Potential precipitating factors among patients hospitalized with HF vary by EF group and are independently associated with clinical outcomes.

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Objectives This study analyzed the relationship between payment source and quality of care and outcomes in heart failure (HF). Background HF is a major cause of morbidity and mortality. There is a lack of studies assessing the association of payment source on HF quality of care and outcomes. Methods We analyzed 99,508 HF admissions from 244 sites between January 2005 and September 2009. Patients were grouped based on payer status (private/HMO; no insurance; Medicare; Medicaid) with the private/HMO group as reference. Results The no insurance group was less likely to receive evidence-based beta-blockers (EBBB; adjusted odds ratio [OR] 0.73, 95% confidence intervals [CI] 0.62 to 0.86), an implantable cardioverter defibrillator (ICD; OR 0.59, 95% CI 0.50 to 0.70) or anticoagulation for atrial fibrillation (OR 0.73, 95% CI 0.61 to 0.87). Similarly, the Medicaid group was less likely to receive EBBB (OR 0.86, 95% CI 0.78 to 0.95) or ICD (OR 0.86, 95% CI 0.78 to 0.96). ACEI/ARB and beta-blockers were prescribed less frequently in the Medicare group (OR 0.89, 95% CI 0.81 to 0.98). Medicare, Medicaid, and no insurance groups had longer hospital stays. Higher adjusted rates of in-hospital mortality were seen in patients with Medicaid (OR 1.22, 95% CI 1.06 to 1.41) and in reduced systolic function patients with no insurance. Conclusion Decreased quality of care and outcomes for patients with HF was observed in no insurance, Medicaid and Medicare groups compared to the private/HMO group.

Context.— Wolf isotopic response has infrequently been reported in the literature, mainly as isolated case reports. Objective.— To aid in recognition of the occurrence of postherpetic granuloma annulare for accurate histologic interpretation of granulomatous dermatitides. Design.— We report 5 cases of patients with Wolf isotopic response manifesting as granuloma annulare, developing in a site of previous herpes zoster, and discuss the clinicopathologic findings. Results.— Previous infection with herpes zoster or herpes simplex virus was found in 5 of 5 cases reported. The differential diagnosis of a dermal lymphohistiocytic infiltrate with multinucleated giant cells includes postherpetic granuloma annulare. Conclusions.— All cases of postherpetic Wolf isotopic response reported in this series revealed granuloma annulare, with a perineurovascular or perifollicular pattern of lymphohistiocytic infiltration including multinucleated giant cells, and occurred following herpes zoster or herpes simplex infection, although herpes viral infection was not always associated with a subsequent isotopic eruption. Awareness of this entity can aid in the clinicopathologic diagnosis of granuloma annulare occurring at the site of prior herpes viral infection.

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Advances in digital imaging and archiving have made the measurement and documentation of wound areas possible over time. To assess the reproducibility and precision of digital image measurements, we used WoundMatrix Web (http://www.woundmatrix.com/) and recruited a group of caregivers from the Johns Hopkins Wound Center to measure the size of wounds on digital images by measuring length and width and tracing the circumference of the same wounds. One set of images was provided by WoundMatrix (WoundMatrix Inc, Chadds Ford, PA) and a second set used our own photographs taken at the Johns Hopkins Wound Center. Our results demonstrate that digital analysis with WoundMatrix Web is reproducible and precise with acceptable variation among readers. This supports the use of digital images of wounds to follow clinical progress as well as analyze the effects of new clinical interventions in clinical trials.

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