Observational study to estimate the proportion of surgical site infection following excision of ulcerated skin tumours (OASIS study).

BACKGROUND: Ulceration is a recognized risk factor for surgical site infection (SSI); however, the proportion of patients developing SSI after excision of an ulcerated skin cancer is unknown. AIM: To determine the proportion of participants with SSI after surgical excision of an ulcerated skin cancer. A secondary aim was to assess feasibility outcomes to inform the design of a randomized controlled trial to investigate the benefits and harms of perioperative antibiotics following excision of ulcerated tumours. METHODS: This was a multicentre, prospective, observational study of patients undergoing excision of an ulcerated skin cancer between March 2019 and March 2020. Prior to surgical excision, surface swabs of the ulcerated tumours of participants recruited from one centre were undertaken to determine organism growth. At 4 weeks after surgery, all participants were e-mailed or posted the Wound Healing Questionnaire (WHQ) to determine whether they had developed SSI. RESULTS: In total, 148 participants were recruited 105 (70.9%) males; mean ± SD age 77.1 ± 12.3 years. Primary outcome data were available for 116 (78.4%) participants, of whom 35 (30.2%) were identified as having an SSI using the WHQ with a cutoff score of 8, and 47 (40.5%) were identified with a cutoff score of 6. Using the modified WHQ in participants with wounds left to heal by secondary intention, 33 (28.4%) and 43 (37.1%) were identified to have SSI respectively. CONCLUSION: This prospective evaluation of SSI identified with the WHQ following excision of ulcerated skin cancers demonstrated a high proportion with SSI. The WHQ was acceptable to patients; however, further evaluation is required to ensure validity in assessing skin wounds.

Environmentally sustainable dermatology.

In 2017, health and social care organizations contributed 6.3% of carbon emissions in England. Efforts to reduce the environmental footprint of the National Health Service (NHS) have been broadly focused on reducing demand, through prevention and patient empowerment, and modifying supply side factors by focusing on lean care systems and low carbon alternatives. This narrative review concentrates on supply side factors to identify sustainable practices with a focus on actions that could be implemented in dermatology departments. For this study, a literature review was conducted In MEDLINE in April 2020. The search terms included 'environmental sustainability' and 'climate change' with 'dermatology', 'telemedicine', 'NHS', 'surgery' and 'operating theatres'. Out of 95 results, 20 were deemed relevant to the review. Although the review showed that there is clearly growing interest in environmental sustainability, the identified literature lacked examples of comprehensive implementation and evaluation of initiatives. The literature discussed distinct areas including transport, waste management and procurement as part of a lean healthcare system. A number of papers highlighted the potential contribution of carbon-reducing actions without citing verifiable outcome data. This narrative review highlights the need for detailed environmental impact assessments of treatment options in dermatology, in tandem with economic analysis. In conclusion, we have identified a clear need for evidence-based guidance setting out implementable actions with identifiable benefits achievable within local clinical teams. This will require engagement between clinicians, patients and healthcare organizations.

Do perioperative antibiotics reduce the risk of surgical-site infections following excision of ulcerated skin cancers? A Critically Appraised Topic.

AIM: To review the efficacy of perioperative antibiotics in reducing the risk of surgical-site infections (SSIs) following excision of ulcerated skin cancers. SETTING AND DESIGN: Study selection, data extraction and analysis were carried out independently by four authors. Only randomized controlled trials (RCTs) reported in the English language were included. INCLUDED STUDIES: RCTs in the English language in which patients received perioperative topical, intralesional or oral antibiotics for dermatological surgery, including Mohs micrographic surgery in general practice, dermatology or plastic surgery departments, were included. OUTCOME: The proportion of participants developing SSI following excision of skin lesions. RESULTS: Thirteen RCTs were identified from our literature search of PubMed and Embase, which evaluated SSI following use of topical (n = 5), oral (n = 3), intramuscular (n = 2), intravenous (n = 1) and intralesional antibiotics (n = 2) in dermatological surgery. Two RCTs specifically investigated SSIs in ulcerated skin cancer excisions; one RCT investigated the SSI rate following surgical treatment specifically for ulcerated skin cancers in individuals randomized to topical antibiotics vs. oral cephalexin; and one RCT compared intravenous cefazolin with no antibiotic, demonstrating significant reduction in SSI rates for ulcerated tumours (P = 0·04). CONCLUSIONS: The heterogeneity of the RCTs included in this study makes it difficult to make a direct comparison of the outcomes measured. High-quality evidence demonstrating a beneficial effect of the use of perioperative antibiotics to prevent SSI following excision of ulcerated skin cancers is lacking. In the absence of an evidence base, we propose that a well-designed multicentre RCT could evaluate the effect of perioperative antibiotics following excision of ulcerated tumours, and potentially reduce inappropriate antibiotic prescription.

General distress, hopelessness-suicidal ideation and worrying in adolescence: concurrent and predictive validity of a symptom-level bifactor model for clinical diagnoses.

BACKGROUND: Clinical disorders often share common symptoms and aetiological factors. Bifactor models acknowledge the role of an underlying general distress component and more specific sub-domains of psychopathology which specify the unique components of disorders over and above a general factor. METHODS: A bifactor model jointly calibrated data on subjective distress from The Mood and Feelings Questionnaire and the Revised Children's Manifest Anxiety Scale. The bifactor model encompassed a general distress factor, and specific factors for (a) hopelessness-suicidal ideation, (b) generalised worrying and (c) restlessness-fatigue at age 14 which were related to lifetime clinical diagnoses established by interviews at ages 14 (concurrent validity) and current diagnoses at 17 years (predictive validity) in a British population sample of 1159 adolescents. RESULTS: Diagnostic interviews confirmed the validity of a symptom-level bifactor model. The underlying general distress factor was a powerful but non-specific predictor of affective, anxiety and behaviour disorders. The specific factors for hopelessness-suicidal ideation and generalised worrying contributed to predictive specificity. Hopelessness-suicidal ideation predicted concurrent and future affective disorder; generalised worrying predicted concurrent and future anxiety, specifically concurrent generalised anxiety disorders. Generalised worrying was negatively associated with behaviour disorders. LIMITATIONS: The analyses of gender differences and the prediction of specific disorders was limited due to a low frequency of disorders other than depression. CONCLUSIONS: The bifactor model was able to differentiate concurrent and predict future clinical diagnoses. This can inform the development of targeted as well as non-specific interventions for prevention and treatment of different disorders.

Adolescent mental health and subsequent parenting: a longitudinal birth cohort study.

BACKGROUND: Adolescent mental health problems are associated with a range of adverse outcomes in adulthood but little is known about the effects on adult parenting practices. This study aimed to examine prospective associations between adolescent conduct and emotional problems and subsequent parenting behaviours in adulthood. METHODS: The study sample comprised 1110 members from the MRC National Survey of Health and Development. Prospective data were collected from teacher reports of conduct and emotional problems at age 13 and 15 years and adult outcome measures of parenting included intellectual environment, cognitive stimulation, coercive discipline, parental interest and parental aspiration. RESULTS: In regression models adjusted for the confounding effects of social background, cognition and education, adolescent conduct problems predicted coercive parenting behaviours in adulthood. The effects of adolescent emotional problems on the development of coercive discipline practices were explained by covariates. Likewise, the inability of parents who displayed conduct problems in adolescence to provide an intellectually stimulating home environment was fully explained by the adjustment for education. CONCLUSIONS: Adolescents who exhibit conduct problems are more likely to develop coercive styles of parenting.

Subacute cutaneous lupus erythematosus associated with radioiodine treatment.

Subacute cutaneous lupus erythematosus (SCLE) is characterized by nonscarring, photodistributed, annular or papulosquamous plaques with antibodies to Ro/SS-A antigen. We report a case of SCLE associated with radioiodine treatment.

A comparison of two screening methods to determine the validity of 24-h food and drink records in children and adolescents.

BACKGROUND/OBJECTIVES: Dietary assessment in humans is hampered by the phenomena of under and overreporting of energy intake, when food records are used to evaluate habitual dietary intake. Different methods to evaluate mis-reporting have been proposed using cut-offs derived from estimates of reported energy intake and basal metabolic rate, or, from predictions of total energy expenditure. This study compares the effect of using two different cut-off approaches to screen food records for validity, completed by a large cohort of Australian children (n=2460), from Grades 1, 5 and 10 (aged 5-17 years). SUBJECTS/METHODS: Energy intake was calculated from 24-h food and drink records for each child. These data were screened using the Goldberg and McCrory cut-offs. The effect of using these two cut-offs on the collected dataset was explored by considering the mean and standard deviation of energy intake in each year level before and after the cut-offs were applied. RESULTS: The use of the Goldberg cut-off resulted in 9% of the total cohort being classified as underreporters, with 60% of these subjects being in Grade 10. The McCrory cut-offs revealed that overall, 22% of the total cohort underreported EI. 33.3% of Grade 1 children were classified as overreporters with this value falling to about 20% of Grade 10 children, while 10-15% of Grade 1 children underreported, with this figure rising to about 30% in Grade 10. CONCLUSIONS: Both the Goldberg and McCrory approaches have their advantages and disadvantages, and we suggest that consideration should be given to the reason for screening data before a particular approach is used, with recognition that these methods do differ in their aims and outcomes. The McCrory method consistently classified a greater number of children as underreporters.

Parental practices predict psychological well-being in midlife: life-course associations among women in the 1946 British birth cohort.

BACKGROUND: Certain parenting styles are influential in the emergence of later mental health problems, but less is known about the relationship between parenting style and later psychological well-being. Our aim was to examine the association between well-being in midlife and parental behaviour during childhood and adolescence, and the role of personality as a possible mediator of this relationship. METHOD: Data from 984 women in the 1946 British birth cohort study were analysed using structural equation modelling. Psychological well-being was assessed at age 52 years using Ryff's scales of psychological well-being. Parenting practices were recollected at age 43 years using the Parental Bonding Instrument. Extraversion and neuroticism were assessed at age 26 years using the Maudsley Personality Inventory. RESULTS: In this sample, three parenting style factors were identified: care; non-engagement; control. Higher levels of parental care were associated with higher psychological well-being, while higher parental non-engagement or control were associated with lower levels of psychological well-being. The effects of care and non-engagement were largely mediated by the offspring's personality, whereas control had direct effects on psychological well-being. The psychological well-being of adult women was at least as strongly linked to the parenting style of their fathers as to that of their mothers, particularly in relation to the adverse effects of non-engagement and control. CONCLUSIONS: This study used a prospective longitudinal design to examine the effects of parenting practices on psychological well-being in midlife. The effects of parenting, both positive and negative, persisted well into mid-adulthood.