Daily Cosmetic Research Analysis
A controlled time-series study from Scotland links universal ICU decolonisation to higher MRSE bloodstream infections and shows that de-escalation reduces resistant lineages. A systematic review suggests neoadjuvant radiotherapy may enable immediate breast reconstruction with favorable cosmetic outcomes and acceptable complication rates. A clinical review underscores validated psychological screening tools preoperatively in aesthetic surgery to improve patient selection and outcomes.
Summary
A controlled time-series study from Scotland links universal ICU decolonisation to higher MRSE bloodstream infections and shows that de-escalation reduces resistant lineages. A systematic review suggests neoadjuvant radiotherapy may enable immediate breast reconstruction with favorable cosmetic outcomes and acceptable complication rates. A clinical review underscores validated psychological screening tools preoperatively in aesthetic surgery to improve patient selection and outcomes.
Research Themes
- ICU infection prevention strategy and antimicrobial resistance
- Radiotherapy sequencing with immediate breast reconstruction and cosmetic outcomes
- Preoperative psychological screening in aesthetic plastic surgery
Selected Articles
1. Universal versus targeted chlorhexidine and mupirocin decolonisation and clinical and molecular epidemiology of Staphylococcus epidermidis bloodstream infections in patients in intensive care in Scotland, UK: a controlled time-series and longitudinal genotypic study.
In two ICUs with divergent policies, de-escalating from universal to targeted decolonisation did not increase overall bloodstream infections but significantly reduced MRSE-BSI incidence and the proportion of multidrug-resistant sequence types. MRSE-BSI incidence was positively associated with chlorhexidine use, suggesting selection pressure from universal biocide exposure.
Impact: This quasi-experimental study integrates clinical epidemiology with genotyping to show that universal decolonisation can select for MRSE and that de-escalation mitigates this risk. It informs infection-prevention policy in ICUs with low MRSA prevalence.
Clinical Implications: ICUs with low MRSA prevalence should consider shifting from universal to targeted decolonisation, monitor MRSE epidemiology, and rationalise chlorhexidine exposure to reduce selection of resistant S. epidermidis without increasing overall BSI.
Key Findings
- De-escalation at ICU1 reduced MRSE-BSI incidence from 10.4 to 4.3 per 1000 occupied bed days with no rise in overall BSI; no parallel changes occurred at the control ICU.
- The probability that SE-BSI were MRSE fell from 89.2% to 56.7% after de-escalation.
- MRSE-BSI incidence density correlated positively with chlorhexidine use but not with mupirocin.
- Genotyping (MLST and WGS) showed fewer multidrug-resistant sequence types and mobile genetic elements after de-escalation.
Methodological Strengths
- Before-after-control-impact time-series design across two ICUs over 12+ years
- Integration of phenotypic susceptibility with MLST and whole-genome sequencing
Limitations
- Retrospective observational design susceptible to confounding
- Generalizability limited to two adjacent health boards and low-MRSA settings
Future Directions: Prospective multicentre or cluster-randomised evaluations of decolonisation strategies, dose-response of chlorhexidine exposure, and routine genomic surveillance to track resistance evolution.
2. Neoadjuvant radiotherapy and immediate breast reconstruction: A systematic review of literature of the last decade.
Across 21 studies (1,199 patients), neoadjuvant radiotherapy followed by immediate breast reconstruction yielded generally excellent-to-good cosmetic outcomes and acceptable complication rates, with low implant loss and no complete flap failures. Oncologic outcomes, including pCR (12–53%) and locoregional recurrence (3–10%), were within expected ranges, supporting feasibility while calling for randomized confirmation.
Impact: This systematic review synthesizes patient-reported, surgical, and oncologic outcomes for NART enabling IBR, informing multidisciplinary sequencing decisions in breast cancer care.
Clinical Implications: In centers with NART capability, considering NART followed by immediate reconstruction may improve patient satisfaction and streamline treatment timelines, with careful patient selection and multidisciplinary planning.
Key Findings
- Included 21 studies (1,199 patients) with mean follow-up 35 months; six studies compared NART vs adjuvant RT.
- Patient-reported cosmetic outcomes were excellent-to-good; one comparative study favored NART over adjuvant RT.
- Complications: no complete flap failures, low implant loss; unplanned reoperation mean 11% (2–21%); grade 3 skin toxicity 1–17% with no grade 4–5 events; mastectomy skin necrosis 3–17%.
- Oncologic outcomes: pCR 12–53% after NARCT; locoregional recurrence 3–10%.
Methodological Strengths
- Systematic search across PubMed, EMBASE, and Cochrane with risk-of-bias appraisal
- Comprehensive synthesis of PROMs, complications, and oncologic outcomes
Limitations
- Predominance of non-randomised designs and inclusion of conference abstracts
- Heterogeneity in regimens (e.g., high use of neoadjuvant chemoradiotherapy) and outcomes reporting
Future Directions: Randomised head-to-head trials of NART vs adjuvant RT with standardised cosmetic and complication endpoints, and longer oncologic follow-up.
3. Validated Survey Tools for Pre-operative Psychological Assessment in Plastic Surgery.
This review outlines validated patient-reported outcome measures (BREAST-Q, FACE-Q, BODY-Q) and advocates preoperative psychological screening, including for body dysmorphic disorder, in plastic surgery. It highlights practical barriers for surgeons and aligns with guideline recommendations to improve holistic care.
Impact: By consolidating validated tools and guideline recommendations, it provides a practical framework for integrating psychological assessment into preoperative workflows in aesthetic and reconstructive surgery.
Clinical Implications: Implement routine screening for psychological disorders (e.g., BDD) and incorporate PROMs (BREAST-Q, FACE-Q, BODY-Q) into preoperative consultations, with referral pathways to mental health professionals.
Key Findings
- Validated PROMs (BREAST-Q, FACE-Q, BODY-Q) measure quality of life and satisfaction in surgical patients.
- Cosmetic surgery patients have high rates of psychological disorders, underscoring the need for preoperative screening.
- Guidelines (e.g., NICE) recommend screening for body dysmorphic disorder before surgery.
- Surgeons face time and familiarity barriers when integrating psychological assessments.
Methodological Strengths
- Synthesis of validated instruments and practical implementation considerations
- Alignment with external guideline recommendations (e.g., NICE)
Limitations
- Narrative review without systematic search or quantitative synthesis
- Heterogeneity and potential bias in cited studies limit strength of inference
Future Directions: Prospective studies to validate streamlined screening pathways and thresholds, and trials linking preoperative psychological screening to postoperative satisfaction and complication reduction.