The use of an e-learning module on return to work advice for physiotherapists - A prospective cohort study.

Background: Nonspecific low back pain (LBP) can progress to chronic disability and prolonged absence from work. Despite clinical and professional guidelines, physiotherapists often fail to address return to work outcomes. Aims: The aim of this exploratory study was to determine whether an e-learning resource tailored to physiotherapy practice could affect physiotherapists' attitudes and beliefs regarding return to work advice for their patients. Design: A prospective interventional cohort study (pilot). Methods: Participants were recruited via the Chartered Society of Physiotherapy website. Responses on a clinical vignette, the Health Care Providers' Pain and Impairment Scale (HC-Pairs), and the Behavioral Constructs Questionnaire (BCQ) were collected online at baseline (Q1) and 2-months post-intervention (Q2). Results: Fifty-four physiotherapists completed Q1 and the response rate for Q2 was 44/54 (81%). Changes in the degree of agreement with guidelines indicated that the intervention made an impact on respondents (kappa 0.345; p = 0.003). HC-Pairs and BCQ results showed a nonstatistically significant trend toward the target behavior. Conclusions: There is a need for interventions to improve adherence with advice for return to work following nonspecific LBP. An e-learning tool for physiotherapists on advising patients regarding return to work has potential to positively affect self-reported clinical behavior.

A finding of granuloma faciale associated with basal cell carcinoma.

The clinical differential diagnosis of violaceous plaques on the face is broad and includes both neoplasms and inflammatory dermatoses. We report the first case of a basal cell carcinoma (BCC) superficial to an underlying granuloma faciale (GF). This is a single case report with clinicopathological correlation. Histological examination of a skin biopsy from the cheek revealed superficial BCC and GF. This case constitutes the first reported finding of coincident GF and BCC.

Development of new-onset psoriasis in a patient receiving infliximab for treatment of rheumatoid arthritis.

Infliximab is a chimeric monoclonal antibody that selectively blocks tumor necrosis factor-alpha (TNF-alpha). It is indicated for the treatment of numerous inflammatory diseases, including rheumatoid arthritis, Crohn disease, ulcerative colitis, ankylosing spondyilitis, and psoriatic arthritis. Infliximab has also been shown to be a well tolerated and highly effective treatment for psoriatic skin lesions. We report an interesting case of unexpected, new-onset psoriasis in a patient on infliximab for rheumatoid arthritis.

Verrucous linear (segmental) psoriasis of the right leg responding to radiation therapy.

Verrucous linear segmental psoriasis (VLSP) is invariably recalcitrant to treatment. It is a distinct variant of psoriasis that frequently is considered a form of a verrucous linear, epidermal nevus. The hypertrophic nature of the plaques makes treatment particularly challenging. The authors present a case of verrucous linear psoriasis of the right leg that responded to radiation therapy.

Congenital atrophic dermatofibrosarcoma protuberans in a 7-month-old boy treated with Mohs micrographic surgery.

Dermatofibrosarcoma protuberans is a rare, malignant, slow-growing, locally invasive tumor of the skin. Although most cases are acquired and diagnosed in adulthood, there have been an increasing number of congenital dermatofibrosarcoma protuberans mimicking benign birthmarks described in the literature. The clinical presentation of this tumor is often one of an indurated exophytic plaque or nodule; however, a rare variant can present as atrophic or sclerotic in nature. We report a case of congenital atrophic dermatofibrosarcoma protuberans of the groin in a 7-month-old boy, successfully treated with Mohs micrographic surgery.

Cutis verticis gyrata: three cases with different aetiologies that demonstrate the classification system.

Cutis verticis gyrata describes a scalp condition where there are convoluted folds and deep furrows that resemble the surface of the cerebral cortex. We report three cases of cutis verticis gyrata that demonstrate the current classification structure. The first case is the most commonly described primary non-essential acquired form, appearing in the scalp of an 11-year-old girl with mental retardation. The second case is the primary non-essential congenital form, presenting at birth in a baby with Noonan's syndrome. An association between cutis verticis gyrata and Noonan's syndrome has been rarely described. The third case illustrates secondary cutis verticis gyrata, occurring in a 27-year-old man with discoid eczema.

Education together with a preprinted sticker improves the prescribing of prophylactic enoxaparin.

INTRODUCTION: Substantial evidence exists for the use of prophylactic heparin in medical inpatients with congestive heart failure and severe respiratory disease, and in surgical patients with a moderate-to-high risk of thromboembolism (Grade 1A recommendations). Despite this, many patients who would benefit from prophylaxis do not receive this treatment. METHODS: We implemented an education programme to promote the use of prophylactic enoxaparin. In addition, preprinted stickers were placed in the notes of patients to serve as a reminder, where appropriate, that the patient was a candidate for prophylaxis. To assess changes in practice, we undertook an audit of the charts of 105 medical patients and 100 surgical patients over a 3-month period before the intervention and a further 100 medical patients and 99 surgical patients over a 3-month period after the intervention. RESULTS: Before the campaign, prophylaxis with enoxaparin was used in 11% of eligible medical patients. Following the intervention, prophylaxis increased to 47% (95%CI 23-50, p<0.0001). The audit of surgical patients showed an increase in the use of enoxaparin from 36% of eligible patients to 50% (95%CI 0-28, p = 0.07) however there was no improvement in the proportion of those treated who received the appropriate dose according to guidelines. CONCLUSION: Prophylactic heparin is under-used. An education programme together with the use of a sticker led to an improvement in the use of this treatment.