Clinical Factors Associated with Readmission among Patients with Lower Limb Cellulitis.

BACKGROUND: There is substantial allocation of resources directed towards evaluation and management of lower limb cellulitis (LLC) in the acute care setting. Readmission for LLC is poorly understood, and there is little evidence with which to identify patients at risk for readmission. OBJECTIVE: To describe demographics, comorbidities, admission vital signs, and laboratory markers of infection among patients with LLC who are readmitted, and to investigate which among these factors is associated with readmission. METHODS: A cross-sectional retrospective cohort study was performed at tertiary and community hospitals within a regional health care system in order to summarize readmission characteristics. Univariate and multivariate models were created to estimate the likelihood of independent variables being associated with LLC readmission. RESULTS: The readmission rate was 11.2% with a median age of 68.6 years for the cohort. Increased age and subsidized insurance were associated with more frequent admissions. For every 10-year age increase, cellulitis subjects had a 14% increase in readmission odds (OR 1.14, CI 1.07-1.20). Patients with subsidized insurance had an almost twofold increased risk (OR 1.88, CI 1.42-2.50). Smoking, obesity, hypertension, diabetes mellitus, renal insufficiency, tachycardia, hypotension, leukocytosis, and neutrophilia were not more frequent in readmitted patients. CONCLUSIONS: Older age and subsidized insurance were associated with readmission whereas severity indicators for infection including abnormal vital signs and laboratory markers were not significantly associated. Factors other than severity of infection, such as socioeconomic factors, may influence clinical decisions related to readmission for LLC.

Clinical characteristics associated with days to discharge among patients admitted with a primary diagnosis of lower limb cellulitis.

BACKGROUND: Clinicians have limited ability to classify risk of prolonged hospitalization among patients with lower limb cellulitis. OBJECTIVE: We sought to identify characteristics associated with days to discharge and prolonged stay. METHODS: We conducted retrospective cohort analysis including patients admitted with a primary diagnosis of lower limb cellulitis at community and tertiary hospitals. RESULTS: There were 4224 admissions for lower limb cellulitis among 3692 patients. Mean age of the cohort was 64.4 years. Frequencies of tobacco smoking, obesity, and diabetes mellitus were 25.1%, 44.9%, and 19.3%, respectively. Patients having decreased likelihood of discharge included those with the following: 10-year age increments 0.90 (95% confidence interval [CI] 0.88-0.92), obesity 0.90 (95% CI 0.83-0.97), diabetes mellitus 0.90 (95% CI 0.82-0.98), tachycardia 0.76 (95% CI 0.67-0.85), hypotension 0.77 (95% CI 0.65-0.90), leukocytosis 0.86 (95% CI 0.79-0.93), neutrophilia 0.80 (95% CI 0.73-0.87), elevated serum creatinine 0.74 (95% CI 0.68-0.81), and low serum bicarbonate 0.84 (95% CI 0.75-0.95). LIMITATIONS: This analysis is retrospective and based on coded data. Unknown confounding variables may also influence prolonged stay. CONCLUSIONS: Patients with lower limb cellulitis and prolonged stay have a number of clinical characteristics which may be used to classify risk for prolonged stay.

A comparison of two 810 diode lasers for hair removal: low fluence, multiple pass versus a high fluence, single pass technique.

BACKGROUND & OBJECTIVE: Laser hair removal has become an increasingly popular method to remove unwanted or excessive hair. We have assessed the relative efficacy and discomfort associated with competing hair removal techniques, namely a high average power 810 nm diode laser using an "in-motion" technique with a market-leading 810 nm device with a single-pass vacuum-assisted technique. This study has determined the long-term (6-12 months) hair reduction efficacy and the relative pain induction intensities of these devices. STUDY DESIGN/MATERIALS AND METHODS: Prospective, randomized, side-by-side comparison of either the legs or axillae was performed comparing the Soprano XL 810 nm diode in super hair removal (SHR) mode (Alma Lasers, Buffalo Grove, IL) hereafter known as the "in-motion" device vs. the LightSheer Duet 810 nm diode laser (Lumenis) hereafter known as the "single pass" device. Five laser treatments were performed 6 to 8 weeks apart with 1, 6, and 12 months follow-ups for hair counts. Pain was assessed in a subjective manner by the patients on a 10-point grading scale. Hair count analysis was performed in a blinded fashion. RESULTS: There was a 33.5% (SD 46.8%) and 40.7% (SD 41.8%) reduction in hair counts at 6 months for the single pass and in-motion devices respectively (P = 0.2879). The average pain rating for the single pass treatment (mean 3.6, 95% CI: 2.8 to 4.5) was significantly (P = 0.0007) greater than the in-motion treatment (mean 2.7, 95% CI 1.8 to 3.5). CONCLUSIONS: This data supports the hypothesis that using diode lasers at low fluences and high average power with a multiple pass in-motion technique is an effective method for hair removal, with less pain and discomfort, while maintaining good efficacy. The 6 month results were maintained at 12 month for both devices.

A prospective, interventional assessment of psoriasis quality of life using a nonskin-specific validated instrument that allows comparison with other major medical conditions.

BACKGROUND: Psoriasis significantly impacts patients' quality of life. OBJECTIVES: The purpose of this study was to prospectively assess the quality-of-life impact of treatment for moderate to severe plaque psoriasis by using a validated quality-of-life psychometric instrument that has been widely used in nondermatologic settings. METHODS: In all, 32 patients with moderate to severe plaque psoriasis received 24 weeks of adalimumab treatment. Patients completed the Psychological General Well-Being (PGWB) Index, which evaluates 6 domains including anxiety and depression. The primary end point was the change in total PGWB score at weeks 12 and 24 of adalimumab treatment compared with baseline. RESULTS: Statistically significant improvement in the total PGWB score was documented by week 4. By week 24, all 6 PGWB domains showed statistically significant improvement from the pretreatment baseline. LIMITATIONS: One limitation of this study is that the comparison between our psoriasis data and PGWB data from other major medical conditions was not conducted in a head-to-head manner. Another limitation is that we did not have a controlled (placebo) arm. CONCLUSION: Based on PGWB scores, patients with untreated psoriasis have as much impairment in psychological well-being as patients with other major medical diseases including breast cancer, coronary artery disease, congestive heart failure, and diabetes and that potent intervention improves psychological well-being to where it is comparable with that of patients with asymptomatic hypertension. A prompt intervention with an effective dermatologic treatment is not only critical, but capable of restoring the physical and psychological well-being of patients with psoriasis.

The psychosocial and occupational impact of chronic skin disease.

Chronic skin diseases, particularly psoriasis and atopic dermatitis, have a negative impact on patients' quality of life. Patients often experience significant psychological and social distress such as increased levels of depression and fear of stigma. Skin diseases can also impact patients' occupational lives by causing them to miss work or be less productive. Quality of life instruments provide important information for healthcare professionals, the general public, and those involved in distribution of healthcare resources, which helps prevent chronic skin disease from being overlooked amidst other medical conditions.