Guest Editorial: How to Succeed in Medicine

In this guest editorial, Professor Andrew Y Finlay discusses how to succeed in medicine. As a Professor of Dermatology, pioneer of the Dermatology Life Quality Index and co-founder of the Journal of Dermatological Treatment, alongside many other achievements, his career demonstrates the breadth and variety a career in medicine can offer. His editorial provides valuable insights and practical advice for career development, as well as methods for contributing to the improvement of clinical care

The impact of patients' chronic disease on family quality of life : an experience from 26 specialties

BACKGROUND: Previous studies have assessed family quality of life in individual disease areas and specialties. The aim of this study was to investigate the impact of disease on family members of patients over a wide range of specialties and identify key impact areas. This information is essential in order to reveal the extent of this impact and to allow strategies to be developed to support the family members of patients with chronic disease. METHODS: Semi-structured interviews were carried out with 133 family members of mostly chronically ill patients from 26 medical specialties. Family members were invited to discuss all areas of their lives that had been affected by having an unwell relative. Thematic analysis was carried out using NVivo9® software. RESULTS: Most family members were female (61%), the partner or spouse of the patient (56%), or the parent (22%). Their mean age was 56.1 years (range: 21-85 years) and the mean duration of the patient's disease was 8.9 years (range: 1 month to 60 years). Ten key themes of family quality of life were identified from interviews. The median number of themes reported by family members was six (range: 1-10). The key themes included: emotional impact (mentioned by 92% of subjects), daily activities (91%), family relationships (69%), sleep and health (67%), holidays (62%), involvement in medical care and support given to family members (61%), work and study (52%), financial impact (51%), social life (37%), and time planning (14%). Relationships between the themes were identified. CONCLUSION: This large scale multi-specialty study has demonstrated the significant, yet similar, impact that illness can have on the quality of life of patients' family members. Family quality of life is a previously neglected area of health care which needs to be addressed in order to provide appropriate support for the patient and the family unit.Peer reviewedFinal Published versio

The development and clinical evaluation of a 'traffic-light' design dermatology outpatient discharge information checklist

Background Although multiple factors influence discharge decisions, there is no structured guidance to assist clinicians in making informed decisions. A discharge information checklist might improve the appropriateness of dermatology clinicians’ discharge decisions. Objectives To generate consensus among dermatologists on the content of an outpatient discharge checklist, to create one and to seek clinicians’ opinions on its usefulness. Methods Seventeen consultant dermatologists from five National Health Service trusts completed a 72‐item Delphi questionnaire. A five‐point Likert scale was used to rate each item for importance in contributing to a high‐quality discharge decision. Eighteen clinicians completed a questionnaire evaluating checklist use. Results Consensus was determined when ≥ 75% of consultants rated an item ‘very important’ or ‘important’. There was strong inter‐rater reliability (intraclass correlation coefficient = 0·958) and fair inter‐rater agreement (Fleiss kappa = 0·269). There were 26 consensus‐agreed items, condensed to 13 that formed the ‘traffic‐light’ checklist. These are disease‐related issues (diagnostic certainty, disease severity, treatment appropriateness, patient manageable in primary care, patient's benefit from follow‐up), patient empowerment issues (understanding diagnosis and treatment outcome, having a clear plan, treatment side‐effects, ability to self‐manage) and addressing concerns (patient concerns, easy reaccess to secondary care, whether patient and clinician are happy with the decision). Twelve clinicians (67%) found the checklist useful, 11 (61%) wanted to use it in future, 10 (56%) thought it was useful for training and three (17%) said it helped their thinking. Clinicians suggested its use for auditing and for training clinicians and administrators. Conclusions Items were identified to create an outpatient discharge information checklist, which demonstrated high acceptability

Comparison of the paper-based and electronic versions of the Dermatology Life Quality Index (DLQI): evidence of equivalence

BACKGROUND: The use of patient-reported outcome measures in electronic format has been increasing. However, these formats are usually not validated or compared to the original paper-based formats, so there is no evidence that they are completed in the same way. OBJECTIVES: The aim of this study was to compare the conventional paper version and a web-based application version (iPad® ) of the DLQI to assess equivalence of scores. METHODS: The study employed a randomized cross-over design using a within-subjects comparison of the two formats of the questionnaire. International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines were followed. Subjects aged over 18 years with any confirmed skin condition were recruited from a teaching hospital dermatology outpatient clinic. Expected Intra-class correlation coefficient (ICC) was 0.9 (α = 0.05) RESULTS: A total of 104 patients were recruited, median age=53.5 years (IQR=37.3-67.8, 43% male). The Intraclass correlation coefficient (ICC) showed high concordance between the total DLQI scores from paper and iPad® versions (ICC = 0.98; 95% CI 0.97-0.99). Patients took a median of 78 seconds to complete the electronic version and 73 seconds for paper (p=0.008): 76% preferred the electronic version and perceived completion to take a shorter time. CONCLUSIONS: There is high concordance, and thus equivalence, between the iPad and paper versions of the DLQI, with an ICC of 0.98, and a clear patient preference for the iPad version

Japanese version of the family dermatology life quality index: translation and validation

Skin conditions affect the quality of life (QoL) of patients and their family. To assess family members' QoL, a questionnaire uniquely designed for family members is necessary. We translated the Family Dermatology Life Quality Index (FDLQI), originally created and validated by Basra et al., into Japanese, and evaluated its reliability and validity. For psychometric evaluations, 150 dermatology patients and their family members were included. The Japanese version of the FDLQI showed high test–retest reliability (intraclass correlation coefficient = 0.95) and internal consistency reliability (Cronbach's alpha = 0.86). FDLQI scores significantly correlated with DLQI scores (r = 0.58, P < 0.01, Spearman's rho) and global question (GQ) which measured the patient's skin condition on a visual analog scale (r = 0.36, P < 0.01). Family members of patients with inflammatory skin diseases showed higher FDLQI scores than those with isolated lesions, but the difference was not statistically significant (P = 0.062, Mann–Whitney U-test). Responsiveness to change was demonstrated in a group in which the patient's skin condition was assessed as improved (n = 37, r = 0.46, P < 0.01) but not in that in which it became worse. The difference of the change between the two groups was statistically significant (P < 0.01). Additionally, the change in FDLQI scores and GQ were significantly correlated (r = 0.40, P < 0.01). Exploratory factor analysis suggested essential unidimensionality of the instrument. We showed acceptable validity and responsiveness of this Japanese version of FDLQI. Further clinical epidemiological studies are required to confirm this

Overview of In Situ X-ray Studies of Light Alloy Solidification in Microgravity

Gravity has significant effects on alloy solidification, primarily due to thermosolutal convection and solid phase buoyancy. Since 2004, the European Space Agency has been supporting investigation of these effects by promoting in situ X-ray monitoring of the solidification of aluminium alloys on microgravity platforms, on earth, and in periodically varying g conditions. The first microgravity experiment – investigating foaming of liquid metals – was performed on board a sounding rocket, in 2008. In 2012 the first ever X-ray-monitored solidification of a fully dense metallic alloy in space was achieved: the focus was columnar solidification of an Al-Cu alloy. This was followed in 2015 by a similar experiment, investigating equiaxed solidification. Ground reference experiments were completed in all cases. In addition, experiments have been performed on board parabolic flights – where the effects of varying gravity have been studied. We review here the technical and scientific progress to date, and outline future perspectives

The development and validation of the major life changing decision profile (MLCDP)

Background Chronic diseases may influence patients taking major life changing decisions (MLCDs) concerning for example education, career, relationships, having children and retirement. A validated measure is needed to evaluate the impact of chronic diseases on MLCDs, improving assessment of their life-long burden. The aims of this study were to develop a validated questionnaire, the “Major Life Changing Decision Profile” (MLCDP) and to evaluate its psychometric properties. Methods 50 interviews with dermatology patients and 258 questionnaires, completed by cardiology, rheumatology, nephrology, diabetes and respiratory disorder patients, were analysed for qualitative data using Nvivo8 software. Content validation was carried out by a panel of experts. The first version of the MLCDP was completed by 210 patients and an iterative process of multiple Exploratory Factor Analyses and item prevalence was used to guide item reduction. Face validity and practicability was assessed by patients. Results 48 MLCDs were selected from analysis of the transcripts and questionnaires for the first version of the MLCDP, and reduced to 45 by combination of similar themes. There was a high intraclass correlation coefficient (0.7) between the 13 members of the content validation panel. Four more items were deleted leaving a 41-item MLCDP that was completed by 210 patients. The most frequently recorded MLCDs were decisions to change eating habits (71.4%), to change smoking/drinking alcohol habits (58.5%) and not to travel or go for holidays abroad (50.9%). Factor analysis suggested item number reduction from 41 to 34, to 29, then 23 items. However after taking into account item prevalence data as well as factor analysis results, 32 items were retained. The 32-item MLCDP has five domains education (3 items), job/career (9), family/relationships (5), social (10) and physical (5). The MLCDP score is expressed as the absolute number of decisions that have been affected. Conclusions The 32-item (5 domains) MLCDP has been developed as an easy to complete generic tool for use in clinical practice and for quality of life and epidemiological research. Further validation is required