Development of a Novel, Reusable Task Trainer for Foreign Body Removal and Abscess Incision and Drainage.

INTRODUCTION: Cutaneous abscess incision and drainage and foreign body removal are 2 common procedures in a variety of outpatient settings. The goal of this project was to create a novel, clean, reusable task trainer that could more accurately reproduce all the steps necessary to perform cutaneous abscess drainage or foreign body removal including ultrasound to identify the abscess cavity or foreign body. METHODS: The novel task trainer was constructed using silicone for both the base and the top skin. Toothpaste mixed with saline was used for the abscess material as this produced an ultrasound image that mimicked purulent material. A piece of a metal paper clip was imbedded in the top skin to mimic a cutaneous foreign body. Physician assistant (PA) students given a didactic lecture then used the novel task trainer as part of a clinical skills course. RESULTS: After the activity, the PA students were asked to voluntarily complete a brief preretrospective/postretrospective survey comprised 8 questions that addressed their self-perceived knowledge and skills using a 5-point Likert scale. Survey data from an initial cohort of PA students at one university show effectiveness of the models when used with the associated curriculum. DISCUSSION: This study demonstrates the feasibility of constructing a practical, low-cost, non-animal-based task trainer for the purpose of training incision and drainage of cutaneous abscesses and removal of cutaneous foreign bodies. This novel task trainer allows for ultrasound skill development and provides realistic imaging experience.

New-Onset Bullous Pemphigoid in a COVID-19 Patient.

This manuscript presents a report of bullous pemphigoid rash associated with COVID-19 for the first time. The objective of this manuscript is to present a unique dermatological case in the setting of a COVID-19-positive infection to further recognize the virus symptomatology. A 37-year-old female with a past medical history of class III obesity, type II diabetes mellitus, and hypertension presented to the emergency department in September 2020 with inpatient and outpatient follow-up through to November 2020. The patient denied any personal or family history of skin disorders. The patient tested positive for COVID-19 prior to hospitalization and presented to the hospital with severe, persistent, pruritic rash meeting dermatopathological, serologic, and clinical criteria for bullous pemphigoid diagnosis. Histopathology H&E punch biopsy from her left flexor wrist demonstrated epidermal keratinocyte necrosis, subepidermal vesiculation with eosinophils, gossamer stranding of the papillary dermis, and subepidermal edema. Direct immunofluorescence punch biopsy from her left flexor wrist demonstrated strong linear IgG staining at the dermoepidermal junction, with weaker and focal linear C3 staining. Antigen-specific serology was consistent with bullous pemphigoid. There was no previously reported cutaneous association of COVID-19 infection with bullous pemphigoid making this case an important addition to the body of evidence helping to identify bullous pemphigoid in the setting of viral infection.

An assessment of radon in groundwater in New York state.

A set of 317 samples collected from wells throughout New York State (excluding Long Island) from 2003 through 2008 was used to assess the distribution of radon gas in drinking water. Previous studies have documented high concentrations of radon in groundwater from granitic and metamorphic bedrock, but there have been only limited characterizations of radon in water from sedimentary rock and unconsolidated sand-and-gravel deposits in New York. Approximately 8% of the samples from bedrock wells exceed 89 Bq L (eight times the proposed regulatory limit), but only 2% of samples from sand-and-gravel wells exceed 44 Bq L. Specific metamorphic and sedimentary rock formations in New York are associated with the high radon concentrations, indicating that specific areas of New York could be targeted with efforts to reduce the risk of exposure to radon in groundwater. Additionally, radon in groundwater from the sand-and-gravel aquifers was found to be directly correlated to radon in indoor air when assessed by county.