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Williams G, Kwan E, Giraldo CN, Lincoln M, Lewin-Smith M. Panniculitis at the Site of Injection: Infection or Foreign Body Reaction? Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
A 63 year old diabetic female presented to the dermatology clinic with painful abdominal nodules. The nodules seemed to wax and wane every 1–2 weeks and appeared in different locations on the abdomen. The lesions were subcutaneous, tender, firm, and mobile with no discoloration. The patient had diabetes treated with injectable exenatide but no other significant medical or travel history.
Methods
The differential diagnoses included mycobacterial infection, mechanical insult from injectable diabetes medication, erythema nodosum, erythema induratum, and lupus panniculitis. Ultrasound was indicative of panniculitis. A biopsy of the active lesion was performed.
Results
The biopsy showed septal and lobular panniculitis with mixed inflammation and multinucleated giant cells. Small, circular, non-polarizable pink amphorous material was associated with the infiltrate. The amphorous material was strongly acid fast. The patient had a negative quantiferon-TB test. Scanning electron microscopy with energy dispersive x-ray analysis showed that the material contained more oxygen and less carbon than surrounding tissue, but no abnormal elements were identified. Infrared spectroscopy of the foreign material most closely matched poly(L- lactide-co-glycolide).
Conclusion
The diagnosis of exenatide induced granulomatous panniculitis was made. The patient had recently started using this injectable glucagon-like peptide-1 receptor agonist, which has been associated with panniculitis. The injectable formulation is loaded onto microspheres composed of poly (DL-lactic-co-glycolic acid), which is closely related to poly(L-lactide-co-glycolide). This material has been shown to stain strongly acid fast. This case of granulomatous panniculitis due to injectable diabetic medication highlights an important potential pitfall that pathologists should be aware of, especially in cases where mycobacterial infection is in the differential.
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Affiliation(s)
- G Williams
- DPALS, SAUSHEC, Schertz, Texas, UNITED STATES
| | - E Kwan
- DPALS, SAUSHEC, Schertz, Texas, UNITED STATES
| | - C N Giraldo
- DPALS, SAUSHEC, Schertz, Texas, UNITED STATES
| | - M Lincoln
- DPALS, SAUSHEC, Schertz, Texas, UNITED STATES
| | - M Lewin-Smith
- The Joint Pathology Center, Silver Spring, Maryland, UNITED STATES
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Pollard N, Lincoln M, Nisbet G, Penman M. Patient perceptions of communication with diagnostic radiographers. Radiography (Lond) 2019; 25:333-338. [DOI: 10.1016/j.radi.2019.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/26/2019] [Accepted: 04/06/2019] [Indexed: 11/26/2022]
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Gallego G, Dew A, Lincoln M, Bundy A, Bulkeley K, Brentnall J, Veitch C. Carers' preferences for the delivery of therapy services for people with disability in rural Australia: evidence from a discrete choice experiment. J Intellect Disabil Res 2018; 62:371-381. [PMID: 29363218 DOI: 10.1111/jir.12469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 11/27/2017] [Accepted: 12/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The implementation of the Australian National Disability Insurance Scheme is expected to generate a responsive, person-centred system that will empower people with disability to choose the services and support they receive. However, little attention has been paid to examine how users of the National Disability Insurance Scheme will choose and spend their individual budgets. This study aimed to determine quantitatively the relative importance that carers of people with a disability living in rural Australia place on different therapy service delivery characteristics. METHODS A stated preference discrete choice experiment was incorporated into a survey of carers of people with disability living in rural Australia. Carers chose between therapy delivery services differing in attributes such as travel time to receive therapy, sector providing the service (i.e. Government, not-for-profit and private), out-of-pocket costs, person who delivers the therapy (therapist or other staff) and waiting time. RESULTS A total of 133 carers completed the discrete choice experiment. The majority of respondents cared for a child with a disability (84%); the average age of the person they cared for was 17 years (SD 14.25). Participants expressed strong preferences for a short waiting time (0-3 months) to receive therapy services; services delivered by a therapist, no out-of-pocket cost and travelling up to 4 h to receive a therapy session (P < 0.05). Sector providing the service was not statistically significant. CONCLUSION Carers of people with a disability in rural Australia exhibited strongest preferences for short waiting times (0-3 months). Therapy services that are delivered by therapy assistants or support workers will require careful introduction to achieve uptake and acceptability.
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Affiliation(s)
- G Gallego
- School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia
| | - A Dew
- Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
- Faculty of Arts and Social Sciences, University of New South Wales, Sydney, NSW, Australia
| | - M Lincoln
- Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - A Bundy
- Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - K Bulkeley
- Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - J Brentnall
- Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - C Veitch
- Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
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Gwynne K, McCowen D, Cripps S, Lincoln M, Irving M, Blinkhorn A. A comparison of two models of dental care for Aboriginal communities in New South Wales. Aust Dent J 2016; 62:208-214. [PMID: 28008634 DOI: 10.1111/adj.12496] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aboriginal people, and particularly those in rural areas, continue to suffer very high levels of dental disease despite significant reductions in the wider Australian population in the past 30 years. Until recently, there has been a shortage of oral health clinicians and the majority have provided care in major cities. The NSW Government funded various models of care for rural and regional areas and vulnerable population groups including Aboriginal people. This study utilizes a comparative retrospective analysis to compare two models of oral health care for Aboriginal people including those living in rural NSW to inform future policy decisions. METHODS Two models (Model A - Fly in Fly out and Model B - Collective impact) of public oral health care for Aboriginal patients in NSW were examined using publicly available descriptive information. Two years of funding and Dental Weighted Activity Units (DWAUs) data were analysed for the two different models and regression analysis was used to compare the trends of monthly time series of DWAUs. CONCLUSIONS Based on the standardized national weighted pricing for public dentistry, model B offers significantly more services for less financial resources.
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Affiliation(s)
- K Gwynne
- Poche Centre for Indigenous Health, The University of Sydney, Camperdown, New South Wales, Australia.,Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - D McCowen
- Armajun Aboriginal Health Service, Inverell, New South Wales, Australia
| | - S Cripps
- Centre of Translational Data Science, Sydney Business School, The University of Sydney, Camperdown, New South Wales, Australia
| | - M Lincoln
- Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - M Irving
- Poche Centre for Indigenous Health, The University of Sydney, Camperdown, New South Wales, Australia.,Faculty of Dentistry, The University of Sydney, Camperdown, New South Wales, Australia
| | - A Blinkhorn
- Faculty of Dentistry, The University of Sydney, Camperdown, New South Wales, Australia
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Bott J, Blumenthal S, Buxton M, Ellum S, Falconer C, Garrod R, Harvey A, Hughes T, Lincoln M, Mikelsons C, Potter C, Pryor J, Rimington L, Sinfield F, Thompson C, Vaughn P, White J. Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax 2009; 64 Suppl 1:i1-51. [PMID: 19406863 DOI: 10.1136/thx.2008.110726] [Citation(s) in RCA: 215] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Brown SH, Lincoln M, Hardenbrook S, Petukhova ON, Rosenbloom ST, Carpenter P, Elkin P. Derivation and evaluation of a document-naming nomenclature. J Am Med Inform Assoc 2001; 8:379-90. [PMID: 11418545 PMCID: PMC130083 DOI: 10.1136/jamia.2001.0080379] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The Computerized Patient Record System is deployed at all 173 Veterans Affairs (VA) medical centers. Providers access clinical notes in the system from a note title menu. Following its implementation at the Nashville VA Medical Center, users expressed dissatisfaction with the time required find notes among hundreds of irregularly structured titles. The authors' objective was to develop a document-naming nomenclature (DNN) that creates informative, structured note titles that improve information access. DESIGN One thousand ninety-four unique note titles from two VA medical centers were reviewed. A note-naming nomenclature and compositional syntax were derived. Compositional order was determined by user preference survey. MEASUREMENTS The DNN was evaluated by modeling note titles from the Salt Lake City VA Medical Center (n=877), Vanderbilt University Medical Center (n=554), and the Mayo Clinic (n=42). A preliminary usability evaluation was conducted on a structured title display and sorting application. RESULTS Classes of note title components were found by inspection. Components describe characteristics of the author, the health care event, and the organizational unit providing care. Terms were taken from VA medical center information systems and national standards. The DNN model accurately described 97 to 99 percent of note titles from the test sites. The DNN term coverage varied, depending on component and site. Users found the DNN title format useful and the DNN-based title sorting and note review application easy to learn and quick to use. CONCLUSION The DNN accurately models note titles at five medical centers. Preliminary usability data indicate that DNN integration with title parsing and sorting software enhances information access.
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Affiliation(s)
- S H Brown
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee, USA.
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Weir C, Lincoln M, Roscoe D, Moreshead G. Successful implementation of an integrated physician order entry application: a systems perspective. Proc Annu Symp Comput Appl Med Care 1995:790-4. [PMID: 8563399 PMCID: PMC2579202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Direct physician order entry is required for effective implementation of an integrated electronic medical record. This effort involves multi-level changes in the whole system of care, from physicians attitudes to interdepartmental relations. This study reports the findings of a follow-up study that quantified dimensions associated with successful implementation identified in a previous study. Results identified several implementation strategies associated with success. These include an interdisciplinary implementation group, involvement of large numbers of regular staff, early and intensive training and support, and 24 hour available assistance as important to success. In addition, attitudes of physicians and their level of involvement were found to be associated with success.
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Affiliation(s)
- C Weir
- Salt Lake City Veteran's Affair Information Systems Center, Utah, USA
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Abstract
A preliminary study (Onslow, Costa, & Rue, 1990) suggested that a parent-conducted program of verbal response-contingent stimulation would be an effective treatment for stuttering children younger than 5 years. The present study was designed to expand those preliminary findings by using a larger group of children and by comparing them to a control group of children. Twelve children in the experimental group achieved median percent syllables stuttered (%SS) scores below 1.0 for a 12-month posttreatment period. The children's treatments were completed in a median of 10.5 1-hour clinic sessions and a median of 84.5 days from the start of treatment. The majority of parents of the control children withdrew from the study and elected to have treatment begin for their child. These results suggest that the program may be a cost-effective method for managing a clinical caseload of stuttering children younger than 5 years. It is suggested that controlled clinical trials cannot be used validly or ethically to determine the number of cases of early stuttering who recover without formal intervention.
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Affiliation(s)
- M Onslow
- School of Communication Disorders, University of Sydney, Australia
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Weir C, Lincoln M, Roscoe D, Turner C, Moreshead G. Dimensions associated with successful implementation of a hospital based integrated order entry system. Proc Annu Symp Comput Appl Med Care 1994:653-7. [PMID: 7950009 PMCID: PMC2247902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Implementation of an integrated electronic medical record requires direct physician order entry. This application involves multi-level changes in the whole system of care, from physicians attitudes to interdepartmental relations. This study reports the results of the first round of a modified Delphi, where a diverse group of individuals were asked to identify the most important facilitating and impeding factors associated with implementation of an order entry application. From a Q-sort of their responses, we identified 20 systemic, behavioral, and attitudinal dimensions perceived to be causal factors in successful implementation. We also explored how these dimensions may influence success by comparing successful with unsuccessful hospitals in terms of the frequency with which these dimensions were differently mentioned by respondents. We found that although available functionality was the most commonly mentioned factor by all participants, hardware availability, physician involvement, administration support, and medical administration involvement were more often mentioned by successful hospitals than by less successful hospitals. These results suggest that these factors were not present in the less successful hospitals. We also found that the frequency of responses within each category varied depending on the institutional role of the individuals responding. Those involved in support tended to see organizational variables as more important than those in clinical positions, whereas clinicians viewed administrative support and involvement of the chief as more important. These findings support the notion that the changes involved in instituting a physician order entry system are system wide and involve individual as well as organizational factors.
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Affiliation(s)
- C Weir
- Salt Lake City Veteran's Affair Information Systems Center, Utah
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Richardson F, Leonard R, Lincoln M, Andrews R. A short story. Don't they know the blind are helpless? RN 1973; 36:53-6. [PMID: 4490441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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