Although safety theory predicts a positive association between safety culture and quality, we found no meaningful associations between safety culture and currently accepted measures of primary care clinical quality. Larger studies across several health care organizations are needed to determine whether these findings are reproducible. If so, it may be necessary to reconsider the dimensions of safety culture in primary care as well as the relationship between safety culture and primary care clinical quality.

While there are multiple reports on sorafenib-induced hand foot skin reaction, this case report details a patient presenting with an unusually severe and painful skin reaction. As the armamentarium of anti-neoplastic kinase inhibitors continues to increase, clinicians must be aware of the array of skin reactions these drugs can induce. A 66 years old Caucasian male with metastatic renal cell carcinoma presented with flu-like symptoms, rash, and painful bullous lesions of his fingertips. After empiric coverage with antibiotics and an infectious workup that turned up negative, it was determined that the patient's presentation was due to a severe and painful hand skin reaction to sorafenib. While most patients taking sorafenib will experience a cutaneous side effect, the hand foot skin reaction can be extremely debilitating and occurs frequently. Oncologists and dermatologists must be informed about the array of adverse effects of kinase inhibitors, as treatment adherence and outcomes are at stake. In this case report, the bullous skin reaction, debilitating hand pain, and absence of foot involvement were the interesting features.