Onicomadesis asociada a la enfermedad de boca, mano, pie / Onychomadesis associated to mouth, hand, and foot disease

Introducción: la onicomadesis es el desprendimiento completo y espontáneo de la uña desde su extremo proximal, sin dolor o inflamación, consecutivo a la detención mitótica de la matriz ungular que conlleva a un cambio de su función. Objetivo: describir una serie de casos de onicomadesis atendidos en la consulta de Dermatología del Hospital Pediátrico Docente del Cerro, entre noviembre y diciembre del año 2017, después de presentar un cuadro clínico compatible con enfermedad boca, mano, pie, con la finalidad de contribuir al conocimiento de esta patema. Presentación de los casos: las edades estuvieron comprendidas en un rango entre 1 y 12 años, con solo 3 pacientes correspondientes al sexo masculino y solo uno con el color de la piel negra. Los días previos al padecimiento de la enfermedad boca, mano, pie se enmarcan entre 15 y 47 días de haber tenido los síntomas que indujeron al diagnóstico del citado morbo. El estudio virológico se efectuó en dos pacientes con presencia del Coxsackie A6. La evolución resultó satisfactoria en todos los casos. Conclusiones: los hallazgos, en general, coinciden con los mencionados en la literatura. Todos los pacientes presentaron semanas anteriores signos y síntomas compatibles con enfermedad boca, mano, pie. Es necesario orientar a los padres de los enfermos con este morbo, la posibilidad de la ocurrencia de onicomadesis como complicación, cuyo tratamiento es sintomático, seguido de buen pronóstico, para evitar la ansiedad familiar y los gastos de recursos innecesarios(AU)

Introduction: onychomadesis is the total and spontaneous detachment of the nail from its proximal end, without pain or inflammation, and following the mitotic halting of the nail matrix that leads to a change in its function. Objective: to describe a series of cases of onychomadesis attended in the Dermatology clinic of the Pediatric Teaching Hospital of Cerro, in the period of November to December of 2017, after presenting clinical manifestations compatible with mouth, hand, and foot disease, and in order to contribute to the knowledge of this pathology. Presentation of cases: ages were among 1 and 12 years old, with only 3 patients corresponding to the male sex and only one with black skin. The days before presenting symptoms of mouth, hand, and foot disease were between 15 and 47 days after having the symptoms that led to the diagnosis of the aforementioned disease. The virological study was carried out in two patients with the presence of Coxsackie A6. The evolution was satisfactory in all cases. Conclusions: in general the findings coincide with those mentioned in the literature. All patients presented previous signs and symptoms compatible with mouth, hand, and foot disease in the previous weeks. It is necessary to guide the parents of patients with this disease on the possibility of the onychomadesis occurrence as a complication, whose treatment is symptomatic, followed by a good prognosis to avoid family anxiety and the expense of unnecessary resources(AU)

Cost-effectiveness of negative pressure wound therapy for postsurgical patients in long-term acute care.

OBJECTIVES: To evaluate the cost-effectiveness of negative pressure wound therapy (NPWT) using reticulated open-cell foam (NPWT/ROCF) as delivered by a Vacuum-Assisted Closure* (KCI Licensing, Inc, San Antonio, Texas) in patients with complex wounds in a long-term acute care (LTAC) setting. These patients are routinely discharged to LTAC hospitals with the goal of accelerating wound healing and timely transfer to a lower acuity care setting and are usually affected with serious comorbidities and deep, complex wounds with exposed anatomical structures, which require extended care (stay > 25 days). DESIGN: A retrospective chart review was conducted to determine the average daily wound volume reduction, average daily wound area reduction, and average cost per cubic centimeter of wound volume reduction for patients treated with NPWT/ROCF as compared with topical advanced moist healing strategies (non-NPWT). SETTING: All patients received treatment in an LTAC hospital. PARTICIPANTS: Patients admitted from November 2001 to August 2004 were identified using a computerized hospital database. The inclusion criteria were postsurgical patients of at least 18 years of age, with a single acute wound. INTERVENTION: Patients were treated with either NPWT/ROCF or advanced moist wound-healing therapies (non-NPWTs). MEASUREMENTS: Data collected included age, sex, wound measurements, Bates-Jensen Wound Assessment Tool severity score, procedures performed, wound care products and devices used, wound-healing outcomes, and costs associated with treatment. RESULTS: Fifty-one patients met the inclusion criteria: 36 were identified as NPWT/ROCF and 15 as non-NPWT. The NPWT/ROCF patients showed a statistically significantly higher average daily rate of volume reduction as compared with the advanced moist wound-healing group (5.02 +/- 13.36 vs 0.40 +/- 0.88 cm(3)/day; P = .046). The cost per cubic centimeter reduction was $11.90/cm(3) in the NPWT/ROCF group versus $30.92/cm in the moist wound-healing group. CONCLUSION: Postsurgical LTAC patients who were treated by NPWT/ROCF had a more accelerated rate of wound closure, compared with patients treated with advanced moist wound-healing therapy. These results suggest that, for this patient group, NPWT/ROCF may be more clinically effective in reducing wound volume, compared with advanced moist wound healing. Furthermore, the lower cost per cubic centimeter volume reduction suggests that NPWT/ROCF produces a more favorable cost-effective solution. Therefore, it is important when developing a wound-healing strategy that cost decisions be based on overall cost and not individual product cost when using advanced technology as part of the overall treatment plan. This study serves as a basis for further work in cost-benefit analysis when considering evidence-based outcomes in wound care.

Clinical algorithms as a tool for psychotherapy with Latino clients.

Clinical algorithms have the advantage of being able to integrate clinical, cultural, and environmental factors into a unified method of planning and implementing treatment. A model for practice is proposed that uses 3 algorithms as guides for conducting psychotherapy with Latino clients, the uses of which are illustrated in a single, ongoing case vignette. The algorithm format has the additional advantage of easily adapting itself for data gathering for research purposes.

Translating research into action: reducing disparities in mental health care for Mexican Americans.

This article describes a case study in which epidemiologic research findings were translated for multiple stakeholders and applied to reduce disparities in mental health services for Mexican Americans in Fresno County, California. The aims of this evidence-based process were to educate the community and mobilize action, translate research for multiple stakeholders to inform practitioners and policy makers about the need for improved mental health care for minorities, and effect regional policy changes to increase and improve the availability, accessibility, and appropriateness of mental health care for Mexican Americans. Through this process, a community-driven and consumer-oriented model evolved, which resulted in the allocation of resources to expand mental health services in rural areas of Fresno County. The authors discuss the process of translating research into action, key antecedents to an effective outcome, and lessons learned from the process.