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Cheung JJC, Esmaeli B, Lam SC, Kwok T, Yuen HKL. The practice patterns in the management of sebaceous carcinoma of the eyelid in the Asia Pacific region. Eye (Lond) 2019; 33:1433-1442. [PMID: 30952958 DOI: 10.1038/s41433-019-0432-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/04/2019] [Accepted: 03/13/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To determine the practice patterns of ophthalmic plastic surgeons regarding the management of eyelid sebaceous carcinoma (SC). METHODS An electronic survey was distributed to oculoplastic surgical colleagues in the Asia Pacific region requesting clinical information and treatment approaches to SC. RESULTS The responses from 192 respondents from the Asia Pacific region was included and analyzed in this study. For initial diagnosis, most surgeons selected incisional biopsy (55%), followed by complete excision (35%). Initial workup was mainly by palpation of lymph nodes, chest X-ray, and computerized tomography scan (CT-scan) of the orbit. Conjunctival map biopsy was done in selected cases. Sentinel lymph node biopsy (SLNB) was done mainly for tumors larger than 10 mm. Management was mainly by surgical excision (5 mm margin) combined with adjuvant therapy in some cases, with radiotherapy being the most common. Margin status was determined most frequently by frozen section as evaluated by the pathologist (57%) followed by Mohs micrographic surgery (18%). Surveillance was based mainly on physical examination alone. CONCLUSION The Asia Pacific oculoplastic surgeons prefer incisional biopsy for lesions suspicious of SC prior to definitive surgery. This is in contrast to survey results previously reported in other populations. Frozen section control (done by an oculoplastic surgeon with pathology support) is most commonly used for margin control and conjunctival map biopsies are done only in selected cases. Despite the potential benefits of SLNB, access and expertise in this area is currently lacking in the Asia Pacific region.
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Affiliation(s)
- Janice J C Cheung
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China. .,Department of Ophthalmology, Grantham Hospital, Aberdeen, Hong Kong SAR, China.
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stacey C Lam
- Department of Ophthalmology, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Tracey Kwok
- Department of Ophthalmology, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Hunter K L Yuen
- Department of Ophthalmology, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Ho AMH, Zamora JE, Holcomb JB, Ng CS, Karmakar MK, Dion PW. The Many Faces of Survivor Bias in Observational Studies on Trauma Resuscitation Requiring Massive Transfusion. Ann Emerg Med 2015; 66:45-8. [DOI: 10.1016/j.annemergmed.2014.12.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Indexed: 12/01/2022]
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Novak DJ, Bai Y, Cooke RK, Marques MB, Fontaine MJ, Gottschall JL, Carey PM, Scanlan RM, Fiebig EW, Shulman IA, Nelson JM, Flax S, Duncan V, Daniel-Johnson JA, Callum JL, Holcomb JB, Fox EE, Baraniuk S, Tilley BC, Schreiber MA, Inaba K, Rizoli S, Podbielski JM, Cotton BA, Hess JR. Making thawed universal donor plasma available rapidly for massively bleeding trauma patients: experience from the Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial. Transfusion 2015; 55:1331-9. [PMID: 25823522 PMCID: PMC4469576 DOI: 10.1111/trf.13098] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/21/2014] [Accepted: 11/21/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND The Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial was a randomized clinical trial comparing survival after transfusion of two different blood component ratios for emergency resuscitation of traumatic massive hemorrhage. Transfusion services supporting the study were expected to provide thawed plasma, platelets, and red blood cells within 10 minutes of request. STUDY DESIGN AND METHODS At the 12 Level 1 trauma centers participating in PROPPR, blood components transfused and delivery times were tabulated, with a focus on universal donor (UD) plasma management. The adequacy of site plans was assessed by comparing the bedside blood availability times to study goals and the new American College of Surgeons guidelines. RESULTS Eleven of 12 sites were able to consistently deliver 6 units of thawed UD plasma to their trauma-receiving unit within 10 minutes and 12 units in 20 minutes. Three sites used blood group A plasma instead of AB for massive transfusion without complications. Approximately 4700 units of plasma were given to the 680 patients enrolled in the trial. No site experienced shortages of AB plasma that limited enrollment. Two of 12 sites reported wastage of thawed AB plasma approaching 25% of AB plasma prepared. CONCLUSION Delivering UD plasma to massively hemorrhaging patients was accomplished consistently and rapidly and without excessive wastage in high-volume trauma centers. The American College of Surgeons Trauma Quality Improvement Program guidelines for massive transfusion protocol UD plasma availability are practicable in large academic trauma centers. Use of group A plasma in trauma resuscitation needs further study.
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Affiliation(s)
- Deborah J. Novak
- Department of Pathology, College of Medicine, University of Arizona
| | - Yu Bai
- Department of Pathology and Laboratory Medicine, Medical School, University of Texas Health Science Center at Houston
| | - Rhonda K. Cooke
- Department of Pathology, School of Medicine, University of Maryland
| | - Marisa B. Marques
- Division of Laboratory Medicine, Department of Pathology, School of Medicine, University of Alabama at Birmingham
| | | | | | - Patricia M. Carey
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Cincinnati
| | - Richard M. Scanlan
- Division of Laboratory Medicine, Department of Pathology, Oregon Health and Science University
| | - Eberhard W. Fiebig
- Department of Laboratory Medicine, University of California, San Francisco
| | - Ira A. Shulman
- Department of Pathology, Keck School of Medicine, University of Southern California
| | - Janice M. Nelson
- Department of Pathology, Keck School of Medicine, University of Southern California
| | - Sherri Flax
- Clinical Laboratories, Regional Medical Center
| | - Veda Duncan
- Clinical Laboratories, Regional Medical Center
| | | | | | - John B. Holcomb
- Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston
| | - Erin E. Fox
- Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston
| | - Sarah Baraniuk
- Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston
| | - Barbara C. Tilley
- Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston
| | - Martin A. Schreiber
- Division of Trauma, Critical Care and Acute Care Surgery, School of Medicine, Oregon Health and Science University
| | - Kenji Inaba
- Division of Trauma and Critical Care, University of Southern California
| | - Sandro Rizoli
- Trauma and Acute Care Surgery, St Michael's Hospital, University of Toronto
| | - Jeanette M. Podbielski
- Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston
| | - Bryan A. Cotton
- Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston
| | - John R. Hess
- Department of Laboratory Medicine, University of Washington
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Del Junco DJ, Bulger EM, Fox EE, Holcomb JB, Brasel KJ, Hoyt DB, Grady JJ, Duran S, Klotz P, Dubick MA, Wade CE. Collider bias in trauma comparative effectiveness research: the stratification blues for systematic reviews. Injury 2015; 46:775-80. [PMID: 25766096 PMCID: PMC4402274 DOI: 10.1016/j.injury.2015.01.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 01/02/2015] [Accepted: 01/26/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Collider bias, or stratifying data by a covariate consequence rather than cause (confounder) of treatment and outcome, plagues randomised and observational trauma research. Of the seven trials of prehospital hypertonic saline in dextran (HSD) that have been evaluated in systematic reviews, none found an overall between-group difference in survival, but four reported significant subgroup effects. We hypothesised that an avoidable type of collider bias often introduced inadvertently into trauma comparative effectiveness research could explain the incongruous findings. METHODS The two most recent HSD trials, a single-site pilot and a multi-site pivotal study, provided data for a secondary analysis to more closely examine the potential for collider bias. The two trials had followed the a priori statistical analysis plan to subgroup patients by a post-randomisation covariate and well-established surrogate for bleeding severity, massive transfusion (MT), ≥ 10 unit of red blood cells within 24h of admission. Despite favourable HSD effects in the MT subgroup, opposite effects in the non-transfused subgroup halted the pivotal trial early. In addition to analyzing the data from the two trials, we constructed causal diagrams and performed a meta-analysis of the results from all seven trials to assess the extent to which collider bias could explain null overall effects with subgroup heterogeneity. RESULTS As in previous trials, HSD induced significantly greater increases in systolic blood pressure (SBP) from prehospital to admission than control crystalloid (p=0.003). Proportionately more HSD than control decedents accrued in the non-transfused subgroup, but with paradoxically longer survival. Despite different study populations and a span of over 20 years across the seven trials, the reported mortality effects were consistently null, summary RR=0.99 (p=0.864, homogeneity p=0.709). CONCLUSIONS HSD delayed blood transfusion by modifying standard triggers like SBP with no detectable effect on survival. The reported heterogeneous HSD effects in subgroups can be explained by collider bias that trauma researchers can avoid by improved covariate selection and data capture strategies.
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Affiliation(s)
- Deborah J Del Junco
- University of Texas Health Science Center, Department of Surgery, Houston, TX, United States.
| | - Eileen M Bulger
- University of Washington, Department of Surgery, Seattle, WA, United States
| | - Erin E Fox
- University of Texas Health Science Center, Department of Surgery, Houston, TX, United States
| | - John B Holcomb
- University of Texas Health Science Center, Department of Surgery, Houston, TX, United States
| | - Karen J Brasel
- Oregon Health & Science University, Department of Surgery, Portland, OR, United States
| | - David B Hoyt
- American College of Surgeons, Chicago, IL, United States
| | - James J Grady
- University of Connecticut Health Center, Institute for Clinical and Translational Science, Farmington, CT, United States
| | - Sarah Duran
- University of Texas Health Science Center, Department of Surgery, Houston, TX, United States
| | - Patricia Klotz
- University of Washington, Department of Surgery, Seattle, WA, United States
| | - Michael A Dubick
- U.S. Army Institute of Surgical Research, San Antonio, TX, United States
| | - Charles E Wade
- University of Texas Health Science Center, Department of Surgery, Houston, TX, United States
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