Ideal proportion of the population to be patch tested: How many should we be doing?

BACKGROUND: How many patients should we be patch testing? A previous study suggested that the minimum proportion of a population to be patch tested for allergic contact dermatitis was 1:700 annually. OBJECTIVES: To evaluate if the current minimum rate for patch testing has changed over the 20 years since the previous study in order to maximize the value. METHODS: In cooperation with the British Society for Cutaneous Allergy, a proforma for collation of retrospective data between January 2015 and December 2017 was sent to patch-test centers in the United Kingdom (UK) and the Republic of Ireland (ROI). The number of positive tests was analyzed against the proportion of population tested to see what proportion of the population would yield the greatest number of positive results. RESULTS: Responses from 11 centers showed that the minimum number needed to patch test had increased to 1:550 per head of population per year using the current criteria. CONCLUSIONS: In agreement with previous studies, we should be patch testing more people than we are. We could reduce the threshold for referral of patients we patch test to derive the most benefit from this investigation.

Postgraduate students' perceptions of what makes for effective assessment feedback: a case study of a clinical masters course.

The purpose of this study was to examine postgraduate students' perceptions of assessment feedback. Using the Critical Incident Technique, students enrolled on a taught clinical course were asked for their perceptions of effective and ineffective examples of assessment feedback. The data were analysed using thematic analysis and nine themes emerged that capture perceptions associated with feedback content and feedback process. Students perceived effective feedback if it was specific and clear, using positive tone of language. They expressed a preference for feedback that is delivered in a standardised format, reflecting the grades given, individualised, and when the marking criteria is explicit and enables dialogue with the marker. Students perceived feedback to be ineffective when it focused on grammatical errors rather than content, when it was provided by anonymous graders and if it was too personal. Timeliness of feedback was also important to participants. Practical implications and suggestions for future research are highlighted in this paper.

Cutaneous venous malformations presenting in an adolescent boy: Cerebral cavernous malformation syndrome.

Cerebral cavernous malformations (CCM) are collections of enlarged capillaries with irregular structure, located in the brain or spinal cord, that can be life-threatening. We describe a neurologically asymptomatic 15-year-old boy who presented with cutaneous venous malformations (CVM) that developed in adolescence. Owing to his family history of CCM, genetic testing was obtained and confirmed a new mutation in the CCM3 (PDCD10) gene. Brain imaging showed multiple CCM. Although currently asymptomatic, he will continue to be monitored annually by neurology to assess for symptoms of intracranial hemorrhage (ICH) that would warrant investigation with MRI.

Preconception thyroid-stimulating hormone and pregnancy outcomes in women with hypothyroidism.

OBJECTIVES: Maternal hypothyroidism may adversely affect pregnancy outcomes. International practice guidelines recommend that women with hypothyroidism should attain a preconception and early gestation serum thyroid-stimulating hormone (TSH) level of <2.5 mU/L. Our objective was to ascertain what proportion of women realize this target in practice and whether a TSH level above this threshold has adverse fetal and maternal consequences. METHODS: This was an observational study of women with hypothyroidism referred to an endocrine antenatal clinic between 2008 and 2010 (n = 78; mean age, 30.4 years; range, 19 to 43 years). Thyroid profiles (free thyroxine [FT4] and TSH) before conception and through pregnancy were documented. Obstetrics outcomes were examined, including low birth weight, preterm births, preeclampsia, caesarean sections, and admissions to special care neonatal units. RESULTS: Thyroid testing was undertaken in 80% of subjects before conception, and in 64, 94, and 96% of subjects in the first, second, and third trimesters of pregnancy, respectively. TSH >2.5 mU/L was seen in 49% of women before conception and in 68% of women in the first trimester. Six women were overtly hypothyroid before conception, attaining normal thyroid function at gestational ages ranging from 12 to 36 weeks. Neither the preconception nor the first postconception TSH level (>2.5 mU/L or ≤2.5 mU/L) was associated with gestational age at delivery, birth weight, or rates of caesarean section or preeclampsia. CONCLUSION: The majority of women with hypothyroidism do not achieve the recommended preconception and early gestation TSH targets. Preconception and early gestation TSH >2.5 mU/L was not associated with adverse fetal and maternal outcomes. Studies in larger cohorts will be required to confirm these findings, however.