Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Letter to the Editor - Letter in Response to Published Article
2017:83:6;684-686
doi: 10.4103/ijdvl.IJDVL_26_17
PMID: 28980536

Nurture Indian dermatology innovations as man-maximum, machine-minimum research

SR Narahari, KS Prasanna
 Institute of Applied Dermatology, Kasaragod, Kerala, India

Correspondence Address:
S R Narahari
Institute of Applied Dermatology, Uliyathadka, Madhur P.O., Kasaragod - 671 124, Kerala
India
Published: 04-Oct-2017
How to cite this article:
Narahari S R, Prasanna K S. Nurture Indian dermatology innovations as man-maximum, machine-minimum research. Indian J Dermatol Venereol Leprol 2017;83:684-686
Copyright: (C)2017 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Indian doctors, during their training, read western books that focus mainly on diseases that are concentrated in developed nations. Our initial training on important diseases of India gets limited to its understanding by western authors. Consider Vitiligo patients who do not respond to phototherapy. Shouldn't Indian dermatologists study why this happens? Pasricha advised to confront Indian problems with Indian solutions. He suggested that Indian academia could work as extended research and development wings of pharmaceuticals instead of producing robots that extend western research laboratories.[1] Innovations of Srinivas, our teacher, led to better management of his chronic skin patients.[2] How do we cultivate a culture of innovation among young dermatologists? Innovations begin by recording and structuring tacit and highly subjective insights that are often ignored as “silly.” Systematic information processing will convert such ideas into innovations. Information processing should supplement basic learning in medical colleges and incremental gains from clinical experience. Frequent brainstorming and sharing ideas and knowledge with colleagues are central to converting ideas into innovations. Those who are new to conference/journal discussion groups could stumble on communication dysfunction; “we know more than we could express.” Colleagues must help them come out of this bottleneck. Innovation begins by better managing their “knowledge and intellect.” This requires sharing, transfer of knowledge, and even learning skills from technicians. A classical example is the invention of bread making machines; producing similar color, taste, and consistency as that of manually prepared breads. Matsushika electric company in Japan asked its software developer Ikuko Tamaka to work with the head baker of Osaka international hotel. Tamaka spent a few weeks assisting and observing distinctive ways of stretching the dough to gain consistency and taste. Tamaka learnt this manual “twist dough” bread making and adopted the finger movements by inserting additional ribs to the machine.[3] Banana leaf bed sheets and its disinfection are a similar observation in India that reduced pain in bullous diseases from the sticking of bed sheets.

“Everyone cannot become Archimedes;”[2] but is there a way to train young dermatologists to become innovators? Young dermatologists must be made aware of their strengths and of ways to improvise them. Psychologists recognize that there is a distinct intellectual dominance similar to dominance of one hemisphere of brain in right and left handers. The left-brain thinkers are predominantly analytical, logical, having stepwise approach to problem solving. Gut feelings (intuitive), value-based, and nonsequential approach to patients' problems come from right brain thinking. Right-brained people look at the big picture, relationships, and patterns in existing data whereas left-brained people focus on details and often look at data-based evidence to resolve issues. There are two instruments to identify this intellectual dominance; identifying how we think: the Myers-Briggs type indicators and Herrmann brain dominance instrument. In the current scenario of student admissions and staff recruitments, there is little opportunity to transform the entire department to research culture purely on merit. The leader of the department has to identify available talent (intellect) of teaching staff, students, paramedical staff, and nonclinical staff. The leader should attain a “balance” of left and right-brained people in a team and assign them to address a selected problem. Nurturing the intellect of paramedical and nonclinical staff is essential. Small teams who do not have celebrities as great achievers could innovate if they are “whole brained” and have social empathy, allowing them to share knowledge and experience with colleagues, related disciplines, and patients. Such teams should be encouraged to perform small activities every day that lead to incremental gains as structured knowledge. This can be done by experimenting with ideas of a team member as soon as they occur. Using steps such as documenting new observations, relating them to past experience to look for patterns, and adopting best practices and protocols for patient care will lead to small steps in the march towards innovation. There should be a process to support and integrate such ideas into the daily routine. At the Institute of Applied Dermatology, such new flashes are known as “great ideas.” Dermatology counseling department, “dermatology nurses,” therapists, and staff at community dermatology outreach programs always conduct an informal survey (inquiries) on patients' sufferings which often generates “great ideas.” They include inserting low adherent and highly absorbent cotton and acrylic dressing pads to the intertrigo of toe web spaces. Great ideas are later linked to systematic patients' problem-solving sessions to undergo repeated molting before its metamorphosis into a full research question. In this world of peer review, consensus building through sharing and rating the idea is an initial step. Next is the analysis of cause and effect, linking the idea to the ontology of the problem through literature search that should go beyond PubMed. This should be followed by activity planning and setting milestones to cross. Xerox's problem-solving process is a popular model put forward during human resource development training. A proposal to simplify Institute of Applied Dermatology's self-care lymphoedema treatment protocol originated when our nurses visited patients to understand how home based self-care is carried out. A survey finding led to a brainstorming on why some patients are not concordant to treatment procedures. It later evolved as a research question and ranked as the top priority for morbidity reduction in lymphoedema research.[4]

Let us consider how to further innovate treatments for toe web space intertrigo, a challenge in the management of lymphoedema. It is a bacterial entry lesion and a major risk factor for recurrent cellulitis that leads to disease progression. Only 18% of the lesions had positive microscopy or culture for fungi (dermatophytes and Scytalidium).[5] Despite the latest antifungal and toe separators, it refuses to be eliminated. In eliminating intertrigo, the right-brained approach would be to use toe separators to reduce maceration coupled with different antifungals. In our experience of treating over 2700 lymphoedema patients, this combination didn't always work. In fishermen, toe separators have little value. Left-brained approach would search and systematically analyze literature. Hassab-El-Naby et al. showed that many cases of web space lesions can be overdiagnosed, underdiagnosed, or misdiagnosed. Intertrigo may be caused by different conditions including eczema, fungi, erythrasma, callosity, wart, or even lichen planus.[6] Whole-brained approach is thus essential to address many such diseases.

When we don't have the required intellect or facilities, whole-brained teams could be formed through collaborations, as not all clinical issues can be resolved through applied research alone. Applied dermatology focuses on routine practice problems. Basic sciences view these problems at a tissue and molecular level. Basic science research will help us view clinical problems, fundamentally, in a different manner. This would be most beneficial for chronic disease management that has no readymade interventions available in biomedicine. This approach requires clinical investigators to team up with patients and collaborate with pathologists, big data analysts, and molecular biologists to generate greater insights into data analysis, and thereby disease reversal mechanisms. This will, in turn, lead to intersectoral collaborations through inter-institutional links and help in capacity building of all collaborating institutions. The coming-together of such institutions will bring in the much-required expertise, which is nonexistent in individual teams, to the clinical investigator led pioneering studies. We believe that such teams, by setting a goal of new innovation, should be developed over a long period of time; however, these teams may require decades of isolation and perseverance as in the case of Institute of Applied Dermatology.

Past presidents of the Indian Association of Dermatologists, Venereologists & Leprologists (IADVL) felt that such teams are rare and not many institutes exist in India dedicated to dermatology.[7] National association should initiate programs to develop such teams of Indian dermatologists with long-term goals. The Association must identify “IADVL Mentors” to dedicate time to nurture innovative teams. One model for mentoring is that of Professor Terence Ryan who initiated the dermatology department at Oxford, UK. Post retirement, he has been tirelessly mentoring the team at the Institute of Applied Dermatology and its work, a process that began as a small steering committee formed in 2002.[8] Our team was unlike one of his back home. Institute functions in a poor-resource setting and in isolation from academia and large modern medical facilities. Ryan's dedicated mentoring led to an innovation in dermatology and was awarded Neutrogena oration in 2011 [Figure - 1]. He focused on the needs of community dermatology through “man-maximum and machine-minimum” approach.[3] Ryan himself nurtured his own dermatology innovations in an incremental manner. The photobiologist Ian Magnus in his Dowling oration (1969) said “Scientists and research workers need plenty of 'lateral thinking', of provocative and disturbing ideas... Examples in British dermatology of such disturbers of the peace are in Ian Whimster and Terence Ryan.”[9]

Figure 1: Indian innovation mentored by Terence Ryan, emeritus professor of dermatology, Oxford: response of lower extremity lymphatic filariasis (lymphoedema) to self-care and home based integrative medicine treatment is maintained after 12 years

Ideas exist in abundance at all levels of life and workplace in diverse India. Mentors must devote sufficient time to mentees to nurture innovation culture among Indian dermatology circles. “IADVL mentors” must push their mentees beyond the comfort of book knowledge. Intellect expands when frequently dealing with challenges. Mentors should be intolerant to partial efforts made by mentees and motivate young dermatologists to “create a future” dermatology service “that would not have existed without them.”[3]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References
1.
Parischa JS. Presidential address. Indian J Dermatol Venereol Leprol 1996;62:1-2.
[Google Scholar]
2.
Srinivas CR. Innovations in dermatology. Indian J Dermatol Venereol Leprol 2016;82:641-4.
[Google Scholar]
3.
Drucker PF. Harvard Business Review on Knowledge Management. Boston: Harvard Business Press; 1998.
[Google Scholar]
4.
Narahari SR, Aggithaya MG, Moffatt C, Ryan TJ, Keeley V, Vijaya B, et al. Future research priorities for morbidity control of lymphedema. Indian J Dermatol 2017;62:33-40.
[Google Scholar]
5.
McPherson T, Persaud S, Singh S, Fay MP, Addiss D, Nutman TB, et al. Interdigital lesions and frequency of acute dermatolymphangioadenitis in lymphoedema in a filariasis-endemic area. Br J Dermatol 2006;154:933-41.
[Google Scholar]
6.
Hassab-El-Naby HM, Mohamed YF, Abdo HM, Kamel MI, Hablas WR, Mohamed OK. Study of the etiological causes of toe web space lesions in Cairo, Egypt. Dermatol Res Pract 2015;2015:701489.
[Google Scholar]
7.
Okhandiar RP. Presidential address. Indian J Dermatol Venereol Leprol 1995;61:1-3.
[Google Scholar]
8.
Ryan TJ. Disease management in the developing world; The journey from leprosy to diabetes mellitus. Eur Tissue Repair Soc Bull 2003;10:18-21.
[Google Scholar]
9.
Magnus I. Dowling oration. Trans St Johns Hosp Dermatol Soc 1969;55:41.
[Google Scholar]

Fulltext Views
140

PDF downloads
42
Show Sections