Assessment of the quality of patient-oriented information over internet on testicular cancer.

BACKGROUND: This study aimed to assess the quality and readability of patient education information available on the internet on testicular cancer. METHODS: Internet searches were performed using the keywords 'testicular cancer', 'testicular tumour', 'testicular tumor', 'testicular malignancy', 'germ cell tumour' and 'germ cell tumor' using Google, Yahoo! And Bing search engines with default settings. The first 50 web links appeared in each search engine were evaluated for their readability by using the validated Flesch Reading Ease Score (FRES) while accessibility, usability and reliability were assessed using the LIDA tool. The quality was assessed using DISCERN instrument. Non-parametric tests were used for statistical analysis. RESULTS: Overall, 900 websites were assessed and 62 websites were included in the analysis. Twenty two (22) websites (35.5%) were certified by Health on the Net Foundation code of conduct (HON code). The majority (n = 57, 91.9%) were non-governmental websites. The median FRES score was 51.6 (range: 28.1-74.1), the overall median LIDA score was 115 (range: 81-147); accessibility 55 (range: 46-61), reliability 22 (range: 8-45) and usability 38.5 (range: 21-50), while the median DISCERN score was 43.5 (range: 16-69). The DISCERN score was significantly associated with the overall LIDA score and usability and reliability components of the LIDA score (p < 0.001). However, no significant associations were observed between readability and accessibility. A significant correlation was noted between usability and reliability components of the LIDA score (Spearman's rho: 0.789, p < 0.001). CONCLUSION: In this study, the readability, reliability and quality scores of most websites were found to be suboptimal and hence, there is potential for improvement. As the internet is expanding rapidly as a readily available source of information to the public, it is essential to implement steps to ensure that highest quality information is provided without any commercial motivation or bias.

Incidence and histological patterns of thyroid cancer in Sri Lanka 2001-2010: an analysis of national cancer registry data.

BACKGROUND: An increasing incidence of thyroid cancer is observed in many developed countries. Increasing incidence may also reflect better reporting or increased diagnostic scrutiny. We conducted this study to examine trends in thyroid cancer incidence and histological patterns in Sri Lanka. METHODS: A retrospective cohort evaluation of patients with thyroid cancer during 2001-2010 was performed using population based data published from the Sri Lanka National Cancer Registry. Trends in incidence and histological patterns were analysed by age and gender. RESULTS: The age-standardized incidence of thyroid cancer increased from 2.44 per 100,000 in 2001 (95% confidence interval [95% CI]: 2.21-2.67) to 5.16 per 100,000 in 2010 (95% CI: 4.85-5.47); a 2.1-fold increase (p < 0.05 for trend). A greater part of this increase is attributable to increase in incidence of papillary thyroid cancer, which increased from 1.64 to 3.61 per 100,000; a 2.2-fold increase (p < 0.05 for trend). Follicular cancer showed lesser, yet a significant increase from 0.56 to 0.95 per 100,000 (p < 0.05). Other varieties of thyroid cancer showed no significant increases in incidence. Trends in the increases in incidence of papillary cancer in females showed a much greater increase compared with males (from 2.45 to 5.60 per 100,000, a 2.28-fold increase in females compared with from 0.82 to 1.55; a 1.89-fold increase in males, p < 0.001). Highest incidence of papillary cancer was observed in 30-39-year age group, which has increased from 5.56 to 12.9 per 100,000; a 2.32-fold increase (p < 0.001). CONCLUSIONS: The increasing incidence of thyroid cancer in Sri Lanka is predominantly due to the increasing incidence of papillary cancers. These trends may reflect increased detection and better reporting, although an inherent increase in the incidence is the likely main contributor. Further studies including tumour stage and mortality may help answer these questions.

Incidence trends and patterns of breast cancer in Sri Lanka: an analysis of the national cancer database.

BACKGROUND: A gradual decline in the incidence of breast cancer is documented in developed countries especially over last two decades, while in developing countries the incidence continues to rise. We conducted this study to examine trends in incidence of breast cancer in a developing country, Sri Lanka. METHODS: A retrospective cohort evaluation of patients with breast cancer during 2001-2010 was performed using population based data from the Sri Lanka National Cancer Registry. Trends in incidence were analysed using Joinpoint regression analysis. RESULTS: The age standardized incidence of female breast cancer in Sri Lanka appears to have increased from 17.3 per 100,000 in 2001 (95% confidence interval [95% CI] 16.5-18.2) to 24.7 per 100,000 in 2010 (95% CI 23.7-25.7); a 1.4-fold increase (p < 0.05) with an estimated annual percentage change (EAPC) of 4.4 (95% CI 3.3-5.5). Highest incidence of breast cancer was seen among women of 60 to 64-year age group which has increased from 68.1 to 100.2 per 100,000 over this period (EAPC 4.6%, 95% CI 3.9-5.2, p < 0.001 for trend). A substantially greater increase was observed among women older than 50 years (from 50.4 to 76.9 per 100,000; EAPC 5.5, 95% CI 4.1-7.0, p < 0.05) compared with women younger than 50 years (from 32.0 to 39.6 per 100,000; EAPC 2.3, 95% CI 1.1-3.5, p < 0.05). CONCLUSIONS: A gradual but a significant increase in the incidence of female breast cancer is observed in Sri Lanka. A rapid rise in the breast cancer incidence among post-menopausal women appears to be the major contributor towards this increase. Improving cancer data collection appears to have been a contributor to the observed increase. However, an inherent increase is also likely as differential rates of increase were observed by age groups. Further research is needed to identify the reasons for the observed increase which may help with future cancer control efforts in Sri Lanka.

Prophylactic prednisolone for the prevention of early and intermediate adverse effects of radioactive iodine therapy in patients with thyroid cancer: study protocol for a single-centre, phase II/III, randomized, double-blinded, placebo-controlled clinical trial.

BACKGROUND: Radioactive iodine (RAI) therapy is the standard adjuvant treatment for differentiated thyroid cancer (i.e. papillary and follicular). RAI is associated with troublesome early, intermediate and late adverse effects. Although glucocorticoids are used for the management of these adverse effects, there is little evidence regarding the effectiveness of prophylactic glucocorticoids to prevent these complications. This trial will evaluate the efficacy of a short course of prophylactic glucocorticoids in the prevention of adverse effects of RAI treatment in patients with differentiated thyroid cancer. METHODS: A phase II/III, single-centre, randomized, double-blinded, placebo-controlled, parallel-arm clinical trial will be conducted. Patients with differentiated thyroid cancer who are referred to RAI therapy at the National Cancer Institute, Sri Lanka, will be randomized into two arms consisting of 200 patients each. The experimental group will receive prophylactic oral prednisolone 0.5 mg/kg and omeprazole 20 mg single dose 6 h before RAI therapy followed by oral prednisolone 0.5 mg/kg and omeprazole 20 mg daily for 3 days. The control group will receive oral placebo and omeprazole 20 mg single dose 6 h before RAI therapy followed by oral placebo and omeprazole 20 mg daily for 3 days. Clinically significant adverse effects assessed as related to RAI as well as prednisolone therapy and the quality of life parameters will be compared between the two groups. DISCUSSION: If proven beneficial, this intervention can be incorporated into the standard practice to reduce early and intermediate adverse effects of RAI for thyroid cancer with a potential improvement of quality of life. TRIAL REGISTRATION: Sri Lanka Clinical Trials Registry SLCTR/2020/009 . Registered prospectively on 23 February 2020. Items of the WHO Trial Registration Data Set are provided in the supplementary file.

Quality of life following surgery for recurrent fistula-in-ano.

BACKGROUND: The management of fistula-in-ano remains a major surgical challenge and carries a significant morbidity affecting the quality of life (QOL) due to the disease and repeated operations. The aim of the study was to assess the QOL before and after successful surgical treatment of recurrent fistula-in-ano using the gastrointestinal quality of life index (GIQLI) which is a validated instrument consisting of 36 questions for measuring quality of life in patients with gastrointestinal disorders including fistula-in-ano. METHODS: All patients who underwent successful surgical treatment for recurrent fistula-in-ano over a period of 12 months were prospectively analysed using the GIQLI preoperatively and after a minimum of 18 months (mean, 24; range, 18-30) after complete cure following surgery. The difference in the QOL scores were analysed using Wilcoxon rank test. RESULTS: In the 21 patients recruited for the study there was a significant (P < 0.01) difference between the average preoperative (97.02) and postoperative (116.14) GIQLI scores. Of all the areas assessed by the GIQLI questionnaire, greater statistical significance was seen in areas of emotions (P < 0.01), social integration (P < 0.01) and effects of treatment (P < 0.01). CONCLUSIONS: Recurrent fistula-in-ano significantly affects the patients' QOL, and also, successful surgery results in significantly improved long-term QOL. This improvement shows the need for those patients with fistula-in-ano to be subjected to further surgery despite the possible risk of anal incontinence.

Medical undergraduates' perceptions on the end of course assessment in Surgery in a developing country in South Asia.

OBJECTIVE: This study reports findings from a feedback assessment conducted among final year medical undergraduates on the end of course assessment in Surgery. A self-administered questionnaire was used among 201 final year medical undergraduates of the Faculty of Medicine Colombo to collect students' perceptions on clinical assessment (i.e. long and short cases), performance of examiners during clinical assessments and student perceptions on different types of undergraduate assessments in Surgery. RESULTS: Approximately 90% of undergraduates perceived that both long and short case assessments were fair in assessing their knowledge and clinical skills. On the overall assessment in Surgery, approximately 90% agreed that tasks reflected those taught, assessment covered a wide area of knowledge and skills in Surgery and time given for assessment was adequate. Most felt long case to be the best method in assessing whether one is a safe doctor with good communication skills and ability to apply knowledge practically. Thus, a majority of students were satisfied with the current assessment system and most perceived the clinical component to be superior to all other components in assessing whether a student is suitable to become a good and a safe doctor.

Horner's syndrome: an unusual complication of thyroidectomy: a case report.

BACKGROUND: Horner's syndrome is a very rare complication following surgery of the thyroid gland with only a handful of cases reported in the literature. Exact pathophysiology of post-thyroidectomy Horner's syndrome is not fully understood, and once diagnosed, management remains mostly conservative. CASE PRESENTATION: A 36-year-old Sri Lankan Sinhalese woman developed unilateral partial ptosis with enophthalmos and myosis one week after total thyroidectomy for a benign multinodular goiter. A clinical diagnosis of Horner's syndrome was made. A postoperative ultrasound scan did not show a collection or hematoma compressing the sympathetic trunk. Our patient was managed conservatively and she had a slow and an incomplete recovery at 1-year follow up. CONCLUSIONS: This case report highlights the importance of being aware of the close anatomical relationship between the thyroid gland and cervical sympathetic trunk during thyroidectomy. This would enable the surgeon to undertake measures to minimize the risk of damaging the sympathetic trunk during thyroidectomy.