Expert Consensus Statement on Proficiency Standards for Dermoscopy Education in Primary Care.

BACKGROUND: Primary care providers (PCPs) frequently address dermatologic concerns and perform skin examinations during clinical encounters. For PCPs who evaluate concerning skin lesions, dermoscopy (a noninvasive skin visualization technique) has been shown to increase the sensitivity for skin cancer diagnosis compared with unassisted clinical examinations. Because no formal consensus existed on the fundamental knowledge and skills that PCPs should have with respect to dermoscopy for skin cancer detection, the objective of this study was to develop an expert consensus statement on proficiency standards for PCPs learning or using dermoscopy. METHODS: A 2-phase modified Delphi method was used to develop 2 proficiency standards. In the study's first phase, a focus group of PCPs and dermatologists generated a list of dermoscopic diagnoses and associated features. In the second phase, a larger panel evaluated the proposed list and determined whether each diagnosis was reflective of a foundational or intermediate proficiency or neither. RESULTS: Of the 35 initial panelists, 5 PCPs were lost to follow-up or withdrew; 30 completed the fifth and last round. The final consensus-based list contained 39 dermoscopic diagnoses and associated features. CONCLUSIONS: This consensus statement will inform the development of PCP-targeted dermoscopy training initiatives designed to support early cancer detection.

Comparison of the Effect of Dog, Surgeon and Surgical Procedure Variables on Improvement in Eight-Week Static Weight-Bearing following Tibial Plateau Levelling Osteotomy.

OBJECTIVE: The purpose of this article was to compare the effect of surgeon and tibial plateau levelling osteotomy (TPLO) procedure variations on the outcome of TPLO in naturally occurring cranial cruciate ligament disease. MATERIALS AND METHODS: Records from 142 dogs that had a TPLO procedure were reviewed for information regarding surgical procedure, status of meniscus at the time of surgery, surgeon identity, ACVS diplomate or resident, meniscal release, progression of healing at the progress evaluation based on radiographic interpretation and complications encountered. The primary outcome measure was static force on the affected limb at re-evaluation (42-84 days postoperatively) on a PetSafe Stance Analyzer. RESULTS: Re-evaluation tibial plateau angle (TPA) was negatively and significantly correlated with improvement (r = -0.2132, p = 0.013). Postoperative and re-evaluation TPA were all significantly correlated with one another. The amount of TPA change from initial to immediate postoperative values was significantly correlated with the preoperative TPA (r = 0.628, p < 0.001). Surgeon, surgical experience, arthrotomy, meniscal damage, meniscal intervention, complications, postoperative TPA and preoperative TPA had no significant effect on weight-bearing at recheck. CLINICAL SIGNIFICANCE: TPLO show improvement of 4.58% body weight on the affected limb at 6 to 12 weeks rechecks on a Stance Analyzer. Surgeon, surgical experience, arthrotomy, meniscal damage, meniscal intervention, complications, postoperative TPA and initial TPA have no effect on this measurement of surgical outcome.

Comparison of surgical time and complication rate of subcutaneous and skin closure using barbed suture or traditional knotted suture in dogs.

This prospective study evaluated the handling, intraoperative and postoperative complication rates of a barbed knotless suture for closure of subcutaneous tissue and skin in 17 client-owned dogs (group A) following a tibial plateau leveling osteotomy procedure. Clinical characteristics, surgical time, and complication rates were compared to a control group of 17 client-owned dogs (group B) with subcutaneous tissue and skin closure using traditional suture material. Signalment was not significantly different between groups and did not have an effect on complication rates. Surgical times were not significantly different for subcutaneous tissue or skin closure between the 2 groups. There were significantly more intraoperative complications in the barbed suture group (A: 4/17; B: 0/17; P = 0.033) but no difference in minor or major postoperative complication rates (minor A: 2/16; B: 1/14; P = 0.626, major A: 2/16; B: 0/14; P = 0.171).

Comparaison du temps opératoire et du taux de complication de la fermeture sous-cutanée et de la peau en utilisant des points de suture barbelés ou des points de suture noués traditionnels chez les chiens. Cette étude prospective a évalué les taux de complication liés à la manipulation, peropératoire et postopératoire des points de suture barbelés sans noeuds pour la fermeture du tissu sous-cutané et de la peau chez 17 chiens appartenant à des clients (groupe A) après une intervention d'ostéotomie de nivellement du plateau tibial. Les caractéristiques cliniques, le temps opératoire et les taux de complication ont été comparés à un groupe témoin de 17 chiens appartenant à des clients (groupe B) avec du matériel de suture traditionnel pour la fermeture du tissus sous-cutanés et de la peau. Le signalement n'était pas significativement différent entre les groupes et n'a pas eu d'effet sur les taux de complication. Le temps opératoire n'était pas significativement différent pour la fermeture du tissu sous-cutané ou de la peau entre les deux groupes. Il y avait significativement plus de complications peropératoires dans le groupe à points de suture barbelés (A : 4/17; B : 0/17; P = 0,033) mais aucune différence pour les taux de complications postopératoires mineures ou majeures (mineure A : 2/16; B : 1/14; P = 0,626, majeure A : 2/16; B : 0/14; P = 0,171).(Traduit par Isabelle Vallières).