Factors influencing teamwork and collaboration within a tertiary medical center

AIM: To understand how work climate and related factors influence teamwork and collaboration in a large medical center.METHODS: A survey of 3462 employees was conducted to generate responses to Sexton’s Safety Attitudes Questionnaire (SAQ) to assess perceptions of work environment via a series of five-point, Likert-scaled questions. Path analysis was performed, using teamwork (TW) and collaboration (CO) as endogenous variables. The exogenous variables are effective communication (EC), safety culture (SC), job satisfaction (JS), work pressure (PR), and work climate (WC). The measurement instruments for the variables or summated subscales are presented. Reliability of each sub-scale are calculated. Alpha Cronbach coefficients are relatively strong: TW (0.81), CO (0.76), EC (0.70), SC (0.83), JS (0.91), WP (0.85), and WC (0.78). Confirmatory factor analysis was performed for each of these constructs.RESULTS: Path analysis enables to identify statistically significant predictors of two endogenous variables, teamwork and intra-organizational collaboration. Significant amounts of variance in perceived teamwork (R² = 0.59) and in collaboration (R² = 0.75) are accounted for by the predictor variables. In the initial model, safety culture is the most important predictor of perceived teamwork, with a β weight of 0.51, and work climate is the most significant predictor of collaboration, with a β weight of 0.84. After eliminating statistically insignificant causal paths and allowing correlated predictors1, the revised model shows that work climate is the only predictor positively influencing both teamwork (β = 0.26) and collaboration (β = 0.88). A relatively weak positive (β = 0.14) but statistically significant relationship exists between teamwork and collaboration when the effects of other predictors are simultaneously controlled.CONCLUSION: Hospital executives who are interested in improving collaboration should assess the work climate to ensure that employees are operating in a setting conducive to intra-organizational collaboration.     

An isolated Merkel cell carcinoma metastasis at a distant cutaneous site presenting as a second 'primary' tumor

Merkel cell carcinoma (MCC) is an aggressive neuroendocrine carcinoma of the skin. Disease progression usually occurs via lymphatic spread to regional lymphatic draining basins, followed by distant metastasis. We report the clinical course, histopathology and genetic analysis of a 69-year-old woman with likely hematogenous spread of cutaneous neuroendocrine carcinoma manifesting as a single metastatic lesion to a distant cutaneous site. Although the possibility of two cutaneous primary MCCs was considered, array comparative genomic hybridization (aCGH) identified identical distal amplification of a region of chromosome 12p, and synchronous loss of chromosomes 8p and 17p, effectively ruling out the possibility of independent primaries. We propose that this represents a primary cheek MCC with rapid, isolated cutaneous metastasis to the contralateral ankle via hematogenous spread. The distinction between a second primary MCC and a distant cutaneous metastasis clearly has important implications with regard to staging, treatment and prognosis. To our knowledge, this represents the first report of the use of aCGH to clarify the relationship of multiple synchronous cutaneous MCCs and the first report of a single distant cutaneous focus of hematogenous spread. Our data calls into question prior reports alleging multiple cutaneous primaries of this very rare tumor.     

Giant fibromyxoid tumors of the adventitial dermis. Forme fruste of trichodiscoma?

A 36-year-old paraplegic man developed multiple giant fibromyxoid tumors surrounding a meningomyelocele scar that we believe are forme fruste of trichodiscomas. Histologic examination showed a papillated, slightly hyperplastic epidermis surrounding a delicate fibrovascular proliferation set in a stroma of loose fibrillar connective tissue and stellate fibroblasts. A melanocytic nevus was incorporated into one of the lesions. We believe that these giant lesions are connective tissue nevi of the adventitial dermis that comprise a new clinical variant of trichodiscoma. The potential significance of the relationship between these abortive trichodiscomas and abnormalities of the neural crest is discussed.     

Sensitization to thimerosal (Merthiolate) is still present today

The results on thimerosal (Merthiolate) hypersensitivity of a retrospective study, together with the relevant data on thimerosal hypersensitivity referred to in the literature up to 1993, are presented. Positive patch test reactions to thimerosal (0.1% pet.) were observed in 32 (1.3%) of 2461 adult patients with suspected contact allergy examined in the period 1987–1992. 20 (0.8%) patients had a solitary positive patch test to thimerosal. The observed incidence is low. Clinical symptoms related to thimerosal hypersensitivity were observed in only 3 patients. The collected results are discussed with emphasis on the clinical implications of sensitization to thimerosal. It appears that a positive patch test to thimerosal is frequently clinically irrelevant.     

Test battery for metal allergy in dentistry

Some alloys used in restorative dentistry may evoke an allergic contact stomatitis in certain persons. In order to protect patients from materials with undesired reactions, and considering corrosion characteristics of different alloys used, it is useful to devise an adequate patch test battery to include the most relevant metals. Dental alloys are composed of a combination of various metals. 12 different ions of frequent occurrence (Au3+, Pd2+, Zn2+, Mo6+, Sn2+, Ga3+, In3+, Co2+, Cr3+(6+), Ni2+, Fe2+(3+) and Si4+) were epicutaneously tested as the aqueous solution of the respective salt. The concentrations are given in g/100 ml and also in m.mole/l. The 12 different metal ion solutions were patch tested on patients in 3 groups: one group with a positive history of contact stomatitis (30 patients, group 1), one group with a positive history of contact dermatitis (16 patients, group 2), and a control group (17 persons, group 3). In contrast to the control group, a remarkable high percentage (11%) of positive skin reactions to Pd was found in groups 1 and 2. No allergic or irritant skin reactions were detected to Ga, Sn and Zn. No irritant reaction was observed at pH values as low as 1.5. In the case of SiCl4 (pH = 0.5), 41% positive irritant reactions were evoked. In the group with a positive history of contact dermatitis (group 1), a positive reaction was found more often (69%) than in the group with a positive history of contact stomatitis (30%) (group 2). The difference between these groups was mainly caused by reactions to Ni and Pd.(ABSTRACT TRUNCATED AT 250 WORDS)     

Autoimmune skin and connective tissue diseases and risk of venous thromboembolism: a population‐based case‐control study

Summary. Background: Systemic inflammation is associated with vessel wall damage, upregulation of procoagulants, downregulation of anticoagulants, and suppression of fibrinolysis. Autoimmune diseases may therefore increase the risk of venous thromboembolism (VTE). Objectives: To examine whether autoimmune skin and connective tissue diseases are associated with increased VTE risk. Methods: We conducted this population‐based case–control study in northern Denmark, using administrative databases. From 1999 to 2009, we identified 14 721 VTE cases and 147 210 birth year‐matched, sex‐matched and county‐matched population controls. The date of diagnosis/matching was considered to be the index date for cases and controls. For all study subjects, we identified hospital diagnoses of autoimmune skin or connective tissue diseases between 1977 and the index date. We used conditional logistic regression with adjustment for VTE risk factors to calculate odds ratios and 95% confidence intervals (CIs) for patients with vs. without autoimmune disease. Given the risk‐set sampling design, odds ratios estimate incidence rate ratios (IRRs). Results: Autoimmune skin disease was not associated with VTE (IRR 1.0; 95% CI 0.9–1.2). Patients with connective tissue disease had an increased VTE risk within 90 days (IRR 2.3; 95% CI 1.5–3.7) and 91–365 days (IRR 2.0; 95% CI 1.5–2.8) after diagnosis, but not thereafter (IRR 1.1; 95% CI 1.0–1.2). Among connective tissue diseases, the greatest overall risk increases were found for juvenile rheumatoid arthritis (IRR 3.0; 95% CI 1.4–6.4) and systemic lupus erythematosus (IRR 2.8; 95% CI 1.7–4.7). Conclusions: Autoimmune connective tissue disease was associated with an increased risk of VTE within 1 year after diagnosis, whereas skin diseases were not.     

Merkel cell carcinoma with heterologous rhabdomyoblastic differentiation: the role of immunohistochemistry for Merkel cell polyomavirus large T-antigen in confirmation

Merkel cell carcinoma (MCC) represents an uncommon and lethal form of cutaneous malignancy. Historically, the pathogenesis of MCC has been presumed to be linked to ultraviolet light overexposure, but recently, it has been documented that some examples harbor polyomavirus genome, the presence of which is presumed to be of pathogenetic importance. Extremely rare cases of MCC may show heterologous differentiation. We report an example of MCC with heterologous rhabdomyosarcomatous differentiation, the third such case to date, with emphasis on its distinction from fusion-negative alveolar rhabdomyosarcoma. The role of immunohistochemistry for Merkel cell polyomavirus large T-antigen in this differential diagnosis is emphasized.