A cost-effectiveness comparison between early surgery and non-surgical approach for incidental papillary thyroid microcarcinoma

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Validation and comparison of nomograms in predicting disease-specific survival for papillary thyroid carcinoma

BACKGROUND: Nomogram could estimate individualized prognosis in papillary thyroid carcinoma (PTC). We aimed to create and validate a new nomogram and compare it with other published nomograms using a large patient cohort. METHODS: Eight-hundred and forty-nine PTC patients with ≥7 years follow-up were randomly assigned to the development (n = 425) and validation (n = 424) groups. The former was used for developing a nomogram for disease-specific survival (DSS), while the latter was for validating the nomogram by discrimination [or area under curve (AUC)]. AUC of the newly developed nomogram was compared to other published nomograms. RESULTS: The 5- and 10-year risk of dying from PTC were 1.4 and 3.3 %, respectively, while dying from non-PTC-related causes were 2.3 and 5.1 %, respectively. The new nomogram was developed from age, tumor size, multifocality, nodal status and distant metastases. The discrimination was excellent (AUC (95 % CI) for 5- and 10-year DSS were 0.896 (0.683-0.971) and 0.919 (0.871-0.967), respectively). Its predictability was similar to other published nomograms (p > 0.05). Based on the new nomogram, a total score of <28 meant 99.72 % chance of surviving from PTC at 10 years while a score of ≥28 meant 9.09 % chance of dying from PTC at 10 years. CONCLUSIONS: Using variables from the current tumor node metastasis (TNM) staging system, a new nomogram was developed. It exhibited excellent discriminatory ability and accuracy in predicting 10-year DSS relative to other published nomograms. However, given the excellent prognosis of PTC, the new nomogram was better at ruling out than predicting PTC-related death. Further validation by an external cohort is required.postprin

A Peer-Led, Social Media-Delivered, Safer Sex Intervention for Chinese College Students: Randomized Controlled Trial

Background: The peer-led, social media-delivered intervention is an emerging method in sexual health promotion. However, no research has yet investigated its effectiveness as compared with other online channels or in an Asian population. Objective: The objective of this study is to compare a peer-led, social media-delivered, safer sex intervention with a sexual health website. Both conditions target Chinese college students in Hong Kong. Methods: A randomized controlled trial was conducted with a peer-led, safer sex Facebook group as the intervention and an existing online sexual health website as the control. The intervention materials were developed with peer input and followed the information-motivation-behavioral skills model; the intervention was moderated by peer educators. The participants filled out the online questionnaires before and after the 6-week intervention period. Outcome evaluations included safer sex attitudes, behavioral skills, and behaviors, while process evaluation focused on online experience, online-visiting frequency, and online engagement. The effect of online-visiting frequency and online engagement on outcome variables was investigated. Results: Of 196 eligible participants—100 in the control group and 96 in the intervention group—who joined the study, 2 (1.0%) control participants joined the Facebook group and 24 of the remaining 194 participants (12.4%) were lost to follow-up. For the process evaluation, participants in the intervention group reported more satisfying online experiences (P<.001) and a higher level of online-visiting frequency (P<.001). They also had more positive comments when compared with the control group. For outcome evaluation, within-group analysis showed significant improvement in condom use attitude (P=.02) and behavioral skills (P<.001) in the intervention group, but not in the control group. No significant between-group difference was found. After adjusting for demographic data, increased online-visiting frequency was associated with better contraceptive use behavioral intention (P=.05), better behavioral skills (P=.02), and more frequent condom use (P=.04). Conclusions: A peer-led, social media-delivered, safer sex intervention was found to be feasible and effective in improving attitudes toward condom use and behavioral skills, but was not significantly more effective than a website. Future research may focus on the long-term effectiveness and cost-effectiveness of this popular method, as well as the potential cultural differences of using social media between different countries.published_or_final_versio

Primary care service utilisation rates and pattern of the Hong Kong population

Poster presentationThis journal supplement contains meeting abstracts of the 15th Medical Research Conferencepublished_or_final_versionThe 15th Annual Research Conference of the Department of Medicine, The University of Hong Kong, Hong Kong, 16 January 2010. In Hong Kong Medical Journal, 2010, v. 16, suppl. 1, p. 57, abstract no. 9

A Cost-Minimization Analysis Comparing Total Thyroidectomy Alone and Total Thyroidectomy with Prophylactic Central Neck Dissection in Clinically Nodal-Negative Papillary Thyroid Carcinoma

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A systematic review and meta-analysis comparing outcomes between robotic-assisted thyroidectomy and non-robotic endoscopic thyroidectomy

Background: Despite its feasibility, using the da Vinci robot in remote-access thyroidectomy remains controversial. This meta-analysis compared surgical and oncological outcomes between robotic-assisted thyroidectomy (RT) and non-robotic endoscopic thyroidectomy (ET). Methods: A systematic review was performed to identify studies comparing outcomes between RT and ET. Outcomes included operating time, drain output, complications, number of central lymph nodes retrieved, and preablation stimulated thyroglobulin level. A random-effects model was used. Results: Six studies were eligible. Of the 3510 patients, 2167 (61.7%) underwent RT whereas 1343 (38.3%) underwent ET. Despite a higher drain output (185.8 mLs versus 173.3 mLs, P = 0.019), RT had fewer temporary recurrent laryngeal nerve injury (2.6% versus 3.3%, P = 0.035) and shorter length of hospital stay (3.4 d versus 3.5 d, P = 0.030). In terms of oncological outcomes, despite higher incidence of multicentricity and larger tumors, the number of central lymph nodes retrieved during unilateral central neck dissection in RT was significantly greater than ET (4.5 ± 2.6 and 3.4 ± 2.5, P < 0.001) whereas the preablation stimulated thyroglobulin was comparable (0.8 ng/mL versus 1.1 ng/mL, P = 0.456). However, follow-up data were relatively scarce. Conclusions: Adding the robot in remote-access thyroidectomy was associated with a significantly lower risk of temporary recurrent laryngeal nerve injury and shorter length of hospital stay. However, despite achieving a comparable level of surgical completeness for low-risk differentiated thyroid carcinoma between RT and ET, this study highlighted the limitations with the current literature and the need for more prospective studies with adequate follow-up. © 2014 Elsevier Inc. All rights reserved.postprin

Psychometric validation of the cross-culturally adapted traditional Chinese version of the Back Beliefs Questionnaire (BBQ) and Fear-Avoidance Beliefs Questionnaire (FABQ)

Purpose: To translate and cross-culturally adapt the Back Beliefs Questionnaire (BBQ) and Fear-Avoidance Beliefs Questionnaire (FABQ) into traditional Chinese for their use in patients experiencing low back pain (LBP). Methods: This was a prospective questionnaire translation and psychometric validation of the BBQ and FABQ in Chinese patients with back pain. Patients also completed the Traditional Chinese (Hong Kong) versions of the Oswestry Disability Index (ODI), the Short Form-12 version 2 (SF-12v2) questionnaires and the visual analogue scale (VAS) for LBP. Construct validity was assessed using Spearman’s correlation test against the subscales and domains with similar constructs. Internal consistency was assessed by Cronbach’s alpha (α). Sensitivity was determined by known-group comparisons. Results: A total of 100 patients were recruited. Both BBQ (α = 0.810) and FABQ (α = 0.859) demonstrated excellent overall internal consistency. BBQ scores significantly correlated with ODI scores, VAS-LBP and all domains of SF-12v2 (p < 0.01–0.05), whereas only FABQ Work subscale correlated with ODI scores (p < 0.01) and VAS-LBP (p < 0.05). Both FABQ subscales correlated with only specific domains of SF-12v2 (p < 0.01–0.05). FABQ-W was sensitive to difference between patients with acute versus chronic back pain. Conclusions: Both the adapted BBQ and FABQ (Traditional Chinese-Hong Kong) were demonstrated to have satisfactory psychometric properties, with adequate internal consistencies, construct validity and sensitivity to certain clinical parameters. Our findings were based on a clinically relevant patient group and provides insight into patients’ own perception of back pain which may often be different from that of surgeons. This is a platform for future cross-cultural comparisons

A systematic review and meta-analysis on acoustic voice parameters after uncomplicated thyroidectomy

BACKGROUND: Postthyroidectomy voice changes are common even without apparent laryngeal nerve injury. Our study evaluated the impact of open cervical thyroidectomy on five acoustic voice parameters in the early (< 3 months) and late (≥ 3 months) postoperative periods. METHODS: A systematic review was performed to identify studies that quantitatively assessed voice quality by acoustic voice analysis before and after thyroidectomy. Parameters included average fundamental frequency (F0 , Hz), jitter (%), shimmer (%), noise-to-harmonic ratio (NHR), and maximum phonation time (MPT) (in secs). Meta-analysis was performed using both fixed- and random-effects models. RESULTS: A total of 896 patients were analyzed. Relative to baseline, F0 significantly worsened in the early period (from 194.9 ± 34.9 Hz to 188.0 ± 34.0 Hz, P = 0.001). This was equivalent to a quarter-tone loss (P = 0.004). Shimmer (from 3.15 ± 1.59% to 3.19 ± 1.70%, P = 0.040) and MPT (from 17.9 secs to 16.7 secs, P = 0.046) also worsened in the early period, whereas jitter and NHR remained unchanged in the early and late periods. Males suffered greater deterioration in F0 (from 120.6 ± 18.8 Hz to 111.0 ± 18.5 Hz, P = 0.048) and in NHR (from 0.12 ± 0.02 to 0.16 ± 0.03, P = 0.019) than females in the early period. Four of the five acoustic parameters (F0 , jitter, shimmer, and NHR) significantly worsened after total thyroidectomy (TT) and not after lesser resection. CONCLUSION: F0 , shimmer, and MPT significantly worsened in the early and not in the late postoperative period. F0 impairment was perceptually significant. Males and those undergoing TT suffered greater voice impairment than their counterparts during the early period.postprin

A systematic review of quality of thyroid-specific health-related quality of life instruments recommends ThyPRO for patients with benign thyroid diseases

Objective: To appraise the measurement properties of thyroid-specific health-related quality of life (HRQOL) instruments, and to provide recommendations on the choice of HRQOL instruments. Study Design and Setting: Systematic review of English-language literature published between 1993 and 2015 identified psychometric studies involving patients with thyroid disease through a search of Pubmed, Web of Science, Embase, and OVID Medline. HRQOL instruments were graded on methodological quality and overall levels of evidence using a COSMIN checklist. Results: After a review of 743 original studies, 23 studies reporting 14 standardized HRQOL instruments targeted for Graves’ ophthalmopathy (n=4), hypothyroidism (n=3), thyroid cancer (n=2), other thyroid disease (n=3) and non-thyroid tumor sites (n=2) were identified. Hypothesis testing was evaluated most frequently. The 84-item thyroid-specific patient-reported outcome measure (ThyPRO) and 16-item Graves' ophthalmopathy specific Quality of Life (GO-QOL) instruments were the most extensively evaluated instrument. The highest number of positive ratings in overall level of psychometric evidence was found in ThyPRO, GO-QOL and 11-item Thyroid Treatment Satisfaction Questionnaire (ThyTSQ) instruments. Conclusions: The ThyPRO is recommended for the assessment of HRQOL in patients with benign thyroid diseases whilst measurement properties of GO-QOL and ThyTSQ are satisfactory in measuring HRQOL of patients with Graves’ ophthalmopathy and hypothyroidism, respectively.postprin

Improving the mapping of condition-specific health-related quality of life onto SF-6D score

Background This study sought to improve the predictive performance and goodness-of-fit of mapping models, as part of indirect valuation, by introducing cubic spline smoothing to map a group of health-related quality of life (HRQOL) measures onto a preference-based measure. Methods This study was a secondary analysis of a cross-sectional health survey data assessing the HRQOL for patients with colorectal neoplasms. Mapping functions of condition-specific functional assessment of cancer therapy—colorectal (FACT-C) onto preference-based SF-6D measure were developed using a dataset of 553 Chinese subjects with different stages of colorectal neoplasm. The missing values of FACT-C were imputed using multiple imputation. Then three widely applicable models (ordinary least square (OLS), Tobit and two-part models) were employed for the mapping function after applying the cubic spline smoothing on the data. For the evaluation of the effectiveness of cubic spline smoothing and multiple imputation, the goodness-of-fit and prediction performance of each model were compared. Results Analyses showed that the models fitted with transformed data from cubic spline smoothing offered better performance in goodness-of-fit and prediction than the models fitted with the original data. The values of $R^2$ were improved by over 10 %, and the root mean square error and the mean absolute error were both reduced. The best goodness-of-fit and performance were achieved by OLS model using transformed data from cubic spline smoothing. Conclusions Cubic spline smoothing and multiple imputation were recommended for the mapping of HRQOL measures onto the preference-based measure. Among the three mapping models, the simple-to-use OLS model had the best performance.postprin