Implementation of a Neonatal Hyperbilirubinemia Clinical Pathway in a Pediatric Emergency Department.

Background: High volumes and competing priorities delay care initiation for neonatal hyperbilirubinemia within the pediatric emergency department (ED). Our freestanding children's hospital developed a quality improvement project to implement a nurse-initiated neonatal hyperbilirubinemia clinical pathway (CP) intended to decrease treatment initiation and intravenous fluid (IVF) rates.

Methods: A multidisciplinary team used the model for improvement to delineate and address key drivers of treatment delays.

Improving Consistency in the Use of Sucrose With Comfort Measures During Minor Painful Procedures.

Background: Inconsistent pain management practices can have negative physiologic and neurodevelopmental consequences in the neonate. Low rates of oral sucrose use with comfort measures for pain management during minor painful procedures were identified at a level III neonatal intensive care unit. Underutilization of pain management resources occurs despite the availability of evidence-based pain management interventions.

Dermatofibrosarcoma protuberans with platelet-derived growth factor-D rearrangement; two cases with morphologically distinct presentations.

Dermatofibrosarcoma protuberans (DFSP) is a mesenchymal neoplasm that is usually located in the dermis or subcutis and is locally aggressive. Rarely, these lesions may undergo fibrosarcomatous transformation, which is thought to increase their metastatic potential. DFSP is classically associated with a 17;22 translocation (or ring chromosome thereof) resulting in fusion of the COL1A1 and PDGFB genes.

Validation of a Novel Cutaneous Neoplasm Diagnostic Self-Efficacy Instrument (CNDSEI) for Evaluating User-Perceived Confidence With Dermoscopy.

Background: Accurate medical image interpretation is an essential proficiency for multiple medical specialties, including dermatologists and primary care providers. A dermatoscope, a ×10-×20 magnifying lens paired with a light source, enables enhanced visualization of skin cancer structures beyond standard visual inspection. Skilled interpretation of dermoscopic images improves diagnostic accuracy for skin cancer.

Eruption of squamous cell carcinomas after beginning nilotinib therapy.

Chronic myelogenous leukemia (CML) is characterized by a reciprocal translocation between the long arms of chromosomes 9 and 22 leading to the formation of a constitutively active tyrosine kinase. Tyrosine kinase inhibitors (TKIs) are the treatment of choice for patients diagnosed with CML and have many associated side effects including the rarely-reported eruption of squamous cell carcinomas (SCCs). Herein, we report a patient with CML who presented with sudden onset of multiple scaly lesions on his legs and trunk after beginning treatment with nilotinib, a novel TKI.

Trypophobia, skin, and media.

Trypophobia is the fear of patterns of clustered holes, bumps, or nodules. Trypophobia has a special relationship with dermatology because of its effects on individuals with skin disease, its relationship with disease avoiding behavior, and its utilization in many online skin disease hoaxes. Trypophobic patterns on skin and characters can be found in movies, TV shows, and videogames.

Testing Pediatric Acuity With an iPad: Validation of "Peekaboo Vision" in Malawi and the UK.

Purpose: To evaluate two builds of the digital grating acuity test, "Peekaboo Vision" (PV), in young (6-60 months) populations in two hospital settings (Malawi and United Kingdom).

Methods: Study 1 evaluated PV in Blantyre, Malawi ( = 58, mean age 33 months); study 2 evaluated an updated build in Glasgow, United Kingdom ( = 60, mean age 44 months). Acuities were tested-retested with PV and Keeler Acuity Cards for Infants (KACI).

Antineutrophil cytoplasmic antibodies negative levamisole-induced leukocytoclastic vasculitis: a presumed case and literature review.

Levamisole-contaminated cocaine toxicity is a serious emerging public health concern, and providers should be aware of its presentation and management. Most cases of levamisole-induced vasculitis/vasculopathy (LIV) are associated with high antineutrophil cytoplasmic antibodies (ANCA). We describe a unique case of a cocaine user who presented with an acute purpuric eruption and negative ANCA laboratory findings.

Nephrogenic systemic fibrosis: A 15-year retrospective study at a single tertiary care center.

Background: Despite multiple therapeutic approaches for nephrogenic systemic fibrosis (NSF), no single treatment has convincingly shown consistent benefit. The most successful outcomes have been associated with recovery of renal function, although evidence remains limited and past studies have been inconclusive.

Objective: We sought to investigate whether improvement of renal function via successful transplantation or via return of renal function after acute kidney injury correlates with improvement of NSF, and to further characterize the clinical features and progression of NSF.

The measurement of New Zealand health care.

The effective and economical measurement of the quality and safety of health and disability services in New Zealand is of signal importance. The Health Quality and Safety Commission has overseen the introduction of an architecture of interacting measures. These include quality and safety indicators, or QSIs, which are whole-system measures; quality and safety markers, or QSMs, which are targeted measures of quality and safety interventions comprising process and outcome measures in sets; and the New Zealand Atlas of Healthcare Variation, which illustrates the differences in the health care received in different regions and by different groups of patients within New Zealand.

The Health Quality and Safety Commission: making good health care better.

New Zealand has one of the best value health care systems in the world, but as a proportion of GDP our spending on health care has increased every year since 1999. Further, there are issues of quality and safety in our system we must address, including rates of adverse events. The Health Quality and Safety Commission was formed in 2010 as a crown agent to influence, encourage, guide and support improvement in health care practice in New Zealand.

Synergistic cytotoxicity and DNA strand breaks in cells and plasmid DNA exposed to uranyl acetate and ultraviolet radiation.

Depleted uranium (DU) has a chemical toxicity that is independent of its radioactivity. The purpose of this study was to explore the photoactivation of uranyl ion by ultraviolet (UV) radiation as a chemical mechanism of uranium genotoxicity. The ability of UVB (302 nm) and UVA (368 nm) radiation to photoactivate uranyl ion to produce single strand breaks was measured in pBR322 plasmid DNA, and the presence of adducts and apurinic/apyrimidinic sites that could be converted to single strand breaks by heat and piperidine was analyzed.