How is oral isotretinoin prescribed for the treatment of acne vulgaris? Results from a UK Dermatology Clinical Trials Network (UKDCTN) and British Dermatological Nursing Group (BDNG) survey of health professionals.

We undertook a survey of UK healthcare professionals through the UK Dermatology Clinical Trials Network and British Dermatological Nursing Group to understand clinicians' routine practice of prescribing oral isotretinoin for treatment of acne vulgaris. We also wanted to understand clinicians' experiences and views on prescribing low daily dose regimens. Overall, the survey showed that clinicians adopted a patient-centred approach when deciding isotretinoin dosing. The rationale for using a low-dose regimen varied, but was focused on patient wellbeing during treatment. Some clinicians were concerned that use of a low-dose regimen could be less effective and lead to longer treatment durations. The survey results will be useful to inform a clinical trial investigating the effectiveness and safety of low daily dose isotretinoin for the treatment of acne.

Setting research priorities for management and treatment of hyperhidrosis: the results of the James Lind Alliance Priority Setting Partnership.

BACKGROUND: Hyperhidrosis is a common skin condition characterized by excessive sweating, which can negatively impact on quality of life. It is under-researched compared with other conditions of similar prevalence. AIM: To generate a Top 10 list of research priorities for the treatment and management of hyperhidrosis, with equal input from people with hyperhidrosis and healthcare professionals (HCPs). METHODS: A priority setting partnership (PSP) was established and processes from the James Lind Alliance Handbook were followed. An online survey asked participants what questions they would like research to answer. These questions were grouped into 'indicative questions', which were ranked in a second survey of 45 indicative questions. The top 23 questions were then taken to a final workshop event attended by key stakeholders, and ranked to generate the Top 10 list of research priorities. RESULTS: There were 592 questions submitted by 268 respondents for the first survey. For the second survey, 286 participants ranked the indicative questions in order of priority. At the final workshop, the Top 10 list was generated. The top three priorities were: (i) Are there any safe and effective permanent solutions for hyperhidrosis? (ii) What is the most effective and safe oral treatment (drugs taken by mouth) for hyperhidrosis? and (iii) What are the most effective and safe ways to reduce sweating in particular areas of the body? CONCLUSIONS: There are many unanswered research questions that both people with hyperhidrosis and HCPs would like to see answered. The results from this PSP will help to ensure future research funding can be directed to these areas of priority.

Establishing priorities on the range of conditions managed by UK community practitioner nurse prescribers: A modified Delphi consensus study.

AIM: To provide national consensus on the range of conditions community practitioner nurse prescribers manage and for which it is considered important that they can prescribe. BACKGROUND: Around 35,000 community practitioner nurse prescribers in the United Kingdom are able to prescribe from a limited formulary. Although prescribing is a key role for these nurses, there has been a decline in the numbers of community practitioner nurse prescribers who prescribe. It is evident that changing patterns of client and service delivery, changes the role of community nurses and the conditions they manage, however, little is known about the conditions community practitioner nurse prescribers manage. DESIGN AND METHODS: A modified Delphi approach comprising three on-line surveys delivered to a national Expert Panel of 89 qualified community practitioner prescribers. Data collection took place between January-March 2017. RESULTS: Panelists reached a consensus, with consistent high levels of agreement reached, on nineteen conditions for which it is believed community practitioner nurse prescribers should be able to prescribe. Conditions identified by school nurses (N = 12) and health visitors (N = 7) were mainly acutely focused, whereas those identified by district nurses (N = 9) and community staff nurses (N = 6) included both long-term and acute conditions. CONCLUSION: Given the high degree of consensus, this list of conditions should influence any decisions about the items community and public health nurses should be able to prescribe. The findings should also influence the education and training of these nurses.

Skin hygiene for patients with bariatric needs.

Patients with bariatric needs are likely to experience skin problems because maintaining skin hygiene, particularly between skin folds, can be a challenge. This article is a summary of a literature review that explored the evidence on skin hygiene for people with bariatric needs. The findings reveal a gap in the evidence base and the authors make several recommendations for further research.

What do we know about skin-hygiene care for patients with bariatric needs? Implications for nursing practice.

AIM: This article presents a discussion of the current state of knowledge about bariatric skin-hygiene care and whether this is sufficient to underpin evidence-based nursing practice. BACKGROUND: The challenges of providing bariatric skin-hygiene care are highlighted and include managing specific skin changes with associated risk of skin breakdown and practical management needs. The risk of skin breakdown is high and can have a devastating impact on well-being and increased treatment costs. DATA SOURCES: A four-stage search strategy included: (i) literature search using electronic databases from inception-May 2013; (ii) hand search of selected journals; (iii) review of internet-based guidelines, policies or protocols and (iv) contact with clinical experts. DISCUSSION: There is a dearth of robust evidence on bariatric skin-hygiene care. Whilst a range of information and guidelines exist, these are generally based on expert opinion and often used only in a local context. IMPLICATIONS FOR NURSING: Nurses are increasingly faced with the challenge of providing skin-hygiene care for patients with bariatric needs. At present, care is largely based on custom and practice or clinical opinion; this limits capacity to provide optimum evidence-based nursing care. CONCLUSION: As the prevalence of people needing bariatric skin-hygiene care continues to increase, there is a lack of evidence to inform interventions and hence a growing need for further research in this challenging clinical area to help nurses and patients select the best possible interventions that will meet individual personal-hygiene needs and preserve skin integrity.

Maintaining skin health in older people.

The article examines general skin care for older people, skin barrier function and the skin changes associated with the ageing process. Skin assessment and the use of washing products and emollients are discussed. Methods by which older people and nursing staff can help to promote and improve skin health are identified.

The development of a nurse-led complex wound clinic.

This article describes the development of a nurse-led complex wound clinic in Lincolnshire in April 2003, and describes one patient's experience of the service. It also explores the benefits of collaborative initiatives that have the potential to improve patient outcomes.

NICE guidance on use of topical corticosteroids in atopic eczema.

This article examines in detail the use of topical corticosteroids in treating atopic eczema and the related guidance recently issued by the National Institute for Clinical Excellence (NICE, 2004).