Dysplastic nevi with severe atypia: Long-term outcomes in patients with and without re-excision.

BACKGROUND: Dysplastic nevi with severe atypia (severely dysplastic nevi [SDN]) are frequently re-excised because of the concern that these lesions may in fact represent early melanoma. Data on long-term follow-up of these patients are limited. OBJECTIVE: We sought to determine the rate of subsequent melanoma development in patients with SDN who underwent re-excision versus those who did not and to determine factors associated with decision to re-excise. METHODS: A retrospective single institutional study was conducted with 451 adult patients (mean age 41.3 years) with SDN biopsied between November 1994 and November 2004, with clinical follow-up of at least 5 years. RESULTS: In 451 patients with SDN, re-excision was performed on 36.6%. Two melanomas were diagnosed in the re-excision specimens. Subsequent metastatic melanoma developed in 7 patients, all of whom had a history of melanoma. Margin comments influenced decision to re-excise. LIMITATIONS: This was a retrospective study at a single institution. CONCLUSION: Re-excision of all SDN may not be necessary.

A multidimensional assessment of payback: Evaluating the impact of Breast Cancer Trials.

AIM: This study evaluates the impact created by clinical trial investment and research undertaken by Breast Cancer Trials (BCT). METHODS: The approach involved using the Payback Framework, and included a review of BCT archival information, public health data, a questionnaire sent to BCT members, individual interviews with key informants, a focus group with members of the organization's Consumer Advisory Panel, and case studies of select BCT trials. The evaluation assessed the evidence against the Payback Framework criteria: informing policy and product development, knowledge production, the research system, health and health sector benefits, and broader economic benefits. RESULTS: Analysis using the Payback Framework revealed impact was created in each category and a range of positive outcomes were identified for various stakeholder groups. BCT is maximizing the impact of its research and contributing to a global pool of scientific knowledge by collaborating with over 100 institutions and 820 researchers, yet its benefits go beyond research contributions. Findings highlight strong financial returns from BCT's research program and that BCT has played an important role in enhancing the public perception of clinical trials by promoting participation in trials, educating and empowering participants, and communicating trial outcomes. CONCLUSION: BCT's clinical trials have had a significant impact on the prevention, detection, treatment, and management of breast cancer. Measuring and reporting impact can be resource intensive but support BCT in remaining accountable to all those invested in the organization and in breast cancer clinical trials, evidencing the multiple dimensions of payback resulting from the organization's research.

Patient-centered communication strategies for patients with aphasia: discrepancies between what patients want and what physicians do.

BACKGROUND: Communication during clinical encounters can be challenging with patients with communication disabilities. Physicians have the potential to positively affect the encounter by using communication strategies that engage the patient in patient-centered communication. OBJECTIVE: We engaged patients and their physicians in defining their preferences for patient-centered communication strategies, then evaluated the use of the identified strategies during observed clinical encounters. METHODS: We video-recorded 25 clinical encounters with persons with aphasia. All encounters were previously scheduled with community physicians and a companion was present. Following each encounter, physicians completed a brief questionnaire and the person with aphasia and his or her companion participated in a video elicitation interview. RESULTS: While many of the communication strategies identified and described by physicians, patients and companions were similar, patients and companions identified three additional key communication strategies. These strategies included (1) using visual aids, (2) writing down key words while speaking, and (3) using gestures. In the video recorded clinical encounters, no physicians wrote down key words while speaking and only one used a visual aid during the clinical encounter. The frequency with which physicians used gestures varied greatly, even within the same patient, suggesting the use of gestures was independent of patient or companion characteristics. CONCLUSIONS: To maximize patient-centered communication with patients with communication disabilities, physicians should use "disability-specific" communication strategies. Our study suggests that physicians should routinely ask patients and companions about communication preferences and then incorporate identified communication strategies into their communication style.