Perioperative leadership in the non-operating room and ambulatory setting.

To create a successful ambulatory care center, healthcare systems need management that can understand and improve key ambulatory success factors such as quality of clinical care, clinical competence, regulatory compliance, financial management, and customer service. Effective leadership is a vital skill that can improve all these factors. This manuscript discusses successful perioperative leadership styles in the ambulatory setting and provides a framework for proven strategies that have improved patient care.

Cutaneous Manifestations in COVID-19-Positive African American Patients.

Background: The United States of America is the leading country in confirmed cases of and deaths from severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19). In April and May 2020, respectively, 0.2% of patients in a Chinese COVID-19-positive cohort and 20.4% of patients in an Italian COVID-19-positive cohort developed cutaneous abnormalities. Cutaneous abnormalities associated with COVID-19 are not well documented or discussed, and investigation of cutaneous manifestations is necessary to determine if they have any clinical value. Methods: We conducted a retrospective study of COVID-19-positive patients who were admitted to Ochsner-Louisiana State University-Shreveport and Ochsner-Louisiana State University-Monroe facilities in Louisiana. Cutaneous manifestations were determined from clinical notes, descriptions in medical records, and a billing code for skin rashes. Results: Of 1,086 COVID-19-positive patients investigated, 871 were African American and 130 were Caucasian. Only 10 patents exhibited probable COVID-19-induced cutaneous abnormalities: 6 (0.7%) of the 871 African American patients and 4 (3.1%) of the 130 Caucasian patients. Dermatologic abnormalities included pruritic or erythematous rash and hypopigmentation of the face, upper chest, abdomen, and trunk areas. Our data are consistent with the smaller percentage of patients in the Chinese cohort study vs the larger percentage in the Italian cohort study. Conclusion: Our data provide evidence that cutaneous manifestations of COVID-19, especially in African American patients, are rare, but documentation of more cases is necessary to establish a cause and effect for COVID-19-induced skin manifestations.

Proliferating trichilemmal tumour of the eyelid in a 7-year-old girl.

Proliferating trichilemmal tumours (PTTs) are rare cutaneous adnexal tumours derived from the hair shaft outer root sheath. We are reporting the first case of PTT in a young child. In this case, a 7-year-old girl presented with trichilemmal keratinisation consistent with PTT. The patient was monitored with no signs of recurrence. PTT is a rare tumour occurring primarily in adults and we present this case so that young patients with PTT can be diagnosed and treated appropriately with a painless, mobile, rapidly growing mass on the right upper eyelid. CT imaging showed well-circumscribed, heterogenous mass measuring 1.6 cm with fluid-filled appearance and no tissue invasion. Surgical excision was performed and pathology revealed an unencapsulated, well-demarcated tumour.

Intratracheal parathyroid gland: an unexpected diagnosis.

Ectopic or supernumerary parathyroid tissue has been generally described in the literature in cases found during workup for parathyroid adenoma. We present two unique cases of intratracheal parathyroid gland, a rare occurrence that has not yet been described in the literature. In both cases, the masses were found incidentally and showed no clinical or laboratory evidence of hyperparathyroidism. In both cases, surveillance was chosen as the method of treatment. We present this case series to increase awareness of this potential diagnosis.