Follow-up Tools Research Articles

Utility of a Mobile Clinical Decision Support Application in Patients Undergoing Spinal Cord Stimulation.

Abstract INTRODUCTION Novel technologies to support real-time patient education, engagement and scalable outcomes monitoring to make clinically meaningful decisions are needed. The ManageMySurgery (MMS) Spinal Cord Stimulation (SCS) module is a mobile clinical decision support application that provides: (1) a mobile, patient-centered engagement tool for delivering pre-, peri- and postoperative SCS information; (2) scalable patient-reported outcomes collection; (3) a HIPAA-compliant 2-way messaging platform with a Clinical Specialist Educator for real-time support and goal setting. METHODS Prospective data was collected using the MMS mobile smartphone application in patients undergoing Medtronic SCS trial and permanent implant procedures. E-consent was obtained through the HIPAA compliant, mobile software platform. All data was de-identified, aggregated and analyzed. RESULTS A total of 20 patients (15-trial SCS and 5 permanent SCS patients) agreed to participate and logged onto the mobile software platform. For trial SCS patients, 100% of those that participated experienced >50% pain relief as documented in their patient-reported outcomes. Furthermore, patients found various features of the software platform helpful for navigating different aspects of their SCS procedure, with 81% finding MMS helpful in preparing for their SCS procedure, 88% finding MMS helpful in recovering from their SCS procedure and 94% in communicating with their Clinical Specialist Educator. In addition, 95% of patients would recommend MMS to a friend or family member. CONCLUSION The MMS platform appears to have utility both during the SCS Trial and Permanent procedures. In patients with chronic pain, novel patient engagement and follow-up tools such as MMS may be a good option for keeping patients engaged with the therapy and ensuring patients stay on track during their procedural journey. Randomized, controlled trials with extended follow-up are in progress and needed to further evaluate the utility of MMS in patients with chronic pain undergoing SCS.

Follow-up recommendations for the late preterm infant

The population of late preterm infants (PT), those born between 34+0 and 36+6 weeks of gestation, accounts for 70–74% of all premature infants, and is not specifically included in most of the follow-up protocols for preterm infants. For many years, PTs have been handled as if they were term newborns, which has led to a limited knowledge of their outcome in the medium and long term. Their neonatal morbidity is associated with a higher incidence of postnatal complications, with an increased rate of hospital re-admissions due to malnutrition, hyperbilirubinaemia, and respiratory problems, when compared to term infants. Cerebral immaturity may be the main cause of the deficits observed in the long-term neurodevelopment of this population, making them more vulnerable. Several issues have been described, such as delays or disabilities in the pre-school stage, cerebral palsy, mental retardation, intellectual disability, schizophrenia, and psychological development of behavioural and emotional disorders.The SEN34-36 Group of the Spanish Society of Neonatology, in collaboration with the Spanish Association of Primary Care Paediatrics, have developed these follow-up recommendations with the main objective of reducing the impact of prematurity on PT development. The secondary objectives of the document are to make neonatologists and paediatricians aware of the risks of sequelae of PTs, to determine and unify the evaluations and/or interventions that should be carried out, to offer clinical follow-up tools for the early detection of developmental delays, and to coordinate the care by all the professionals involved.

Non-invasive imaging techniques for the in vivo diagnosis of Bowen's disease: Three case reports.

Bowen's disease (BD) is a relatively frequent non-melanoma skin cancer occurring mostly in elderly people. Until now, the usual way to establish the diagnosis is histopathological examination of a skin biopsy. Dermoscopy and reflectance confocal microscopy (RCM) are modern alternative methods that can be used as quick and non-invasive diagnostic techniques and as follow-up instruments in cases in which a conservative treatment is chosen for the management of BD. There are no very specific dermoscopic criteria for the diagnosis of this disease, but some dermoscopic features (scaly surface, vascular structures and pigmentation) can be found more frequent and can be helpful for the diagnosis. RCM of BD shows an acanthotic epidermis with two types of targetoid cells: the first, a large cell with bright center and dark peripheral halo, the second, a cell with dark center and a bright rim surrounded by a dark hallo, related with dyskeratotic cells on histological examination. BD management could be improved by using non-invasive, in vivo imaging techniques that allow a fast and easy diagnosis and can be used as follow-up tools. However, larger studies are necessary for the validation of our observations.

Análisis y evaluación de procesos de interactividad en entornos virtuales de aprendizaje

El presente artículo refiere a la interactividad educativa en plataformas de formación online, para optimizar sus potencialidades en pro de auspiciar la formación virtual. El objetivo de este escrito es caracterizar las TIC más utilizadas y determinar si existe asociación entre algunos elementos relacionados con la interactividad virtual, a fin de proponer atributos, métricas e indicadores que permitan cualificar la operatividad en entornos virtuales de aprendizaje. Por lo tanto, se llevó a cabo un estudio descriptivo que examinó el uso y la aplicabilidad de las TIC en el e-learning, en dos programas de Ingeniería de Sistemas, los cuales pertenecen a la Universidad de Medellín - Colombia y a la Universidad de Córdoba - Argentina. Se analiza la necesidad de repensar la evaluación y seguimiento de la interactividad, para brindar aportes metodológicos claves que generen en dicho proceso un mejoramiento y favorezcan la interacción social en un entorno virtual de aprendizaje. El tema de interés no solo cobra validez en el proceso formativo sino también en la socialización de fundamentos que pueden contribuir a la calidad educativa en entornos virtuales. También, se comparten juicios a partir de elementos teóricos que optimizan la interactividad mediada con TIC y la interacción virtual. En este texto se logra establecer como conclusión principal, que algunos entornos virtuales no incorporan herramientas de seguimiento para potenciar el desarrollo de procesos de interactividad desde requisitos expuestos por los actores educativos.

Implementation of lean manufacturing techniques in the bakery industry in Medellin

Abstract The bakery industry has great economic and social importance in the city of Medellin; most of the companies are small with high levels of informality, low value added and productivity. Lean Manufacturing has become one of the most popular paradigms of waste disposal in the industrial sector and services, with great benefits of their practice on the improvement of the quality and organizational productivity. This work evaluates the level of implementation of the lean manufacturing techniques in the micro and small enterprises in Medellin, in the food sector. It was using diagnostic and follow-up tools with questionnaire to the production chief, which include 9 techniques or tools, and a variable of administration that allow organizations to a guide, to improve the current conditions of productivity. The main results show that the outstanding Lean practices are: PokaYoke, Kaizen and visual factory. However, for which the sector is considered to be of world class, the practices must be strengthened: VSM (generation of value), JIT (Production Flow) and ADMON (Administration). In addition, organizations must increase sales least 139, 20% to increase the level of efficiency of the sector, without changing the number of employees.

A Comparison Study among Several Tumor Markers in Serum Samples of Patients with Colon Cancers

During six years ago, 109 patients with malignant colon cancers at metastasis stages (II to IV stages), 112 patients “as a pathological control group”, and 85 healthy individuals were enrolled in the present work. CLEC4E, CEA, CA 19-9, and Serotonin levels were measured in the sera of study individuals using sandwich ELISA technique. Current study demonstrated significant increase in the levels of CLEC4E, CEA, and CA 19-9 in the malignant colorectal cancers comparison to pathological controls as well as healthy individuals. Serotonin levels were seemed to be lower at cancerous patients comparison to healthy controls. CLEC4E may be used as a definitive diagnostic marker for cancers than other nonmalignant diseases, moreover CLEC4E and serotonin can be considered as new diagnostic tools for colon cancer and are highly effective follow-up tools and can be diagnostic and follow-up tools when measured with other resident parameters. Measured parameters (CLEC4E, CEA, CA19-9, and Serotonin) can be effective screening tools when diagnosing tumor infections in the colon.

Clinical, Laboratory, and Molecular Characteristics and Remission Status in Children With Severe Congenital and Non-congenital Neutropenia.

Objectives: Severe congenital neutropenia (SCN) is a primary immunodeficiency disease characterized by the early onset of recurrent infections and persistent severe neutropenia, with or without genetic defect. We aimed to study the different clinical features and hematological and bone marrow characteristics of patients with SCN and the non-congenital form of severe neutropenia (SN) with unknown etiology.Methods: Thirty-nine Chinese children with severe neutropenia for longer than 6 months unrelated to virus infection or autoimmune diseases were enrolled in the study to analyse the clinical, laboratory, and molecular characteristics. They were followed clinically to observe their remission status.Results: Seven patients were found to have SCN mutations, including ELANE and G6PC3. Among 26 patients with close follow-up, one died for an unknown reason, and 10 resolved spontaneously with a median neutropenia duration of 14.5 months; these patients were designated as having recovered SN. The demographic characteristics of both groups were similar, with a median infection rate of 5 times/year. SCN patients had more frequent infection than recovered SN patients (4 times/year, P = 0.039). The median absolute neutrophil count (ANC) was 0.40 × 109/L in SCN patients, which was significantly higher than 0.2 × 109/L in SN with unknown etiology and 0.21 × 109/L in recovered SN patients (P = 0.021, P = 0.017). The median monocyte count was 1.60 × 109/L in SCN patients, which was also significantly higher than 0.57 × 109/L in SN of unknown etiology and 0.55 × 109/L in recovered SN patients (P = 0.018, P = 0.001). Bone marrow examinations demonstrated myeloid maturation arrest at the myelocyte-metamyelocyte stage in SCN patients and normal findings in SN with unknown etiology and recovered SN patients.Conclusions: Patients with severe neutropenia due to gene mutations demonstrate more serious symptoms than patients with unknown etiology. Patients with relatively higher ANC and monocyte counts are more likely to have known gene mutations. Future studies should focus on more detailed laboratory investigation, prolonged follow-up and advanced molecular biology tools to facilitate accurate diagnosis and effective treatment.

Política indutora brasileira de formação em saúde: avaliação do desenvolvimento da formação integral para o SUS

Trata-se de um estudo resultante de uma dissertação de mestrado, de abordagem qualitativa, que buscou avaliar a preparação dos sujeitos envolvidos no Programa de Educação pelo Trabalho (PET-Saúde) de uma universidade da região norte do RS para atuarem no SUS segundo os preceitos da integralidade e interprofissionalidade. É imprescindível o monitoramento e avaliação das orientações propostas pelas Diretrizes Curriculares Nacionais para os cursos da saúde, bem como pelos programas de reorientação da formação profissional, para tanto se faz necessária a construção e aplicação de instrumentos de avaliação e acompanhamento que funcionem como indicadores de rumos e de correções de percurso. Como resultados obtidos podemos enfatizar uma familiaridade dos sujeitos entrevistados com os conceitos utilizados pelos autores que trabalham o assunto; demonstraram em suas falas o quanto é claro em suas concepções o papel que o programa possui no processo de formação em saúde; também foi possível reconhecer que o programa está conseguindo incutir em seus participantes a necessidade e benefício do desenvolvimento de algumas habilidades essências para a qualificação do SUS; o reconhecimento dos participantes sobre a relevância da integração ensino-serviço-comunidade.

A quantitative assessment of the evolution of cerebellar syndrome in children with phosphomannomutase-deficiency (PMM2-CDG)

BackgroundWe aim to delineate the progression of cerebellar syndrome in children with phosphomannomutase-deficiency (PMM2-CDG) using the International Cooperative Ataxia Rating Scale (ICARS). We sought correlation between cerebellar volumetry and clinical situation. We prospectively evaluated PMM2-CDG patients aged from 5 to 18 years through ICARS at two different time points set apart by at least 20 months. We reviewed available MRIs and performed volumetric analysis when it was possible.ResultsFrom the eligible 24, four patients were excluded due to severe mental disability (n = 2) and supratentorial lesions (n = 2). Two different ICARS evaluations separated by more than 20 months were available for 14 patients showing an improvement in the cerebellar syndrome: ICARS1: 35.71 versus ICARS2: 30.07 (p < 0.001). When we considered time, we saw an improvement of 2.64 points in the ICARS per year with an SD of 1.97 points (p < 0.001). The ICARS subscales results improved with time, reaching statistical significance in “Posture and gait” (p < 0.001), “Kinetic functions” (p = 0.04) and “Speech abnormalities” (p = 0.045). We found a negative correlation between the ICARS results and total cerebellar volume (r = −0.9, p = 0.037) in a group of five patients with available volumetric study, meaning that the higher the ICARS score, the more severe was the cerebellar atrophy.ConclusionsOur study shows a stabilization or mild improvement in the cerebellar functions of paediatric PMM2-CDG patients despite cerebellar volume loss. ICARS is a valid scale to quantify the evolution of cerebellar syndrome in PMM2-CDG patients. The availability of ICARS and other reliable and sensitive follow-up tools may prove essential for the evaluation of potential therapies.

Correlate: A PACS- and EHR-integrated Tool Leveraging Natural Language Processing to Provide Automated Clinical Follow-up.

A major challenge for radiologists is obtaining meaningful clinical follow-up information for even a small percentage of cases encountered and dictated. Traditional methods, such as keeping medical record number follow-up lists, discussing cases with rounding clinical teams, and discussing cases at tumor boards, are effective at keeping radiologists informed of clinical outcomes but are time intensive and provide follow-up for a small subset of cases. To this end, the authors developed a picture archiving and communication system-accessible electronic health record (EHR)-integrated program called Correlate, which allows the user to easily enter free-text search queries regarding desired clinical follow-up information, with minimal interruption to the workflow. The program uses natural language processing (NLP) to process the query and parse relevant future clinical data from the EHR. Results are ordered in terms of clinical relevance, and the user is e-mailed a link to results when these are available for viewing. A customizable personal database of queries and results is also maintained for convenient future access. Correlate aids radiologists in efficiently obtaining useful clinical follow-up information that can improve patient care, help keep radiologists integrated with other specialties and referring physicians, and provide valuable experiential learning. The authors briefly review the history of automated clinical follow-up tools and discuss the design and function of the Correlate program, which uses NLP to perform intelligent prospective searches of the EHR. © RSNA, 2017.

Colorectal Cancer Surveillance: What Is the Optimal Frequency of Follow-up and Which Tools Best Predict Recurrence?

Up to 50% of patients with stage II or III colon cancer are estimated to develop locoregional recurrence, distant metastasis, or metachronous colon cancers within 5 years of initial treatment. Given the high risk of recurrence, surveillance is critical, but what is the optimal frequency and testing of surveillance, and is it possible to tailor surveillance plans based on risk prediction tools? We reviewed the current national guidelines from 6 reputable oncologic organizations, as well as 10 randomized controlled trials and numerous meta-analyses in the last 22 years evaluating more intensive to less intensive surveillance to answer this question. Currently available adjunct testing, such as genomic testing, and risk calculators were also evaluated. Overall, high-frequency surveillance, to a limit, has been established as superior to less frequency surveillance. Future research will likely demonstrate evidence for adjunct testing for personalized surveillance screening based on individual recurrence risk.

31Phosphorus magnetic resonance spectroscopy of the liver for evaluating inflammation and fibrosis in autoimmune hepatitis

Background: Liver biopsy is the gold standard in evaluating inflammation and fibrosis in autoimmune hepatitis.Aims: In search of non-invasive follow-up tools in autoimmune hepatitis, we evaluated 31phosphorus magnetic resonance spectroscopy (31P MRS).Methods: Twelve consecutive AIH patients (mean age 42.8 years, 10 women) underwent liver biopsy, routine laboratory liver function tests, which were compared to findings in 31P MRS and transient elastography (TE).Results: Phosphoenolpuryvate (PEP) correlated with the grade of inflammation (r = 0.746, p = .005) and thromboplastin time (r = 0.592, p = .043). It also differentiated patients with active inflammation from patients without (t = 3.781, p = .009). There was no correlation between PEP and aminotransferase or immunoglobulin G levels.The phosphoethanolamine (PE)/phosphocholine (PC) ratio, PE/glyserophosphoethanolamine (GPE) ratio and PC/[total phosphomonoester (PME) + phosphodiester (PDE)] ratios correlated with immunoglobulin G (r = 0.764, p = .006; r = 0.618, p = .043; and r= −0.636, p = .035, respectively).PME/PDE and PE/GPE correlated with fibrosis (r = 0.668, p = .018 and r = 0.604, p = .037). PE/GPE also differentiated F3 from F0-2 patients (t = 3.810, p = .003).Phosphorus metabolites did not correlate with TE results and TE did not correlate with liver histology or laboratory parameters.Conclusions: 31P MRS seems to detect active inflammation and advanced fibrosis in AIH patients. TE was ineffective in fibrosis quantification.

A Correlative Study of Spirometric Parameters and Markers of Right Ventricular Dysfunction in Pediatric Patients with Pulmonary Arterial Hypertension

AbstractBackground:Alteration in lung function is present in children with pulmonary arterial hypertension (PAH). We aimed to study the pulmonary function indices obtained by spirometry in pediatric patients with PAH, and to correlate them with B-type natriuretic peptide (BNP) and echocardiographic parameters.Methods:Thirty-one children with PAH were enrolled in this study, of those 26 patients (83.87%) associated shunt defect and 5 patients (16.12%) were diagnosed with idiopathic PAH. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, peak expiratory flow rate (PEFR), forced expiratory flow at 25–75% of the pulmonary volume (FEF 25–75) were evaluated by spirometry and correlated with BNP and echocardiographic parameters that reflect right ventricle function.Results:Restrictive pattern of pulmonary function was present in 51.6% (n = 16) of all PAH children. There were significant correlations between BNP with FVC (p = 0.001), FEV1 (p = 0.001), and FEV1/FVC (p = 0.001). Serum BNP level was significantly increased in the group of patients without shunt. Of those echocardiographic parameters that reflect right ventricle function, we found that TAPSE significantly correlated with PEFR (r = −0.47, p &lt;0.01), and with FEF 25–75 (r = −0.39, p &lt;0.01).Conclusions:Deterioration of the pulmonary function indices are correlated with BNP and echocardiographic parameters, markers of RV dysfunction. Being easy and reliable tests, pulmonary functions can be introduced among the follow-up tools in children with PAH.

Systematic review and meta-analysis of isolated posterior fossa malformations on prenatal imaging (part 2): neurodevelopmental outcome.

Diagnosis of isolated posterior fossa anomalies in children is biased by the fact that only those that are symptomatic are brought to the attention of the appropriate clinical personnel, and the reported rate is often affected by the adoption of different nomenclature, diagnostic criteria, outcome measures, duration of follow-up and neurodevelopmental tools. The aim of this systematic review was to explore the neurodevelopmental outcome of fetuses with a prenatal diagnosis of isolated posterior fossa anomalies. MEDLINE and EMBASE were searched electronically, utilizing combinations of the relevant medical subject heading terms for 'posterior fossa' and 'outcome'. Studies assessing the neurodevelopmental outcome in children with a prenatal diagnosis of isolated posterior fossa malformations were considered eligible. The posterior fossa anomalies analyzed included Dandy-Walker malformation (DWM), mega cisterna magna (MCM), Blake's pouch cyst (BPC) and vermian hypoplasia (VH). Two authors reviewed all abstracts independently. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale for cohort studies. Meta-analyses of proportions were used to combine data, and between-study heterogeneity was explored using the I(2) statistic. A total of 1640 articles were identified; 95 were assessed for eligibility and a total of 16 studies were included in the systematic review. The overall rate of abnormal neurodevelopmental outcome in children with a prenatal diagnosis of DWM was 58.2% (95% CI, 21.8-90.0%) and varied from 0-100%. In those with a prenatal diagnosis of MCM, the rate of abnormal neurodevelopmental outcome was 13.8% (95% CI, 7.3-21.9%), with a range of 0-50%. There was no significant association between BPC and the occurrence of abnormal neurodevelopmental delay, with a rate of 4.7% (95% CI, 0.7-12.1%) and range of 0-5%. Although affected by the very small number of studies, there was a non-significant occurrence of abnormal neurodevelopmental delay in children with a prenatal diagnosis of VH, with a rate of 30.7% (95% CI, 0.6-79.1%) and range of 0-100%. Fetuses diagnosed with isolated DWM are at high risk of abnormal neurodevelopmental outcome, while isolated MCM or BPC have a generally favorable outcome. The risk of abnormal developmental delay in cases with isolated VH needs to be further assessed. In view of the wide heterogeneity in study design, time of follow-up, neurodevelopmental tests used and the very small number of included cases, further future large prospective studies with standardized and objective protocols for diagnosis and follow-up are needed in order to ascertain the rate of abnormal neurodevelopmental outcome in children with isolated posterior fossa anomalies. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

The specialist physician's approach to rheumatoid arthritis in South Africa.

Rheumatoid arthritis (RA) is expected to increase in Africa and South Africa. Due to the low numbers of rheumatologists in South Africa, specialist physicians also have to care for patients with RA. Furthermore several new developments have taken place in recent years which improved the management and outcome of RA. Classification criteria were updated, assessment follow-up tools were refined and above all, several new biological disease-modifying anti-rheumatic drugs were developed. Therefore it is imperative for specialist physicians to update themselves with the newest developments in the management of RA. This article provides an overview of the newest developments in the management of RA in the South African context. This approach may well apply to countries with similar specialist to patient ratios and disease profiles.

HRS Expert Consensus Statement on remote interrogation and monitoring for cardiovascular implantable electronic devices.

DavidSlotwiner,MD, FHRS, FACC(Chair),Niraj Varma,MD,PhD, FRCP(Co-chair), JosephG.Akar,MD,PhD, George Annas, JD, MPH, Marianne Beardsall, MN/NP, CCDS, FHRS, Richard I. Fogel, MD, FHRS, Nestor O. Galizio, MD, Taya V. Glotzer, MD, FHRS, FACC, Robin A. Leahy, RN, BSN, CCDS, FHRS, Charles J. Love, MD, CCDS, FHRS, FACC, FAHA, Rhondalyn C. McLean, MD, Suneet Mittal, MD, FHRS, Loredana Morichelli, RN, MSN, Kristen K. Patton, MD, Merritt H. Raitt, MD, FHRS, Renato Pietro Ricci, MD, John Rickard, MD, MPH, Mark H. Schoenfeld, MD, CCDS, FHRS, FACC, FAHA, Gerald A. Serwer, MD, FHRS, FACC, Julie Shea, MS, RNCS, FHRS, CCDS, Paul Varosy, MD, FHRS, FACC, FAHA, Atul Verma, MD, FHRS, FRCPC, Cheuk-Man Yu, MD, FACC, FRCP, FRACP From the Hofstra School of Medicine, North Shore Long Island Jewish Health System, New Hyde Park, New York, Cleveland Clinic, Cleveland, Ohio, Yale University School of Medicine, New Haven, Connecticut, Boston University School of Public Health, Boston, Massachusetts, Southlake Regional Health Centre, Newmarket, Ontario, Canada, St. Vincent Medical Group, Indianapolis, Indiana, Favaloro Foundation University Hospital, Buenos Aires, Argentina, Hackensack University Medical Center, Hackensack, New Jersey, Sanger Heart & Vascular Institute, Carolinas HealthCare System, Charlotte, North Carolina, New York University Langone Medical Center, New York City, New York, University of Pennsylvania Health System, Philadelphia, Pennsylvania, The Arrhythmia Institute at Valley Hospital, New York, New York, Department of Cardiovascular Diseases, San Filippo Neri Hospital, Rome, Italy, University of Washington, Seattle, Washington, VA Portland Health Care System, Oregon Health & Science University, Knight Cardiovascular Institute, Portland, Oregon, Johns Hopkins University, Baltimore, Maryland, Yale University School of Medicine, Yale-New Haven Hospital Saint Raphael Campus, New Haven, Connecticut, University of Michigan Congenital Heart Center, University of Michigan Health Center, Ann Arbor, Michigan, Brigham and Women’s Hospital, Boston, Massachusetts, Veterans Affairs Eastern Colorado Health Care System, University of Colorado, Denver, Colorado, and Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.

Cervical lymph node metastasis in differentiated thyroid carcinoma: does it have an impact on disease-related morbid events?

The aim of the study was to evaluate the prognostic impact of cervical lymph node (CLN) metastasis in well-differentiated thyroid cancer (WDTC). A cohort of 164 patients who underwent thyroidectomy for WDTC in the last 12 years was studied. Patients were classified into those with CLN metastasis (group 1) and those without (group 2), with 82 patients in each group. Morbid events (recurrence and death) and prognostic risk factors were analyzed. The mean age of the whole group was 41.3±14.2 years, with 52.4% being at least 45 years old; 69.6% of the patients were female (P=0.02), with a female to male ratio of 2.3 : 1. Near-total thyroidectomy and radioactive iodine-131 therapy were performed in all 81.1% of patients in whom papillary cancer was found. Morbid events were found in 22/164 (13.4%) patients (17 recurrences and five deaths). All recurrences occurred in patients with the papillary subtype, whereas 4/5 deaths occurred in those with follicular thyroid cancer. Morbid events were found in 14/82 (17.1%) and 8/82 (9.6%) patients in group 1 and group 2, respectively (P=0.1). Comparison of morbid events between group 1 and group 2 showed statistically significant differences with respect to tumor size of 1 cm or more, multifocality, and positivity of the follow-up diagnostic tools at 6-12 months. Kaplan-Meier analysis revealed no significant difference between the two groups (P=0.4) over a mean follow-up period of 125.1±14.6 months. Multivariate Cox analysis showed that development of remote deposits, lymph node metastasis five or more nodes, extracapsular nodal invasion in at least three nodes, and positivity of the follow-up diagnostic tools at 6 months were the significant prognostic factors of morbid events. Our study revealed the impact of CLN metastasis on the occurrence of morbid events in WDTC patients (especially in those with the papillary subtype) with node metastasis five or more, extracapsular nodal invasion in at least three nodes, and positivity of follow-up diagnostic tools at 6 months. Hence, these patients should be optimally managed and more closely monitored.

Differential expression levels of plasma-derived miR-146b and miR-155 in papillary thyroid cancer

Specific circulating microRNAs (miRNAs) in each organ may contribute to the diagnosis and prognosis in some cancers. miRNA from papillary thyroid cancer (PTC) may be released into the bloodstream. This study was performed to detect miRNAs in the plasma and estimate their diagnostic usefulness for discriminating between benign and malignant lesions. Patients who underwent thyroidectomy for benign thyroid nodules or PTC were enrolled in this study. The patients were divided into three groups: benign, PTC without lymph node metastasis (LNM), and PTC with LNM. The levels of miR-146b, miR-221, miR-222, and miR-155miRNA expression in blood samples before surgery were evaluated. Of 89 patients enrolled in this study, 19 and 70 had benign lesions (21.3%) and PTC (78.7%), respectively. The mean levels of miR-146b and miR-155 expression were higher in the PTC group than the benign group. For discrimination between benign and PTC lesions, the area under the ROC curve (AUC) for miR-146b was 0.649 with 61.4% sensitivity and 57.9% specificity. The AUC for miR-155 was 0.695 with 74.3% sensitivity and 63.2% specificity (P<0.05). The levels of miR-146b, miR-221, and miR-222 were slightly higher in the N1 group than the N0 group. The levels of miR-146b, miR-155, and miR-222 increased in proportion to tumor size. miR-146b and miR-155 helped to discriminate between benign and malignant lesions. Circulating miRNA is likely a useful alternate serological marker for PTC. This preliminary study suggested that circulating miRNAs may be useful as follow-up tools as well as diagnostic tools.

Ga-68-DOTA-TATE PET/CT for Discrimination of Tumors of the Optic Pathway

Purpose: Symptomatic tumors of the optic nerve pathway may endanger vision. They are difficult to classify by imaging alone and biopsy may damage visual function. Tumor pathology influences treatment decision and a diagnostic tool with a high sensitivity and specificity would therefore be invaluable. We hypothesized that Ga-68-DOTA-TATE PET/CT may help in discriminating optic nerve tumors as uptake of somatostatin is elevated in meningiomas.Material and Methods: Ga-68-DOTA-TATE PET/CT was used to examine 13 patients with ambiguous, symptomatic lesions of the optic pathway for treatment planning. The presence or absence of meningioma was validated by histopathology or supplementary diagnostic work-up.Results: Ga-68-DOTA-TATE PET/CT identified 10 meningiomas (en plaque = 1, optic nerve sheath = 4, sphenoidal = 5) correctly via increased SSTR (somatostatin receptor) expression (mean SUVmax (maximum standardized uptake value) = 14.3 ± 15.4). 3 tumors did not show elevated Ga-68-DOTA-TATE uptake (SUVmax = 2.1 ± 1.0). Subsumizing all clinical-radiological follow-up tools available, these lesions were classified as an intracerebral metastasis of an advanced gastric carcinoma, histologically proven inflammatory collagenous connective tissue and presumed leukemic infiltration of a newly diagnosed chronic lymphocytic leukemia. In this case series, Ga-68-DOTA-TATE PET/CT demonstrated both a sensitivity and specificity of 100%. Yet, the golden standard of histopathology was only available in a subset of patients included.Conclusion: Ga-68-DOTA-TATE PET/CT proved to be a valuable diagnostic tool for the correct classification of equivocal, symptomatic tumors of the anterior optic pathway requiring therapy. PET/CT results influenced therapy decision essentially in all cases.

147: Pediatric Residents' Continuity Clinic: An Evaluation Survey

Training in ambulatory care and continuity of care has become an integral part of residency programs. Continuity clinics attempt to address these challenging aspects of medical education. Our centre has a long-standing paediatric residents' continuity clinic (PRCC) that had never been formally evaluated. To assess resident satisfaction of their continuity clinic experience, before and after evidence-based improvements were made. Cross-sectional surveys were conducted at a single paediatric training site in the academic years of 2012–2013 and 2013–2014 using online questionnaires. Our ethics committee approved this study. Most eligible residents participated in both questionnaires, of which around 60% had a high probability of becoming a general paediatrician. Residents had one monthly clinic; half the residents would increase this frequency. The majority had a mean of three to four appointments per session and in general they thought this was just enough. Before the study, 37% of residents were using standardised general follow-up tools, and 7% were using developmental screening tools. These figures only slightly improved at the time of the second questionnaire (48% and 8%). This is in the process of being formally addressed. Complex patients were perceived as being a difficult population to attend to within the settings of the PRCC, yet more than half the residents (55%) wished to see a greater number of complex patients. To attempt to facilitate this, PRCC patients became eligible to care coordination in our medical home program. Perception of teaching seemed to greatly improve during the study, becoming more consistent amongst preceptors. Teachers were generally perceived as being more enthusiastic and better acquainted with the resident following changes in the clinic's schedule. Evaluation was drastically improved; at the beginning of the study, one resident out of two had never been evaluated and 80% had never experienced direct observation of their ambulatory performance. In 2013–2014, the majority of residents had been evaluated (84%) and directly observed (56%). General resident satisfaction was also significantly enhanced; no resident said to be unsatisfied with the experience in the second questionnaire as opposed to 26% in the first. The overwhelming majority of residents agree that the continuity clinic is important in their training and for their future career. Residents highly value the continuity clinic educational experience; satisfaction markedly increased after improvements were made. These findings reiterate the importance of the continuity clinic model and the need for constant appraisal of this fundamental teaching opportunity.