The modified HoVert (mHoVert) method improves diagnostic certainty compared to the St John's protocol for alopecia biopsy specimens: A retrospective single center study.

BACKGROUND: Access to vertical and transverse sections of a punch biopsy specimen improves the diagnosis of alopecia. Both two biopsy specimen and single-punch biopsy specimen techniques to visualize both transverse and vertical sections have been described. Their comparative diagnostic certainty is not known. We aimed to assess the diagnostic certainty of a modified HoVert (mHoVert) method, without direct immunofluorescence (DIF), compared to the St John's protocol, a two-biopsy technique with DIF. METHODS: Fifty-seven cases of alopecia processed using the St John's protocol and 60 cases of alopecia processed using mHoVert were reviewed. Diagnoses made were rated as certain/probable, possible, or uncertain, depending on the language in the histopathology report. Cases processed by the St John's protocol had final diagnosis and DIF result recorded. RESULTS: In the mHoVert group, significantly more diagnoses were certain/probable (66%, 95% confidence interval [CI]: 57%-75%), compared to 46% (95% CI: 36%-56%) of diagnoses in the St John's protocol group (p = 0.005). DIF result did not affect the final diagnosis in any of the 57 cases reviewed. CONCLUSIONS: DIF is not required in the diagnosis of most cases of alopecia. The mHoVert method provides more certain/probable diagnoses than the St John's protocol and can reduce cost and patient morbidity.

An update on cutaneous granular cell tumours for dermatologists and dermatopathologists.

Granular cell tumours are rare soft tissue neoplasms, which occur at a wide variety of sites and commonly involve the skin. Distinction between benign and malignant granular cell tumours is important because benign tumours can be fully cured by complete excision, whereas malignant tumours commonly recur and cause fatal metastatic disease. Communication between the dermatologist and pathologist is also important, as pathology may provide false reassurance by evaluating a benign-appearing part of a clinically malignant tumour. The following review summarizes the current literature on the epidemiology, clinical presentation, pathology, radiology, treatment and prognosis of cutaneous granular cell tumours, with a focus on improving diagnosis and management for dermatologists and dermatopathologists.

Improving wellbeing among UK doctors redeployed during the COVID-19 pandemic.

BACKGROUND: In response to the COVID-19 pandemic, the NHS has implemented significant workforce changes to manage the increased and changing demand on healthcare services. We aimed to investigate the impact of redeployment on the wellbeing of doctors as well as highlighting ways to improve. METHODS: We conducted a survey at three NHS trusts over 2 weeks asking redeployed doctors to rate their morale, work-life balance and perceived support and safety, and to voice concerns. RESULTS: 172 redeployed doctors responded to the survey. 66.3% felt confident in their new role, 65.7% felt satisfied or neutral with their new role and only 31.4% felt stressed at work. 66.3% felt valued by their team and 79% felt valued by the general public. 64.5% had noticed an increase in the length of breaks and 89% felt their rotas provided sufficient respite. 55.2% did not feel confident in the guidance from Public Health England/Wales on using personal protective equipment (PPE) and 54.7% did not feel safe while wearing PPE. The three most common concerns were training opportunities, PPE and family health. CONCLUSION: Our findings suggest that morale is higher than might be expected with doctors feeling valued, confident and well rested in their new role. Concerns about training opportunities/career progression, PPE and family safety need to be addressed.

Nurse-led treatment for occipital neuralgia.

Occipital neuralgia is a headache resulting from dysfunction of the occipital nerves. Medically resistant occipital neuralgia is treated by greater occipital nerve injection, which is traditionally performed by neurologists. A nurse-led clinic was developed to try to improve the service. Patient feedback showed that the clinic was positively perceived by patients, with most stating the nurse-led model was more efficient than the previous one, which had been led by consultants.