The Role of Photography in Increasing Efficiency of Dermatologic Inpatient Consulting Service

Abstract Introduction: Inpatient dermatology consultations can bring a mixed bag of pathologies. Due to the highly specialized nature of dermatology and the lack of dermatologic training in medical school, the dermatologic team is consulted for matters that range from non-urgent to pressing. Pictures are a critical component of dermatology and greatly aid in the diagnosis of cutaneous diseases. In the inpatient setting, pictures can help streamline diagnosis and prevent unnecessary tests or procedures. The purpose of this study was to evaluate for the presence of pictures in patients’ chart after a dermatology consult had been placed through EPIC at the University of Nebraska Medical Center (UNMC). Methods: Baseline data was gathered for two months in regards to the presence or absence of pictures in patients’ charts upon consultation of the UNMC academic dermatology service. At the two month mark, a prompt was added to the EPIC order for dermatology consultation stating, “Are there pictures in the chart?” This prompt required the consulting team to check ‘yes’ or ‘no’ before proceeding with signing the electronic order. Data was then gathered after two months following initiation of the prompt. Results: In the baseline two months, 15/33 (45.4%) consults contained photographs. In the two months following the prompt, “Are there pictures in the chart?”, 57/71 (80.3%) of consult orders placed contained a photograph. A Chi-squared analysis was preformed and revealed a significant difference (Chi-squared statistic 12.823, p-value \u3c 0.001) between the number of pictures placed in the chart with consult order before and after prompt. Conclusion: By adding a prompt in the EPIC order questioning picture availability, a significant increase was seen in pictures taken by consulting teams. This can help improve patient care by decreasing time to diagnosis, preventing unnecessary testing or procedures, and practicing cost-efficient medicine

Symmetrical Drug-Related Intertriginous and Flexural Exanthema Induced by Cellulitis Prophylaxis

Penicillin VK and hydroxyzine are typically well-tolerated antipruritic agents that are indicated in the prophylaxis of cellulitis. We herein report a case of a unique rash occurring during penicillin VK and hydroxyzine treatment in combination with the ingestion of cashews. A 77-year-old male presented with new onset rash. Eleven days after the administration of penicillin VK and hydroxyzine for cellulitis prophylaxis, he developed a symmetric, erythematous, scaling rash on his buttocks and perineal region with associated pruritus and bleeding without fevers, chills, adenopathy, night sweats, or any other symptoms. He was diagnosed with symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) secondary to systemic treatment, an adverse drug reaction that presents as an erythematous rash involving the skin folds. The condition is also known as “baboon syndrome,” as it predominately affects the buttocks. A good outcome was achieved due to a thorough history and physical, timely diagnosis, and cessation of the offending agents

Metabolic derangements in the gastrocnemius and the effect of Compound A therapy in a murine model of cancer cachexia

BackgroundCancer cachexia is a severe wasting syndrome characterized by the progressive loss of lean body mass and systemic inflammation. Inhibiting the signaling of the transcription factor nuclear factor kappa B (NF-κB) largely prevents cancer-induced muscle wasting in murine models. We have previously shown the utility of Compound A, a highly selective novel NF-κB inhibitor that targets the IκB kinase complex, to provide clinical benefit in cancer-induced skeletal muscle and cardiac atrophy.MethodsUsing a metabolomics approach, we describe the changes found between cachectic and noncachectic gastrocnemius muscles before and after Compound A treatment at various doses.ResultsOf the 234 metabolites in the gastrocnemius, cachexia-induced changes in gastrocnemius metabolism reset the steady-state abundances of 42 metabolites (p < 0.05). These changes, not evenly distributed across biochemical categories, are concentrated in amino acids, peptides, carbohydrates and energetics intermediates, and lipids. The gastrocnemius glycolytic pathway is markedly altered—changes consistent with tumor Warburg physiology. This is the first account of a Warburg effect that is not exclusively restricted to cancer cells or rapidly proliferating nonmalignant cells. Cachectic gastrocnemius also displays tricarboxylic acid cycle disruptions, signs of oxidative stress, and impaired redox homeostasis. Compound A only partially rescues the phenotype of the cachectic gastrocnemius, failing to restore the gastrocnemius’ baseline metabolic profile.ConclusionsThe findings in the present manuscript enumerate the metabolic consequences of cachexia in the gastrocnemius and demonstrate that NF-kB targeted treatment only partly rescues the cachectic metabolic phenotype. These data strengthen the previous findings from metabolomic characterization of serum in cachectic animals, suggesting that many of the metabolic alterations observed in the blood originate in the diseased muscle. These findings provide significant insight into the complex pathophysiology of cancer cachexia and provide objective criteria for evaluating future therapeutics.Electronic supplementary materialThe online version of this article (doi:10.1007/s13539-012-0101-7) contains supplementary material, which is available to authorized users

Enhanced metastatic risk assessment in cutaneous squamous cell carcinoma with the 40-gene expression profile test

Aim: To clinically validate the 40-gene expression profile (40-GEP) test for cutaneous squamous cell carcinoma patients and evaluate coupling the test with individual clinicopathologic risk factor-based assessment methods. Patients & methods: In a 33-site study, primary tumors with known patient outcomes were assessed under clinical testing conditions (n = 420). The 40-GEP results were integrated with clinicopathologic risk factors. Kaplan–Meier and Cox regression analyses were performed for metastasis. Results: The 40-GEP test demonstrated significant prognostic value. Risk classification was improved via integration of 40-GEP results with clinicopathologic risk factor-based assessment, with metastasis rates near the general cutaneous squamous cell carcinoma population for Class 1 and ≥50% for Class 2B. Conclusion: Combining molecular profiling with clinicopathologic risk factor assessment enhances stratification of cutaneous squamous cell carcinoma patients and may inform decision-making for risk-appropriate management strategies