ABSTRACT
Standardized evaluation criteria would be useful for sorting through the huge volume of medical educational information now available on the Internet. The authors developed and pilot-tested a simple rating instrument. Using this instrument, students identified preferred Web sites and indicated that speed was particularly important in their assessments.
Subject(s)
Education, Medical, Undergraduate , Internet , Attitude of Health Personnel , Humans , Pilot ProjectsSubject(s)
Ambulatory Care Information Systems/organization & administration , Family Practice/organization & administration , Internship and Residency/organization & administration , Maternal Health Services/organization & administration , Obstetrics/organization & administration , Ambulatory Care Information Systems/statistics & numerical data , Attitude of Health Personnel , Attitude to Computers , California , Computer Graphics , Evaluation Studies as Topic , Family Practice/education , Female , Hospital Bed Capacity, 100 to 299 , Hospitals, County/organization & administration , Humans , Outpatient Clinics, Hospital/organization & administration , Pregnancy , Surveys and QuestionnairesABSTRACT
Ninety-five surgically treated patients with well-differentiated carcinoma of the thyroid with an average of 11.2 years of follow-up were reviewed. Overall complications included 13% recurrence, 3% deaths due to thyroid cancer, 3% recurrent laryngeal nerve damage, and 2% hypoparathyroidism. Statistically significant prognostic findings included lower rates of recurrence and/or death among patients who were female, without lymph node involvement, or younger than 45. In comparison with total thyroidectomy, subtotal thyroidectomy was associated with markedly higher rates of recurrence and death among Stage II+ patients. No such difference appeared among Stage I patients. No statistically significant differences or meaningful trends could be found in the recurrence or death rates for age, sex, and lymph node status-matched patients treated with total versus subtotal thyroidectomy. These findings suggest the use of age, sex, and staging criteria to decide between subtotal and total thyroidectomy in patients with localized, well-differentiated thyroid cancer. More specifically, females younger than 45 with small tumors and no clinical evidence of nodal involvement or metastases can be treated using subtotal thyroidectomy with some confidence that undue recurrence or death due to cancer will not result. This selective use of subtotal thyroidectomy would avoid the complications of total thyroidectomy, namely, bilateral recurrent laryngeal nerve trauma and hypoparathyroidism, the latter being a particularly troublesome iatrogenic disease.
