Practice Size and Geographical Location and Annual Merit-Based Incentive Payment System Scores in Dermatology

Despite the transition to value-based care in the healthcare industry using the Merit-Based Incentive Payment Systems (MIPS), small and rural physician practices still score in the poor category annually. These poor performances negatively impact funding for staffing and service availability; further, little research has focused on the factors behind these poor performance scores. The purpose of this study was to examine the relationship between practice size and organization geographical location on annual MIPS scores among dermatologists in the South-Central United States. The Donabedian model was used as the theoretical framework for this study that focused on the three qualities of care: structure, process, and outcome. The research design included an independent samples t test, which evaluated the relationship between the variables. The findings of the parametric test demonstrated statistical significance (p-value \u3c.001) for practice size. Geographical location was not statistically significant (p-value 0.23). Further analysis was conducted using the same parametric test for the South-Central United States and the relationship of the variables. Practice size in the region demonstrated statistical significance (p-value \u3c.001) while geographical location in the region was not statistically significant. Texas was the only state to be significant within the region (p-value \u3c.001). The most important implication of this study’s findings for positive social change could be the direct support healthcare administrators will have to actively improve their organization’s MIPS scores and the potential incentives and additional funding they may receive by CMS

Practice Size and Geographical Location and Annual Merit-Based Incentive Payment System Scores in Dermatology

Despite the transition to value-based care in the healthcare industry using the Merit-Based Incentive Payment Systems (MIPS), small and rural physician practices still score in the poor category annually. These poor performances negatively impact funding for staffing and service availability; further, little research has focused on the factors behind these poor performance scores. The purpose of this study was to examine the relationship between practice size and organization geographical location on annual MIPS scores among dermatologists in the South-Central United States. The Donabedian model was used as the theoretical framework for this study that focused on the three qualities of care: structure, process, and outcome. The research design included an independent samples t test, which evaluated the relationship between the variables. The findings of the parametric test demonstrated statistical significance (p-value \u3c.001) for practice size. Geographical location was not statistically significant (p-value 0.23). Further analysis was conducted using the same parametric test for the South-Central United States and the relationship of the variables. Practice size in the region demonstrated statistical significance (p-value \u3c.001) while geographical location in the region was not statistically significant. Texas was the only state to be significant within the region (p-value \u3c.001). The most important implication of this study’s findings for positive social change could be the direct support healthcare administrators will have to actively improve their organization’s MIPS scores and the potential incentives and additional funding they may receive by CMS

Apocrine carcinoma of the male breast: a case report of an exceptional tumor

Apocrine carcinoma of the male breast is an exceptional malignant tumor. It does not have a particular clinical or radiological appearance, but it's microscopically characterized by the presence of granular cells and foamy cells representing over 90% of tumor cells. These cells express most of the time the GCDFP-15 and the androgen receptors. This tumor is a distinct molecular entity. In this observation, we report the case of a 70 year old man presenting apocrine carcinoma of the left breast diagnosed at the stage of lung metastasis

Lichen planus pemphigoides in a child

AbstractIntroductionLichen planus pemphigoides (LPP) is a rare autoimmune subepidermal blistering disease characterized by evolution of vesico-bullous skin lesions in patients with active lichen planus. We describe a case of LPP in a 12-year-old girl with clinical, histological and direct immunofluorescence findings.Case reportA 12-year-old Moroccan girl presented, after sun burn, pruritic violaceus papules on hands and feet complicated by the apparition of bullous lesions on apparent normal skin and on lichenoid eruption. A white reticulated pattern was present on the oral mucosa. Histopathology of lichenoid papule and bulla was consistent with the diagnosis of LPP. Direct immunofluorescence of peribullous skin showed linear deposits of IgG and C3 at the basal membrane zone. Treatment with Dapsone was successful.DiscussionLPP is exceptional in children; just fifteen cases were reported in the literature. This condition seems to be idiopathic. However, in rare cases it has been associated with some drugs or after PUVA therapy. In our patient, it was probably induced by prolonged sun exposure

Endometrial stromal tumors with sex cord-like elements: a case report

Endometrial stromal nodules are rare. They represent less than a quarter of endometrial stromal tumors. Clement and Scully described as variants of endometrial stromal nodules two types of tumor ressembling ovarian sex cord tumors. Type I is tumor that resembles focally an ovarian sex cord tumor which can be abbreviated ESTSCLE, or endometrial stromal tumors with sex cord-like elements and type II; uterine tumors with more than 40% sex cord-like differentiation so called UTROSCT for uterine tumor resembling ovarian sex cord tumor. Uterine tumours with sex cord-like differentiation are very rare with only 50 cases reported in the literature so far. The diagnostic is based on microscopic findings. Immunohistochemical tests to elucidate their nature yield variable and polyphenotypic with coexpression of markers of epithelial, myoid and sex cord lineage as well as hormone receptors. We report an additional case of an endometrial stromal tumors with sex cord-like elements in a 48-year-old woman presenting with abnormal mass.Pan African Medical Journal 2013; 14:5

Hepatobiliary Cystadenoma Revealed by a Jaundice: A Case Report

Introduction. Hepatobiliary cystadenomas are rare benign cystic tumors and have a potential for recurrence and malignant transformation. The diagnosis may be very difficult because of absence of typical imaging feature in some cases. Case Presentation. In this paper, the authors discuss a 57-year-old woman who presented a jaundice related to hepatobiliary cystadenoma. Biological and radiological examinations have led to surgery, and the diagnosis is made after a histological examination of surgical specimens. Conclusion. This observation illustrates a hepatobiliary cystadenoma revealed by jaundice. Histology examination contributed to diagnosis. The authors discussed the mechanisms of biliary obstruction and differential diagnoses through a review of the literature

Solitary Granular Cell Tumor of Cecum: A Case Report

Granular cell tumor (GCT) was first described by Abrikossof in 1926. This tumor is a benign neoplasm of unclear histogenesis that is generally believed to be of nerve sheath origin. GCT is not common and most often affects the tongue, skin, and soft tissue, although it may occur anywhere in the body. Gastrointestinal tract involvement, and especially that of the colon, is very rare. This usually benign tumor appears as a submucosal nodule, measuring less than 2 cm in diameter and is often found incidentally during colorectal examinations. We describe the case of a 27-year-old man with a GCT in the cecum that was detected after a screening colonoscopy. Endoscopic examination revealed a yellowish submucosal tumor, 0.7 cm in diameter. An endoscopic mucosal polypectomy was done for histological confirmation and treatment

The Undesirable Communication: A Case of Cerebral Air Emboli in the Setting of Atrio-Esophageal Fistula Following Atrial Fibrillation Catheter Ablation

Atrial-esophageal fistula is an extremely rare condition but is often a deleterious complication following catheter ablation for atrial fibrillation. The associated iatrogenic communication acts as a conduit for air and bacterial translocation, which may lead to cerebral air embolism and polymicrobial sepsis, respectively. Coupled with a history of invasive procedures, the diagnosis is largely based on the accompanying neurological symptoms. In this report, we present the case of a 73-year-old female who presented with neurological deficits attributed to cerebral vascular emboli three weeks after catheter ablation for the treatment of chronic atrial fibrillation

Ponction biopsies rénales dans le Service de Néphrologie de Fès: indications et résultats: à propos de 522 cas

L'apport de la ponction biopsie rénale (PBR) dans le diagnostic, le choix thérapeutique et l'évaluation pronostique des néphropathies est considérable. Aucune étude marocaine n'a évalué la pratique et l'apport de la PBR. Notre objectif est d'étudier les indications de la PBR, déterminer la fréquence des maladies rénales identifiées par PBR dans notre région et de faire une confrontation entre les données clinico-biologiques et le diagnostic historique. Notre étude menée entre Janvier 2009 et Décembre 2012, est rétrospective. Nous avons inclus tous les patients du service de Néphrologie du CHU Hassan II de Fès ayant bénéficié d'une biopsie de reins natifs. 522 PBR ont été réalisées. Nous avons exclu 8 biopsies devant le manque de renseignements et avons donc retenu 514. L'âge moyen des patients au moment de la PBR est de 39 ±17 ans (3-82 ans). Le sex ratio est de 0,9. Le syndrome néphrotique est le diagnostic clinique le plus fréquent à tous les âges (58,2%). Les néphropathies glomérulaires représentent 94,2% des maladies rénales diagnostiquées, leur distribution varie selon l'âge des patients. La PBR a confirmé le premier diagnostic suspecté cliniquement dans 40,65 % des cas, alors qu'elle a révélé un diagnostic inattendu chez 22,5% d'entre eux. Le diagnostic syndromique permet d'orienter vers la maladie rénale la plus probable et de guider les thérapeutiques urgentes en attendant les résultats de la PBR. Mais il ne peut en aucun remplacer la PBR qui reste le gold standard.Pan African Medical Journal 2016; 2