting.
The goal for this activity is to increase the participant’s knowledge and ability to apply the Age-Friendly 4Ms Framework when caring for older adults (65 and up) with Cerumen Impaction in a convenience care setting.
GR AFHS Shingles 4.22.21-ho version wo CH.pptxAFHSResources
The learning outcome for this activity: Participants will have increased knowledge of using the Age-Friendly 4Ms Framework while caring for an older adult patient with Shingles in a convenient care setting.
The learning outcome for this activity: Participants will have increased knowledge of using the Age-Friendly 4Ms Framework while caring for an older adult patient experiencing Dementia, Depression or Delirium in a convenient care setting.
Primary medical care settings are ideal for treating chronic illnesses but are underutilized venues for addressing this particular chronic disease. Addiction treatment specialists are too few and many patients find this path to be unacceptable. The question becomes: how to get primary care medical providers to integrate the treatment of patients with opioid use disorders into their practices?
Different ways to accomplish this were the topic of the Louis Kolodner Memorial Lecture at MedChi for the second year in a row. Last year, Dr. Michael Fingerhood described the model that he has developed at Johns Hopkins Medicine. This year, Dr. Richard Schottenfeld, now the Chief of Psychiatry at Howard University, presented research studies done by Yale University and other centers. These studies demonstrated four successful interventions:
Methadone given to already stabilized opioid addiction patients in a primary care setting instead of a specialized opioid treatment program (OTP)
Buprenorphine along with medical counseling given in a primary care setting
An initial dose of buprenorphine given in a hospital emergency department along with a next-day follow up appointment for ongoing treatment
Injectable naltrexone, although more difficult to initiate for patients than was buprenorphine, was effective for those patients who were able to start it
Two barriers that needed to be reduced to achieve these successes were the disinclination of providers to use these medications and general pessimism about the prognosis of opioid use disorders. My hope is that as more successes are demonstrated, these barriers will slowly be lowered. For those interested in more details about these studies, I invite you to access the lecture slides, available here.
Leading Quality Improvements in Pediatric Rheumatology Care - Dr. Esi MorganSystemic JIA Foundation
This talk was given by Dr. Esi Morgan of Cincinnati Childrens Hospital to a group of patient families, at Systemic Juvenile Idiopathic Arthritis (or SJIA) Family Day on July 22nd, 2017.
Objective
1.Understand how building a coordinated cross sectoral team impacts the patient experience during transitions.
2.Learn how hospital, case managers, nursing home and pharmacy came together to change the Medication Reconciliation process resulting in reduced polypharmacy and hospital visits due to medication adverse effects.
3.Recognize the impact of BOOMR (BARRIE COORDINATED CROSS SECTORAL MEDICATION RECONCILIATION) on system efficiencies, inter-professional communication and resident, family and staff satisfaction.
4.Learn about a new tool designed for patients to help engage them and their health care providers in a conversation about their medications.
WATCH: http://bit.ly/1Q3MGp8
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
ALKAMAGIC PLAN 1350.pdf plan based of door to door delivery of alkaline water...rowala30
Alka magic plan 1350 -we deliver alkaline water at your door step and you can make handsome money by referral programme
we also help and provide systematic guideline to setup 1000 lph alkaline water plant
COVID-19 PCR tests remain a critical component of safe and responsible travel in 2024. They ensure compliance with international travel regulations, help detect and control the spread of new variants, protect vulnerable populations, and provide peace of mind. As we continue to navigate the complexities of global travel during the pandemic, PCR testing stands as a key measure to keep everyone safe and healthy. Whether you are planning a business trip, a family vacation, or an international adventure, incorporating PCR testing into your travel plans is a prudent and necessary step. Visit us at https://www.globaltravelclinics.com/
Veterinary Diagnostics Market PPT 2024: Size, Growth, Demand and Forecast til...IMARC Group
The global veterinary diagnostics market size reached US$ 6.6 Billion in 2023. Looking forward, IMARC Group expects the market to reach US$ 12.6 Billion by 2032, exhibiting a growth rate (CAGR) of 7.3% during 2024-2032.
More Info:- https://www.imarcgroup.com/veterinary-diagnostics-market
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
Rate Controlled Drug Delivery Systems, Activation Modulated Drug Delivery Systems, Mechanically activated, pH activated, Enzyme activated, Osmotic activated Drug Delivery Systems, Feedback regulated Drug Delivery Systems systems are discussed here.
About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
This document is designed as an introductory to medical students,nursing students,midwives or other healthcare trainees to improve their understanding about how health system in Sri Lanka cares children health.
5. 5
Coursework
• Qstream
• Case Reviews
• Follow the
instructions on the
first page
• Submit on Blackboard
or email or by fax to
Madeleine Kuhn
• Process Maps, due by
11/11/2016
8. 8
Patient
Calls for
acne appt
or derm
referral
Front desk
schedules Appt.
within a few days
PCP/PNP
examine patient
Severe
cystic
scarring
acne
Start topical or
oral medication
F/U in 6-8 weeks
Refer to
Derm
Adjust
meds if
needed
YES
NO
What happens to
patient after
referral?
Address Acne at
well/sick visits?
CURRENT PROCESS
Andover Pediatrics
9. 9
Patient
Calls for
sick/well
visit
Front desk
schedules Appt.
PCP/PNP examine
patient including
skin exam (starting
age 11)
Severe
cystic
scarring
acne
Talk with patient
about acne and
potential treatment
options
Offer Rx that day
or reschedule for
visit dedicated to
acne
Refer to Derm
YES
NO
Start topical or
oral medication
Follow-up in 6-8
weeks to
reassess
Patient
improving
Follow-up
in 6-8
weeks to
reassess
Follow-up
in 6-8
weeks to
reassess
Adjust meds Patient
improving
YES
YES
NO
NO
NEW PROCESS
10. 10
Annual well
visit 13 and up
Questionnaire given that
inquires about acne and
desire to treat
Patient has
acne and
wants to treat
Do not discuss
Discuss and make
treatment plan
Follow up in
office in 8
weeks
Are we missing patients who might not
be ready but become so during year –
Can we give them education and let
them know about our ability to treat
effectively?
No Yes
CURRENT PROCESS Westwood –Mansfield Pediatric
Associates
Karen Halle, MD; Jen Hyde, MD; Jill
Fischer, MD; Erin Kish, MD; Helen
Lyon, MD; Sandra Ventura NP;
Meridith Liebman, MD
12. 12
Annual well
visit 10 and up
All patients receive
handout on good skin care
and basic acne treatment
Discuss acne management and make
treatment plan. Acknowledge need for
and ability to recommend changes if
initial treatment not working
Providers routinely identify
and document patients
with acne on physical
exam
Patient with
acne
Provider
educates patient and
family about calling
office if acne develops
and otc treatments not
working
Make follow up
visit in 8 weeks
no
yes
NEW PROCESS
Patient reports interest in
treatment
yes
Provider educates
patient and family
regarding availability of
acne treatment if and
when they consider
no
13. 13
Process Map Coursework Q & A
1. How will you implement your new process? What do office-staff need to
know about it and how will you train them on the new process?
We will need to develop a handout to be placed in our well child packets (both
online and in office) and make sure that the office staff responsible for these
are aware. We will need to train our providers through provider meeting and
in office memo that this handout is being provided and that documenting and
discussing basics of acne treatment will improve the care of our patients. We
will inform front desk staff of the 8 week follow up on initial acne
management.
2. Will your new process require any patient/family outreach or education?
If so , how will you accomplish the necessary patient/family education? We
will need to develop the handout and formulate anticipatory guidance for well
visit discussion on acne. We will need to educate providers on such.
3. How will you monitor that the new process is happening correctly over
time in your practice?
We will check website and packets and will monitor referrals to dermatology
for patients we could have likely managed.
14. 14
Itchy eruption in classic areas
Assess for complicating factors
like contact dermatitis (airborne,
saliva) and infection
When treating, remember to
treat both the barrier dysfunction
and the immune system
upregulation
Don't be afraid to use a higher
potency topical steroid-when in
doubt, schedule frequent follow
ups and limit quantities and refills
Atopic Dermatitis
20. 20
Acne Treatment:
Benzoyl Peroxide
Initial treatment for any patient with acne:
– My preference: once daily wash
– easier to get chest and back as well
– Panoxyl 4% creamy wash (or generic) = less drying
• BP creams an alternative to entire face
• Gels can be drying
21. 21
Acne Treatment
• Mild: Benzoyl peroxide wash QD & topical retinoid, topical
antibiotic if inflammatory
• Moderate: Mild + oral antibiotic +/- OCP
• Severe: Moderate + consideration of isotretinoin if scarring or
refractory
• Isotretinoin: Best bet for curing scarring acne
– Females need to be on two forms of birth control
– Not associated with increased risk for inflammatory bowel
disease
22. 22
Acne Treatment Commandments
All acne patients should be using a benzoyl peroxide and topical
retinoid.
All patients on an antibiotic should also be on a benzoyl peroxide.
Refer to Derm early for isotretinoin discussion if scarring.
Consider OCPs in female patients with acne.
Manage expectations for results that may take months.
23. 23
Questions: Acne Complications
Discoloration
Post-inflammatory
Hyperpigmentation and
Hypopigmentation
– Sunscreen!
– Tretinoin targets this as well
– Pulsed dye laser decreases
redness
– Chemical peels and bleaching
agents may play a role
24. 24
Acne Complications: Scarring
• Remodel and improve in
appearance over time
• Chemical peels, laser
resurfacing, surgical procedures
(subcision) may play a role once
acne is well controlled
• Tretinoin has a modest role in
the remodeling of acne scars
http://acner.org/img/care_and_prevention/acne-scars-and-pitting_2_3157.jpg
25. 25
Acne Complications (contd.)
Keloids: aberrant scar tissue
that grows beyond the direct
area of tissue damage
Common sites: shoulders,
chest, back, jawline
Treatments: PREVENTION IS
KEY (treat acne aggressively)
Intralesional kenalog (steroid
injections), radiation therapy
DO NOT EXCISE without a
game plan!
26. 26
Questions: Acne and Oral Contraceptives
3 FDA approved OCPs for treatment of acne:
Ortho Tri Cyclen (norgestimate/ethinyl estradiol)
Estrostep (norethindrone acetate and ethinyl estradiol)
Yaz (drosperinone/ethinyl estradiol)
For moderate-severe acne in females who have had their menses
for 1 year
27. 27
Oral Contraceptives and Acne (Contd.)
Pertinent History that Should Be
Elicited
Family history of thrombotic
events
Smoking history
(Migraine with aura)
Thrombotic events are rare in
adolescence
Most common side effects: nausea,
vomiting, breast tenderness,
headache, weight gain, breakthrough
bleeding
28. 28
Oral Contraceptives and Acne: Important
Consideration
Maximization of bone mineral density
50% bone mass accrued between 12-18
years of age
24 month study of postmenarchal girls on
OC did not reveal osteopenia; BMD
femoral neck 4.2% compared to 6.3% in
control; conclusion was effects of OC
unclear
Prescribing of OC based on provider level
of comfort
Fertil Steril. 2008 Dec;90(6):2060-7. doi: 10.1016/j.fertnstert.2007.10.070. Epub 2008 Jan 28.
29. 29
Salicylic acid + duct tape at all times. Goal is maceration
Pare down before treatments to get to affected keratinocytes
Cryotherapy: 2 cycles of 7 seconds with slow thaw in between
Tretinoin cream for facial flat warts, imiquimod for genital warts
May take months of treatment
Potential benefit of HPV vaccine
Genital warts red flags: Child>4-5, out of diapers with no known
non-abuse exposure route)
Wart:
Treatment
32. 32
Questions: Cryotherapy Practical
Considerations
Various methods (Cry-ac,
Q-tip, Q-tip with cotton
“10-15 second” cycle
The margin around the
lesion correlates to the
depth of your freeze
Complications include
blister formation,
hyperpigmentation,
hypopigmentation and
ring wart formation
33. 33
Questions: Cryotherapy Billing
CPT codes
17110 (Destruction of flat warts,
molluscum or milia up to 14 lesions)
17111 (Destruction 15 or more
lesions)
ICD10 codes
B07.0 plantar warts
B07.8 other viral warts
B07.9 viral wart, unspecified
B08.1 molluscum contagiosum
Procedure only v. procedure and an office visit
Follow up treatment for destruction
only: bill the CPT code only
Destruction and addressing of other
issues: bill the office visit and the CPT
34. 34
Molluscum Treatment
• Resolves 6-24 months
• Treat molluscum dermatitis with
emollients and lower potency topical
steroids
• OTC Treatment: tea tree oil, apple cider
vinegar, tape stripping
• Rx: Cantharidin, light cryotherapy,
extraction/curettage
35. 35
Questions: Imiquimod (Aldara) for Molluscum
• Imiquimod still used by Derms and
PCP for molluscum
• Based on 2 unpublished RTC, in 2007
FDA changed imiquimod prescribing
info to state that it was not effective
for molluscum.
• Concern that relative expensive med
used when not effective
36. 36
“Newbies”
Questions on disease entities not yet
covered
• Gianotti Crosti
• Papular Urticaria
For more dermatologic conditions, stay
tuned for Derm 2.0!
37. 37
Gianotti-Crosti
Tx: Topical steroids don’t help pruritus much but lower potency (desonide
triamcinolone) likely doesn’t hurt BID for 1-2 weeks
Resolves in weeks without scarring
Triggers: EBV, HepB, entero, CMV, RSV, echo, vaccinations
Symmetric papules on extensor knees, elbows and buttocks
Localized id reaction
Papular Acrodermatitis of Childhood
42. 42
Papular Urticaria
Tx: topical steroids, antihistamines, evaluation of home for
infestations
Can wax and wane for weeks to months
Id response to arthropod bites
Misnomer: Lesions last > 24 hours
45. 45
Diaper Dermatitis
• Irritant contact dermatitis
• Potential for secondary bacterial and fungal infections
• Typically need a multiple-prong:
– Barrier Cream
– Antifungal given risk of candidiasis
– Lower potency topical steroids (Hydrocortisone 2.5% or
Desonide)
– Antibacterial if concern for infection
46. 46
Barrier Creams
• Thicker = Better.
• If you see the rash without wiping, it isn’t thick enough
• Wet diapers pat dry and apply more gobs of cream
• Soiled diapers wipe off soiled portions and apply more gobs of
cream
• Vaseline, Desitin, Triple Paste, A&D.
– Basically anything that is thick and non-irritating is ok.
47. 47
Bacterial Infections
Signs: spreading erythema,
pustules, peri-anal erythema
(think strep)
Add mupirocin
BID to topical
applications. Can
be mixed with
other treatments
(antifungal or
barrier)
48. 48
Diaper Derm Mimics
• Psoriasis – Typically will improve once out of diapers.
– Should improve with basic treatments (barrier, topical barriers)
• Langerhans cell histiocytosis (LCH)
– Petechial/non-blanching, favors inguinal creases
– Similar lesions on scalp, post-auricular
– Can have visceral lesions, including osteolytic lesions and
diabetes insipidus
– WONT RESPOND TO TOPICAL DIAPER TREATMENTS