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Purpose: Frozen section analysis has been a cornerstone in intraoperative pathological evaluation for oral cancer surgeries, aiding in achieving tumor-free margins. However, its utility and availability are subjects of ongoing debate and research. This study evaluates the efficacy of a guideline-based approach to surgical resection margins in the absence of frozen section analysis in a resource-constrained setting., Materials and Methods: We conducted a retrospective audit of 490 oral cavity cancer patients treated from December 2021 to December 2023 at our center, where frozen section analysis was not available. Surgical resections adhered to the guidelines of maintaining 1 cm mucosal soft tissue and base margins, and a 7 mm specimen-driven margin assessment intraoperatively. The outcomes measured were the rates of close (between 1 mm and 5 mm) and involved (less than or equal to 1 mm) margins in final histopathology reports (HPR)., Results: 448 patients were included in our audit. On final HPR, a gross margin of 7 mm or more achieved intraoperatively translated into safe (more than 5 mm) margins in 410 patients (91.1 %). 25 (5.1 %) had at least one close margin, of which 11 were technical due to the desire to minimize functional morbidity. 15 (3.1 %) had involved margins, where R0 resection was not achieved due to anatomical constraints. An additional finding was the correlation of compromised margins with worst pattern of invasion (WPOI) 4&5 on Chi-square analysis (p = 0.021) and depth of invasion (DOI) more than 5 mm (OR 3.81, p = 0.010)., Conclusion: This study indicates that a margin of 7 mm or more intraoperatively translates into safe margins on final HPR, and calls for a pragmatic and judicious use of FS in the interest of choosing wisely., Competing Interests: Declaration of competing interest No conflict of interest by any of the authors to disclose., (Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Psychologically informed physical therapy (PIPT) blends psychological strategies within a physical therapist's treatment approach for the prevention and management of chronic musculoskeletal pain. Several randomized trials have been conducted examining the efficacy of PIPT compared to standard physical therapy on important patient-reported outcomes of disability, physical function, and pain. In this review, we examine recent trials published since 2012 to describe current PIPT methods, discuss implications from findings, and offer future directions. Twenty-two studies, representing 18 trials, were identified. The studied PIPT interventions included (1) graded activity or graded exposure (n = 6), (2) cognitive-behavioral-based physical therapy (n = 9), (3) acceptance and commitment-based physical therapy (n = 1), and (4) internet-based psychological programs with physical therapy (n = 2). Consistent with prior reviews, graded activity is not superior to other forms of physical activity or exercise. In a few recent studies, cognitive-behavioral-based physical therapy had short-term efficacy when compared to a program of standardized exercise. There is a need to further examine approaches integrating alternative strategies including acceptance-based therapies (ie, acceptance and commitment therapy or mindfulness) or internet-based cognitive-behavioral programs within physical therapy. Although PIPT remains a promising care model, more convincing evidence is needed to support widespread adoption, especially in light of training demands and implementation challenges., Competing Interests: The authors have no conflicts of interest to declare. During manuscript development, R.A. Coronado was supported by a Vanderbilt Faculty Research Scholars Award.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.)