Journal of the American College of Surgeons
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The modern generation of trials evaluating the role of adjuvant radiation have turned to genomic profiling as a further risk stratification tool. The LUMINA trial by Whelan et al, published in the New England Journal of Medicine, applied Ki67 testing to identify those with luminal A disease and evaluated locoregional outcomes with Breast Conserving Surgery (BCS) and endocrine therapy (ET) alone. This paper was reviewed at the Canadian Association of General Surgeons' "Evidence-Based Reviews in Surgery" (EBRS) webinar series. ⋯ While the LUMINA study was rigorously designed and executed, there are significant pragmatic limitations to the implementation of the proposed approach using their protocol. We advocate that there is no "one size fits all" approach to early ER+ breast cancer. Choice of treatment strategy should strongly consider patient goals and preferences, with need for incorporation of Quality of Life and patient-reported endpoints into future studies evaluating this population to help guide these nuanced decisions.
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After decades of experience supporting surgical quality and safety by the American College of Surgeons (ACS), the ACS Quality Verification Program (ACS QVP) was developed to help hospitals improve surgical quality and safety. This review is the final installment of a 3-part review aimed to synthesize evidence supporting the main principles of the ACS QVP. ⋯ The identified literature supports the importance of standardized multidisciplinary and disease-based processes and external regulatory systems to improve quality of care.
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Traumatic hemothorax (HTX) is often managed with tube thoracostomy (TT); however, TT carries a high complication rate. In 2017, a guideline was implemented at our Level I trauma center to observe traumatic HTX 300 mL or less in patients who are hemodynamically stable. We hypothesized that this guideline would decrease TT placement without increasing observation failure rates. ⋯ The implementation of the 300-mL guideline led to a decrease in TT placement without increasing observation failure or complication rates.