RESUMEN
Raynaud's phenomenon describes symptoms caused by digital vascular spasm and is classically induced by cold exposure. Severe cases can result in ulceration, necrosis, and digital autoamputation. When standard and adjunctive medical therapies fail or are contraindicated, botulinum toxin A (BTX-A) is an effective treatment option that can be added to existing regimens and should be considered before utilizing rescue therapies associated with higher risk and often higher cost. This report describes our technique, highlights considerations relevant to pediatric patients, and provides photos and videos of the procedure performed on a 16-year-old girl.
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Toxinas Botulínicas Tipo A , Enfermedad de Raynaud , Úlcera Cutánea , Femenino , Humanos , Niño , Adolescente , Toxinas Botulínicas Tipo A/uso terapéutico , Resultado del Tratamiento , Úlcera Cutánea/etiología , Enfermedad de Raynaud/tratamiento farmacológico , Enfermedad de Raynaud/diagnóstico , NecrosisRESUMEN
This study used the crowdsourcing platform GoFundMe to analyze the financial hardships associated with treatment of juvenile dermatomyositis. Uncovered medical expenses, travel costs, and loss of income were all commonly cited reasons for fundraising, demonstrating high out-of-pocket costs and significant economic hardship associated with this disease, even among families with health insurance.
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Colaboración de las Masas , Dermatomiositis , Dermatomiositis/diagnóstico , Dermatomiositis/terapia , Gastos en Salud , Humanos , Renta , Seguro de SaludRESUMEN
Nevus lipomatosus cutaneous superficialis (NLCS) is an idiopathic hamartomatous condition characterized by the presence of mature adipose tissue in the dermis. We report a case of NLCS initially misdiagnosed as condyloma acuminata in a 14-year-old boy. This case highlights classic clinical and histologic features of NLCS. The case presented here underscores the need for a high degree of clinical suspicion in diagnosing NLCS and in differentiating benign anogenital lesions from sexually transmitted conditions to avoid unnecessary work-up and undue emotional stress.
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Neoplasias de los Genitales Masculinos/patología , Lipomatosis/patología , Nevo/patología , Neoplasias Cutáneas/patología , Adolescente , Condiloma Acuminado/diagnóstico , Diagnóstico Diferencial , Humanos , MasculinoRESUMEN
An increased number of melanocytic nevi and lentigines have been reported in patients with two types of autosomal recessive congenital ichthyosis (ARCI): lamellar ichthyosis and nonbullous congenital ichthyosiform erythroderma. These melanocytic lesions may have clinical and dermoscopic features of atypia, necessitating close surveillance. Here, we report two interesting cases of pediatric patients with harlequin ichthyosis (HI) who developed increased melanocytic nevi and lentigines. These cases are unique in that the patients presented at a younger age and one patient had a darker skin phototype than previously described in the literature.
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Ictiosis Lamelar/complicaciones , Lentigo/diagnóstico , Nevo Pigmentado/diagnóstico , Neoplasias Cutáneas/diagnóstico , Niño , Preescolar , Progresión de la Enfermedad , Femenino , Humanos , Ictiosis Lamelar/terapia , Lentigo/etiología , Masculino , Nevo Pigmentado/etiología , Neoplasias Cutáneas/etiología , Espera VigilanteRESUMEN
Prurigo pigmentosa is a rare inflammatory dermatosis that primarily affects Japanese patients. Various triggers have been identified, including the ketogenic diet. Given the current popularity of the ketogenic diet, the incidence of prurigo pigmentosa may be on the rise. Herein, to the best of our knowledge, we present the first case of prurigo pigmentosa reported in a Hispanic patient in the United States.
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Dieta Cetogénica/efectos adversos , Hiperpigmentación/etiología , Prurigo/etiología , Piel/patología , Femenino , Humanos , Hiperpigmentación/patología , Prurigo/patología , Adulto JovenRESUMEN
BACKGROUND: Improving medication management is an important component of comprehensive care coordination for health systems. The Managing Your Medication for Education and Daily Support (MyMeds) medication management program at the University of California Los Angeles addresses medication management issues by embedding trained clinical pharmacists in primary care practice teams. OBJECTIVES: The aim of this work was to examine and explore physician opinions about the clinical pharmacist program and identify common themes among physician experiences as well as barriers to integration of clinical pharmacists into primary care practice teams. METHODS: We conducted a mixed quantitative-qualitative methods study consisting of a cross-sectional physician survey (n = 69) as well as semistructured one-on-one physician interviews (n = 13). Descriptive statistics were used to summarize survey responses, and standard qualitative content-analysis methods were used to identify major themes from the interviews. RESULTS: The survey response rate was 61%; 13 interviews were conducted. Ninety percent of survey respondents agreed or strongly agreed that having the pharmacist in the office makes management of the patient's medication more efficient, 93% agreed or strongly agreed that pharmacist recommendations are clinically helpful, 71% agreed or strongly agreed that having access to a pharmacist has increased their knowledge about medications they prescribe, and 75% agreed or strongly agreed that having a pharmacist as part of the primary care team has made their job easier. Qualitative interviews corroborated survey findings, and physicians highlighted the value of the clinical pharmacist's communication, team care and expanded roles, and medication management. CONCLUSION: Primary care physicians valued the integrated pharmacy program highly, particularly its features of strong communication, expanded roles, and medication management. Pharmacists were viewed as integral members of the health care team.
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Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Administración del Tratamiento Farmacológico , Grupo de Atención al Paciente , Farmacéuticos/psicología , Médicos/psicología , Atención Primaria de Salud , Competencia Clínica , Conducta Cooperativa , Estudios Transversales , Prescripciones de Medicamentos , Femenino , Humanos , Comunicación Interdisciplinaria , Entrevistas como Asunto , Los Angeles , Masculino , Investigación Cualitativa , EspecializaciónAsunto(s)
Carcinoma Basocelular/prevención & control , Carcinoma de Células Escamosas/prevención & control , Fármacos Dermatológicos/uso terapéutico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Neoplasias Cutáneas/prevención & control , Acitretina/uso terapéutico , Humanos , Práctica Institucional/estadística & datos numéricos , Queratosis Actínica/prevención & control , Cirugía de Mohs , Niacinamida/uso terapéutico , Práctica Privada/estadística & datos numéricos , Encuestas y Cuestionarios , Complejo Vitamínico B/uso terapéuticoRESUMEN
Although calciphylaxis generally occurs in patients with chronic renal failure, we present a patient with widespread calciphylaxis in the setting of normal renal function following renal transplant. IV and IL sodium thiosulfate injections were not beneficial in our patient.
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Calcifilaxia/tratamiento farmacológico , Funcionamiento Retardado del Injerto/complicaciones , Tasa de Filtración Glomerular/fisiología , Trasplante de Riñón/efectos adversos , Enfermedades de la Piel/tratamiento farmacológico , Piel/patología , Tiosulfatos/administración & dosificación , Adulto , Biopsia , Calcifilaxia/diagnóstico , Calcifilaxia/etiología , Quelantes/administración & dosificación , Funcionamiento Retardado del Injerto/fisiopatología , Funcionamiento Retardado del Injerto/terapia , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intravenosas , Fallo Renal Crónico/cirugía , Diálisis Renal , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/etiologíaRESUMEN
This cohort study investigated the association between treatment of dermatomyositis with intravenous immunoglobulin and thromboembolic events.
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Dermatomiositis , Tromboembolia Venosa , Humanos , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/tratamiento farmacológico , Tromboembolia Venosa/etiología , Inmunoglobulinas Intravenosas/uso terapéutico , Dermatomiositis/complicaciones , Dermatomiositis/diagnóstico , Dermatomiositis/tratamiento farmacológico , Factores de Riesgo , Medición de RiesgoRESUMEN
INTRODUCTION: UCLA Health embarked to transform care by integrating lean methodology in a key clinical project, Readmission Reduction Initiative (RRI). METHODS: The first step focused on assembling a leadership team to articulate system-wide priorities for quality improvement. The lean principle of creating a culture of change and accountability was established by: 1) engaging stakeholders, 2) managing the process with performance accountability, and, 3) delivering patient-centered care. The RRI utilized three major lean principles: 1) A3, 2) root cause analyses, 3) value stream mapping. RESULTS: Baseline readmission rate at UCLA from 9/2010-12/2011 illustrated a mean of 12.1%. After the start of the RRI program, for the period of 1/2012-6/2013, the readmission rate decreased to 11.3% (p<0.05). CONCLUSION: To impact readmissions, solutions must evolve from smaller service- and location-based interventions into strategies with broader approach. As elucidated, a systematic clinical approach grounded in lean methodologies is a viable solution to this complex problem.
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Readmisión del Paciente/estadística & datos numéricos , Mejoramiento de la Calidad/tendencias , Gestión de la Calidad Total/métodos , Centros Médicos Académicos/organización & administración , Centros Médicos Académicos/normas , Centros Médicos Académicos/estadística & datos numéricos , California , Humanos , Análisis de Causa Raíz , Responsabilidad SocialRESUMEN
BACKGROUND: Patient engagement is critical in delivering high-quality care. However, literature investigating patient perspectives on readmissions is lacking. OBJECTIVES: To understand patients' beliefs and attitudes about 30-day readmissions and to elucidate areas for improvement aimed at reducing readmissions. DESIGN: In person survey. SETTING: Academic medical center and affiliated community hospital. PATIENTS: Patients with 30-day readmissions to medicine and cardiology services. MEASUREMENTS: Patient readiness, attitudes toward readmissions, discharge instructions, ambulatory resources, and follow-up care. RESULTS: Of 479 eligible patients approached for interviews, 230 (48%) were interviewed. Of these, 28% reported not feeling ready for discharge, and this correlated with inadequate symptom resolution, poor pain control, and concerns about self-care. Sixty-five percent remembered reviewing discharge paperwork, but over 22% could not identify critical information on this paperwork. Eighty-five percent reported having a primary doctor; however, only 56% of patients who received a contact number on discharge called a physician before returning to the hospital. One-third of patients knew where to obtain same-day care outside of the emergency room. Lastly, patients reported feeling more relieved than burdened upon readmission (7.7 [standard deviation {SD} 2.8) vs 5.9 [SD 3.4]; P < 0.001, scale of 1-10). CONCLUSIONS: By engaging readmitted patients we have illuminated areas for future interventions, including better symptom management and self-care planning before discharge, more clarity in discharge instructions, promoting awareness of outpatient resources, and improved alignment of patient and provider attitudes about readmissions. As the United States strives to reduce readmissions, attending to the patient perspective is critical in informing appropriate avenues for quality improvement. Journal of Hospital Medicine 2016;11:407-412. © 2016 Society of Hospital Medicine.