ItemHow to critically appraise a systematic review: an aide for the reader and reviewer(Wiley, 2023-07-01) Frewen, J.; de Brito, M.; Pathak, A.; Barlow, R.; Williams, H. C.The number of published systematic reviews has soared rapidly in recent years. Sadly, the quality of most systematic reviews in dermatology is substandard. With the continued increase in exposure to systematic reviews, and their potential to influence clinical practice, we sought to describe a sequence of useful tips for the busy clinician reader to determine study quality and clinical utility. Important factors to consider when assessing systematic reviews include: determining the motivation to performing the study, establishing if the study protocol was prepublished, assessing quality of reporting using the PRISMA checklist, assessing study quality using the AMSTAR 2 critical appraisal checklist, assessing for evidence of spin, and summarizing the main strengths and limitations of the study to determine if it could change clinical practice. Having a set of heuristics to consider when reading systematic reviews serves to save time, enabling assessment of quality in a structured way, and come to a prompt conclusion of the merits of a review article in order to inform the care of dermatology patients. ItemHow to do digital Advice and Guidance well(Wiley, 2023-07-01) Charman, C.; Wainman, H.; Rabindranathnambi, A.; Whybrew, C.; Williams, H. C.The COVID-19 pandemic has accelerated a rapid expansion of digital Advice and Guidance (A&G) across UK medical and surgical specialties. Dermatology A&G requests have increased by over 400% since the onset of the pandemic in 2020, with rapid expansion of teledermatology A&G services across England. Dermatology A&G is usually carried out asynchronously through dedicated digital platforms such as the National Health Service e-referral service, with streamlined conversion to referral if clinically indicated. A&G with images is advocated as the main referral pathway to dermatology specialist services in England (excluding the 2-week wait suspected skin cancer pathway). Providing dermatological care through A&G requires specific clinical skill sets to ensure rapid, safe and collaborative delivery, and optimization of educational benefit. Little published guidance is available to signpost clinicians to what constitutes a high-quality A&G request and response. This educational article discusses good clinical practice based on extensive local and national experience from primary and secondary care doctors. We cover digital communication skills, shared decision making, clinical competency and building collaborative links between patients, referrers and specialists. High-quality A&G, with agreed turn-around times and optimization of technology, can significantly streamline patient care and strengthen links between clinicians, providing it is appropriately resourced within the wider planning of elective care and outpatient activity. ItemUse of a pregnancy dermatology clinical scoring system to differentiate between pemphigoid gestationis and polymorphic eruption of pregnancy: practical considerations for the obstetrician(Elsevier, 2023-09-01) Xie, F.; Davis, D. M. R.; Baban, F.; Johnson, E. F.; Theiler, R. N.; Todd, A.; Pruneddu, S.; Murase, J. E.; Maul, J. T.; Ambros-Rudolph, C. M.; Lehman, J. S. ItemDevelopment and multicenter international validation of a diagnostic tool to differentiate between pemphigoid gestationis and polymorphic eruption of pregnancy(Elsevier, 2023-02-03) Xie, F.; Davis, D. M. R.; Baban, F.; Johnson, E. F.; Theiler, R. N.; Todd, A.; Pruneddu, S.; Murase, J. E.; Maul, J. T.; Ambros-Rudolph, C. M.; Lehman, J. S.BACKGROUND: Pemphigoid gestationis (PG) and polymorphic eruption of pregnancy (PEP) may be similar morphologically but confer different maternal and fetal risks. Direct immunofluorescence is the gold standard test used to differentiate between the 2 diagnoses but is not always available. OBJECTIVE: To develop and validate a clinical scoring system to differentiate PG from PEP. METHODS: After developing a scoring system based on differentiating clinical factors reported in existing literature, we tested its diagnostic accuracy in a retrospective international multicenter validation study in collaboration with the European Academy of Dermatology and Venereology's Skin Diseases in Pregnancy Taskforce. RESULTS: Nineteen pregnancies (16 patients) affected by PG and 39 pregnancies (39 patients) affected by PEP met inclusion criteria. PG had a mean score of 4.6 (SD, 2.5) and PEP had a mean score of -0.3 (SD, 2.0). The area under the curve was 0.93 (95% CI, 0.86-1.00). Univariate analysis revealed that almost all criteria used in the scoring system were significantly different between the groups (P < .05), except for skip pregnancy and multiple gestations, which were then removed from the final scoring system. LIMITATIONS: Small retrospective study. CONCLUSION: The Pregnancy Dermatoses Clinical Scoring System may be useful to differentiate PG from PEP in resource-limited settings. ItemDelusional infestation in healthcare professionals: Outcomes from a multi-centre case series(Wiley, 2022-11-28) Frewen, J.; Lepping, P.; Goulding, J. M. R.; Walker, S.; Bewley, A.Delusional infestation (DI) describes an unwavering fixed belief of infestation with pathogens, despite a lack of medical evidence supporting this. Effective management of DI with antipsychotics is made challenging by the fixed belief that the condition is an infestation or infection rather than a mental illness. A case series of individuals diagnosed with DI included 11% who were healthcare professionals (HCPs). We sought to characterise a cohort of HCPs who presented with DI in the UK. The case notes of HCPs diagnosed with DI at specialist clinics between 2015 and 2019 were reviewed. Demographic and clinical data were obtained. Twelve HCPs were identified out of a total of 381 individuals diagnosed with DI. Median age was 52.5 (IQR = 14.5) years. 75% (n = 9) were women. Ten individuals had primary DI, whilst two had secondary DI (one to recreational drug use, one to depression). Four individuals (33%) engaged with antipsychotic treatment. Two responded well, both had secondary DI. Of the two individuals with primary DI who engaged, one did not respond to antipsychotic medication and the other was unable to tolerate two antipsychotic drugs. In Primary DI (n = 10), the rate of adherence was lower at 20% (n = 2). In DI, high engagement and adherence rates to treatment have been reported in specialist centres. Improvement has been reported as high as 70%-75%. This indicates that a large proportion of individuals who adhere to treatment appear to derive benefit. In this series, engagement with treatment by HCPs with primary DI was low at 20%, and improvement was only achieved in individuals with secondary DI. Mental illness-related stigma, feelings of distress and difficulty forming therapeutic relationships with a professional peer are significant challenges. Developing rapport is key to treatment success in DI. In HCPs this may be suboptimal due to these negative feelings, resulting in lower engagement. A diagnosis of DI in a HCP may raise concerns regarding fitness to practise. An assessment of the impact of DI and the potential to interfere with professional duties warrants consideration. We highlight the occurrence of DI in HCPs, and the apparent lower engagement with treatment in this cohort.