St Helens and Knowsley Teaching Hospitals NHS Trust

Prominent ear is a common auricular malformation that can have long-term psychosocial consequences on affected individuals. Otoplasty remains the standard surgical corrective treatment; however, the optimal technique has long been debated, with >200 methods described in the literature. This systematic review, conducted in accordance with PRISMA guidelines, aimed to evaluate the available evidence on the most effective otoplasty approach. The outcomes assessed across different techniques (exclusive suture, exclusive cartilage-scoring, incisionless, suture + flap, suture + cartilage-scoring, and cartilage-scoring + flap hybrids) included: a) number of patients suffering a complication, b) recurrence, c) reoperation, d) infection, e) keloid or hypertrophic scar formation, and f) haematoma. A search of PubMed and MEDLINE identified 412 papers. Following PICOT framework-guided screening, application of inclusion and exclusion criteria, and quality assessment, 22 studies were included: 19 retrospective and three prospective cohort studies. Current medical literature suggests that suture + cartilage-scoring and cartilage-scoring + flap hybrid methods, may be associated with lower rates of recurrence, and reoperation when compared to single-technique or suture + flap approaches. However, high-quality, long-term randomised control trials are required to determine the superior technique for otoplasty.

Hand hygiene is one of the most significant components of standard infection control precautions. This study aimed to assess local hand hygiene technique and the effectiveness of an instructional video plus adding a seventh step to the Ayliffe technique. Adherence of practitioners to the six-step Ayliffe technique and its effectiveness were assessed using a lotion that shows areas not cleansed adequately under ultraviolet light. This was followed by a short instructional video plus an added step to improve cleansing of the dorsal hand. Technique was re-evaluated immediately and 3-4 weeks later. 43% of participants correctly performed all six steps of the Ayliffe technique during the initial assessment; this rose to 97% after watching the video. A majority (59%) of participants initially missed the dorsal hands, which improved to 13% at the third assessment. An instructional video is an effective tool for improving hand hygiene technique. Adding the seventh step to the Ayliffe technique improves coverage of the dorsal hand so will increase the effectiveness of hand hygiene protocols.

ABSTRACTBackgroundAlopecia areata (AA) is a common non‐scarring alopecia. Data continue to emerge on associations with autoimmune and other conditions. Janus kinase inhibitors (JAKi) are increasingly used to treat AA.ObjectivesThe aim was to assess variation in laboratory testing in patients with AA among hair experts internationally and to compare subspecialized clinical practice to current guidelines.MethodsThirty hair experts from 14 countries and six continents contributed to develop a 24‐item survey collecting demographic information on respondents; methods of severity assessment; and laboratory testing practices in AA for mimics, contributory factors, associations, and workup for systemic therapy. The survey was distributed to a global network of expert hair specialists.ResultsOf 214 respondents, 79.9% (171/214) had special interest/expertise in hair loss disorders, and 35.5% (n = 76) were based in Europe. Most cared for both adults and children (87.9%, n = 188). For clinical assessment, almost two‐thirds (63.6%, n = 136) used the Severity of Alopecia Tool and 38% (n = 84) used the Dermatology Life Quality Index. Only 24.3% (n = 52) typically tested for alternative infectious or inflammatory diagnoses, 39.7% (n = 85) typically tested for contributory conditions such as nutritional deficiencies, and 50.9% (n = 109) typically tested for co‐existent autoimmune illnesses. Thyroid function testing was routinely performed in 73.4% (n = 157) and complete blood count (CBC) was checked in 65.9% (n = 141). Compared to conventional systemic therapy, experts were more likely to check lipid levels, creatine kinase, coagulation profiles, thrombophilia screens, tuberculosis blood testing, hepatitis B and C serology before prescribing JAKi.ConclusionsReal world practice of laboratory testing for AA by hair experts, who may see more severe or complex alopecia, is variable. Most experts routinely perform thyroid function and CBC testing. We discuss evidence for indications for testing for AA mimics, contributory factors, associated autoimmune conditions, and before systemic therapy. Further research is required to characterise the role of laboratory testing in AA.

The emergency department (ED) plays a crucial role in the care of patients, being the first point of contact for patients with the hospital system. Patient satisfaction metrics are crucial indicators of ED care quality, which can significantly impact other hospital departments. Increased patient satisfaction in the ED is associated with better outcomes and fosters trust in the health system. This article explores the key factors influencing patient satisfaction and solutions to enhance patient satisfaction.

Abstract BackgroundTherapeutic management of hair loss is frequently complicated by a lack of high‐quality evidence and reliant on the use of unlicensed therapies. Treatment decision‐making is predominantly based on expert opinion, local availability, personal experience, and cost, which make informed choices challenging for clinicians and patients in this area.ObjectivesThe aims were to determine prescribing patterns amongst UK Dermatologists with a special interest in hair disorders, when treating mild‐moderate alopecia areata (AA), severe AA (including alopecia totalis/alopecia universalis), female pattern hair loss (FPHL) and frontal fibrosing alopecia (FFA).MethodsConsultant members of the British Hair and Nail society, a special interest group affiliated to the British Association of Dermatologists, were invited to participate from across the United Kingdom. Participants were questioned on their current prescribing patterns in both NHS and private practice, were asked to rank their first‐to‐fifth line treatments for each condition and highlight the treatment they perceive as most effective for each disorder.ResultsTwenty‐six Consultant Dermatologists completed the questionnaire, from twenty‐three institutions. For treatment of mild‐moderate AA, topical corticosteroids were used first line amongst 65% (n = 17) of respondents, and 82% (n = 23) reported that intralesional corticosteroids were the most effective treatment. For severe AA, oral corticosteroids were used first line amongst 38% (n = 10) of respondents, and 25% (n = 8) reported that oral corticosteroids were the most effective treatment. For FPHL, topical minoxidil was used first line amongst 84% (n = 25) of respondents, and 42% (n = 10) reported that oral minoxidil was the most effective treatment. For FFA, topical corticosteroids were used first line amongst 62% (n = 16) of respondents, and 37% (n = 14) reported that hydroxychloroquine was the most effective treatment.ConclusionsThis study reports real‐world prescribing practices amongst dermatologists treating common hair loss conditions. These results aim to support clinicians with decision making for managing hair loss conditions.

Contexte : Il n’est pas rare que les besoins psychosociaux des jeunes adultes atteints de cancer ne soient pas satisfaits. Peu d’études se sont penchées de manière exhaustive sur l’efficacité des ressources de soutien par les pairs en ligne pour répondre aux besoins de cette population. Méthodologie : Une recherche dans les bases de données Cochrane Central Register of Controlled Trials, CINAHL, Embase et Medline a permis de trouver des articles portant sur les interventions de soutien par les pairs à l’intention des jeunes survivants du cancer âgés entre 18 et 40 ans. Résultats : Cette recherche a fait ressortir 2 773 articles, dont 12 ont été retenus par consensus. Les articles ont fait l’objet d’une synthèse qualitative à partir de données extraites à l’aide de la liste de vérification Template for Intervention Description and Replication (TIDieR; modèle pour la description et la reproduction des interventions). En tout, 6 études ont montré l’existence d’une corrélation entre le soutien par les pairs en ligne et l’amélioration du bien-être. Ce type d’intervention pourrait donc être utile pour les jeunes atteints de cancer. Conclusion : La présente revue systématique résume l’état actuel des connaissances sur la disponibilité et l’évaluation des programmes en ligne de soutien par les pairs à l’intention des jeunes; elle révèle également le besoin d’approfondir la recherche dans ce domaine. Mots-clés : jeune adulte, soutien social, survivant au cancer, survivance sociale, médias sociaux, intervention sur Internet