Critical thinking and diagnostic reasoning when advanced practitioners assess and treat skin conditions

Advanced clinical practitioner (ACP) roles require a broad range of knowledge of both medical and surgical medicine and the ability to work autonomously in a variety of settings. Despite around half of the UK adult population presenting with a skin condition requiring attention, this is something many ACPs feel unprepared to be consulted on. However, due to the complexity and large number of potential diagnoses, it is imperative that ACPs develop their confidence and knowledge to diagnosis, request investigations and initiate treatment for a patient with a skin complaint. In the first part of this clinical review the authors presented the key elements of history taking, consultation and assessment of the skin. This second clinical review discusses the main differential diagnoses, mimics, common investigations and treatments. This article is designed to support novice ACPs from acute hospital settings to primary care to develop a foundation of understanding in the main diagnosis and treatment options that should be considered following a clinical assessment of patients’ skin outside the dermatology setting.

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Conducting a consultation and clinical assessment of the skin for advanced clinical practitioners

British Journal of Nursing ◽

10.12968/bjon.2021.30.21.1232 ◽

2021 ◽

Vol 30 (21) ◽

pp. 1232-1236

Author(s):

Hazel McPhillips ◽

Alison F Wood ◽

Bruce Harper-McDonald

Keyword(s):

Primary Care ◽

Adult Population ◽

Skin Condition ◽

Acute Hospital ◽

History Taking ◽

Ability To Work ◽

Key Points ◽

Patient Consultation ◽

Skin Conditions ◽

The Uk

Advanced clinical practitioner (ACP) roles require a broad range of knowledge of both medical and surgical areas and the ability to work autonomously in a variety of settings. Despite around half of the UK adult population presenting with a skin condition requiring attention at some point, this is an area many ACPs feel unprepared to manage. However, due to the complexity and large number of potential diagnoses, it is imperative that ACPs develop their knowledge of skin conditions so that they can confidently conduct consultations with patients. This clinical review presents the key elements of patient consultation, history taking and assessment of the skin. This is designed to support novice ACPs, whether working in acute hospital settings or primary care, to develop an understanding of the key points that should be included when consulting with and assessing the skin of patients outwith the dermatology setting.

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Case Study of Ruqyah Therapy On Muslim Patient with Eczema

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2021.3.1.696 ◽

2021 ◽

Vol 3 (1) ◽

pp. 41-43

Author(s):

Hamidi Abdul Rahman ◽

Supyan Hussin

Keyword(s):

East Asian ◽

Skin Condition ◽

Asian Countries ◽

Rapid Improvement ◽

Remarkable Improvement ◽

Hospital Beds ◽

Skin Conditions ◽

The Uk ◽

Muslim Patient

A case study on a female Malay living in the UK with serious eczema was presented. Her parents believed that it was a condition called santau, a common cultural belief in South East Asian countries. Santau is believed as the insertion of poisonous materials into the victim’s body with the help of jinn. Santau is normally differentiated from other medical skin conditions by the rapid deterioration of the condition and rapid improvement after successful treatment. Her skin condition was intolerable after a trip to Malaysia. Unable to be admitted to hospital because of the pressure on hospital beds during the Covid-19 pandemic, she resorted to intensive multiple-day ruqyah therapy, a therapy based on the incantation of verses from the Quran. Remarkable improvement was observed after three days. Apart from delivering therapeutic outcome, ruqyah therapy as a Traditional and Complementary Medicine has its role in relieving the pressure on the mainstream health system especially in time of pandemic.

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Reliability, Validity, and Gender Invariance of the Exercise Benefits/Barriers Scale: An Emerging Evidence for a More Concise Research Tool

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073516 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3516

Author(s):

Stefan Koehn ◽

Farzad Amirabdollahian

Keyword(s):

Factor Structure ◽

Adult Population ◽

Research Tool ◽

Future Research ◽

Gender Invariance ◽

The United Kingdom ◽

And Gender ◽

The Uk ◽

Fit Index ◽

Northwest Region

The Exercise Benefits/Barriers Scale (EBBS) research instrument has been extensively used to investigate the perceived benefits and barriers of exercise in a range of settings. In order to examine theoretical contentions and translate the findings, it is imperative to implement measurement tools that operationalize the constructs in an accurate and reliable way. The original validation of the EBBS proposed a nine-factor structure for the research tool, examined the EBBS factor structure, and suggested that various factors are important for the testing of the perception of exercise benefits and barriers, whereas a few items and factors may not be vital. The current study conducted a confirmatory factor analysis (CFA) using hierarchical testing in 565 participants from the northwest region of the United Kingdom, the results of which provided evidence for a four-factor structure of the benefits measure, with the Comparative Fit Index (CFI) = 0.943, Tucker–Lewis Index (TLI) = 0.933, and root means square error of approximation (RMSEA) = 0.051, namely life enhancement, physical performance, psychological outlook, and social interaction, as well as a two-factor structure of the barrier measures, with the CFI = 0.953, TLI = 0.931, and RMSEA = 0.063, including exercise milieu and time expenditure. Our findings showed that for a six-factor correlated model, the CFI = 0.930, TLI = 0.919, and RMSEA = 0.046. The multi-group CFA provided support for gender invariance. The results indicated that after three decades of the original validation of the EBBS, many of the core factors and items are still relevant for the assessment of higher-order factors; however, the 26-item concise tool proposed in the current study displays a better parsimony in comparison with the original 43-item questionnaire. Overall, the current study provides support for a reliable, cross-culturally valid EBBS within the UK adult population, however, it proposes a shorter and more concise version compared with the original tool, and gives direction for future research to focus on the content validity for assessing the perception of the barriers to physical activity.

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‘Not just a piece of skin in front of you’—a qualitative exploration of the experiences of adolescents with eczema and psoriasis with healthcare professionals

BMJ Open ◽

10.1136/bmjopen-2020-041108 ◽

2021 ◽

Vol 11 (1) ◽

pp. e041108

Author(s):

Isabella Joy de Vere Hunt ◽

Abigail McNiven ◽

Amanda Roberts ◽

Himesh Parmar ◽

Tess McPherson

Keyword(s):

Young People ◽

Skin Disease ◽

Healthcare Professionals ◽

Healthcare Delivery ◽

Healthcare Providers ◽

Secondary Analysis ◽

Emotional Impact ◽

Skin Conditions ◽

The Uk ◽

Qualitative Exploration

BackgroundThere is little qualitative research in the UK focussing on adolescents’ experience of their healthcare providers, and inflammatory skin conditions are a common heath problem in adolescence.AimTo explore the experiences of adolescents with eczema and psoriasis with healthcare professionals, and to distil the participants’ key messages for their healthcare providers.DesignThis is a secondary thematic analysis of interviews with adolescents with eczema or psoriasis.ParticipantsThere were a total of 41 text transcripts of interviews with young people with eczema or psoriasis who had given permission for secondary analysis; 23 of the participants had eczema, and 18 psoriasis. Participants were living in the UK at time of interview, and aged 15–24 years old.ResultsWe have distilled the following key messages from young people with eczema and psoriasis for healthcare providers: (1) address the emotional impact; (2) give more information, with the subtheme and (3) appreciate patient research. We identified the following eczema-specific themes: (ECZ-4) ‘It’s not taken seriously’; (ECZ-5) offer choice in treatment and (ECZ-6) lack of structure/conflicting advice. Two psoriasis-specific themes were identified: (PSO-4) feeling dehumanised/treat me as a person; and (PSO-5) think about how treatments will affect daily life.ConclusionThis qualitative data analysis highlights the need for greater recognition of the emotional impact of skin disease in adolescence, and for more comprehensive provision of information about the conditions. We call for greater sensitivity and flexibility in our approach to adolescents with skin disease, with important implications for healthcare delivery to this group.

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Primary repair versus surgical and transcatheter palliation in infants with tetralogy of Fallot

Heart ◽

10.1136/heartjnl-2018-312958 ◽

2018 ◽

Vol 104 (22) ◽

pp. 1864-1870 ◽

Cited By ~ 6

Author(s):

Dan M Dorobantu ◽

Alireza S Mahani ◽

Mansour T A Sharabiani ◽

Ragini Pandey ◽

Gianni D Angelini ◽

...

Keyword(s):

Right Ventricular ◽

Tetralogy Of Fallot ◽

Primary Repair ◽

Treatment Options ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Outflow Tract ◽

Young Infants ◽

Using Data ◽

The Uk

ObjectivesTreatment of infants with tetralogy of Fallot (ToF) has evolved in the last two decades with increasing use of primary surgical repair (PrR) and transcatheter right ventricular outflow tract palliation (RVOTd), and fewer systemic-to-pulmonary shunts (SPS). We aim to report contemporary results using these treatment options in a comparative study.MethodsThis a retrospective study using data from the UK National Congenital Heart Disease Audit. All infants (n=1662, median age 181 days) with ToF and no other complex defects undergoing repair or palliation between 2000 and 2013 were considered. Matching algorithms were used to minimise confounding due to lower age and weight in those palliated.ResultsPatients underwent PrR (n=1244), SPS (n=311) or RVOTd (n=107). Mortality at 12 years was higher when repair or palliation was performed before the age of 60 days rather than after, most significantly for primary repair (18.7% vs 2.2%, P<0.001), less so for RVOTd (10.8% vs 0%, P=0.06) or SPS (12.4% vs 8.3%, P=0.2). In the matched groups of patients, RVOTd was associated with more right ventricular outflow tract (RVOT) reinterventions (HR=2.3, P=0.05 vs PrR, HR=7.2, P=0.001 vs SPS) and fewer pulmonary valve replacements (PVR) (HR=0.3 vs PrR, P=0.05) at 12 years, with lower mortality after complete repair (HR=0.2 versus PrR, P=0.09).ConclusionsWe found that RVOTd was associated with more RVOT reinterventions, fewer PVR and fewer deaths when compared with PrR in comparable, young infants, especially so in those under 60 days at the time of the first procedure.

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Infective skin conditions in an adult sea-going population

Journal of The Royal Naval Medical Service ◽

10.1136/jrnms-100-49 ◽

2014 ◽

Vol 100 (1) ◽

pp. 49-57

Author(s):

J Tanzer ◽

A Macdonald ◽

S Schofield

Keyword(s):

Primary Care ◽

Staphylococcus Aureus ◽

Military Personnel ◽

Family Doctor ◽

Soft Tissue Infections ◽

Close Proximity ◽

Skin Conditions ◽

The Uk ◽

Panton Valentine Leukocidin ◽

Valentine Leukocidin

AbstractInfective skin conditions represent a significant element of the caseload for sea-going and shore-side clinicians. They are common within the wider military setting due to the frequent requirement to live in close proximity to others in conditions which favour the spread of skin and soft tissue infections (SSTI) (1, 2). Within the UK civilian population, 24% of individuals see their family doctor for skin conditions each year, accounting for 13 million primary care consultations annually. Of these, almost 900,000 were referred to dermatologists in England in 2009-2010 and resulted in 2.74 million secondary care consultations (3).Several recent articles have highlighted the problem of Panton-Valentine Leukocidin Staphylococcus aureus (PVL-SA) infection and carriage in sailors on submarines, and soldiers deployed to Afghanistan (4, 5). However, the majority of published articles relate to land-based military personnel. This article aims to provide an overview of the most common infective skin conditions presenting among Naval personnel (based on the authors’ experience), illustrated by several case studies, together with an approach to their diagnosis and management.

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Understanding the Experiences of Anger in the Onset and Progression of Psoriasis: A Qualitative Study Using Social Media (Preprint)

10.2196/preprints.33920 ◽

2021 ◽

Author(s):

Olivia Hughes ◽

Rachael Hunter

Keyword(s):

Social Media ◽

Qualitative Interviews ◽

Psychosocial Interventions ◽

Skin Condition ◽

Future Research ◽

Social Media Platforms ◽

Chronic Skin ◽

Skin Conditions ◽

The Impact

BACKGROUND Psoriasis is a chronic inflammatory skin condition, which can be affected by stress. Living with psoriasis can trigger negative emotions, which may influence quality of life. OBJECTIVE This study explored the experiences of people with psoriasis with attention to the potential role of anger in the onset and progression of the chronic skin condition. METHODS Semi-structured qualitative interviews were conducted with twelve participants (n=5 females, n=7 males) recruited online from an advert on a patient charity’s social media platforms. Data were transcribed and analysed using thematic analysis. RESULTS Four key themes were identified: (1) ‘I get really angry with the whole situation:’ anger at the self and others, (2) the impact of anger on psoriasis: angry skin, (3) shared experiences of distress, and (4) moving past anger to affirmation. CONCLUSIONS Findings suggest that anger can have a perceived impact on psoriasis through contributing to sensory symptoms and unhelpful coping cycles and point to a need for enhanced treatment with more psychological support. The findings also highlight the continued stigma which exists for people living with skin conditions and how this may contribute to, and sustain, anger for those individuals. Future research could usefully focus on developing targeted psychosocial interventions to promote healthy emotional coping with psoriasis.

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Cannabis and epilepsy

Practical Neurology ◽

10.1136/practneurol-2018-002058 ◽

2018 ◽

Vol 18 (6) ◽

pp. 465-471 ◽

Cited By ~ 7

Author(s):

Rhys H Thomas ◽

Mark O Cunningham

Keyword(s):

Treatment Options ◽

Current Treatment ◽

High Profile ◽

High Street ◽

The Usa ◽

The Difference ◽

The One ◽

The Uk ◽

Genetic Epilepsies ◽

Trial Evidence

Click here to listen to the PodcastThe one-third of people who do not gain seizure control through current treatment options need a revolution in epilepsy therapeutics. The general population appears to be showing a fundamental and rapid shift in its opinion regarding cannabis and cannabis-related drugs. It is quite possible that cannabidiol, licensed in the USA for treating rare genetic epilepsies, may open the door for the widespread legalisation of recreational cannabis. It is important that neurologists understand the difference between artisanal cannabidiol products available legally on the high street and the cannabidiol medications that have strong trial evidence. In the UK in 2018 there are multiple high-profile reports of the response of children taking cannabis-derived medication, meaning that neurologists are commonly asked questions about these treatments in clinic. We address what an adult neurologist needs to know now, ahead of the likely licensing of Epidiolex in the UK in 2019.

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MEDICAL MANAGEMENT OF TINEA INFECTION THROUGH SHODHANA AND SHAMANA – A CASE SERIES

November 2020 - International Ayurvedic Medical Journal ◽

10.46607/iamj1509092021 ◽

2021 ◽

Vol 9 (9) ◽

pp. 2029-2036

Author(s):

Asha A Bhat ◽

Prashanth A S

Keyword(s):

Case Series ◽

Skin Condition ◽

Wilcoxon Rank Sum Test ◽

Common Skin ◽

Skin Conditions ◽

Almost All ◽

Continuous Use ◽

Present Case Study

Skin is one of the most beautiful organs God has ever blessed to anyone. Everyone craves for beautiful skin and makes all possible efforts to make it glow. To achieve this, they are engaged in continuous use of creams, moist- urizers and other cosmetic articles which lead to immediate or long-term skin issues. Itching being the predomi- nant symptom of these cosmetic issues make people highly embarrassed in society. In Ayurveda, almost all skin conditions are explained under one umbrella called Kushta. It is broadly classified into Mahakushta and Kshudra- kushta1. Dadru Kushta one among the Kshudra Kushta is the most common skin condition accounts for 20% in all consultation in general practice2. North Karnataka is well known for its hot and humid conditions making its population at risk of many Tinea infections. Kandu, Raga and Atasi Pushpa Sankashavat Mandala are the cardi- nal features of Dadru3. In the present case study, 40 patients of Dadru Kushta were taken according to inclusion criteria. The combined effect of both Shodhana and Shamana was assessed. Keywords: Dadru Kushta, Aupasargika, Anushangi, Wilcoxon Rank Sum Test

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The Development of Non-Religious Pastoral Support in the UK

Religions ◽

10.3390/rel12100812 ◽

2021 ◽

Vol 12 (10) ◽

pp. 812

Author(s):

David Savage

Keyword(s):

Religious Beliefs ◽

Adult Population ◽

Armed Forces ◽

Support Network ◽

Active Listening ◽

Carl Rogers ◽

Inclusive Language ◽

Set Up ◽

Pastoral Support ◽

The Uk

In UK society today, over half of the adult population identify as ‘non-religious’. Of those, about three quarters describe themselves as very or extremely non-religious. The ‘non-religious’ can be seen not merely as those without religion but as people with seriously and sincerely held non-religious beliefs. Responding to this situation, Humanists UK set up the Non-Religious Pastoral Support Network to meet the need for non-religious pastoral care. In healthcare and prisons, they have trained hundreds of volunteers to offer an active listening service based on a humanistic Carl Rogers approach, conduct ceremonies, improve education, and provide advocacy, all grounded in non-religious worldviews. Those completing an appropriate Master’s degree have been successfully recruited by the National Health Service into paid professional roles. However, the Prison Service and Armed Forces still restrict such recruitment to people with religious beliefs. Further progress will be enhanced by using more respectful and inclusive language (rather than ‘nones’ and ‘chaplaincy’), promoting equality in recruitment, and adopting a person-centred approach where service users determine their pastoral and spiritual care priorities.

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