Intralesional corticosteroids and diathermy ablation for the management of anogenital granulomatosis: a retrospective cohort study.

BACKGROUND: Anogenital granulomatosis (AGG) is a rare, chronic condition that presents as progressive inflammation and lymphoedema of the anogenital region in both male and female patients. No guidelines exist for the management of AGG. Systemic immunosuppressants are the current cornerstone of medical therapy for AGG, but results from case series with small numbers of patients have reported variable responses. AIM: To investigate whether intralesional corticosteroid injections with or without diathermy ablation (ILC +/- DA) would provide effective control of symptoms over a 6-month period in patients diagnosed with AGG. METHODS: This retrospective observational cohort study enrolled 11 patients with AGG consecutively treated with ILC +/- DA at a single centre. The primary outcome was defined as a statistically significant decrease in mean disease severity score, at both 1 and 6 months post-treatment. The secondary outcome was a statistically significant association between reduction in disease severity score at 6 months post-treatment and any potentially confounding factors. Wilcoxon sign-ranked tests and ordinal logistic regression analysis were applied to assess the data. Ancillary outcomes are also reported, including whether patients experienced adverse effects post-treatment and if patients experienced recurrence at any point beyond 6 months post-treatment. RESULTS: Compared with pretreatment disease severity scores, there was a statistically significant decrease in disease severity scores at both 1 and 6 months post-treatment (P = 0.01). No significant association was found between identified confounding factors and reduction in disease severity score at 6 months post-treatment. Of the 11 patients, 1 patient experienced an episode of cellulitis within 1 week of treatment. Five patients never experienced a recurrence of symptoms during a mean follow-up period of 28 months post-treatment, while all six patients who did experience recurrence of symptoms reported that when the symptoms returned, at a mean of 8 months post-treatment, they were milder than before the treatment. CONCLUSION: To our knowledge, this is the first study to investigate ILC +/- DA for patients with AGG. Our results indicate this could be an effective treatment for AGG. We would recommend comparative and longitudinal studies to further explore this treatment.

Open tibia/fibula in the elderly: A retrospective cohort study.

The incidence of open tibia/fibula fractures in the elderly is increasing, but current national guidelines focus on the aggressive treatment of high-energy injuries in younger patients. There is conflicting evidence regarding whether older age affects treatment provision and outcomes in open fractures. The aim of this study was to determine if elderly patients are sustaining a different injury to younger patients and how their treatment and outcomes differ. This may have implications for future guidelines and verify their application in the elderly. In this retrospective single centre cohort study (December 2015-July 2018), we compared the injury characteristics, operative management and outcomes of elderly (≥65 years) and younger (18-65 years) patients with open tibia/fibula fractures. An extended cohort examined free flap reconstruction. In total, 157 patients were included. High-energy injuries were commoner in younger patients (88% vs 37%; p<0.001). Most were Gustilo-Anderson IIIb in both age groups. Elderly patients waited longer until debridement (21:19 vs 19:00 h) and had longer inpatient stays (23 vs 15 days). There was no difference in time to antibiotics, operative approach or post-operative complications. Despite the low-energy nature of elderly patients' injuries, the severity of soft tissue insult was equivalent to younger patients with high-energy injuries. Our data suggest that age and co-morbidities should not prohibit lower limb reconstruction. The current application of generic guidelines appears suitable in the elderly, particularly in the acute management. We suggest current management pathways and targets be reviewed to reflect the greater need for peri-operative optimisation and rehabilitation in elderly patients.

Animated stories of medical error as a means of teaching undergraduates patient safety: an evaluation study.

BACKGROUND: Storytelling is a powerful form of communication which can improve attention and lead to lasting behavioural changes. Addressing the need to incorporate patient safety teaching into undergraduate medical curricula, it was hypothesized that medical students could benefit from hearing clinician stories of medical error. The medium of animation was considered to be a potentially engaging means of presenting stories of error to a large audience. METHODS: Three animated videos were developed to accompany audio recordings of junior doctors describing their experiences of a serious incident or near-miss event. The videos were delivered to 200 final-year medical students with a subsequent large-group discussion directed at understanding contributory factors. An evaluative questionnaire exploring learners' reactions and modification of beliefs and perception was distributed. The questionnaire included questions rated on a modified Likert scale and a free-text box. A mixed-methods analysis was conducted with descriptive statistics and qualitative content analysis of the free-text responses. RESULTS: Of the 200 students who attended, 104 completed the questionnaire and 83 completed free-text feedback. Most students responded positively to hearing stories of medical error and felt that the animated videos improved their engagement while the voice recordings helped bring the cases to life. The majority of students agreed the session would impact on their future practice. CONCLUSION: This pilot study confirmed that undergraduate students consider animated, personal stories of medical error an effective, engaging means of learning about patient safety. Longitudinal studies are required to confirm if measurable behaviour change is achieved.

Requirements of a new communication technology for handover and the escalation of patient care: a multi-stakeholder analysis.

RATIONALE, AIMS AND OBJECTIVES: In order to enable safe and efficient information transfer between health care professionals during clinical handover and escalation of care, existing communication technologies must be updated. This study aimed to provide a user-informed guide for the development of an application-based communication system (ABCS), tailored for use in patient handover and escalation of care. METHODS: Current methods of inter-professional communication in health care along with information system needs for communication technology were identified through literature review. A focus group study was then conducted according to a topic guide developed by health innovation and safety researchers. Fifteen doctors and 11 nurses from three London hospitals participated in a mixture of homogeneous and heterogeneous sessions. The sessions were recorded and transcribed verbatim before being subjected to thematic analysis. RESULTS: Seventeen information system needs were identified from the literature review. Participants identified six themes detailing user perceptions of current communication technology, attitudes to smartphone technology and anticipated requirements of an application produced for handover and escalation of care. Participants were in favour of an ABCS over current methods and expressed enthusiasm for a system with integrated patient information and group-messaging functions. CONCLUSION: Despite concerns regarding confidentiality and information governance a robust guide for development and implementation of an ABCS was produced, taking input from multiple stakeholders into account. Handover and escalation of care are vital processes for patient safety and communication within these must be optimized. An ABCS for health care professionals would be a welcome innovation and may lead to improvements in patient safety.