scholarly journals Primary versus Tertiary Care Follow-Up of Low-Risk Differentiated Thyroid Cancer: Real-World Comparison of Outcomes and Costs for Patients and Health Care Systems

2018 ◽  
Vol 8 (4) ◽  
pp. 208-214 ◽  
Author(s):  
Syed Ali Imran ◽  
Karen Chu ◽  
Murali Rajaraman ◽  
Drew Rajaraman ◽  
Sunita Ghosh ◽  
...  
Keyword(s):  
Health Care ◽  
Thyroid Cancer ◽  
Real World ◽  
Differentiated Thyroid Cancer ◽  
Health Care Systems ◽  
Tertiary Care ◽  
Low Risk ◽  
Care Systems

Primary versus tertiary care follow-up of low risk well differentiated thyroid cancer

2017 ◽  
Author(s):  
Syed Imran ◽  
Mal Rajaraman ◽  
Karen Chu ◽  
Stan VanUum ◽  
Stephanie Kaiser
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Tertiary Care ◽  
Low Risk ◽  
Well Differentiated

scholarly journals Naprapathy Versus Orthopaedic Standard Care for Common Musculoskeletal Disorders: An 8-year Follow-up of a Pragmatic Randomized Controlled Trial in Sweden

2021 ◽  
Author(s):  
Stina Lilje ◽  
Andreas Eklund ◽  
Anders Wykman ◽  
Tobias Sundberg ◽  
Eva Skillgate
Keyword(s):  
Health Care ◽  
Musculoskeletal Disorders ◽  
Health Care Systems ◽  
Controlled Trial ◽  
Bodily Pain ◽  
Control Group ◽  
National Health Care ◽  
Care Systems ◽  
Experimental Group

Abstract Background: Musculoskeletal pain is among the most common reasons for seeking care, specialist competence for its treatment in primary care limited and waiting lists for orthopaedics often amongst the longest. Many referrals to orthopaedics do not concern disorders that benefit from surgery. Manual therapy is effective, yet not integrated in national health care systems, and there is a lack of research on other than neck and low back pain, and a lack of long-term follow-ups. The present study evaluates the long-term effects of a complementary therapy for common orthopaedic disorders.Methods: An 8-year follow-up (96 months) of a pragmatic randomized controlled trial of naprapathy (experimental group) versus standard orthopaedic care (control group) for non-surgical patients of working age with the most common musculoskeletal disorders on the waiting lists(n=78). Bodily pain, physical function (SF36), Quality of life (QoL; SF6D), and data on health care utilization were collected.Results: N=75 participants in the original study sample completed the 8-year follow-up. The differences in bodily pain (21,7 (95% CI: 9,1-34,3)), physical function (17,6(6,7-28,4)), and QoLs (0,823 (95% CI: 0.785-0.862) compared with 0,713 (95% CI: 0.668-0.758)) were statistically significantly in favor of the experimental group (p-values<0,01). After sensitivity analysis the experimental group had altogether 260 health care visits compared with 1 161 in the control group.Conclusions:Naprapathy is a continuously effective treatment. Together with earlier research our study suggests that specialized manual therapy should be considered when triaging patients with common non-surgical musculoskeletal disorders in national health care systems.Trial registration: Not applicable, as per information given by ClinicalTrials.gov.

scholarly journals Total Thyroidectomy Versus Lobectomy for Thyroid Cancer: Single-Center Data and Literature Review

2021 ◽  
Author(s):  
Carla Colombo ◽  
Simone De Leo ◽  
Marta Di Stefano ◽  
Matteo Trevisan ◽  
Claudia Moneta ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Risk Group ◽  
Tertiary Care ◽  
Thyroid Stimulating Hormone ◽  
Low Risk ◽  
The Other ◽  
Intermediate Risk ◽  
Other Hand

Abstract Background Controversies remain about the ideal risk-based surgical approach for differentiated thyroid cancer (DTC). Methods At a single tertiary care institution, 370 consecutive patients with low- or intermediate-risk DTC were submitted to either lobectomy (LT) or total thyroidectomy (TT) and were followed up. Results Event-free survival by Kaplan–Meier curves was significantly higher after TT than after LT for the patients with either low-risk (P = 0.004) or intermediate-risk (P = 0.032) tumors. At the last follow-up visit, the prevalence of event-free patients was higher in the TT group than in the LT low-risk group (95% and 87.5%, respectively; P = 0.067) or intermediate-risk group (89% and 50%; P = 0.008). No differences in persistence prevalence were found among microcarcinomas treated by LT or TT (low risk, P = 0.938 vs. intermediate-risk, P = 0.553). Nevertheless, 15% of the low-risk and 50% of the intermediate-risk microcarcinomas treated by LT were submitted to additional treatments. On the other hand, macrocarcinomas were significantly more persistent if treated with LT than with TT (low-risk, P = 0.036 vs. intermediate-risk, P = 0.004). Permanent hypoparathyroidism was more frequent after TT (P = 0.01). After LT, thyroglobulin (Tg)/thyroid-stimulating hormone (TSH) had shown decreasing trend in 68% of the event-free patients and an increasing trend in the persistent cases. Conclusions Lobectomy can be proposed for low-risk microcarcinomas, although in a minority of cases, additional treatments are needed, and a longer follow-up period usually is required to confirm an event-free outcome compared with that for patients treated with TT. On the other hand, to achieve an excellent response, TT should be favored for intermediate-risk micro- and macro-DTCs despite the higher frequency of postsurgical complications.

scholarly journals Utility of Stimulated Thyroglobulin in Reclassifying Low Risk Thyroid Cancer Patients’ Following Thyroidectomy and Radioactive Iodine Ablation: A 7-Year Prospective Trial

2021 ◽  
Vol 11 ◽  
Author(s):  
Anwar A. Jammah ◽  
Afshan Masood ◽  
Layan A. Akkielah ◽  
Shaimaa Alhaddad ◽  
Maath A. Alhaddad ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Differentiated Thyroid Cancer ◽  
Radioactive Iodine ◽  
Prospective Trial ◽  
Low Risk ◽  
University Hospital ◽  
Serum Thyroglobulin ◽  
Risk Of Recurrence

ContextFollowing total thyroidectomy and radioactive iodine (RAI) ablation, serum thyroglobulin levels should be undetectable to assure that patients are excellent responders and at very low risk of recurrence.ObjectiveTo assess the utility of stimulated (sTg) and non-stimulated (nsTg) thyroglobulin levels in prediction of patients outcomes with differentiated thyroid cancer (DTC) following total thyroidectomy and RAI ablation.MethodA prospective observational study conducted at a University Hospital in Saudi Arabia. Patients diagnosed with differentiated thyroid cancer and were post total thyroidectomy and RAI ablation. Thyroglobulin levels (nsTg and sTg) were estimated 3–6 months post-RAI. Patients with nsTg &lt;2 ng/ml were stratified based on their levels and were followed-up for 5 years and clinical responses were measured.ResultsOf 196 patients, nsTg levels were &lt;0.1 ng/ml in 122 (62%) patients and 0.1–2.0 ng/ml in 74 (38%). Of 122 patients with nsTg &lt;0.1 ng/ml, 120 (98%) had sTg levels &lt;1 ng/ml, with no structural or functional disease. sTg levels &gt;1 occurred in 26 (35%) of patients with nsTg 0.1–2.0 ng/ml, 11 (15%) had structural incomplete response. None of the patients with sTg levels &lt;1 ng/ml developed structural or functional disease over the follow-up period.ConclusionSuppressed thyroglobulin (nsTg &lt; 0.1 ng/ml) indicates a very low risk of recurrence that does not require stimulation. Stimulated thyroglobulin is beneficial with nsTg 0.1–2 ng/ml for re-classifying patients and estimating their risk for incomplete responses over a 7 years follow-up period.

scholarly journals Microscopic Positive Tumor Margin Increases Risk for Disease Persistence but Not Recurrence in Patients with Stage T1-T2 Differentiated Thyroid Cancer

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Olfat Kamel Hasan ◽  
Sarah De Brabandere ◽  
Irina Rachinsky ◽  
David Laidley ◽  
Danielle MacNeil ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Recurrent Disease ◽  
Positive Margin ◽  
Disease Recurrence ◽  
Low Risk ◽  
Recurrence Rates ◽  
Persistent Disease ◽  
Positive Margins

Introduction. Differentiated thyroid cancer (DTC) has an overall excellent prognosis. Patients who develop recurrent disease have a more unfavorable disease course than those with no recurrence. Higher recurrence rates are seen with incomplete surgical resection and gross positive margins. It is unclear whether microscopic positive margin affects disease recurrence rates as much as grossly positive margin. Aim of the Study. To assess whether microscopic positive margin is an independent predictor of disease recurrence in patients with overall low-risk DTC. Patients and Methods. We conducted a retrospective single-center institutional review of 1,583 consecutive patients’ charts from 1995–2013 using the Canadian Thyroid Cancer Consortium Registry. We included adult patients with nonmetastasizing T1 and T2 DTC with a minimum of three years follow-up. Univariate and multivariate analyses were used to study factors that may influence the risk of persistent/recurrent disease. Strict definitions of persistent versus recurrent disease were applied. Results. 963 patients (152 men and 811 women) were included in the study with a mean age of 46 years. Microscopic positive margins were present in 12% of the specimens and were associated with an increased rate of persistent disease (8% versus 2% in the controls) but not with an increased risk of recurrent disease (1% in both groups). T2 tumors had a significantly higher incidence of positive margins than T1 tumors (48% versus 36%) and significantly higher nodal staging. Conclusions. Microscopic positive margin in the histopathology report in patients with low-risk DTC was associated with a higher rate of persistent disease but did not increase the risk of disease recurrence. A close follow-up of biomarkers and occult residual cancerous lesions is needed, especially in the first year. Further studies are needed to determine whether additional therapeutic measures to prevent recurrence are indicated in T1 and T2 DTC with positive microscopic surgical margins.

Use of imaging for staging of early breast cancer in two integrated health care systems.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 184-184
Author(s):  
Erin Elizabeth Hahn ◽  
Tania Tang ◽  
Janet S. Lee ◽  
Corrine Munoz-Plaza ◽  
Joyce O Adesina ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Cancer Patients ◽  
Early Stage ◽  
Health Care Systems ◽  
Integrated Health Care ◽  
Low Risk ◽  
Breast Cancer Patients ◽  
Chart Abstraction ◽  
Care Systems

184 Background: The initial ASCO “Top 5” list, created as part of the Choosing Wisely campaign, recommends against use of imaging for staging of early stage breast cancer in asymptomatic women at low risk for metastasis. The objective of this study was to measure and compare use of imaging for staging in two large integrated health care systems, Kaiser Permanente (KP) and Intermountain Healthcare (IH). We also sought to distinguish whether imaging was used for routine staging or for diagnostic purposes. Methods: We identified stage 0-IIB breast cancer patients diagnosed between January 1, 2010 and December 31, 2012 with first primary malignancy from tumor registries in three KP regions (Southern California, Northwest, and Mid-Atlantic) and IH. Using the KP and IH electronic health records, we identified use of imaging tests (PET, CT, bone scan) during the staging window (30 days prior to diagnosis up to initial surgery). We performed chart abstraction on a random sample of patients who received an imaging test to identify indication. Results: For the total sample of 10,014, mean age at diagnosis was 60 (range 22-99); with 21% stage 0, 47% stage I, 32% stage II. Overall, 8% of patients (792 patients) received at least one imaging test during the staging window, including 8% at KP and 6% at IH (p=0.0005). Chart abstraction (N=129) revealed that overall, almost half of all imaging tests (48%) were performed to evaluate a symptom, sign or prior imaging finding, including 55% at KP and 32% at IH. Conclusions: Use of imaging for staging of low-risk breast cancer was very low in both health care systems, with clinically trivial differences between them. Approximately half of imaging services were in response to a sign or symptom. Strategies to reduce use of imaging at staging for early stage breast cancer patients within these health care systems are unlikely to yield meaningful improvement. [Table: see text]

Abstract WP64: City-wide Stroke Team in the U.S. Delivers the Highest Intravenous Thrombolysis Treatment Rate

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Andrei V Alexandrov ◽  
Georgios Tsivgoulis ◽  
Katherine Nearing ◽  
Marc Malkoff ◽  
Odysseas Kargiotis ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Tertiary Care ◽  
Intravenous Thrombolysis ◽  
Population Based ◽  
Treatment Rate ◽  
Practice Plan ◽  
Care Systems ◽  
Tertiary Care Centers ◽  
The U.S

Background: An increasing shortage of vascular neurologists forced an academic provider to find a city-wide solution to offer 24x7 access to intravenous thrombolysis (IVT) across independent and competing health care systems in the area. We sought to prospectively evaluate the annual IVT treatment delivery in our population and compare it to leading stroke centers worldwide. Methods: The largest single ER system and 3 other independent hospital providers in the area agreed to work with a single practice plan vascular neurology team (catchment area of 1,344,127 individuals). All acute ischemic stroke patients that were treated with IVT across all primary or tertiary care centers in our area were prospectively documented over a 12-month period (January-December 2015). A literature search was performed using narrative review methodology to document similar population-based treatment rates across leading stroke centers in North America, Europe and Australasia. Results: A total of 552 patients received IVT with tissue plasminogen activator (tPA) in 2015. Single ER system delivered 433 IV tPA treatments and 119 more patients were treated in the remaining hospitals. The annual tPA treatment rate was 41 per 100.000 individuals (95%CI: 38-44) favorably comparable to published annual treatment rates from leading international stroke centers (Table, 1998 thru 2015). Conclusions: A city-wide vascular neurology team can attend to patient populations across competing health care systems in the U.S. and deliver IVT at volumes and rates above those reported by leading treatment centers worldwide. Communities with competing systems can improve tPA delivery by sharing vascular neurology resources.

scholarly journals Delayed risk stratification, to include the response to initial treatment (surgery and radioiodine ablation), has better outcome predictivity in differentiated thyroid cancer patients

2011 ◽  
Vol 165 (3) ◽  
pp. 441-446 ◽  
Author(s):  
Maria Grazia Castagna ◽  
Fabio Maino ◽  
Claudia Cipri ◽  
Valentina Belardini ◽  
Alexandra Theodoropoulou ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
High Risk ◽  
Risk Stratification ◽  
Initial Treatment ◽  
Differentiated Thyroid Cancer ◽  
Low Risk ◽  
Risk Category ◽  
Radioiodine Ablation ◽  
Risk Patients

IntroductionAfter initial treatment, differentiated thyroid cancer (DTC) patients are stratified as low and high risk based on clinical/pathological features. Recently, a risk stratification based on additional clinical data accumulated during follow-up has been proposed.ObjectiveTo evaluate the predictive value of delayed risk stratification (DRS) obtained at the time of the first diagnostic control (8–12 months after initial treatment).MethodsWe reviewed 512 patients with DTC whose risk assessment was initially defined according to the American (ATA) and European Thyroid Association (ETA) guidelines. At the time of the first control, 8–12 months after initial treatment, patients were re-stratified according to their clinical status: DRS.ResultsUsing DRS, about 50% of ATA/ETA intermediate/high-risk patients moved to DRS low-risk category, while about 10% of ATA/ETA low-risk patients moved to DRS high-risk category. The ability of the DRS to predict the final outcome was superior to that of ATA and ETA. Positive and negative predictive values for both ATA (39.2 and 90.6% respectively) and ETA (38.4 and 91.3% respectively) were significantly lower than that observed with the DRS (72.8 and 96.3% respectively,P<0.05). The observed variance in predicting final outcome was 25.4% for ATA, 19.1% for ETA, and 62.1% for DRS.ConclusionsDelaying the risk stratification of DTC patients at a time when the response to surgery and radioiodine ablation is evident allows to better define individual risk and to better modulate the subsequent follow-up.

scholarly journals Effect of Public Deliberation on Patient Attitudes Regarding Consent and Data Use in a Learning Health Care System for Oncology

2019 ◽  
Vol 37 (34) ◽  
pp. 3203-3211 ◽  
Author(s):  
Reshma Jagsi ◽  
Kent A. Griffith ◽  
Rochelle D. Jones ◽  
Chris Krenz ◽  
Michele Gornick ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Record ◽  
Medical Records ◽  
Health Care Systems ◽  
Insurance Companies ◽  
Future Research ◽  
Democratic Deliberation ◽  
Recommended Care ◽  
Care Systems

PURPOSE We sought to generate informed and considered opinions regarding acceptable secondary uses of deidentified health information and consent models for oncology learning health care systems. METHODS Day-long democratic deliberation sessions included 217 patients with cancer at four geographically and sociodemographically diverse sites. Patients completed three surveys (at baseline, immediately after deliberation, and 1-month follow-up). RESULTS Participants were 67.3% female, 21.7% black, and 6.0% Hispanic. The most notable changes in perceptions after deliberation related to use of deidentified medical-record data by insurance companies. After discussion, 72.3% of participants felt comfortable if the purpose was to make sure patients receive recommended care ( v 79.5% at baseline; P = .03); 24.9% felt comfortable if the purpose was to determine eligibility for coverage or reimbursement ( v 50.9% at baseline; P < .001). The most notable change about secondary research use related to believing it was important that doctors ask patients at least once whether researchers can use deidentified medical-records data for future research. The proportion endorsing high importance decreased from baseline (82.2%) to 68.7% immediately after discussion ( P < .001), and remained decreased at 73.1% ( P = .01) at follow-up. At follow-up, non-Hispanic whites were more likely to consider it highly important to be able to conduct medical research with deidentified electronic health records (96.8% v 87.7%; P = .01) and less likely to consider it highly important for doctors to get a patient’s permission each time deidentified medical record information is used for research (23.2% v 51.6%; P < .001). CONCLUSION This research confirms that most patients wish to be asked before deidentified medical records are used for research. Policies designed to realize the potential benefits of learning health care systems can, and should be, grounded in informed and considered public opinion.

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