Purpose-To review institutional outcomes for patients treated for differentiated thyroid cancer with post-operative conformal external beam radiotherapy (EBRT).Methods-This is a single institution retrospective review of one hundred thirty-one consecutive patients with differentiated thyroid cancer who underwent EBRT between 1/1996 and 12/2005. Histologic diagnoses included 104 papillary, 21 follicular, and 6 mixed papillary-follicular. AJCC stage distribution was 2 stage III, 128 stage IVa-c, and not accessible in 1. Thirty-four (26%) patients had high-risk histology and 76 (58%) had recurrent disease. Extraglandular disease spread was seen in 126 (96%) cases, microscopically positive surgical margins in 62 (47%) and gross residual disease in 15 (11%). Median EBRT dose was 60 Gy [range: 38-72 Gy]. Fifty-seven (44%) patients were treated with IMRT to a median dose of 60 . Median follow-up was 38 months (range: 0-134).Results-Kaplan-Meier estimates of locoregional relapse free survival (LRFS), disease specific survival (DSS), and overall survival (OS) at 4 years were 79%, 76%, and 73%, respectively. On multivariate analysis, high-risk histologic features and gross residual disease predicted for inferior LRFS, while high-risk histologic features, M1 disease, and gross residual disease predicted for inferior DSS and OS. IMRT did not impact survival outcomes, but was associated with less frequent severe late morbidity (12% vs.2%).

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Background Increased documentation and charting requirements are challenging for residents, given duty hour limits. Use of mobile electronic devices may help residents complete these tasks efficiently. Objective To collect initial data on usage rates, information technology (IT) support requirements, and resident use of iPads during training. Methods In this pilot study, we provided 12 residents/fellows from various specialties at the University of Virginia with an iPad with IT support. The system used a virtual private network with access to the institution's electronic health record. Participants were allowed to develop their own methods and systems for personalized iPad use, and after 9 months they provided data on the utility of the iPad. Feedback from the IT team also was obtained. Results Average iPad use was 2.1 h/d (range, 0.5–6 h/d). The average self-reported reduction in administrative work due to the iPad was 2.7 h/wk (range, 0–9 h/wk). A total of 75% (9 of 12) of the users would recommend universal adoption among residents and fellows. More than 90% (11 of 12) of users reported the iPad would improve communication for coordination of care. A total of 68% (8 of 12) of users reported that an iPad facilitated their activities as educators of medical students and junior residents. Residents cited slow data entry into the electronic health record and hospital areas lacking Wi-Fi connectivity as potential drawbacks to iPad use. The IT team reported minimal support time for device setup, maintenance, and upgrades, and limited security risks. Conclusions The iPad may contribute to increased clinical efficiency, reduced hours spent on administrative tasks, and enhanced educational opportunities for residents, with minimal IT support.

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