No abstract

IMPORTANCE Physician assistants (PAs) are increasingly used in dermatology practices to diagnose skin cancers, although, to date, their diagnostic accuracy compared with board-certified dermatologists has not been well studied.OBJECTIVE To compare diagnostic accuracy for skin cancer of PAs with that of dermatologists.

Background Inflammatory bowel disease (IBD) is a heterogeneous chronic inflammatory condition requiring significant healthcare expenditure. Subgroups of individuals contribute disproportionately to spending. We aimed to determine demographic and clinical factors predictive of high healthcare expenditures for IBD patients followed over a multiyear period. Methods This was a registry analysis using a prospective observational, consented, natural history registry from a tertiary IBD center and associated medical charges, not including pharmacy expenses. The 100 patients with the highest medical charges (top 5%) were compared to the median 300 patients. Logistic regression determined demographic and clinical factors associated with high charge patients. Results IBD patients in the high charge group had significantly more unemployment (p<0.0001), black race (p=0.013), comorbid psychiatric illness (p=0.002), hypertension (p=0.01), diabetes (p=0.004), opiate use (p<0.0001), perianal involvement (p=0.002), penetrating disease (p<0.0001), and extensive colitis (p=0.01). In multivariate analysis unemployment (CD: OR 3.04; 95% CI 1.32–7.02; UC: OR 2.68; 95% CI 1.20–5.99), psychiatric illness (UC: OR 2.08; 95% CI 1.03–4.19), opiates (CD: OR 5.61; 95% CI 2.67–11.82; UC: OR 5.14; 95% CI 2.52–10.48), prior surgery (CD: OR 3.29; 95% CI 1.59–6.82; UC: OR 2.72; 95% CI 1.39–5.32), penetrating CD (OR 3.29; 95% CI 1.02–10.62), and corticosteroid requirement (CD: OR 3.78; 95% CI 1.86–7.65; UC: OR 2.98; 95% CI 1.51–5.90) remained independently associated with high charges. Conclusion High expenditure IBD patients were affected by more severe disease. The high prevalence of depression, anxiety, and chronic pain in these patients suggests the need for focused treatment of these comorbidities ultimately to reduce financial burden.

We found development of an IBD SMH to be feasible and significantly reduce unplanned care and disease activity and increase patient QoL 1 year after enrollment.

This multi-year study of a large IBD cohort suggests that peripheral blood eosinophilia represents a biomarker of a distinct IBD subgroup, with a unique inflammatory signature, and at risk for worse clinical outcomes.

At 2 years postoperatively, CD patients with ETEA demonstrated better QoL and less healthcare utilization compared with STSA, despite having similar patterns of disease recurrence and CD treatment. These findings suggest that surgical reconstruction of the bowel as an intact tube (ETEA) contribute to improved functional and clinical status in patients with CD.

Melanoma detection through total body skin examination is most efficient in patients ≥50 years of age and those with a personal history of melanoma. Our findings will be helpful in modeling the cost effectiveness of melanoma screening by dermatologists.

Background Inflammatory bowel disease (IBD) is associated with alterations of the innate and adaptive immune systems. Monocytes respond to inflammation and infection, yet the relationship between monocytosis and IBD severity is not fully understood. We aimed to characterize the prevalence of monocytosis in IBD and the association between monocytosis and disease severity and IBD-related health care utilization. Methods We used a multiyear, prospectively collected natural history registry to compare patients with IBD with monocytosis to those without monocytosis, among all patients and by disease type. Results A total of 1290 patients with IBD (64.1% with Crohn disease; 35.9% with ulcerative colitis) were included (mean age 46.4 years; 52.6% female). Monocytosis was found in 399 (30.9%) of patients with IBD (29.3% with Crohn disease; 33.9% with ulcerative colitis). Monocytosis was significantly associated with abnormal C-reactive protein level and erythrocyte sedimentation rate, anemia, worse quality of life, active disease, and increased exposure to biologics (all P &lt; 0.001). Compared with patients without monocytosis, patients with monocytosis had a 3-fold increase in annual financial health care charges (median: $127,013 vs. $32,925, P &lt; 0.001) and an increased likelihood of hospitalization (adjusted odds ratio [AOR], 4.5; P &lt; 0.001), IBD-related surgery (AOR, 1.9; P = 0.002), and emergency department (ED) use (AOR, 2.8; P &lt; 0.001). Patients with monocytosis had a shorter time to surgery, hospitalization, and ED visit after stratifying by disease activity (all P &lt; 0.05). Conclusions Patients with IBD with monocytosis, regardless of disease type, are at increased risk for worse clinical outcomes, hospitalization, surgery, and ED use. Peripheral monocytosis may represent a routinely available biomarker of a distinct subgroup with severe disease.