Accumulating evidence indicates that microbiota plays a critical role in physiological processes in humans. However, it might also contribute to body malodor by producing numerous odorous molecules such as ammonia, volatile sulfur compounds or trimethylamine. Although malodor is commonly overlooked by physicians, it constitutes a major problem for many otherwise healthy people. Thus, this review aims to investigate most common causes of malodor and describe potential therapeutic options. We searched PUBMED and Google Scholar databases to identify the clinical and pre-clinical studies on bad body smell, malodor, halitosis and microbiota. Unpleasant smell might originate from the mouth, skin, urine or reproductive fluids and is usually caused by odorants that are produced by resident bacterial flora. The accumulation of odorous compounds might result from diet, specific composition of microbiota, as well as compromised function of the liver, intestines and kidneys. Evidence-based guidelines for management of body malodor are lacking and no universal treatment exists. However, the alleviation of the symptoms may be achieved by controlling the diet and physical elimination of bacteria and/or accumulated odorants.

BACKGROUND The World Health Organization (WHO) surgical checklist is associated with reduced morbidity and mortality. Efficacy correlates with compliance. OBJECTIVE This study aims to (1) establish completion rate and (2) identify and address barriers to use. METHODS Records of patients undergoing dermatological surgery were studied. Staff completed attitude and barriers questionnaires. Checklist process was modified, and use was reassessed twice. RESULTS Cycle 1 involved 217 subjects; 72% had excisions. Thirteen percent had surgery to multiple sites. Five percent of checklists were fully completed, with an average of 76% of available points per checklist marked as checked. The lowest single field use included “patient identity” (76%) and “surgical site” (72%). Questionnaire responses from 25 staff showed the checklist to be “important” and “relevant” in dermatology; key barrier to completion was lack of time. Checklist modifications and educational sessions were undertaken; checklist use was reassessed twice more with 103 and 134 patients. Average use increased to 96% and 98%; full completion increased to 71% and 70%; “surgical site” and “identity” completion increased to 100%. CONCLUSION The WHO checklist is relevant and important in dermatology. Introduction must be supported by repeated training sessions. Adequate time and training can significantly improve checklist completion and patient safety.

We highlight the growing challenge of undertaking skin cancer surgery in adult patients lacking capacity, given the nature of the ageing population, increasing prevalence of dementia and rise in skin cancer diagnoses. In such cases a decision must be made in the patient’s best interests, taking into account the patient’s own views, the existence of a lasting power of attorney, and the views of close family and friends. On occasion it may be reasonable not to aim to cure a skin cancer in a patient approaching the end of life.

Background & aims: The WHO surgical checklist is associated with reduced morbidity, mortality, and improved team work. However its efficacy depends on compliance. The aim of this study is to 1) establish compliance 2) identify attitudes & barriers, 3) address barriers to improve compliance. Methods: Records of patients who had dermatological surgery at a British regional centre were studied December 2014-May 2015. Questionnaires were sent to staff to establish attitudes & barriers. Changes were implemented including delivering Education Sessions, and allocating a specified time for checklist completion. Compliance was reassessed 4 weeks later. Results: 217 patient notes were studied. The most common procedure was excision biopsy (66%); 13% had surgery to multiple sites. On average, 76% of checklist items were filled in; 5% of checklists were fully filled in. Items with the highest completion were 'Pace Maker' (93%), 'Allergies' (90%), 'Immunosuppression' (90%); items with the lowest were 'Identity' 76%), 'Site'(72%), 'Antibiotic' (67%). Questionnaire responses from 10 nurses and 15 doctors showed the Checklist was felt to be important for communication, safety, and is applicable to dermatology. Key barriers were lack of time, & need for Checklist information through 'educational sessions' and 'online resources'. Barriers were addressed & compliance was reassessed in 100 patient notes. There were significant improvements in compliance (p<0.0001) with average completion rate 98% vs. 76% previously, and full completion rate 71% vs. 5%. 'Surgical Site' & 'Identity' both had 100% compliance, compared to 76% & 72% previously. Conclusions: The WHO Checklist is relevant & important in Dermatology, but lack of time may explain baseline compliance. 'Patient identity' & 'surgical site' were the least filled items, which could lead to wrong patient or wrong site surgery especially as a sixth of our patients have multiple-site surgery. Providing specified time for Checklist completion and different information formats can increase 'buy-in' from staff, and significantly improve compliance and patient safety.

No abstract