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Background The multi-morbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse COVID-19 outcomes but data are limited. Objective Characterize the course of COVID-19 in psoriasis and identify factors associated with hospitalization. Methods Clinicians reported psoriasis patients with confirmed/suspected COVID-19 via an international registry, PsoProtect. Multiple logistic regression assessed the association between clinical/demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviours. Results Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% a non-biologic and 10% no systemic treatment for psoriasis. 348 (93%) fully recovered from COVID-19, 77 (21%) were hospitalized and nine (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted OR 1.59 per 10 years, 95% CI 1.19-2.13), male sex (OR 2.51, 95% CI 1.23-5.12), non-white ethnicity (OR 3.15, 95% CI 1.24-8.03) and comorbid chronic lung disease (OR 3.87, 95% CI 1.52-9.83). Hospitalization was more frequent in patients using non-biologic systemic therapy than biologics (OR 2.84, 95% CI 1.31-6.18). No significant differences were found between biologic classes. Independent patient-reported data (n=1,626 across 48 countries) suggested lower levels of social isolation in individuals receiving non-biologic systemic therapy compared to biologics (OR 0.68, 95% CI 0.50-0.94). Conclusion In this international moderate-severe psoriasis case series, biologics use was associated with lower risk of COVID-19-related hospitalization than non-biologic systemic therapies, however further investigation is warranted due to potential selection bias and unmeasured confounding. Established risk factors (being older, male, non-white ethnicity, comorbidities) were associated with higher hospitalization rates. Clinical Implications We identify risk factors for COVID-19-related hospitalization in psoriasis patients, including older age, male sex, non-white ethnicity and comorbidities. Use of biologics was associated with lower hospitalization risk than non-biologic systemic therapies., Capsule summary: In this global registry-based study, risk factors for COVID-19-related hospitalization in psoriasis patients were older age, male sex, non-white ethnicity and comorbidities. Use of biologics was associated with lower hospitalization risk than non-biologic systemic treatment.

A Dermatology walk‐in clinic available to all hospital staff (HS) was commenced to treat skin problems related to personal protective equipment (PPE) during the COVID‐19 pandemic. An observational case series was conducted in a single district general hospital within Wales (United Kingdom) to record the dermatological diagnoses. Our participant sample comprised of clinical and non‐clinical staff working in COVID‐19 and non‐COVID‐19 areas of the hospital. Over the data collection period (6 weeks), a total of 72 patients attended the clinic of whom 62 were female and 10 were male (mean age = 43yrs). Data comprised of demographic data, current occupation (shown in Table 1), duration of symptoms, past medical history, regular medication and treatment interventions. An analysis of the clinical diagnoses seen are reported in Table 2.

Objectives The objectives of this study were to: (1) document the incidence of surgical site dehiscence after full-thickness gastrointestinal biopsy in dogs and cats and (2) identify potential risk factors. Methods Data relating to dogs and cats undergoing full-thickness gastrointestinal biopsy were reviewed retrospectively following submission of a completed questionnaire by 12 referral institutions. Outcome measures were definite dehiscence, possible dehiscence (clinical records suggestive of dehiscence but not confirmed), suspected dehiscence (definite and possible combined) and death within 14 days. Logistic regression was planned for analysis of association of dehiscence with low preoperative serum albumin, biopsy through neoplastic tissue, biopsy alongside another major abdominal surgical procedure and biopsy of the colon. Results Of 172 cats, two (1·2%) had definite dehiscence, and four (2·3%) had possible dehiscence. Low preoperative serum albumin was significantly associated with definite dehiscence in univariable analysis and with suspected dehiscence and death within 14 days in univariable analysis, but all odds ratios had wide 95% confidence intervals. A histopathological diagnosis of neoplasia was significantly associated with death within 14 days in univariable analysis. Of 195 dogs, two (1·0%) had definite dehiscence, and three (1·5%) had possible dehiscence. In dogs, there was no association between any outcome measure and the putative risk factors. Clinical Significance Incidence of dehiscence following full-thickness gastrointestinal biopsy was low in this study. When determining the appropriateness of biopsy in individual cases, this information should be balanced against the potentially life-threatening consequences of dehiscence.

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.

Aim: Progression detail of the development of YODELS (Yorkshire Organ Donation End of Life Simulation) course from a single site, single discipline faculty to a multi-centre, multi-disciplinary faculty. Objectives: The development of a faculty across multiple trusts The introduction of a multi–disciplinary faculty To improve the equity of delegate attendance from other trusts outside CHFT To improve best practice adherence when facilitating End of Life/Organ Donation discussions within the Emergency Department and Intensive Care Units with Yorkshire and Humber Continued use of specialised and dedicated actors in the role of family members Summary of work undertaken: Ensuring that families receive optimum communication at a time when they are at their most vulnerable is imperative. YODELS inception began five years ago in collaboration with NHS Blood and Transplant. It developed into a course delivered bi-annually to CHFT employees, funded by the local Organ Donation Committee. In recent years it became apparent that this high evaluating course could indeed serve a wider audience, a change in leadership resulted in a broader faculty line up and incorporating a multidisciplinary ownership. The next step saw the faculty inviting members to join them from other local trusts, this enabled greater practice sharing and broader knowledge/experience base. The next step saw non CHFT candidates attending YODELS for the first time. This variance increased practice sharing further and ensured that ‘best practice’ messages were being delivered to a much wider audience than just one trust. The course outline, structure and evaluation are under constant review, with simplified course documents developed to provide a greater ability for course portability. It was felt that inviting external candidates from across the region could in future cause issues with funding, travel, time away from clinical areas etc, therefore the base unit remained at Huddersfield Royal. However, as we look to the future of this course, it is now planned that future cohorts will be run externally, BTHFT, Mid-Yorkshire have committed, and we are currently in early discussion with Leeds Teaching Hospital Trust. The Yorkshire Organ Donation Services Team provide services to a population of 6.2 million. Geographically, the team cover North, South, and West Yorkshire, East Riding, Lincolnshire, North Nottingham, and Derbyshire. Within this geographical area, the team provides a service for 16 NHS trusts.1 The ever-changing staff base within these trusts depicts a future ongoing education requirement which YODELS can positively influence. Impact on practice: By providing multidisciplinary simulation-based education, candidates gain insight into the difficulties each speciality experience during end of life management, decisions and subsequent communication exchanges. Organ donation conversations are uncommon even in the busiest of trusts therefore enabling practice/trial of communication techniques within a safe environment is invaluable. Evaluations of the course frequently report a greater mutual understanding of their colleagues’ roles within the clinical setting which is believed to improved inter speciality communication. YODELS promotes all areas of best practice2 3 surrounding organ donation, from the point of a patient being identified, right through to family consenting to their loved one’s donation. References NHS Blood and Transplant. (2019). We stand for Life. We stand for Hope. Available at: https://www.nhsbt.nhs.uk/Accessed: 11 June 2019. Department of Health. (2019). Taking Organ Transplantation to 2020: A UK strategy. Available at: https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/4241/nhsbt_organ_donor_strategy_summary.pdf Accessed: 11 June 2019. NICE. (2016). Organ donation for transplantation: improving donor identification and consent rates for deceased organ donation. Available at: https://www.nice.org.uk/guidance/CG135 Accessed: 11 June 2019.

The COVID-19 pandemic forced changes to the daily work routine of hospital staff (HS) around the world. HS faced skin problems caused or worsened by the use of personal protective equipment (PPE), but also by the rigorous hand hygiene regimen. A dermatology clinic that took place twice weekly and

These (fig 1) are chilblain-like lesions in a woman in her late 20s. Fig 1 She presented with a two week history of burning and itching of her fingers and toes, with erythematous and purple papules. Erosions were present on her …

Dear Jamil,Thank you for agreeing to take part in a dialogue inspired by your research article ‘Wishing for a World Without “Theatre for Development”: Demystifying the Case of Bangladesh’ (Ahmed 20...

The main utility I see in my erstwhile mountaineering was this education of my composure, which enabled me to sleep upright on the narrowest ledge overlooking an abyss.1 1. Marcel Mauss, ‘Technique...

This essay presents a study of the economic and theatrical life of two iconic theatre productions from British theatre in the 1980s: the Royal Shakespeare Company/Cameron Mackintosh production of Les Miserables (1985), and Jim Cartwright’s Road at the Royal Court (1986). These two productions were selected with the aim of exploring theatre’s relationship to poverty in a neoliberal economy. Both productions successfully transformed their respective representations of the poor, and the impoverishments introduced by neoliberal economic policy in the theatre during this period, into enduring forms of monetary and aesthetic value. The production of Les Miserables was the outcome of a public/private partnership that exploited new opportunities for financial speculation emerging at this time. Road ’s production was supported by recourse to what the then Royal Court director, Max Stafford Clarke, presented as a pauperized mode of entrepreneurship, developed to adapt to new, economically precarious conditions for subsidized theatre. The essay traces similarities between the economics and aesthetics of the two productions, and draws on these to provide perspectives on theatre’s relationship to the poor. Specifically, it argues that theatre forms productive coalitions with neoliberal economies, which work both onstage and off to transform the “human waste” of impoverishment into gold.

A 15-year-old boy with type 1 diabetes mellitus presented with a 4-month history of an itchy, erythematous rash confined to the site of his continuous glucose monitoring sensor (CGMS) device (figure 1). CGMS had been initiated following problems with nocturnal hypoglycaemia. Information obtained from the manufacturer confirmed that the adhesive in the dressing contained cyanoacrylate. Patch testing showed a positive reaction to ethyl cyanoacrylate …

Introduction: Women diagnosed with cancer and facing potentially sterilising cancer treatment have to make time-pressured decisions regarding fertility preservation with specialist fertility services whilst undergoing treatment of their cancer with oncology services. Oncologists identify a need for resources enabling them to support women’s fertility preservation decisions more effectively; women report wanting more specialist information to make these decisions. The overall aim of the ‘Cancer, Fertility and Me’ study is to develop and evaluate a new evidence-based patient decision aid (ptDA) for women with any cancer considering fertility preservation to address this unmet need. Methods and analysis: This is a prospective mixed-method observational study including women of reproductive age (16 years +) with a new diagnosis of any cancer across two regional cancer and fertility centres in Yorkshire, UK. The research involves three stages. In Stage 1 the aim is to develop the ptDA using a systematic method of evidence synthesis and multidisciplinary expert review of current clinical practice and patient information. In Stage 2, the aim is to assess the face validity of the ptDA. Feedback on its content and format will be ascertained using both questionnaires and interviews with patients, user groups and key stakeholders. Finally, in Stage 3 the acceptability of using this resource when integrated into usual cancer care pathways at the point of cancer diagnosis and treatment planning will be evaluated. This will involve a quantitative and qualitative evaluation of the ptDA in clinical practice. Measures chosen include using count data of the ptDAs administered in clinics and accessed online, decisional and patient-reported outcome measures and qualitative feedback. Quantitative data will be analysed using descriptive statistics, paired sample t tests and confidence intervals; interviews will be analysed using thematic analysis. Ethics and dissemination: Research Ethics Committee approval (Ref: 16/EM/0122) and Health Research Authority approval (Ref: 194751) has been granted. Findings will be published in open access peer-reviewed journals, presented at conferences for academic and health professional audiences, with feedback to health professionals and program managers. The Cancer, Fertility and Me ptDA will be disseminated via a diverse range of open-access media, study and charity websites, professional organisations and academic sources. External endorsement will be sought from the International Patient Decision Aid Standards (IPDAS) Collaboration inventory of ptDAs and other relevant professional organisations e.g. the British Fertility Society. Trial registration number: NCT02753296 (www.clinicaltrials.gov); pre-results.

This article presents a guided tour of the Men's Room, an arts and social welfare project that works with young men with experiences of homelessness, sex work and the criminal justice system. Focusing on three ‘dwelling moments’ that capture how the project occupies space and time, the article describes how a queer spatial practice supports the regular appearance of encounter, attachment and relationship in the lives of some of the most disaffected young men in the city. These appearances are challenging for project staff to maintain, and help to generate networks of support that cannot be measured against conventional modes of social care. The project provides a provocative terrain for exploring a queer future for arts projects that engage those living in spaces and times of crisis. Drawing on a concept of ‘queer choreography’, primarily informed by the work of Shannon Jackson, the article privileges description of moments of practice over extended explication or analysis; it adopts a methodological appr...

The Deal Versus the People was a theatrical response created by people in Bradford (UK) to the Transatlantic Trade and Investment Partnership (TTIP). A controversial trade deal between the European Union and United States being negotiated at the time of the production, TTIP threatened to deepen trade liberalisation, with potentially negative impacts for communities on both sides of the Atlantic. In this article, I examine the ways The Deal Versus the People critically engaged with TTIP, and the neoliberal economic paradigm that it is an expression of, by mobilising a ‘commons’ across the theatrical and social landscapes of its production.

Within TACCLE 3 – Coding European Union Erasmus+ KA2 Programme project, a review and evaluation of a set of resources that can contribute to teaching programming to younger children has made. This paper presents a survey of this review including the most outstanding products in order to help teachers to introduce programming in pre-university studies.

Children frequently present with either a skin rash or skin lesion. It is important to be able to differentiate between well children and those that are systemically ill. A systematic approach with a comprehensive history and examination, along with appropriate investigations, enables clinicians to reach diagnosis. To support this approach a number of examples have been given.

In this study, the authors demonstrate how mixed logit analysis of discrete choice experiment (DCE) data can provide information about unobserved preference heterogeneity. Their application investigates unobserved heterogeneity in men’s preferences for benign prostatic hyperplasia (BPH) treatment. They use a DCE to elicit preferences for seven characteristics of BPH treatment: time to symptom improvement, sexual and nonsexual treatment side effects, risks of acute urinary retention and surgery, cost of treatment, and reduction in prostate size. They investigate the importance of these characteristics and the trade-offs men are willing to make between them. Preferences are elicited from a sample of 100 men attending an outpatient clinic in Ireland. The authors find all treatment characteristics are significant determinants of treatment choice. There is significant preference heterogeneity in the population for four treatment characteristics: time to symptom improvement, treatment reducing prostate size, risk of surgery, and sexual side effects. The importance of preference heterogeneity at the policy level within the context of shared decision making is discussed.

in times of blood and crime, what are we, as artists and human beings, supposed to do? (Dubravka Kneževic, 19961) 1. Dubravka Kneževic, ‘Marked with Red Ink’, Theatre Journal, 48:4 (1996), 407–418 ...

Background Cow’s milk allergy (CMA) is the commonest food allergy in UK children with many misleading presentations. In 2011, the National Institute for Health and Care Excellence (NICE) provided primary care guidelines on food allergy. In Northern Ireland (NI), a regional expert group was convened in 2012 to develop a CMA-focused guidance document, later published as Milk Allergy in Primary care (MAP) guideline, along with other infant feeding issues. MAP was designed for shortcomings of national and international guidelines in the initial clinical recognition and management of mild to moderate non-IgE-mediated disease in primary care.

Topical sirolimus, or rapamycin, is known to inhibit tumorigenesis in tuberous sclerosis. We report two cases of successful treatment of children with facial angiofibromata and summarize the encouraging evidence of the effectiveness of this therapy in the literature.

It is a fundamental requirement of the University that ALL projects involving University staff or students undertaking research using human subjects receive ethical approval from the University's S...

This study is concerned with examining ways of alerting student teachers to the importance of developing questioning skills in their teaching. A survey of the literature on questioning skills revealed a wealth of examples for student teachers of traditionally ‘academic’ subjects, and a corresponding lack of available material for student teachers of practical subjects, where there may be different issues, techniques and situations to consider. In the early stages of their Postgraduate Certificate in Education (PGCE) course, secondary music student teachers were invited to make a video recording of themselves teaching in school, which included some questioning of pupils at the beginning and end of the lesson. Using guidelines provided by the course, student teachers were then invited to transcribe a short extract of the questioning sections, and critically to evaluate their performance. A range of methods for preparing questions was revealed through subsequent discussion and reflection, demonstrating that ...

This article describes the main findings of a study of youth theatre commissioned by the National Association of Youth Theatres (NAYT), funded by Arts Council England (ACE) and carried out by the C...

Hyperpigmentation after torture in darker skinned patients has regularly been noted, although its pathophysiology, and thus its forensic importance, has not previously been documented. Hyperpigmentation is not well described in the dermatological literature. It is the result of inflammation. Any inflammation can cause hyperpigmentation, and the shape of the resulting lesion can closely follow the contours of the site of original inflammatory response. This can be important in correlating the lesion with the alleged cause. It also helps to establish the differential diagnosis of the lesion, which also assists in assessing the degree of consistency between the lesion and the alleged cause. Patterns of hyperpigmentation can therefore, be helpful in assessing allegations of torture months or years after the event.

IntroductionThe Medication Prescription and Administration Record (Kardex) must always be legible and complete. It is this initial point of prescription writing that opens the way for errors and delays to delivery of treatment to occur due to omitted or misinterpretation of the prescription.1A Regional Safety Forum introduced a Paediatric Safety, Quality and Improvement Collaborative in November 2013, where the local Trusts could come together to learn about new initiatives and discuss ongoing projects. One area our Trust felt was important and decided to explore was medication safety, starting with medication prescribing.Overall aimThe aim of this project is to examine how well the kardex is being completed and how it can be improved.MethodsData collection was commenced in September 2014 by the paediatric pharmacist.A weekly kardex review audit was carried out looking at two areas:The correct completion of the front of the kardex (against 7 criteria – patient name, hospital number, date of birth, allergy status, ward, weight, date of weight).The overall prescription writing error per drug (against 17 criteria).Five kardexes each week were audited and were selected randomly from the current in-patients.An education intervention was a poster for the ward to highlight best practice prescribing guidelines.The initial 4 week results were presented at the next Paediatric Learning Session. Any particular areas of concern were fed back to the medical staff on the ward. Data collection continued to determine if there was any improvement with medical staff being aware of the audit and also with the poster being prominently displayed on the ward.ResultsIn September 2014 the accurate completion of the front of the kardex was 94.3% (week 1); 94.3% (week 2); 93.9% (week 3) and 94.3% (week 4). This improved in October to 94.3% (week 5); 100% (week 6); 94.3% (week 7) and 100% (week 8).The mean prescription writing error per drug in September was 1.375 error per drug with the weekly results documented as 1.8 (week 1); 0.8 (week 2); 1.7 (week 3); 1.2 (week 4), compared to October which showed the overall mean prescription writing error per drug to be 0.3275. The weekly results were 0.62 (week 5); 0.2 (week 6); 0.36 (week 7) and 0.13 (week 8).ConclusionThe completion of the front page of the kardex has shown improvement from September to October. It is now being completed 100% accurately, compared to initially only 94.3%.There has been a reduction in the prescription writing error rate, as is shown in the results, but there is room for further improvement.At the most recent Paediatric Safety Forum meeting it was discussed how the different Trusts were auditing prescribing and that we could consider the possibility of both a regional audit tool and also look at a Regional Paediatric Pharmacy Training on Prescription Writing for the paediatric doctors rotating.ReferenceMaxwell SRJ, Wilkinson K. Writing safe and effective prescriptions in a hospital kardex. J R Coll Physicians Edinb2007;37:348–351.

Pilomatrixomas are relatively common childhood tumors that usually occur in the head and neck region. The clinical diagnosis of these lesions may be difficult, especially if the examining physician is unfamiliar with them. Excision is usually recommended, as a foreign body reaction due to calcification of the lesion may occur and cause a vigorous inflammatory response with risk of scarring. A retrospective study was carried out by examining the preoperative ultrasound scans of 28 suspected pilomatrixomas in 25 children. The findings on sonography were correlated with the histologic results in 19 cases (18 pilomatrixomas and one ruptured epidermoid cyst). In the majority of patients, sonography either correctly supported or excluded the clinical diagnosis of pilomatrixoma and contributed to appropriate preoperative assessment and subsequent management of the lesion. We therefore found sonography of suspected pilomatrixomas in children to be a useful and noninvasive procedure, offering a significant improvement in the accurate diagnosis of these lesions.

The Men’s Room is an arts and social care agency that works creatively with young men, offering them opportunities to get involved in arts projects whilst accessing support for challenges they may be facing in their lives. The project engages different constituencies of young men experiencing severe and multiple disadvantage, including those involved with sex work or with experience of sexual exploitation, and those with experience of homelessness and/or the criminal justice system. ‘Surviving in Manchester’ was commissioned by the Lankelly Chase Foundation (LCF) and aimed to explore young men’s routes into the Men’s Room as well as how they defined successful service provision. The research included ethnographic fieldwork, walking tours led by young men to sites that they connected with their survival in the city, and a Visual Matrix conducted with staff and volunteers. It argues that the relational approach of the Men’s Room is a key organisational strength. This approach combines informal and formal support, unconditional acceptance, clear ground rules, and gauging of supportive interventions in ways that are sensitive to the young men’s readiness and ability to ‘move on’. It also includes valuable opportunities for social gathering, creative expression and public storytelling and image-making that extend the artistic and imaginative capacities of the young men and celebrate their abilities and experiences.

Cough is a common problem in childhood and generates much anxiety amongst parents. There are numerous different causes of cough in children and this article provides the reader with a logical approach, using a worked example, for its differential diagnosis. Non-specific isolated persistent cough is discussed.