In Taiwan a certification program on the

In Taiwan, a certification program on the quality of cancer care in hospitals was initiated by the National Health Research Institutes in 2008. Establishing MDTs for cancer care is required for certification. The results of certification are available on a website for public access and influence national health insurance payments by the government. At Taipei Veterans General Hospital, Taipei, Taiwan an MDT for colorectal cancer was established in October 2007. The core members are surgeons, medical oncologists, nadph oxidase oncologists, pathologists, diagnostic and interventional radiologists, nurse specialists, and coordinators. Regular weekly group meetings are held for treatment planning. Initially, the group included colorectal and hepatobiliary surgeons as team members, and because of an increase in treatment demands for pulmonary metastatic lesions, thoracic surgeons have been included since October 2011.
Conclusion
Introduction Mineral dysfunction and hyperparathyroidism are common complications of end-stage renal disease (ESRD). The prevalence of renal hyperparathyroidism among dialysis populations ranges from 12% to 54%. Elevated levels of parathyroid hormone (PTH) are associated with several inflammatory markers. For patients with severe uncontrollable hyperparathyroidism, parathyroidectomy may improve overall survival, bone mineral density (BMD), and quality of life as well as alleviate symptoms and fracture nonunion. In the United States, the rate of parathyroidectomy declined between 1988 and 1998 but increased thereafter, despite advances in medical treatment. For patients requiring renal replacement therapy, no clear survival benefit exists for hemodialysis or peritoneal dialysis. Nonetheless, dialysis modalities significantly influence hemoglobin, ferritin, albumin, cholesterol, and PTH levels. Some studies have shown that the prevalence of adynamic bone disease is consistently higher in peritoneal dialysis patients than in hemodialysis patients. To our knowledge, no study has compared the effects of dialysis modality on surgical patients with renal hyperparathyroidism. This study evaluated the influence of different dialysis modalities on perioperative features among patients undergoing parathyroidectomy for renal hyperparathyroidism.
Methods From January 2004 to December 2014, 389 consecutive ESRD patients underwent initial parathyroidectomy for renal hyperparathyroidism at a tertiary care center. Three patients younger than 20 years were excluded. Overall, 386 patients who had biochemically confirmed renal hyperparathyroidism comprised the study population. The indication for parathyroidectomy was severe hyperparathyroidism associated with hypercalcemia and/or hyperphosphatemia disruptive selection was refractory to medical therapy. Serum calcium, phosphate, total alkaline phosphatase, albumin, and intact PTH levels (1–84) were regularly monitored preoperatively and during follow-up. Most referring dialysis centers examined electrolytes on a monthly basis and alkaline phosphatase and PTH levels at 3-month intervals. When the serum albumin level was <4.0 g/dL, serum calcium levels were corrected using the following formula: BMD at the lumbar spine and hip was measured using dual-energy X-ray absorptiometry. After August 2008, the serum aluminum level was determined preoperatively and/or within 1 week after surgery. All operations were performed or supervised by board-certified endocrine surgeons. Bilateral cervical exploration was followed by subtotal parathyroidectomy or total parathyroidectomy with or without autotransplantation; the decision was at the discretion of the operating surgeon. After parathyroidectomy, persistent disease was defined as any measurement of an intact PTH level >300 pg/mL in the postoperative 6 months. Recurrence was defined as any measurement of an intact PTH level >300 pg/mL beyond 6 months after surgery. After August 2008, the Parathyroidectomy Assessment of Symptoms (PAS) questionnaire was used to assess relevant symptoms preoperatively and 6–12 months after the surgery. The PAS scoring system addresses 13 parameters: pain in the bones, feeling tired easily, mood swings, feeling “blue” or depressed, pain in the abdomen, feeling weak, feeling irritable, pain in the joints, being forgetful, difficulty getting out of a chair or car, headaches, itchy skin, and being thirsty. Each item was scored on a 100-point visual analog scale, and the PAS score was calculated as the sum of all 13 answers (range, 0–1300). The reliability and validity of the Taiwan Chinese-translated version were established in our previous study.