Publications by authors named "Max A Schumm"
Article Synopsis
- The study examines thyroid tumors with isolated RAS mutations, comparing their oncologic outcomes to tumors with isolated BRAF mutations using comprehensive molecular testing.
- A total of 368 patients with Bethesda III-VI thyroid nodules were reviewed, revealing that 14% had isolated RAS mutations, with a 46% malignancy rate but no instances of structural recurrence after 5 years.
- The findings suggest that isolated RAS-mutated tumors have lower aggressive characteristics, indicating that thyroid lobectomy may be an adequate treatment option for these patients.
Association of BRAF V600E Allele Frequency With Clinicopathologic Outcomes in Papillary Thyroid Cancer.
J Clin Endocrinol Metab
July 2025
Context: BRAF V600E mutation is the most common genetic driver of papillary thyroid cancer (PTC), where it is found with various allele frequency (AF), reflecting the proportion of cells carrying the mutant and wild-type gene alleles.
Objective: To determine whether BRAF V600E AF can improve prognostication and inform initial surgical management of PTC.
Methods: This retrospective cohort study (2016-2019) at UCLA Health included consecutive patients with Bethesda V/VI nodules and isolated BRAF V600E mutation who underwent surgery with histopathology showing PTC.
Article Synopsis
- Molecular testing plays a significant role in diagnosing thyroid nodules, particularly those with indeterminate cytology, but its effectiveness in predicting outcomes for nodules that are already suspicious or malignant remains uncertain.
- This study aimed to assess whether molecular profiling of Bethesda V and VI thyroid nodules can improve the prognostication of oncological outcomes and aid in determining initial treatment strategies.
- Among 105 patients studied, ThyroSeq identified genomic alterations in 95% of samples, revealing that patients classified as low risk did not experience recurrence, while those at intermediate risk had some recurrence, and high-risk patients had multiple concerning mutations.
Background And Objectives: The recent de-escalation of care for differentiated thyroid cancer (DTC) has broadened the range of initial treatment options. We examined the association between physicians' perception of risk and their management of DTC.
Methods: Thyroid specialists were surveyed with four clinical vignettes: (1) indeterminate nodule (2) tall cell variant papillary thyroid cancer (PTC), (3) papillary thyroid microcarcinoma (mPTC), and (4) classic PTC.
Background: General surgery residents commonly engage in research years after the second (Post-postgraduate year 2 [PostPGY2]) or third (PostPGY3) clinical training year. The impact of dedicated research training timing on training experience is unknown. Our aim was to examine the progression of residents' perceived meaningful operative autonomy and evaluate career satisfaction, in relation to research timing.
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- A study was conducted to analyze the perioperative risks of patients with asymptomatic or mild COVID-19 undergoing surgery, following reports of high postoperative complications in COVID-19 patients.
- The research included 53 patients diagnosed with mild COVID-19 within 8 days of surgery, focusing on 30-day mortality and complications, resulting in a 0% mortality rate.
- The findings suggested that patients with mild or asymptomatic COVID-19 have low risks for postoperative morbidity and mortality, implying that surgery might be safe if the benefits outweigh the risks.
Article Synopsis
- * Conducted at a tertiary referral center, the trial included 102 adults who underwent surgery and recorded their pain levels and medication use over a week.
- * Results showed the opt-in group had similar pain levels compared to those who received routine prescriptions, suggesting a safe way to reduce opioid consumption post-surgery.
Longitudinal Assessment of Quality of Life Following Molecular Testing for Indeterminate Thyroid Nodules.
Ann Surg Oncol
December 2021
Article Synopsis
- Molecular testing for thyroid nodules can help determine cancer risk and reduce unnecessary surgeries, but its impact on patients' quality of life (QOL) is not well understood.
- This study evaluated QOL in patients with benign and suspicious test results, finding that those with benign results maintained stable QOL during surveillance, while those with suspicious results improved post-surgery.
- Overall, benign test results do not increase anxiety or depression, and surgery can enhance QOL for patients with suspicious results.
Article Synopsis
- Molecular testing is increasingly used to help diagnose indeterminate thyroid nodules, and this study compares the costs of two testing strategies: reflexive vs. selective.
- A Markov model was used to analyze the costs associated with both strategies, revealing that the average cost per patient was higher in the reflexive approach ($8,045) compared to the selective approach ($6,090).
- The study concludes that while reflexive testing is more expensive, it prevents unnecessary surgeries, leading to a significant cost savings of approximately $20,600 for each avoided thyroid lobectomy.
Article Synopsis
- The study investigated the effectiveness of recombinant human TSH (rhTSH) compared to thyroid hormone withdrawal (THW) in children and adolescents under 21 years old with differentiated thyroid cancer (DTC) after total thyroid removal.
- Sixteen patients treated with rhTSH were compared to 29 historical controls receiving THW, measuring factors like serum TSH levels and disease progression over a median follow-up of 2.4 years.
- Results indicated no significant differences in oncologic outcomes between the two groups, suggesting rhTSH may be as effective as THW for this patient population.
Article Synopsis
- The COVID-19 pandemic has led to a shortage of personal protective equipment, prompting hospitals to explore reprocessing methods for N95 respirators.
- A systematic review evaluated the effectiveness and feasibility of various decontamination processes for N95 respirators, focusing on UV irradiation, vaporized hydrogen peroxide, moist-heat incubation, microwave-generated steam, and ethylene oxide.
- The review analyzed 42 laboratory studies, concluding that both UV irradiation and vaporized hydrogen peroxide effectively sterilized respirators, with specific dosage recommendations for optimal pathogen reduction without damaging the masks.
Objective: To determine the frequency of levothyroxine (LT4) supplementation after therapeutic lobectomy for low-risk differentiated thyroid cancer (DTC).
Methods: This retrospective cohort study enrolled adult patients with low-risk DTC confirmed using surgical pathology who underwent therapeutic lobectomy at a single institution from January 2016 through May 2020. The outcome measures were postoperative serum thyroid-stimulating hormone (TSH) levels and the initiation of LT4.
Quality of Life Following Molecular Marker Testing for Indeterminate Thyroid Nodules.
Endocr Pract
September 2020
Article Synopsis
- Thyroid cancer negatively impacts quality of life (QOL) more than other cancers with worse prognoses, and the effects of indeterminate thyroid nodules on QOL were previously unexplored.
- The study assessed patients with indeterminate biopsy results using a short Thyro-39 questionnaire, revealing that 44.4% of the 825 participants completed it, with notable findings on their symptoms.
- Results showed that patients with benign molecular test results reported better QOL compared to those with suspicious results, particularly regarding symptoms of goiter and depression, indicating that benign results may help alleviate anxiety about malignancy.
Article Synopsis
- In response to the COVID-19 pandemic, this study evaluated patient satisfaction with postoperative telemedicine versus in-person visits after thyroid and parathyroid surgery.
- The research included 45 telemedicine and 32 in-person encounters, with both groups reporting similar high satisfaction ratings around 9.7 to 9.8 out of 10.
- Results indicated that patients experienced excellent communication with their surgeons, showing no significant difference between telemedicine (83%) and in-person visits (86%), while the use of telemedicine in endocrine surgery increased dramatically during the study period.
Article Synopsis
- Thyroid surgeons are shifting towards less aggressive management for low-risk thyroid conditions to avoid overdiagnosis, which requires strong communication skills to explain rationale to patients.
- A study involving 107 adult patients assessed communication skills using the Makoul Communication Assessment Tool, revealing that 23% of patients fell into the low-outlier group for communication effectiveness.
- The overall communication scores were high, but the study highlighted a particular concern where 29% of patients felt doctors did not encourage them to ask questions, indicating areas for potential improvement.
Background: Nonoperative management (NOM) of uncomplicated appendicitis has gained recognition as an alternative to surgery. In the largest published randomized trial (Appendicitis Acuta), patients received a 3-d hospital stay for intravenous antibiotics; however, cost implications for health care systems remain unknown. We hypothesized short stay protocols would be cost saving compared with a long stay protocol.
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