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Aims
The 2014 British Thyroid Association thyroid cancer guidelines recommend lifelong follow-up of thyroid cancer patients. This is probably unnecessary, can cause patient anxiety, is time consuming and places significant demand on National Health Service resources. It has been suggested that low-risk differentiated thyroid cancer (DTC) patients could be discharged to primary care once they are 5 years from diagnosis and treatment. The aim of this study was to investigate the potential safety of this practice.Materials and methods
In total, 756 patients with dynamically risk-stratified (DRS) low-risk/excellent response to treatment DTC treated over 2001–2013 in the Leeds region were followed after diagnostic surgery and the recurrence rate calculated.Results
The median follow-up time was nearly 10 years (5–17 years). Radiological recurrence occurred in 13/756 (1.7%) patients and was always preceded by raised thyroglobulin/ thyroglobulin antibody levels. In all 13 patients elevation of thyroglobulin occurred within 5 years of diagnosis. Two additional patients were found to have rising thyroglobulin at almost 9 and 10.5 years from diagnosis, although to date radiological recurrence has not been detected. Assuming these two patients developed recurrence with longer duration of follow-up, then 0.26% (2/756) of patients would not have their recurrence discovered within 5 years of diagnosis. To detect 100% of patients with a putative recurrence in our cohort would require 10.5 years of follow-up. Four patients had transiently raised thyroglobulin, which became undetectable within 2 years (in three patients), without any treatment and radiological recurrence was not discovered.Conclusion
Discharge of DRS low-risk DTC patients to primary care after 5 years of secondary care follow-up is reasonable, accepting that late recurrence may occur in a very small minority of individuals (0.26%, ~1:400). A more cautious approach would be to continue monitoring for 10 years, although the frequency of assessments could be reduced with increasing duration of follow-up. 相似文献Methods: This case series includes three women with transradial amputation. Structured surveys and semi-guided interviews were administered after completion of in-laboratory training and a home trial of the DEKA Arm. A constant comparative method with a grounded theory approach was used to generate a model describing women’s decision-making related to the DEKA Arm. Quantitative data on prosthetic satisfaction was used to triangulate findings.
Results: Factors that enhanced desirability of the DEKA Arm were improved functionality, increased abilities and the availability of someone to service the prosthesis. Factors that detracted from desirability of the device were its appearance, conspicuousness, lifestyle incompatibility, weight, need for service and difficulty of use. Each woman weighted these factors within the larger context of the capabilities of and satisfaction with her personal prostheses, her self-concept and lifestyle needs. Situational demands, particularly the desire to appear feminine and professional or need to perform certain activities, also altered the valuation of these priorities.
Conclusion: Findings strongly suggest that advanced upper limb prosthetic technologies, like the DEKA Arm, will be better accepted by women if appropriately gendered in appearance and designed with women’s priorities in mind.
- Implications for Rehabilitation
Women should be able to derive the functional benefits of advances in upper limb technology without needing to compromise their feminine identity and lifestyle preferences.
Advanced upper limb prosthetic technologies will be better accepted by women if they are appropriately gendered.