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5th March 2020
So far, as studies at the University of Gothenburg show, this has been unexploited and this research forms the basis for a new experimental platform for cancer diagnostics, prognoses and testing cancer drugs.
The study published by the research group to date, in the journal Biomaterials, relates to breast cancer. Ongoing studies of colon, ovarian and other cancers also show positive results for the new technological platform and strategy.
In traditional cancer diagnostics, tumor cells in the extracted tissue are the targets of investigation. Depending on the form of cancer involved, more or less extensive molecular analyses and investigations of prognostic markers are performed.
For the patients with breast cancer in the current study, this was carried out routinely. The scientists then proceeded to apply the new technology, in cases where tumour tissue that had been removed was still available for them to analyse. Instead of looking at tumour cells, they studied the extracellular matrix (ECM). This is composed partly of protein fibres around the cells and determining the structure of the tissue, like a kind of scaffold for tumour cells.
Anders Stahlberg, Associate Professor of Molecular Medicine, is one of the two people primarily responsible for the study and platform.
“Normally,” he says, “we investigate tumour cells and get rid of the rest. Here, we do the reverse. What we look at are the extracellular matrices, and early on we found major differences among tumours from different patients. These differences were discoverable only from analyses of the ECMs.”
The scientists were able, for instance, to predict the risk of a recurrence of breast cancer, by studying the properties of the ECMs in various patients’ tissues. This was done by allowing cancer cell lines to grow in the matrices and then analyse how the scaffold affects them.
Goran Landberg, Professor of Pathology, is the other driving force for the research.
“Our results have clear connections with clinical parameters, such as how aggressive a tumour is. We’re now working on finding out which parts of the ECMs affected specific cancer-specific properties. The technology works, and we’ve been able to show that this is a superb experimental platform with major clinical potential,” he says.
Besides diagnostics and prognoses for the course of a cancer disease, the scientists see drug testing as an important area for the new platform. A drug candidate can then be tested in several individuals’ surgically removed tissue, to explore its potential efficacy in various patients with cancer.
The purpose of the model is to ascertain which patients will benefit from a treatment before it is commenced. Another advantage is that the use of animal testing can decrease.
Lead researcher Dr Pablo Lamata, from King’s College London, said: “We found that making appropriate clinical decisions is not only about data, but how to combine data with the knowledge that we have built up through years of research.”
The team have coined the phrase the Digital Twin to describe this integration of the two models, a computerised version of our heart which represents human physiology and individual data.
“The Digital Twin will shift treatment selection from being based on the state of the patient today to optimising the state of the patient tomorrow,” the researchers wrote in the paper.
This could mean that a trip to the doctor’s office could be a more digital experience. “The idea is that the electronic health record will be growing into a more detailed description of what we could call a digital avatar, a digital representation of how the heart is working,” said Dr Lamata.
Mechanistic models see researchers applying the laws of physics and maths to simulate how the heart will behave. Statistical models require researchers to look at past data to see how the heart will behave in similar conditions and infer how it will do it over time. Models can pinpoint the most valuable piece of diagnostic data and can also reliably infer biomarkers that cannot be directly measured or that require invasive procedures.
Dr Lamata said more information about how the heart is behaving could be retrieved by using these models. “We already extract numbers from the medical images and signals, but we can also combine them through a model to infer something that we don’t see in the data, like the stiffness of the heart. We obviously cannot touch a beating heart to know the stiffness, but we can give these models with the rules and laws of the material properties to infer that importance piece of diagnostic and prognostic information. The stiffness of the heart becomes another key biomarker that will tell us how the health of the heart is coping with disease.”
The team of researchers believe that the power of computational models in cardiovascular medicine could also provide us with more control over our daily heart health. Much like the popularity of wearable monitoring devices, a digital twin of our hearts could inform about its current health and alert wearers to any risk factors. “It is also the vision of people being more empowered and being more in control and aware of the impact of their lifestyle choices in the health of their hearts. We will have more wearables that can monitor aspects of our health rhythm, heart sounds or level of physical activity. This unit is also talking to the digital twin that lives in the hospital,” said Dr Lamata.
“It’s like the weather: understanding better how it works, helps us to predict it. And with the heart, models will also help us to predict how better or worse it will get if we interfere with it.”
The randomised, controlled, double-blind trial (RCT) is considered as the gold standard method for determining the effects of a treatment. The process of randomisation helps to eliminate any conscious or unconscious bias, whereas blinding assures that the analysis of outcomes are not prejudiced.1 An RCT is designed such that the results have external validity, in other words, that the conclusions are generalisable to clinical practice.
Since the 1990’s the terms “evidence-based medicine and evidence-based practice” have been a common theme in the medical literature and describe how clinical decision-making should be informed by current, valid and relevant evidence. Furthermore, there are numerous clinical practice guidelines that have incorporated the best available evidence to support health professionals on the assessment and management of patients.
However, the origins of evidence-based medicine appear to have arisen primarily as a means to ensure consistency of care and treatment given the wide variation observed in clinical practice.2 In addition, the rigid inclusion criteria of an RCT often means that patients who are older and those who are less able to provide informed consent because of sickness or lower levels of education are more likely to be excluded.
As a consequence, a clinical guideline even where it incorporates the best available evidence, may not reflect every day clinical practice.3 For example, guidelines focus purely on single condition whereas in reality, many patients have several co-morbidities which makes decision-making increasingly difficult, as a clinician struggles to balance the benefits and risks to the individual patient from the advice in the guideline.
One potential solution to simply relying upon the results of RCTs is to utilise the observations from real-world studies. This presents a pragmatic yet complementary approach to assessing the value of an intervention of treatment. For instance, the RCT will provide the required evidence that a treatment or intervention if efficacious, whereas a real-world study offers insight of the actual effectiveness in a clinical setting. Thus a real-world study provides information on how well an intervention performs outside of the confines of a clinical trial. In fact, the value of real world data is becoming increasingly recognised as outlined in a discussion paper by the Association of the British Pharmaceutical Industry (ABPI).4
But how does the real world effectiveness of a drug compare with the results obtained in an RCT? A recent study in JAMA Open set out to compare these differences using the latest class of oral anti-hyperglycaemic agents, the sodium-glucose co-transporter 2 inhibitors (SGLT2).5 In NICE guidance, the SGLT2 drugs are licensed for the use in type 2 diabetes as an adjunct to diet and exercise, either as monotherapy or as an add-on to other diabetic treatments.6
The JAMA study focused on empagliflozin which gained approval based on the results of four Phase III RCTs7 and was conducted in Denmark. One of the unique advantages of the country is the Danish Civil Registration system,8 in which individuals are assigned a unique identifier that allows researchers to track information on prescribed treatments and the associated outcomes.
The Danish cohort included 7034 first-time users of empagliflozin from 2014 to 2018. Interestingly, 55.1% of these individuals would have been ineligible for enrolment in the phase 3 trials which evaluated empagliflozin. The main reasons for exclusion were; noneligible glucose lowering drugs (27.8%), HbA1C levels outside of the range specified in the clinical trials (25.2%) and comorbidities (15.3%).
Nevertheless, after 6 months of treatment (the endpoint used in the RCTs), the mean reduction in HbA1C levels was -0.91% (95% confidence interval, -0.94% to -0.87%). In comparison, the pooled estimated mean reduction in HbA1C levels from the trials was -0.74% (95% confidence interval, -0.75% to -0.73%). Interestingly, the mean reduction in HbA1C levels was -1.01% (95% confidence interval, -1.07% to -0.95%) among patients who were ineligible for the trials.
These results from a real world study clearly show that the reductions in HbA1C levels were broadly comparable with those obtained from the RCTs, despite nearly half of patients not meeting the trial inclusion criteria. In addition, a group of patients in the Danish cohort were using empagliflozin as monotherapy rather than as an add-on, which was not included in the trials which indicates that the possible benefits of empagliflozin in the real world study may have been underestimated.
A further example illustrating the comparability RCT and real world data among those with type 2 diabetes was found with respect to cardiovascular outcomes. The EMPA-REG OUTCOME was an RCT designed to explore the impact of empagliflozin on cardiovascular events.9 The trial observed a significant reduction in cardiovascular events for those given empagliflozin and similar benefits were found in a real world study of those prescribed SGLT-2 inhibitors compared to other glucose lowering drugs.10
Despite RCTs having rigorous inclusion and exclusion criteria, emerging evidence from real world studies reassuringly highlights how the purported benefits observed in RCTs can still be achieved among patients with multiple co-morbidities encountered in clinical practice.
References
This study aimed to determine physicians’ acceptance of interventions communicated by pharmacists over the phone, and associated factors, at a teaching hospital in The Netherlands.
The analysis included 841 interventions related to drug-drug interactions and drug dosing for 623 adults with renal impairment, captured from January 2012 to June 2013. From these, 599 were accepted by physicians (71.2%).
The acceptance rate increased with the number of prescribed drugs at the time of the intervention and the severity of the drug-related problem. In addition, acceptance rates were inversely associated with continuation of pre-admission treatment. No associations were observed between acceptance and underlying pathology, prescriber or pharmacists’ seniority. Recommendations mainly involved agents for the treatment of infections (33.9%).
Overall, the rate of acceptance of pharmacists’ interventions was high in this particular setting, but those involving treatment received prior to hospitalisation were accepted less frequently.
Approaches to include general practitioners in the medications review during hospital stays can potentially optimise patient care and reduce drug-related problems
27th February 2020
The researchers concluded that CT should be used as the primary screening tool for COVID-19.
In the absence of specific therapeutic drugs or vaccines for COVID-19, it is essential to detect the disease at an early stage and immediately isolate an infected patient from the healthy population.
According to the latest guidelines published by the Chinese government, the diagnosis of COVID-19 must be confirmed by reverse-transcription polymerase chain reaction (RT-PCR) or gene sequencing for respiratory or blood specimens, as the key indicator for hospitalisation. However, with limitations of sample collection and transportation, as well as kit performance, the total positive rate of RT-PCR for throat swab samples has been reported to be about 30% to 60% at initial presentation.
In the current public health emergency, the low sensitivity of RT-PCR implies that a large number of COVID-19 patients won’t be identified quickly and may not receive appropriate treatment. In addition, given the highly contagious nature of the virus, they carry a risk of infecting a larger population.
“Early diagnosis of COVID-19 is crucial for disease treatment and control. Compared to RT-PCR, chest CT imaging may be a more reliable, practical and rapid method to diagnose and assess COVID-19, especially in the epidemic area,” the authors wrote.
Chest CT, a routine imaging tool for pneumonia diagnosis, is fast and relatively easy to perform. Recent research found that the sensitivity of CT for COVID-19 infection was 98% compared to RT-PCR sensitivity of 71%.
For the current study, researchers at Tongji Hospital in Wuhan, China, set out to investigate the diagnostic value and consistency of chest CT imaging in comparison to RT-PCR assay in COVID-19.
Included in the study were 1014 patients who underwent both chest CT and RT-PCR tests between 6 January and 6 February, 2020. With RT-PCR as reference standard, the performance of chest CT in diagnosing COVID-19 was assessed. For patients with multiple RT-PCR assays, the dynamic conversion of RT-PCR test results (negative to positive, and positive to negative, respectively) was also analysed as compared with serial chest CT scans.
The results showed that 601 patients (59%) had positive RT-PCR results, and 888 (88%) had positive chest CT scans. The sensitivity of chest CT in suggesting COVID-19 was 97%, based on positive RT-PCR results. In patients with negative RT-PCR results, 75% (308 of 413 patients) had positive chest CT findings. Of these, 48% were considered as highly likely cases, with 33% as probable cases. By analysis of serial RT-PCR assays and CT scans, the interval between the initial negative to positive RT-PCR results was 4 to 8 days.
“About 81% of the patients with negative RT-PCR results but positive chest CT scans were re-classified as highly likely or probable cases with COVID-19, by the comprehensive analysis of clinical symptoms, typical CT manifestations and dynamic CT follow-ups,” the authors wrote.
“This study helps us to better understand the disease,” said Aida Habtezion, MD, associate professor of gastroenterology and hepatology. “We hope it also leads to our being able to treat it with a naturally produced metabolite that’s already present in high amounts in a healthy gut.”
When the researchers compared two groups of patients – one group with ulcerative colitis, the other group with a rare non-inflammatory condition – who had undergone an identical corrective surgical procedure, they discovered that a particular family of bacteria was depleted in patients with ulcerative colitis. These patients also were deficient in a set of anti-inflammatory substances that the bacteria make, the scientists report.
A paper describing the research findings is published online in Cell Host & Microbe.
The discoveries raise the prospect that supplementing ulcerative colitis patients with those missing metabolites – or perhaps someday restoring the gut-dwelling bacteria that produce them – could effectively treat intestinal inflammation in these patients and perhaps those with a related condition called Crohn’s disease, Habtezion said.
A clinical trial to determine whether those metabolites (secondary bile acids) are effective in treating the disease is now underway at Stanford.
Surgery often required
Patients with ulcerative colitis can suffer from heavy bleeding, diarrhoea, weight loss and, if the colon becomes sufficiently perforated, life-threatening sepsis.
There is no known cure. While immunosuppressant drugs can keep ulcerative colitis at bay, they put patients at increased risk for cancer and infection. Moreover, not all patients respond, and even when an immunosuppressant drug works initially, its effectiveness can fade with time. About one in five ulcerative colitis patients progress to the point where they require total colectomy, the surgical removal of the colon and rectum, followed by the repositioning of the lower end of the small intestine to form a J-shaped pouch that serves as a rectum.
These “pouch patients” can lead quite normal lives. However, as many as half will develop pouchitis, a return of the inflammation and symptoms they experienced in their initial condition.
The new study began with a clinical observation. “Patients with a rare genetic condition called familial adenomatous polyposis, or FAP, are at extremely high risk for colon cancer,” Habtezion said. “To prevent this, they undergo the exact same surgical procedure patients with refractory ulcerative colitis do.” Yet FAP pouch patients rarely if ever experience the inflammatory attacks on their remaining lower digestive tract that ulcerative-colitis patients with a pouch do, she said.
The Stanford scientists decided to find out why. Their first clue lay in a large difference in levels of a group of substances called secondary bile acids in the intestines of seven FAP patients compared with 17 patients with ulcerative colitis who had undergone the pouch surgery. The investigators measured these metabolite levels by examining the participants’ stool samples.
Primary bile acids are produced in the liver, stored in the gallbladder and released into the digestive tract to help emulsify fats. The vast majority of secreted primary bile acids are taken up in the intestine, where resident bacteria perform a series of enzymatic operations to convert them to secondary bile acids.
Prior research has suggested, without much elaboration or follow-up, that secondary bile acids are depleted in ulcerative colitis patients and in those with a related condition, Crohn’s disease, in which tissue-destroying inflammation can occur in both the colon and the small intestine.
The researchers confirmed that levels of the two most prominent secondary bile acids, deoxycholic acid and lithocholic acid, were much lower in stool specimens taken from the ulcerative colitis pouch patients than from FAP pouch patients. Clearly, the surgical procedure hadn’t caused the depletion.
Diminished microbial diversity
These findings were mirrored by the scientists’ observation that microbial diversity in the specimens from ulcerative colitis pouch patients was diminished. Moreover, the investigators showed that a single bacterial family – Ruminococcaceae – was markedly underrepresented in ulcerative colitis pouch patients compared with FAP pouch patients. A genomic analysis of all the gut bacteria in the participants showed that the genes for making enzymes that convert primary bile acids to secondary bile acids were under-represented, too. Ruminococcaceae, but few other gut bacteria, carry those genes.
“All healthy people have Ruminococcaceae in their intestines,” Habtezion said. “But in the UC pouch patients, members of this family were significantly depleted.”
Incubating primary bile acids with stool samples from FAP pouch patients, but not from ulcerative colitis pouch patients, resulted in those substances’ effective conversion to secondary bile acids.
In three different mouse models of colitis, supplementation with lithocholic acid and deoxycholic acid reduced infiltration by inflammatory immune cells and levels of several inflammatory signaling proteins and chemicals in the mice’s intestines, the researchers showed. The supplements also mitigated the classic symptoms of colitis in the mice, such as weight loss or signs of colon pathology.
All three mouse models are considered representative of not just ulcerative colitis but inflammatory bowel disease in general, a category that also includes Crohn’s disease. So the findings may apply to Crohn’s disease patients, as well, Habtezion said.
In an ongoing Phase II trial at Stanford, Sinha, Habtezion and their colleagues are investigating the anti-inflammatory effects, in 18- to 70-year-old ulcerative colitis pouch patients, of oral supplementation with ursodeoxycholic acid, a naturally occurring secondary bile acid approved by the Food and Drug Administration for treatment of primary biliary sclerosis and for management of gall stones.
The animals have the same genetic and immune system characteristics as humans who develop coeliac after eating gluten. This provides a vital research tool for developing and testing new treatments for the disease.
“Based on our understanding of the human disease, we were able to retro-engineer a mouse model of coeliac disease,” said Bana Jabri, MD, PhD, Director of Research at the University of Chicago Medicine Celiac Disease Center and senior author of the new study, published this week in Nature. “It’s the first model where the mouse develops damage to the small intestine just by eating gluten, which can later reverse itself on a gluten-free diet.”
Even while maintaining a strict gluten-free diet, 40% of coeliac disease patients still show signs of inflammation and villous atrophy, or damage to the villi. Therefore, treatments that can reverse or prevent the disease are greatly needed to improve quality of life for people with coeliac disease.
A complex interplay of contributing factors
Scientists do not know the exact cause of coeliac disease, but researchers have identified several genetic, immune system, and environmental components that work together to trigger the disease. People with coeliac have one of two genetic variants, HLA-DQ2 and HLA-DQ8, that are part of a group of genes that help the immune system recognise foreign antigens and mount an immune response. However, possessing one these variants is not sufficient to develop the disease alone.
Based on studies in coeliac disease patients, Jabri and her colleagues have proposed that signs of tissue distress associated with high levels of an inflammatory protein called IL-15 in the lining of the small intestine were required to cause villous atrophy, the hallmark of the disease.
Certain environmental factors may come into play as well. In 2017, for example, Jabri and her team discovered that a common and relatively harmless virus can cause changes to the immune system that set the stage for celiac. All of these factors work together to trigger an autoimmune response when someone ingests gluten that causes villous atrophy.
All the puzzle pieces fall into place
For more than 20 years, researchers have attempted to develop a mouse model for coeliac that reflects these conditions. However, none of these models resulted in mice with one of the HLA gene variants that also developed villous atrophy in response to gluten.
“In coeliac disease, the main feature of disease is tissue destruction of the small intestinal lining,” said Valerie Abadie, PhD, a research assistant professor at UChicago and lead author of the study. “This new HLA-DQ8 mouse model is unique because it’s the only one that actually develops villous atrophy when the animal does eat gluten. In addition, once the mice are placed on a gluten-free diet, their small intestine can recover and heal, just as in humans with coeliac disease.”
Jabri said that all of these elements must be present in a research model to truly represent the conditions that cause disease in humans.
“It’s like a puzzle where different pieces need to come together for everything to fall into place,” Jabri said. “If you have a model where only one piece of the puzzle causes the disease because it’s in a laboratory setting, then you cannot test how to block or interfere with the other components. You need to have a setup where you have the entire complex interplay that takes place for the development of coeliac disease.”
The new mouse model provides a vital tool for developing new treatments to reverse coeliac once it has developed, or prevent it from developing in people at risk for the disease. Researchers will be able to identify new targets for drugs and then test them in a model that faithfully represents the condition in humans.
“This wouldn’t be possible without first conducting human studies to understand the nature of the disease,” Jabri said. “Now, using the mouse model, we can interrogate more and apply what we learned back into the human system. The integration of those two approaches is very important.”
“Food allergies are scary for both parents and children, which is why it’s important for parents to offer fact-based strategies in order to not increase their child’s concerns” says researcher Lisa Lombard, PhD, lead author of the article. “According to the allergists we interviewed, thoughtful and balanced communication and having credible information to share with your child go a long way toward helping your child with food allergies cope with their fears.”
Researchers conducted interviews with six board-certified allergists who treat a high volume of children with food allergies. The goal of the interviews was, in part, to get the allergists’ perspectives on the major factors contributing to elevated anxiety in food allergic patients.
“The allergists said the major factors contributing to elevated anxiety in kids with food allergies included fear of the epinephrine auto-injector needle, fear of anaphylaxis and apprehension about participating in oral food challenges or oral immunotherapy,” said Ruchi Gupta, MD, ACAAI member and study co-author. “They also said that although allergic reactions and epinephrine can be scary and disruptive, those experiences were often opportunities for positive coping. For example, successfully using epinephrine can bring a sense of relief after the unknown is faced.”
The allergists noted that with younger children in particular, the child might not be especially anxious, but the parents are. They also said that food challenges – where small amounts of a food a child might be allergic to are introduced in increasingly larger amounts – are an opportunity for families to lessen their fear of the unknown.
“Because children take cues from their parents, and their level of anxiety often reflects their parents’ level of anxiety, parents need to recognise how they’re communicating with their children about food allergies,” says Dr. Gupta. “The allergists interviewed told us they sometimes have parents come in for counselling without the child because doing so helps them take care of the child and the family at the same time. One allergist suggested parents use reassuring dialogue like ‘we’ll get through this’ with their kids rather than expressing their own anxiety of fear.”
Researchers from Trinity College Dublin have made a breakthrough that may eventually lead to improved therapeutic options for people living with asthma.
The researchers have uncovered a critical role for a protein (Caspase-11), which had previously never been implicated in the disease. The findings were reported in Nature Communications.
Lead author Zbigniew Zaslona, working with a team led by Luke O’Neill, Professor of Biochemistry in the School of Biochemistry and Immunology in the Trinity Biomedical Sciences Institute, has been exploring the role that inflammation plays in asthma – a very common and often serious disease of childhood.
Ireland has one of the highest incidences of asthma in Europe, which in its most severe form remains difficult to treat and can be fatal. Caspase-11 is a protein with an important role in defending against bacteria, but the team in Trinity has found that when it is over-active it can provoke a damaging inflammatory reaction. When this happens, it is likely to be a key driver of allergic inflammation in the lungs of asthmatics.
Dr Zaslona said: “Caspase-11 can cause cells to die, which is a very inflammatory event as the cells then release their contents, which can irritate tissues in our body. We have found that Caspase-11 is a key driver of inflammation in the airways in asthma. This causes the signs and symptoms of asthma which most notably involves difficulty breathing.”
Although symptoms of mild asthma can be managed with current therapies, severe asthma remains very difficult to treat and asthma rates are constantly on the rise.
Dr Zaslona added: “A variety of irritants such as airborne pollutants, certain types of pollen and house dust mites can induce cell death in the lungs. Our work suggests that Caspase-11 is sensing these noxious things and causing disease.”
Professor O’Neill said: “Caspase-11 – or its human equivalent, which is Caspase-4 – has never been implicated in asthma before so we think it holds great promise as a possible target for new drugs to treat this common, debilitating disease.”
24th February 2020
The guidelines provide an expert perspective on current approaches to surgical management for patients with benign and malignant thyroid disease. “To help provide safe, effective, and appropriate care of patients, these American Association on Endocrine Surgeons(AAES)-sponsored multidisciplinary clinical guidelines analyse the conduct, indications, and outcomes of adult thyroid surgery guided by a comprehensive evidence-based review of the medical literature,” according to the guideline statement. The lead author was Kepal N Patel, MD, of NYU Langone Health, New York, NY.
Emphasis on evidence-based, personalised care for patients undergoing thyroidectomy
The guidelines consist of a total of 66 specific recommendations, identified by a search of the medical literature from 1985 to 2018 and review by a multidisciplinary panel of 19 experts in thyroid disorders.
Recommendations are graded according to the strength and quality of the supporting evidence; the full guidelines document provides guidance on how to best apply the recommendations to individual patients. The project was coordinated by Sally E Carty, MD, of University of Pittsburgh School of Medicine and Christopher R McHenry, MD, of Case Western Reserve University, Cleveland.
Thyroidectomy, referring to any type of thyroid surgery, is a common procedure – more than 100,000 thyroidectomies are performed each year in the United States. While thyroidectomy is “typically a definitive and often curative procedure,” ongoing advances in diagnosis and management have led to variability and even controversy in the treatment of thyroid disease.
While other specialty societies have published recommendations addressing the management of thyroid nodules and thyroid cancer, the new AAES guidelines focus on surgical management of thyroid disease in adults.
Specific objectives include:
Helping surgical team members understand the epidemiology and pathogenesis of thyroid disease. Thyroidectomy is most frequently performed for thyroid dysfunction, symptomatic benign thyroid nodules, and thyroid cancer, including the newer category of “borderline” thyroid tumours.
Outlining the diagnosis of thyroid disease, including the clinical findings; imaging, including ultrasound examination; thyroid function tests; voice assessment, reflecting the risk of vocal fold dysfunction related to thyroid disease and surgery; and the use of fine-needle aspiration biopsy, a key test for evaluation of suspicious thyroid nodules and lymph nodes.
Defining the indications for thyroidectomy, including recommendations related to the extent and outcomes of surgery for patients with different categories of thyroid disease. One recommendation states that, when possible, thyroidectomy should be performed by surgeons who perform a high volume of such procedures.
Detailing methods for safe and effective perioperative management, including steps to prevent complications and the use of thyroid tissue diagnosis during surgery.
Analysing the optimal management of thyroid cancer – emphasising a personalised, evidence-based approach tailored to the patient’s situation and preferences.
On behalf of the AAES, the members of the expert panel hope their efforts will meet the need for evidence-based recommendations to “define practice, personalise care, stratify risk, reduce health care costs, improve outcomes, and identify rational challenges for future efforts.”
They conclude: “Throughout the writing process, [our] intent was to advise surgeons about the right thing to do for the patient” in need of surgical treatment for thyroid disease.
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