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1.  Quality of Scar after Total Thyroidectomy: A Single Blinded Randomized Trial Comparing Octyl-Cyanoacrylate and Subcuticular Absorbable Suture 
ISRN Surgery  2013;2013:270953.
Objective. To compare the quality of resulting scar at 6 weeks after total thyroidectomy with the use of the tissue adhesive octyl-cyanoacrylate or subcuticular absorbable suture for the closure of cervicotomy. Material and Methods. There are 50 patients undergoing a cervicotomy for total thyroidectomy. Twenty-five patients were randomly assigned to closure with tissue adhesive and 25 with subcuticular absorbable suture. At week 6 the scar was evaluated by blinded assessors with the Italian version of POSAS questionnaire, a validated wound scale composed of an observer's and a patient's subscale. Results. Assessment of scar appearance showed a statistically significant difference (p = 0. 038) in favor of subcuticular suture with respect to tissue adhesive on observer's assessment. The difference on patients' self-assessment was not significant. A multivariate analysis of six qualitative features of scars showed a significant influence on assessment for hyperpigmentation and relief of scar. The Italian version of POSAS proved to be reliable. Conclusion. Though tissue adhesive represents a valid method of skin closure, subcuticular absorbable suture provides a better aesthetic outcome in small cervical incisions in the early phase after thyroid surgery.
doi:10.1155/2013/270953
PMCID: PMC3845629  PMID: 24324898
2.  Evaluation of the acceptability of Peer Physical Examination (PPE) in medical and osteopathic students: a cross sectional survey 
BMC Medical Education  2013;13:111.
Background
Peer physical examination (PPE) is a method of training in medical and osteopathic curricula. The aim of this study was to compare the acceptability of PPE in two classes of medical and osteopathic students after their first experience, to obtain comparative information useful for an understanding of the different professional approaches. The leading hypothesis was that osteopathic students enter the curriculum with a more positive attitude to bodily contact.
As a secondary aim, this study validated the new version of a questionnaire to assess the acceptability of PPE.
Methods
A new version of a previously validated questionnaire and an instrument from the literature (the Examining Fellow Student [EFS] questionnaire) were used for a cross-sectional survey in a class of 129 3rd year medical students and in two parallel classes of 1st year osteopathic students (total of 112 students).
Results
The mean score of the new questionnaire was significantly higher for the osteopathic students than for the medical students (53.4 ± 6.3 vs. 43.4 ± 8.9; p < 0.01). The only independent variables that were significantly predictive of the score in a linear regression analysis were gender and the condition of medical or osteopathic student. The EFS mean score also showed a significant difference between the osteopathic and medical students (30.76 ± 2.9 vs. 27.85 ± 4.3; p < 0.01).
Factor analysis of the new questionnaire identified three factors (appropriateness and usefulness, sexual implications and passive role) accounting for 62.8% of the variance. Criterion validity was assessed by correlation with the EFS (Pearson’s r coefficient = 0.61). Reliability was expressed in terms of Cronbach’s alpha coefficient, which equals 0.86.
Conclusions
These quantitative results are consistent with previous qualitative research on the process of embodiment both in medicine and osteopathy. The new questionnaire proved to be valid and reliable. The objective assessment of the acceptability of PPE is a way to determine differences in students’ attitudes towards contact with the body and can be used for counselling students regarding career choice. This study can also highlight differences between students from different professions and serve as a basis for reflection for improved mutual interprofessional understanding and future interprofessional education.
doi:10.1186/1472-6920-13-111
PMCID: PMC3846411  PMID: 23968312
Peer physical examination; Embodiment; Medical student; Osteopathic student; Cross sectional survey
3.  Factors influencing the length of the incision and the operating time for total thyroidectomy 
BMC Surgery  2012;12:15.
Background
The incision used for thyroid surgery has become shorter over time, from the classical 10 cm long Kocher incision to the shortest 15 mm access achieved with Minimally Invasive Video-Assisted Thyroidectomy. This rather large interval encompasses many different possible technical choices, even if we just consider open surgery.
The aim of the study was to assess the correlation between incision length and operation duration with a set of biometric and clinical factors and establish a rationale for the decision on the length of incision in open surgery.
Methods
Ninety-seven consecutive patients scheduled for total thyroidectomy were prospectively evaluated. All operations were performed by the same team and the surgeon decided the length of the incision according to his personal judgement. Patients who had previously undergone neck surgery were excluded.
Results
The length of the incision was strongly correlated with gender, thyroid volume, neck circumference and clinical diagnosis and weakly correlated with the body mass index. Operation duration was only weakly correlated with gender and neck circumference. Multiple linear regression revealed that the set of factors assessed explained almost 60 % of the variance in incision length but only 20 % of the variance in operation duration. When patients were classified according to the distribution of their thyroid volume, cases within one standard deviation of the mean did not show a significant difference in terms of operation duration with incisions of various lengths.
Conclusions
Although thyroid volume was a major factor in driving the decision with respect to the length of the incision, our study shows that it had only minor effect on the duration of the operation. Many more open thyroidectomies could therefore be safely performed with shorter incisions, especially in women. Duration of the operation is probably more closely linked to the inherent technical difficulty of each case.
doi:10.1186/1471-2482-12-15
PMCID: PMC3447649  PMID: 22849398
4.  Developing professionalism in Italian medical students: an educational framework 
Developing and assessing professionalism in medical students is an international challenge. This paper, based on preliminary research at the Faculty of Medicine and Dentistry of the University Sapienza of Rome, Italy, briefly summarizes the main issues and experiences in developing professionalism among Italian undergraduate medical students. It concludes with a proposed framework suited to the Italian medical curricula. In our educational system, professionalism is defined as the context of medical expertise, the combination of rules, conditions, and meanings in which the act of health care occurs, as well as the ability of critical reflection on technical expertise. It is a multidimensional construct of ethical, sociocultural, relational, and epistemological competencies, requiring a wide range of tools for assessment. With reference to Italian versions of validated tools of measure, vignettes, videos, and a student’s portfolio of reflective writings, this paper outlines the manner in which education for professionalism is embedded in the existing curriculum and overall framework of assessment.
doi:10.2147/AMEP.S31228
PMCID: PMC3650871  PMID: 23762002
professionalism; undergraduate medical education; tools for assessment
5.  Nulliparity enhances the risk of second primary malignancy of the breast in a cohort of women treated for thyroid cancer 
Background
Many studies have reported an increased risk of developing a second primary malignancy (SPM) of the breast in women treated for thyroid cancer. In this study, we investigated several potential risk factors for this association. The aim of this retrospective cohort study was to identify a subgroup of women surgically treated for papillary thyroid cancer that may benefit from more careful breast cancer screening.
Methods
A total of 101 women surgically treated for papillary thyroid cancer from 1996 to 2009 with subsequent follow-up were interviewed by phone regarding personal risk factors and lifestyle habits. Only 75 questionnaires could be evaluated due to a 25.7% rate of patients not retrieved or refusing the interview. Data analysis was performed using a multivariate logistic model.
Results
The standardised incidence ratio (SIR) for breast cancer was 3.58 (95% IC 1.14 - 8.37). Our data suggest a protective effect of multiparity on the development of a SPM of the breast (O.R. 0.15; 95% IC 0.25 - 0.86). Significant associations were not found with other known risk factors including Body Mass Index (BMI), age at first tumour, concurrent metabolic diseases, smoking, physical activity and familiarity.
Conclusions
This study confirms that a higher incidence of SPM of the breast is observed in women treated for papillary thyroid cancer. Additionally, this risk is increased by nulliparity, thus a strict breast screening program for nulliparous women treated for thyroid cancer may be advisable.
doi:10.1186/1477-7819-9-88
PMCID: PMC3174118  PMID: 21835042
thyroid cancer; breast cancer; second primary malignancy; risk factor

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