News in brief: Screen for depression in psoriasis; Call to review procedural specialist incomes; Dermatophytes test delivers results in four hours

20 Jul 2021

Screen for depression in psoriasis

Screening for depression should form an important part of clinical assessment of patients with psoriasis.

A cross-sectional study of 100 psoriasis patients presenting to Waikato Hospital, New Zealand during November and December 2020 found 25 had a Patient Health Questionnaire (PHQ-9) ≥10 indicative of clinically significant depression.

These patients also experienced significantly worse skin-related quality of life measured by the Dermatology Life Quality Index (DLQI).

Elevated PHQ scores were also associated with underlying psoriatic arthritis (RR= 2.4, P = 0.035), genital involvement (RR = 1.5, P = 0.05) and pre-existing diagnoses of depression (RR= 5.6, P < 0.0001) or anxiety (RR= 3.4, P = 0.003).

“While prior diagnoses of depression or anxiety were, unsurprisingly, associated with depressive symptoms measured in this study, 12 of the 25 patients with significantly elevated PHQ had no prior diagnosis or treatment of depression.”

“This observation underscores the value of screening tools such as PHQ-9 and DLQI to identify unmet need and prompt further assessment and treatment,” the investigators said.

Australasian Journal of Dermatology

Call for Medicare to review procedural specialist incomes

Procedural specialists are overpaid compared to other specialists and there needs to be a review of the inequities in the Medicare Benefits Schedule, according to two senior physicians.

The high incomes for procedural specialists are not justified by their long years of training, level of skill or the hours worked compared to other physicians or GPs, according to Dr Kerry Breen and Dr Kerry Goulston.

Writing in Pearls and Irritations, they say the imbalance in incomes between specialties has become wider and more distorted in recent years because of a flaw in the original MBS when Medicare was set up favoured procedural work over consultations.

The distortion is now deterring medical graduates from working in low income specialities, and there is an urgent need for the federal health department to commission a new study to review the 2005 Productivity Commission report on how to address  the income bias.

“Such a study should also be invited to examine whether the earning differentials between various groups of doctors are justifiable and are in the best interests of the health care system and patients,” they suggest.

Dermatophytes test delivers results in four hours

A novel real-time PCR assay can provide rapid and accurate diagnosis of dermatophytosis compared to conventional microscopy, a Victorian study has shown.

In an analysis of 300 samples the AusDiagnostics Dermatophytes and Fungi panel (RT-PCR) showed almost two-fold higher sensitivity and high specificity in the diagnosis of skin and nail dermatophytosis compared to traditional microscopy and culture.

The RT-PCR assay also reduced turnaround time from four to six weeks to four to six hours, allowing earlier initiation of oral therapy, according to Dorevitch Pathology, Melbourne.

Their findings are published in Diagnostic Microbiology and Infectious Disease.


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