The Birth of Endowiki, An Italian Online Platform For Continuous Medical Education in Endocrinology

Background Conventional tools for medical education are burdened by many drawbacks. Textbooks become rapidly outdated, meeting attendance is expensive, and results reported in journals are not easily suitable for clinical practice. Uptodate and Endotext are excellent online tools, but they have been developed for a clinical context far different from that of our country. Methodology Italian Association of Clinical Endocrinologists (AME) charged a task force aiming to develop an educational tool specifically tailored for Italian clinical endocrinologists. Required characteristics were clinical approach, modularity, continuous updating, full online availability (even by mobile devices), open sections and sections for registered members only, opportunity for individualization, indexing and search engine to facilitate browsing. Starting from an open-source platform, Joomla, several changes were implemented. Results Three editors, 2 central editorial secretaries, 30 section coordinators and over 350 authors have been involved in the writing of 21 different sections covering all fields of endocrine and metabolic diseases. The access to Endowiki is free for AME members and is fully open in sections for patients. All readers are requested to serve as referee, pointing to mistakes and need for revision. The system is attended daily by a mean of 250 individuals. Conclusions Endowiki stands alone as an opportunity for medical education in Italy. The big challenges will be the continuous updating and the link to the national certified system for CME

Shift From Levothyroxine Tablets To Liquid Formulation At Breakfast Improves Quality Of Life Of Hypothyroid Patients

Until recently, treatment of hypothyroidism has been accomplished using monotherapy of synthetic L-thyroxine (L-T4) sodium tablets that should be taken 30-60 minutes before breakfast. Nowadays, a liquid preparation of levothyroxine is available and can effectively replace tablets without the need of waiting before having breakfast. Evidence of Quality of life (QoL) improvement when shifting from the former to the latter preparation, however, are still lacking

Predictive Value of Malignancy of Thyroid Nodule Ultrasound Classification Systems: A Prospective Study

Context British Thyroid Association (BTA), American Thyroid Association (ATA), and American Association of Clinical Endocrinologists (AACE/ACE/AME) recommend for thyroid nodules an ultrasound (US)-based stratification of risk of malignancy. Aim of our study was to assess the diagnostic accuracy of US classification systems and their reliability for indication to fine-needle aspiration (FNA). Design Prospective study on 987 thyroid nodules consecutively referred for FNA. US images were independently reviewed by four experts for assignment of malignancy risk. Cytologically benign nodules had confirmation with a second FNA, whereas Bethesda class IV, V, and VI nodules were operated upon. Class III nodules had surgery or follow-up on the basis of clinical, immunocytochemical, and US features. Results BTA: Malignancy rate was 2.8% in benign, 10.0% in indeterminate, 51.3% in suspicion, and 80.9% in malignant US class. Sensitivity was 0.74, specificity was 0.92, and accuracy was 0.89. ATA: Malignancy rate was 0.0% in benign, 2.2% in very low suspicion, 3.0% in low suspicion, 5.8% in intermediate, and 55.0% in high suspicion US class. Sensitivity was 0.81, specificity was 0.87, and accuracy was 0.86. AACE/ACE/AME: Malignancy rate was 1.1% in low-risk, 4.4% in intermediate-risk, and 54.9% in high-risk US class. Sensitivity was 0.82, specificity was 0.87, and accuracy was 0.86. K correlation coefficient was 78.9%, 76.9%, and 82.0% for BTA, ATA, and AACE/ACE/AME classifications. Conclusions Classification systems had elevated predictive value of malignancy in high-risk classes. ATA and AACE/ACE/AME systems were effective for ruling out indication to FNA in low-US-risk nodules. A similar diagnostic accuracy and a substantial interobserver agreement was provided by the three- and the five-category classifications

A comparison of laser with radiofrequency ablation for the treatment of benign thyroid nodules: a propensity score matching analysis

reserved18Purpose: To compare technique efficacy and safety of laser ablation (LA) and radiofrequency ablation (RFA) in treatment of benign thyroid nodules.Materials and methods: Institutional review board approval was obtained, and patients' consent was waived. 601 nodules were treated from May 2009 to December 2014 at eight centres, 449 (309 females, age 5714years) with LA and 152 (107 females, age 5714years) with RFA. A matched cohort composed of 138 patients from each group was selected after adjustment with propensity score matching. Factors influencing volume reduction at 6 and 12months and complications were evaluated.Results: No significant differences were observed in the baseline characteristics between groups after propensity score matching adjustment. Mean nodule reduction at 6 and 12months was -67 +/- 19% vs. -57 +/- 21% (p<0.001)-70 +/- 19% vs. -62 +/- 22% (p =0.001) in LA group and in RFA group, respectively. Nodules with volume>30mL had significantly higher percentage volume reduction at 6 and 12months (-69 +/- 19 vs. -50 +/- 21, p=0.001) and (-73 +/- 18 vs. -54 +/- 23 8, p=0.001) in the LA group than in the RFA group, respectively. In both groups, operator's skills affected the results. Major complications occurred in 4 cases in each group (p=0.116)Conclusions: LA and RFA showed nearly similar outcome but LA was slightly more effective than RFA in large nodules. Operator's skills could be crucial in determining the extent of nodule volume reduction regardless of the used technique.mixedPacella, Claudio Maurizio; Mauri, Giovanni; Cesareo, Roberto; Paqualini, Valerio; Cianni, Roberto; De Feo, Pierpaolo; Gambelunghe, Giovanni; Raggiunti, Bruno; Tina, Doris; Deandrea, Maurilio; Limone, Pier Paolo; Mormile, Alberto; Giusti, Massimo; Oddo, Silvia; Achille, Gaetano; Di Stasio, Enrico; Misischi, Irene; Papini, EnricoPacella, Claudio Maurizio; Mauri, Giovanni; Cesareo, Roberto; Paqualini, Valerio; Cianni, Roberto; De Feo, Pierpaolo; Gambelunghe, Giovanni; Raggiunti, Bruno; Tina, Doris; Deandrea, Maurilio; Limone, Pier Paolo; Mormile, Alberto; Giusti, Massimo; Oddo, Silvia; Achille, Gaetano; Di Stasio, Enrico; Misischi, Irene; Papini, Enric