South Dakota Dermatology: Urban vs Rural Wait Times and Dermatologist Density.

BACKGROUND: As of 2019, South Dakota had only 32 registered dermatologists, one per 27,569 people. Wait times for dermatologic care are affected by factors such as socioeconomic status, provider distribution, and patient to provider ratios. This inaccessibility to care or prolonged wait times may lead to diagnosis and treatment delays as well as disease progression. We hypothesized wait times to see a dermatologist would be longer in rural areas than urban areas in South Dakota. METHODS: Dermatology clinics throughout South Dakota were contacted to obtain wait times. An internet search was conducted to develop a list of dermatology providers. A population of 50,000 or greater defined an urban area and a ratio of four dermatologists per 100,000 people was used as an ideal patient to provider ratio. RESULTS: Overall, 75% of South Dakota's dermatology clinics participated with an equal rural to urban distribution. There was no difference in wait times for new (p=0.787) or established patients (p=0.461) comparing rural and urban clinics. All South Dakota cities with clinics met the goal patient to dermatologist ratio except for Dakota Dunes (included as part of the Sioux City, Iowa, metro population). CONCLUSIONS: The data does not support the hypothesis that wait times for dermatologists would be longer in rural locations than urban locations. Despite adequate dermatologist to patient ratios throughout most of South Dakota, wait times of over six weeks were found at both urban and rural locations, indicating the need for future studies to assess potential solutions for improving timely access to dermatologic care.

Is beauty worth the risk? Self-confidence is the key motivating factor driving tanning bed use among undergraduate students at South Dakota universities.

Background: Exposure to ultraviolet radiation is a leading risk factor for developing all types of skin cancer. In the United States, an estimated 7.8 million young adults engage in indoor tanning. Objective: Here, it is hypothesized that certain populations of students at undergraduate universities, namely sorority members, have a greater frequency of tanning bed usage than other groups of students and that regardless of sorority status, the most important motivating factor will be the intent to enhance one's appearance. Methods: Undergraduate students at 2 state-funded universities were recruited for participation in this institutional review board-exempt survey via distribution to e-mail addresses and social media accounts affiliated with student organizations/clubs. Results: Among all respondents, the most common motivating factors for tanning bed use were the perception of improved self-appearance and boosted self-confidence. Female sorority members were more likely to use tanning beds and also more likely to report being motivated by enhanced appearance and self-confidence, than their female counterparts who were not sorority members. Limitations: The sample size (n = 321) and population of this study allows data to only be generalizable to surrounding states with similar demographics. The findings of this study are subject to recall bias as the data is self-reported. Conclusion: Tanning bed use remains a popular practice among young people. Understanding motivations for tanning bed use among populations at increased risk of partaking in this behavior allows for educating these groups on the risks associated with ultraviolet radiation exposure. It is crucial that providers continue to promote skin health and take steps to dissuade detrimental practices and possible habit-forming behaviors at the individual and state levels.

South Dakota Dermatology: Urban vs Rural Wait Times Survey and Dermatologist Density.

BACKGROUND: As of 2019, the state of South Dakota had only 32 registered dermatologists, one per 27,569 people. Wait times to be seen for dermatologic care are affected by factors such as socioeconomic status, provider distribution, and patient to provider ratios. This inaccessibility to care or prolonged wait times may lead to diagnosis and treatment delays, and disease progression. We hypothesized wait times to see a dermatologist would be longer in rural areas than urban areas in South Dakota. METHODS: Dermatology clinics throughout South Dakota were contacted to obtain wait times. An internet search was conducted to develop a list of dermatology providers. A population of 50,000 or greater defined an urban area and a ratio of 4 dermatologists per 100,000 people was used as an ideal patient to provider ratio. RESULTS: Overall, 75% of South Dakota's dermatology clinics participated with an equal rural to urban distribution. There was no statistically significant difference in wait times for new (p=0.787) or established patients (p=0.461) comparing rural and urban clinics. All South Dakota cities with clinics met the goal patient to dermatologist ratio except for Dakota Dunes (included as part of the Sioux City, Iowa metro population). CONCLUSIONS: The data does not support the hypothesis that wait times for dermatologists would be longer in rural locations than urban locations. Despite adequate dermatologist to patient ratios throughout most of South Dakota, wait times of over 6 weeks were found at both urban and rural locations, indicating the need for future studies to assess potential solutions for improving timely access to dermatologic care.

A Retrospective Cohort Study to Evaluate a Swallow Study Use in the NICU Population to Optimize Feeding Support.

INTRODUCTION: Premature neonates demonstrate difficulties with swallowing due to neurological immaturity as well as a weaker suck reflex compared to full term infants. Swallowing starts to mature by 33-34 weeks of gestational age. In neonates, dysphagia is evaluated clinically by speech-language pathologists and a swallow study is ordered for infants with swallowing difficulties. However, leaving the NICU to undergo a swallow study puts infants under environmental stressors and a swallow study exposes infants to radiation. There is a concern that swallow studies are being over-utilized in the NICU. METHODS: All premature infants born before 36 weeks GA admitted to the Sanford Boekelheide NICU between January 2015 and December 2019 who underwent a swallow study were enrolled in data analysis. Deidentified data was collected retrospectively through electronic medical record review and RedCap was utilized for data storage. Infants were divided in two cohorts; those who underwent a feeding change (feeding thickening) following a swallow study vs those who continued with prior feedings. Infant demographics and characteristics were assessed to identify a group of infants who are at high risk of aspiration. RESULTS: A total of 179 infants were identified. DISCUSSION: A swallow study can identify infants at high risk for aspiration, however, many could potentially be avoided by allowing more time for infant maturation.

Surveying Motivations to Use Tanning Beds Among Undergraduate Students at South Dakota Universities.

BACKGROUND: Exposure to UV radiation is one of the biggest risk factors for developing all types of skin cancer. It is estimated that in the United States, 7.8 million young adults engage in indoor tanning. It is hypothesized that certain populations of students at undergraduate universities, such as sorority participants, have greater frequency of tanning bed usage than other populations and that regardless of sorority status, the most important motivating factor will be the intent to enhance one's appearance. METHODS: This study was granted exemption from the USD Institutional Review Board (IRB). Study participants were recruited through survey distribution to email addresses affiliated with undergraduate student organizations/clubs. Inclusion criteria were undergraduate student status at The University of South Dakota (USD) or South Dakota State University (SDSU), and age 18+. Survey development included interviews of dermatologists and public health professionals. Qualtrics database was used for both anonymous data collection and storage. RESULTS: Overall, 95 of 321 participants identified as being in a sorority. When asked to identify motivations for tanning bed use, the 3 highest ranked responses of participants in a sorority were: "I think I look better when I am tan", "I tan to look better for special events", and "I have more self-confidence when I am tan" with 56.47%, 48.65%, and 60.71% of participants answering, "strongly agree", respectively. There were 147 participants that identified as not being in a sorority. The 3 highest ranked responses for motivations for indoor tanning use were the same as those in a sorority with 40.82%, 26.00%, and 40.15% of participants answering "strongly agree" to the above options, respectively. CONCLUSION: The data does support the hypothesis that the most important motivating factor for young adults to use tanning beds is one's appearance. Understanding motivations for tanning bed use among at risk populations such as undergraduate students or more specifically, those participating in sororities, allows opportunity for education on the risks associated with UV radiation exposure.

Identifying the Use of Tanning Beds Among Undergraduate Students at South Dakota Universities and the Role of Providers: A Survey Analysis.

INTRODUCTION: Tanning bed use is common among young adults in the United States, and it contributes to over 400,000 cases of skin cancer annually. Many college students acknowledge the risk of skin cancer with tanning bed use, but this is not always a deterrent to the behavior. This study assesses the trends regarding tanning bed usage among university students and analyzes the role that primary care providers (PCPs) and dermatologists could play in reducing participation in this risky habit. METHODS: This study used a digital survey to assess the tanning bed usage trends and other aspects of skin health among undergraduate students at South Dakota universities. The survey was developed through interviews with dermatologists and public health professionals affiliated with the University of South Dakota. RESULTS: 321 students responded to the survey; 80% identified as female, 86% as Caucasian, and 93% were from the Midwest. 41% of respondents reported having previously used tanning beds. 46% of respondents reported never having seen a dermatologist for a skin check, and 42% indicated that their PCP does not perform a skin check during routine visits. When asked how a provider might influence participants to reconsider the use of tanning beds, responses included being presented statistics related to skin cancer and visualization of physical damage resulting from exposure to ultraviolet light. CONCLUSION: This study aims to better understand the prevalence of tanning bed usage among students at South Dakota universities. It also sought to better understand how providers can intervene to help reduce participation in this behavior. Given the risk associated with tanning bed exposure, our findings suggest that many students may be at increased risk of skin cancer from this behavior alone. This should encourage PCPs to consider incorporating skin checks into their examinations and provide preventative counseling recommendations to this population.

Detection and Phylogenetic Analyses of Taura Syndrome Virus from Archived Davidson's-Fixed Paraffin-Embedded Shrimp Tissue.

Taura syndrome is a World Organization for Animal Health (OIE)-listed disease of marine shrimp that is caused by Taura syndrome virus (TSV), a single-stranded RNA virus. Here we demonstrate the utility of using 15-year-old archived Davidson's-fixed paraffin-embedded (DFPE) shrimp tissues for TSV detection and phylogenetic analyses. Total RNA was isolated from known TSV-infected DFPE tissues using three commercially available kits and the purity and ability to detect TSV in the isolated RNA were compared. TSV was successfully detected through RT-qPCR in all the tested samples. Among the TSV-specific primers screened through RT-PCR, primer pair TSV-20 for the RNA-dependent RNA polymerase (RdRp), primers TSV-15 and TSV-16 for the capsid protein gene VP2 and primers TSV-5 for the capsid protein gene VP1 amplified the highest number of samples. To assess the phylogenetic relation among different TSV isolates, the VP1 gene was amplified and sequenced in overlapping segments. Concatenated sequences from smaller fragments were taken for phylogenetic analyses. The results showed that the TSV isolates from this study generally clustered with homologous isolates from the corresponding geographical regions indicating RNA derived from DFPE tissues can be used for pathogen detection and retrospective analyses. The ability to perform genomic characterization from archived tissue will expedite pathogen discovery, development of diagnostic tools and prevent disease spread in shrimp and potentially other aquaculture species worldwide.

Early mobilisation in intensive care during renal replacement therapy: A quality improvement project.

OBJECTIVE: To improve mobility for patients undergoing renal replacement therapy within intensive care. DESIGN: A quality improvement study utilising a step-wise mobility protocol within a before-and-after audit design. SETTING: Twenty-four bed Trauma/Surgical intensive care unit within a level one trauma and academic centre. MAIN OUTCOME: Improvement of compliance to the mobility plan following introduction of a step-wise mobility protocol. RESULTS: A total of fifty-six renal replacement therapy patients were measured on a randomly selected day each week during the nine month before-and-after protocol audit period. Before introducing the protocol, compliance to mobility was 12.5%, compared to 62.5% after the protocol was introduced. There were no identified negative outcomes, such as catheter loss, filter loss or bleeding, associated with mobilising these patients following implementation of the protocol. CONCLUSION: The use of a step-wise mobility protocol was effective and safe strategy to increase mobility in the renal replacement therapy patient population.