Levamisole-Induced Vasculitis in the Lower Extremities: A Case Report

2019 ◽  
Vol 109 (2) ◽  
pp. 150-154 ◽  
Author(s):  
Vi Nguyen ◽  
Deepal Dalal ◽  
Mark Razzante
Keyword(s):  
Social History ◽  
Wound Care ◽  
Skilled Nursing Facility ◽  
Lower Extremities ◽  
The United States ◽  
Punch Biopsy ◽  
Cancer Treatments ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Number Of Patients

Background: Since 2006 there have been increased reports of severe agranulocytosis and vasculitis associated with levamisole use. Historically, levamisole was an immunomodulatory agent used in various cancer treatments in the United States. Currently the drug is used as an antihelminthic veterinary medication, but it is also used as an additive in freebase cocaine. There are multiple reports of levamisole-induced vasculitis in the head and neck but limited reported cases in the lower extremities. This article describes a 60-year-old woman who presented to the emergency department with multiple painful lower-extremity ulcerations. Results: Radiographs, laboratory studies, and punch biopsy were performed. Physical examination findings and laboratory results were negative for signs of infection. Treatment included local wound care and education on cocaine cessation, and the patient was transferred to a skilled nursing facility. Her continued use of cocaine, however, prevented her ulcers from healing. Conclusions: Local wound care and cocaine cessation is the optimal treatment for levamisole-induced lesions. With the increase in the number of patients with levamisole-induced vasculitis, podiatric physicians and surgeons would benefit from the immediate identification of these ulcerations, as their appearance alone can be distinct and pathognomonic. Early identification of levamisole-induced ulcers is important for favorable treatment outcomes. A complete medical and social history is necessary for physicians to treat these lesions with local wound care and provide therapy for patients with addictions.

scholarly journals The Role of Wound Care in 2 Group A Streptococcal Outbreaks in a Chicago Skilled Nursing Facility, 2015‒2016

2018 ◽  
Vol 5 (7) ◽  
Author(s):  
Sana S Ahmed ◽  
Kasey E Diebold ◽  
Jacob M Brandvold ◽  
Saadeh S Ewaidah ◽  
Stephanie Black ◽  
...  
Keyword(s):  
Group A Streptococcus ◽  
Wound Care ◽  
Skilled Nursing Facility ◽  
Prevention Measures ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Group A ◽  
Care Practices ◽  
Transmission Factors

Abstract Two consecutive outbreaks of group A Streptococcus (GAS) infections occurred from 2015–2016 among residents of a Chicago skilled nursing facility. Evaluation of wound care practices proved crucial for identifying transmission factors and implementing prevention measures. We demonstrated shedding of GAS on settle plates during care of a colonized wound.

scholarly journals Improving Healthcare Value: COVID-19 Emergency Regulatory Relief and Implications for Post-Acute Skilled Nursing Facility Care

2020 ◽  
Vol 15 (8) ◽  
pp. 495-497
Author(s):  
Ann M Sheehy ◽  
Charles FS Locke ◽  
Farah A Kaiksow ◽  
W Ryan Powell ◽  
Andrea Gilmore Bykovskyi ◽  
...  
Keyword(s):  
Care Delivery ◽  
Skilled Nursing Facility ◽  
Marked Change ◽  
Hospital Medicine ◽  
The United States ◽  
Medicare Beneficiaries ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Social Security Act ◽  
The 1960S

Rarely, if ever, does a national healthcare system experience such rapid and marked change as that seen with the COVID-19 pandemic. In March 2020, the president of the United States declared a national health emergency, enabling the Department of Health & Human Services authority to grant temporary regulatory waivers to facilitate efficient care delivery in a variety of healthcare settings. The statutory requirement that Medicare beneficiaries stay three consecutive inpatient midnights to qualify for post-acute skilled nursing facility coverage is one such waiver. This so-called Three Midnight Rule, dating back to the 1960s as part of the Social Security Act, is being scrutinized more than half a century later given the rise in observation hospital stays. Despite the tragic emergency circumstances prompting waivers, the Centers for Medicare & Medicaid Services and Congress now have a unique opportunity to evaluate potential improvements revealed by COVID-19 regulatory relief and should consider permanent reform of the Three Midnight Rule. Journal of Hospital Medicine 2020;15:XXX-XXX. © 2020 Society of Hospital Medicine

Professional characteristics of deficiency citations at F-248 in skilled nursing facilities in the United States

2012 ◽  
Vol 11 (2) ◽  
pp. 32-38
Author(s):  
Timothy J. Legg, PhD, RN-BC, CNHA, GNP-BC, CTRS, FACHCA ◽  
Sharon A. Nazarchuk, PhD, MA, MHA, RN
Keyword(s):  
Skilled Nursing Facility ◽  
The United States ◽  
Therapeutic Recreation ◽  
Professional Activity ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Survey Participant ◽  
Professional Characteristics ◽  
Participant Response

In an earlier study, the authors attempted to determine which professional activity group (the certified therapeutic recreation therapist vs certified activity director) received fewer survey deficiencies in the skilled nursing facility. The original study was unable to provide an answer to this question due to low-survey participant response rate. The study was further limited in terms of geographic scope, as it was confined to a single state. The current study replicates that earlier study with an increased sample size and nationwide geographic distribution of participants.

Implementation of Interdisciplinary Wound Care Rounds in a Skilled Nursing Facility

2019 ◽  
Vol 20 (3) ◽  
pp. B20
Author(s):  
Monica Stout ◽  
M. Stout ◽  
A. Ogunwale ◽  
N. Ramlal ◽  
K. Thompson ◽  
...  
Keyword(s):  
Wound Care ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing

scholarly journals 432. An Outbreak of Coronavirus Disease, 2019 (COVID-19) in a Skilled Nursing Facility – California, 2021: Description, Mitigation, Challenges, and Opportunities

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S318-S319
Author(s):  
Anastasia Maletz ◽  
Grace Kang ◽  
Raymond Y Chinn ◽  
John D Malone ◽  
Hosniyeh Bagheri ◽  
...  
Keyword(s):  
Whole Genome Sequencing ◽  
Genome Sequencing ◽  
Skilled Nursing Facility ◽  
Geographic Location ◽  
The United States ◽  
Infection Prevention And Control ◽  
Whole Genome ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Increased Risk

Abstract Background Skilled nursing facility (SNF) residents comprised 11% of all COVID-19 cases in the United States; however, they account for 43% of deaths with case fatality rates (CFR) of 26.0-33.7%. Methods We report an outbreak of COVID-19, from June 15 to July 21, 2020 in a 159-bed SNF with a staff of 172 that resulted in an infection rate of 97% in residents and 23% in HCWs (Figure 1). A retroactive review outlined mitigation efforts, discussed challenges, identified risk factors among residents and health care workers (HCW) for acquisition of COVID-19, and reviewed opportunities for improvement (Figure 2). Figure 1. Epi Curve of COVID-19 Outbreak in a Skilled Nursing Facility Figure 2. Timeline of COVID-19 Outbreak in a Skilled Nursing Facility Results Factors that contributed to the outbreak: delay in test results had an impact on cohorting; suboptimal adherence to the principles of infection prevention and control (IPC) and minimal adherence monitoring; strict criteria were used to screen for infection; the underappreciated transmissibility of COVID-19 from presymptomatic and asymptomatic persons; symptomatic HCWs who continued to work; the changing guidance on, the suboptimal use of, and an inadequate supply of personal protective equipment; poor indoor air quality due to ventilation challenges; and the important role of community/family/interfacility spread on the outbreak. Whole genome sequencing, performed in 52 samples, identified a common strain that was also found in clusters of 2 other facilities: 1 in the same geographic location, the other in a different geographic location but whose HCWs had the same zip codes as the facility (Figure 3). Certified nursing and restorative nursing assistants had the highest risk of infection with an odds ratio (OR) of 4.02 (confidence interval 1.29-12.55, p value: 0.02) when compared to registered and licensed vocational nurses. The residents’ CFR was 24%. The OR for death was increased by 10.5 (10.20-11.00) for every decade of life as was morbid obesity (BMI > 35) with an OR of 8.50. BMI as a continuous variable increased risk of mortality for every additional unit, OR 1.07 (Tables 1, 2). Whole Genome Sequencing of Isolates from a Skilled Nursing Facility Outbreak Univariate Analysis of Selected Variables Associated with Mortality among Residents at Facility A during COVID-19 Outbreak, June 19 - July 21, 2021 Multivariate Analysis of Factors Associated with Mortality from COVID-19 after Adjusting for Age among Residents (N =124) of Facility A, June 15 - July 21, 2020 Conclusion While implementation of optimal IPC measures in the pre-COVID-19 vaccination era had no impact on the infections in residents who were likely already infected or exposed at the onset of the outbreak, these measures along with non-pharmacologic strategies were effective in halting the spread among HCWs. Disclosures All Authors: No reported disclosures

Abstract P387: Length of Stay Among Medicare Beneficiaries Hospitalized with Heart Failure

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Emily B Levitan ◽  
Melissa K Van Dyke ◽  
Ligong Chen ◽  
Meredith L Kilgore ◽  
Todd M Brown ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Systolic Dysfunction ◽  
Skilled Nursing Facility ◽  
The United States ◽  
Demographic Characteristics ◽  
Hospital Length Of Stay ◽  
Medicare Beneficiaries ◽  
Nursing Facility ◽  
Skilled Nursing

Background: Heart failure (HF) is among the most common reasons for hospitalization in the United States. Hospital length of stay (LOS) is a driver of cost and disease burden. Objectives: To examine factors associated with LOS of HF hospitalizations. Methods: Medicare beneficiaries with fee-for-service and pharmacy coverage who had HF hospitalizations (inpatient claims with ≥1 overnight stay/2 hospital days with HF as the primary discharge diagnosis, discharged alive) between 2007 and 2011 were identified in the Medicare national 5% sample. The median and interquartile range (IQR) LOS was calculated by demographic characteristics, comorbidities, and discharge status based on Medicare claims data with the Kruskal-Wallis test to compare distributions in the overall population with HF (n = 45,584) and in the subpopulation with documented systolic dysfunction (n = 10,256). Results: The median LOS was 5 days (range 2-255, IQR 4-8 days) in the overall HF population and 5 days (range 2-204, IQR 4-8 days) in those with systolic dysfunction. Across most demographic characteristics and comorbidities, the median LOS was 5 days but was higher among nursing home residents and individuals with malnutrition in both groups and with chronic kidney disease in those with systolic dysfunction ( Figure ). All comorbidities were associated with a shift in the distribution toward longer LOS in the population with systolic dysfunction and all but coronary heart disease in the overall population (p < 0.001). HF patients discharged to a skilled nursing facility had longer LOS (median 7 days, IQR 5-10 days) versus other discharge statuses (median 5 days, IQR 3-7 days, p < 0.001) in both populations. Conclusions: In patients hospitalized for HF, the median LOS was 5 days across most comorbidities and other characteristics, but comorbidities were associated with a shift in the upper tail of the distribution toward longer LOS. Worse functional status (nursing residence or discharge to a skilled nursing facility) was associated with a higher median LOS.

Improving Wound Care in a Skilled Nursing Facility

2014 ◽  
Vol 15 (3) ◽  
pp. B20-B21
Author(s):  
Kim Petrone ◽  
Kim Petrone ◽  
Cheryl Nolan ◽  
Leanne Mathis
Keyword(s):  
Wound Care ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing

scholarly journals Clinical Features and Outcomes of 105 Hospitalized Patients With COVID-19 in Seattle, Washington

2020 ◽  
Vol 71 (16) ◽  
pp. 2167-2173 ◽  
Author(s):  
Frederick S Buckner ◽  
Denise J McCulloch ◽  
Vidya Atluri ◽  
Michela Blain ◽  
Sarah A McGuffin ◽  
...  
Keyword(s):  
Medical Center ◽  
Severe Disease ◽  
Academic Medical Center ◽  
Skilled Nursing Facility ◽  
The United States ◽  
Washington State ◽  
Hospitalized Patients ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Academic Medical

Abstract Background Washington State served as the initial epicenter of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in the United States. An understanding of the risk factors and clinical outcomes of hospitalized patients with coronavirus disease 2019 (COVID-19) may provide guidance for management. Methods All laboratory-confirmed COVID-19 cases in adults admitted to an academic medical center in Seattle, Washington, between 2 March and 26 March 2020 were included. We evaluated individuals with and without severe disease, defined as admission to the intensive care unit or death. Results One hundred five COVID-19 patients were hospitalized. Thirty-five percent were admitted from a senior home or skilled nursing facility. The median age was 69 years, and half were women. Three or more comorbidities were present in 55% of patients, with hypertension (59%), obesity (47%), cardiovascular disease (38%), and diabetes (33%) being the most prevalent. Most (63%) had symptoms for ≥5 days prior to admission. Only 39% had fever in the first 24 hours, whereas 41% had hypoxia at admission. Seventy-three percent of patients had lymphopenia. Of 50 samples available for additional testing, no viral coinfections were identified. Severe disease occurred in 49%. Eighteen percent of patients were placed on mechanical ventilation, and the overall mortality rate was 33%. Conclusions During the early days of the COVID-19 epidemic in Washington State, the disease had its greatest impact on elderly patients with medical comorbidities. We observed high rates of severe disease and mortality in our hospitalized patients.

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