Clostridium difficile infection risk in patients with hidradenitis suppurativa.

Widespread use of antibiotics for hidradenitis suppurativa (HS) opens up the possibility of Clostridium difficile infection (CDI) and an increased risk of mortality. The purpose of this study was to identify risk factors for acquiring CDI in patients with HS. We suggest that providers should take risk factors including increased antibiotic class, hospitalizations, and advanced patient age into consideration when prescribing antibiotics for HS.

Reflections of an Integrated Maternal-Child Health Medical Student Assignment.

INTRODUCTION: Clinical experiences expose learners to the patient perspective, which can have a lasting impact on students' professional identity. However, in busy clinical settings where opportunities for reflection may be limited, listening to patients' stories is often neglected. We used a reflection assignment to augment a new maternal-child health integrated curriculum. METHODS: Medical students completed a brief assignment from their session in the neonatal intensive care unit (NICU), which included reflective writing, between fall 2016 and summer 2017. The Depth of Reflection rubric was used to score reflections on a scale: "Knowledge and Comprehension" (Level I), "Analysis" (Level II), and "Synthesis and Evaluation" (Level III). A constant comparison method based on grounded theory elicited prenatal and postnatal themes from medical students' reflective writing. RESULTS: All students completed narratives (n = 166); 70% (n = 116) achieved a Depth of Reflection of Level II or III. Six overarching themes emerged: (1) Conception, Pregnancy, and Delivery Experiences; (2) Positive Support Structures; (3) Barriers and Stressors to Care; (4) Future Plans; (5) Unexpected Complications; and (6) Student Career and Professional Considerations. DISCUSSION: Reflections from a novel and brief integrated maternal-child health experience demonstrated high levels on the Depth of Reflection scale. This experience exposed students to core themes central to a family's pregnancy and perinatal experience. Professional identity formation also emerged as a theme. Reflective writing assignments in a busy NICU can facilitate exploration of medical students' knowledge of maternal-child health patient experiences.

Determining the optimal dose of infliximab for treatment of hidradenitis suppurativa.

BACKGROUND: Few data exist to guide infliximab dosing in hidradenitis suppurativa (HS). OBJECTIVES: To determine optimal infliximab dosing for patients with HS based on treatment response and achievement of stable dosing. METHODS: Retrospective cohort study of 52 patients with HS treated with infliximab. Primary outcome was achievement of stable dosing regimen for at least 8 weeks. Secondary outcomes were time to discontinuation, time to titration, changes to inflammatory markers, and clinical response. RESULTS: Thirty-five patients (67%) achieved stable dosing, most at a schedule of 10 mg/kg every 6 or 8 weeks. At 1 year from initiation, most patients (64%) required dose escalation. Patients tolerated infliximab well and achieved significant improvements in abscess and nodule count, draining sinuses, and erythrocyte sedimentation rate. LIMITATIONS: Retrospective nature and lack of HS clinical response data for many patients. CONCLUSIONS: Infliximab 10 mg/kg every 6 or 8 weeks may be a reasonable starting dosage for most patients.