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Biomedical subjects

S M Wilkinson

Publications and source records attributed to S M Wilkinson.

At least 19 recordsLinked to original sources
PubMed2006

Photopatch testing-- a retrospective review using the 1 day and 2 day irradiation protocols.

Photopatch testing is indicated in the investigation of patients with eczematous eruptions, affecting mainly light-exposed sites and in those who give a history of worsening of their condition with sun exposure. 3 different protocols are described by the British Photodermatology Group (Br J Dermatol 1997:136:371-376), 1 of which includes irradiation of allergens 1 day after application and 2 using irradiation of allergens 2 days after application. There is no evidence for superiority of any of these protocols. We reviewed the records of all patients who underwent photopatch testing in Leeds over a 50-month period, who had had the allergens applied in triplicate with 1 set irradiated after 1 day occlusion and another after 2 days. The control was occluded for 2 days. Readings were performed at 2 days and 4 days. 15 of 74 patients photopatch tested during this period had 49 positive results between them. 43 of these were felt to be of current relevance to their clinical problem. 34 of the positive results were indicative of photoallergy. Additional photoallergic reactions were detected following 2 days occlusion and irradiation compared with 1 day occlusion (16 versus 5). In conclusion, our case series suggests that 2 days occlusion before irradiation of allergens is more sensitive at detecting photoallergy.

Allergens↗
PubMed2006

Allergic contact dermatitis in children: should pattern of dermatitis determine referral? A retrospective study of 500 children tested between 1995 and 2004 in one U.K. centre.

BACKGROUND: Allergic contact dermatitis (ACD) increases with age, and a prevalence of between 13.3% and 24.5% has been reported. Patch testing infants may be particularly difficult, and false-positive reactions may occur. OBJECTIVES: The purpose of this retrospective study was to determine whether the site of primary dermatitis in children could predict a diagnosis of ACD. The current frequency of sensitization in children was also evaluated and the main sensitizing substances among children were verified. METHODS: Between 1995 and 2004, 500 children were patch tested and entered on to the patch test database at Leeds General Infirmary. Analysis of the database included identifying the presenting patterns of eczema and reviewing the patch test results for each child. RESULTS: Of the children, 133 (27%) had one or more positive patch test result. The effect of age on the likelihood of a positive patch test was highly significant (P < 0.001). Girls were significantly more likely to have a positive patch test compared with boys: odds ratio for a positive test 0.62 (95% confidence interval 0.41-0.95; P = 0.029). Type IV allergy to nickel (33%) was the most frequent finding. Reactions to fragrance mix (18%), cobalt (11%), mercapto chemicals, Myroxylon pereirae and p-phenylenediamine (each 8%) were the next most common. No statistical significance was found in the relationship between the site of primary dermatosis and a positive patch test result. CONCLUSIONS: The pattern of presenting dermatitis in children should not determine referral for patch testing. Any child with persistent eczema should be referred for patch testing.

Adolescent↗
PubMed2005

Contact dermatoses in healthcare workers: reduction in type I latex allergy in a UK centre.

Natural rubber latex (NRL) allergy has been recognized as a public health concern. NRL allergy frequently occurs in healthcare professionals. In this retrospective study we report the changing frequency of Type I NRL allergy amongst healthcare workers suffering from hand dermatitis referred to our department between 1996 and 2003. We identified 224 healthcare workers from the patch test database with a diagnosis of hand dermatitis who had undergone NRL skin prick testing (SPT). We report the SPT results, patch test results and diagnoses for each individual. The percentage of positive SPT to NRL in healthcare workers decreased from 62% in 1996 to 10% in 2003. Type IV allergy to fragrance mix (13%) was the most frequent cause of allergic contact dermatitis. Thiuram mix (8%) and carba mix (4%) were the most frequent indicators of type IV allergy to chemicals in rubber gloves. Fragrance allergy was the most frequent type IV allergen found in healthcare workers with hand dermatitis. We conclude that hand care preparations free from fragrance allergens should be available in all areas of clinical work.

Dermatitis, Occupational↗
PubMed2004

Audit of primary and secondary care as a source of patch test clinic referrals.

BACKGROUND: Referral for patch testing is important in managing patients with eczema/dermatitis. These referrals come from many different sources. OBJECTIVES: To assess the appropriateness of referrals from general practitioners (GPs) to a dedicated patch test clinic. METHODS: Referral sources were recorded for patch testing in a dedicated contact dermatitis unit for a 4-month period between November 2002 and February 2003. RESULTS: Of 217 referrals reviewed, 45 (21%) were received from GPs. There was no significant difference in the percentages of positive patch test results and of relevant positive patch test results obtained from GP referrals compared with those received from other sources, including dermatology departmental referrals. CONCLUSIONS: Referrals from GPs, if selected appropriately, can be seen directly in the patch test clinic without prior assessment in a general dermatology clinic.

Clinical Competence↗
PubMed2003

Can intensive three-day programmes improve nurses' communication skills in cancer care?

Effective communication is widely regarded as a crucial component of patient care that can determine patient satisfaction, compliance and recovery. The plethora of communication skills training programmes available to health professionals is also a testament to the importance of this element of care. However a review of studies evaluating the effectiveness of such training programmes concluded that little behavioural change in health professionals' communication skills was evident. This paper reports the findings of a programme offered to cancer/palliative care nurses (n=108) via eight condensed three-day workshops at various UK venues. Behavioural change was assessed through evaluation of audiotaped nursing assessments made pre- and six weeks post-course, scored along nine previously identified key communication areas. Mean overall scores rose by 6 points ( p<0.001) to 20 (out of 27) with statistically significant improvements on eight of the nine individual areas. Improvements in subjective levels of confidence in the areas of communication found difficult pre-course were observed immediately post-course ( p<0.001) and were still evident six weeks later. Similar improvements immediately post-course for teaching communication skills to colleagues ( p<0.001) were further improved six weeks post-course for seven of the eight areas assessed. These results suggest that three-day training courses can lead to clinically relevant behavioural change and improvements in perceived confidence in communication and dissemination of skills.

Adult↗
PubMed2003

The British standard series of contact dermatitis allergens: validation in clinical practice and value for clinical governance.

BACKGROUND: All centres use an empirically determined set of 'standard' test allergens for patch testing that contain the commoner environmental sensitizers. Objectives To assess the validity of the British standard series of 12 allergens used in addition to the 23 already in the European standard series. PATIENTS AND METHODS: Results for 3062 consecutive patients patch tested in seven centres across the United Kingdom during the year 2000 were analysed. RESULTS: The additional allergens from the British series and positive rates were: methyl dibromoglutaronitrile 2.4%, carba mix 1.6%, tixocortol pivalate 1.5%, ethylenediamine 1.3%, cetearyl alcohol 0.8%, 2-bromo-2-nitropane-1,3-diol 0.8%, diazolidinyl urea 0.7%, chlorocresol 0.6%, budesonide 0.6%, fusidic acid 0.5%, imidazolidinyl urea 0.5%, and chloroxylenol 0.4%. The allergens with the lowest positive rate in the European standard series were primin at 0.6% and isopropyl-phenyl-para-phenylenediamine at 0.4%. CONCLUSIONS: The 12 allergens in the British series should continue being tested as a standard addition to the European series within the U.K. The collection of data in this manner to allow comparisons between centres shows differences that reflect selection criteria and interpretation of results, and offers a useful tool for audit and clinical governance. Testing fewer than 1 : 2150 population may indicate underprovision of service. Similarly, rates of sensitization for nickel contact allergy above 26% and for fragrance mix above 16% (the upper 95% confidence intervals) should stimulate inquiry into the reasons behind this.

Allergens↗
PubMed2003

What are you like?: A personality profile of cancer and palliative care nurses in the United kingdom.

Occupational psychology has long been concerned with the proposed link between personality and occupational success or stress. The role of the cancer and palliative care nurse can be challenging and stressful, and the aim of the current study was to explore the existence of a personality profile for nurses working in this area. For this study, 178 nurses undertaking degree and diploma studies in cancer and palliative care at a specialist palliative care unit in northwest England completed the 16PF personality inventory and a demographic questionnaire. The mean age of these nurses was 38 years, and 95% were women. Approximately half (52%) were staff nurses, and the majority (77%) worked in hospital or community environments. The profile suggested that the nurses were extraverted, empathic, trusting, open, expressive, insightful, and group oriented. They were likely to be cautious when facing new ideas, potentially naïve in dealings with more astute others, and somewhat lacking in objectivity. Positive aspects of the profile suggested that they would thrive in a stressful occupation wherein caring for others and multidisciplinary team working are important. However, less positive elements may affect their ability to be influential members of the multidisciplinary team. The potential for using personality profiling for effective targeting of personnel, education, training, and improvement of self-awareness is explored.

Adaptation, Psychological↗
PubMed2003

Learning the hard way! Setting up an RCT of aromatherapy massage for patients with advanced cancer.

Aromatherapy massage is used in cancer palliative care to improve quality of life but there is little evidence for its effectiveness. A large pragmatic multicentre randomized controlled trial was set up to examine the effectiveness of aromatherapy in improving psychological distress and quality of life in patients with cancer. This paper examines the challenges encountered in the design and execution of the study. The original design, i) focused on palliative care patients with advanced disease; ii) had both a no-intervention and a treatment control group (relaxation therapy); and iii) adopted 90% power for sample size calculations. A varied measurement strategy was employed. Recruitment proved difficult, referrers were 'gate-keeping', patients were often too ill to approach and others declined. The trial was modified to ensure viability. Eligibility was extended to all patients with cancer irrespective of stage, the relaxation group was removed and the power reduced to 80%. Although it is not generally good practice to change a study design once recruitment has started, the changes were consistent with the original basic study aims and design principles. The data collection phase was successfully completed in July 2002.

Aromatherapy↗
PubMed2002

Type IV hypersensitivity reactions to natural rubber latex: results of a multicentre study.

BACKGROUND: Positive patch test reactions to natural rubber latex (NRL) have been interpreted as allergic or irritant by different groups. Additives to the NRL test solution have also caused positive reactions in previous studies. OBJECTIVES: Five centres of the British Contact Dermatitis Group conducted a prospective study on the prevalence of type IV hypersensitivity to NRL, using ammonia-preserved NRL solution for testing. PATIENTS AND METHODS: A total of 2738 consecutive patients were patch tested. Where clinically indicated, specific IgE was measured or a prick test done. RESULTS: Twenty-seven patients (1%) had a positive patch test reaction to NRL, which was considered to be allergic and of current relevance in 19 (70%) patients. Fourteen of these also had a positive prick test or specific IgE. Thirteen patients (48%) were male, 19 (70%) atopic and 13 (48%) had eczema on their hands. CONCLUSIONS: We conclude that delayed-type hypersensitivity to NRL is a problem for a proportion of patients with eczema, particularly on their hands, and that patch testing with ammonia-preserved NRL can be recommended to identify these patients. Patients with a positive patch test should be investigated for contact urticaria to NRL.

Adult↗
PubMed2002

Eczema: quality of life by body site and the effect of patch testing.

BACKGROUND: Patients with dermatitis are known to have impaired quality of life. Whether this varies according to body site has not been evaluated. Patch tests have previously been shown to influence quality of life, although no previous studies have shown if this is dependent on the results of the patch tests. OBJECTIVES: To evaluate the impact of patch testing on quality of life according to the outcome of the investigations and to determine how quality of life varies according to eczema body site. METHODS: One hundred and sixty consecutive adult patients with active eczema were selected from a patch test clinic for inclusion into the study. Quality of life was determined using the Dermatology Life Quality Index (DLQI) and the SF-36, prior to patch testing and 2 months later. Perceived eczema severity at each time point was also noted, along with the outcome of patch testing. Baseline comparison of quality of life was performed between four body site groups (face, hand, generalized, other). RESULTS: Patients confirmed as having relevant positive contact allergens were shown to have a significant improvement in both perceived eczema severity (P = 0.0004) and DLQI score (P = 0.0015) at 2 months after patch testing. No significant changes were noted in the SF-36 score, other than a borderline improvement in the pain score (P = 0.048). The improvement in quality of life and eczema severity was not noted in patients with negative patch tests. Eighty-nine per cent of patients diagnosed as having contact allergy were able to comply with avoidance advice. No significant variation was noted in quality of life according to body site affected by eczema. There was a positive correlation between DLQI score and perceived eczema severity (P < 0.0001). CONCLUSIONS: Patients confirmed as having contact allergy show a subsequent improvement in eczema severity and an improvement in quality of life.

Adolescent↗