The Effect of a Quality Improvement Intervention on Sleep and Delirium in Critically Ill Patients in a Surgical ICU.

Background: Delirium is a deleterious condition affecting up to 60% of patients in the surgical ICU (SICU). Few SICU-focused delirium interventions have been implemented, including those addressing sleep-wake disruption, a modifiable delirium risk factor common in critically ill patients.

Research Question: What is the effect on delirium and sleep quality of a multicomponent nonpharmacologic intervention aimed at improving sleep-wake disruption in patients in the SICU setting?

Study Design And Methods: Using a staggered pre-post design, we implemented a quality improvement intervention in two SICUs (general surgery or trauma and cardiovascular) in an academic medical center.

Inguinal Metastasis from Basal Cell Carcinoma of the Vulva.

Vulval basal cell carcinomas (BCC) are an important differential diagnosis of painful, itchy vulval lesions, which can occur at all ages but commonly affect women in their senium. BCC tend to grow locally in an invasive and destructive pattern and seldom metastasize. Here we describe the rare case of inguinal metastasis in a 70-year-old woman with vulval BCC who was treated with radical hemivulvectomy, bilateral inguinal node sampling and adjuvant external beam radiotherapy.

Primary Genital Herpes Simplex Virus Type I in Preterm Prelabour Rupture of Membranes at 30 Weeks' Gestation.

Background. Disseminated herpes simplex virus (HSV) in the neonate is associated with significant morbidity and mortality. Current guidelines recommend caesarean in third-trimester maternal primary genital HSV outbreaks to prevent transmission from mother to fetus.