The Representation of Skin Tones in Google Images of Skin Cancers.

Skin self-examinations play a vital role in skin cancer detection and are often aided by online resources. Available reference photos must display the full spectrum of skin tones so patients may visualize how skin lesions can appear. This study investigated the portrayal of skin tones in skin cancer-related Google Images, discovering a significant underrepresentation of darker skin tones. J Drugs Dermatol. 2024;23(5):e132-e133.     doi:10.36849/JDD.7886e.

Skin Tone Representation on Patient-Facing Skin Cancer Education Websites.

When patients self-detect suspicious skin lesions, they often reference online photos prior to seeking medical evaluation. Online images must be available in the full spectrum of skin tones to provide accurate visualizations of disease, especially given the increased morbidity and mortality from skin cancer in patients with darker skin tones. The purpose of this study was to evaluate the representation of skin tones in photos of skin cancer on patient-facing websites. Six federally-based and organization websites were evaluated, and of the 372 total representations identified only 49 depicted darker skin tones (13.2%). This highlights the need to improve skin tone representation on patient-facing online resources. J Drugs Dermatol. 2024;23(5):e137-e138.     doi:10.36849/JDD.7905e.

Emergency department documentation of legal intervention injuries at a Washington, DC, hospital.

BACKGROUND: The U.S. Centers for Disease Control and Prevention (CDC) defines legal intervention injuries as injuries caused by law enforcement agents in the course of official duties. Public health databases utilize International Classification of Diseases, 10th Revision (ICD-10), coding to collect these data through the "Y35" family ICD-10 code. Prior studies report deficiencies in public health recording of fatal legal intervention injuries. Few studies have characterized nonfatal injuries. This study investigates emergency department (ED) capture of legal intervention injury diagnostic coding. METHODS: A retrospective chart review was performed on ED encounter data from January 1, 2017, to June 30, 2019, at an academic hospital in Washington, DC. Charts were identified using a keyword search program for "police." Chart abstracters reviewed the flagged charts and abstracted those that met injury definition. Primary outcomes included injury severity, patient demographics, and documented ICD-10 codes. One sample proportion testing was performed comparing sample census ED data. RESULTS: A total of 340 encounters had sufficient descriptions of legal intervention injuries. A total of 259 had descriptions consistent with the patient specifier of "suspect." Hospital coders recorded 74 charts (28.6%) with the Y35 family legal intervention injury code. A total of 212 involved a Black patient. A total of 122 patients had Medicaid and 94 were uninsured. Black patients made up a higher proportion of individuals in the "suspect identified legal intervention injury" group than the total population (0.819 vs. 0.609, p < 0.01, 95% CI 0.772-0.866). Patients with Medicaid or who were uninsured made up substantial proportions as well (0.471 vs. 0.175, p < 0.01, 95% CI 0.410-0.532 for Medicaid patients and 0.363 vs. 0.155, p < 0.01, 95% CI 0.304-0.424 for the uninsured patients). CONCLUSION: A large proportion of nonfatal legal intervention injuries remain unreported. Black and low-income patients are disproportionately affected. More research is needed but benefits from interprofessional data sharing, injury pattern awareness, and diagnostic coding guidance may improve reporting.

From Hip Screening to Hip Surveillance: Transforming Care for Patients With Cerebral Palsy: An Analysis of a Single Institution.

INTRODUCTION: Surveillance programs aimed at monitoring hip displacement in patients with cerebral palsy have been demonstrated to decrease the incidence of hip dislocations and properly time surgical intervention, ultimately improving patient outcomes. The objective of this study was to determine whether the implementation of a hip screening to surveillance program at a tertiary academic teaching hospital in 2017 increased the frequency of radiographic evaluations and changed the timing of surgical intervention. METHODS: A total of 592 patients with cerebral palsy were identified, and 468 of these patients had initial radiograph date data available. In this analysis, 246 patients with initial radiograph dates after 2012 were included. The study population was divided into two groups based on the initial radiograph date, 2012 to 2016 versus 2017 to 2022. One hundred sixty patients (65%) were in the 2012 to 2016 group, and 86 (35%) were in the 2017 to 2022 group. Statistical analysis was conducted using various techniques, such as two-sample Student t-test, Mann-Whitney U test, chi square/Fisher exact test, and multivariable linear regression analysis. RESULTS: The average number of radiographs per year in the 2017 to 2022 group was 0.11 (95% CI: 0.02, 0.20, P = 0.017) higher than the 2012 to 2016 group. After adjusting for confounders using multivariable linear regression analysis, this difference was even larger (difference 0.16, 95% CI: 0.06, 0.25, P = 0.001). The surgical intervention rate was significantly lower in the 2017 to 2022 group compared with the 2012 to 2016 group (12.9% versus 40.6%, P < 0.001). DISCUSSION: The results of this study suggest that the implementation of a hip screening to surveillance program results in more frequent radiographic evaluations and possibly a reduced need for surgical intervention from 2017 to 2022. In the 2012 to 2016 group, more surgical interventions were performed likely because of the lack of any hip surveillance or screening program in place.

"Skin Popping" and "Shooter's Patch" As Manifestations of Intradermal Drug Abuse.

Talc, a common adulterant in injectable opioids and filler in oral tablets, is frequently abused as crushed suspensions in injections. This review aims to recognize intradermal drug injection referred to colloquially as "skin popping" or "shooter's patch" as a cause of granulomatous disease and prevention of systemic complications from cutaneous cues.

Participant Satisfaction of a Community-based Telehealth Clinic for Atopic Dermatitis.

Atopic dermatitis (AD), a chronic, relapsing inflammatory disease that affects more than 30 million children and adults in the US, disproportionally impacts African American (AA) and Hispanic children, with a higher prevalence of severe AD in these populations than in white children.1,2 Visits to urgent care, emergency departments, and hospitalizations for AD in the United States were more common among AA and Hispanic adults, and those with lower socioeconomic status.1,3 In Washington DC, outcomes and access to care among the District's poor and underrepresented minorities lag far behind other groups. Ward 8, for example, which is 89% Black, has the District's highest per capita rate of coronavirus-related deaths - 6 for every 10,000 residents.4 These disparities have been long-lived and pervasive in all areas of medicine, including dermatology.5.

Metabolic Syndrome: Is Arthroscopic Rotator Cuff Repair Safe in This Patient Population?

Purpose Metabolic syndrome is associated with postoperative morbidity and mortality in surgical patients. With the increased use of arthroscopic techniques for rotator cuff repair (RCR), it is important to identify the impact this disorder has on surgical patients. The purpose of this study is to evaluate the clinical impact of metabolic syndrome on outcomes following arthroscopic RCR. Methods The 2006-2019 National Surgical Quality Improvement Program database was queried for adult patients who underwent arthroscopic RCR. Two patient groups were categorized: patients with metabolic syndrome and patients without metabolic syndrome. Demographics, comorbidities, and 30-day postoperative outcomes were compared using bivariate and multivariate analyses. Results Of 40,156 patients undergoing arthroscopic RCR, 36,391 did not have metabolic syndrome and 3,765 had metabolic syndrome. After adjusting for differences in baseline characteristics between the two groups, those with metabolic syndrome had an increased risk of developing renal complications and cardiac complications, as well as requiring hospital admission postoperatively and hospital readmission. Conclusion Metabolic syndrome is an independent risk factor for developing renal and cardiac complications, as well as requiring overnight hospital admission and hospital readmission. Providers should understand the need for preoperative evaluation and surveillance of these patients following their surgery to minimize the risk of poor outcomes.

The association between anesthesia type and postoperative outcomes in patients receiving primary total shoulder arthroplasty.

PURPOSE: There has been interest to investigate optimal anesthetic techniques for primary total shoulder arthroplasty (TSA). In this study, we investigate if there are differences in postoperative complications in patients receiving (1) regional alone; (2) general alone; and (3) regional plus general anesthesia for primary TSA. METHODS: Patients undergoing primary TSA from 2014 to 2018 were identified in a national database. Patients were stratified into 3 cohorts: general anesthesia, regional anesthesia, and general anesthesia combined with regional anesthesia. Thirty-day complications were assessed using bivariate and multivariate analyses. RESULTS: Of 13,386 total patients undergoing TSA, 9079 patients (67.8%) had general anesthesia, 212 (1.6%) had regional anesthesia, and 4095 (30.6%) had general anesthesia combined with regional anesthesia. There were no significant differences in postoperative complications between the general anesthesia group and the regional anesthesia group. Following adjustment, an increased risk of extended length of hospital stay was seen in the combined general and regional anesthesia group compared to those who only had general anesthesia (p = 0.001). CONCLUSION: General versus regional versus general plus regional anesthesia have no difference in postoperative complications in patients receiving primary total shoulder arthroplasty. However, addition of regional anesthesia to general anesthesia is associated with increased length of stay. LEVEL OF EVIDENCE: III.

Reintervention Rate After Pigtail Catheter Insertion Compared to Surgical Chest Tubes.

BACKGROUND: Prior studies suggest similar efficacy between large-bore chest tube (CT) placement and small-bore pigtail catheter (PC) placement for the treatment of pleural space processes. This study examined reintervention rates of CT and PC in patients with pneumothorax, hemothorax, and pleural effusion. METHODS: This retrospective study examined patients from September 2015 through December 2020. Patients were identified using ICD codes for pneumothorax, hemothorax, or pleural effusion. Use of a pigtail catheter (≤14Fr) or surgical chest tube (≥20Fr) was noted. The primary outcome was overall reintervention rate within 30 days of tube insertion. Patients who died with a pleural drainage catheter in place, unrelated to complications from chest tube placement, were excluded. RESULTS: There were 1032 total patients in the study: 706 CT patients and 326 PC patients. The PC group was older with more comorbidities and more likely to have effusion as the indication for pleural drainage. Patients with PC were 2.35 times more likely to have the tube replaced or repositioned (P < .0001), 1.77 times more likely to require any reintervention (P = .001) and 2.09 times more likely to remain in the hospital >14 days (P < .0001) compared to patients with CT. CONCLUSION: PCs have a significantly higher reintervention rate compared to CT for the treatment of pneumothorax, hemothorax, and pleural effusion. Although PC are believed to cause less pain and tissue trauma, they do not necessarily drain the pleural space as well as CT. Decisions on which method of draining the chest should be made on a case-by-case basis.

Correction: Evaluating Postoperative Immobilization Following Hip Reconstruction in Children With Cerebral Palsy.

[This corrects the article DOI: 10.7759/cureus.30270.].

Evaluating Postoperative Immobilization Following Hip Reconstruction in Children With Cerebral Palsy.

Objectives Currently, there is no standardized protocol for postoperative immobilization techniques in patients with cerebral palsy undergoing hip reconstructive procedures. The purpose of this study was to evaluate the effects of several methods of postoperative immobilization and to determine which postoperative immobilization technique has the fewest complications. Materials and methods A retrospective cohort study of pediatric patients with cerebral palsy who underwent hip reconstructive procedures, in which a hip spica cast, Petrie cast, or abduction pillow was placed for postoperative hip immobilization, was conducted. Patients who underwent revision surgery and those without cerebral palsy were excluded from the analysis. The final cohort consisted of 70 cases. Demographics, laterality of surgery, procedure type, hip immobilization technique, and 30-day postoperative complications were recorded. Complications were defined as those related to casting immobilization, such as re-dislocation or loss of surgical fixation, and soft tissue complications, such as pressure ulcers or any superficial or deep wound infection. Results Of the 70 patients, 27 received spica casting, 28 received Petrie casting, and 15 received an abduction pillow. The complication rates, as defined in the methods section, were 14.8% for the spica cast group, 17.9% for Petrie cast, and 26.7% for abduction pillow. There was no significant difference in complication rates among spica cast, Petrie cast, or abduction pillow groups (P=0.76). Conclusions There was no significant difference in length of stay, pain control duration, or complication rates among the three methods of immobilization. Clinicians should be advised of the comparable outcomes among the postoperative immobilization techniques.