Citations

Health care provider’s acceptance of telemonitoring is pivotal for implementation. The aim of this study was to determine provider’s feelings about telemonitoring using a qualitative method. In regard to method, we interviewed physicians, nurse practitioners, and registered nurses to explore their attitudes toward telemonitoring. Thematic and content analysis strategies were used to identify core concepts and develop categories for coding interview data. Results reveal that providers view telemonitoring as most appropriate for specific types of patients, especially older patients with chronic medical conditions. Telemonitoring offers reassurance to patients and providers. Some providers expressed concerns about excessive information that at times may not be clinically useful. In conclusion, home telemonitoring provides reassurance to patients and health care providers. Taking provider preferences into consideration when implementing telemonitoring may improve provider acceptance of this form of care.

SummaryThere is much concern expressed in the literature regarding the lack of predictive power of the thyroid fine needle aspiration/biopsy (TFNAB) approach to defining the nature of clinically detected thyroid nodules. This has been exacerbated in the past decade or more by the routine use of ultrasonography (US) in examining the thyroid as well as the introduction of molecular testing in the realm of thyroid pathology. Some have even gone so far as to suggest replacing the TFNAB with molecular signature testing to reduce the degree of uncertainty for a specific cytological diagnosis. This review addresses those concerns with a re‐emphasis on understanding the basic keys to successfully evaluating a patient with a thyroid nodule by routine TFNAB examination. These keys include bringing to bear an experienced group of physicians in an integrated team approach, a sharpened focus on the TFNAB cytological categories and a grounded understanding of the predictive ability of molecular testing in a given patient when the cytological interpretation creates too much uncertainty in the minds of the patients and clinicians in attempting to reach a decision on how to manage a thyroid nodule. With this practical approach in mind, the false‐negative and false‐positive rates of “negative (benign)” and “positive (malignant)” thyroid aspirates should be no more than 1%; and the prevalence of an “indeterminate” aspirate – the area in TFNAB attracting the most attention for improvement with novel biomarkers – should be 10% or less. Thus, physicians should be capable of managing at least 90% of patients undergoing TFNAB in a confident manner without further testing beyond the routine, future re‐examination of the patient's nodule to re‐assess for any change in its nature or its impact on the patient's quality of life. The other 10% can then be considered for molecular testing in a manner tailored to those individuals truly in need of a more sophisticated – and expensive – approach to the characterization of their thyroid nodules. As the era of US has matured – just as with the era of serum PSA testing for prostate cancer in men – we have experienced a paradigm shift: Given the incidence of thyroid nodules in the U.S. adult population in comparison with the risk of dying of thyroid malignancy, the main role of TFNAB is to reduce the need for surgical intervention.

AbstractMicroRNAs (miRNAs) are small, regulatory non‐coding RNAs that have potent effects on gene expression. Several miRNA are deregulated in cellular processes involved in human liver diseases and regulation of cellular processes. Recent studies have identified the involvement of miR‐29 in hepatic fibrosis and carcinogenesis. Although several targets of miR‐29 have been identified, there is limited information regarding the cell‐type specific roles of miR‐29 in the liver, and we sought to evaluate the role of this miRNA in hepatic pathobiology. We report the generation of a tissue–specific knockout mouse to evaluate the role of miR‐29 in hepatic fibrosis and carcinogenesis in response to injury. We hypothesized that miR‐29 contributes to the hepatocyte driven response to chronic cellular injury that results in fibrosis. In support of this hypothesis, fibrosis and mortality were enhanced in miR29 knockout mice in response to carbon tetrachloride. Genome‐wide gene expression analysis identified an over‐representation of genes associated with fibrosis. The oncofetal RNA H19 was modulated in a miR‐29 dependent manner following exposure to carbon tetrachloride in vivo. The impact of a hepatocyte specific miR‐29 knockout on survival following chronic hepatic injury in vivo implicates this miRNA as a potential target for intervention. These results provide evidence of the involvement of miR‐29 in chronic hepatic injury, and suggest a role for deregulated hepatocyte expression of miR‐29 in the response to hepatic injury, fibrosis and carcinogenesis.

As physicians how do we counsel our patients with clinically isolated syndrome (CIS) when they ask, ‘what is the benefit of injecting disease-modifying agents (DMAs) over many years? What disability will they prevent in my future?’ In this debate, we will provide three core points supporting the concept that a watchful waiting approach (annual neurological evaluation and magnetic resonance imaging of the head (with gadolinium) at least for the first few years after diagnosis) for most patients with CIS represents appropriate medical care.

Periocular tumors are common in infancy. The most common periocular tumors are capillary hemangiomas, which are present in 1-2% of newborns and develop in 10%–12% of children by the age of 1 year old. Deep capillary hemangiomas may be more challenging to diagnose than superficial capillary hemangiomas and can be confused with other orbital lesions. Deep orbital hemangiomas can mimic teratoma, lymphangioma, rhabdomyosarcoma, metastatic neuroblastoma, and granulocytic sarcoma. In this paper, we describe 2 pediatric cases where previously diagnosed dermoid cyst and dacrocystocele were found to be capillary hemangiomas upon biopsy. Approaches to distinguish capillary hemangiomas from other periocular tumors are further discussed. To our knowledge, this is the first case report of periocular hemangiomas imitating a dermoid cyst and a dacrocystocele. These cases emphasize the importance of including infantile hemangiomas in the differential diagnosis of subcutaneous periocular abnormalities.