Clinics in dermatology
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Conflicts of interest (COIs) exist when someone who has a fiduciary responsibility for another's welfare acts, or has the potential to act, in a manner inconsistent with their charge's best interests. COIs exist in all professions as well as in public service; however, in medicine, COIs pose a unique problem, given the responsibilities and special status that society grants to physicians. ⋯ I define the term "conflicts of interest" and review its ethical basis, offer common examples of COIs, discuss the importance of disclosure, and suggest ways beyond disclosure to minimize or limit COIs in the various settings in which physicians work. Ideally, physicians should try to avoid COIs, but when situations arise where physicians have COIs, how they manage them will depend on a combination of physicians' personal conscience and professional ethics, professional society ethics codes, and governmental regulation.
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Clinics in dermatology · Mar 2012
Ethical considerations in health care reform: pros and cons of the Affordable Care Act.
The sweeping changes to be implemented over the next few years by the Affordable Care Act (ACA) will have a profound effect on how health care is delivered and will subject society, providers, and patients to many new and different ethical dilemmas, challenges, relationships, and unintended consequences. This contribution discusses the ethical considerations of the ACA from 3 perspectives: society, health care providers in general, and dermatologists specifically.
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Physicians often face tremendous pressures and incentives to publish, sometimes leading to a compromise of ethical standards, either consciously or unconsciously. From the vantage of ethical authorship, we discuss what constitutes authorship; avoidance of ghost authorship; plagiarism, as well as self-plagiarism and duplicate publication; falsification; and fabrication. ⋯ Editors need to deal with authors who fragment their work into multiple publications to enhance their curriculum vitae ("salami factor"), as well as to manage the financial benefits of advertising and to avoid conflicts of interest for the journal. Both authors and editors should be straightforward and principled throughout the publication process.
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Clinics in dermatology · Jan 2012
ReviewInherited epidermolysis bullosa: new diagnostic criteria and classification.
Epidermolysis bullosa (EB) is a group of inherited, mechanobullous disorders caused by mutations in various structural proteins in the skin. There have been several advances in the classification of EB since it was first introduced in the late 19th century. We now recognize four major types of EB, depending on the location of the target proteins and level of the blisters: EB simplex (epidermolytic), junctional EB (lucidolytic), dystrophic EB (dermolytic), and Kindler syndrome (mixed levels of blistering). ⋯ We have also included new subtypes, such as autosomal dominant junctional EB and autosomal recessive EB due to mutations in the dystonin (DST) gene, which encodes the epithelial isoform of bullouspemphigoid antigen 1. The main laboratory diagnostic techniques-immunofluorescence mapping, transmission electron microscopy, and mutation analysis-will also be discussed. Finally, the clinical characteristics of the different major EB types and subtypes will be reviewed.
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Lesions that may present in a grouped way include diseases with grouped vesicles such as dyshidrosis, nummular dermatitis, herpes simplex, and herpes zoster; diseases with grouped vesicobullae such as dermatitis herpetiformis, herpes gestationis, subacute lupus erythematosus in the bullous variant, and pemphigus herpetiformis; and diseases with grouped pustules such as pustular psoriasis, dermatitis continua of Hallopeau, and impetigo herpetiformis.