Cost-effectiveness of atenolol compared to propranolol as first-line treatment of infantile haemangioma: A pilot study.

Propranolol is the first-line agent for the treatment of infantile haemangioma (IH). Due to its non-selective beta blockade respiratory adverse events are commonplace. Atenolol is a selective beta-1 antagonist and is a second line for patients with a significant respiratory history or those intolerant of propranolol. Previous studies suggest that the two treatments are equally efficacious; however; the narrow side effect profile and once-daily administration of atenolol makes it an attractive alternative. The aim of this study was to compare the cost-effectiveness of atenolol and propranolol in the treatment of IH. Over a two-year period, five patients with nine IH received the first-line treatment with atenolol. Nine individual lesions from six propranolol patients were matched to these lesions, according to patient demographics and IH characteristics. Treatment response was determined by two independent clinician using both the Visual Analogue Score (VAS) and Haemangioma Activity Score (HAS). A cost-analysis of those treated with atenolol was undertaken and compared to the equivalent costing for standard and maximum dose propranolol. Treatment efficacy of atenolol was comparable to propranolol with mean change in VAS and HAS scores of -7.0 (vs -7.2) and 6.1 (vs 5.7), respectively. The cost analysis revealed atenolol was over 20 times less expensive than standard dose propranolol. In conclusion, the findings of this study suggest that atenolol is significantly less expensive and at least as effective as propranolol. These findings highlight the need for a multicentre randomised controlled trial to further investigate the cost-effectiveness of these two agents in the treatment of IH.

Implementation of a telemedicine service to provide skin cancer care in a tertiary plastic surgery unit during COVID-19 - a comprehensive review.

BACKGROUND: In response to the COVID-19 pandemic, our tertiary skin cancer service had to adapt rapidly to reduce hospital footfall. Consequently, all clinic appointments for skin cancer patients were converted to telephone consultations. This study aims to provide a comprehensive review of this new service. METHODS: This study consisted of three domains: patient and staff experience, efficacy and productivity. Patient and staff experience was assessed through prospective surveys. Efficacy of telephone appointments was assessed through prospective review of clinic coding to evaluate outcomes including rate of conversion to face-to-face appointment. Markers of treatment pathway efficacy included time from referral to surgical listing and the incidence of benign lesions placed on skin cancer pathways. Productivity was evaluated through review of the cumulative number of completed and missed appointments over a 1-month period before and during the pandemic. RESULTS: All patients were satisfied with the telephone consultation and were preferred to previous experience of face-to-face appointments by 67%. Over 80% of responding clinicians felt telephone clinics should remain as a legacy of COVID-19. Time from referral to scheduling for surgery was significantly shorter for urgent lesions when listed through a teleclinic compared to face-to-face appointment. The telephone service allowed us to maintain 46% of the plastic surgery outpatient activity of May 2019 and missed appointments almost halved. CONCLUSION: Patients and clinicians have responded positively to the new service. This study highlights the merits of an ongoing telephone clinic service for select patients on resolution of the COVID-19 impact on health services.

Pet dog bites in children: management and prevention.

Dog bite injuries are a significant public health problem and many are sustained by children. These injuries can be complex, both physically and psychologically, and in rare cases fatal. This paper will review current evidence-based approaches to treatment, explore identified patterns in biting incidents and discuss the effectiveness of prevention strategies. Safe management of these patients requires a comprehensive approach. Physical injuries need to be accurately assessed with a high index of suspicion for underlying injuries, particularly in younger children less able to communicate. Treatment depends on severity and location, but all bites must be irrigated to reduce the risk of infection but may not always require prophylactic antibiotic use. Careful exploration of the circumstances in which the bite occurred is essential to make safeguarding decisions and prevent future bites. Reducing the incidence of paediatric dog bites requires education of both children and parents that any dog can bite, regardless of breed, and all child-dog interactions must be highly supervised. However, education alone is unlikely to prevent dog bites. Policies that support environmental changes need to be developed such as provision of pet dogs less likely to bite (or bite as severely), through breeding for temperament and appropriate socialisation. Additionally, investment in psychological support for bite victims and their families is required to reduce the long-term impacts of being bitten.

Neurosurgical transection of the breast: an unexpected extracranial complication of ventriculoperitoneal shunt insertion.

Ventriculoperitoneal (VP) shunt placement is among the most common surgical procedures undertaken by neurosurgeons. Complications arising from the thoracic portion of the shunt are relatively rare in comparison with those of the intraventricular and peritoneal portions. Disruption of primary breast development following VP shunt placement has not previously been reported. The authors describe the case of a 15-year-old girl referred to the plastic surgery department with a significant right breast deformity and associated asymmetry following VP shunt placement performed during the neonatal period. The calcified shunt was excised and the breast deformity was corrected surgically through multiple scar tissue releases and restoration of the normal breast parenchymal anatomy via a minimally invasive approach, resulting in an excellent aesthetic outcome. This case highlights the potential for injury to occult breast tissue in pediatric patients undergoing VP shunt placement, which can impair subsequent cosmesis and quality of life.