American journal of surgery
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Surgical excision remains the primary and only potentially curative treatment for melanoma. Although current guidelines recommend excisional biopsy as the technique of choice for evaluating lesions suspected of being primary melanomas, other biopsy types are commonly used. We sought to determine the impact of biopsy type (excisional, shave, or punch) on outcomes in melanoma. ⋯ Both shave and punch biopsies demonstrated a significant risk of finding residual tumor in the WLE, with pathologic upstaging of the WLE. Punch biopsy also led to a larger mean WLE area compared with other biopsy types. However, biopsy type did not impact SLNB accuracy or results, tumor recurrence, or disease-specific survival (DSS). Punch and shave biopsies, when used appropriately, should not be discouraged for the diagnosis of melanoma.
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Trauma patients are at risk for the development of venous thromboembolism (VTE). The purpose of this study was to validate the Risk Assessment Profile (RAP) as a tool for stratifying the risk of VTE. ⋯ The RAP score is highly associated with VTE in trauma patients regardless of mechanism of injury and is a valid risk assessment tool.
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Comparative Study Clinical Trial
Correlation of conventional thrombelastography and rapid thrombelastography in trauma.
Conventional thrombelastography has been in use for over 6 decades and provides a functional assay of coagulation. Rapid thrombelastography was developed to provide more rapid comprehensive analysis of coagulation status in an emergency setting. The purpose of this study was to determine the correlation of rapid thrombelastographic values with conventional thrombelastographic values in trauma patients. ⋯ Overall, there is a strong correlation between rapid thrombelastography and conventional thrombelastography in terms of overall clot strength and platelet function. There is a moderate correlation in assessing the degree of fibrin cross-linking and a poor correlation in evaluating thrombolysis. These correlations should be considered when evaluating coagulation status using rapid thrombelastography.
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Little is known about the reliability of data collected by abstractors without professional medical training. This investigation sought to determine the level of agreement among untrained volunteer abstractors as part of a study to evaluate the risk assessment of venous thromboembolism in patients who have undergone trauma. ⋯ The performance of volunteers showed outstanding inter-rater reliability; however, limitations of interpretation can influence reliability.
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Surgical trainees are evaluated based on the Accreditation Council for Graduate Medical Education 6 core competencies. The ability for a learner to recognize strengths and weaknesses in these areas allows for critical self-improvement. ⋯ Residents appear to have a more critical self-analysis than attending surgeons, with senior residents, general surgery residents, and highest one third-performing residents being the most critical of their own performance. Poorly performing residents appeared to lack insight into their abilities. This method of self-evaluation helps trainees reflect on their performance and highlights trainees who lack self-awareness and need counseling for improvement.