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BackgroundThe Contextualized Health Research Synthesis Program (CHRSP), developed in 2007 by the Newfoundland and Labrador Centre for Applied Health Research, produces contextualized knowledge syntheses for health-system decision makers. The program provides timely, relevant, and easy-to-understand scientific evidence; optimizes evidence uptake; and, most importantly, attunes research questions and evidence to the specific context in which knowledge users must apply the findings.MethodsAs an integrated knowledge translation (KT) method, CHRSP:Involves intensive partnerships with senior healthcare decision makers who propose priority research topics and participate on research teams;Considers local context both in framing the research question and in reporting the findings;Makes economical use of resources by utilizing a limited number of staff;Uses a combination of external and local experts; andWorks quickly by synthesizing high-level systematic review evidence rather than primary studies. Although it was developed in the Canadian province of Newfoundland and Labrador, the CHRSP methodology is adaptable to a variety of settings with distinctive features, such as those in rural, remote, and small-town locations.ResultsCHRSP has published 25 syntheses on priority topics chosen by the provincial healthcare system, including:Clinical and cost-effectiveness: telehealth, rural renal dialysis, point-of-care testing;Community-based health services: helping seniors age in place, supporting seniors with dementia, residential treatment centers for at-risk youth;Healthcare organization/service delivery: reducing acute-care length of stay, promoting flu vaccination among health workers, safe patient handling, age-friendly acute care; andHealth promotion: diabetes prevention, promoting healthy dietary habits. These studies have been used by decision makers to inform local policy and practice decisions.ConclusionsBy asking the health system to identify its own priorities and to participate directly in the research process, CHRSP fully integrates KT among researchers and knowledge users in healthcare in Newfoundland and Labrador. This high level of decision-maker buy-in has resulted in a corresponding level of uptake. CHRSP studies have directly informed a number of policy and practice directions, including the design of youth residential treatment centers, a provincial policy on single-use medical devices, and most recently, the opening of the province’s first Acute Care for the Elderly hospital unit.

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These histology results suggest that, given a good clinical suspicion of keloid, it may be unnecessary to send specimens at excision for routine histology.

A 61-year-old man presented to his general practitioner (GP) with a 6-month history of an asymptomatic cutaneous lesion to the upper left side-wall of his nose. He was otherwise well and was taking no medication. Physical examination demonstrated a 5-Â 5-mm firm red cystic lesion. There was no evidence of regional metastases.The GP performed a biopsy using sharp ring curettage. Histology of the lesion demonstrated a sebaceous carcinoma (SC) (Figure 1). The subject was subsequently referred to our service.A literature review revealed the potential metastatic nature of extraocular SC. After discussion at our multidisciplinary team meeting, it was concluded that wide local excision with a 4-mm margin should be performed in combination with sentinel lymph node biopsy.The lymphoscintigraphy technique was used with technetium Tc-99m sulfur colloid and patent blue dye injected around the site of the original excision. Three level II (upper jugular group) nodes were localized using a radiation counter and direct visualization. These were excised. Lymphoscintigraphy images are shown in Figure 2.Wide local excision with a 4-mm margin was performed and the defect resurfaced with a fullthickness skin graft. Histology of the wide local excision showed no evidence of malignancy, and sentinel node biopsy from the left neck showed no evidence of metastatic disease. Three years after sentinel node biopsy, the subject had no evidence of any local or regional reoccurrence.We present the articles that have reported the metastatic nature of extraocular SC and report to the best of our knowledge the first extraocular SC sentinel node biopsy. We therefore advocate the benefit of sentinel node biopsy for these tumors.