Part II: Cutaneous manifestations of peripheral vascular disease.

In this Part 2 of a 2-part continuing medical education series, we review the epidemiology of peripheral vascular disease, its association with cutaneous symptoms, and the diagnosis and evaluation of cutaneous features of vascular disorders. As peripheral vascular disease becomes more prevalent globally, it is essential for dermatologists to become competent at accurately recognizing and diagnosing cutaneous manifestations and directing individuals to receive appropriate care and treatment.

Pressure Urticaria in an Infant Appearing Similar to Physical Abuse.

A healthy Hispanic boy was born via cesarean delivery after an uncomplicated pregnancy. At 4 weeks old , his parents brought him to the emergency department for bruising on both soles of the feet. At 6 weeks old, his parents brought him to primary care for new bruises on his arms and back. After evaluation, primary care referred the patient to the emergency department. The parents denied any recent trauma, fever, cough, decreased urine, or change in appetite. Because of 2 episodes of unexplained bruising, the Department of Children and Families was granted emergency custody of the child. Hematology and ophthalmology did not identify any clear abnormalities. Skeletal surveys were normal. Dermatology was consulted. The examination was normal except for pink blanching patches on the upper back and linearly arranged pink blanching papules on the right lower leg. No crusting, erosions, hyperpigmentation, purpura, petechiae, or ecchymoses were seen. These lesions completely resolved the next day. He tested positive for dermatographism and developed similar lesions on his soles after pushing his feet down onto a soft surface. The intermittent urticarial skin changes were most consistent with physical urticaria. Such lesions could be mistaken for trauma; however, blood vessel damage typically results in progressive coloration changes for >1 day. At the emergency court hearing, given the concurring medical opinions of the dermatologist, pediatrician, and Child Protective Services, the judge returned full custody to the parents. This case reveals the value of dermatologic expertise in assessing skin changes, particularly those associated with physical abuse.

Concordance between dermatologist self-reported and industry-reported interactions at a national dermatology conference.

Physician-industry interactions are prevalent. Accurate reporting allows for transparency regarding potential conflicts of interest. We sought to compare the self-reported interactions in the American Academy of Dermatology (AAD) Annual Meeting disclosures with the industry-reported interactions in the Open Payments (OP) database. We performed a retrospective review of the 2014 OP database and the presenter disclosures for the AAD 73rd Annual Meeting in 2015. We examined general, research, and associated research payments for 768 dermatologists, totaling $35,627,365 in 2014. Although differences in the categorization and requirements for disclosure between the AAD and the OP database may account for much of the discordance, dermatologists should be aware of potentially negative public perceptions regarding transparency and prevalence of physician-industry interaction. Dermatologists should review their industry-reported interactions listed in the OP database and continue to disclose conflicts of interest as accurately as possible.

Patients' Perceptions of Bedside Rounding.

OBJECTIVES: Concerns regarding lack of privacy, poor patient understanding, and physician discomfort have led to a decline in rounding at the bedside. Our project explored patient perceptions of the implementation and value of bedside rounding. METHODS: This mixed-methods study used semi-structured qualitative interviews and a five-item Likert survey, which included questions about patients' experiences with rounds, their comfort level with the rounding process, and their understanding of care after rounds. Interviews were analyzed using the constant comparative method and conducted until thematic saturation occurred. RESULTS: Patients described positive attributes of bedside rounds: meeting the medical team, helping teach the medical team, and understanding more about their illness. Although patients enjoyed undivided attention from physicians, distractions included too many participants in rounds, confusion about roles, and unclear expectations about the goal of rounds. Although physicians sought to use patient-centered language, 53% of patients stated that medical jargon was still used. Male patients reported a statistically significant improvement in their understanding about the plan for the day and borderline significance regarding knowing who was responsible for their care as compared with female patients. CONCLUSIONS: Well-conducted, patient-centered bedside rounds greatly enhance patient-physician rapport and foster patient understanding and satisfaction.

Cross-sectional Analysis of the Relationship between Paranasal Sinus Balloon Catheter Dilations and Industry Payments among Otolaryngologists.

Objective To characterize the relationship between industry payments and use of paranasal sinus balloon catheter dilations (BCDs) for chronic rhinosinusitis. Study Design Cross-sectional analysis of Medicare B Public Use Files and Open Payments data. Setting Two national databases, 2013 to 2014. Subjects and Methods Physicians with Medicare claims with Current Procedural Terminology codes 31295 to 31297 were identified and cross-referenced with industry payments. Multivariate linear regression controlling for age, race, sex, and comorbidity in a physician's Medicare population was performed to identify associations between use of BCDs and industry payments. The final analysis included 334 physicians performing 31,506 procedures, each of whom performed at least 11 balloon dilation procedures. Results Of 334 physicians, 280 (83.8%) received 4392 industry payments in total. Wide variation in payments to physicians was noted (range, $43.29-$111,685.10). The median payment for food and beverage was $19.26 and that for speaker or consulting fees was $409.45. One payment was associated with an additional 3.05 BCDs (confidence interval [95% CI],1.65-4.45; P < .001). One payment for food and beverages was associated with 3.81 additional BCDs (95% CI, 2.13-5.49; P < .001), and 1 payment for speaker or consulting fees was associated with 5.49 additional BCDs (95% CI, 0.32-10.63; P = .04). Conclusion Payments by manufacturers of BCD devices were associated with increased use of BCD for chronic rhinosinusitis. On separate analyses, the number of payments for food and beverages as well as that for speaker and consulting fees was associated with increased BCD use. This study was cross-sectional and cannot prove causality, and several factors likely exist for the uptrend in BCD use.

A class of human proteins that deliver functional proteins into mammalian cells in vitro and in vivo.

We discovered a class of naturally occurring human proteins with unusually high net positive charge that can potently deliver proteins in functional form into mammalian cells both in vitro and also in murine retina, pancreas, and white adipose tissues in vivo. These findings represent diverse macromolecule delivery agents for in vivo applications, and also raise the possibility that some of these human proteins may penetrate cells as part of their native biological functions.