Red‐fingers syndrome in a patient negative for HIV, HBV and HCV
Red‐fingers syndrome in a patient negative for HIV, HBV and HCV
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HIV、HBV 和 HCV 阴性患者的红手指综合征
DOI：
10.1111/j.1365-2230.2006.02250.x
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
C. Vidaurrázaga
中科院分区：
文献类型：
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作者：
L. Campos;A. Quesada;C. Rubio;M. Martín;C. Vidaurrázaga
在手术部位。这降低了基底细胞癌在该部位复发的风险，并被称为充分切除。外科手术的成功和操作者的经验之间的关系已经在腹股沟疝修补术和糖尿病足截肢术等手术中得到证实。鉴于这些关系的存在，基底细胞癌切除术的成功也可能与操作者的经验有关。在英国，一部分BCC切除术由社区的全科医生（GP）进行。据我们所知，以前没有比较全科医生和皮肤科医生之间的基底细胞癌切除充分性。因此，我们对基底细胞癌的切除充分性进行了回顾性研究，以了解不同手术者（包括全科医生）之间是否存在差异。我们在Whittington医院的组织病理学数据库中检索了2000-2002年（含）期间进行的所有BCC切除术（不包括活检）。选择这段时间是为了避免偏倚，因为目前在医院工作的皮肤科顾问医生在这段时间内都没有在这里工作。如组织病理学报告所述，切除不充分定义为切除标本边缘存在任何BCC。程序寄存器用于识别所涉及的操作员。研究结果见表1。总共包括277个BCC样品。皮肤科专家注册和临床助理被分组在一起，因为两者都享有皮肤科顾问医生的密切监督。皮肤科医生和全科医生之间的充分切除率有显著差异（v 1/4 19.423，P < 0.001），但皮肤科医生和专科登记员/临床助理之间没有显著差异（v 1/4 1.2129，p > 0.1）。普通外科团队切除的基底细胞癌太少，无法与其他手术者进行公平比较。这项研究表明，在277例基底细胞癌切除的样本中，全科医生的适当切除率确实低于皮肤科专家。一个可能的原因是，全科医生可能有较少的经验，皮肤科比顾问皮肤科医生。皮肤科的强大知识是必要的医生胜任诊断和管理皮肤癌，如BCC。然而，皮肤科专家注册和临床助理在皮肤科顾问医生的监督下工作，从他们的经验中受益。如果缺乏皮肤科经验是一个关键因素，那么其他皮肤病变的切除充分性可能会受到操作者经验的影响。以前的回顾性研究已经确定了不准确的临床诊断和不充分的切除黑色素瘤的全科医生。在医院皮肤科进行有监督的研究生培训可能是提高全科医生切除充分率的适当方法，这将通过避免再次切除和更长时间的随访来加强患者护理并带来经济利益。这项研究受到样本量小的限制。需要一项更大规模的研究来支持这里发表的研究结果，这对改善BCC的临床管理至关重要。
in the operative site. This reduces the risk of recurrence of BCC at the site, and is known as an adequate excision . Relationships between the success of surgical procedures and the experience of the operator have been demonstrated for procedures such as inguinal hernia repair and diabetic foot amputation. Given that these relationships exist, the success of BCC excision may also be related to operator experience. In the UK, a proportion of BCC excisions are performed by general practitioners (GPs) in the community. To our knowledge, there has been no previous comparison of the excision adequacy of BCC between GPs and consultant dermatologists. Therefore, we undertook a retrospective study of excision adequacy of BCC to see if any variation exists between different operators, including GPs. We searched the histopathology database at the Whittington Hospital for all BCC excisions (excluding biopsies) performed during 2000–2002, inclusive. This period was chosen to avoid bias, as none of the consultant dermatologists currently working at the hospital were working here during this period. An inadequate excision was defined as the presence of any BCC in the margin of the excised specimen, as noted in histopathology reports. Procedure registers were used to identify the operator involved. The study findings are shown in Table 1. In total, 277 BCC samples were included. The dermatology specialist registrars and clinical assistants were grouped together, as both enjoy close supervision from consultant dermatologists. There was a significant difference in the rate of adequate excision between consultant dermatologists and GPs (v 1⁄4 19.423, P < 0.001) but not between consultant dermatologists and specialist registrars ⁄ clinical assistants (v 1⁄4 1.2129, p > 0.1). The general surgical teams excised too few BCCs to be compared fairly with other operators. This study demonstrates that in a sample of 277 BCC excisions, GPs did achieve lower rates of adequate excision than specialist dermatology staff. A possible reason for this is that GPs may have less experience of dermatology than consultant dermatologists. A robust knowledge of dermatology is necessary for a doctor to competently diagnose and manage skin cancers such as BCC. However, dermatology specialist registrars and clinical assistants work under consultant dermatologists’ supervision, benefiting from their experience. If a lack of experience in dermatology is a key factor, then the excision adequacy of other skin lesions may be affected by operator experience. A previous retrospective study has already identified inaccurate clinical diagnosis and inadequate excision of melanomas by GPs. Supervised postgraduate training in a hospital dermatology department may be an appropriate way of improving GPs’ excision adequacy rates, which would enhance patient care and bring financial benefits by avoiding reexcision and longer follow-up. This study is limited by its small sample size. A larger study is needed to support the findings published here and will be vital to improving the clinical management of BCC.