Are Positive Biopsy Margins in Melanoma Significant?: A Cohort Study of Micro- Versus Macroscopic Margin Status and Their Impact on Residual Disease and Survival.

BACKGROUND: Presence of positive biopsy margins in melanoma can provoke anxiety over potential disease progression from delays to surgical excision, but their impact on outcomes is unknown. We aimed to compare the presence of residual melanoma in the surgical excision specimen and survival between patients with negative, microscopically positive, and macroscopically positive biopsy margins. METHODS: Patients with cutaneous melanoma who underwent surgical excision over a 13-year period were included. Biopsy characteristics, residual disease in the surgical specimen, and overall and recurrence-free survival were compared between patients with negative, microscopically positive (only scar visible), and macroscopically positive (visible remaining melanoma) biopsy margins. RESULTS: Of 901 patients, 42.4%, 33.3%, and 24.3% had negative, microscopically positive, and macroscopically positive margins, respectively. The incidence of residual invasive melanoma in the surgical specimen varied (P < 0.001), occurring in 5.5%, 17.0%, and 74.9% of patients, respectively. Both microscopically and macroscopically positive margins were associated with residual disease (P < 0.001) but only the latter predicted worse overall (P = 0.013) and recurrence-free survival (P = 0.009). Kaplan-Meier estimated survival was comparable between those with negative and microscopically positive margins, but overall (P = 0.006) and recurrence-free survival (P = 0.004) were significantly worse in the macroscopically positive margin group. These patients had worse prognosis melanoma, with 33.8% being stage III disease, and 23.2% having positive sentinel lymph nodes. CONCLUSIONS: Patients and physicians may be reassured in the presence of microscopically positive biopsy margins which are not associated with worse survival, However, patients with macroscopically positive margins have poorer prognosis and should be treated within an acceptable time frame.

YouTube as a source of misinformation on COVID-19 vaccination: a systematic analysis.

INTRODUCTION: Vaccines for SARS-CoV-2 have been accessible to the public since December 2020. However, only 58.3% of Americans are fully vaccinated as of 5 November 2021. Numerous studies have supported YouTube as a source of both reliable and misleading information during the COVID-19 pandemic. Misinformation regarding the safety and efficacy of COVID-19 vaccines has negatively impacted vaccination intent. To date, the literature lacks a systematic evaluation of YouTube's content on COVID-19 vaccination using validated scoring tools. The objective of this study was to evaluate the accuracy, usability and quality of the most widely viewed YouTube videos on COVID-19 vaccination. METHODS: A search on YouTube was performed on 21 July 2021, using keywords 'COVID-19 vaccine' on a cleared-cache web browser. Search results were sorted by 'views', and the top 150 most-viewed videos were collected and analysed. Duplicate, non-English, non-audiovisual, exceeding 1-hour duration, or videos unrelated to COVID-19 vaccine were excluded. The primary outcome was usability and reliability of videos, analysed using the modified DISCERN (mDISCERN) score, the modified Journal of the American Medical Association (mJAMA) score and the COVID-19 Vaccine Score (CVS). RESULTS: CONCLUSION: As the COVID-19 pandemic evolves, widespread adoption of vaccination is essential in reducing morbidity, mortality, and returning to some semblance of normalcy. Providing high-quality and engaging health information from reputable sources is essential in addressing vaccine hesitancy.

Assessing the impact of predatory journals on policy and guidance documents: a cross-sectional study protocol.

INTRODUCTION: Many predatory journals fail to follow best publication practices. Studies assessing the impact of predatory journals have focused on how these articles are cited in reputable academic journals. However, it is possible that research from predatory journals is cited beyond the academic literature in policy documents and guidelines. Given that research used to inform public policy or government guidelines has the potential for widespread impact, we will examine whether predatory journals have penetrated public policy. METHODS AND ANALYSIS: This is a descriptive study with no hypothesis testing. Policy documents that cite work from the known predatory publisher OMICS will be downloaded from the Overton database. Overton collects policy documents from over 1200 sources worldwide. Policy documents will be evaluated to determine how the predatory journal article is used. We will also extract epidemiological details of the policy documents, including: who funded their development, the discipline the work is relevant to and the name of the organisations producing the policy. The record of scholarly citations of the identified predatory articles will also be examined. Findings will be reported with descriptive statistics using counts and percentages. ETHICS AND DISSEMINATION: No ethical approval was required for this study since it does not involve human or animal research. Study findings will be discussed at workshops on journalology and predatory publishing and will be disseminated through preprint, peer-reviewed literature and conference presentations.

Variation in management of post-operative atrial fibrillation (POAF) after thoracic surgery.

OBJECTIVES: New-onset post-operative atrial fibrillation (POAF) is a frequent adverse event following major thoracic surgery and is associated with increased risk of perioperative morbidity, length of stay and stroke. It is managed initially with rate and rhythm control therapy; however, optimal duration and the need for anticoagulation are poorly understood. This study aims to assess practice variation regarding POAF management and duration. METHODS: This retrospective, single-center cohort study included patients who underwent major thoracic surgery and developed POAF between 2008 and 2017, managed with rate and rhythm control therapy alone. Demographic, clinical, and surgical variables/outcomes, POAF management, and incidence of POAF recurrence in the 30-day post-operative period were collected. Chi-square and T-tests determined significance. RESULTS: Of 2054 patients undergoing thoracic surgery, 155 (75%) patients developed POAF. Different rate and rhythm control agents were used, most commonly metoprolol. 107 (69%) continued rate and rhythm control therapy upon hospital discharge for a mean of 56 days. Among the 48 patients with discontinuation of rate and rhythm control therapy on discharge, none demonstrated recurrence of POAF; in contrast to 3 of 107 patients who continued on therapy. Among patients with CHA2DS2-VASc score ≥ 2, 15% were prescribed anticoagulation on discharge. CONCLUSIONS: Use of rate and rhythm control therapy and anticoagulation for POAF is significantly varied in practice. Many patients are not continued on rate and rhythm control after hospital discharge, which does not appear to impact risk of POAF recurrence. Further research to inform guidelines for POAF management, including therapy duration and indications for anticoagulation is warranted.

External validity of a model to predict postoperative atrial fibrillation after thoracic surgery.

OBJECTIVES: A prediction model developed by Passman et al. stratifies patients' risk of postoperative atrial fibrillation (POAF) after major non-cardiac thoracic surgery using 3 simple factors (sex, age and preoperative resting heart rate). The model has neither undergone external validation nor proven to be relevant in current thoracic surgery practice. METHODS: A retrospective single-centre analysis of all patients who underwent major non-cardiac thoracic surgery (2008-2017) with prospective documentation of incidence and severity of POAF was used for external validation of Passman's derivation sample (published in 2005 with 856 patients). The model calibration was assessed by evaluating the incidence of POAF and patients' risk scores (0-6). RESULTS: A total of 2054 patients were included. Among them, POAF occurred in 164 (7.9%), compared to 147 (17.2%) in Passman's study. Differences in our sample compared to Passman's sample included mean heart rate (75.7 vs 73.7 bpm, P < 0.001), proportion of patients with hypertension (46.1 vs 29.4%, P < 0.001), proportion of extensive lung resections, particularly pneumonectomy (6.1 vs 21%, P < 0.001) and proportion of minimally invasive surgeries (56.6% vs 0%). The model demonstrated a positive correlation between risk scores and POAF incidence (risk score 1.2% vs 6.16%). CONCLUSIONS: The POAF model demonstrated good calibration in our population, despite a lower overall incidence of POAF compared to the derivation study. POAF rates were higher among patients with a higher risk score and undergoing procedures with greater intrathoracic dissection. This tool may be useful in identifying patients who are at risk of POAF when undergoing major thoracic surgery and may, therefore, benefit from targeted prophylactic therapy.