Retrospective cohort study of the economic value of providing microprocessor knees to the population of Medicare fee-for-service K2 beneficiaries with a knee disarticulation/above knee amputation.

Background: Microprocessor knees (MPKs) improve the functional mobility, quality of life, and safety of individuals with a knee disarticulation or above knee amputation and are cost-effective when adjusting for quality-of-life years gained. However, few studies have been conducted on the K2 population, and to this point, the Centers for Medicare and Medicaid Services has not covered MPKs for the K2 population.

Objectives: The aim of this study was to determine the extent to which MPK provision to the K2 population is cost effective at the person and population levels.

The Mystery of an Inflamed "Soul Patch".

A 20-year-old man had developed dermatitis on his scalp and facial hair between his lower lip and chin, his 'soul patch', for one month. He initially presented to urgent care, where the dermatitis was attributed to infection, for which he was treated with both oral valacyclovir and topical acyclovir. When no change was observed, he consulted his pediatrician, who prescribed oral clindamycin and referred him to dermatology.

Preoperative planning with three-dimensional CT vs. three-dimensional magnetic resonance imaging does not change surgical management for shoulder instability.

Background: This study aims to determine the effect of time and imaging modality (three-dimensional (3D) CT vs. 3D magnetic resonance imaging (MRI)) on the surgical procedure indicated for shoulder instability. The hypothesis is there will be no clinical difference in procedure selection between time and imaging modality.

Total Hip Replacement Interrupted by Intraoperative Arrest with a Final Component in Place: A Case Report.

No consensus recommendations exist as to the management of implants exposed during an interrupted total hip arthroplasty (THA). Given the infrequency of such events, documentation of successful outcomes in single case reports aids in decision-making. A 71-year-old male with a history of coronary artery disease and a BMI of 39.

Glenoid Version Assessment When the CT Field of View Does Not Permit the Friedman Method: The Robertson Method.

Background: To improve spatial resolution, current clinical shoulder cross-sectional imaging studies reduce the field of view of the shoulder, excluding the medial scapula border and preventing glenoid version measurement according to the Friedman method.

Purpose: To evaluate a method to accurately and reliably measure glenoid version on cross-sectional shoulder images when the medial scapula border is not included in the field of view, and to establish measurements equivalent to the Friedman method.

Study Design: Controlled laboratory study.

Safety of dupilumab in a 5-month-old infant with severe atopic dermatitis.

Dupilumab is a fully humanized monoclonal antibody that suppresses Th2-mediated inflammation by inhibiting signaling of interleukin-4 and interleukin-13 through the interleukin-4 alpha receptor subunit, and is approved by the FDA for the treatment of moderate to severe atopic dermatitis (AD) in children 6 years of age and older. While initial data from phase 2 trials in children less than 6 years are promising, dupilumab use in children less than 6 months of age is not well studied. Here we present a case of a 5-month-old boy with severe primary AD, eosinophilia, hypogammaglobulinemia, and poor weight gain, who was successfully treated with dupilumab and experienced no serious adverse effects.

Assessing the accuracy of arthroscopic and open measurements of the size of rotator cuff tears: A simulation-based study.

Background: Arthroscopic procedures are commonly performed for rotator cuff pathology. Repair of rotator cuff tears is a commonly performed procedure. The intraoperative evaluation of the tear size and pattern contributes to the choice and completion of the technique and the prognosis of the repair.

New-onset head and neck dermatitis in adolescent patients after dupilumab therapy for atopic dermatitis.

Background/objectives: Head and neck dermatitis after dupilumab therapy for atopic dermatitis has been frequently reported in adults and only rarely in adolescents. No cases detailing disease course and treatment response have previously been described in adolescents.

Methods/results: This case series presents five adolescent patients who developed new-onset or worsening head and neck dermatitis after dupilumab therapy for atopic dermatitis.

Implementation of a pediatric provider-to-provider store-and-forward teledermatology system: Effectiveness, feasibility, and acceptability in a pilot study.

Background/objectives: Long wait times for in-person appointments in pediatric dermatology can lead to delays in specialty care, additional health system touchpoints, patient and family dissatisfaction, poorer outcomes, and increased overall health care costs. Store-and-forward teledermatology may address these challenges and improve access to care in pediatric dermatology.

Methods: We describe a prospective, non-blinded cohort study with follow-up surveys conducted from March 1, 2018, to September 20, 2018.

Surgical treatment for recurrent shoulder instability: factors influencing surgeon decision making.

Background: The optimal surgical approach for recurrent anterior shoulder instability remains controversial, particularly in the face of glenoid and/or humeral bone loss. The purpose of this study was to use a contingent-behavior questionnaire (CBQ) to determine which factors drive surgeons to perform bony procedures over soft tissue procedures to address recurrent anterior shoulder instability.

Methods: A CBQ survey presented each respondent with 32 clinical vignettes of recurrent shoulder instability that contained 8 patient factors.

Cutaneous manifestations of congenital malignant rhabdoid tumor: Unusual papillomatous plaques and other skin presentations.

Background/objectives: Malignant rhabdoid tumors (MRT) are highly aggressive tumors with a predilection for the kidney, central nervous system, and soft tissues that usually affect young children under three years of age. Primary presentation in the skin is rarely reported, and features of the cutaneous manifestations are not well described. We report six cases of metastatic MRT that first manifested with congenital nodules and masses in the skin.

Development and Initial Validation of a Multidimensional Acne Global Grading System Integrating Primary Lesions and Secondary Changes.

Importance: The qualitative grading of acne is important for routine clinical care and clinical trials, and although many useful systems exist, no single acne global grading system has had universal acceptance. In addition, many current instruments focus primarily on evaluating primary lesions (eg, comedones, papules, and nodules) or exclusively on signs of secondary change (eg, postinflammatory hyperpigmentation, scarring).

Objectives: To develop and validate an acne global grading system that provides a comprehensive evaluation of primary lesions and secondary changes due to acne.

Further delineation of the phenotypic spectrum of nevus comedonicus syndrome to include congenital pulmonary airway malformation of the lung and aneurysm.

Nevus comedonicus syndrome (NCS) is a rare epidermal nevus syndrome characterized by ocular, skeletal, and central nervous system anomalies. We present a 23-month-old boy with a history of a congenital pulmonary airway malformation (CPAM) of the lung and a congenital cataract who developed progressive linear and curvilinear plaques of dilated follicular openings with keratin plugs (comedones) on parts of his scalp, face, and body consistent with nevus comedonicus. MRI of the brain demonstrated an aneurysm of the right internal carotid artery.

Reasons for not completing postvasectomy semen analysis.

Objective: To identify noncompliance rates for 3-month postvasectomy semen analysis (PVSA) in men who have undergone vasectomy and to explore the self-reported reasons for not completing the 3-month PVSA.

Design: Retrospective chart review followed by semistructured telephone interviews.

Setting: Two family medicine clinics in Saskatoon, Sask.

Wait times, health care touchpoints, and nonattendance in an academic pediatric dermatology clinic.

Background And Objectives: Timely access to pediatric dermatology care remains a challenge. While awaiting appointments, many patients and families utilize so-called health care touchpoints outside of the dermatology clinic such as primary care or emergency department visits to address dermatologic concerns. Long waiting periods also factor into nonattendance rates at pediatric dermatology appointments.

Mathematical model of gender bias and homophily in professional hierarchies.

Women have become better represented in business, academia, and government over time, yet a dearth of women at the highest levels of leadership remains. Sociologists have attributed the leaky progression of women through professional hierarchies to various cultural and psychological factors, such as self-segregation and bias. Here, we present a minimal mathematical model that reveals the relative role that bias and homophily (self-seeking) may play in the ascension of women through professional hierarchies.

Unilateral hypertrophy of the labia minora: A case series.

Asymmetric hypertrophy of the labia minora is a variant of normal anatomy that has not been described in the pediatric dermatology literature. Although often asymptomatic, in some cases, it can cause functional, emotional, and psychological problems. We report the clinical characteristics and outcomes of four children who presented with unilateral labium minus hypertrophy.

Diagnostic Accuracy of Pediatric Teledermatology Using Parent-Submitted Photographs: A Randomized Clinical Trial.

Importance: Advances in smartphone photography (both quality and image transmission) may improve access to care via direct parent-to-clinician telemedicine. However, the accuracy of diagnoses that are reliant on parent-provided photographs has not been formally compared with diagnoses made in person.

Objective: To assess whether smartphone photographs of pediatric skin conditions taken by parents are of sufficient quality to permit accurate diagnosis.

Usability, Acceptability, and Impact of a Pediatric Teledermatology Mobile Health Application.

Objective: Pediatric dermatology appointment wait times often exceed several months. We evaluated the usability, acceptability, and clinical impact of a store-and-forward teledermatology mobile application (app) linking families with pediatric dermatologists.

Methods: Parents of children age 6 weeks to 17 years or individuals 18-21 years old were invited (by e-mail or referral) to participate in this single group, prospective study.

Pediatric Dermatology.

Skin changes are common in children. Common concerns are birthmarks (e.g.