Background and objectives Venous thromboembolism (VTE) occurs in 7%-40% of nephrotic patients. The risk of VTE depends on the severity and underlying cause of nephrotic syndrome. This study investigated the use of low-dose prophylactic anticoagulation to prevent VTE in patients with nephrotic syndrome caused by primary glomerulonephritis.Design, setting, participants, & measurements Since 2006, all patients presenting with nephrotic syndrome to Imperial College Kidney and Transplant Centre have been considered for treatment with a novel anticoagulation prophylaxis regimen. All cases of nephrotic syndrome secondary to primary membranous nephropathy, minimal-change disease, and FSGS over a 5-year period were retrospectively reviewed. Patients with serum albumin,2.0 g/dl received prophylactic-dose low-molecular-weight heparin or low-dose warfarin; patients with albumin levels of 2.0-3.0 g/dl received aspirin, 75 mg once daily. All thrombotic events and bleeding complications were recorded.Results A total of 143 patients received the prophylactic anticoagulation regimen. Median follow-up was 154 weeks (range, 30-298 weeks). The cohort had features associated with a high risk of developing VTE; 40% of the cohort had an underlying diagnosis of membranous nephropathy, and the initial median serum albumin was 1.5 g/dl (range, 0.5-2.9 g/dl). No VTE occurred in patients established on prophylaxis for at least 1 week. VTE was diagnosed in 2 of 143 patients (1.39%) within the first week after presentation and starting prophylaxis. In both cases, it is unclear whether the thrombus had developed before or after the start of prophylaxis. One of 143 (0.69%) patients receiving prophylaxis was admitted urgently with gastrointestinal hemorrhage. Two of 143 patients (1.40%) had elective blood transfusions and procedures to manage occult gastrointestinal bleeding. No other bleeding events occurred in patients receiving prophylaxis.Conclusions This regimen of prophylactic antiplatelet or anticoagulant therapy appears effective in preventing VTE in nephrotic syndrome, with relatively few hemorrhagic complications.

DEAR EDITOR, Skin cancer incidence is increasing worldwide, with higher incidence rates in Wales than in other UK countries. 1,2 The majority of skin cancers are caused by overexposure to ultraviolet radiation, and prevention measures are recommended at government level and by individuals. 3,4 In Wales, the Sunbeds Act was passed in 2010 prohibiting people under the age of 18 years from using sunbeds.This study aimed to assess skin cancer awareness, preventive behaviour and knowledge of vitamin D to inform skin cancer prevention strategies in Wales. A questionnaire was developed in conjunction with HealthWise Wales, a population-based online study of individuals over 16 years old and residing or accessing healthcare in Wales. The questionnaire was based on the Northern Ireland Omnibus Survey 'Care in the Sun' module and a Danish validated sun exposure questionnaire. [5][6][7] Participants registered with HealthWise Wales were invited to complete the questionnaire, either online or over the phone, between October 2017 and October 2018. Responders were analysed by demographics and socioeconomic factors, with differences tested using z-tests.In total 6386 participants responded (4476 female, 70Á1%), with the following age distribution: 6Á4% age < 25 years, 26Á4% age 25-44 years, 41Á4% age 45-64 years and 25Á8% age ≥ 65 years. The majority (91Á3%) reported Fitzpatrick type skin I-III. Participants reported that they check their skin daily (6Á2%), weekly (11Á3%), monthly (10Á0%), every 2-

Background. Ulceration is a recognized risk factor for surgical site infection (SSI); however, the proportion of patients developing SSI after excision of an ulcerated skin cancer is unknown. Aim. To determine the proportion of participants with SSI after surgical excision of an ulcerated skin cancer. A secondary aim was to assess feasibility outcomes to inform the design of a randomized controlled trial to investigate the benefits and harms of perioperative antibiotics following excision of ulcerated tumours. Methods. This was a multicentre, prospective, observational study of patients undergoing excision of an ulcerated skin cancer between March 2019 and March 2020. Prior to surgical excision, surface swabs of the ulcerated tumours of participants recruited from one centre were undertaken to determine organism growth. At 4 weeks after surgery, all participants were e-mailed or posted the Wound Healing Questionnaire (WHQ) to determine whether they had developed SSI. Results. In total, 148 participants were recruited 105 (70.9%) males; mean AE SD age 77.1 AE 12.3 years. Primary outcome data were available for 116 (78.4%) participants, of whom 35 (30.2%) were identified as having an SSI using the WHQ with a cutoff score of 8, and 47 (40.5%) were identified with a cutoff score of 6. Using the modified WHQ in participants with wounds left to heal by secondary intention, 33 (28.4%) and 43 (37.1%) were identified to have SSI respectively. Conclusion. This prospective evaluation of SSI identified with the WHQ following excision of ulcerated skin cancers demonstrated a high proportion with SSI. The WHQ was acceptable to patients; however, further evaluation is required to ensure validity in assessing skin wounds.

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This book contains the abstracts of the papers presented at The 3rd Annual Graduate Entry Research in Medicine Conference (GERMCON 2020) Organized by Warwick Medical School, University of Warwick in collaboration with Swansea University Medical School, Swansea University, Wales, UK held on 12–18 October 2020. This was especially important for Graduate Entry Medical (GEM) students, who have less opportunity and time to engage in research due to their accelerated medical degree.