Katherine G. Thompson’s research while affiliated with Johns Hopkins University and other places

Tumor necrosis factor-alpha inhibitors (TNFi) can be an effective treatment for organ transplant recipients (OTR) with various diseases but can increase the risk of infection and drug interactions.¹ There is also a potential for acute graft rejection while on TNFi with an unclear causal relationship. Two patients experienced acute graft rejection out of sixteen in a retrospective study of kidney transplant patients on TNFi, but the rejections were deemed unlikely to be related to biologic use.⁴ The purpose of this larger, multicenter study was to evaluate the safety of TNFi use in OTR by assessing rates of complications in patients treated with TNFi post-transplant.

Patient-reported outcomes (PROs) describe measures of a patient’s experience throughout medical care as reported by the patient (Mercieca-Bebber et al. in Patient Relat Outcome Meas, 2018). Various PRO instruments exist. It is challenging to select appropriate instruments given the absence of an organizational framework which describes all measurable PROs in dermatologic surgery and represents which instruments measure which outcomes. Our objective was to systematically review all validated PRO instruments in dermatologic surgery and use qualitative analysis to develop an organizational framework representing PRO measures and instruments. PubMed/MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane databases were searched to retrieve validated PRO instruments in the dermatologic surgery population. The constant comparative method of qualitative analysis was used to develop an organizational framework representing all PROs in dermatologic surgery. All instruments were sorted into this framework. The search identified 3195 articles; 35 validated instruments were extracted and qualitatively analyzed. The organizational framework sorted all instruments into 36 PRO measures aligned with the National Institutes of Health Patient-Reported Outcomes Measurement Information System (Gershon RC, Rothrock N, Hanrahan R, et al (2010) The use of PROMIS and assessment center to deliver patient-reported outcome measures in clinical research). Measures were grouped into four categories (expectations, satisfaction, quality of life, needs) describing how patients experience these outcomes and lenses through which researchers can evaluate them. In conclusion, we have proposed an organizational framework for use in choosing validated instruments to develop and answer PRO research questions.

BACKGROUND Delays or failure to complete a dermatologic referral may affect health care outcomes. Factors associated with these delays remain understudied. OBJECTIVE This study investigated socioeconomic and demographic factors associated with delays or failure to complete dermatology referrals and potential impact on surgical outcomes. METHODS A retrospective chart review was performed for 400 patients internally referred to an academic dermatology center from 19 primary-care clinics from July 2018 to June 2019. Only patients referred after an in-person primary-care visit in which the provider documented a specific concerning lesion were included. Multivariate analyses were performed to explore variables associated with delays or failure to complete dermatology referrals. RESULTS Patients were more likely to complete their referral if they had a personal history (adjusted odds ratio [aOR] = 7.843, 95% CI 1.383–14.304) or family history (aOR = 11.307, 95% CI 2.344–20.27) of skin cancer. Patients were more likely to delay referral completion past 30 days if they were ages 18 to 34 (aOR = 6.665, 95% CI 1.285–12.044) and less likely to delay referral past 30 days if they had a previous history of skin cancer (aOR = 0.531, 95% CI 0.181–0.882). LIMITATIONS Single institution, retrospective study, limited surgical patients. CONCLUSION Understanding factors associated with delays in dermatology referral completion can help identify at-risk patient populations.

Background: Despite the importance of patient satisfaction in ensuring high-quality care, studies investigating patient satisfaction in Mohs micrographic surgery (MMS) are limited. Objective: We investigated the factors associated with patient satisfaction in MMS for non-melanoma skin cancer and how patient satisfaction changes in the post-operative period. Methods: In this prospective cohort study including 100 patients, patient satisfaction surveys were administered at the time of surgery and at three months post-surgery. Sociodemographic characteristics, medical history, and surgical parameters were collected by chart review. Univariate linear and logistic regression models were created to examine these relationships. Results: Decreased satisfaction was observed in patients requiring three or more MMS stages both at the time of surgery (p=0.047) and at three months post-surgery (p=0.0244). Patients with morning procedures ending after 1:00 PM had decreased satisfaction at the time of surgery (p=0.019). A decrease in patient satisfaction between the time of surgery and three months post-surgery was observed in patients with surgical sites on the extremities (p=0.036), larger pre-operative lesion sizes (p=0.012), and larger defect sizes (p=0.033). Limitations: Single-institution data, self-selection bias, and recall bias. Conclusion: Patient satisfaction for MMS is impacted by numerous factors and remains dynamic over time.