Daily Cosmetic Research Analysis

BACKGROUND: There are concerns that biocide skin and mucous membrane decolonisation, which is widely used to prevent health-care-associated infections in intensive care units (ICUs), might select for multidrug-resistant pathogens. We aimed to evaluate the effects of de-escalating from universal to targeted skin and nasal decolonisation on Staphylococcus epidermidis bloodstream infections (SE-BSI). METHODS: We did a retrospective, before-after-control-impact time-series analysis and longitudinal genotypic study in two ICUs with divergent decolonisation practice in tertiary care hospitals of adjacent health boards in Scotland, UK. Participants were aged at least 16 years and admitted between July 1, 2009, and Feb 28, 2022. There were no exclusion criteria for the study. In ICU one (intervention site) universal decolonisation in all admissions was de-escalated to targeted decolonisation of meticillin-resistant Staphylococcus aureus (MRSA) carriers on Feb 1, 2019, while in ICU two (control site) targeted decolonisation was applied throughout. We collected bloodstream infection data from all causes, including clinically significant SE-BSI. Antimicrobial susceptibility testing was used to define meticillin-resistant S epidermidis (MRSE) and chlorhexidine susceptibility. We used multilocus sequence typing to identify sequence types from archived SE-BSI isolates. Whole-genome sequencing was applied to a sample from ICU one. The primary outcomes were incidence densities of all bloodstream infections, SE-BI, and meticillin-resistant S epidermidis bloodstream infections (MRSE-BSI), and the percentage probability that SE-BSI were MRSE-BSI. The effects of de-escalation on primary outcomes were estimated by differences between the intervention and control sites, before and after de-escalation, using a before-after-control-impact time-series design. Secondary outcomes included the proportion of multidrug resistant sequence types, carriage of mobile genetic elements and genes for multidrug resistance and biofilm production. FINDINGS: Between July 1, 2009, and Feb 28, 2022, S epidermidis was identified in 334 (45%) of 735 bloodstream infections in ICU one, of which 197 occurred before the de-escalation intervention in Feb 1, 2019, and S epidermidis was identified in 167 (60%) of 278 bloodstream infections in ICU two. There was no increase in all bloodstream infection incidence coinciding with de-escalation in ICU one, whereas MRSE-BSI incidence declined significantly from 10·4 cases per 1000 occupied bed days (OBDs; 95% credible interval [CrI] 7·2-15·4) to 4·3 cases per 1000 OBDs (2·5-6·7), as did the percentage probability of MRSE (from 89·2%, 95% CrI 77·8-96·5 to 56·7%, 34·3-77·5%). No significant changes in the primary outcomes were seen in ICU two. MRSE-BSI incidence density was positively associated with chlorhexidine use, but not mupirocin use. De-escalation was associated with a reduced proportion of SE-BSI due to multidrug-resistant sequence types and reduced carriage of mobile genetic elements and genes for multidrug resistance and biofilm production, as observed by multi-locus sequence typing and whole genome sequencing. INTERPRETATION: In ICU settings with low MRSA incidence, the benefits of universal decolonisation should be balanced against the risks of selecting MRSE sequence types adapted for invasive and device-associated infection. FUNDING: National Health Service Grampian Charity.

BACKGROUND AND PURPOSE: Adjuvant radiotherapy (RT) of the chestwall in breast cancer treatment negatively influences complication rates and cosmetic outcomes of breast reconstructions (BR). Neoadjuvant radiotherapy (NART) offers potential advantages, theoretically enabling immediate BR (IBR) with less complications. This comprehensive systematic review provides an overview of patient-reported, complications, and oncological outcomes of NART followed by IBR in breast cancer treatment. MATERIALS AND METHODS: A systematic literature search was conducted on PubMed, Ovid EMBASE and Cochrane library including studies published between 2014-2024. Risk of bias and methodological quality were appraised. RESULTS: Twenty-one articles (16 journal articles, 5 abstracts) involving 1.199 patients (mean follow-up 35 months) were included. Six studies compared NART to adjuvant RT, with majority of patients (98 %) receiving neoadjuvant chemoradiotherapy. Patient-reported outcomes, assessed in three studies, reported excellent-to-good cosmetic outcomes, with one reporting significantly better on cosmetic outcomes for NART compared to adjuvant RT. Complications were reported in eighteen studies. There were no complete flap failures, loss of implant rates were low. Mean incidence of unplanned surgical intervention was 11 % (range: 2-21 %). Grade 3 skin toxicity ranged from 1-17 %, with no Grade 4-5 events. Mastectomy skin necrosis varied from 3-17 %. Pathological complete response after NARCT was achieved in 12-53 % of patients, and locoregional recurrences ranged between 3 %-10 %. CONCLUSION: This review indicates that NART followed by IBR may result in higher patient satisfaction, lower complication rates and shorter total treatment time compared to adjuvant RT. Randomized trials with head-on comparison between NART and adjuvant RT are needed to confirm this.

Psychological assessment in plastic and reconstructive surgery is gaining recognition, prompting interest in preoperative screening. Surgeons face challenges in integrating these evaluations due to time constraints and unfamiliarity with psychological measures. Patient-reported outcome measures, such as BREAST-Q, FACE-Q, and BODY-Q, assess quality of life and satisfaction in surgical patients. Studies indicate high rates of psychological disorders among cosmetic surgery patients, highlighting the need for screening. Some guidelines, like those from the United Kingdom's National Institute for Health and Care Excellence, recommend preoperative screening for conditions like body dysmorphic disorder. Increased awareness of validated psychological tools can enhance holistic patient care.