scholarly journals Pilot Study of a Web-based Decision Tool on Post-operative Use of Radioactive Iodine

2017 ◽  
Vol 13 (01) ◽  
pp. 26
Author(s):  
Shrujal S Baxi ◽  
Rachel Kurtzman ◽  
Anne Eaton ◽  
Eliza Dewey ◽  
Craig Bickford ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Pilot Study ◽  
High Risk ◽  
Radioactive Iodine ◽  
Clinical Decision Making ◽  
Weighted Kappa ◽  
Clinical Decision ◽  
Risk Level ◽  
Lymph Node Staging ◽  
Web Based

Background: The Thyroid Cancer Care Collaborative developed a web-based clinical decision-making module (CDMM) to inform riskadjusted decisions on post-thyroidectomy radioactive iodine (RAI) use in papillary thyroid cancer (PTC). Methods: In a pilot study, we evaluated the CDMM in 19 PTC cases representing low- (five), intermediate- (seven) and high-risk (seven) disease. Two PTC experts and 10 PTC physicians reviewed cases and assigned risk level and RAI recommendation. The experts used a standard approach while the others used the CDMM. We assessed agreement between responses using a weighted Kappa. Results: Between experts, risk-assignment was concordant in 100%, 57% and 86% of low-, intermediate- and high-risk cases, respectively. Between CDMM users, risk-assignment was concordant in 100%, 29% and 14% in low-, intermediate- and high-risk cases, respectively (p=0.01). CDMM-assigned risk agreed with the expert-assigned risk in 100%, 25% and 0% of low-, intermediate- and high-risk cases, respectively (Kappa=0.69). For RAI use, the experts agreed in 15 cases while CDMM users agreed in eight. On further analysis, interpretation of extrathyroidal extension and lymph node staging led to discrepancies with the CDMM. Conclusions

IMMUNOGLOBULIN PREPARATIONS CAN MISLEAD CLINICAL DECISION-MAKING IN FOLLOW-UP OF DIFFERENTIATED THYROID CANCER

2020 ◽  
Vol 26 (9) ◽  
pp. 1031-1038
Author(s):  
Mélissa Yéléhé-Okouma ◽  
Catherine Malaplate ◽  
Nadine Petitpain ◽  
Mélanie Metallo ◽  
François Ziegler ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Radioactive Iodine ◽  
Clinical Decision Making ◽  
Current Knowledge ◽  
Clinical Decision ◽  
Needle Aspiration ◽  
Thyroid Peroxidase ◽  
Immunoglobulin Preparations

Objective: Intravenous and subcutaneous immunoglobulins are commonly used for immune substitution or as immune modulators in a variety of inflammatory and autoimmune disorders. Exogenous thyroid-specific thyroglobulin (Tg) antibodies present in the donor plasma may interfere with the interpretation of measurements of Tg autoantibodies (Tg-Abs) in the recipient’s plasma and potentially trigger an immune response in the recipient’s immune cells. Levels of antibodies causing bioassay interferences or those leading to clinically relevant changes in patient outcomes are not known. Tg is used as a biomarker in the long-term surveillance of patients with differentiated thyroid cancer (DTC) following total thyroidectomy and radioactive iodine ablation. However, the presence of Tg-Abs in the circulation interferes with Tg measurements. Assessment of levels of Tg-Abs is thus recommended as a part of standard follow-up of DTC together with Tg testing. Methods: To understand the potential mechanisms and pathophysiologic significance of possible interferences associated with administration immunoglobulin preparations and Tg measurement, we overview the current knowledge on interactions between Tg autoimmunity and immunoglobulin preparations and illustrate diagnostic challenges and perspectives for follow-up of patients with DTC treated with exogenous immunoglobulins. Results: In patients with DTC treated with immunoglobulin preparations, monitoring of thyroid cancer using Tg and Tg-Abs is challenging due to possible analytical interferences through passive transfer of exogenous antibodies from immunoglobulin preparations. Conclusion: Analytical interferences must be suspected when a discrepancy exists between clinical examination and diagnostic tests. Collaboration between endocrinologists, biologists, and pharmacologists is fundamental to avoid misdiagnosis and unnecessary medical or radiologic procedures. Abbreviations: CT = computed tomography; DTC = differentiated thyroid cancer; FNAB = fine-needle aspiration biopsy; HAb = heterophile antibody; IMA = immunometric assay; IVIg = intravenous immunoglobulin; RAI = radioactive iodine; RIA = radioimmunoassay; SCIg = subcutaneous immunoglobulin; Tg = thyroglobulin; Tg-Ab = thyroglobulin autoantibody; Tg-MS = thyroglobulin mass spectrometry; TPO-Ab = thyroid peroxidase autoantibody; TSHR-Ab = thyrotropin receptor autoantibody

scholarly journals Impact of repeated dose of stable iodine in an in utero rat model using a metabolomic approach

2019 ◽  
Vol 14 ◽  
pp. 06007
Author(s):  
Clément Rosique ◽  
Dalila Lebsir ◽  
Maâmar Souidi ◽  
Jean-Charles Martin
Keyword(s):  
Thyroid Cancer ◽  
High Risk ◽  
Power Plant ◽  
Nuclear Power ◽  
Radioactive Iodine ◽  
Repeated Administration ◽  
Undesirable Effect ◽  
Extended Exposure ◽  
Metabolomic Approach ◽  
Stable Iodine

The Fukushima nuclear power plant blast resulted in the release of 131Iodine for several weeks. This unexpected issue challenged the iodin doctrine [1], in which the counter-measure is to provide a unique iodine tablet to saturate thyroid during the radioactive contamination not expected to last more than several hours. A new doctrine must be implemented to take into account such case of extended exposure based on repeated iodine administration with adapted dosage. But repeated administration of iodine can block the thyroid [2] and few scientific evidences regarding repeated iodine administration (and its potential undesirable effect) are at our disposal [3]. Moreover, unborn and young children are at high risk during a nuclear incident: it is currently recognized that one of the risks of exposure to radioactive iodine is the development of thyroid cancer, especially when exposure occurred during childhood [4]. Their protection is a main priority. Our goal was to evaluate the potential undesirable effects of such repeated iodine administration in the offspring using an untargeted metabolomic approach on a rat reproductive model.

Dentists clinical decision-making for erosive tooth wear: An online pilot study

2020 ◽  
Vol 100 ◽  
pp. 103424 ◽  
Author(s):  
Micah B. Goldfarb ◽  
Gerardo Maupomé ◽  
Adam T. Hirsh ◽  
Joana C. Carvalho ◽  
George J. Eckert ◽  
...  
Keyword(s):  
Decision Making ◽  
Pilot Study ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Tooth Wear ◽  
Erosive Tooth Wear

scholarly journals How to make good-enough risk decisions

2009 ◽  
Vol 15 (3) ◽  
pp. 192-198 ◽  
Author(s):  
Andrew Carroll
Keyword(s):  
Social Psychology ◽  
Decision Making ◽  
High Risk ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Managing Risk

SummaryMaking decisions in the context of risk is an integral part of psychiatric work. Despite this, decision-making skills are rarely systematically taught and the processes behind decisions are rarely made explicit. This article attempts to apply contemporary evidence from cognitive and social psychology to common dilemmas faced by psychiatrists when assessing and managing risk. It argues that clinical decision-making should acknowledge both the value and limitations of intuitive approaches in dealing with complex dilemmas. After discussing the various ways in which clinical decision-making is commonly derailed, the article outlines a framework that accommodates both rational and intuitive modes of thinking, with the aim of optimising decision-making in high-risk situations.

scholarly journals Effects of environmental distractors on nurse emergency triage accuracy: a pilot study

2020 ◽  
Author(s):  
philippe delmas ◽  
Assunta fiorentino ◽  
matteo antonini ◽  
severine Vuilleumier ◽  
guy Stotzer ◽  
...  
Keyword(s):  
Pilot Study ◽  
Large Scale ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Serious Game ◽  
Control Group ◽  
Emergency Nurses ◽  
Group B ◽  
Experimental Group ◽  
Nurse Triage

Abstract Background: Patient safety is a top priority of the health professions. In emergency departments, the clinical decision making of triage nurses must be of the highest reliability. However, studies have repeatedly found that nurses over- or undertriage a considerable portion of cases, which can have major consequences for patient management. Among the factors that might explain this inaccuracy, workplace distractors have been pointed to without ever being the focus of specific investigation, owing in particular to the challenge of assessing them in care settings. Consequently, the use of a serious game reproducing a work environment comprising distractors would afford a unique opportunity to explore their impact on the quality of nurse emergency triage. Methods/Design : A factorial design will be used to test the acceptability and feasibility of a serious game created to explore the primary effects of distractors on emergency nurse triage accuracy. A sample of 80 emergency nurses will be randomised across three experimental groups exposed to different distractor conditions and one control group not exposed to distractors. Specifically, experimental group A will be exposed to noise distractors only; experimental group B to task interruptions only; and experimental group C to both types combined. Each group will engage in the serious game to complete 20 clinical vignettes in two hours. For each clinical vignette, a gold standard will be determined by experts. Pre-tests will be planned with clinicians and specialised emergency nurses to examine their interaction with the first version of the serious game. Discussion : This study will shed light on the acceptability and feasibility of a serious game in the field of emergency triage. It will also advance knowledge of the possible effects of exposure to common environmental distractors on nurse triage accuracy. Finally, this pilot study will inform planned large-scale studies of emergency nurse practice using serious games.

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