1
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Dunbar TK, Olsen MK, Yang H, Kennedy D, Jackson LR, Thomas KL, Alkon A, Prose NS, Pollak KI. Characteristics Associated with Burnout among Cardiologists in an Academic Medical Setting: Baseline Survey Results from a Communication Coaching RCT. Behav Sci (Basel) 2022; 12:362. [PMID: 36285931 PMCID: PMC9598081 DOI: 10.3390/bs12100362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Clinician burnout poses risks not just to clinicians but also to patients and the health system. Cardiologists might be especially prone to burnout due to performing high-risk procedures, having to discuss serious news, and treating diseases that incur significant morbidity and mortality. Few have attempted to examine which cardiologists might be at higher risk of burnout. Knowing at-risk cardiologists can help frame resilience interventions. METHODS We enrolled 41 cardiologists across five ambulatory cardiology clinics into a randomized controlled trial where we assessed the Maslach Burnout Inventory at baseline. We used bivariate analyses to assess associations between cardiologist demographics and burnout. RESULTS Cardiologists reported low burnout for depersonalization and personal accomplishment and moderate levels for emotional exhaustion. Female cardiologists reported emotional exhaustion scores in the "low" range (M = 12.3; SD = 10.06), compared to male cardiologists whose score was in the "moderate" range 19.6 (SD = 9.59; p = 0.113). Cardiologists who had greater than 15 years in practice reported higher mean scores of emotional exhaustion, indicating moderate burnout (M = 20.0, SD = 10.63), compared to those with less than 15 years in practice (M = 16.6, SD = 9.10; p = 0.271). CONCLUSIONS In this sample, unlike prior studies, male cardiologists reported more burnout. Consistent with prior work, mid-level cardiologists might be at highest risk of emotional exhaustion.
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Affiliation(s)
- Travia Kayla Dunbar
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| | - Maren K. Olsen
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC 27705, USA
| | - Hongqiu Yang
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710, USA
| | | | - Larry R. Jackson
- Division of Cardiology, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27705, USA
| | - Kevin L. Thomas
- Division of Cardiology, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27705, USA
| | - Aviel Alkon
- Department of General Internal Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Neil S. Prose
- Department of Dermatology and Pediatrics, Duke University School of Medicine, Durham, NC 27710, USA
| | - Kathryn I. Pollak
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Cancer Research Institute, Durham, NC 27710, USA
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2
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Sarver MM, Quow K, Prose NS. Atopic dermatitis leading to failure to thrive: A case report. Pediatr Dermatol 2022; 39:594-597. [PMID: 35575183 DOI: 10.1111/pde.14983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present an infant with severe atopic dermatitis, protein loss, and subsequent failure to thrive. With proper management, the patient's laboratory findings normalized, and he gained weight appropriately. In this report, we highlight the impact that severe atopic dermatitis may have growth and development and review the genetic conditions that can result in a similar clinical presentation.
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Affiliation(s)
| | - Krystina Quow
- Duke Dermatology Department, Durham, North Carolina, USA
| | - Neil S Prose
- Duke Dermatology Department, Durham, North Carolina, USA
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3
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Koppel PD, De Gagne JC, Docherty S, Smith S, Prose NS, Jabaley T. Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: A Qualitative Study (Preprint). J Med Internet Res 2022; 24:e39920. [PMID: 36074558 PMCID: PMC9501656 DOI: 10.2196/39920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/08/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although videoconferencing between oncology patients and nurses became routine during the pandemic, little is known about the development of clinician-patient rapport in this care environment. Evidence that virtual visits may challenge nurses’ ability to form connections with patients, demonstrate empathy, and provide support suggests that videoconferencing may not ensure optimal care for persons with cancer. Establishing rapport during videoconferencing visits (VCVs) is important in oncology nursing, as rapport enables the nurse to provide emotional support and assistance to patients as they navigate their cancer journey. Objective This study investigated the nature of nurse-patient rapport in ambulatory cancer care videoconferencing telehealth visits. Objectives included exploring (1) how patients with cancer and nurses describe experiences of and strategies for cultivating rapport and (2) similarities and differences between rapport in videoconferencing and in-person visits (IPVs). Methods In this qualitative descriptive study, interviews were conducted from October 2021 to March 2022 with 22 participants, including patients with cancer (n=10, 45%) and oncology nurses (n=12, 55%), about their experiences of rapport building during VCVs. All interviews were analyzed using conventional content analysis. Data from nurses and patients were analyzed separately using identical procedures, with a comparative analysis of patient and nurse results performed in the final analysis. Results Most patients in the study had experienced 3-5 video visits within the past 12 months (n=7, 70%). Half of the nurse participants (n=6, 50%) reported having participated in over 100 VCVs, and all had experiences with videoconferencing (ranging from 3 to 960 visits) over the past 12 months. In total, 3 themes and 6 categories were derived from the patient data, and 4 themes and 13 categories were derived from the nurse data. Comparisons of themes derived from participant interviews identified similarities in how nurses and patients described experiences of rapport during VCVs. Three themes fit the collective data: (1) person-centered and relationship-based care is valued and foundational to nurse-patient rapport in oncology ambulatory care regardless of how care is delivered, (2) adapting a bedside manner to facilitate rapport during VCVs is feasible, and (3) nurses and patients can work together to create person-centered options across the care trajectory to ensure quality care outcomes. Barriers to relationship building in VCVs included unexpected interruptions from others, breaks in the internet connection, concerns about privacy, and limitations associated with not being physically present. Conclusions Person-centered and relationship-based approaches can be adapted to support nurse-patient rapport in VCVs, including forming a personal connection with the patient and using active listening techniques. Balancing the challenges and limitations with the benefits of videoconferencing is an essential competency requiring additional research and guidelines. International Registered Report Identifier (IRRID) RR2-10.2196/27940
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Affiliation(s)
- Paula D Koppel
- School of Nursing, Duke University, Durham, NC, United States
| | | | | | - Sophia Smith
- School of Nursing, Duke University, Durham, NC, United States
- Duke Cancer Institute, Duke Health, Durham, NC, United States
| | - Neil S Prose
- Department of Dermatology, Duke University, Durham, NC, United States
- Department of Pediatrics, Duke University, Durham, NC, United States
| | - Terri Jabaley
- Phyllis F Cantor Center for Research in Nursing & Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, United States
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4
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Alexopoulos EA, Guinee EP, Stewart KA, Brown CS, Gold DT, Engle D, Talenti F, Klevansky R, Barfield R, Ross E, Prose NS. Keepers of the House: A documentary. Clin Teach 2021; 19:36-41. [PMID: 34802183 PMCID: PMC9261469 DOI: 10.1111/tct.13439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 10/12/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Our documentary, Keepers of the House, highlights ways that hospital housekeepers, typically unnoticed care team members, provide emotional support for patients and their families. This film addresses a gap in education by emphasizing the importance of valuing and reflecting on the unique lived experiences of others. APPROACH We created this documentary to expose students to the experiences and perceptions of hospital housekeepers. A focus group with six hospital housekeepers informed an interview script for the film's creation. Nine additional housekeepers were then interviewed, which developed into a 15-min documentary. Healthcare students and educators from five disciplines viewed the documentary during their institution's Medical Education Day. EVALUATION To expose students and educators to housekeepers' experiences, we designed our post-viewing survey to address whether the housekeepers' stories impacted their understanding of the role and value of these workers. Viewers were surprised by the depth and breadth of patient-housekeeper interactions, the trauma housekeepers experienced from patient loss and the pride housekeepers take in their work. The stories that touched the viewers varied but centred on connections between housekeepers and patients. Lessons learned focused on recognizing the contributions of unseen team members. IMPLICATIONS This innovative documentary amplifies the perspectives of voices rarely heard in healthcare. We aim to use this film, alongside its associated learning session, in education and grand round settings to foster discussion around empathy, valuing underrecognised team members and applying these insights in practice. This work can be disseminated to other institutions, further amplifying underrepresented narratives in healthcare.
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Affiliation(s)
| | | | - Kearsley A Stewart
- Global Health and Cultural Anthropology, Duke University, Durham, North Carolina, USA
| | - Candace S Brown
- Department of Public Health Sciences, University of North Carolina-Charlotte, Charlotte, North Carolina, USA
| | - Deborah T Gold
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Deborah Engle
- Practice of Medical Education and Assistant Dean for Assessment and Evaluation, Duke University School of Medicine, Durham, North Carolina, USA
| | - Francesca Talenti
- Department of Communication, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Raymond Barfield
- Memorial Health University Medical Center, Savannah, Georgia, USA
| | - Elizabeth Ross
- Department of Orthopedics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Neil S Prose
- Department of Dermatology and Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
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5
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Heath C, Freeman E, Prose NS. Skin-colored bandages: A call to action. Pediatr Dermatol 2021; 38 Suppl 2:185-186. [PMID: 34850432 DOI: 10.1111/pde.14483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022]
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6
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Mengistu B, Alemu H, Kassa M, Zelalem M, Abate M, Bitewulign B, Mathewos K, Njoku K, Prose NS, Magge H. An innovative intervention to improve respectful maternity care in three Districts in Ethiopia. BMC Pregnancy Childbirth 2021; 21:541. [PMID: 34362332 PMCID: PMC8343890 DOI: 10.1186/s12884-021-03934-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mistreatment of women during facility-based childbirth is a major violation of human rights and often deters women from attending skilled birth. In Ethiopia, mistreatment occurs in up to 49.4% of mothers giving birth in health facilities. This study describes the development, implementation and results of interventions to improve respectful maternity care. As part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed respectful maternity care training module with three core components: testimonial videos developed from key themes identified by staff as experiences of mothers, skills-building sessions on communication and onsite coaching. Respectful maternity care training was conducted in February 2017 in three districts within three regions. METHODS Facility level solutions applied to enhance the experience of care were documented. Safe Childbirth Checklist data measuring privacy and birth companion offered during labor and childbirth were collected over 27 months from 17 health centers and three hospitals. Interrupted time series and regression analysis were conducted to assess significance of improvement using secondary routinely collected programmatic data. RESULTS Significant improvement in the percentage of births with two elements of respectful maternal care-privacy and birth companionship offered- was noted in one district (with short and long-term regression coefficient of 18 and 27% respectively), while in the other two districts, results were mixed. The short-term regression coefficient in one of the districts was 26% which was not sustained in the long-term while in the other district the long-term coefficient was 77%. Testimonial videos helped providers to see their care from their clients' perspectives, while quality improvement training and coaching helped them reflect on potential root causes for this type of treatment and develop effective solutions. This includes organizing tour to the birthing ward and allowing cultural celebrations. CONCLUSION This study demonstrated effective way of improving respectful maternity care. Use of a multipronged approach, where the respectful maternity care intervention was embedded in quality improvement approach helped in enhancing respectful maternity care in a comprehensive manner.
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Affiliation(s)
- Birkety Mengistu
- Institute for Healthcare Improvement, Ethiopia Project Office, Kirkos Sub-city, House No. 226, Addis Ababa, Ethiopia.
| | - Haregeweyni Alemu
- Institute for Healthcare Improvement, Ethiopia Project Office, Kirkos Sub-city, House No. 226, Addis Ababa, Ethiopia
| | - Munir Kassa
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Mehiret Abate
- Institute for Healthcare Improvement, Ethiopia Project Office, Kirkos Sub-city, House No. 226, Addis Ababa, Ethiopia
| | - Befikadu Bitewulign
- Institute for Healthcare Improvement, Ethiopia Project Office, Kirkos Sub-city, House No. 226, Addis Ababa, Ethiopia
| | | | - Kendra Njoku
- Institute for Healthcare Improvement, Abuja, Nigeria
| | | | - Hema Magge
- Institute for Healthcare Improvement, Ethiopia Project Office, Kirkos Sub-city, House No. 226, Addis Ababa, Ethiopia.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
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7
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Kennedy DL, Olsen MK, Yang H, Gao X, Alkon A, Prose NS, Dunbar K, Jackson LR, Pollak KI. Communication Coaching in Cardiology (CCC): A study protocol and methodological challenges and solutions of a randomized controlled trial in outpatient cardiology clinics. Contemp Clin Trials 2021; 105:106389. [PMID: 33798730 DOI: 10.1016/j.cct.2021.106389] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/19/2021] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
Given the role of effective communication in improving patient adherence and satisfaction, high quality patient-clinician communication is critical. Building on previous communication interventions in oncology and pediatrics, we developed a tailored communication coaching intervention to improve empathic communication quality and patient-centered care. In this randomized controlled trial, cardiologists record their patient encounters for review by a communication coach who provides tailored feedback. We are recruiting 40 cardiologists and 400 patients, or 4 patients per cardiologist in the Pre-intervention phase and 6 patients per cardiologists in the Post-intervention phase, from outpatient cardiology clinics within the Duke Health System. The primary goal of the trial is to determine the efficacy of the clinician communication coaching versus usual care in the post-intervention phase (240 patient encounters). In this paper, we describe the development of the communication coaching intervention. We also describe the details of the methods and outcomes of the ongoing trial. Finally, we discuss the challenges, solutions, and lessons learned during the start-up phase of the study.
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Affiliation(s)
- Danielle L Kennedy
- Cancer Prevention and Control, Duke Cancer Institute, Durham, NC 27710, United States of America.
| | - Maren K Olsen
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710, United States of America; Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC 27705, United States of America
| | - Hongqiu Yang
- Duke Cancer Research Institute, Durham, NC 27710, United States of America
| | - Xiaomei Gao
- Cancer Prevention and Control, Duke Cancer Institute, Durham, NC 27710, United States of America
| | - Aviel Alkon
- Department of General Internal Medicine, Duke University School of Medicine, Durham, NC 27710, United States of America
| | - Neil S Prose
- Department of Dermatology and Pediatrics, Duke University School of Medicine, Durham, NC 27710, United States of America
| | - Kayla Dunbar
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, United States of America
| | - Larry R Jackson
- Department of Cardiology, Duke University School of Medicine, Durham, NC 27710, United States of America
| | - Kathryn I Pollak
- Cancer Prevention and Control, Duke Cancer Institute, Durham, NC 27710, United States of America; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, United States of America
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8
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Affiliation(s)
- Neil S Prose
- Department of Dermatology, Pediatrics, and Global Health, Duke University Medical Center, Durham, North Carolina
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9
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Abstract
Inflammatory linear verrucous epidermal nevus (ILVEN) is a chronic, a linear, or whorled array of inflammatory, following the lines of Blaschko. Treatment of ILVEN is challenging with numerous therapies of varying degrees of success reported. We present a case of ILVEN in a 5-year-old-boy, treated successfully with crisaborole 2% ointment. This brief report suggests that there may be additional cellular immunologic pathways responsible for the presentation of ILVEN that may be explained by management with crisaborole use.
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Affiliation(s)
- Emily Barney
- Duke University School of Medicine, Durham, North Carolina
| | - Neil S Prose
- Duke University School of Medicine, Durham, North Carolina.,Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Mary Ramirez
- Duke University School of Medicine, Durham, North Carolina.,Department of Dermatology, Duke University Medical Center, Durham, North Carolina
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10
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Hamidi S, Prose NS, Selim MA. Neutrophilic figurate erythema of infancy: A diagnostic challenge. J Cutan Pathol 2018; 46:216-220. [DOI: 10.1111/cup.13394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/03/2018] [Accepted: 11/11/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Sepehr Hamidi
- Department of PathologyDuke University Durham North Carolina
| | - Neil S. Prose
- Department of DermatologyDuke University Durham North Carolina
| | - Maria A. Selim
- Department of PathologyDuke University Durham North Carolina
- Department of DermatologyDuke University Durham North Carolina
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11
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Abstract
There are few reports of chemotherapy-induced eccrine squamous syringometaplasia in children. We report the first case of an infant developing this condition after treatment with busulfan, fludarabine, and antithymocyte globulin in preparation for bone marrow transplantation. Twenty-eight days after transplantation, the infant developed faintly erythematous papules and plaques on the bilateral axillae, inguinal folds, and sites of adhesives. Punch biopsy revealed eccrine glands with dyskeratotic cells and focal squamous metaplasia consistent with chemotherapy-induced eccrine squamous syringometaplasia.
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Affiliation(s)
| | - Megan Casady
- Department of Dermatology, Duke University Medical Center, Durham, NC, USA
| | - Maria A Selim
- Department of Dermatology, Duke University Medical Center, Durham, NC, USA.,Pathology, Duke University Medical Center, Durham, NC, USA
| | - Neil S Prose
- Department of Dermatology, Duke University Medical Center, Durham, NC, USA
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12
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Affiliation(s)
- Neil S. Prose
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
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13
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Abstract
Eccrine chromhidrosis can occur secondary to hyperbilirubinemia. We report an adolescent with sickle cell disease who presented with eccrine chromhidrosis on his palmar and plantar surfaces. He had extremely high levels of conjugated bilirubin but no fever. This is the youngest known reported patient with eccrine chromhidrosis and the first in a patient with sickle cell disease.
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Affiliation(s)
- Jong G Park
- School of Medicine, Duke University, Durham, North Carolina
| | - Neil S Prose
- School of Medicine, Duke University, Durham, North Carolina.,Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Reed Garza
- School of Medicine, Duke University, Durham, North Carolina.,Department of Dermatology, Duke University Medical Center, Durham, North Carolina
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14
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Zissette S, Watt MH, Prose NS, Mntambo N, Moshabela M. "If you don't take a stand for your life, who will help you?": Men's engagement in HIV care in KwaZulu-Natal, South Africa. Psychol Men Masc 2016; 17:265-273. [PMID: 27616937 PMCID: PMC5012535 DOI: 10.1037/men0000025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The needs of South African men with HIV may often be overlooked in the provision of HIV services, leading to care programs that do not adequately serve the unique needs of male patients. Additionally, norms of masculinity guide men's behaviors as they navigate health decision-making and the healthcare systems. The aim of this study is to examine how masculinity influences healthcare access and utilization in South Africa, and to identify opportunities for interventions. The qualitative study took place at one primary health care clinic in a peri-urban township in KwaZulu-Natal, South Africa. In-depth individual interviews were conducted with 21 HIV-infected men recruited from the study clinic. Direct observations of the clinic waiting area were conducted to provide context. Data were analyzed using a grounded theory-informed approach involving memo writing and thematic exploration with data coding. On average, participants were 42 years old and had been on ART for 3.6 years. Participants expressed a range of ways in which masculine ideals and identity both promoted and inhibited their willingness and ability to engage in HIV care. Notions of masculinity and social identity were often directly tied to behaviors influencing care engagement. Such engagement fostered the reshaping of identity around a novel sense of clinic advocacy in the face of HIV. Our findings suggested that masculinities are complex, and are subject to changes and reprioritization in the context of HIV. Interventions focusing on reframing hegemonic masculinities and initiating treatment early may have success in bringing more men to the clinic.
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15
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Rand AJ, Buck AB, Love PB, Prose NS, Selim MA. Cutaneous acquired toxoplasmosis in a child: a case report and review of the literature. Am J Dermatopathol 2016; 37:305-10. [PMID: 24614207 DOI: 10.1097/dad.0000000000000072] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cutaneous toxoplasmosis is a rare and diagnostically challenging entity. Today, the acquired form occurs predominantly in immunocompromised patients with human immunodeficiency virus or after hematopoietic stem cell transplantation. We report a case of cutaneous toxoplasmosis in a 6-year-old girl after allogeneic stem cell transplantation for immune-mediated encephalopathy, first manifesting at 16 months of age. In the post-transplant setting, she developed a rash consisting of approximately 8 scattered 3–4-mm round, erythematous macules and papules on her back, abdomen, and right shoulder. Sections from a biopsy of a lesion on the back revealed numerous spherules tightly packed within small cystic structures in the epidermis. The diagnosis of cutaneous toxoplasmosis was confirmed by an immunohistochemical stain for Toxoplasma gondii and polymerase chain reaction on the peripheral blood for the T. gondii genome. This case should raise awareness that acquired toxoplasmosis with cutaneous involvement can occur in the pediatric population, particularly in immunocompromised patients after stem cell transplantation. Early diagnosis and treatment of this life-threatening opportunistic infection may improve patient outcomes.
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16
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Haglund MM, Rudd M, Nagler A, Prose NS. Difficult conversations: a national course for neurosurgery residents in physician-patient communication. J Surg Educ 2015; 72:394-401. [PMID: 25687955 DOI: 10.1016/j.jsurg.2014.11.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/21/2014] [Accepted: 11/30/2014] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To describe the design, content, implementation, and evaluation of a national curriculum for teaching practical skills in empathic communication to residents in neurosurgery. DESIGN Based on needs assessed through a national survey of neurosurgery program directors, videotaped scenarios using standardized patients illustrating good and bad communication skills were developed. Presurveys and postsurveys were conducted querying participants on their level of competence and the specific behaviors they would attempt to change following participation. A subgroup of residents was evaluated before and after the training based on videotaped role-play exercises. SETTING A pilot study was conducted at the authors' institution and later implemented at National Neurosurgery Boot Camps. PARTICIPANTS A total of 14 Duke graduate medical education neurosurgery residents agreed to participate in the pilot study. From across the country, 93 residents (representing 59 institutions) participated in the communication training as part of the Neurosurgery Boot camps, 11 of whom volunteered to participate in a role-playing session before and after the formal teaching session. RESULTS Most of the neurosurgery program directors responding to the survey indicated that an interactive online communication-training module would be of value (77%). A total of 93 residents participated in communication training as part of the Neurosurgery Boot Camps. Approximately half of the residents reported having no formal physician-patient communication training. Presurvey and postsurvey results showed significant improvement in several of the communication scenarios. Those who participated in role-play showed significant improvement in "asking open-ended questions," "listening," "fire warning shot," "allowing patient to absorb," and "explaining in clear language." CONCLUSIONS Neurosurgeons frequently participate in difficult conversations. Both residents and faculty note that exposure to this content is suboptimal. A hybrid approach to teaching communication skills is well received and enhances graduate medical education training of surgical subspecialists.
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Affiliation(s)
- Michael M Haglund
- Duke Epilepsy Center, Duke University Medical Center, Durham, North Carolina
| | - Mariah Rudd
- Graduate Medical Education, Duke University Hospital, Durham, North Carolina
| | - Alisa Nagler
- Graduate Medical Education, Duke University Hospital, Durham, North Carolina
| | - Neil S Prose
- Duke Global Health Institute, Duke University School of Medicine, Durham, North Carolina.
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17
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Nguyen TV, Hong J, Prose NS. Compassionate care: Enhancing physician–patient communication and education in dermatology. J Am Acad Dermatol 2013; 68:353.e1-8. [DOI: 10.1016/j.jaad.2012.10.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 10/22/2012] [Accepted: 10/24/2012] [Indexed: 10/27/2022]
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18
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Love PB, Patterson SS, Prose NS, Atwater AR. Griscelli syndrome associated with hemophagocytic lymphohistiocytosis. J Drugs Dermatol 2012; 11:1126. [PMID: 23135662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Porcia B Love
- Department of Dermatology, Duke University, Durham, NC, USA.
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19
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Abstract
BACKGROUND Paediatric scalp naevi may represent a source of anxiety for practitioners and parents, as the clinical and dermoscopic features of typical naevi have yet to be defined. Prompted by concern about the large size, irregular borders and colour variation of scalp naevi, clinicians and parents may request unnecessary excision of these naevi. OBJECTIVES To establish the typical clinical and dermoscopic patterns of scalp naevi in children younger than 18 years old to help optimize clinical care and management. METHODS Scalp naevi were imaged with a camera (Canon Rebel, XSi; Canon, Tokyo, Japan) and dermoscopic attachment (Dermlite Foto, 30 mm lens; 3Gen, San Juan Capistrano, CA, U.S.A.) to the camera. The clinical and dermoscopic images were reviewed and analysed. Both acquired and congenital scalp naevi were included but were not further differentiated from each other. RESULTS We obtained clinical and dermoscopic images of 88 scalp naevi in 39 white children. Two subjects had received chronic immunosuppressive medication. Nineteen children had a family history of melanoma. Boys (18/39 subjects, 46%) possessed 68% (60 naevi) of scalp naevi imaged. Younger (< 10 years old) subjects (24/39 subjects, 62%) possessed 42% (37 naevi) of scalp naevi. The main clinical patterns included eclipse (n=18), cockade (n = 3), solid brown (n=42) and solid pink (n=25) naevi. Solid-coloured naevi showed the following dermoscopic patterns: globular (57%), complex (reticular-globular) (27%), reticular (9%), homogeneous (6%) and fibrillar (1%). The majority of naevi had a unifying feature - perifollicular hypopigmentation, which caused the appearance of scalloped, irregular borders if occurring on the periphery, or variegation in pigmentation, if occurring within the naevi. CONCLUSIONS Older subjects and boys tend to harbour a larger proportion of scalp naevi. The main clinical patterns include solid-coloured and eclipse naevi. The most common dermoscopic pattern of scalp naevi is the globular pattern. Perifollicular hypopigmentation is a hallmark feature of signature scalp naevi. Dermoscopy is a noninvasive tool in the evaluation of cutaneous melanocytic lesions in children and may decrease the number of unnecessary excisions.
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Affiliation(s)
- W J Tcheung
- Department of Dermatology, Institute for Genome Sciences and Policy, Duke University Medical Center, Durham, NC 27710, USA
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Prose NS, Brown H, Murphy G, Nieves A. The morbidity and mortality conference: a unique opportunity for teaching empathic communication. J Grad Med Educ 2010; 2:505-7. [PMID: 22132268 PMCID: PMC3010930 DOI: 10.4300/jgme-d-10-00074.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 06/12/2010] [Accepted: 07/06/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The morbidity and mortality conference is an educational tradition in American medicine that dates to the early 20th century. Traditionally, this conference has focused entirely on issues of diagnosis and treatment, in the context of a disappointing clinical outcome. INTERVENTION We report on a new method for teaching empathic doctor-patient communication skills at an obstetrics and gynecology morbidity and mortality conference. For each case presented, we identified the communications challenges and allowed faculty and residents to "practice" the discussion they would have with the patient and the patient's family in that situation. In some sessions, actors assumed the role of the patient. Following the discussion of the case, we offered didactic presentations on how we communicate with patients and their families. These focused on techniques for being patient centered and included the use of body language, open-ended questioning, reflective listening before offering to explain, and the importance of naming and validating emotions. RESULTS The majority of participants felt the sessions to be helpful, and after one month many were able to identify a positive change in their interactions with patients. CONCLUSIONS We believe that this unique teaching format allows learners to refine their communication skills in the context of situations that they know to be both realistic and important.
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Affiliation(s)
- Neil S. Prose
- Corresponding author: Neil S. Prose, MD, Box 3252, Duke University Medical Center, Durham, NC 27710, 919.684.5146,
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Abstract
Trichothiodystrophy (TTD) is a rare group of autosomal recessive disorders of DNA repair unified by the presence of sulfur-deficient brittle hair. We report a 3-year-old boy with classic clinical features of TTD, including ichthyosis, alopecia, developmental delay, and tiger-tail banding of the hair shaft on polarizing microscopy. Brain MR imaging showed both diffuse dysmyelination and osteosclerosis, findings that, in combination, may be specific for TTD.
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Affiliation(s)
- J H Harreld
- Department of Neuroradiology, Duke University Medical Center, Durham, NC 27710, USA.
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Theletsane T, Redfern A, Raynham O, Harris T, Prose NS, Khumalo NP. Life-threatening infantile haemangioma: a dramatic response to propranolol. J Eur Acad Dermatol Venereol 2009; 23:1465-6. [DOI: 10.1111/j.1468-3083.2009.03261.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cowen EW, Nguyen JC, Miller DD, McShane D, Arron ST, Prose NS, Turner ML, Fox LP. Chronic phototoxicity and aggressive squamous cell carcinoma of the skin in children and adults during treatment with voriconazole. J Am Acad Dermatol 2009; 62:31-37. [PMID: 19896749 DOI: 10.1016/j.jaad.2009.09.033] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 09/20/2009] [Accepted: 09/23/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Voriconazole is a broad-spectrum antifungal agent associated with photosensitivity and accelerated photoaging. A possible link with aggressive squamous cell carcinoma (SCC) has also been reported. OBJECTIVE We sought to determine the incidence and frequency of cutaneous SCC among patients undergoing long-term treatment with voriconazole who also manifest features of chronic phototoxicity. METHODS We conducted a retrospective review of patients who developed one or more squamous cell neoplasms during long-term treatment with voriconazole at 3 academic dermatology centers. RESULTS A total of 51 cutaneous SCC were identified in 8 patients (median age 34.5 years, range 9-54) treated with chronic voriconazole (median duration 46.5 months, range 13-60). Underlying diagnoses included graft-versus-host disease, HIV, and Wegener granulomatosis. Signs of chronic phototoxicity and accelerated photoaging included erythema, actinic keratoses, and lentigo formation. LIMITATIONS The retrospective nature of the study cannot determine the true population risk of SCC associated with voriconazole therapy. A prospective cohort study is needed. CONCLUSION A high index of suspicion for photosensitivity and SCC may be warranted with chronic voriconazole use when used in the setting of concurrent immunosuppression.
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Affiliation(s)
- Edward W Cowen
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Josephine C Nguyen
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Daniel D Miller
- Department of Dermatology, University of California, San Francisco, California
| | - Diana McShane
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Sarah T Arron
- Department of Dermatology, University of California, San Francisco, California
| | - Neil S Prose
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Maria L Turner
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Lindy P Fox
- Department of Dermatology, University of California, San Francisco, California
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Higgins SP, Freemark M, Prose NS. Acanthosis nigricans: a practical approach to evaluation and management. Dermatol Online J 2008; 14:2. [PMID: 19061584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Acanthosis nigricans is a dermatosis characterized by thickened, hyperpigmented plaques, typically of the intertriginous surfaces and neck. Common in some populations, its prevalence depends on race. Clinicians should recognize acanthosis nigricans; it heralds disorders ranging from endocrinologic disturbances to malignancy. In this review, we discuss the pathogenesis of acanthosis nigricans and its clinical implications and management.
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Affiliation(s)
- Steven P Higgins
- Division of Dermatology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina, USA.
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Franco LM, Goldstein J, Prose NS, Selim MA, Tirado CA, Coale MM, McDonald MT. Incontinentia pigmenti in a boy with XXY mosaicism detected by fluorescence in situ hybridization. J Am Acad Dermatol 2006; 55:136-8. [PMID: 16781308 DOI: 10.1016/j.jaad.2005.11.1068] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Revised: 11/09/2005] [Accepted: 11/18/2005] [Indexed: 11/30/2022]
Abstract
We report the case of a male infant with incontinentia pigmenti (MIM 308310) and low-grade XXY mosaicism. Fluorescence in situ hybridization may reveal the underlying genetic alteration in male patients with incontinentia pigmenti and a normal karyotype.
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Affiliation(s)
- Luis M Franco
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA
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Abstract
Vitiligo é um achado dermatológico relativamente comum, observado desde a Antiguidade. A doença caracteriza-se por despigmentação da pele, com perda de melanócitos ao exame histológico. Diversos fenótipos clínicos resultam em diferentes graus de morbidade. A causa do vitiligo ainda é desconhecida e a etiologia mais provável parece ser auto-imune. O tratamento é difícil e várias alternativas mostram um potencial terapêutico significativo. Nesta revisão, abordaremos a classificação do vitiligo na infância, as hipóteses sobre a patogênese e o tratamento.
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Abstract
Pemphigus vulgaris is an uncommon autoimmune blistering skin disorder that is particularly rare in children. Immunosuppressive treatment can be challenging. Rituximab (anti-CD20 monoclonal antibody) has been used to treat autoimmune disorders by depletion of CD20 B cells. Successful rituximab therapy has been reported in adults with refractory pemphigus vulgaris. We present a girl with childhood pemphigus vulgaris unresponsive to treatment with azathioprine, mycophenolate mofetil, plasmapheresis, and intravenous immunoglobulin with systemic prednisone who responded to treatment with rituximab. She had a corresponding decline in circulating antibodies against desmoglein 1 and 3 and a decline in diphtheria and tetanus-specific antibody titers.
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Affiliation(s)
- Heidi H Kong
- Division of Dermatology, Duke University Medical Center, Durham, North Carolina 27710, USA
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Abstract
PURPOSE OF REVIEW Bacillus Calmette-Guerin (BCG) vaccination has been performed since 1921, and remains the best method of preventing severe infections caused by Mycobacterium tuberculosis. Tuberculosis, in its various forms, remains a public health problem, and more than 100 countries continue BCG vaccination in an effort to control the disease. Since the initiation of BCG vaccination, numerous complications have been reported. In this review we will focus on the cutaneous complications of BCG vaccination. RECENT FINDINGS Recent case reports detail the development of large keloids, and also of juvenile sarcoidosis after BCG vaccination. Adverse outcomes from inadvertent intradermal injection of the forearm and from revaccination with BCG have also been reported. Other recently described skin complications subsequent to BCG vaccination include lupus vulgaris, delayed granuloma formation, cutaneous BCG infection in immune disorders, anterior chest wall mass, acute erythroderma with multiple skin abscesses, ulceration at the BCG site during Kawasaki disease, fixed drug eruption, and cutaneous abscesses following mesotherapy. SUMMARY BCG vaccination will continue to be a key method of preventing severe tuberculosis infections for the foreseeable future. The World Health Organization currently recommends BCG vaccination for all infants living in tuberculosis endemic areas. As such, it is important for health care providers to recognize the routinely anticipated cutaneous findings of the vaccination, in addition to complications relating to the injection. Subsequent care of these skin complications is of paramount importance to the health of these patients.
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Affiliation(s)
- Jane S Bellet
- Department of Medicine, Division of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
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Abstract
The incidence of skin disease secondary to infestation with the human bedbug, Cimex lectularius, has increased dramatically in the United States and in the United Kingdom. We describe a child with a recurrent pruritic eruption of urticarial, erythematous papules on the face, neck, and extremities. The etiology of her cutaneous lesions was discovered to be a bedbug infestation in the home. The epidemiology, entomology, presentation, and treatment of bedbugs and their bites are discussed.
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Affiliation(s)
- Maryanna C Ter Poorten
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina, USA
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Abstract
Precalcaneal congenital fibrolipomatous hamartomas are uncommon, congenital, nontender papules located on the medial plantar aspects of the heel. We report the occurrence of this rare disorder in two half brothers, suggesting that it may occur in a familial pattern.
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Affiliation(s)
- William L Fangman
- Department of Medicine, Division of Dermatology, Duke University Medical Center, DUMC 3822, Durham, North Carolina 27710, USA.
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Abstract
Congenital cutaneous candidiasis (CCC) is usually a benign condition characterized by various skin manifestations and is rarely associated with nail changes. We report a premature infant with CCC who developed dystrophy of all 20 nails at about 1 month of age. Nail dystrophy due to Candida albicans in the young infant may be differentiated from other congenital or hereditary nail malformations by appearance, recovery of the organism in nail culture, and complete resolution over a period of several months.
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Affiliation(s)
- Herbert W Clegg
- Department of Pediatrics, Presbyterian Hospital, Charlotte, NC 28204, USA.
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Segal JM, Rao C, Shea CR, Prose NS. Recurrent vesicles, papules, and plaques in a teenager. Arch Dermatol 2003; 139:933-8. [PMID: 12873897 DOI: 10.1001/archderm.139.7.933-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Affiliation(s)
- Neil S Prose
- Division of Dermatology, Duke University Medical Center, Durham, NC 22710, USA.
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Haisley-Royster C, Enjolras O, Frieden IJ, Garzon M, Lee M, Oranje A, de Laat PCJ, Madern GC, Gonzalez F, Frangoul H, Le Moine P, Prose NS, Adams DM. Kasabach-merritt phenomenon: a retrospective study of treatment with vincristine. J Pediatr Hematol Oncol 2002; 24:459-62. [PMID: 12218593 DOI: 10.1097/00043426-200208000-00010] [Citation(s) in RCA: 172] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Kasabach-Merritt phenomenon (KMP) is characterized by profound thrombocytopenia, microangiopathic hemolytic anemia, a consumptive coagulopathy, and an enlarging vascular lesion. The syndrome develops in infancy and is associated with a high morbidity and mortality rate. The purpose of this study was to assess the effectiveness of vincristine in the treatment of KMP. METHODS We retrospectively reviewed the clinical and laboratory data of 15 patients with KMP treated with vincristine at 9 institutions across the United States, South America, and Europe. RESULTS All 15 patients had profound thrombocytopenia and consumption of fibrinogen at presentation. Ten patients had biopsies of their lesions, and results included five (33.3%) kaposiform hemangioendotheliomas, three (20%) tufted angiomas, one lesion (6.7%) with features of both kaposiform hemangioendothelioma and tufted angioma, and one (6.7%) unclassified vascular tumor. All 15 patients had an increase in platelet count of at least 20,000 with an average response time of 4.0 weeks after initiation of vincristine therapy. Thirteen patients had an increase in fibrinogen level of 50 mg/dL with an average response time of 3.4 weeks. In 13 patients there was a significant decrease in the size of the vascular lesion. The average duration of treatment was 21.5 (+/-12.6) weeks. Four patients (26%) relapsed. All four were successfully treated with a second course of vincristine. Complications included one patient with abdominal pain, one patient with transient loss of deep tendon reflexes, and one patient with irritability. CONCLUSION Vincristine presents a safe and sometimes effective treatment option in the management of KMP.
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Haisley-Royster CA, Allingham RR, Klintworth GK, Prose NS. Hereditary benign intraepithelial dyskeratosis: Report of two cases with prominent oral lesions. J Am Acad Dermatol 2001; 45:634-6. [PMID: 11568764 DOI: 10.1067/mjd.2001.116336] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hereditary benign intraepithelial dyskeratosis is a rare autosomal dominant disorder of the oral and ocular mucosa initially described in the Haliwa-Saponi Native American tribe of North Carolina. We describe 2 sisters with the characteristic oral and ocular findings. This entity should be distinguished from several other diseases that cause white lesions in the mouth including white sponge nevus.
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Affiliation(s)
- C A Haisley-Royster
- Department of Medicine, Division of Dermatology, Duke University Medical Center, Durham, NC 27710, USA
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Abstract
Waxy keratoses of childhood is a rare genodermatosis previously noted in both familial and isolated presentations. Three previous cases have been described in which the lesions appeared over the trunk and extremities. We report a case in which the waxy keratoses of childhood lesions appeared in a segmental distribution along a single lower extremity, differing from the more extensive patterns reported previously. We suggest a possible postzygotic mutation hypothesis for this unique segmental distribution, addressing both the possibility of a genomic mosaicism and loss of heterozygosity.
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Affiliation(s)
- D Mehrabi
- Northeastern Ohio Universities College of Medicine, Rootstown, Ohio, USA
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Abstract
BACKGROUND Epidermal necrosis in a neonate is an uncommon event with a variety of potential cases. RESULT We report a case of intrauterine epidermal necrosis in a preterm infant, with death occurring soon after birth. The histopathology of the denuded skin revealed full-thickness epidermal necrosis and calcification within both the epidermis and follicular structures. CONCLUSION We believe this represents the fourth reported case of lethal intrauterine epidermal necrosis and follicular calcification.
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Affiliation(s)
- J E Allee
- Department of Medicine (Dermatology), Duke University Medical Center, Durham, North Carolina 27710, USA
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Antaya RJ, Gardner ES, Bettencourt MS, Daines M, Denise Y, Uthaisangsook S, Buckley RH, Prose NS. Cutaneous complications of BCG vaccination in infants with immune disorders: two cases and a review of the literature. Pediatr Dermatol 2001; 18:205-9. [PMID: 11437999 DOI: 10.1046/j.1525-1470.2001.018003205.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Two infants, one with a T-cell-signaling defect resulting in a primary immunodeficiency syndrome and the other with severe combined immunodeficiency (SCID), are described. Both infants developed cutaneous infections secondary to their bacillus Calmette-Guérin (BCG) vaccinations. Both patients were from countries where BCG is routinely administered in infancy. The infant with the T-cell-signaling defect developed a disseminated infection involving the skin, while the infant with SCID developed a localized cutaneous infection at the site of his BCG immunization. These two cases resemble other reported cases of cutaneous BCG infection following routine vaccination in immunocompromised patients. Mycobacterium bovis infection should be considered in patients with cutaneous eruptions who have received BCG vaccination, especially those who are immunocompromised.
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Affiliation(s)
- R J Antaya
- Departments of Dermatology and Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
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Abstract
Skin and nail changes from long-term hydroxyurea therapy are reported in adults. Skin and nail changes, including nail hyperpigmentation, longitudinal bands, and hyperpigmentation of the palms and other skin surfaces, developed in 7 children with sickle cell anemia after 6 to 16 weeks of hydroxyurea therapy. Cutaneous and nail changes may occur in children receiving hydroxyurea.
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Affiliation(s)
- E E O'branski
- Duke University Pediatric Sickle Cell Program and Division of Hematology/Oncology, Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA
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Wheeler CE, Carroll MA, Groben PA, Briggaman RA, Prose NS, Davis DA. Autosomal dominantly inherited generalized basaloid follicular hamartoma syndrome: report of a new disease in a North Carolina family. J Am Acad Dermatol 2000; 43:189-206. [PMID: 10906638 DOI: 10.1067/mjd.2000.108018] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND An 8-year-old girl presented with hundreds of milia, measuring 1 to 2 mm; comedone-like lesions; skin-colored and hyperpigmented papules on the face, scalp, ears, neck, upper trunk, and lower arms along with diffuse scalp hypotrichosis; and pinpoint palm/sole pits. Onset was in early childhood and the disease was historically present in 6 generations. OBJECTIVE Our objectives were to delineate the clinical and histopathologic features and mode of inheritance as a base for gene studies. METHODS Eighteen family subjects were studied. Twenty-six skin biopsy specimens were examined. A detailed pedigree was constructed. A complete literature search was done concerning diseases with generalized basaloid follicular hamartomas. RESULTS The lesions were basaloid follicular hamartomas and other folliculocentric abnormalities. Inheritance was autosomal dominant. Extensive literature search confirmed the finding of a unique genodermatosis. CONCLUSION A new genodermatosis termed dominantly inherited generalized basaloid follicular hamartoma syndrome was defined by delineating its clinical and histopathologic features and mode of inheritance and by extensive literature review.
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Affiliation(s)
- C E Wheeler
- Departments of Dermatology and Pathology, University of North Carolina School of Medicine, Chapel Hill 27599-7287, USA.
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Affiliation(s)
- R J Antaya
- Duke University Medical Center, Durham, NC, USA
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Abstract
PURPOSE To describe the magnetic resonance (MR) imaging findings of subcutaneous granuloma annulare (SGA), a rare mass of early childhood. MATERIALS AND METHODS MR imaging studies and clinical records in six children aged 2 1/2-4 years in whom SGA was diagnosed between 1993 and 1997 were retrospectively reviewed. All MR imaging examinations included T1-weighted and fast spin-echo T2-weighted sequences. Three children received intravenous contrast material. The diagnosis was established by using excisional biopsy results, with confirmation by means of characteristic features in mucin-stained specimens. RESULTS All children presented with a nontender, nonmobile mass. The lesion in all six children was confined to the pretibial (n = 5) or prepatellar (n = 1) soft tissues. MR imaging characteristics were uniform. Masses were subcutaneous in location and had ill-defined margins. On T1-weighted images, the lesion was isointense or slightly hyperintense to muscle. On T2-weighted images, the signal intensity was more heterogeneous, but the lesion was predominantly hyperintense. In three children who received contrast material, the lesion enhanced nearly homogeneously. CONCLUSION Although SGA can often be diagnosed on the basis of clinical characteristics, MR imaging may be requested by practitioners unfamiliar with the lesion. In these cases, with recognition of typical MR imaging features, a limited biopsy and specific histologic preparation that includes mucin staining can be recommended.
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Affiliation(s)
- S Chung
- Department of Radiology, Duke University Medical Center, NC 27710, USA
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Prieto VG, Adams DM, Prose NS, Shea CR. Cell proliferation markers do not reliably discriminate between pediatric hemangiomas and vascular malformations. J Dermatol Sci 1998. [DOI: 10.1016/s0923-1811(98)83671-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
- T A Laude
- University of Washington School of Medicine, Seattle, USA
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Affiliation(s)
- R M Colven
- Department of Medicine, Duke University Medical Center, Durham, NC 27710
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