Percepción de los endocrinólogos clínicos sobre los potenciales efectos perjudiciales del tratamiento supresor de la TSH en el carcinoma diferenciado de tiroides / Clinical endocrinologists’ perception of the deleterious effects of TSH suppressive therapy in patients with differentiated thyroid carcinoma

Objetivo Conocer la opinión de un grupo endocrinólogos sobre los potenciales efectos perjudiciales del tratamiento supresor (TS) en el carcinoma diferenciado de tiroides (CDT).Material y métodos Encuesta a un grupo de endocrinólogos con experiencia en el tratamiento del CDT. El cuestionario constaba de 3 preguntas: la primera respecto a los posibles efectos adversos sobre diferentes órganos y sistemas, la segunda sobre la trascendencia clínica de los mismos y la tercera sobre la utilidad de las guías de tratamiento del CDT. Resultados Respondieron 91 endocrinólogos con una gran discrepancia de opiniones. Ninguna pregunta tuvo más del 80% de respuestas en un determinado sentido. De los posibles efectos indeseables del TS, en 3 de ellos (aumento de la masa ventricular izquierda, la taquicardia de reentrada y la disfunción diastólica) se reconoció un elevado grado de desconocimiento, en 7 (demencia, disminución de la calidad de vida, enfermedad tromboembólica, disminución de la densidad mineral ósea en mujeres premenopáusicas y varones, signos y síntomas de hipertiroidismo y aumento del riesgo de fracturas), la mayoría de los encuestados consideraron que no se afectaban por el TS, mientras que en 2 (aumento de la frecuencia cardiaca y disminución de la densidad mineral ósea en mujeres postmenopáusicas), la mayoría respondieron afirmativamente. El 80% de los encuestados consideró que estos efectos no tenían trascendencia clínica. Respecto a las guías de tratamiento, un 33% opinó que deberían ser revisadas. Conclusione sLa percepción de los endocrinólogos sobre los potenciales efectos perjudiciales del tratamiento supresor en el CDT es muy heterogénea (AU)

Objective To explore the opinion of clinical endocrinologists as to the deleterious effects of thyrotropin (TSH) suppressive therapy in patients with differentiated thyroid carcinoma (DTC).Materials and methods A self-administered survey was sent by e-mail to a group of endocrinologists with expertise in the treatment of patients with differentiated thyroid carcinoma. The questionnaire consisted of three questions related to: 1) the possible adverse effects of this therapy on different organ systems, 2) the clinical significance of these effects and 3) the usefulness of treatment guidelines for DTC. Results A total of 91 endocrinologists responded with a wide divergence of opinions. No question had more than 80% of answers in a particular option. Of the possible side effects of suppressive therapy, a high degree of ignorance to three of them (increased left ventricular mass, reentrant tachycardia and diastolic dysfunction). Most respondents felt that the seven items, dementia and Alzheimer, decreased quality of life, decreased bone mineral density (BMD) in premenopausal women and men, thromboembolic disease, signs and symptoms of hyperthyroidism and increased risk of fractures were not affected by suppressive therapy, while most responded positively to two items (increased heart rate and decreased BMD in postmenopausal women). Eighty percent of the respondents felt that in any case these effects were not clinically significant and 33% considered that treatment guidelines should be reviewed. Conclusions Clinical endocrinologists seem to have a very heterogeneous opinion regarding the potential harmful effects of TSH-suppressive therapy for DTC (AU)

Estudio comparativo de las series históricas de carcinoma diferenciado de tiroides en dos centros hospitalarios de tercer nivel españoles en relación a series norteamericanas / Comparative study of historical series of differentiated thyroid carcinoma in two tertiary hospitals in Spain versus north American series

Antecedentes y objetivo Existe escasa literatura nacional de series descriptivas de pacientes con carcinoma diferenciado de tiroides (CDT) y seguimiento a largo plazo en España. El objetivo de nuestro estudio ha sido describir las series de CDT de dos hospitales de tercer nivel (Hospital Clínic de Barcelona [HC] i Hospital Germans Trias i Pujol de Badalona [HGTiP]) y compararlas con las descritas en la National Cancer Data Base (NCDB), y la Clínica Mayo (CM), las series internacionales más destacadas por número de pacientes y tiempo de seguimiento. Material y método Estudio retrospectivo de revisión de historias clínicas de pacientes diagnosticados de CDT en dos hospitales de tercer nivel del área de Barcelona. Revisión y comparación con los resultados publicados por la NCDB y la CM. Resultados Se revisaron 480 historias clínicas de pacientes con CDT diagnosticados entre 1973 y 2006 y con un tiempo de seguimiento de 16±8 años. No hubo diferencias significativas entre la serie conjunta HC/HGTiP y la NCDB respecto a las características clínicas, los factores de riesgo y la forma de presentación más frecuente. La ecografía y la citología fueron los métodos diagnósticos más utilizados en todas las series y el principal tipo de cirugía fue una tiroidectomía total o casi total, sin diferencias entre los grupos estudiados. Se administró con más frecuencia tratamiento postoperatorio con i131 en la serie HC/HGTiP (83,9%) que en la de la NCDB (55,1%) o la CM (46%). En los pacientes de la serie conjunta la recidiva tumoral fue del 9,3% y la mortalidad específica del 1,8%.Conclusiones Las series del HC y HGTiP fueron comparables entre sí con similitud de las diferentes técnicas diagnósticas y terapéuticas. El estudio pone en evidencia evolución histórica respecto al uso de exploraciones de imagen, y diferencias respecto a las grandes series americanas referentes a ciertas exploraciones (p.ej. laringoscopia) o al uso de tratamiento ablativo con i131 (AU)

Background and objective There is little national literature on descriptive series of patients with differentiated thyroid carcinoma (DTC) and long-term monitoring in Spain. The aim of our study was to describe the DTC series in two tertiary hospitals [Hospital Clínic de Barcelona (HC) and Hospital Germans Trias i Pujol (HGTiP)] and compare these series with those described in the National Cancer Data Base (NCDB) and the Mayo Clinic, the leading international series by number of patients and length of follow-up.Material and methods We performed a retrospective review of the medical records of patients diagnosed with DTC in two tertiary hospitals in the Barcelona area. The results were compared with those published by the NCDB and the Mayo Clinic.Results We reviewed 480 medical records of patients with DTC diagnosed between 1973 and 2006, with a mean follow-up of 16±8 years. No significant differences were observed in clinical characteristics, risk factors or the most frequent form of presentation between the joint HC/HGTiP group and the NCDB series. The most commonly used diagnostic methods were ultrasound and cytology in all series and the main type of surgery was total or nearly total thyroidectomy, with no differences between groups. Postoperative I-131 was administered more often in the HC/HGTiP series (83.9%) than in the NCDB series (55.1%) and in the Mayo Clinic (46%). In the HC/HGTiP group tumor recurrence was 9.3% and mortality 1.8%.Conclusions The HC and HGTiP series were comparable and the various diagnostic and therapeutic techniques used were similar. This study highlights historical trends in the use of imaging techniques, as well as differences with large American series in some procedures (such as laryngoscopy) and the use of radioiodine therapy (AU)

[Comparative study of historical series of differentiated thyroid carcinoma in two tertiary hospitals in Spain versus North American series]. / Estudio comparativo de las series históricas de carcinoma diferenciado de tiroides en dos centros hospitalarios de tercer nivel españoles en relación a series norteamericanas.

BACKGROUND AND OBJECTIVE: There is little national literature on descriptive series of patients with differentiated thyroid carcinoma (DTC) and long-term monitoring in Spain. The aim of our study was to describe the DTC series in two tertiary hospitals [Hospital Clínic de Barcelona (HC) and Hospital Germans Trias i Pujol (HGTiP)] and compare these series with those described in the National Cancer Data Base (NCDB) and the Mayo Clinic, the leading international series by number of patients and length of follow-up. MATERIAL AND METHODS: We performed a retrospective review of the medical records of patients diagnosed with DTC in two tertiary hospitals in the Barcelona area. The results were compared with those published by the NCDB and the Mayo Clinic. RESULTS: We reviewed 480 medical records of patients with DTC diagnosed between 1973 and 2006, with a mean follow-up of 16±8 years. No significant differences were observed in clinical characteristics, risk factors or the most frequent form of presentation between the joint HC/HGTiP group and the NCDB series. The most commonly used diagnostic methods were ultrasound and cytology in all series and the main type of surgery was total or nearly total thyroidectomy, with no differences between groups. Postoperative I-131 was administered more often in the HC/HGTiP series (83.9%) than in the NCDB series (55.1%) and in the Mayo Clinic (46%). In the HC/HGTiP group tumor recurrence was 9.3% and mortality 1.8%. CONCLUSIONS: The HC and HGTiP series were comparable and the various diagnostic and therapeutic techniques used were similar. This study highlights historical trends in the use of imaging techniques, as well as differences with large American series in some procedures (such as laryngoscopy) and the use of radioiodine therapy.

[Clinical endocrinologists' perception of the deleterious effects of TSH suppressive therapy in patients with differentiated thyroid carcinoma]. / Percepción de los endocrinólogos clínicos sobre los potenciales efectos perjudiciales del tratamiento supresor de la TSH en el carcinoma diferenciado de tiroides.

OBJECTIVE: To explore the opinion of clinical endocrinologists as to the deleterious effects of thyrotropin (TSH) suppressive therapy in patients with differentiated thyroid carcinoma (DTC). MATERIALS AND METHODS: A self-administered survey was sent by e-mail to a group of endocrinologists with expertise in the treatment of patients with differentiated thyroid carcinoma. The questionnaire consisted of three questions related to: 1) the possible adverse effects of this therapy on different organ systems, 2) the clinical significance of these effects and 3) the usefulness of treatment guidelines for DTC. RESULTS: A total of 91 endocrinologists responded with a wide divergence of opinions. No question had more than 80% of answers in a particular option. Of the possible side effects of suppressive therapy, a high degree of ignorance to three of them (increased left ventricular mass, reentrant tachycardia and diastolic dysfunction). Most respondents felt that the seven items, dementia and Alzheimer, decreased quality of life, decreased bone mineral density (BMD) in premenopausal women and men, thromboembolic disease, signs and symptoms of hyperthyroidism and increased risk of fractures were not affected by suppressive therapy, while most responded positively to two items (increased heart rate and decreased BMD in postmenopausal women). Eighty percent of the respondents felt that in any case these effects were not clinically significant and 33% considered that treatment guidelines should be reviewed. CONCLUSIONS: Clinical endocrinologists seem to have a very heterogeneous opinion regarding the potential harmful effects of TSH-suppressive therapy for DTC.

Adolescent Satisfaction with Computer-Assisted Behavioural Risk Screening in Primary Care.

BACKGROUND: This study measures patient satisfaction with a computerised mental health and risk-behaviour screening tool and predictors of satisfaction. METHOD: Youth, aged 11-20, were recruited to use a laptop-based screening system in nine primary care clinics. The study assessed correlations between satisfaction with the system and selected predictors. RESULTS: Most users were satisfied with their experience. Multivariate logistic regression found perceived ease of use, perceived usefulness, and trust to be significantly associated with high satisfaction. Satisfaction was not related to computer experience or risk behaviour status. CONCLUSIONS: Adolescent patients, even those at risk, accept computer-assisted screening in primary care. KEY PRACTITIONER MESSAGE: Screening adolescents for behavioural and mental health issues in the primary care setting is time consuming. Computer assisted screening has the potential to improve screening. This study finds that youth will accept computerised screening if the system is perceived to be useful and easy to use.

Using technology to enhance prevention services for children in primary care.

Primary care is the principal setting for implementation of prevention services for children and their families. However, aspects of primary care practice and lack of patient adherence to therapeutic regimens that ultimately lead to lifestyle and behavior changes are barriers to the delivery of prevention services. The authors of this paper present descriptive information about how a web-based computer application is being used to assist physicians in a major medical center overcome some of these impediments. This information is presented in the hopes of generating discussion about the utility of computer based support for prevention services in primary care settings. Additional steps to optimize the care of patients are also described.

Confirmatory factor analysis of the Family Emotional Involvement and Criticism Scale: evidence of the dimensionality of expressed emotion.

Using a convenience sample of 152 married couples, the present study tested models that alternately considered family members' perceptions of Expressed Emotion to be a one-, two-, three-, or four-factor construct as measured by the Family Emotional Involvement and Criticism Scale. Results of confirmatory factor analysis procedures indicated that perceptions of Expressed Emotion were best represented by a four-factor model that consisted of involvement, criticism, upset feelings, and approval. The methodological implications of these findings are discussed.