PEDIATRIC CARE
Intimate partner abuse should be identified in the pediatric setting
Thackeray JD, Hibbard R, Dowd MD, Committee on Child Abuse and Neglect; Committee on Injury, Violence, and Poison Prevention. Clinical report-intimate partner violence: the role of the pediatrician. Pediatrics. 2010;125(5):1094-1100.
Intimate partner abuse is typically considered to be a women's health issue. However, studies have shown that both child abuse and intimate partner violence occur simultaneously in 30% to 60% of families where one occurs. Therefore, it is logical that identifying an abused caregiver in the pediatric setting may also prevent child abuse. A report on this topic can be found in the May 2010 issue of Pediatrics.
Most abused individuals will not seek care for themselves, but will do so for their children. This makes the pediatric setting an ideal place for detection of abuse. Often, signs of intimate partner abuse are very subtle, if evident at all. Because of this, the U.S. Preventative Services Task Force determined that there is not enough evidence to require universal screening. Rather, a "case finding" approach is preferred.
This entails early and repeated questioning of caregivers in a nonthreatening and nonjudgmental manner. A self-administered written or computerized assessment may be the easiest method.
An abused adult's risk of further injury and/or death increases once the abuse has been disclosed because there are no state agencies required to step in to protect them, as there are in situations involving children. Therefore, the caregiver typically will not disclose the situation unless he or she feels safe in doing so.
Any efforts to intervene should be done in a way that is the most sensitive, and most safe for the caregiver and the children involved. This includes discretion when documenting any health information that is accessible to the abuser, or providing printed information that the abuser could find.
DERMATOLOGIC CARE
E-visits preferred over office visits in acne patients
Watson AJ, Bergman H, Williams CM, Kvedar JC.. A randomized trial to evaluate the efficacy of online follow-up visits in the management of acne. Arch Dermatol. 2010;146:406-411.
Online healthcare appointments for certain ailments are increasing in popularity, with both patients and providers. One study has shown that online "e-visits" are just as effective in acne management as in-person office visits, and may actually be preferred.
The researchers examined 151 patients who had mild-to-moderate facial acne over 2 years. The mean age was 28 years; 78% of the patients were female, 65% were white, and 69% were college educated. An initial in-person visit was done in a dermatologist's office, where digital baseline photographs were taken of the patients' faces. Each patient was given a digital camera, and was instructed on how to take accurate photos of their own faces to be properly compared to the baseline photos at a later time.
The patients were randomly split into a control group, who attended four follow-up office visits in person; and an intervention group, who did their follow-up via four e-visits. The intervention groups uploaded their own digital photographs to the secure website, answered an online questionnaire about their acne, and were responded to within 3 days by the dermatologists.
The information obtained from the survey responses and digital photographs was sufficient to make appropriate acne management decisions. The dermatologists were able to revise the patients' treatment plans, prescribe medication, and discuss patient history through this online system. Insurance copayments were also able to be processed securely through this system.
Most of the e-visit patients preferred this method to in-person office visits because it eliminated travel times and costs, as well as time spent in the waiting room. Patients who were located in rural or remote areas enjoyed the convenient and quick access to the dermatologist.
The system is not refined yet by any means. Many of the patients' photographs had to be redone and resubmitted because they were not clear enough, some patients were overwhelmed by the technologic aspects and dropped out of the study, and issues such as comedones and cysts could not be addressed because they are not detectable through digital photography.