both, we ruled out herpes simplex virus and varicella zoster virus clinically and by performing polymerase chain reaction.Most patients who presented with an erythematous rash had mild itch. There was no correlation between the presence of rash and fever. Involved sites were primarily the trunk and upper limbs, but the head and face were largely spared. In this group, younger patients seem to display more intense and disseminated cutaneous manifestations, including darker red, larger wheal-like and purpuric lesions. All exanthems were short-lived and resolved spontaneously without specific dermatologic treatment after mean of 3 days (range, 2-5 days). The dermatologic manifestations could not be correlated to COVID-19 severity.Diffuse petechiae, gravity-dependent, and multiple, generalized palpable purpura, and acroischemia ( primarily finger/toe cyanosis, but neither skin bulla nor dry gangrene) were seen in more severe cases. These manifestations were associated with clotting disorders, reflected in increased prothrombin time and fibrinogen and D-dimer levels, which are seen in intensive care patients. [3][4][5] In conclusion, some patients with COVID-19 present with inflammatory cutaneous findings: 7.8% in our cohort of hospitalized adults. These skin findings are generally mild and self-limiting and do not correlate with overall prognosis. They generally resolve promptly without specific therapy.

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The internship is an integrative training experience and the capstone of doctoral training for developing professionals (Madson, Hasan, Williams-Nickelson, Kettmann, & Van Sickle, 2007). The imbalance between supply and demand of internships is an increasingly critical problem in professional psychology and one that the American Psychological Association of Graduate Students (APAGS) is committed to resolving with all stakeholders. This paper will provide a brief overview of the problem, summarize the efforts of APAGS to address the issue since its last article on the internship crisis (Madson et al., 2007), and provide a framework by which APAGS will continue to address the internship crisis-an issue we have defined as one of the most critical facing psychology graduate students today.Although systemic data collection was not underway at the time, it was suspected that the number of applicants outweighed the SHANDA R. WELLS earned her doctorate in clinical psychology from MidWestern University. She is currently a behavioral health psychologist at the Departments of Pediatrics and Psychiatry, University of Wisconsin working in integrated care with a dual appointment in pédiatrie and adolescent medicine and psychiatry. In addition to training and education, her research and clinical interests include integrated health care, primary care behavioral health and pédiatrie obesity.

BackgroundIn November 2002, the Centers for Medicare & Medicaid Services (CMS) launched a Nursing Home Quality Initiative that included publicly reporting a set of Quality Measures for all nursing homes in the country, and providing quality improvement assistance to nursing homes nationwide. A pilot of this initiative occurred in six states for six months prior to the launch.MethodsReview and analysis of the lessons learned from the six Quality Improvement Organizations (QIOs) that led quality improvement efforts in nursing homes from the six pilot states.ResultsQIOs in the six pilot states found several key outcomes of the Nursing Home Quality Initiative that help to maximize the potential of public reporting to leverage effective improvement in nursing home quality of care. First, public reporting focuses the attention of all stakeholders in the nursing home industry on achieving good quality outcomes on a defined set of measures, and creates an incentive for partnership formation. Second, publicly reported quality measures motivate nursing home providers to improve in certain key clinical areas, and in particular to seek out new ways of changing processes of care, such as engaging physicians and the medical director more directly. Third, the lessons learned by QIOs in the pilot of this Initiative indicate that certain approaches to providing quality improvement assistance are key to guiding nursing home providers' desire and enthusiasm to improve towards a using a systematic approach to quality improvement.ConclusionThe Nursing Home Quality Initiative has already demonstrated the potential of public reporting to foster collaboration and coordination among nursing home stakeholders and to heighten interest of nursing homes in quality improvement techniques. The lessons learned from this pilot project have implications for any organizations or individuals planning quality improvement projects in the nursing home setting.