Angiosarcoma: hiding in plain sight.

Angiosarcoma is a rare, aggressive soft-tissue sarcoma of endothelial origin that necessitates early recognition, diagnosis, and treatment. The most commonly reported presentation consists of violaceous patches and plaques on the head and neck of elderly white men, with fewer reports affecting patients with Skin of Color. Most cases of angiosarcoma are idiopathic and tend to recur locally with early metastasis, conferring a poor prognosis. We report a case of an 83-year-old Fitzpatrick skin type IV man who presented with a large violaceous-to-black mamillated plaque on the frontotemporal scalp that was clinically highly suggestive of cutaneous angiosarcoma. However, unrevealing histopathology complicated our diagnostic process and delayed management. Immunohistochemistry was invaluable in determining the diagnosis of angiosarcoma. Our case highlights the aggressive nature of cutaneous angiosarcoma, necessitating close clinicopathologic correlation to confirm the diagnosis and initiate treatment.

Integrating Community and Clinical Data to Assess Patient Risks with A Population Health Assessment Engine (PHATE).

Clinicians are concerned about their patients' social determinants of health (SDH); yet, they are unsure how to effectively gather patient-level SDH data and intervene without adding to current administrative burdens. Designed properly, clinical registries offer solutions to integrate neighborhood SDH data with clinical data from electronic health records, enabling the understanding of community factors to guide patient care. Federal and state interest in adjusting reimbursements based on SDH further underscores the need for strategies that integrate SDH and clinical data. The Population Health Assessment Engine (PHATE) exemplifies a registry-based SDH data integration solution that adjusts payments, contributes to public health surveillance, organizes care around hot spots (gaps in quality or uncontrolled disease), assesses patient risk, and connects with community organizations. PHATE also permits residency training to meet community health competency milestones by incorporating the PHATE curriculum. These functions enhance value, and their utility in education and care delivery would benefit from further investigation.

Is It "In" to Wear Scrubs Out?

OBJECTIVE: This study aimed to identify differences in perceptions between healthcare and non-healthcare personnel when it comes to wearing scrubs in non-healthcare settings. METHODS: An anonymous survey with 11 closed-ended questions sent via e-mail to healthcare students and employees at The University of Texas Health San Antonio and non-healthcare students and employees at The University of Texas at San Antonio. The answers were scored from 1 to 5 for each question, with a total score ranging from 11-55. Total scores were analyzed and compared between the two groups using a sample t test. RESULTS: 2730 people responded to the survey. The mean healthcare-related group responses scored 33.96 ± 7.65, while the non-healthcare group scored 34.47 ± 8.08, (p=0.096). CONCLUSIONS: In this study, we found no significant difference in attitudes about wearing scrubs in public between healthcare and non-healthcare; it appears that both groups are concerned about wearing scrubs in public. Both groups agree with the value of wearing scrubs in the clinical settings only. Healthcare professionals in this study did not endorse the need to change out of scrubs after work, while non-healthcare subjects believed changing one's scrubs before leaving a clinical setting was proper. The authors believe healthcare institutions should emphasize wearing scrubs only in professional circumstances, make a distinction between uniform and surgical scrubs, provide clean surgical scrubs to their employees, and designate locker rooms to encourage staff to change before the end of the work period.