The use of perioperative prophylactic antibiotics following excision of ulcerated skin lesions in the UK – A national, multi‐speciality survey of clinicians

Cutaneous involvement of dental sepsis is a rare occurrence in children. It often presents as a diagnostic dilemma, especially in the absence of oral symptoms, with initial presentation to non-dental professionals. This article discusses three cases of children presenting with cutaneous involvement of odontogenic origin to two paediatric dentistry departments in the UK. All cases had delayed presentations and were initially submitted to ineffective treatment, with significant impact on the children’s well-being. Final management included antibiotic therapy, drainage and extraction of the septic tooth. These three cases highlight the importance of considering a dental aetiology for localized inflammatory and purulent skin lesions of the mandible. Prompt diagnosis and early treatment are determinant for early resolution and avoidance of systemic or psychological complications. CPD/Clinical Relevance: This article discusses diagnosis and management of three different presentations of odontogenic sepsis with cutaneous involvement in children.

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Intravenous co-amoxiclav to prevent infection after operative vaginal delivery: the ANODE RCT

Health Technology Assessment ◽

10.3310/hta23540 ◽

2019 ◽

Vol 23 (54) ◽

pp. 1-54

Author(s):

Marian Knight ◽

Virginia Chiocchia ◽

Christopher Partlett ◽

Oliver Rivero-Arias ◽

Xinyang Hua ◽

...

Keyword(s):

Single Dose ◽

Primary Outcome ◽

Controlled Trial ◽

Prophylactic Antibiotic ◽

Health Technology ◽

Prophylactic Antibiotics ◽

Vaginal Birth ◽

Suspected Infection ◽

The Uk ◽

Care Costs

Background Sepsis is a leading cause of direct and indirect maternal death in both the UK and globally. All forms of operative delivery are associated with an increased risk of sepsis, and the National Institute for Health and Care Excellence’s guidance recommends the use of prophylactic antibiotics at all caesarean deliveries, based on substantial randomised controlled trial evidence of clinical effectiveness. A Cochrane review, updated in 2017 (Liabsuetrakul T, Choobun T, Peeyananjarassri K, Islam QM. Antibiotic prophylaxis for operative vaginal delivery. Cochrane Database Syst Rev 2017;8:CD004455), identified only one small previous trial of prophylactic antibiotics following operative vaginal birth (forceps or ventouse/vacuum extraction) and, given the small study size and extreme result, suggested that further robust evidence is needed. Objectives To investigate whether or not a single dose of prophylactic antibiotic following operative vaginal birth is clinically effective for preventing confirmed or presumed maternal infection, and to investigate the associated impact on health-care costs. Design A multicentre, randomised, blinded, placebo-controlled trial. Setting Twenty-seven maternity units in the UK. Participants Women who had an operative vaginal birth at ≥ 36 weeks’ gestation, who were not known to be allergic to penicillin or constituents of co-amoxiclav and who had no indication for ongoing antibiotics. Interventions A single dose of intravenous co-amoxiclav (1 g of amoxicillin/200 mg of clavulanic acid) or placebo (sterile saline) allocated through sealed, sequentially numbered, indistinguishable packs. Main outcome measures Primary outcome – confirmed or suspected infection within 6 weeks of giving birth. Secondary outcomes – severe sepsis, perineal wound infection, perineal pain, use of pain relief, hospital bed stay, hospital/general practitioner visits, need for additional perineal care, dyspareunia, ability to sit comfortably to feed the baby, maternal general health, breastfeeding, wound breakdown, occurrence of anaphylaxis and health-care costs. Results Between March 2016 and June 2018, 3427 women were randomised: 1719 to the antibiotic arm and 1708 to the placebo arm. Seven women withdrew, leaving 1715 women in the antibiotic arm and 1705 in the placebo arm for analysis. Primary outcome data were available for 3225 out of 3420 women (94.3%). Women randomised to the antibiotic arm were significantly less likely to have confirmed or suspected infection within 6 weeks of giving birth (180/1619, 11%) than women randomised to the placebo arm (306/1606, 19%) (relative risk 0.58, 95% confidence interval 0.49 to 0.69). Three serious adverse events were reported: one in the placebo arm and two in the antibiotic arm (one was thought to be causally related to the intervention). Limitations The follow-up rate achieved for most secondary outcomes was 76%. Conclusions This trial has shown clear evidence of benefit of a single intravenous dose of prophylactic co-amoxiclav after operative vaginal birth. These results may lead to reconsideration of official policy/guidance. Further analysis of the mechanism of action of this single dose of antibiotic is needed to investigate whether earlier, pre-delivery or repeated administration could be more effective. Until these analyses are completed, there is no indication for administration of more than a single dose of prophylactic antibiotic, or for pre-delivery administration. Trial registration Current Controlled Trials ISRCTN11166984. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 54. See the National Institute for Health Research Journals Library website for further project information.

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Managing suspicious skin lesions on deployed operations

Journal of The Royal Naval Medical Service ◽

10.1136/jrnms-104-115 ◽

2018 ◽

Vol 104 (2) ◽

pp. 115-119

Author(s):

T J Holland ◽

S McIntosh ◽

J J Smith

Keyword(s):

Skin Cancer ◽

Risk Stratification ◽

Skin Lesions ◽

Key Factors ◽

Military Population ◽

The Uk ◽

The Military

AbstractThe incidence of skin cancer is rising year on year. The general risk in the military population is low, but a missed lesion may have severe consequences. This paper outlines the key factors to consider when assessing a lesion, risk stratification methods and the challenges of managing suspected malignancy when operating remote from the UK.

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Accessing Mole-Scanning through Community Pharmacy: A Pilot Service in Collaboration with Dermatology Specialists

Pharmacy ◽

10.3390/pharmacy8040231 ◽

2020 ◽

Vol 8 (4) ◽

pp. 231

Author(s):

Charlotte L. Kirkdale ◽

Zoe Archer ◽

Tracey Thornley ◽

David Wright ◽

Mette Valeur ◽

...

Keyword(s):

Malignant Melanoma ◽

Community Pharmacy ◽

Skin Lesions ◽

Service Evaluation ◽

Outcome Data ◽

Medical Attention ◽

Community Pharmacies ◽

Service Outcomes ◽

The Uk ◽

Care Costs

Early identification and treatment of malignant melanoma is crucial to prevent mortality. The aim of this work was to describe the uptake, profile of users and service outcomes of a mole scanning service in the community pharmacy setting in the UK. In addition, health care costs saved from the perspective of general practice were estimated. The service allowed patients to have concerning skin lesions scanned with a dermatoscopy device which were analyzed remotely by clinical dermatology specialists in order to provide recommendations for the patient. Patients were followed up to ascertain the clinical outcome. Data were analyzed for 6355 patients and 9881 scans across 50 community pharmacies. The majority of the scans required no further follow-up (n = 8763, 88.7%). Diagnosis was confirmed for 70.4% (n = 757/1118) of scans where patients were recommended to seek further medical attention. Of these, 44.3% were ultimately defined as normal (n = 335) and 6.2% as malignant melanoma (n = 47/757). An estimated 0.7% of scans taken as part of the service led to a confirmed diagnosis of malignant melanoma. This service evaluation has shown that a mole scanning service available within community pharmacies is effective at triaging patients and ultimately playing a part in identifying diagnoses of malignant melanoma.

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Pathological and phylogenetic characterization ofAmphibiothecumsp. infection in an isolated amphibian (Lissotriton helveticus) population on the island of Rum (Scotland)

Parasitology ◽

10.1017/s0031182016001943 ◽

2016 ◽

Vol 144 (4) ◽

pp. 484-496 ◽

Cited By ~ 5

Author(s):

CATERINA FIEGNA ◽

CHARLOTTE L. CLARKE ◽

DARREN J. SHAW ◽

JOHANNA L. BAILY ◽

FRANCES C. CLARE ◽

...

Keyword(s):

Infectious Disease ◽

Phylogenetic Analysis ◽

Clinical Outcome ◽

Novel Species ◽

Skin Lesions ◽

Phylogenetic Characterization ◽

Gross Pathology ◽

Lissotriton Helveticus ◽

The Uk ◽

Cyst Morphology

SUMMARYOutbreaks of cutaneous infectious disease in amphibians are increasingly being attributed to an overlooked group of fungal-like pathogens, the Dermocystids. During the last 10 years on the Isle of Rum, Scotland, palmate newts (Lissotriton helveticus) have been reportedly afflicted by unusual skin lesions. Here we present pathological and molecular findings confirming that the pathogen associated with these lesions is a novel organism of the order Dermocystida, and represents the first formally reported, and potentially lethal, case of amphibian Dermocystid infection in the UK. Whilst the gross pathology and the parasite cyst morphology were synonymous to those described in a study from infectedL. helveticusin France, we observed a more extreme clinical outcome on Rum involving severe subcutaneous oedema. Phylogenetic topologies supported synonymy between Dermocystid sequences from Rum and France and as well as their distinction fromAmphibiocystidiumspp. Phylogenetic analysis also suggested that the amphibian-infecting Dermocystids are not monophyletic. We conclude that theL. helveticus-infecting pathogen represents a single, novel species;Amphibiothecum meredithae.

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VivaScope® 1500 and 3000 systems for detecting and monitoring skin lesions: a systematic review and economic evaluation

Health Technology Assessment ◽

10.3310/hta20580 ◽

2016 ◽

Vol 20 (58) ◽

pp. 1-260 ◽

Cited By ~ 13

Author(s):

Steven J Edwards ◽

Ifigeneia Mavranezouli ◽

George Osei-Assibey ◽

Gemma Marceniuk ◽

Victoria Wakefield ◽

...

Keyword(s):

Systematic Review ◽

Cost Effectiveness ◽

Economic Model ◽

Cost Effective ◽

Skin Lesions ◽

Dominant Strategy ◽

Diagnostic Assessment ◽

Cochrane Library ◽

Diagnostic Data ◽

The Uk

BackgroundSkin cancer is one of the most common cancers in the UK. The main risk factor is exposure to ultraviolet radiation from sunlight or the use of sunbeds. Patients with suspicious skin lesions are first examined with a dermoscope. After examination, those with non-cancerous lesions are discharged, but lesions that are still considered clinically suspicious are surgically removed. VivaScope®is a non-invasive technology designed to be used in conjunction with dermoscopy to provide a more accurate diagnosis, leading to fewer biopsies of benign lesions or to provide more accurate presurgical margins reducing the risk of cancer recurrence.ObjectivesTo evaluate the clinical effectiveness and cost-effectiveness of VivaScope®1500 (Caliber Imaging and Diagnostics, Rochester, NY, USA; Lucid Inc., Rochester, NY, USA; or Lucid Inc., MAVIG GmbH, Munich, Germany) and VivaScope®3000 (Caliber Imaging and Diagnostics, Rochester, NY, USA) in the diagnosis of equivocal skin lesions, and VivaScope 3000 in lesion margin delineation prior to surgical excision of lesions.Data sourcesDatabases (MEDLINE, EMBASE and The Cochrane Library) were searched on 14 October 2014, reference lists of included papers were assessed and clinical experts were contacted for additional information on published and unpublished studies.MethodsA systematic review was carried out to identify randomised controlled trials (RCTs) or observational studies evaluating dermoscopy plus VivaScope, or VivaScope alone, with histopathology as the reference test. A probabilistic de novo economic model was developed to synthesise the available data on costs and clinical outcomes from the UK NHS perspective. All costs were expressed as 2014 prices.ResultsSixteen studies were included in the review, but they were too heterogeneous to be combined in a meta-analysis. One of two diagnostic studies that were deemed most representative of UK clinical practice reported that dermoscopy plus VivaScope 1500 was significantly more sensitive than dermoscopy alone in the diagnosis of melanoma (97.8% vs. 94.6%;p = 0.043) and significantly more specific than dermoscopy alone in the diagnosis of non-melanoma (92.4% vs. 26.74%;p < 0.000001). The results of another study suggest 100% [95% confidence interval (CI) 86.16% to 100%] sensitivity for dermoscopy plus VivaScope 1500 versus 100% (95% CI 91.51% to 100%) for dermoscopy alone. Specificity varied from 51.77% to 80.2% depending on the analysis set used. In terms of margin delineation with VivaScope, one study found that 17 out of 29 patients with visible lentigo maligna (LM) had subclinical disease of > 5 mm beyond the dermoscopically identified margin. Using ‘optimistic’ diagnostic data, the economic model resulted in an incremental cost-effectiveness ratio (ICER) of £8877 per quality-adjusted life-year (QALY) (£9362 per QALY), while the ‘less favourable’ diagnostic data resulted in an ICER of £19,095 per QALY (£25,453 per QALY) in the diagnosis of suspected melanomas. VivaScope was also shown to be a dominant strategy when used for the diagnostic assessment of suspected basal cell carcinoma (BCC). Regarding margin delineation of LM, mapping with VivaScope was cost-effective, with an ICER of £10,241 per QALY (£11,651 per QALY). However, when VivaScope was used for diagnosis as well as mapping of LM, then the intervention cost was reduced and VivaScope became a dominant strategy.LimitationsThere is an absence of UK data in the included studies and, therefore, generalisability of the results to the UK population is unclear.ConclusionsThe use of VivaScope appears to be a cost-effective strategy in the diagnostic assessment of equivocal melanomas and BCCs, and in margin delineation of LM prior to surgical treatment.Future workHigh-quality RCTs are required in a UK population to assess the diagnostic accuracy of VivaScope in people with equivocal lesions.Study registrationThis study is registered as PROSPERO CRD42014014433.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Conversation Map™: strumento per l’educazione del caregiver sulla prevenzione delle lesioni da pressione/Conversation Map™: a tool for the education of the caregiver on the prevention of pressure ulcers

Italian Journal of Wound Care ◽

10.4081/ijwc.2018.36 ◽

2018 ◽

Vol 2 (3) ◽

Author(s):

Alessandra Chiossi

Keyword(s):

Care Setting ◽

Pressure Ulcers ◽

National Health System ◽

Epidemiological Data ◽

Skin Lesions ◽

Track And Field ◽

Braden Scale ◽

Extended Care ◽

The Uk ◽

Conversation Map

Lo sviluppo di Lesioni da Pressione (LdP) rappresenta un evento molto frequente ma potenzialmente prevenibile; tuttavia, avere una fotografia reale del fenomeno è molto difficile. Le stime variano in rapporto al setting assistenziale considerato: nei reparti per acuti l’incidenza varia dallo 0,4 al 38%, nelle residenze sanitarie assistenziali dal 2,2 al 23,9%, mentre nell’ambito domiciliare dallo 0 al 17%. Si valuta che negli USA sia una condizione che colpisce circa 1,5-3 milioni di persone, comportando una spesa sanitaria annua di circa 5 miliardi di dollari, da 1.4 a 2.1 miliardi di sterline nel Regno Unito e 1 miliardo di euro in Italia, pari al 4% dei costi totali del Sistema Sanitario Nazionale. Partendo dai dati epidemiologici si è voluto indagare se i caregivers delle persone assistite a rischio di LdP conoscano le strategie idonee a prevenire questo tipo di lesioni cutanee. Quindi, con la somministrazione di un questionario di 23 domande a 60 caregivers si è voluto valutare il bisogno o meno di una conoscenza sulla prevenzione delle lesioni da pressione. Lo studio ha rivelato che 83,3% degli intervistati non ha ricevuto informazioni né su cosa siano le LdP né su come si sviluppano; di poco inferiore la percentuale riguardante le informazioni sulla prevenzione di LdP. Si è voluto trovare, quindi, una risposta a questo bisogno di informazione, sviluppando una Conversation Map™, da proporre come strumento per l’educazione dei caregivers alla prevenzione delle LdP. La Conversation Map™, creata da Healthy Interactions Inc., è uno strumento didattico unico e speciale, perché favorisce la partecipazione della persona assistita o dei caregivers in un momento didattico sia verbale che visivo. Nella mappa, che ha il setting di un campo d’atletica, vengono toccati i punti principali della prevenzione delle lesioni: cura della cute, cambi di postura, presidi antidecubito, alimentazione e le medicazioni come prevenzione. Vengono spiegate le definizioni di LdP e di LdP di 1° stadio oltre che i principali fattori che concorrono alla formazione delle LdP, la scala di Braden e l’indice di Norton. The development of Pressure Ulcers (PU) is a very frequent, but potentially preventable, event; however having a real time picture of the phenomenon is very difficult. The estimates vary depending on the considered care setting: in the acute care wards the incidence varies between 0,4 and 38%, in the Extended Care Unit between 2,2 and 23,9%, while in the home-care setting between 0 and 17%. It is estimated that in the US it’s a condition that affects around 1,5-3 million of persons, involving a healthcare expenditures of around 5 billion of dollars per year, between 1.4 and 2.1 billion of pounds in the UK and 1 billion euros in Italy; equal to the 4% of the total costs of the National Health System. Starting from epidemiological data, it has been investigated if the caregivers of the assisted persons with PU risk know the appropriate strategies to prevent this type of skin lesions. Therefore, in order to evaluate the need of knowledge on the prevention of Pressure Ulcers, a questionnaire with 23 questions was administered to 60 caregivers. The study revealed that 83,3% of those interviewed haven’t received any information on what the PU are or on how they develop, slightly less the percentage about the information on the PU prevention. The aim was to find an answer to this need of information by developing a Conversation Map™, to propose as a tool for the education of the caregivers on the prevention of PU. The Conversation Map™, created by Healthy Interactions Inc., is a unique and special teaching tool: it encourages the participation of the assisted person or the caregivers in an educational moment that is both verbal and visual. In the map, that has the setting of a track and field stadium, the main points of the Pressure Ulcers prevention are covered: skin care, posture changes, anti-bedsores surfaces, nutrition and dressing as prevention. The definitions of PU and 1st stage PU are explained, in addition to the main factors that concur to the PU development, the Braden scale and the Norton index.

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Trends in dermoscopy use in the UK: results from surveys in 2003 and 2012

Dermatology Practical & Conceptual ◽

10.5826/dpc.0502a04 ◽

2015 ◽

pp. 29-38

Author(s):

Thomas D. Butler ◽

Rubeta N. Matin ◽

Andrew G. Affleck ◽

Colin J. Fleming ◽

Jonathan C. Bowling

Keyword(s):

Online Survey ◽

Skin Lesions ◽

Clinical Use ◽

The United Kingdom ◽

Paper Questionnaire ◽

Previous Decade ◽

Period Data ◽

Pigmented Skin Lesions ◽

Reported Data ◽

The Uk

Background: Dermoscopy is a useful tool to aid diagnosis of pigmented and non-pigmented skin lesions, as well as many other dermatological conditions. Use of dermoscopy is increasing worldwide, but to date, there are no reported data on attitudes of dermatologists in the United Kingdom (UK) towards dermoscopy. Objective: To determine current attitudes of UK dermatologists towards dermoscopy and assess how these attitudes have changed over the last decade. Methods: In October 2012, an online survey was sent to members of British Association of Dermatologists over a 12-week period. Data were subsequently compared with data from a similar UK nationwide paper questionnaire distributed to members in 2003. Results: The 2003 survey collected 292 responses (uptake 42%), and in 2012 there were 209 responses (22%), predominantly from consultants and registrars. In 2012, 86% respondents reported increased use of dermoscopy over the previous decade with 98.5% of respondents reporting regular clinical use of dermoscopy, compared with 54% in 2003. Overall, 81% respondents in 2012 had received dermoscopy training, mainly from UK-based courses (62% of respondents) but increasingly via Internet-based resources (30% vs. 7% in 2003). However, 39% respondents lacked confidence when making a diagnosis based on their interpretation of dermoscopy findings. Conclusions: Over the last decade, use of dermoscopy has increased amongst UK dermatologists and the majority of respondents now employ dermoscopy in daily clinical practice. However, the use of dermoscopy in the dermatology community overall is not known and for those individuals there is a continued need for education.

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Fine Structural Alterations in Thyroid Follicular Cells (FC) and Changes in Serum Thyroxine Produced by Feeding Polychlorinated Biphenyl (PCB) to Rats

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100079929 ◽

1977 ◽

Vol 35 ◽

pp. 498-499

Author(s):

W.T. Collins ◽

Charles C. Capen ◽

Louis Kasza

Keyword(s):

Feed Efficiency ◽

Polychlorinated Biphenyl ◽

Serum Proteins ◽

Skin Lesions ◽

Hepatic Necrosis ◽

Ultrastructural Changes ◽

Lymphoid Tissues ◽

Heat Transfer Fluids ◽

Thyroid Follicular Cells ◽

Peripheral Metabolism

The widespread contamination of the environment with PCB, a compound used extensively by industry in hydraulic and heat transfer fluids as well as plasticizers and solvents in adhesives and sealants, has resulted in detectable tissue levels in a large portion of the human population, domestic animals, and wildlife. Intoxication with PCB produces severe hepatic necrosis, degeneration of lymphoid tissues and kidney, skin lesions, decreased reproductive performance, reduced feed efficiency, and decreased weight gain. PCB also has been reported to reduce the binding of thyroid hormone to serum proteins and enhance the peripheral metabolism of thyroxine with increased excretion of thyroxine-glucuronide in the bile (Bastomsky, Endocrinology 95: 1150-1155, 1974).The objectives of this investigation were (1) to investigate the histopathologic, histochemical, and ultrastructural changes in thyroid FC produced by the acute (4 week) and chronic (12 week) administration of low (50 ppm) and high (500 ppm) doses of PCB to rats, (2) to correlate these alterations to changes in serum immunoreactive thyroxine concentration, and (3) to investigate the persistence of the effects of PCB on the thyroid gland.

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