Objectives For small thyroid cancers (≤2 cm), tumour volume may better predict aggressive disease... more Objectives For small thyroid cancers (≤2 cm), tumour volume may better predict aggressive disease, defined by lymphovascular invasion (LVI) than a traditional single measurement of diameter. We aimed to investigate the relationship between tumour diameter, volume and associated LVI. Methods Differentiated thyroid cancers (DTC) ≤ 2 cm surgically resected between 2007 and 2016 were analysed. Volume was calculated using the formula for an ellipsoid shape from pathological dimensions. A ‘larger volume’ cut-off was established by receiver operating characteristic (ROC) analysis using the presence of lateral cervical lymph node metastasis (N1b). Logistic regression was performed to compare the ‘larger volume’ cut-off to traditional measurements of diameter in the prediction. Results During the study period, 2405 DTCs were surgically treated and 523 met the inclusion criteria. The variance of tumour volume relative to diameter increased exponentially with increasing tumour size; the interq...
BACKGROUND Due to the excellent prognosis and relatively high incidence of small low-risk thyroid... more BACKGROUND Due to the excellent prognosis and relatively high incidence of small low-risk thyroid cancers, more conservative management strategies such as active surveillance (AS) or hemithyroidectomy (HT) may be preferable to total thyroidectomy (TT) for patients seeking to balance long-term survival rates with the potential adverse effects of overtreatment. The aim of this review was to synthesise key factors or variables which inform patient decision making about treatment for low-risk thyroid cancer, from current primary investigations that presented participants with information facilitating this choice Methods: Studies were identified from the Medline, Cochrane and Embase databases up until March 2022. Study characteristics were extracted into a pre-piloted form. Factors were hypothesised to include treatment related risks and possible outcomes and identified from review of studies with consensus by discussion. RESULTS The search identified 444 unique studies, 397 were excluded on review of abstract and title with 47 studies undergoing full text review with six studies identified to be eligible. Four were cross-sectional, one a prospective cohort study and one a mixed-methods study with both a prospective observational and qualitative component. The decisions addressed included: the choice between AS vs surgery (HT and/or TT) and HT vs TT and enrolled participants ranging from healthy volunteers to thyroid cancer patients. Treatment choice was the primary outcome in five studies. Across the studies, participants who were given the option of AS or surgery predominately chose the more conservative pathway, with a range of 70-84%. Major factors represented by information provision in the studies were risk of cancer recurrence or spread, need for hormone replacement therapy, and voice change. CONCLUSIONS A framework of key factors informing patient treatment choice may be derived from current studies involving information provision for low-risk thyroid cancer management. Further research evaluating the efficacy and optimal timing for decision support interventions would help inform the design and clinical use of these tools to promote shared decision-making.
Additional file 4. Complete univariate associations between monitoring and evaluation results and... more Additional file 4. Complete univariate associations between monitoring and evaluation results and weekly alerts.
Additional file 2. Monthly RDT rates and incidence: Additional details on the average monthly RDT... more Additional file 2. Monthly RDT rates and incidence: Additional details on the average monthly RDT rates and P. falciparum and P. vivax incidence by year and number of years open.
Myanmar has one of the largest malaria burdens in Southeast Background: Asia. Along the border wi... more Myanmar has one of the largest malaria burdens in Southeast Background: Asia. Along the border with Thailand, parasites are Plasmodium falciparum increasingly showing reduced sensitivity to artemisinin combination therapies. Given that there are no current alternative treatment therapies, one proposed solution to the threat of untreatable malaria is to eliminate the P. falciparum parasite from the region. Several small-scale elimination projects have been piloted along the Myanmar-Thailand border. Following their success, this operational research aimed to scale up the elimination to a broad area of Eastern Kayin State, Myanmar. The project relied on geographic reconnaissance and a geographic Methods: information system, community engagement, generalized access to community-based early diagnosis and treatment, near real-time epidemiological surveillance, cross sectional malaria prevalence surveys and targeted mass drug administration in villages with high prevalence of P. malaria. M...
Background Tumor size is an important prognostic factor in papillary thyroid cancer (PTC). Manage... more Background Tumor size is an important prognostic factor in papillary thyroid cancer (PTC). Management guidelines, staging systems, and pathological definitions use maximum diameter (Dmax) as a surrogate marker of tumor size. However, PTC nodules are three-dimensional (3D) structures, with behavior reflective of tumor cell count, which is directly proportional to volume. We explored the relationship between sonographically determined Dmax, volume, and lymph node status (LNS) in a cohort of patients with PTC. Methods All patients treated for PTC between 2003 and 2015 in our institution who had sonographic 3D nodule measurements available were evaluated. We examined the relationship between diameter, volume, and LNS. Results A total of 159 nodules in 153 patients met the inclusion criteria. Mean nodule dimensions were 2.4 × 1.9 × 1.5 cm, giving “ideal” nodule dimensions of y × 0.78y × 0.62y, where y is the Dmax. Observed volumes differed from predicted nodule volumes by an average of 2...
JBI database of systematic reviews and implementation reports, 2015
Craniosynostosis is a condition characterized by the premature closure of one or more of the cran... more Craniosynostosis is a condition characterized by the premature closure of one or more of the cranial vault sutures. It can occur alone or in association with other congenital defects and may be part of a syndrome. The sagittal suture is most commonly affected, comprising 40-60% of cases. Premature fusion of the sagittal suture can cause scaphocephaly due to compensatory anterior-posterior growth of the skull. This is morphologically considered as a narrow elongated skull with a decreased cephalic index, and is diagnosed clinically and/or radiologically. Both the indications for surgery and the techniques used have varied with time and location. Surgical techniques have evolved, from limited craniectomy to calvarial remodeling. In recent times a return to craniectomy methods has occurred with the more recent introduction of endoscopic methods. The objectives of this review were to identify and synthesize the best available evidence on the morphological, functional and neurological ou...
Symptomatic polypoid chronic rhinosinusitis (CRS) that fails an adequate medical trial responds w... more Symptomatic polypoid chronic rhinosinusitis (CRS) that fails an adequate medical trial responds well to endoscopic sinus surgery (ESS). More aggressive (extensive) ESS leads to better clinical outcomes with polypoid CRS. Successful surgical management of the frontal sinus is the most challenging aspect of the management of nasal polyposis. In patients who develop recurrent polyps after surgery, the modified endoscopic Lothrop
Background The Lund-MacKay score (LMS) is the standard for communicating radiological extent of c... more Background The Lund-MacKay score (LMS) is the standard for communicating radiological extent of chronic rhinosinusitis in research. However, retrospective analyses are often hindered by a substantial lack of radiological data. Calculating LMS from radiologists’ reports may overcome this but has not been formally validated. Methods Twenty South Australian and 20 Texan patients with varying degrees of sinus disease were randomly chosen to undergo analysis. CT-derived LMSs were calculated directly by two expert rhinologists at each institution and compared with scores derived solely from accompanying radiology reports by two blinded reviewers. Results The total LMS obtained via the expert rhinologists correlated very highly with that obtained from radiology reports (Spearman rank correlation, 0.75-0.88; p < 0.001). However, when individual sinuses were specifically analyzed, the correlation was highly variable. Conclusion The results show that in both South Australian and Texan tert...
Background Nasal douching is common practice in treatment of chronic sinusitis and after endoscop... more Background Nasal douching is common practice in treatment of chronic sinusitis and after endoscopic sinus surgery. Current nasal delivery techniques show inconsistent sinus penetration. The aim of this study was to compare sinonasal penetration of nasal douching to an optimized nasal nebulizer in an operated cadaver model. Methods Fourteen preserved cadavers were used receiving complete sphenoethmoidectomies with a Draf III, wide maxillary antrostomy, or medial maxillectomy. Seven control cadavers received nasal douching with one standardized squeeze bilaterally of a 200-mL nasal irrigation bottle and seven intervention cadavers were nebulized with 3 minutes of the PARI sinus device bilaterally. Douching solutions were stained with methylene blue. Independent observers documented sinonasal anatomy, staining intensity, and percentage area covered by dye using standardized grading protocols. Results Combined data showed a significant increase in intensity of stain (2.06 versus 0.26, p...
Background: This study evinces how the community engagement (CE) approach of the Malaria Eliminat... more Background: This study evinces how the community engagement (CE) approach of the Malaria Elimination Task Force (METF) in the Karen/Kayin State of southeast Myanmar contributed to generating participation in program activities, such as early detection and treatment, malaria blood surveys and mass drug administration. Methods: We investigated the CE approach through ethnographic and key-informant unstructured interviews as well as focus group discussions and participant observation with program participants METF team members. Interview transcripts were analysed manually applying inductive content analysis. Results: In the context of the Thai-Myanmar border, CE had two main dimensions: The first was to enable the politically sensitive entry of the program into intervention areas, the second was to create mutual understanding among the METF team and people from the population and gain trust. For the first, the METF needed to acknowledge, get permission and communicate with a complex la...
Additional file 5. Complete univariable associations between monitoring and evaluation results an... more Additional file 5. Complete univariable associations between monitoring and evaluation results and M&E visit type (targeted or random).
Additional file 2. Treatment questionnaire administered to malaria post workers, malaria post sup... more Additional file 2. Treatment questionnaire administered to malaria post workers, malaria post supervisors, and zone and assistant zone coordinators.
Additional file 1. Malaria Post assessment sheet used to collect information on malaria post acti... more Additional file 1. Malaria Post assessment sheet used to collect information on malaria post activities during monitoring and evaluation visits.
Background Providing at-risk communities with uninterrupted access to early diagnosis and treatme... more Background Providing at-risk communities with uninterrupted access to early diagnosis and treatment is a key component in reducing malaria transmission and achieving elimination. As programmes approach malaria elimination targets it is critical that each case is tested and treated early, which may present a challenge when the burden of malaria is reduced. In this paper we investigate whether malaria testing rates decline over time and assess the impacts of integrating malaria and non-malaria services on testing rates in the malaria elimination task force (METF) programme in the Kayin state of Myanmar. Methods A retrospective analysis was conducted using weekly collected data on testing rates from a network of more than 1200 malaria posts during the period from 2014 to 2020. To determine whether monthly testing rates changed over the years of programme operations, and whether integrating malaria and non-malaria services impacted these testing rates, we fitted negative binomial mixed-...
Objectives For small thyroid cancers (≤2 cm), tumour volume may better predict aggressive disease... more Objectives For small thyroid cancers (≤2 cm), tumour volume may better predict aggressive disease, defined by lymphovascular invasion (LVI) than a traditional single measurement of diameter. We aimed to investigate the relationship between tumour diameter, volume and associated LVI. Methods Differentiated thyroid cancers (DTC) ≤ 2 cm surgically resected between 2007 and 2016 were analysed. Volume was calculated using the formula for an ellipsoid shape from pathological dimensions. A ‘larger volume’ cut-off was established by receiver operating characteristic (ROC) analysis using the presence of lateral cervical lymph node metastasis (N1b). Logistic regression was performed to compare the ‘larger volume’ cut-off to traditional measurements of diameter in the prediction. Results During the study period, 2405 DTCs were surgically treated and 523 met the inclusion criteria. The variance of tumour volume relative to diameter increased exponentially with increasing tumour size; the interq...
BACKGROUND Due to the excellent prognosis and relatively high incidence of small low-risk thyroid... more BACKGROUND Due to the excellent prognosis and relatively high incidence of small low-risk thyroid cancers, more conservative management strategies such as active surveillance (AS) or hemithyroidectomy (HT) may be preferable to total thyroidectomy (TT) for patients seeking to balance long-term survival rates with the potential adverse effects of overtreatment. The aim of this review was to synthesise key factors or variables which inform patient decision making about treatment for low-risk thyroid cancer, from current primary investigations that presented participants with information facilitating this choice Methods: Studies were identified from the Medline, Cochrane and Embase databases up until March 2022. Study characteristics were extracted into a pre-piloted form. Factors were hypothesised to include treatment related risks and possible outcomes and identified from review of studies with consensus by discussion. RESULTS The search identified 444 unique studies, 397 were excluded on review of abstract and title with 47 studies undergoing full text review with six studies identified to be eligible. Four were cross-sectional, one a prospective cohort study and one a mixed-methods study with both a prospective observational and qualitative component. The decisions addressed included: the choice between AS vs surgery (HT and/or TT) and HT vs TT and enrolled participants ranging from healthy volunteers to thyroid cancer patients. Treatment choice was the primary outcome in five studies. Across the studies, participants who were given the option of AS or surgery predominately chose the more conservative pathway, with a range of 70-84%. Major factors represented by information provision in the studies were risk of cancer recurrence or spread, need for hormone replacement therapy, and voice change. CONCLUSIONS A framework of key factors informing patient treatment choice may be derived from current studies involving information provision for low-risk thyroid cancer management. Further research evaluating the efficacy and optimal timing for decision support interventions would help inform the design and clinical use of these tools to promote shared decision-making.
Additional file 4. Complete univariate associations between monitoring and evaluation results and... more Additional file 4. Complete univariate associations between monitoring and evaluation results and weekly alerts.
Additional file 2. Monthly RDT rates and incidence: Additional details on the average monthly RDT... more Additional file 2. Monthly RDT rates and incidence: Additional details on the average monthly RDT rates and P. falciparum and P. vivax incidence by year and number of years open.
Myanmar has one of the largest malaria burdens in Southeast Background: Asia. Along the border wi... more Myanmar has one of the largest malaria burdens in Southeast Background: Asia. Along the border with Thailand, parasites are Plasmodium falciparum increasingly showing reduced sensitivity to artemisinin combination therapies. Given that there are no current alternative treatment therapies, one proposed solution to the threat of untreatable malaria is to eliminate the P. falciparum parasite from the region. Several small-scale elimination projects have been piloted along the Myanmar-Thailand border. Following their success, this operational research aimed to scale up the elimination to a broad area of Eastern Kayin State, Myanmar. The project relied on geographic reconnaissance and a geographic Methods: information system, community engagement, generalized access to community-based early diagnosis and treatment, near real-time epidemiological surveillance, cross sectional malaria prevalence surveys and targeted mass drug administration in villages with high prevalence of P. malaria. M...
Background Tumor size is an important prognostic factor in papillary thyroid cancer (PTC). Manage... more Background Tumor size is an important prognostic factor in papillary thyroid cancer (PTC). Management guidelines, staging systems, and pathological definitions use maximum diameter (Dmax) as a surrogate marker of tumor size. However, PTC nodules are three-dimensional (3D) structures, with behavior reflective of tumor cell count, which is directly proportional to volume. We explored the relationship between sonographically determined Dmax, volume, and lymph node status (LNS) in a cohort of patients with PTC. Methods All patients treated for PTC between 2003 and 2015 in our institution who had sonographic 3D nodule measurements available were evaluated. We examined the relationship between diameter, volume, and LNS. Results A total of 159 nodules in 153 patients met the inclusion criteria. Mean nodule dimensions were 2.4 × 1.9 × 1.5 cm, giving “ideal” nodule dimensions of y × 0.78y × 0.62y, where y is the Dmax. Observed volumes differed from predicted nodule volumes by an average of 2...
JBI database of systematic reviews and implementation reports, 2015
Craniosynostosis is a condition characterized by the premature closure of one or more of the cran... more Craniosynostosis is a condition characterized by the premature closure of one or more of the cranial vault sutures. It can occur alone or in association with other congenital defects and may be part of a syndrome. The sagittal suture is most commonly affected, comprising 40-60% of cases. Premature fusion of the sagittal suture can cause scaphocephaly due to compensatory anterior-posterior growth of the skull. This is morphologically considered as a narrow elongated skull with a decreased cephalic index, and is diagnosed clinically and/or radiologically. Both the indications for surgery and the techniques used have varied with time and location. Surgical techniques have evolved, from limited craniectomy to calvarial remodeling. In recent times a return to craniectomy methods has occurred with the more recent introduction of endoscopic methods. The objectives of this review were to identify and synthesize the best available evidence on the morphological, functional and neurological ou...
Symptomatic polypoid chronic rhinosinusitis (CRS) that fails an adequate medical trial responds w... more Symptomatic polypoid chronic rhinosinusitis (CRS) that fails an adequate medical trial responds well to endoscopic sinus surgery (ESS). More aggressive (extensive) ESS leads to better clinical outcomes with polypoid CRS. Successful surgical management of the frontal sinus is the most challenging aspect of the management of nasal polyposis. In patients who develop recurrent polyps after surgery, the modified endoscopic Lothrop
Background The Lund-MacKay score (LMS) is the standard for communicating radiological extent of c... more Background The Lund-MacKay score (LMS) is the standard for communicating radiological extent of chronic rhinosinusitis in research. However, retrospective analyses are often hindered by a substantial lack of radiological data. Calculating LMS from radiologists’ reports may overcome this but has not been formally validated. Methods Twenty South Australian and 20 Texan patients with varying degrees of sinus disease were randomly chosen to undergo analysis. CT-derived LMSs were calculated directly by two expert rhinologists at each institution and compared with scores derived solely from accompanying radiology reports by two blinded reviewers. Results The total LMS obtained via the expert rhinologists correlated very highly with that obtained from radiology reports (Spearman rank correlation, 0.75-0.88; p < 0.001). However, when individual sinuses were specifically analyzed, the correlation was highly variable. Conclusion The results show that in both South Australian and Texan tert...
Background Nasal douching is common practice in treatment of chronic sinusitis and after endoscop... more Background Nasal douching is common practice in treatment of chronic sinusitis and after endoscopic sinus surgery. Current nasal delivery techniques show inconsistent sinus penetration. The aim of this study was to compare sinonasal penetration of nasal douching to an optimized nasal nebulizer in an operated cadaver model. Methods Fourteen preserved cadavers were used receiving complete sphenoethmoidectomies with a Draf III, wide maxillary antrostomy, or medial maxillectomy. Seven control cadavers received nasal douching with one standardized squeeze bilaterally of a 200-mL nasal irrigation bottle and seven intervention cadavers were nebulized with 3 minutes of the PARI sinus device bilaterally. Douching solutions were stained with methylene blue. Independent observers documented sinonasal anatomy, staining intensity, and percentage area covered by dye using standardized grading protocols. Results Combined data showed a significant increase in intensity of stain (2.06 versus 0.26, p...
Background: This study evinces how the community engagement (CE) approach of the Malaria Eliminat... more Background: This study evinces how the community engagement (CE) approach of the Malaria Elimination Task Force (METF) in the Karen/Kayin State of southeast Myanmar contributed to generating participation in program activities, such as early detection and treatment, malaria blood surveys and mass drug administration. Methods: We investigated the CE approach through ethnographic and key-informant unstructured interviews as well as focus group discussions and participant observation with program participants METF team members. Interview transcripts were analysed manually applying inductive content analysis. Results: In the context of the Thai-Myanmar border, CE had two main dimensions: The first was to enable the politically sensitive entry of the program into intervention areas, the second was to create mutual understanding among the METF team and people from the population and gain trust. For the first, the METF needed to acknowledge, get permission and communicate with a complex la...
Additional file 5. Complete univariable associations between monitoring and evaluation results an... more Additional file 5. Complete univariable associations between monitoring and evaluation results and M&E visit type (targeted or random).
Additional file 2. Treatment questionnaire administered to malaria post workers, malaria post sup... more Additional file 2. Treatment questionnaire administered to malaria post workers, malaria post supervisors, and zone and assistant zone coordinators.
Additional file 1. Malaria Post assessment sheet used to collect information on malaria post acti... more Additional file 1. Malaria Post assessment sheet used to collect information on malaria post activities during monitoring and evaluation visits.
Background Providing at-risk communities with uninterrupted access to early diagnosis and treatme... more Background Providing at-risk communities with uninterrupted access to early diagnosis and treatment is a key component in reducing malaria transmission and achieving elimination. As programmes approach malaria elimination targets it is critical that each case is tested and treated early, which may present a challenge when the burden of malaria is reduced. In this paper we investigate whether malaria testing rates decline over time and assess the impacts of integrating malaria and non-malaria services on testing rates in the malaria elimination task force (METF) programme in the Kayin state of Myanmar. Methods A retrospective analysis was conducted using weekly collected data on testing rates from a network of more than 1200 malaria posts during the period from 2014 to 2020. To determine whether monthly testing rates changed over the years of programme operations, and whether integrating malaria and non-malaria services impacted these testing rates, we fitted negative binomial mixed-...
Uploads
Papers by May Thwin