Leicester Royal Infirmary

About: Leicester Royal Infirmary is a healthcare organization based out in Leicester, United Kingdom. It is known for research contribution in the topics: Population & Carotid endarterectomy. The organization has 5300 authors who have published 6204 publications receiving 208464 citations.

Dandruff and seborrhoeic dermatitis: causes and management

Abstract: Scalp scaling, with or without irritation, has a high public profile, is very common and can cause significant distress and discomfort; however, the medical profession has a tendency to view such problems as rather trivial unless the changes are gross or part of a more widespread dermatosis. There are a number of reasonably welldefined clinical entities in which scalp scaling may be the only, or predominant, feature, including seborrhoeic dermatitis, psoriasis and pityriasis amiantacea. Scalp involvement with scaling may also occur in a number of other inflammatory dermatoses such as atopic dermatitis, discoid lupus erythematosus, lichen planus and tinea capitis. There are also a number of conditions where there is an overlap in the clinical appearances, such as between seborrhoeic dermatitis and psoriasis— sometimes called sebopsoriasis. The relationship between all these different conditions is not clear, one point of particular difficulty being the distinction between scalp scaling, pityriasis capitis or dandruff, and seborrhoeic dermatitis (SD) confined to the scalp. Many regard these conditions as being identical, with pityriasis capitis being a mild non-inflammatory type of seborrhoeic dermatitis. The skin disease, SD, has been known for many years. While it is difficult to attribute original authorship, as descriptions are difficult to place in view of the problems with case definition, SD has long been recognized as a condition which affects otherwise healthy people as well as those with other diseases.1 The association between seborrhoea, SD and acne has also been difficult to disentangle. Thus, for the purposes of this review, dandruff will be discussed alongside the scalp scaling associated with seborrhoeic dermatitis. In the earlier reports of the disease, SD was ascribed to a small micro-organism, usually thought to be a bacterium, the Flaschen bacillus. However, it is now virtually certain that this organism is identical to the small lipophilic yeast of the genus Malassezia, previously known as Pityrosporum,2 also described in the nineteenth century in association with scalp scaling or dandruff.3 The view of SD as an infection prevailed through much of the early twentieth century, and work in support of this hypothesis included the demonstration that a similar condition could be caused by the application of lipophilic or similar yeasts to the skin surface after scarification.2 The alternative hypothesis, that SD was due to a hyperproliferative state akin to psoriasis, was not put forward until the 1960s and 70s. The demonstration at that time that there was increased epidermal cell turnover in SD4 and the success of simple compound medications such as salicylic acid and later topical corticosteroids were used as evidence for the proposal,5 micro-organisms on lesional skin being thought to reflect the underlying abnormality of the epidermis.5 A further change in opinion then occurred with the introduction of the azole antifungals such as econazole6 and ketoconazole,7 when it was observed that patients with SD receiving these drugs showed significant clinical improvement, the improvement occurring as lipophilic yeast counts dropped and recurrence developing with recolonization. Later, similar observations were made with other specific antifungal drugs and proponents of the view that SD was related to fungal infection were apparently vindicated. What is the current view today?

Methicillin-resistant Staphylococcus aureus on orthopaedic wards: incidence, spread, mortality, cost and control.

Abstract: We examined the rates of infection and colonisation by methicillin-resistant Staphylococcus aureus (MRSA) between January 2003 and May 2004 in order to assess the impact of the introduction of an MRSA policy in October 2003, which required all admissions to be screened. Emergency admissions were treated prophylactically and elective beds ring-fenced. A total of 5594 admissions were cross-referenced with 22 810 microbiology results. The morbidity, mortality and cost of managing MRSA-carrying patients, with a proximal fracture of the femur were compared, in relation to age, gender, American Society of Anaesthesiologists grade and residential status, with a group of matched controls who were MRSA-negative. In 2004, we screened 1795 of 1796 elective admissions and MRSA was found in 23 (1.3%). We also screened 1122 of 1447 trauma admissions and 43 (3.8%) were carrying MRSA. All ten ward transfers were screened and four (40%) were carriers (all p < 0.001). The incidence of MRSA in trauma patients increased by 2.6% per week of inpatient stay (r = 0.97, p < 0.001). MRSA developed in 2.9% of trauma and 0.2% of elective patients during that admission (p < 0.001). The implementation of the MRSA policy reduced the incidence of MRSA infection by 56% in trauma patients (1.57% in 2003 (17 of 1084) to 0.69% in 2004 (10 of 1447), p = 0.035). Infection with MRSA in elective patients was reduced by 70% (0.56% in 2003 (7 of 1257) to 0.17% in 2004 (3 of 1806), p = 0.06). The cost of preventing one MRSA infection was £3200. Although colonisation by MRSA did not affect the mortality rate, infection by MRSA more than doubled it. Patients with proximal fractures of the femur infected with MRSA remained in hospital for 50 extra days, had 19 more days of vancomycin treatment and 26 more days of vacuum-assisted closure therapy than the matched controls. These additional costs equated to £13 972 per patient. From this experience we have been able to describe the epidemiology of MRSA, assess the impact of infection-control measures on MRSA infection rates and determine the morbidity, mortality and economic cost of MRSA carriage on trauma and elective orthopaedic wards.

The predictive properties of frailty-rating scales in the acute medical unit

Abstract: Background: older people are at an increased risk of adverse outcomes following attendance at acute hospitals. Screening tools may help identify those most at risk. The objective of this study was to compare the predictive properties of five frailty-rating scales. Method: this was a secondary analysis of a cohort study involving participants aged 70 years and above attending two acute medical units in the East Midlands, UK. Participants were classified at baseline as frail or non-frail using five different frailty-rating scales. The ability of each scale to predict outcomes at 90 days (mortality, readmissions, institutionalisation, functional decline and a composite adverse outcome) was assessed using area under a receiver-operating characteristic curve (AUC). Results: six hundred and sixty-seven participants were studied. Frail participants according to all scales were associated with a significant increased risk of mortality [relative risk (RR) range 1.6–3.1], readmission (RR range 1.1–1.6), functional decline (RR range 1.2–2.1) and the composite adverse outcome (RR range 1.2–1.6). However, the predictive properties of the frailty-rating scales were poor, at best, for all outcomes assessed (AUC ranging from 0.44 to 0.69). Conclusion: frailty-rating scales alone are of limited use in risk stratifying older people being discharged from acute medical units.