Allergy and Immunology ; Ambulatory Care ; Autoimmune Diseases/therapy* ; COVID-19 ; Communicable Disease Control ; Connective Tissue Diseases/therapy* ; Delivery of Health Care/methods* ; Dermatology ; Humans ; Immunosuppressive Agents/therapeutic use* ; Patient Selection ; SARS-CoV-2 ; Singapore ; Skin Diseases, Vesiculobullous/therapy* ; Telemedicine/methods* ; Tertiary Care Centers ; Vasculitis/therapy*

PURPOSE: This prospective study was conducted to determine the incidence and related characteristics of respiratory medical device-related pressure ulcers (MDRPU) in children admitted to a pediatric intensive care unit (PICU). METHODS: The participants were 184 children who were admitted to the PICU of P University Hospital from April 2016 to January 2017. Data were collected on the occurrence of respiratory MDRPU and characteristics regarding the application of respiratory medical devices. RESULTS: Respiratory MDRPU occurred in 11.9% of participants (58.3%: stage I ulcers, 37.5%: mucosal ulcers). The devices associated with respiratory MDRPU were endotracheal tubes (54.2%), high-flow nasal cannulas (37.5%), and oximetry probes (8.3%). Respiratory MDRPU associated with an endotracheal tube were significant differences according to the site and strength of fixation, the use of a bite block and adhesive tape, skin dryness, and edema. In high-flow nasal cannulas, significant differences were found according to the site of fixation, immobility after fixation, and skin dryness. CONCLUSION: The occurrence of respiratory MDRPU is significantly affected by the method and strength of fixation, as well as skin dryness and edema. Therefore, appropriate consideration of these factors in nursing care can help prevent respiratory MDRPU.
Adhesives ; Catheters ; Child ; Critical Care ; Edema ; Humans ; Incidence ; Intensive Care Units ; Methods ; Nursing Care ; Oximetry ; Pressure Ulcer ; Prospective Studies ; Skin ; Surgical Tape ; Ulcer

It is necessary to organize and arrange the hair before performing surgery on the scalp. The hair is preserved in most cases, and the remaining hair makes it difficult to apply and maintain the drape. Moreover, hair that has not been properly sterilized can be a risk factor for infection. Accordingly, the authors of the present study benchmarked a method of hair control within the operative field using a sterile gel. Prior to surgery, the hair around the lesion can be organized and rearranged to the desired shape by using a sterile medical gel as a hairstyling product. Subsequently, chlorhexidine-isopropyl alcohol can be used for aseptic skin preparation, followed by draping for surgery. By controlling the hair using this method, hair can be prevented from falling into the operative field, thereby reducing the risk of surgical site infection.
Accidental Falls ; Benchmarking ; Hair ; Methods ; Preoperative Care ; Risk Factors ; Scalp ; Skin ; Surgical Drapes ; Surgical Wound Infection

PURPOSE: Blood culture is an essential diagnostic tool and requires clear indications, proper techniques, and quality control. We aimed to investigate whether blood cultures in children are appropriate for indications, are performed correctly, and receive proper quality control. METHODS: We conducted an online survey targeting pediatric infectious diseases (ID) specialists working in general hospitals and neonatologists (Neo) working at hospitals operating a neonatal intensive care unit in Korea. RESULTS: Approximately 81.1% (30/37) of pediatric ID specialists and 72.2% (52/72) of Neo responded to the survey. Some of the respondents (33.3% of ID and 59.6% of Neo) performed blood culture as a regular test irrespective of the indication. Approximately 40% of ID and 65.4% of Neo ordered only one set of blood culture in patients suspected with bacteremia. The most commonly used disinfectant for skin preparation was povidone-iodine, while the skin preparation method varied by institution. Approximately two-thirds of the institutions were monitoring the blood culture contamination rate, whereas relatively few provided staff with feedback on that rate. In addition, less than half of the institutions were providing regular staff training on blood culture (40% of ID and 28.8% of Neo). CONCLUSIONS: The indication and methods of blood culture for children varied according to institution, and few hospitals exert effort in improving the quality of blood culture. Institutions have to strive constantly toward improvement of blood culture quality and evidence-based recommendations for pediatric blood cultures should be standardized.
Bacteremia ; Child ; Communicable Diseases ; Hospitals, General ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Korea ; Methods ; Povidone-Iodine ; Quality Control ; Skin ; Specialization ; Surveys and Questionnaires

Replantation using microvascular anastomosis is considered to be the optimal method in treating the amputated ear in terms of resulting color, texture, and shape. Only a few cases of ear replantation have been reported because it is anatomically difficult to identify suitable vessels for anastomosis. We successfully replanted the amputated helical rim of the ear using single arterial anastomosis. A 37-year-old man had his helical rim amputated by a human bite. The amputee was about 4 × 1 cm in dimension, composed of skin and soft tissue including auricular cartilage. Replantation was performed anastomosing a small artery of the amputee with a terminal branch of the posterior auricular artery. After replantation, intravenous heparinization was performed and prostaglandin E1 and aspirin were administered. Venous congestion was decompressed by stab incisions applied with heparin solution soaked gauze. Venous congestion of the amputee slowly began to resolve at 4 days after the operation. The amputated segment of the helical rim survived completely with good aesthetic shape and color. The authors propose that performing microvascular anastomosis should be attempted especially if it is possible to detect vessels on cut surfaces of ear amputee and stump. Proper postoperative care for venous congestion, arterial insufficiency, and infection should be followed for amputee survival.
Adult ; Alprostadil ; Amputation ; Amputees ; Arteries ; Aspirin ; Bites, Human ; Ear ; Ear Cartilage ; Heparin ; Humans ; Hyperemia ; Methods ; Microsurgery ; Postoperative Care ; Replantation* ; Skin

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic skin condition that can affect any area with apocrine sweat glands and has the potential to involve multiple sites concurrently. Commonly affected sites include the axilla, groin, perineum and perianal areas. In this study we performed a literature review on the surgical methods for HS and describe an innovative technique for reconstructing axilla HS using an inner-arm transposition flap. METHODS: We reviewed all cases (5 cases from 4 patients) of transposition flap reconstruction performed by the senior author at a single London tertiary hospital from 2008–2013. Patient related outcome measures were collected using the Derriford appearance scale (DAS 24) and a study specific questionnaire. RESULTS: All patients were satisfied with their final result. One out of five cases had a complication but did not result in flap failure. There is no disease recurrence to date. DAS 24 scores collected demonstrated acceptable postoperative distress that did not deviate far from the norm tables while study specific questionnaire reveal desirable outcomes. CONCLUSIONS: We have managed to achieve our aim through the use of the innovative inner-arm transposition flap. Our study hopes to provide an additional technique for axillary reconstruction. This technique offers the effective concealment of scars with the benefit of tightening of the arm tissue producing ‘brachioplasty like’ effects. All things considered it would be reasonable to conclude the innovative flap technique is a reliable, effective, and simple method that results in multiple benefits.
Arm ; Axilla ; Cicatrix ; Groin ; Hidradenitis Suppurativa* ; Hidradenitis* ; Hope ; Humans ; Methods ; Outcome Assessment (Health Care) ; Perineum ; Recurrence ; Skin ; Surgical Flaps ; Sweat Glands ; Tertiary Care Centers

STUDY DESIGN: A retrospective review of prospectively collected data. PURPOSE: To introduce the sternum-disk distance (SDD) method for approaching the exact surgical level without C-arm guidance during anterior cervical discectomy and fusion (ACDF) surgery and to evaluate its accuracy and reliability. OVERVIEW OF LITERATURE: Although spine surgeons have tried to optimize methods for identifying the skin level for accessing the operative disk level without C-arm guidance during ACDF, success has rarely been reported. METHODS: In total, 103 patients who underwent single-level ACDF surgery with the SDD method were enrolled. The primary outcome measure was the accuracy of the SDD method. The secondary outcome measures were the mean SDD value at each cervical level from the cranial margin of the sternum in the neutral and extension positions of the cervical spine and the inter- and intra-observer reliability of the SDD outcome determined using repeated measurements by three orthopedic spine surgeons. RESULTS: The SDD accuracy (primary outcome measure) was indicated in 99% of the patients (102/103). The mean SDD values in the neutral-position magnetic resonance imaging (MRI) were 108.8 mm at C3–C4, 85.3 mm at C4–C5, 64.4 mm at C5–C6, 44.3 mm at C6–C7, and 24.1 mm at C7–T1; and those in the extension-position MRI were 112.9 mm at C3–C4, 88.7 mm at C4–C5, 67.3 mm at C5–C6, 46.5 mm at C6–C7, and 24.3 mm at C7–T1. The Cohen kappa coefficient value for intra-observer reliability was 0.88 (excellent reliability), and the Fleiss kappa coefficient value for inter-observer reliability as reported by three surgeons was 0.89 (excellent reliability). CONCLUSIONS: Based on the results of the present study, we recommend performing ACDF surgery using the SDD method to determine the skin level for approaching the surgical cervical segment without fluoroscopic guidance.
Cervical Vertebrae ; Diskectomy* ; Female ; Fluoroscopy* ; Humans ; Magnetic Resonance Imaging ; Methods* ; Orthopedics ; Outcome Assessment (Health Care) ; Prospective Studies ; Retrospective Studies ; Skin* ; Spinal Fusion ; Spine ; Sternum ; Surgeons

BACKGROUND: Delivery of pathology reports to the patient is a key step in the biopsy pathway, which is important for patient safety in dermatology. Automated systems for facilitating such medical process began in 2010 in our hospital, sending short message service to scheduled patients. OBJECTIVE: The purpose of this study was to evaluate the delivery of pathology reports to patients and investigate factors that influence this process and annual trends. METHODS: We retrospectively reviewed the medical records of all outpatients (n=2,452) who underwent skin biopsy at our department of dermatology in 2009 and 2014. In each year group, we analyzed the proportion of revisiting patients in terms of year, sex, age, season, biopsy method and diagnosis. RESULTS: In 2009, a smaller proportion of patients (205; 91.5%) who had undergone shave or excisional biopsy than of those who had undergone punch biopsy returned (781; 98.0%; p<0.001). This trend was not significant in 2014. Whereas there was no significant difference of return visit ratio between men and women in 2009, a higher proportion of women (754; 98.0%) than men (633; 95.6%) re-visited after skin biopsy to confirm their diagnosis in 2014 (p=0.008). Three patients with either a malignant tumor or suspected malignant lesion that required complete excision did not return to our clinic. CONCLUSION: Pathology report delivery rates were fairly satisfactory, regardless of year, age, season, and diagnosis. Sex and biopsy method influenced the return visit ratio. More organized follow-up protocols are required to strengthen patient safety and prevent critical patient drop-out.
Biopsy ; Dermatology ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Methods ; Outpatients ; Pathology* ; Patient Safety ; Retrospective Studies ; Seasons ; Secondary Care Centers* ; Skin ; Text Messaging

OBJECTIVETo determine the efficacy of palliative radiotherapy in treating tumor-stage cutaneous T-cell lymphoma/mycosis fungoides (MF).

METHODSFrom January 2008 to January 2013, a total of 11 patients with tumor-stage MF were treated with local radiation therapy in Peking Union Medical College Hospital. The median age of these patients was 53.36 ± 14.45 years. Female-male ratio was 1:1.2. The average course of disease was 10.82 ± 3.37 years. All the patients were treated with local electronic beam irradiation with a total median dosage of 48.55 ± 9.51 (40-74) Gy in an average of 24.55 ± 5.57 (20-40) fractions, 5 fractions per week.

RESULTSThe median follow-up time was 55.27 ± 29.3 (13-103) months. No severe acute or chronic side effects of irradiation were observed. Complete clinical response (CR) rate of the radiated sites was 54.5% (6/11), partial response (PR) rate was 36.4% (4/11), and the overall response rate (CR+PR) was 90.9%. One patient showed no response.

CONCLUSIONLocal radiotherapy with psolaren plus ultraviolet A and/or interferon maintaining treatment is an effective palliative therapy in the treatment of tumor-stage MF patients.

Adult ; Aged ; Antineoplastic Agents ; administration & dosage ; therapeutic use ; Chemoradiotherapy, Adjuvant ; methods ; Disease-Free Survival ; Female ; Humans ; Interferons ; administration & dosage ; therapeutic use ; Lymphoma, T-Cell, Cutaneous ; drug therapy ; pathology ; radiotherapy ; Male ; Middle Aged ; Mycosis Fungoides ; drug therapy ; pathology ; radiotherapy ; Neoplasm Staging ; PUVA Therapy ; methods ; Palliative Care ; methods ; Radiotherapy Dosage ; Skin Neoplasms ; drug therapy ; pathology ; radiotherapy ; Treatment Outcome

PURPOSE: Anti-tumor necrosis factor-alpha (TNF-alpha) medications represent a major advancement in the management of chronic inflammatory diseases. However, these agents are associated with increased risks of tuberculosis (TB) and other serious infections. The aim of this study was to evaluate the incidences of such disease among tertiary hospitals in Korea. MATERIALS AND METHODS: We retrospectively studied patients who received anti-TNF-alpha therapy; we reviewed serious infections including TB that developed within 6 months after initiation of anti-TNF-alpha therapy. Data concerning patient demographics, types of anti-TNF-alpha agents, concomitant immunosuppressive drugs use, and infection details were collected. RESULTS: A total 175 patients treated with infliximab (n=72) or adalimumab (n=103) with the following conditions were enrolled: Crohn's disease, 34 (19.4%); ulcerative colitis, 20 (11.4%); ankylosing spondylitis, 82 (46.9%); and rheumatoid arthritis, 39 (22.2%). There were 18 cases (6.0%) of serious infections. The most common site of serious infection was the intra-abdomen (n=6), followed by TB (n=3), skin and soft tissue (n=3), bone and joints (n=2), ocular neurons (n=2), lower respiratory tract (n=1), and urinary tract (n=1). Of the 175 patients, only 3 cases showed development of TB. Furthermore, of all those who developed TB, none had taken anti-TB chemoprophylaxis prior to treatment with an anti-TNF agent due to negative screening results. CONCLUSION: Serious infections with anti-TNF-alpha therapy were uncommon among tertiary hospitals in Korea; TB was the second most frequent infection. Nevertheless, there were no TB reactivations after anti-TB chemoprophylaxis. Accordingly, physicians should be aware of TB in subjects undergoing anti-TNF-alpha therapy, especially in countries with a high prevalence of TB.
Arthritis, Rheumatoid ; Chemoprevention ; Colitis, Ulcerative ; Crohn Disease ; Demography ; Humans ; Incidence* ; Joints ; Korea ; Mass Screening ; Methods ; Necrosis* ; Neurons ; Prevalence ; Respiratory System ; Retrospective Studies ; Skin ; Spondylitis, Ankylosing ; Tertiary Care Centers ; Tuberculosis* ; Tumor Necrosis Factor-alpha ; Urinary Tract