Search

BackgroundThe traditional management of papillary thyroid cancer (PTC) is thyroidectomy (total or partial removal of the thyroid). Active surveillance (AS) may be considered as an alternative option for small, low risk PTC. AS involves close follow-up (including regularly scheduled clinical and radiological assessments), with the intention of intervening with surgery for disease progression or patient preference.MethodsThis is a protocol for a prospective, observational, long-term follow-up multi-centre Canadian cohort study. Consenting eligible adults with small, low risk PTC (< 2cm in maximal diameter, confined to the thyroid, and not immediately adjacent to critical structures in the neck) are offered the choice of AS or surgery for management of PTC. Patient participants are free to choose either option (AS or surgery) and the disease management course is thus not assigned by the investigators. Surgery is provided as usual care by a surgeon in an institution of the patient’s choice. Our primary objective is to determine the rate of ‘failure’ of disease management in respective AS and surgical arms as defined by: i) AS arm – surgery for progression of PTC, and ii) surgical arm - surgery or other treatment for disease persistence or progression after completing initial treatment. Secondary outcomes include long-term thyroid oncologic and treatment outcomes, as well as patient-reported outcomes.DiscussionThe results from this study will provide long-term clinical and patient reported outcome evidence regarding active surveillance or immediate surgery for management of small, low risk PTC. This will inform future clinical trials in disease management of small, low risk papillary thyroid cancer.Registration detailsThis prospective observational cohort study is registered on clinicaltrials.gov (NCT04624477), but it should not be considered a clinical trial as there is no assigned intervention and patients are free to choose either AS or surgery.

Background: General pharmacology is the backbone of therapeutic pharmacology. In general pharmacology, pharmacokinetics is a very difficult topic for undergraduate medical students. Knowledge of the kinetics and of the effects of drugs is necessary for the correct use of drugs in therapy. As in the body most of the drugs follow first order elimination kinetics, so it is necessary for all students to know about basic concept of first order kinetics. This can be easily understood by using working models. Our present study is a step in that direction. The objective of this study was planned to develop first order elimination kinetics working models to teach pharmacokinetics principle to the under graduate medical students. Methods: The current study was planned and executed by the department of pharmacology in SHKM government medical college, Mewat, Haryana, India in the first quarter of 2016. This model was developed from household waste materials like thermocol sheets, coke bottles, waste water pipe, colour etc. Results: As we know learning is better with live experimentation as compare to theoretical learning, so difficult topics such as elimination kinetics will be taught by help of working models. Conclusions: First order elimination kinetics is easily understood with the help of above working model. More and more working models could be developed for teaching difficult topics.