Neoadjuvant versus Adjuvant Therapy for Stage IIIB-IIID Melanoma

The treatment landscape for advanced stage melanoma is rapidly evolving due to advancements in our understanding of melanoma biology and the emergence of novel therapies. This necessitates a comprehensive review to guide clinicians in adopting evidence based and patient centric approaches to treat stage IIIB-IIID melanoma. A literature review was conducted to synthesize current information on the most optimal treatment available. Data available from different clinical trials found that neoadjuvant therapy was a more effective treatment compared to adjuvant therapies alone. Furthermore, neoadjuvant therapy with combination therapy was more efficacious in producing a complete pathological response compared to monotherapy. A follow-up study on patients treated with neoadjuvant therapy with PD1 inhibitor pembrolizumab found that patients who produced a major pathologic response (MPR) or complete response (pCR) had higher 5 year Overall Survival rates. The trial highlights the importance of tailoring pharmacological treatment to patients to receive a significant pathological response. In addition, finding robust biomarkers is important in assessing therapies to personalize them to the patient. Longer term follow-up should be emphasized due to observed differences in median time to recurrence

'Correction:'Peer chart audits: A tool to meet Accreditation Council on Graduate Medical Education (ACGME) competency in practice-based learning and improvement

<p>Abstract</p> <p>Background</p> <p>The Accreditation Council on Graduate Medical Education (ACGME) supports chart audit as a method to track competency in Practice-Based Learning and Improvement. We examined whether peer chart audits performed by internal medicine residents were associated with improved documentation of foot care in patients with diabetes mellitus.</p> <p>Methods</p> <p>A retrospective electronic chart review was performed on 347 patients with diabetes mellitus cared for by internal medicine residents in a university-based continuity clinic from May 2003 to September 2004. Residents abstracted information pertaining to documentation of foot examinations (neurological, vascular, and skin) from the charts of patients followed by their physician peers. No formal feedback or education was provided.</p> <p>Results</p> <p>Significant improvement in the documentation of foot exams was observed over the course of the study. The percentage of patients receiving neurological, vascular, and skin exams increased by 20% (from 13% to 33%) (p = 0.001), 26% (from 45% to 71%) (p < 0.001), and 18% (51%–72%) (p = 0.005), respectively. Similarly, the proportion of patients receiving a well-documented exam which includes all three components – neurological, vascular and skin foot exam – increased over time (6% to 24%, p < 0.001).</p> <p>Conclusion</p> <p>Peer chart audits performed by residents in the absence of formal feedback were associated with improved documentation of the foot exam in patients with diabetes mellitus. Although this study suggests that peer chart audits may be an effective tool to improve practice-based learning and documentation of foot care in diabetic patients, evaluating the actual performance of clinical care was beyond the scope of this study and would be better addressed by a randomized controlled trial.</p

Systematic review of diagnostic tests for vaginal trichomoniasis.

Objective: To review critically and to summarize the evidence of diagnostic tests and culture media for the diagnosis of Trichomonas vaginitis. Methods: We performed a systematic review of literature indexed in MEDLINE of studies that used Trichomonas culture as the reference standard (9 882 patients 35 studies). Level I studies (5 047 patients 13 studies) fulfilled at least two of three criteria: 1) onsecutive patients were evaluated prospectively 2) decision to culture was not influenced by test results and 3) there was independent and blind comparison to culture. Results: The sensitivity of the polymerase chain reaction technique (PCR) was 95% (95% CI 91% to 99%) and the specificity was 98% (95% CI 96% to 100%). One study was classified as Level I evidence (52 patients). The sensitivity of the enzyme-linked immunosorbent assay was 82% (95% CI 74% to 90%) and the specificity was 73% (95% CI 35% to 100%). The sensitivity of the direct luorescence antibody was 85% (95% CI 79% to 90%) and the specificity was 99% (95% CI 98% to 100%). Sensitivities of culture media were 95% for Diamond’s 96% for Hollander and 95% for PLM. Conclusions: The sensitivity and specificity of tests to diagnose trichomoniasis vary widely. Originally published Infectious Diseases in Obstetrics and Gynecology Vol. 8 No. 5-6 200

Reporting and Concordance of Methodologic Criteria Between Abstracts and Articles in Diagnostic Test Studies

OBJECTIVE: To evaluate the quality and concordance of methodologic criteria in abstracts versus articles regarding the diagnosis of trichomoniasis. TUDY DESIGN: Survey of published literature. ATA SOURCES: Studies indexed in medline (1976–1998). TUDY SELECTION: Studies that used culture as the gold or reference standard. ATA EXTRACTION: Data from abstract and articles were independently abstracted using 4 methodologic criteria: (1) prospective evaluation of consecutive patients; (2) test results did not influence the decision to do gold standard; (3) independent and blind comparison with gold standard; and (4) broad spectrum of patients used. The total number of criteria met for each report was calculated to create a quality score (0–4). EASUREMENTS AND MAIN RESULTS: None of the 33 abstracts or full articles reported all 4 criteria. Three criteria were reported in none of the abstracts and in 18% of articles (95% confidence interval [95% CI] 8.6% to 34%). Two criteria were reported in 18% of abstracts (95% CI 8.6% to 34%) and 42% of articles (95% CI 27% to 59%). One criterion was reported in 42% of abstracts (95% CI 27% to 59%) and 27% of articles (95% CI 15% to 44%). No criteria were reported in 13 (39%) of 33 abstracts (95% CI 25% to 56%) and 4 (12%) of 33 articles (95% CI 4.8% to 27%). The agreement of the criteria between the abstract and the article was poor (κ−0.09; 95% CI −0.18 to 0) to moderate (κ 0.53; 95% CI 0.22 to 0.83). ONCLUSIONS: Information on methods basic to study validity is often absent from both abstract and paper. The concordance of such criteria between the abstract and article needs to improve. riginally published Journal of General Internal Medicine Vol. 15 No. 3 Mar 200

Correction:Peer chart audits: A tool to meet Accreditation Council on Graduate Medical Education (ACGME) competency in practice-based learning and improvement

Background: The Accreditation Council on Graduate Medical Education (ACGME) supports chart audit as a method to track competency in Practice-Based Learning and Improvement. We xamined whether peer chart audits performed by internal medicine residents were associated with improved documentation of foot care in patients with diabetes mellitus. Methods: A retrospective electronic chart review was performed on 347 patients with diabetes mellitus cared for by internal medicine residents in a university-based continuity clinic from May 2003 to September 2004. Residents abstracted information pertaining to documentation of foot examinations (neurological vascular and skin) from the charts of patients followed by their physician peers. No formal feedback or education was provided. Results: Significant improvement in the documentation of foot exams was observed over the course of the study. The percentage of patients receiving neurological vascular and skin exams ncreased by 20% (from 13% to 33%) (p = 0.001) 26% (from 45% to 71%) (p &lt; 0.001) and 18% (51%–72%) (p = 0.005) respectively. Similarly the proportion of patients receiving a welldocumented xam which includes all three components – neurological vascular and skin foot exam – increased over time (6% to 24% p &lt; 0.001). onclusion: Peer chart audits performed by residents in the absence of formal feedback were associated with improved documentation of the foot exam in patients with diabetes mellitus. Although this study suggests that peer chart audits may be an effective tool to improve practicebased learning and documentation of foot care in diabetic patients evaluating the actual performance of clinical care was beyond the scope of this study and would be better addressed by a randomized controlled trial. Originally published Implementation Science Vol. 2 No. 24 July 200

Deficits in Identification of Goals and Goal‐Concordant Care After Sepsis Hospitalization

In a recent study, identifying and supporting patients' care goals was named the highest priority in hospital medicine. Although sepsis is one of the leading causes of death and postdischarge morbidity among hospitalized patients, little is known about how frequently care goals are assessed prior to discharge and adhered to in the 90 days after sepsis hospitalization. Evaluating a cohort of 679 high-risk sepsis survivors enrolled in a clinical trial, we found that care goals were documented explicitly in a standardized tool in 130 patients; an additional 139 patients were identified using all available clinical documentation, resulting in only 269 (40%) patients with goals that could be ascertained from the electronic health record (EHR). Among those categorized, goals were classified as prioritizing longevity (35%), function (52%), and comfort (12%). Based on expert review of the care provided during the 90 days subsequent to discharge, goal-concordant care was identified in 184 (68%) cases for which goals were specified. Documentation of goals in a standardized EHR tool was associated with increased likelihood of receiving goal-concordant care (odds ratio, 3.6; 95% CI, 2.4-5.5). Hospitalization and peridischarge time points represent important opportunities to address deficits in the documentation of goals and provision of goal-concordant care for sepsis survivors

Reporting and Concordance of Methodologic Criteria Between Abstracts and Articles in Diagnostic Test Studies

OBJECTIVE: To evaluate the quality and concordance of methodologic criteria in abstracts versus articles regarding the diagnosis of trichomoniasis. STUDY DESIGN: Survey of published literature. DATA SOURCES: Studies indexed in medline(1976–1998). STUDY SELECTION: Studies that used culture as the gold or reference standard. DATA EXTRACTION: Data from abstract and articles were independently abstracted using 4 methodologic criteria: (1) prospective evaluation of consecutive patients; (2) test results did not influence the decision to do gold standard; (3) independent and blind comparison with gold standard; and (4) broad spectrum of patients used. The total number of criteria met for each report was calculated to create a quality score (0–4). MEASUREMENTS AND MAIN RESULTS: None of the 33 abstracts or full articles reported all 4 criteria. Three criteria were reported in none of the abstracts and in 18% of articles (95% confidence interval [95% CI] 8.6% to 34%). Two criteria were reported in 18% of abstracts (95% CI, 8.6% to 34%) and 42% of articles (95% CI, 27% to 59%). One criterion was reported in 42% of abstracts (95% CI, 27% to 59%) and 27% of articles (95% CI, 15% to 44%). No criteria were reported in 13 (39%) of 33 abstracts (95% CI, 25% to 56%) and 4 (12%) of 33 articles (95% CI, 4.8% to 27%). The agreement of the criteria between the abstract and the article was poor (κ−0.09; 95% CI, −0.18 to 0) to moderate (κ 0.53; 95% CI, 0.22 to 0.83). CONCLUSIONS: Information on methods basic to study validity is often absent from both abstract and paper. The concordance of such criteria between the abstract and article needs to improve