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International Dermatology Outcome Measures (IDEOM) is a non-profit organization founded in 2013. It is composed of researchers and stakeholders who work to develop evidenced-based outcome measures to enhance research and treatment recommendations of dermatologic diseases.The 2021 IDEOM Virtual Annual Meeting occurred from November 19-20, 2021. Contributions were made by leaders and stakeholders from the psoriasis, psoriatic arthritis, pediatric hidradenitis suppurativa, acne, vitiligo, actinic keratosis, alopecia areata, itch, and cutaneous lymphoma workgroups. The psoriasis, psoriatic arthritis, and actinic keratosis workgroups provided an overview of their respective instruments for treatment satisfaction and symptom measurement. The inaugural meetings of the itch, alopecia areata, and cutaneous lymphoma workgroups identified unmet needs of their respective diseases and future goals. The acne, vitiligo, and pediatric hidradenitis suppurativa workgroups discussed concerns of quality of life, instruments for symptom measurement, and screening tools. Additionally, a representative from the US Food and Drug Administration was in attendance and presented an update on topical drugs and generics. This report provides a summary of workgroup updates from the past year and future directions established during the meeting.This report summarizes progress made by each IDEOM workgroup at the 2021 IDEOM Virtual Annual Meeting. J Drugs Dermatol. 2022;21(8):867-874. doi:10.36849/JDD.6974.

Background/Aims Although continuous composite measures of disease activity for PsA assessment exist, more feasible abbreviated measures are needed for routine screening. The 3VAS and 4VAS scores, developed by abridging the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) Composite Exercise (GRACE) measure, are the first short multidimensional composite measures specifically for routine PsA care. 3VAS/4VAS showed superior performance vs. several established composite measures using small datasets. However, GRAPPA members recommended further testing of 3VAS/4VAS in observational and trial datasets. Methods This post hoc analysis used pooled data through W24 from all treatment groups in the DISCOVER 1/2 and COSMOS studies. Correlation of 3VAS/4VAS with DAPSA, PASDAS, PhGA and PtGA was assessed with Pearson’s correlation coefficient, minimal important difference (MID) with four distribution-based methods and minimal detectable change (MDC) with the standard formula (Table 1). Clinically relevant thresholds for low, moderate and high disease activity were estimated with receiver operating characteristic analysis and DAPSA (≤4, >4-≤14, >14-≤28, >28), PASDAS (≤1.9, >1.9-≤3.2, >3.2-1-≤3, >3-≤6, >6 cm) as anchors. Results This analysis included 1405 patients: 51.3% were male, with a mean (sd) age of 47.1 (11.8) and PsA duration of 6.4 (6.5) years. The mean baseline 3VAS, 4VAS, DAPSA, PASDAS, PhGA and PtGA scores reflected high disease activity levels (Table 1). Through W24, 3VAS and 4VAS showed very strong correlation with PtGA (r3VAS=0.92, r4VAS=0.94) and PASDAS (r3VAS=0.81, r4VAS=0.82), strong with PhGA (r3VAS=0.77, r4VAS=0.74) and moderate-to-strong with DAPSA (r3VAS=0.59, r4VAS=0.61). Calculated MIDs were 0.9 for 3VAS and 0.9 for 4VAS; MDCs were 3.3 for 3VAS and 3.2 for 4VAS (Table 1). Cut-off values for low, moderate and high disease activity were 2.0, 3.4 and 4.9 for 3VAS, and 2.1, 3.5 and 5.1 for 4VAS. Conclusion Using a large pooled clinical trial dataset of patients with active PsA, we have calculated clinically relevant thresholds for improvement, as well as disease activity thresholds, for 3VAS and 4VAS. These estimates are generally comparable to those previously reported and may facilitate setting treatment targets and screening disease activity in routine care when resources are limited or in remote patient monitoring. Disclosure W. Tillett: Other; Received research funding, consulting, speaker fees and/or honoraria from AbbVie, Amgen, Celgene, GlaxoSmithKline, Janssen, Lilly, MSD, Novartis, Pfizer and UCB. L. Coates: Consultancies; AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Novartis, Pfizer and UCB. Member of speakers’ bureau; AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Medac, Novartis, Pfizer and UCB. Grants/research support; AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer and UCB. Other; National Institute for Health Research (NIHR) Clinician Scientist award. The research was supported by the NIHR Oxford Biomedical Research Centre, The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health, We acknowledge the support of the NIHR Clinical Research Network. M. Vis: Other; Received research grants and consulting or speaker fees from AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, UCB and the Dutch Arthritis Foundation. J. Merola: Consultancies; Consultant and/or investigator for AbbVie, Arena, Biogen, Bristol Myers Squibb, Dermavant, Lilly, Janssen, Novartis, Pfizer, Sun Pharma and UCB Pharma. E. Soriano: Consultancies; AbbVie, Janssen, Novartis and Roche. Member of speakers’ bureau; AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, Roche and UCB. Grants/research support; AbbVie, Janssen, Novartis, Pfizer, Roche and UCB. M. Perate: Shareholder/stock ownership; Employee of Janssen and owns stocks in Johnson & Johnson. M. Shawi: Shareholder/stock ownership; Employee of Janssen and owns stocks in Johnson & Johnson. M. Zimmermann: Shareholder/stock ownership; Employee of Janssen and owns stocks in Johnson & Johnson. E. Rampakakis: Consultancies; Employee of JSS Medical Research; paid consultant of Janssen. M. Sharaf: Shareholder/stock ownership; Employee of Janssen and owns stocks in Johnson & Johnson. P. Nash: Other; Received grants for research and clinical trials and honoraria for advice and lectures on behalf of AbbVie, Boehringer-Ingelheim, Gilead/Galapagos, GSK, Janssen, Lilly, MSD, Novartis, Pfizer, Samsung,. P.S. Helliwell: Consultancies; AbbVie, Amgen, Novartis and Janssen. Other; Fees for educational services from AbbVie, Amgen, Novartis and Janssen.

Objectives: Basal ganglia haemorrhage (BGH) is the most common type of intracerebral bleed with high morbidity and mortality rate. Despite advancements in minimally invasive techniques in recent years, the efficacy between craniotomy and endoscopic approach for BGH is still debatable. The aim of this systematic review and meta-analysis was to evaluate the outcomes of craniotomy and endoscopic approach for BGH. Methods: Databases of Pubmed, EMBASE, MEDLINE and CENTRAL were systematically searched from its inception until December 2020. All randomized clinical trials and observational studies comparing craniotomy versus endoscopic approach in BGH were included. Results: Twelve studies enrolling 1,297 patients (craniotomy:675, endoscopy:632) were included for qualitative and quantitative analysis. Endoscopic approach was associated with significantly lower postoperative mortality (OR:0.35, P

BackgroundCauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures.MethodsThis is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated.FindingsIn 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up.InterpretationPost-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively.FundingDCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.

Summary Background Insertion of a ventriculoperitoneal shunt for hydrocephalus is one of the commonest neurosurgical procedures worldwide. Infection of the implanted shunt affects up to 15% of these patients, resulting in prolonged hospital treatment, multiple surgeries, and reduced cognition and quality of life. Our aim was to determine the clinical and cost-effectiveness of antibiotic (rifampicin and clindamycin) or silver shunts compared with standard shunts at reducing infection. Methods In this parallel, multicentre, single-blind, randomised controlled trial, we included patients with hydrocephalus of any aetiology undergoing insertion of their first ventriculoperitoneal shunt irrespective of age at 21 regional adult and paediatric neurosurgery centres in the UK and Ireland. Patients were randomly assigned (1:1:1 in random permuted blocks of three or six) to receive standard shunts (standard shunt group), antibiotic-impregnated (0·15% clindamycin and 0·054% rifampicin; antibiotic shunt group), or silver-impregnated shunts (silver shunt group) through a randomisation sequence generated by an independent statistician. All patients and investigators who recorded and analysed the data were masked for group assignment, which was only disclosed to the neurosurgical staff at the time of operation. Participants receiving a shunt without evidence of infection at the time of insertion were followed up for at least 6 months and a maximum of 2 years. The primary outcome was time to shunt failure due the infection and was analysed with Fine and Gray survival regression models for competing risk by intention to treat. This trial is registered with ISRCTN 49474281. Findings Between June 26, 2013, and Oct 9, 2017, we assessed 3505 patients, of whom 1605 aged up to 91 years were randomly assigned to receive either a standard shunt (n=536), an antibiotic-impregnated shunt (n=538), or a silver shunt (n=531). 1594 had a shunt inserted without evidence of infection at the time of insertion (533 in the standard shunt group, 535 in the antibiotic shunt group, and 526 in the silver shunt group) and were followed up for a median of 22 months (IQR 10–24; 53 withdrew from follow-up). 32 (6%) of 533 evaluable patients in the standard shunt group had a shunt revision for infection, compared with 12 (2%) of 535 evaluable patients in the antibiotic shunt group (cause-specific hazard ratio [csHR] 0·38, 97·5% CI 0·18–0·80, p=0·0038) and 31 (6%) of 526 patients in the silver shunt group (0·99, 0·56–1·74, p=0·96). 135 (25%) patients in the standard shunt group, 127 (23%) in the antibiotic shunt group, and 134 (36%) in the silver shunt group had adverse events, which were not life-threatening and were mostly related to valve or catheter function. Interpretation The BASICS trial provides evidence to support the adoption of antibiotic shunts in UK patients who are having their first ventriculoperitoneal shunt insertion. This practice will benefit patients of all ages by reducing the risk and harm of shunt infection. Funding UK National Institute for Health Research Health Technology Assessment programme.

A collaborative exchange of ideas occurred at The Psoriatic Disease Payer Advisory Panel sponsored by International Dermatology Outcomes Measures (IDEOM) and The National Psoriasis Foundation (NPF) in January, 2016. Patient, provider, payer, pharmaceutical industry, IDEOM board member, and NPF leader representatives shared perspectives to address the unmet needs in the treatment of psoriatic patients. The payers who play a crucial role in controlling treatment access and improving patient outcomes played a pivotal role in the discussion. Progress made during the Payer Advisory Panel will ultimately advance psoriatic initiatives and help to address the persistent challenges of all vested stakeholders.br /br /emJ Drugs Dermatol./em2016;15(5):641-644.

Medical implant devices have evolved in the past decade and now many surgical specialties have turned to polyetheretherketone (PEEK) devices for its ideal properties. In Neurosurgery, PEEK has its role in many operations such as cervical cages after anterior cervical discectomy and as a prosthetic implant for cranioplasty where autologous cranioplasty is not possible. We discuss our case of a poorly differentiated destructive tumour that was surgically removed and the skull deformity replaced with a PEEK implant, assisted by state of the art neuro-navigational technology.

Introduction: In recent years balloon kyphoplasty has become increasingly implemented in the treatment of vertebral compression fractures and has been shown to be safe and efficacious at long term follow up particularly for patients with metastatic disease to the spine. At Waikato hospital, New Zealand, we looked at our outcomes compared with current literature. Methods: All patients who underwent balloon kyphoplastybetween 2008-2012 were included in the study and outcomes measured were pain scores and functional disability using the Oswestry disability index. Results: 12 patients were included in the study and average pain scores both at rest and on activity improved post-operatively. Functional disability significantly improved at short and long term follow-up. Conclusion: Balloon kyphoplasty is a safe and effective procedure and our results so far concur with current literature.

The title compound, [Ir2H2O(C3H9P)6](BF4)2·2H2O, was isolated from the reaction between [Ir(COD)(PMe3)3]BF4 and H2 in water (COD is cyclo-octa-1,5-diene). The asymmetric unit consists of one Ir(III) atom bonded to three PMe3 groups, one hydride ligand and half an oxide ligand, in addition to a BF4 (-) counter-ion and one water molecule of hydration. The single oxide ligand bridging two Ir(III) atoms is disordered across an inversion center with each O atom having a 50% site occupancy. Each Ir(III) atom has three PMe3 groups occupying facial positions, with the half-occupancy O atoms, a hydride ligand and an Ir-Ir bond completing the coordination sphere. The Ir-Ir distance is 2.8614 (12) Å, comparable to other iridium(III) metal-metal bonds. Two water mol-ecules hydrogen bond to two BF4 (-) anions in the unit cell.

We present a case of intracranial abscess in a young female with Ectopia Cordis, an exceptionally rare cardiac condition. The neurosurgical implication is the predisposition to intracranial abscess formation. A heightened awareness of this association will aid diagnosis in similar clinical scenarios.

INTRODUCTION: Pelvic floor injury from obstetric trauma has been associated with increase in future pelvic floor dysfunction. Thus, analysis of factors in women who have had a third- or fourth-degree laceration may help to identify those at risk of developing pelvic floor dysfunction. Several factors such as operative vaginal delivery and median episiotomy have been shown to be risk factors for these lacerations. In this study we attempt search for additional risk factors for obstetric trauma. METHODS: We identified 100 women who had a third- and fourth-degree laceration and 100 randomly selected women in a control group from the same time period. Parity, presence of stretch marks, prepregnancy body mass index, age, smoking, fetal weight, operative vaginal delivery, median episiotomy, and duration of second stage were compared between each group. Odds ratios (ORs) were calculated for each of the listed risk factors. RESULTS: Prepregnancy body mass index greater than 30 kg/m (OR 5.3, P=.01), fetal weight greater than 4,000 g (OR 20.7, P=.01), duration of second stage between 1 and 2 hours (OR 10.8, PCONCLUSION: Of the listed risk factors, duration of second stage as little as 1 hour may increase the risk of obstetric trauma. This may represent a modifiable risk factor to decrease the risk of future pelvic floor dysfunction. Language: en

Introduction: Genital psoriasis is a common but frequently overlooked manifestation of psoriasis with a considerable impact on patients' quality of life. Currently no validated clinical trial outcome measures exist to assess genital psoriasis severity that meet regulatory agency requirements. Methods: This study describes the development of the static Physician's Global Assessment of Genitalia (sPGA-G) scale, a clinical outcome measure for the assessment of genital psoriasis severity that accounts for the erythematous clinical presentation of genital psoriasis. The reliability of the sPGA-G was evaluated using scores collected from clinician assessments of photographs of genital psoriasis cases. Scores were collected from 10 academic and clinical experts in genital psoriasis and 95 clinician assessors who participated in either in-person (n=28) or online (n=67) sPGA-G training modules. Results: The sPGA-G had a high inter-rater reliability (IRR, measured by Kendall's W) for expert raters (W=0.856, P less than 0.0001), in-person assessors (W=0.822, P less than 0.0001), and online assessors (W=0.678, P less than 0.0001). IRR was also high for all clinical assessors combined, (W=0.714, P less than 0.0001). Discussion: This study demonstrates that the sPGA-G is an intuitive and reliable clinical outcome measure that specifically measures the severity of genital psoriasis. J Drugs Dermatol. 2017;16(8):793-799./em/p.