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PubMed2004

Technology--an actor in the ICU: a study in workplace research tradition.

BACKGROUND: The present study focuses on human-machine interaction in an intensive care unit in the West of Sweden. AIMS: The aim of the present study was to explore how technology intervenes and challenges the ICU staff's knowing in practice. THEORETICAL PERSPECTIVE: The study's theoretical starting point draws on workplace research tradition. Workplace studies encompass the interaction between the actors' situated activities and the technological tools that make their activities possible. METHOD: Fieldwork or in situ studies of everyday practice in an intensive care unit documented in written field notes constituted the data. RESULTS: The findings show first how technology intervenes in the division of labour when the taken-for-granted "old" everyday practice is disrupted when a new machine intervenes in the morning's work; secondly, it reveal how technology challenges practical knowing and thirdly, it shows how technology reformulates practice. Staff members' awareness of routine problems is often connected to the ability to see, which is always related to cultural/contextual competence. CONCLUSION: It is concluded that it is not talk alone that helps the caregivers to "(dis)solve" the problems. The ability to see the problems, the work environment and to find the relevant supporting tools for "(dis)solving" the routine problems is also crucial. But it is not possible to say that it is the skillful work of humans that solve problems, nor do we claim it is the tools that do so. Humans and tools are interwoven in the problem-solving process. Relevance to clinical practice. Routine problems in the intensive care unit are not "(dis)solved" through the cognitive work of individual staff members alone. Problems are also "(dis)solved" jointly with other staff members. Staff members "borrow" the knowing from each other and problems are re-represented through communication. The knowing has to be distributed among the intensive care unit staff to make the everyday work flexible.

Anthropology, Cultural↗
PubMed2006

Advances in medical technology and creation of disparities: the case of Down syndrome.

OBJECTIVES: We assessed socioeconomic differences in probabilities of prenatal diagnoses of Down syndrome and continuation of pregnancies after such diagnoses, along with the effects of these differences on disparities in live-birth prevalences of Down syndrome. METHODS: Using population-based data derived from 1433 cases of Down syndrome and 3731 control births, we assessed age-adjusted effects of maternal occupation and geographic origin on prenatal diagnoses, as well as overall and live-birth odds, of Down syndrome. RESULTS: Maternal occupation and geographic origin had significant effects on the probability of a prenatal diagnosis of Down syndrome and on continuation of pregnancy after such a diagnosis. Women in lower-status occupational categories had higher odds of delivering a live-born infant with Down syndrome. In comparison with women in the highest-status occupational category, the age-adjusted odds ratio for a Down syndrome live birth among women without an occupation was 2.4 (95% confidence interval [CI] = 1.7, 3.3). By contrast, there were no disparities in age-adjusted overall likelihood of Down syndrome. CONCLUSIONS: Socioeconomic differences in use of prenatal testing have created disparities in the live-birth prevalence of Down syndrome. Overall Down syndrome risk does not vary according to socioeconomic status.

Abortion, Eugenic↗
PubMed2004

Exploring options for improving healthcare.

New medical technologies generally must receive clearance or approval for marketing by the US Food and Drug Administration and be covered by an insurer, such as the Centers for Medicare and Medicaid Services, before becoming available for widespread clinical use. These 2 approval processes are discrete and usually occur sequentially rather than collaboratively and simultaneously. To explore potential mechanisms for increasing regulatory collaboration between these 2 key health care agencies, the Duke Clinical Research Institute and Health Strategies Consultancy convened an informal meeting of agency, academic, and industry leaders on December 8 and 9, 2002, titled "Registration/Approval and Coverage/Payment: Exploring Options for Improving Healthcare." This article arises from the discussion at this conference; it does not represent the official views of any person or institution involved. Although the group did not attempt to reach a consensus, it examined several important issues surrounding this regulatory debate. Herein are proposed options for enhancing regulatory efficiency through greater coordination between the FDA and CMS, and discussion of these proposals from the perspectives of members of both agencies, members of stakeholder organizations, and academic observers.

Biomedical Technology↗
PubMed2005

A systematic review of interactive computer-assisted technology in diabetes care. Interactive information technology in diabetes care.

BACKGROUND: Excellent diabetes care and self-management depends heavily on the flow of timely, accurate information to patients and providers. Recent developments in information technology (IT) may, therefore, hold great promise. OBJECTIVE: To determine, in a systematic review, how emerging interactive IT has been used to enhance care for adults with type 2 diabetes. METHOD: Eligible studies were randomized controlled trials (RCTs) and observational studies (both before-after designs and post-intervention assessments) focused on computer-assisted interactive IT that included > or =10 adults with diabetes (> or =50% type 2) and reported in English. We searched 4 electronic databases (up to 2003) using terms for diabetes and technology, reviewed bibliographies, and handsearched Diabetes Care (January 1990 to February 2004). Two reviewers independently selected articles and worked serially on data extraction with adjudication of discrepancies by consensus. RESULTS: There were 26 studies (27 reports): internet (n=6; 3 RCTs), telephone (n=7; 4 RCTs), and computer-assisted integration of clinical information (n=13, 7 RCTs). The median (range) sample size was 165 (28 to 6,469 participants) for patients and 37 (15 to 67) for providers; the median duration was 6 (1 to 29) months. Ethnic minorities or underserved populations were described in only 8 studies. Six of 14 interventions demonstrated moderate to large significant declines in hemoglobin A1c levels compared with controls. Most studies reported overall positive results and found that IT-based interventions improved health care utilization, behaviors, attitudes, knowledge, and skills. CONCLUSIONS: There is growing evidence that emerging IT may improve diabetes care. Future research should characterize benefits in the long term (>1 year), establish methods to evaluate clinical outcomes, and determine the cost-effectiveness of using IT.

Biomedical Technology↗
PubMed2005

Technology usage, quality management system, and service quality in Thailand.

PURPOSE: This article aims to explore the relationship between technology and quality management for enhancing Thai hospital service quality. DESIGN/METHODOLOGY/APPROACH: The paper presents the findings of an exploratory study that investigates service quality from the customer and service provider perception. In-depth interviews were conducted with respondents in Thai hospitals. The interviews explored service-related factors that patients and service providers perceive to be important for hospital services. The first interview group consisted of professionals as internal customers in direct contact with external customers, while the second group consisted of external customers of the same hospitals. FINDINGS: The study's outcomes clearly suggest factors that make significant contribution to service quality. These factors can be categorized according to five SERVQUAL dimensions (reliability, responsiveness, assurance, empathy, and tangibility), although some factors required slightly different interpretation. ORIGINALITY/VALUE: The findings suggest that hospitals can develop an appropriate approach to their advantage, which can yield sustainable improvement in service quality as perceived by patients and professionals. Hospitals can make better quality decisions based on structured measurement and knowledge. It is recommended that managers apply this knowledge for successful implementation of activities related to service quality in their organizations.

Biomedical Technology↗
PubMed2005

Technology diffusion, hospital variation, and racial disparities among elderly Medicare beneficiaries: 1989-2000.

BACKGROUND: Low rates of technology utilization in hospitals with high proportions of black inpatients may be a remediable cause of healthcare disparities. OBJECTIVES: Our objective was to determine how differences in technology utilization among hospitals contributed to racial disparity and if temporal reduction in hospital procedure rate variation resulted in decreased racial disparity for these technologies. METHODS: We identified 2,348,952 elderly Medicare beneficiaries potentially eligible for 1 of 5 emerging medical technologies from 1989-2000 and determined if these patients had received the indicated procedure within 90 days of their qualifying hospital admission. Initial multivariate regression models adjusted for age, race, sex, admission year, clinical comorbidity, community levels of education and income, and academic/urban hospital admission. The inpatient racial composition of each patient's admitting hospital and time-race interactions were added as covariates to subsequent models. RESULTS: Blacks had significantly lower adjusted rates (P < 0.001) compared with whites for tissue replacement of the aortic valve, internal mammary artery coronary bypass grafting, dual-chambered pacemaker implantation, and lumbar spinal fusion. Hospitals with > 20% black inpatients were less likely to perform these procedures on both white and black patients than hospitals with < 9% black inpatients, and racial disparity was greater in hospitals with larger black populations. There were no temporal reductions in racial disparities. CONCLUSIONS: Blacks may be disadvantaged in access to new procedures by receiving care at hospitals that have both lower procedure rates and greater racial disparity. Policies designed to ameliorate racial disparities in health care must address hospital variation in the provision of care.

Aged↗
PubMed2005

IT-based diagnostic instrumentation systems for personalized healthcare services.

This paper describes recent research and development activities on the diagnostic instruments for personalized healthcare services in Seoul National University. Utilizing the state-of-the-art information technologies (IT), various diagnostic medical instruments have been integrated into a personal wearable device and a home telehealthcare system. We developed a wrist-worn integrated health monitoring device (WIHMD) which performs the measurements of non-invasive blood pressure (NIBP), pulse oximetry (SpO2), electrocardiogram (ECG), respiration rate, heart rate, and body surface temperature and the detection of falls to determine the onset of emergency situation. The WIHMD also analyzes the acquired bio-signals and transmits the resultant data to a healthcare service center through a commercial cellular phone. Two different kinds of IT-based blood glucometer have been developed using a cellular phone and PDA(personal digital assistant) as a main unit. A blood glucometer was also integrated within a wrist pressure measurement module which is interfaced with a cellular phone via Telecommunications Technology Association (TTA) standard in order to provide users with easiness in measuring and handling two important health parameters. Non-intrusive bio-signal measurement systems were developed for the ease of home use. One can measure his ECG on a bed while he is sleeping; measure his ECG, body temperature, bodyfat ratio and weight on a toilet seat; measure his ECG on a chair; and estimate the degree of activity by motion analysis using a camera. Another integrated diagnostic system for home telehealthcare services has been developed to include a 12 channels ECG, a pressure meter for NIBP, a blood glucometer, a bodyfat meter and a spirometer. It is an expert system to analyze the measured health data and based on the diagnostic result, the system provides an appropriate medical consultation. The measured data can be either stored on the system or transmitted to the central server through the internet. We have installed the developed systems on a model house for the performance evaluation and confirmed the possibility of the system as an effective tool for the personalized healthcare services.

Accidental Falls↗
PubMed2005

New intraocular lens technology.

PURPOSE: To review the current status of phakic intraocular lenses (IOLs), intraocular treatment of presbyopia, and IOLs that filter some blue light. DESIGN: Review of current information on the subject from numerous sources. METHODS: Medline search and Internet search engines on the topics of phakic IOLs, presbyopia or multifocal IOLs, and blue light and macular degeneration. RESULTS: An iris fixated phakic IOLs is now approved in the United States (US). There are concerns for corneal endothelial stability and late dislocation. Other approaches include anterior chamber fixation with concerns of corneal endothelial stability and pupil elongation, and posterior chamber fixation with concerns of cataract formation, IOL dislocation, and pigment dispersion. Intraocular treatment of presbyopia includes monovision, multifocal, and accommodative IOLs. Which approach is superior today is still not clear. There are IOLs designed to block some blue light to potentially lessen the risk of age-related macular degeneration (ARMD). While there is presumptive evidence of this, no definitive study shows such a correlation. Color perception issues are unlikely to be a problem. While decreased scotopic vision has been proposed, there is no study that proves this is an issue of clinical significance. CONCLUSIONS: The IOL field is dynamic with many new choices. Phakic IOLs and treatment of presbyopia will be an increasingly important part of ophthalmology; however, there are important unresolved issues. With better evidence that blue light is an important variable in ARMD, such an approach could rapidly become the standard.

Biomedical Technology↗
PubMed2003

Information technology, the internet, and the future of neurology.

BACKGROUND: This review addresses the impact of information technology and the Internet on the current and future practice of neurology. Information technology is influencing medical practice in ways that could be both beneficial and harmful. Scenarios are presented to depict some of the ways in which the practice of neurology is being influenced by the growth of technology. REVIEW SUMMARY: First, the advantages and disadvantages of e-mail as a means of doctor-patient communication are presented. Some of the ethical and legal issues arising in this context are discussed.Second, the Internet is changing neurologists' relationships to other professionals in the health care industry. Geographical isolation is less problematic than in the past. Telemedicine, including remote consulting via the Web, has special implications for neurologists in several areas, including stroke management, movement disorders, and epilepsy.Third, the growing availability of large databases, powerful search engines, and online full-text journals is discussed. Skill in navigating and managing these resources will become increasingly important. New computer-assisted decision support systems will continue to be implemented. Applications exist or are being developed for use by clinicians for many specific neurologic disorders.Finally, some of the problematic issues concerning medical use of the Internet are discussed, including availability, portability, security, quality, and outcomes. CONCLUSIONS: Medical information systems, with their attendant advantages and limitations, will become increasingly significant in the practice of neurology. Despite overall improvement in access to information, major barriers still exist to the proper implementation and utilization of truly integrated information systems.

Access to Information↗
PubMed2004

Current trends in teaching ethics of healthcare practices.

The unprecedented progress in bio-medical sciences and technology during the last few decades has resulted in great transformations in the concepts of health and disease, health systems and healthcare organisation and practices. Those changes have been accompanied by the emergence of a broad range of ethical dilemmas that confront health professionals more frequently. The classical Hippocratic ethical principles, though still retaining their relevance and validity, have become insufficiently adequate in an increasing range of problems and situations. Healthcare that has been practised for centuries on the basis of a direct doctor-patient relationship has been increasingly transformed into a more complex process integrating the health-team, the patient (healthcare seeker) and the community. Systematic review of the specialised literatures revealed that Healthcare Ethics education has become a basic requirement for any training programme for health professionals, and should cover the different stages of undergraduate, postgraduate and continuing education. Both theoretical foundations and practical skills are required for the appropriate ethical reasoning, ethical attitude and decision-making abilities. There is growing evidence that physicians' professional and moral development is not only determined by the formal curriculum of ethics; rather more, it is determined by the moral environment of the professional practice, the 'hidden curriculum' which deserves serious consideration by medical education.

Biomedical Technology↗
PubMed2004

Telephone-linked care for physical activity: a qualitative evaluation of the use patterns of an information technology program for patients.

Automated health behavior interventions that involve discretionary use by patients or consumers over extended periods of time are becoming more common and it is generally assumed that adherence to the recommended schedule is related to the impact of the system on users. Yet reasons for use or non-use of such systems have not been carefully explored. An understanding of factors that influence people to use, not use, or underutilize these automated behavioral change and self-care management systems can help in designing systems that are more effective and acceptable to users. Using qualitative research methods, this study explored the experiences of 45 users of a multiple-contact health promotion application with the goal of understanding the major factors that affect patterns of use (frequency of and duration of contact). The in-depth exploration of users' perceptions and views made possible by the qualitative research methods revealed a number of important themes. Reported reasons for underutilization or non-use were found to be both user-related and system-related. User-related reasons encompassed personal and individual events that prevented or impeded system utilization. System-related reasons included those that related to the medium itself as well as the content of the application. The qualitative methods employed in this study created a forum through which users' feedback could be fully explored and then synthesized to assist in the improvement of this and other automated health behavior interventions.

Adult↗
PubMed2000

["Best practice" in health care--or why we need evidence-based medicine, guidelines and health technology assessment].

In this article we describe an interdisciplinary approach that aims at developing a framework for the definition of best practice in health care. Its focus is on Health Technology Assessment (HTA), Evidence-based Medicine (EBM) and Clinical Practice Guidelines (CPG), each of which being approaches that increasingly rely on systematic reviews of the best available evidence. The concept is based on an extensive literature search comprising key articles on HTA, EBM and CPG and all relevant related disciplines (e.g. clinical epidemiology, outcomes research). The origin of the term "best practice" is also traced. The framework for the definition of best practice in health care is an iterative loop. It consists of the overriding concept of health care based on reliable evidence. In this concept, HTA, EBM and CPG are related to each other in three "domains", input, implementation and outcome. Information that constitutes evidence is delivered through disciplines and evaluation methods in health care to the input domain. The implementation domain refers to methods to effectively translate evidence into practice as well as to implementation barriers. The outcome domain considers methods to monitor best practice. This implies that indicators of performance at different levels of health care have to be identified which could serve as measures of success. The outcome domain may serve as information source for the input domain (iterative loop). Research recommendations are centered around improving availability and use of evidence (including systematic reviews), and promoting existing activities in best practice.

Biomedical Technology↗
PubMed1988

Giving life, giving death: ethical problems of high-technology medicine.

High-technology medicine, such as dialysis and transplantation is limited and nowhere can all potential beneficiaries receive it. Although very successful, high-technology medicine sometimes makes dying to a cruel spectacle and patients whose lives depend on a machine want to stop. The resulting ethical questions revolve around just distribution of life support - giving life, and withdrawal of life support in giving death. We investigated distributive justice of life-support by setting the number of patients accepted for dialysis in relation to those who died of renal failure and by setting the transplanted patients in relation to those waiting on chronic dialysis. In both Sweden and in the USA, and in both dialysis and transplantation, older patients received less treatment than younger ones. Seventy-year old people had less than 1/10 the chance of 20-40 year old of receiving dialysis and less than 1/30 chance of receiving a transplant. Women had between 70%-90% the chance of men of receiving dialysis and transplantation in both countries. Black people were more often dialyzed, but less often transplanted in the USA. Neither in Sweden, nor in the USA has distributive justice been achieved in dialysis and transplantation. Similar problems have been reported in other areas of high-technology medicine. We studied withdrawal, i.e. passive euthanasia, in chronic dialysis patients and found that 10% of all patients who begun dialysis died because it was stopped, although there was no medical or technical reason. Stopping caused 22% of all dialysis deaths. Half of those who died because dialysis was stopped, made the decision to stop treatment themselves. The other half was incompetent and families and physicians decided to discontinue treatment and let the patient die. The competent and incompetent patients were similar and the decisions seem to have been made on the same ground in both groups suggesting that families and physicians are appropriate surrogate decision-makers for incompetent patients. Home dialysis patients withdrew from dialysis, three times more often than center dialysis patients. The decision did not seem to harm the surviving relatives, but the relatives complained of poor physician communication. Old patients had shorter survival on dialysis, were more often excluded from, and stopped dialyses ten times more often than young patients. However, the ratio of mortality on dialysis compared to the mortality in the population at large was higher in young than in old patients and the self-reported quality of life of the old patients was particularly high.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMedDate not supplied

Eliciting stated preferences for health-technology adoption criteria using paired comparisons and recommendation judgments.

OBJECTIVES: The principal aim of this study was to illustrate applying discrete-choice methods for eliciting preferences for technology adoption criteria, including threshold values for cost-effectiveness ratios. A secondary objective was to compare the criteria weights of a sample of industry stakeholders with the results obtained from a study of National Institute for Health and Clinical Excellence (NICE) recommendations. METHODS: We administered a two-stage stated-preference (SP) question format to a sample of respondents who have expertise in applying economic analysis to technology adoption decisions. We elicited paired comparisons and recommendation judgments for similar criteria from a sample of International Society for Pharmacoeconomics and Outcomes Research members. Respondents evaluated nine pairs of hypothetical drugs, first indicating which drug was "better," then indicating what they would recommend to a reimbursement authority such as the National Health Service. Stated-choice studies often obtain only paired-comparison judgments. RESULTS: Parameter estimates from the initial paired-comparison question indicate only incremental cost-effectiveness ratio and number of affected patients influence evaluations. These two factors have identical weights in the second recommendation question, but all four factors were considered in determining the recommendation threshold. Our sample was more willing than NICE to accept trade-offs between cost-effectiveness and other drug features and was less concerned about cost-effectiveness ratios and information uncertainty. Nevertheless, our sample was in agreement with NICE about the importance of the number of patients who would benefit as a criterion for influencing adoption recommendations. CONCLUSION: This study demonstrates that including a question allowing respondents the opportunity to reject both alternatives in a forced-choice paired comparison can be important for obtaining accurate preference estimates. Our results demonstrate that SP methods offer a feasible means of quantifying a broad set of valuations that incorporate the preferences of patient, citizen, payer, and other stakeholder groups.

Academies and Institutes↗
PubMed2005

How do we get the medical intelligence out?

Two factors are driving a new wave of medical products. The first is the use of technology to make products "intelligent"--that is, build them not only to measure a particular parameter, like blood glucose, but to help patients and caregivers manage conditions. This allows the users of these products focus less on the technical aspects of treating a condition (e.g. calculating the proper amount of insulin to treat a given level of blood glucose) and more on the overall management of the disease. The second development is the rapid movement of devices from the doctor's office to the home. Chain drug stores carry dozens of medical devices for home use by consumers. The challenge for manufacturers and designers is to present the medical device's intelligence in a way that is palatable to the consumer. One important theme is that medical product consumers are also consumers of everything else: home electronics, appliances, clothing, etc. These consumers are applying the same decision-making processes they use when buying a blender to the process of buying a medical device. It is therefore necessary for medical product manufacturers to create devices that interact with consumers in consumer-friendly ways. Putting intelligence into a product is one thing; helping the consumer utilize and appreciate it is quite another. This chapter covers some principles to keep in mind, and discusses a framework for better design of intelligent medical products that connect with consumers on emotional and functional levels beyond simple medical efficacy.

Biomedical Technology↗
PubMed2005

Impact of manufacturing technology and material composition on the surface characteristics of hydrogel contact lenses.

BACKGROUND: Our aim was to investigate the impact of manufacturing method and material composition on the surface characteristics of hydrogel contact lenses. METHODS: Five lens types were examined; three polyhydroxyethyl methacrylate (pHEMA) lenses, each manufactured by a different technique, namely, lathing, spin-casting and cast-moulding, a HEMA/methacrylic acid cast-moulded lens and a HEMA/glycerol methacrylate cast-moulded lens. Six lenses of each type were examined (front and back) using scanning electron microscopy (SEM). Additionally, both surfaces of three lenses from each of the pHEMA lens groups were examined, partially hydrated, using an atomic force microscope (AFM). Qualitative data were gathered for both SEM and AFM studies in addition to root-mean-square (RMS) roughness values for the lenses investigated with AFM. RESULTS: The surfaces of the lathed lenses were covered in lathing/polishing marks. RMS roughness values for the anterior surface (10.9 +/- 4.3 nm) were significantly greater (p = 0.02) than those of the posterior surface (9.3 +/- 0.8 nm). The two surfaces of the spun-cast lens appeared similar by SEM but AFM RMS roughness values were greater (p = 0.02) for the anterior (12.3 +/- 1.8 nm) than the posterior (5.8 +/- 1.9 nm) surface. Both SEM and AFM showed similar topographic appearances for the surfaces of the cast-moulded pHEMA lens, although RMS roughness values were greater (p = 0.02) for the anterior (5.8 +/- 0.9 nm) than the posterior (3.9 +/- 0.3 nm) surface. All three cast-moulded lenses had more processing debris than the lathed and spun-cast pHEMA lenses. Overall, the surfaces of the lathed lens were 'rougher' than those of the cast-moulded lens (p = 0.01). CONCLUSION: The surface topographies of the hydrogel contact lenses are dependent on the method of manufacture. Cast-moulded lenses are associated with apparently 'stickier' surfaces, which may be indicative of surface degradation during the manufacturing process.

Biomedical Technology↗
PubMed2005

Generation of human hepatocytes by stem cell technology: definition of the hepatocyte.

Since 1999, numerous articles have reported the generation of hepatocytes from different types of extrahepatic stem or precursor cells. This opens exciting new possibilities for pharmacology and toxicology, as well as for cell therapy. Hepatocyte marker expression, including albumin, cytokeratin 18, c-met, alpha-fetoprotein and cytochrome P450 3A4 and -2B6, has been observed after transplantation of different types of human stem cells into the liver of laboratory animals or in vitro after incubation with cytokines. These intriguing observations have prompted scientists to classify stem cell-derived cell populations as hepatocytes. However, this conclusion may be premature. It has been shown that factors of the liver microenvironment can induce expression of a limited number of hepatocyte marker genes in nonhepatic cell types. To conclude on the grounds of a limited number of markers that these cells are true hepatocytes is not indicated. In this case one should carefully evaluate crucial hepatocyte-defining enzymatic properties. The present article: i) reviews studies describing the fate of extrahepatic human stem and precursor cells in livers of laboratory animals, including the possibility of cell fusion; and ii) critically discusses the phenotype of stem cells after application of various differentiation protocols aimed at generating human hepatocytes. In addition, the necessary criteria needed for defining a true hepatocyte are suggested. Establishing the necessary properties for stem cell-derived hepatocytes is timely and reasonable, and thus avoids further misleading semantic confusion. Finally, it is essential to understand that the definition of a bona fide hepatocyte should not be limited to qualitative assays, such as reverse transcriptase polymerase chain reaction and immunohistochemistry, but has to include a quantitative analysis of enzymatic activities, which allows direct comparison with primary hepatocytes. Although the stem cell-derived-hepatocyte does not yet exist there is a good chance that this aim may be achieved in the future.

Animals↗
PubMed2004

Molecular technology and the recombinant TSH have changed diagnostics of thyroid carcinoma with positive I-131 whole body scan but low serum thyroglobulin.

The early detection of recurrent differentiated thyroid carcinoma (DTC) cells in the post surgery DTC patients relies on the sensitivity of measuring both the level of thyroglobulin (Tg) and 131-Iodine distribution by Whole Body Scan (WBS). Undetectable level of Tg associated with negative WBS or elevated levels of Tg associated with positive WBS ("concordant") is ordinarily indicative of either absence or presence of disease. At times, elevated level of Tg with negative WBS or low levels of Tg with positive WBS ("discordant") could also occur. In the present study, we retrospectively reviewed series of 573 patients with DTC followed in the Diagnostic Imaging and Radiotherapy of the University "Federico II" of Naples between 1993 and 1997. We focused on 9 out of 573 patients (1.56%) who had a discordant pattern with low level of Tg/positive WBS in the post-surgical follow-up. Four patients were metastatic at presentation while 5 patients with metastasis during follow-up still remained in persistently low levels of Tg (<5 ng/mL). This result does point to some flaw in the evaluation of "discordant" cases. Reviewing data previously described series by resetting cut-off values of Tg <1 ng/ml as undetectable changed the apparent "discordant" subgroup of patients into "concordant". Recent introduction of recombinant human TSH (rhTSH) to enhance the expression level of Tg brought significant increase in the sensitivity of diagnostic evaluation of thyroid cancer patients. The role of burdensome WBS in the follow up evaluation of DTC patients is significantly reduced over time especially in low-risk patients while the relevance of Tg assay is steadily increased. Sensitive Tg assays, significantly improved our ability to assess disease status in follow-up of DTC. Given the possibility of late disease relapses, the need for long-term follow-up, and reduced delay in treatment of persistent disease, there is still need for greater sensitive diagnostic tools for DTC.

Adolescent↗