Examining the validity and reliability of the COMcareSS (Continuity of Midwifery Care Satisfaction Survey).

BACKGROUND: Continuity of midwifery care has been proven to show an improvement in clinical outcomes for women and greater maternal satisfaction with maternity care. Several questionnaires have been developed to measure satisfaction with maternity services although few are suitable for continuity of midwifery maternity care models, and many have not been validated. AIMS: The purpose of this study was to test the reliability and validity of the newly developed Continuity of Midwifery Care Satisfaction Survey (COMcareSS) with a cohort of women who have recently experienced continuity of midwifery care. METHODS: The COMcareSS was distributed to women in Australia who had experienced a live birth within a continuity model of midwifery care and were up to two months postpartum. Factor analysis was conducted, and Cronbach's alpha coefficient calculated for the 34-item scale. FINDINGS: In total 272 completed responses were recorded. Cronbach's alpha coefficient for the scale was 0.96 suggesting some redundancy in items. There was a lack of variation in responses. In factor analysis, only one factor could feasibly be attempted. This accounted for 76 % of variation in responses. CONCLUSION: The COMcareSS scale is the first to be developed to measure maternal satisfaction with continuity of midwifery led care. The 34-item scale has good internal consistency. The scale may be unidimensional though the lack of variation in responses means that other possible latent constructs, were not able to be detected. Use of a standardised scale such as the COMcareSS will facilitate benchmarking between services and, comparison and meta-analysis in research studies.

Comparison of polycyclic aromatic hydrocarbon accumulation in crab tissues with the ambient marine particles from shallow hydrothermal vents, northeast Taiwan.

This study investigated and compared polycyclic aromatic hydrocarbons (PAHs) in crab (Xenograpsus testudinatus), suspended particulate matter, and surface sediment sampled from Kuei-shan-tao (KST) shallow water vents just offshore northeast Taiwan. The total concentrations of PAHs (t-PAHs) in suspended particles near the vents (533-685 ng g-1 dw) were two orders of magnitude higher than the overlying sediment (3.42-6.06 ng g-1 dw). The t-PAHs in sediment were significantly lower than those found in suspended particulate matter and all crab tissues tested, including hepatopancreas (192-1154 ng g-1 dw), gill (221-748 ng g-1 dw), muscle (30-174 ng g-1 dw), and exoskeleton (22-96 ng g-1 dw). Principal component analysis (PCA) indicated tissue-specific bioaccumulation of PAHs in crabs. The compositions of PAHs in gill, muscle, and exoskeleton were mainly low molecular weight, while the composition in the hepatopancreas included both high and low molecular weight PAHs. Highly variable but characteristic PAH congeners and concentrations in crab tissues and ambient aquatic particles reflect bioaccumulation.

Developing an instrument to measure satisfaction with continuity of midwifery care drawing on the Delphi technique.

BACKGROUND: Maternal satisfaction with maternity care is an important indicator of quality maternity services. Continuity of midwifery models of care are increasing in Australia and while several instruments have been developed to measure satisfaction with maternity care most of these have not been validated and there are none that are appropriate to continuity of midwifery maternity care models. AIM: To develop a questionnaire to measure women's satisfaction with maternity services provided in a continuity of midwifery care service model. METHODS: A modified Delphi technique was used. A heterogenous panel of eight experts provided feedback over four rounds. The starting point for the questionnaire was informed by two systematic literature reviews focusing on available instruments for measuring maternal satisfaction with maternity care and what women value continuity of midwifery models of care. FINDINGS: The Continuity of Midwifery Care Satisfaction Survey (COMcareSS) was developed after four rounds of feedback with the expert panel. The survey comprises nine domains and fifty-nine questions. The domains include demographics, maternity care outcomes, facilities, the midwife/woman relationship, building capacity-empowerment, decision making and involvement, personalised care, advice care and support and general. CONCLUSIONS: Consumer satisfaction is an important indicator of quality care. This is the first instrument to be developed that is appropriate to continuity of midwifery models of care. The important next step is to pilot test the instrument to establish its validity and reliability.

Barriers to Cataract Surgery in Peri-urban Regions of Eastern Nepal.

INTRODUCTION: Despite cataract being a condition easily treated by surgery, it continues to be the leading cause of blindness worldwide (35.15%). In Nepal, the proportion of blindness due to cataract is much higher, with cataract accounting for 62.2% of all blindness. An effective method of decreasing this figure is by addressing the main barriers preventing people from accessing cataract surgery. Knowing that these barriers are dynamic and region-specific, our study aimed to determine the current barriers faced in Morang and Sunsari districts of Nepal. MATERIALS AND METHODS: Subjects were patients attending a cataract surgical camp, who had unilateral or bilateral blindness due to cataract. A survey was administered to determine the factors contributing to their delay in receiving treatment for cataract. Furthermore, the percentages of male and female subjects with bilateral blindness receiving treatment at the surgical camp were compared to the percentage of males and females with bilateral blindness due to cataract in Morang and Sunsari. RESULTS: The main barriers for both subjects with unilateral and bilateral blindness were the inability to afford treatment and the lack of awareness that cataract is treatable. Additionally, although more women were bilaterally blind due to cataract compared to men in Morang and Sunsari, men were more likely to receive treatment compared to women. CONCLUSION: Policies targeted at reducing costs of surgery, increasing the awareness of cataract surgery, and specifically increasing women's access to cataract surgery would be effective methods in decreasing the prevalence of avoidable blindness due to cataract in Morang and Sunsari.

Atypical Presentations of COVID-19 in Care Home Residents presenting to Secondary Care: A UK Single Centre Study

PurposeThe United Kingdom (UK) care home population has experienced high mortality during the COVID-19 pandemic. Atypical presentations of COVID-19 are being reported in older adults and may pose difficulties for early isolation and treatment, particularly in institutional care settings. We aimed to characterise the presenting symptoms and associated mortality of COVID-19 in older adults, with a focus on care home residents and older adults living in the community. MethodsThis was a retrospective cohort study of consecutive inpatients over 80 years old hospitalised with PCR confirmed COVID-19 between 10th March 2020 and 8th April 2020. Symptoms at presentation, including those associated with frailty, were analysed. Differences between community dwelling and care home residents, and associations with mortality, were assessed using between-group comparisons and logistic regression. ResultsCare home residents were less likely to experience cough (46.9% vs 72.9%, p=0.002) but more likely to present with delirium (51.6% vs 31.4%, p=0.018), particularly hypoactive delirium (40.6% vs 24.3%, p=0.043). Mortality was more likely in the very frail (OR 1.25, 95% CI 1.00, 1.58, p=0.049) and those presenting with anorexia (OR 3.20, 95% CI 1.21, 10.09, p=0.028). There were no differences in either mortality or length of stay between those admitted from care homes and community dwelling older adults. ConclusionCOVID-19 in those over 80 does not always present with typical symptoms, particularly in those admitted from institutional care. These individuals have a reduced incidence of cough and increased hypoactive delirium. Individuals presenting atypically, especially with anorexia, have higher mortality.

Atypical presentations of COVID-19 in care home residents presenting to secondary care: A UK single centre study.

BACKGROUND: Atypical presentations of COVID-19 pose difficulties for early isolation and treatment, particularly in institutional care settings. We aimed to characterize the presenting symptoms and associated mortality of COVID-19 in older adults, focusing on care home residents admitted to secondary care. METHODS: A retrospective cohort study of 134 consecutive inpatients over 80 years old hospitalized with PCR confirmed COVID-19 in the United Kingdom. Symptoms at presentation and frailty were analysed. Differences between community dwelling and care home residents, and associations with mortality, were assessed using between-group comparisons and logistic regression. RESULTS: Care home residents were less likely to experience cough (46.9% vs 72.9%, P = .002) but more likely to present with delirium (51.6% vs 31.4%, P = .018), particularly hypoactive delirium (40.6% vs 24.3%, P = .043). Mortality was more likely with increasing frailty (OR 1.25, 95% CI 1.00, 1.58, P = .049) and those presenting with anorexia (OR 3.20, 95% CI 1.21, 10.09, P = .028). There were no differences in mortality or length of stay based on residential status. CONCLUSION: COVID-19 in older adults often presents with atypical symptoms, particularly in those admitted from institutional care. These individuals have a reduced incidence of cough and increased hypoactive delirium. Individuals presenting atypically, especially with anorexia, have higher mortality.

Modelling ponatinib resistance in tyrosine kinase inhibitor-naïve and dasatinib resistant BCR-ABL1+ cell lines.

TKI resistance remains a major impediment to successful treatment of CML. In this study, we investigated the emerging modes of ponatinib resistance in TKI-naïve and dasatinib resistant BCR-ABL1+ cell lines. To investigate potential resistance mechanisms, ponatinib resistance was generated in BCR-ABL1+ cell-lines by long-term exposure to increasing concentrations of ponatinib. Two cell lines with prior dasatinib resistance demonstrated BCR-ABL1 kinase domain (KD) mutation(s) upon exposure to ponatinib. In one of these cell lines the T315I mutation had emerged during dasatinib exposure. When further cultured with ponatinib, the T315I mutation level and BCR-ABL1 mRNA expression level were increased. In the other cell line, compound mutations G250E/E255K developed with ponatinib exposure. In contrast, the ponatinib resistant cell lines that had no prior exposure to other TKIs (TKI-naïve) did not develop BCR-ABL1 KD mutations. Rather, both of these cell lines demonstrated Bcr-Abl-independent resistance via Axl overexpression. Axl, a receptor tyrosine kinase, has previously been associated with imatinib and nilotinib resistance. Ponatinib sensitivity was restored following Axl inhibition or shRNA-mediated-knockdown of Axl, suggesting that Axl was the primary driver of resistance and a potential target for therapy in this setting.

What women value in the midwifery continuity of care model: A systematic review with meta-synthesis.

INTRODUCTION: There are a number of qualitative studies indicating women are more satisfied with a continuity model of midwifery care however, their experiences have not been understood to gain an overall picture of what it is they value, appreciate and want in such a model. A metasynthesis was undertaken in order to examine the current qualitative literature to gain a deeper understanding of the woman's perspective as a consumer of maternity care in a continuity model. AIM: To identify and synthesise research findings presenting childbearing women's perspectives on continuity of midwifery care. METHODS: A search using key words was undertaken using the following databases: CINAHL, Cochrane Library, Ovid, Medline, Nursing Reference Centre and Joanna Briggs Institute. Papers were included if they were published since 2006, in English and included qualitative data from the woman's perspective. The selection process followed was the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Quality appraisal was conducted by all authors using the Critical Appraisal Skills Programme (CASP) tool as a screening tool. This allowed for each paper to be appraised to determine risk of bias. FINDINGS: Thirteen quality appraised papers published between 2006 and 2016 were found which included qualitative data and were related to the woman's experience in a continuity model. Six papers were from Australia, three in the United Kingdom, two in New Zealand and one in the United States of America and Denmark. Themes identified included an overarching concept of the relationship which was underpinned by themes of personalised care, trust and empowerment. CONCLUSIONS: The midwife-woman relationship is the vehicle through which personalised care, trust and empowerment are achieved in the continuity of midwifery model of care.

Development and Pilot Testing of the Eating4two Mobile Phone App to Monitor Gestational Weight Gain.

BACKGROUND: The number of pregnant women with a body mass index (BMI) of 30kg/m(2) or more is increasing, which has important implications for antenatal care. Various resource-intensive interventions have attempted to assist women in managing their weight gain during pregnancy with limited success. A mobile phone app has been proposed as a convenient and cost-effective alternative to face-to-face interventions. OBJECTIVE: This paper describes the process of developing and pilot testing the Eating4Two app, which aims to provide women with a simple gestational weight gain (GWG) calculator, general dietary information, and the motivation to achieve a healthy weight gain during pregnancy. METHODS: The project involved the development of app components, including a graphing function that allows the user to record their weight throughout the pregnancy and to receive real-time feedback on weight gain progress and general information on antenatal nutrition. Stakeholder consultation was used to inform development. The app was pilot tested with 10 pregnant women using a mixed method approach via an online survey, 2 focus groups, and 1 individual interview. RESULTS: The Eating4Two app took 7 months to develop and evaluate. It involved several disciplines--including nutrition and dietetics, midwifery, public health, and information technology--at the University of Canberra. Participants found the Eating4Two app to be a motivational tool but would have liked scales or other markers on the graph that demonstrated exact weight gain. They also liked the nutrition information; however, many felt it should be formatted in a more user friendly way. CONCLUSIONS: The Eating4Two app was viewed by participants in our study as an innovative support system to help motivate healthy behaviors during pregnancy and as a credible resource for accessing nutrition-focused information. The feedback provided by participants will assist with refining the current prototype for use in a clinical intervention trial.

Acute Generalized Exanthematous Pustulosis Induced by Parvovirus B19 Infection

No abstract available.

A Case of Bowen Disease in the Finger Web / 대한피부과학회지

No abstract available.

Kaposi Sarcoma in a Patient with Chronic Renal Failure Undergoing Dialysis

Kaposi sarcoma (KS) is a multicentric proliferative vascular tumor involving the skin and other organs. Human herpesvirus 8 (HHV-8) has been detected in KS lesions and is considered the putative causative agent of KS. The relationship between chronic renal failure, HHV-8, and KS is not clear. KS appears to develop in association with renal transplantation, but is unlikely with dialysis, and there have been few reports on this. Here, we report the case of a 51-year-old man, who underwent peritoneal dialysis to treat chronic renal failure, and presented with multiple brownish plaques on his soles. On histopathological examination, abnormally proliferated vessels, vascular slits, and spindle-shaped cells were seen in the dermis. Immunohistochemical staining for HHV-8 was positive. This case is another example in which factors other than immunosuppression contributed to the development of KS, due to activation of HHV-8.

Congenital Melanocytic Nevus with Asymptomatic Neurocutaneous Melanosis / 대한피부과학회지

Congenital melanocytic nevi (CMN) are benign pigmented lesions that are defined as a tissue malformation of the neuroectoderm. Giant melanocytic nevi with multifocal involvement show significantly greater risk of developing malignant melanomas and neurocutaneous melanocytosis, particularly those in a posterior axial location. Neurocutaneous melanosis is a rare, congenital, non-inherited disorder characterized by the presence of large, multiple congenital melanocytic nevi with proliferation of melanocytes in the central nervous system. Asymptomatic neurocutaneous melanosis can be detectable only by MRI. The patients who have clinical manifestations have an extremely poor prognosis. We present a patient with giant congenital melanocytic nevi involving a major portion of the back with multiple satellite nevi scattered over the whole body associated with asymptomatic neurocutaneous melanosis. We emphasize the importance of imaging study for detection of early neurological symptoms or melanomas. To our knowledge, this is the first case of giant congenital melanocytic nevi associated with asymptomatic neurocutaneous melanosis in Korean dermatologic literatures.

Evaluation of Efficacy and Skin Irritation during Treatment of Nadifloxacin 1% Cream in Acne Vulgaris Patient / 대한피부과학회지

BACKGROUND: Nadifloxacin is a synthetic fluoroquinolone with a broad spectrum. It has been suggested to not only have antibacterial, but also anti-inflammatory actions. In addition, it is effective against antibiotic-resistant Propionibacterium acne. Upon review of the literature, however, no studies have been performed concerning the efficacy and safety in terms of irritation potential and skin barrier changes after applying nadifloxacin. OBJECTIVE: This study intended to evaluate the skin irritation and changes of the skin barrier function associated with the administration of nadifloxacin 1% cream for the treatment of acne vulgaris. Furthermore, the efficacy and safety of nadifloxacin 1% cream were also assessed. METHODS: The changes in the lesion counts, Korean Acne Grading System (KAGS) and adverse events were recorded. The biophysical profiles of the skin, including transepidermal water loss (TEWL), skin surface hydration and redness were measured by Tewameter(R), Corneometer(R) and Mexameter(R) for 3 weeks. RESULTS: At the end of the therapy, 69% of inflammatory lesions (p<0.0001) and 27% of noninflammatory lesions (p=0.26) resulting from acne were decreased from the baseline. Adverse events were reported in two patients, but they were transient and tolerable. The skin barrier function showed no changes during the treatment periods. CONCLUSION: Nadifloxacin 1% cream is effective for the treatment of acne vulgaris without the changes of skin barrier function.

Multiple Piloleiomyoma Treated with a Suction-Assisted Cartilage Shaver / 대한피부과학회지

Piloleiomyoma is a benign neoplasm arising from the erector pili muscle in the skin. It occurs as linear or dermatomal arrangements of firm, red to brown intradermal nodules, which are fixed to the skin but not to the deeper tissues. Although various treatments have been attempted, they have shown limited success and several complications remain. A 21-year-old male presented with 3-year history of multiple, erythematous, firm 4 mm to 3 cm sized nodules on the chest. The histopathological examination was compatible with piloleiomyoma. The lesions were removed using the dermal shaving method with a suction-assisted cartilage shaver. Each lesion were markedly flattened. This treatment was quicker and caused less subjective pain to the patient compared with those of classic surgical excision. No signs of adverse events or recurrence have been observed.

Cutaneous Adverse Reactions Associated with Epidermal Growth Factor Receptor Inhibitors / 대한피부과학회지

BACKGROUND: Cutaneous adverse reactions are often observed during chemotherapy with epidermal growth factor receptor (EGFR) inhibitors including papulopustular eruptions, xerosis and paronychia. OBJECTIVE: To investigate and compare the cutaneous adverse reactions induced by EGFR inhibitors including erlotinib, gefitinib and cetuximab which have commonly been used as chemotherapeutic agents in Korea. METHODS: We reviewed cutaneous adverse effects through the medical records and clinical photographs of 43 Korean patients who had been treated with erlotinib, gefitinib or cetuximab at Pusan Paik Hospital between June 2003 and January 2010. RESULTS: Papulopustular eruptions occurred in 28 patients (65.1%); they were easily controlled by topical benzoyl peroxide, clindamycin and a retinoid, or by oral minocycline and tetracycline. There were no significant differences in incidence, duration and severity grades of papulopustular eruptions among EGFR inhibitors. In contrast to previous studies, the frequency and severity of papulopustular eruptions were not significantly correlated with treatment responses to EGFR inhibitors. Xerosis appeared in 14 patients (41%), and was easily controlled by topical emollients and steroids, and by systemic steroids and antihistamines. Paronychia occurred in 8 patients (18.6%) and were controlled by conservative treatments. CONCLUSION: Papulopustular eruptions, xerosis and paronychia are common cutaneous adverse reactions associated with EGFR inhibitors and there are no significant differences in adverse cutaneous reactions among EGFR inhibitors. As these cutaneous adverse reactions are relatively easily controlled with treatment, it will be helpful to detect and treat these adverse reactions early, including reassuring the patients, which should increase compliance of patients during treatment with EGFR inhibitors.

Acute Localized Exanthematous Pustulosis on the Face

Acute localized exanthematous pustulosis (ALEP) is a localized variant of acute generalized exanthematous pustulosis, which is characterized by the eruption of multiple scattered pustules following drug administration. A 26-year-old woman presented with multiple erythematous pustules on her face, which had appeared three days after taking antibiotics. Histopathological findings showed subcorneal pustules and mixed inflammatory cell infiltration in the dermis. The pustules were resolved within 2 weeks after the patient discontinued the antibiotics. Herein, we present a case of a woman with a cutaneous drug reaction consistent with ALEP that occurred subsequent to administration of antibiotics.

A Case of Cutaneous Side Effect of Methotrexate Mimicking Behcet's Disease

Methotrexate (MTX) is an antimetabolite which interferes with DNA synthesis, and it is used for the treatment of moderate to severe psoriasis, atopic dermatitis and a wide variety of cutaneous diseases. Although many adverse effects of MTX, including cutaneous ulcerations, have been documented, multifocal mucosal ulceration mimicking Behcet's disease has not been reported. In our case, a 63-year-old female presented with oral, vaginal ulcer and multiple purpuric patches on both legs. Considering patient's clinical course and histopathologic findings, we presumed that these reactions may be the side effect of MTX administered for treatment of necrotizing scleritis. Herein we report the cutaneous side effect of MTX that manifested clinically like Behcet's disease.

Steatocystoma Multiplex Treated with a Suction-assisted Cartilage Shaver / 대한피부과학회지

Steatocystoma multiplex is a rare autosomal-dominant disorder characterized by asymptomatic multiple, skin-colored to yellowish nodules on the trunk, proximal extremities, and axillae. Although surgical excision is the most effective method, treatment is difficult when lesions occur in multiple numbers. Therefore, various treatments such as CO2 laser therapy, needle aspiration, and oral isotretinoin have been attempted, but results are variable. A 37-year-old man presented with multiple skin-colored subcutaneous nodules on the abdomen and both axillae. A histopathological examination was consistent with steatocystoma multiplex. The lesions were removed by dermal shaving with a suction-assisted cartilage shaver. It was an effective therapeutic method for multiple lesions with no significant adverse events. Herein, we report a case of steatocystoma multiplex treated with a suction-assisted cartilage shaver.