Simultaneous Sentinel Lymph Node Biopsies Using Both the Magtrace/Sentimag System and Radioactive Isotope Tracer/Blue Dye Dual Technique for Concurrent Breast Carcinoma and Malignant Melanoma.

Background: Breast cancer and melanoma are extremely common, with a growing incidence in the United Kingdom. In this case report, we present a patient with synchronous melanoma and breast carcinoma, with focus on the simultaneous use of 2 sentinel lymph node biopsy mapping techniques.

Methods: The use of 2 mapping techniques in this case is necessary to ensure the accurate identification of the correct sentinel node (for each respective primary malignancy), providing vital prognostic information and allowing for appropriate adjuvant therapy.

Malignant melanoma in the hand: current evidence and recommendations.

Malignant melanoma is the leading cause of death from skin cancer. In spite of significant advances in the management of melanoma with the advent of sentinel lymph node biopsy (SLNB) and adjuvant oncological therapies, the death rate continues to increase worldwide. Melanoma in the hand poses additional diagnostic and management challenges.

Sentinel lymph node biopsy for melanoma in the older population: A prospective analysis of outcomes.

Background: The use of sentinel lymph node biopsy (SLNB) in the older population, defined as those over 70 years old, has been debated since the adoption of SLNB into routine practice. Interestingly, there remains a paucity of evidence, especially regarding the rates of SLNB positivity, complications, and subsequent adjuvant therapy in those with node positivity.

Method: Data on patient's comorbidities, positivity rates, complication rates, and subsequent adjuvant treatments were collected prospectively from 998 patients (644 patients < 70 and 354 patients ≥ 70 years old) between 2016 and 2022.

Service implications of the revised 2022 National Institute for Health and Care Excellence (NICE) follow-up guidelines for stage IA-IIC melanoma.

Background: The 2022 National Institute for Health and Care Excellence melanoma guideline update made significant changes to follow-up. The aim of this study was to assess the impact these changes will have on a national melanoma cohort over a 5-year follow-up interval.

Methods: Anonymized, individual-level, population-scale, linkable primary and secondary care National Health Service data for an 18-year interval (2000-2018) in Wales, UK were analysed.

Quantifying the clinical and economic burden of desquamating dermatological conditions: Implications for a supraregional burns centre.

Introduction: This study aimed to identify the spectrum of desquamating skin diseases referred for tertiary burns care and quantify the care requirements and expenses associated with caring for these patients within the burns service.

Methods: Patient records were identified with nonburn-induced skin loss between 2016 and 2022. Data was extracted from inpatient records, operative notes, and dressing clinic records.

A retrospective cohort study of differential attainment, COVID and chaos: taking the difference out of a terrible trinity.

Background: This study aimed to evaluate core surgical training (CST) differential attainment related to coronavirus disease 2019 (COVID-19), gender and ethnicity. The hypothesis was that COVID-19 adversely influenced CST outcomes.

Methods: A retrospective cohort study of 271 anonymised CST records was undertaken at a UK Statutory Education Body.

Differential attainment in higher surgical training: scoping pan-specialty spectra.

Introduction: This study aimed to evaluate differential attainment during higher surgical training (HST; all specialties) related to three ethnic cohorts: White UK (WUKG), Black and Minority Ethnic UK Graduates (BMEUKG), and International Medical Graduates (IMG).

Method: Anonymised records of 266 HSTs (126 WUKG, 65 BMEUKG, 75 IMG; 7 years) in a single UK Statutory Education Body were examined. Primary effect measures were Annual Record of Competency Progression Outcome (ARCPO) and Fellowship of the Royal College of Surgeons (FRCS) pass.

Prognostic significance of competition ratios in surgical specialty training selection.

Background: A competition ratio (CR) indicates the ratio of total applications for a training post when compared with numbers of specialty posts available. This study aimed to evaluate CRs' influence on National Training Number (NTN) selection in a single UK Statutory Education Body.

Methods: Consecutive core surgical trainees numbering 154 (105 men, 49 women; median years since graduation: four) were studied over a 6-year period.

"Burns Behind Bars": A 10-year review and cost analysis of burn injuries in prison inmates presenting to a regional burns centre, and the role of the burns outreach service.

Introduction: From 85348 inmates in England and Wales, over 26,000 incidents of assault and 40,000 of self-harm were reported from within prisons in 2016. This study focuses primarily on burn injuries in prison, determining the predominant aetiology as well as clinical outcomes of these injuries.

Methods: Data was retrieved retrospectively and a case series performed, including all burns referred from regional prisons to our centre from 2007 to 2017 and comprising patient demographics, mechanism of injury, total body surface area affected, management, and outcome.

Rapid redesign and effect on clinical workload of a supra-regional burns and plastic surgery service during the COVID-19 pandemic.

Introduction: In March 2020, South Wales experienced the most significant COVID-19 outbreak in the UK outside of London. We share our experience of the rapid redesign and subsequent change in activity in one of the busiest supra-regional burns and plastic surgery services in the UK.

Methods: A time-matched retrospective service evaluation was completed for a 7-week "COVID-19" study period and the equivalent weeks in 2018 and 2019.

Trainee perspective of the causes of stress and burnout in surgical training: a qualitative study from Wales.

Objectives: Stress and burn-out among surgical trainees has been reported most prevalent in core surgical trainees (CST) and female trainees in particular. This study aimed to identify factors perceived by CSTs to be associated with stress and burnout in those at risk.

Design: An open-ended questionnaire was distributed to 79 CSTs and two researchers categorised responses independently, according to Michie's model of workplace stress.

The Leaning Tower of Pasta: Lessons in Team Performance and Creativity From a Core Surgical Training Boot Camp Design Challenge.

Aims: Unity of effort is an important component of strategic leadership and management theory associated with Core Surgical Training (CST) outcome. The aim was to determine the impact of team diversity on task completion: a creative design challenge, during CST Boot camp.

Methods: Attendees (n = 44) at a single Statutory Education Body's CST Boot camp were stratified into teams related to specialty theme, and set a design challenge as described by Peter Skillman, to build the tallest free-standing tower out of spaghetti (20 pieces), tape (1 m), and string (1 m), with a marshmallow on top in 18 minutes.

Strategic organisational skills predict surgical training success.

Introduction: Surgical career progression is determined by examination success and Annual Review of Competence Progression (ARCP) outcome, yet data on organisational skills are sparse. This study aimed to determine whether organisational skills related to Core Surgical Training (CST) outcome. Primary outcome measures include operative experience, publications, examination success (Membership of the Royal College of Surgeons or the Diploma in Otolaryngology-Head and Neck Surgery (MRCS/DO-HNS)) and ARCP outcome.

Anaphylactic Reaction Rates to Blue Dyes Used for Sentinel Lymph Node Mapping: Systematic Review and Meta-analysis.

Objective: The primary objective of this study was to quantify the risk of anaphylaxis to blue dyes used in SLNB for cancer. Secondary outcomes included the identification of factors that may influence this risk.

Summary Of Background Data: Blue dyes are widely used to help identify sentinel lymph nodes in oncological surgery.

Egalitarianism in surgical training: let equity prevail.

This study aimed to quantify core surgical trainee (CST) differential attainment (DA) related to three cohorts; white UK graduate (White UKG) versus black and minority ethnic UKG (BME UKG) versus international medical graduates (IMGs). The primary outcome measures were annual review of competence progression (ARCP) outcome, intercollegiate Membership of the Royal College of Surgeons (iMRCS) examination pass and national training number (NTN) selection. Intercollegiate Surgical Curriculum Programme (ISCP) portfolios of 264 consecutive CSTs (2010-2017, 168 white UKG, 66 BME UKG, 30 IMG) from a single UK regional post graduate medical region (Wales) were examined.

Summative Supervisor Reporting: A Quality Performance Perspective.

Objective: This study aimed to quality assure Assigned Educational Supervisor (AES) reports, using UK Joint Committee on Surgical Training objective criteria, to evaluate contribution to Annual Review of Competence Progression.

Design: Consecutive 145 AES reports from 75 trainers regarding 68 Core Surgical Trainees were assessed from 9 hospitals (2 Tertiary centers [77 reports], 7 District General Hospitals [68 reports]). Reports were assessed by independent assessors based on free text related to performance mapped to curricular objectives, operative logbooks, and Clinical Supervisor reports, and overall summary grades assigned ranging from development required, adequate, good to excellent.

Measuring coagulation in burns: an evidence-based systematic review.

Introduction: Dynamic monitoring of coagulation is important to predict both haemorrhagic and thrombotic complications and to guide blood product administration. Reducing blood loss and tailoring blood product administration may improve patient outcome and reduce mortality associated with transfusion. The current literature lacks a systematic, critical appraisal of current best evidence on which clinical decisions may be based.