Current patterns of care in low-risk thyroid cancer-A national cross-sectional survey of Australian thyroid clinicians.

INTRODUCTION: De-escalated treatment of hemithyroidectomy without radioactive iodine (RAI) is now accepted for patients with low-risk, well-differentiated thyroid cancer (WDTC). The benefit of long-term follow-up care remains controversial. This study aims to describe parameters associated with less than total thyroidectomy, and discharge from specialist follow-up in patients with low-risk WDTC in Australia. METHODS: An online survey was distributed to Australian members of Endocrine Society of Australia, Australian and New Zealand Endocrine Surgeons, and Australian Society of Otolaryngology, Head and Neck Surgery. Clinicians completed a survey of management and follow-up care preferences for four clinical vignettes (all low-risk WDTC). RESULTS: 119 clinicians (48% endocrinologists, 55% male) answered at least one question. The majority (59%) of respondents recommended less than total thyroidectomy and omission of RAI in patients with WDTC <2 cm. Most (62%) would discharge a patient with micropapillary thyroid cancer within 1 year following total thyroidectomy. In contrast, for WDTC 1-4 cm, >90% of clinicians would continue specialist follow-up for at least 5 years. The majority of clinicians felt that patients experienced disproportionate fear of recurrence and were reassured by follow-up. After multivariable analysis, clinicians who participated in multidisciplinary teams (MDTs) were more likely to choose de-escalated care for both initial treatment (p = .005) and follow-up care (>5 years, p = .05). CONCLUSION: Clinician attitudes captured by this survey reflect recent changes in guidelines towards hemithyroidectomy for low-risk WDTC, particularly amongst MDT attendees. There is a need to further examine the impact of de-escalated care on fear of recurrence and quality of life in thyroid cancer survivors.

Efficacy of dermal substitute on deep dermal to full thickness burn injury: a systematic review.

BACKGROUND: The study aims to systematically examine the efficacy of dermal regeneration templates (DRTs) in comparison to split thickness skin grafting (STSG) in the management of acute burn injuries post-excision and debridement. METHODS: Systematic literature search was conducted by two independent reviewers from the following databases: MEDLINE, EMBASE and Cochrane Library with selection criteria set a priori. Only randomized controlled trials (RCTs) were included. Main outcomes extracted were percent of STSG take, infection rate and scar quality. RESULTS: Seven studies were included. Three of the seven studies reported no significant difference in STSG take between burn wounds treated with dermal substitute and or STSG only. Three of the seven studies reported either low rates of infection or no significant difference in infection rates between dermal substitute and control. Four of the seven studies reported no significant difference in scar quality. Statistical pooling of data was not performed due to heterogeneity of the studies. CONCLUSION: Current RCTs available are generally of small sample size with poor methodological reporting. Given the results of more recent RCTs, the risk associated with DRTs is low and it can be a useful alternative for immediate wound coverage post-burn excision. However, there is still no strong evidence to support that DRTs have significant impact on scaring.