Recognizing sepsis in the adult patient.

Patients in every health care setting are at risk for systemic inflammatory response syndrome, sepsis, severe sepsis, and even septic shock. The increasing incidence of sepsis, especially among older adults, its high mortality rate, and its subtle and rapid progression make prompt recognition and treatment imperative. Even though severe sepsis requires treatment in the ICU, the assessment of sepsis isn't solely the domain of the physician, critical care nurse, or ED nurse.

A descriptive analysis of the non-urgent use of emergency departments.

This study by Carla Brim from the United States analyses why people seek non-urgent care in emergency departments during hours when community providers are available. Results indicate that lack of healthcare insurance and having public insurance are the factors most closely associated with such use of emergency departments. This information can be used to bring about change in policymaking decisions about healthcare assessments.

Interface dermatitis.

Interface dermatitis can be classified based upon the cell type that dominates the infiltrate (ie, neutrophilic, lymphocytic, or lymphohistiocytic) or by the intensity of the interface inflammation. Regarding lymphocytic interface dermatitis, there are 2 broad categories: cell-poor interface dermatitis, when only a sparse infiltrate of inflammatory cells is present along the dermoepidermal junction, or cell rich, which typically occurs as a heavy bandlike infiltrate that obscures the basal layers of the epidermis. In the case of lymphocytic interface dermatitis, the latter is often termed a lichenoid interface dermatitis.

An interdisciplinary team approach to evidence-based improvement in family-centered care.

Family-centered care has become an integral part of total patient care in today's healthcare setting. Meeting family needs can be challenging for staff nurses already overwhelmed with escalating patient acuity and ever-increasing technical and documentation burdens. In the year 2000, an Interdisciplinary team in a tertiary hospital in the midwest employed a collaborative process to design and pioneer an award-winning nursing role in family-centered care.

The molecular basis of melanomagenesis and the metastatic phenotype.

The last two decades have seen spectacular advances in our understanding of the biology of melanoma and, in particular, have elucidated the mechanisms operative in disease initiation and progression. With respect to the former, the genetics of melanoma and in particular the impact of genetic defects on dysregulation of the cell cycle are key issues in malignant transformation and are a major focus of this review. With respect to the latter, consideration also is given to the acquisition of growth factor autonomy and the capacity for invasion and metastasis from the standpoint of cell adhesion, motility, and matrix digestion.

Unusual histologic and clinical variants of melanoma: implications for therapy.

Unusual histologic variants of melanoma may be problematic to the histopathologist. Several of these variants are sufficiently rare that their biologic behavior remains obscure. As identification of some of these melanoma subtypes has specific implications for the therapeutic approach, and as some may mimic other forms of epithelial or mesenchymal neoplasia, their recognition is key to patient management.

Empowering critical care nurses to improve compliance with protocols in the intensive care unit.

Background: Practitioners often do not comply with evidence-based protocols.

Objective: To improve compliance with evidence-based protocols in an intensive care unit.

Methods: A baseline compliance range was obtained by using a sampling of 9 protocols for a 100% audit of 35 beds in an adult intensive care unit.

Unusual histologic and clinical variants of melanoma: implications for therapy.

Unusual histologic variants of melanoma may prove problematic to the histopathologist. Several of these variants are sufficiently rare that their biological behavior remains obscure. Because identification of some of these melanoma subtypes has specific implications for the therapeutic approach and some may mimic other forms of epithelial or mesenchymal neoplasia, their recognition is key to patient management.

Malignant adnexal neoplasms.

Malignant cutaneous adnexal neoplasms are one of the most challenging areas of dermatopathology. Tumors of the pilosebaceous apparatus can occur as single-lineage neoplasms or may manifest as complex proliferations with multilineal differentiation patterns including not only the germinative component of the hair bulb, the inner or outer root sheath epithelium and the sebaceous gland and duct, but also the sweat duct components that relate to the apocrine secretory apparatus which empties into the follicle near the follicular bulge. Eccrine and apocrine neoplasms present a bewildering array of morphologies, which often defy precise classification.

Prognosticators of melanoma, the melanoma report, and the sentinel lymph node.

Since the 1960s, the clinical characteristics of melanoma, its histopathology and its biological basis have been the subject of intense study at pigmented lesion clinics in North America, Europe, and Australia. More recently, the immense database of the Melanoma Committee of the American Joint Committee on Cancer (AJCC) has been exploited through complex mathematical models to measure the impact of various histologic features of primary melanomas and of sentinel lymph node deposits and to correlate these parameters with patient survival. The wealth of modern information available to pathologists and clinicians has become of vital interest to the prognostication of the individual patient with melanoma.

Medicolegal aspects of neoplastic dermatology.

Medical malpractice litigation is rising at an explosive rate in the US and, to a lesser extent, in Canada. The impact of medical malpractice litigation on health care costs and the cost of insurance is dramatic. Certain specialist categories are becoming uninsurable in some parts of the US, while in others, clinicians are retiring early, restricting or changing practice or changing states of residence in consequence of medical malpractice claims and of the cost and availability of insurance.

The future of dermatopathology.

Of the major issues that dermatopathology will face in the immediate future, two powerful challenges loom large. The first is the application of novel nondestructive imaging technologies to in vivo diagnosis in humans. The second is the application of molecular technologies to a diagnostic arena which formerly belonged exclusively to the light microscopist.

Relief of painful diabetic peripheral neuropathy with pregabalin: a randomized, placebo-controlled trial.

Unlabelled: This was a 6-week, randomized, double-blind, multicenter study evaluating the efficacy of pregabalin in the treatment of painful diabetic neuropathy. Two hundred forty-six men and women with painful diabetic neuropathy received pregabalin (150 or 600 mg/day by mouth) or placebo. The primary efficacy variable was mean pain score at the end of treatment.

Interstitial cystitis, chronic nonbacterial prostatitis and chronic pelvic pain syndrome in men: a common and frequently identical clinical entity.

Purpose: In this ongoing review we characterize interstitial cystitis in men, identifying multiple clinical factors in the diagnosis and treatment of men with interstitial cystitis.

Materials And Methods: An ongoing and retrospective chart review of 92 men with interstitial cystitis within our large single specialty practice was performed. Presenting complaints, duration of symptoms, epidemiology, and clinical and physical findings were reviewed.

Atypical lymphocytic lobular panniculitis.

Background: Although subcutaneous T-cell lymphoma (SCTCL) is considered an aggressive form of lymphoma, some patients manifest a long waxing and waning phase unaccompanied by constitutional symptoms.

Methods: Twelve patients were prospectively encountered, presenting with a lymphocytic panniculitis accompanied by lymphoid atypia, although not fulfilling criteria for SCTCL. Clinical, histologic, phenotypic, and genotypic analyses were conducted.

Elevation of cardiac troponin I indicates more than myocardial ischemia.

Elevated cardiac troponin I (cTnI) levels in patients hospitalized with chest pain often lead to a diagnosis of acute myocardial infarction (MI) or unstable angina. However, as we describe in this review, this finding may occur in other conditions, leading to an incorrect diagnosis and other, sometimes invasive, tests. We review briefly cTnI, its release and detection.

Binswanger's disease: its association with hypertension and obstructive sleep apnea.

Subacute arteriosclerotic encephalopathy, also known as Binswanger's disease, is a rare subtype of vascular dementia. A case of probable Binswanger's disease in a patient with hypertension and obstructive sleep apnea is presented. Following the case presentation is a discussion of vascular dementia, with emphasis on Binswanger's disease, specifically the historical aspects, clinical features, neuroimaging and pathological features.

Clear cell atypical fibroxanthoma:a clinicopathologic study.

Introduction: The atypical fibroxanthoma (AFX) is considered by most authorities to represent a superficial or minimally invasive variant of malignant fibrous histiocytoma that most often presents as a solitary nodule on the sun-exposed skin of the elderly. Among the rarest variants is the clear cell AFX, a lesion which raises consideration to a differential diagnosis encompassing a variety of neoplastic and non-neoplastic clear cell proliferations.

Methods: We describe three cases of a distinctive cutaneous neoplasm arising in the sun-exposed skin of elderly patients.

Sudden incapacitation: occupational aviation medicine perspectives.

Within the aviation environment, occupational medicine tends to focus on pilots, because of the very great effects pilot injury or illness can have on public safety. However, medical conditions of other aviation workers can also endanger public and personal safety. Sudden incapacitation an abrupt loss or impairment of consciousness, control, or performance is the most important occupational concern in aviation medicine.

Atypical pigmentary purpura: a clinical, histopathologic, and genotypic study.

Background: The pigmentary purpuras (PPs) are a heterogeneous group of dermatoses defined by specific clinicopathologic features but sharing, at the light microscopic level, superficially disposed dermal lymphocytic infiltrates and hemorrhage. The term atypical pigmentary purpura (APP) is used by the authors in reference to cases of PP in which individual lesions, although clinically presenting as PP, show morphological features typically associated with mycosis fungoides (MF) including Sezary cells and epidermotropism. The integrated concept of lymphocyte atypia and PP is a confusing and enigmatic one to which reference in the literature has been previously made.