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Background: Dermoscopy is a useful technique for improving the diagnostic accuracy of various types of skin disorders. Although the technique has been widely adopted by European, Australian, and United States dermatologists, only limited information is available on the prevalence of dermoscopy use in Taiwan. Objectives: We assessed the use and barriers to adoption of dermoscopy among Taiwanese dermatologists to determine the relationship between dermoscopy use and the characteristics of dermoscopy users. Methods: A questionnaire of 20 items regarding demographic characteristics, dermoscopy training, and application was mailed to all dermatologists listed in the 2013 Taiwanese Dermatological Association registry. Results: Of the 950 mailed questionnaires, 202 were returned and 195 were identified to be eligible. Of the valid respondents, 51.8% used dermoscopy and 62.1% had attended courses for dermoscopy training. Dermoscopy use was significantly associated with women (p = 0.018), residents (p

Background: Acral volar melanocytic lesions have a high potential for malignancy. Dermoscopy is a useful, noninvasive tool for the diagnosis of such malignancies. The use of immersion fluids can provide better visual effects and improve the diagnostic accuracy of dermoscopic examinations. Methods: Fifteen volar melanocytic lesions, including two palmar and 13 plantar lesions, were included in our study. We compared the visual effects of two different immersion fluids as an interface for dermoscopy. Four combinations of immersion fluid (ultrasound jelly or mineral oil) and observation mode (polarized or nonpolarized light) were compared for visual effects during the dermoscopic examination of lesions based on air bubble inclusion and microstructure visibility. Results: Both the mineral oil and the ultrasound jelly allowed at least one microstructure to be clearly visible in each image of the acral volar melanocytic lesions examined. All modes of observation achieved acceptable visual effects. The use of mineral oil and the polarized light mode resulted in the formation of fewer bubbles than the use of mineral oil and the nonpolarized light mode (p

ObjectivesTo surveyed the quantities, types, and related information of potential drug-drug interactions (DDIs) and estimate the off-label use percentage of pediatric outpatient prescriptions for newborns and infants from the National Health Insurance Research Database (NHIRD) of Taiwan. BackgroundAdverse drug reactions (ADR) may cause morbidity and mortality, potential drug-drug interactions (DDI) increase the probability of ADR. Research on ADR and DDI in infants is of particular urgency and importance but the related profiles in these individuals are not well known. MethodsAll prescriptions written by physicians in 2000 were analyzed to identify potential DDIs among drugs appearing on the same prescription sheet. ResultsOf a total of 150.6 million prescription sheets, with 669.5 million prescriptions registered in the NHIRD of Taiwan, six million (3.99%) prescription sheets were for 2.1 million infants with 19.4 million (2.85%) prescriptions. There were 672,020 potential DDIs in this category, accounting for 3.53% per prescription; an estimated one DDI in every three patients. The interactions between aspirin and aluminum/magnesium hydroxide were most common (4.42%). Of the most significant drug-drug interactions, the interaction of digoxin with furosemide ranked first (20.14%), followed by the interactions of cisapride with furosemide and erythromycin (6.02% and 4.85%, respectively). The interactions of acetaminophen and anti-cholinergic agents comprised most types of drug-drug interactions (6.62%). ConclusionAlthough the prevalence rates of DDIs are low, life-threatening interactions may develop. Physicians must be reminded of the potential DDIs when prescribing medications for newborns and infants.

Leprosy is rarely seen in Taiwan. We herein report a foreign worker concomitantly with facial borderline tuberculoid leprosy presenting with trigeminal neuralgia.A 26-year-old male foreign labor from Indonesia, presented with 1 year history of a hypoanaesthetic erythematous plaque of right face and subsequent 6 months constant, severe pain in the right side of his face over the nasolabial groove. Biopsies and histopathological examination confirmed the diagnosis of leprosy. We treated the patient with a multidrug regimen including dapsone, clofazimine, and rifampine since April of 2012 with a good response.We report a rare case of new-onset leprosy presenting with trigeminal neuralgia in Taiwan and suggest leprosy should be listed in the differential diagnosis of unusual skin manifestations and neuralgia.

IntroductionAdverse drug reactions (ADR) increase morbidity and mortality; potential drug-drug interactions (DDI) increase the probability of ADR. Studies have proven that computerized drug-interaction alert systems (DIAS) might reduce medication errors and potential adverse events. However, the relatively high override rates obscure the benefits of alert systems, which result in barriers for availability. It is important to understand the frequency at which physicians override DIAS and the reasons for overriding reminders. MethodAll the DDI records of outpatient prescriptions from a tertiary university hospital from 2005 and 2006 detections by the DIAS are included in the study. The DIAS is a JAVA language software that was integrated into the computerized physician order entry system. The alert window is displayed when DDIs occur during order entries, and physicians choose the appropriate action according to the DDI alerts. There are seven response choices are obligated in representing overriding and acceptance: (1) necessary order and override; (2) expected DDI and override; (3) expected DDI with modified dosage and override; (4) no DDI and override; (5) too busy to respond and override; (6) unaware of the DDI and accept; and (7) unexpected DDI and accept. The responses were collected for analysis. ResultsA total of 11,084 DDI alerts of 1,243,464 outpatient prescriptions were present, 0.89% of all computerized prescriptions. The overall rate for accepting was 8.5%, but most of the alerts were overridden (91.5%). Physicians of family medicine and gynecology-obstetrics were more willing to accept the alerts with acceptance rates of 20.8% and 20.0% respectively (p

Background Primary essential cutis verticis gyrata (CVG) is characterized by folds and furrows of the scalp, resembling the convoluted appearance of the brain, and is not associated with other abnormalities. Most patients with CVG are treated with surgical methods, such as scalp reduction; however, surgery may not be suitable for patients in whom the area involved is large. Methods A 37-year-old man with primary essential CVG was treated with a scalp subcision technique under local anesthesia. Results A successful cosmetic improvement was obtained. Conclusions The scalp subcision technique is a safe procedure and should be a treatment option for primary CVG.

In a clinical decision support system (CDSS), the outcome of the system is related to the user interface directly. A successful CDSS should offer an efficient user interface to clinicians in order to get the most proper consultation results. This study is to assess the impact of user interface to the usability of CDSS. Two different types of input user interfaces were integrated into a well-established CDSS, namely, keyword-based interface and menu-based interface. The operating time of each interface was assessed, and the efficiency of the interfaces, effectiveness of the systems, and enjoyment of the users were also evaluated for degree of usability.

An otherwise healthy 61-year-old female presented with a skin tumor on the left flank, which had been present since her early adulthood. The tumor gradually enlarged during the first 2–3 years and then stabilized in size. There were no symptoms from the tumor. On examination, a red to violaceous, shiny, polypoid, fusiform nodule with firm consis tency, measuring approximately 3.0 cm × 2.0 cm, was noted on her left flank (Figure 1). There were also many skin tumors on her face and scalp, most of which were dome-shaped, smooth surfaced, violaceous, firm nodules measuring several millimeters in diameter. These tumors were 1-cm dermal nodules that caused pain; others were rounded, skin-colored, firm papules with a size of approximately 5 mm in diameter around her nose. An excisional biopsy specimen was obtained from the tumor at the flank. Histopathologic examination revealed a tumor occupying the reticular dermis, which was composed of aggregations of neoplastic cells arranged in a jigsaw puzzle pattern. The aggregations consisted of neoplastic cells with two different appearances: (1) peripheral cells aligned in a palisade with small, dark staining columnar nuclei surrounded by a scant cytoplasm, and (2) cells with nuclei that were larger and paler, and that had a more abundant pale cytoplasm. Each aggregation was surrounded by a rim of homogenous eosinophilic basement membrane-like material. Globules of the same material were also present within the aggregations themselves (Figure 2). The patient then underwent several sessions of surgical removal for other tumors on the face and scalp, and pathology exams showed cylindroma, spiradenoma, trichoepithelioma, or combinations of them (Figure 3A: cylindroma + trichoepithelioma; Figure 3B: cylindroma + spiradenoma). She reported that two of her younger brothers and sisters also had similar skin tumors, but they were not as numerous as hers.

Unilateral nevoid telangiectasia (UNT) is a rare disease characterized by punctuate and stellate telangiectasias that follow dermatomal distribution.1 Its etiology remains elusive; no standard treatment currently exists. We describe a 14-year-old Asian female (skin type IV) with UNT, who underwent treatment with long-pulsed 1064-nm Nd:YAG laser and 595-nm pulsed dye laser for her disease. The patient came to our clinic with linearly arranged, punctate telangiectasias over right side of back, shoulder, and arm (Figure 1). The lesions appeared at the age of 10. The diagnosis of UNT was made based on the clinical manifestations and telangiectasias in superficial dermis (as shown on a histologic exam done previously at another hospital). Angioma serpiginosum is an important differential diagnosis of UNT in this case. Three sessions of treatment with long-pulsed 1064-nm Nd:YAG laser (GentleYAG Laser; Candela Laser, Wayland, MA, USA) were given with parameters (fluence-spot sizepulse width) of 240 J/cm2-3 mm-10 ms (first week), 240 J/ cm2-3 mm-10 ms (second week), and 280 J/cm2-3 mm-10 ms (third week). The interval between each session was 4 weeks. However, there was only slight improvement. Histologic exam performed 2 weeks after the third session revealed marked telangiectasias in papillary dermis (Figure 2). Next, two sessions of pulsed dye laser with 595 nm wavelength (Vbeam Perfecta; Candela Laser) were given with parameters of 13 J/cm2-7 mm-40 ms (fluence-spot sizepulse width) for both sessions. Significant lightening of lesions (> 90%) was observed after the second session (Figure 3). The only adverse reaction was transient purpura that lasted for approximately 2 weeks. There was no hypoor hyper-pigmentation after treatment. There are two forms of UNT, the rarer congenital form and the more common acquired form.2 Telangiectasia develops during puberty in most of the acquired cases, as in our patient. Several reports point out the systemic association of acquired UNT, such as hyperestrogenemia and chronic liver disease.2 In out patient, there was no evidence of high serum level of estrogen or hepatic disease. Both long-pulsed 1064-nm Nd:YAG laser and pulsed dye laser have been shown to be effective in treating vascular lesions.3,4 Major et al3 reported good response with the former for facial and leg telangiectasias. However, it does not seem to be a good treatment modality for UNT for the current case. One possible explanation is that while the 1064-nm Nd:YAG laser beam tends to penetrate to deeper dermis, due to its long wavelength and lesser absorption Figure 1 Clinical picture before treatment.

Background Hospital-acquired infections (HAI) are associated with increased attributable morbidity, mortality, prolonged hospitalization, and economic costs. A simple, reliable prediction model for HAI has great clinical relevance. The objective of this study is to develop a scoring system to predict HAI that was derived from Logistic Regression (LR) and validated by Artificial Neural Networks (ANN) simultaneously. Methodology/Principal Findings A total of 476 patients from all the 806 HAI inpatients were included for the study between 2004 and 2005. A sample of 1,376 non-HAI inpatients was randomly drawn from all the admitted patients in the same period of time as the control group. External validation of 2,500 patients was abstracted from another academic teaching center. Sixteen variables were extracted from the Electronic Health Records (EHR) and fed into ANN and LR models. With stepwise selection, the following seven variables were identified by LR models as statistically significant: Foley catheterization, central venous catheterization, arterial line, nasogastric tube, hemodialysis, stress ulcer prophylaxes and systemic glucocorticosteroids. Both ANN and LR models displayed excellent discrimination (area under the receiver operating characteristic curve [AUC]: 0.964 versus 0.969, p = 0.507) to identify infection in internal validation. During external validation, high AUC was obtained from both models (AUC: 0.850 versus 0.870, p = 0.447). The scoring system also performed extremely well in the internal (AUC: 0.965) and external (AUC: 0.871) validations. Conclusions We developed a scoring system to predict HAI with simple parameters validated with ANN and LR models. Armed with this scoring system, infectious disease specialists can more efficiently identify patients at high risk for HAI during hospitalization. Further, using parameters either by observation of medical devices used or data obtained from EHR also provided good prediction outcome that can be utilized in different clinical settings.

Background Adverse drug reactions increase morbidity and mortality, and potential drug interactions (DIs) increase the probability of adverse drug reactions. Objectives To survey the potential DIs of dermatologic outpatient prescriptions from the National Health Insurance Research Database of Taiwan. Methods All prescriptions written by dermatologists in 2000 were analyzed to identify potential DIs among drugs appearing on the same prescription sheet. Results Of 150.6 million prescription sheets with 669.5 million prescriptions registered in the National Health Insurance Research Database of Taiwan, we identified 6.6 million (4.4%) dermatology prescription sheets with 19 million (2.8%) prescriptions. The findings of the study showed that 283,458 potential DIs were found in this category, accounting for 1.49% per prescription. The most common significance Level 1 interaction (1.1%) was between the less-sedative antihistamines (terfenadine/astemizole) and azole antifungal agents. Among the category of severity, the most common was terfenadine interacting with cimetidine and ketoconazole (4.4%), followed by astemizole interacting with cimetidine and ketoconazole (2.9%). The most common drug class interaction occurred between corticosteroids and antacids (48.5%). Overall, DI incidence in dermatologic patients was lower than that of the general patient population. Conclusions Based on the study findings, we concluded that dermatologists need to be reminded of having possible potential DIs when prescribing medications. Introducing information technology into the computerized physician order entry system into the daily practice may reduce potential DIs.