Talon Noir in a Young Baseball Player: A Case Report.

When evaluating pediatric patients with hyperpigmented lesions on the plantar aspect of the feet, the differential diagnosis should include talon noir, acral melanoma, and verruca with thrombosis. Talon noir are asymptomatic brown-black pigmented macules formed by intraepidermal hemorrhages of the feet caused by shear-force injury. Spontaneous resolution of talon noir typically occurs within 2-3 weeks. Clinicians should ensure that their patients who participate in sports have appropriately fitting shoes, which may prevent these lesions from occurring. This case report highlights a unique case of talon noir occurring in a young baseball player with an atypical distribution of plantar macules.

Patient- and Visit-Level Variables Associated With Late Arrival to Pediatric Clinic Appointments.

We conducted a cross-sectional study to evaluate timeliness of patient arrival at a pediatric multispecialty clinic. Bivariate and ordered logistic regression analyses were conducted to determine the odds of late arrival by specified patient- and visit-level characteristics. A total of 64 856 visits were available for analysis, of which 6513 (10.0%) were late arrivals. The odds of late arrival were higher for patients who spoke English (odds ratio [OR] = 1.34, P < .001) compared with those who spoke Spanish, had Medicaid (OR = 1.54, P < .001) or no insurance (OR = 1.49, P < .001) compared with those with insurance other than Medicaid, and were late to their previous visit (OR = 2.46, P < .001). Visit-level variables associated with late arrival included appointment time earlier in the day (i.e. 8-10 am, OR = 2.77, P < .001 compared with 4-6 pm), earlier in the week (i.e. on Mondays, OR = 1.21, P < .001 compared with Wednesdays), and for certain subspecialty clinics ( P < .001). Numerous variables are significantly associated with late arrival for pediatric clinic appointments.