Cytological Results of Ultrasound-Guided Fine-Needle Aspiration Cytology for Thyroid Nodules: Emphasis on Correlation with Sonographic Findings

PURPOSE: To compare the cytological results of ultrasound-guided fine-needle aspiration (US-FNA) cytology of thyroid nodules to sonographic findings and determine whether US findings are helpful in the interpretation of cytological results. MATERIALS AND METHODS: Among the thyroid nodules that underwent US-FNA cytology, we included the 819 nodules which had a conclusive diagnosis. Final diagnosis was based on pathology from surgery, repeated FNA cytology or follow-up of more than one year. Cytological results were divided into five groups: benign, indeterminate (follicular or Hurthle cell neoplasm), suspicious for malignancy, malignant, and inadequate. US findings were categorized as benign or suspicious. Cytological results and US categories were analyzed. RESULTS: Final diagnosis was concluded upon in 819 nodules based on pathology (n=311), repeated FNA cytology (n=204) and follow-up (n=304), of which 634 were benign and 185 were malignant. There were 560 benign nodules, 141 malignant nodules, 49 nodules with inadequate results, 21 with indeterminate results, and 48 that were suspicious for malignancy. The positive and negative predictive values of the US categories were 59.1% and 97.0%, and those of the cytological results were 93.7% and 98.9%. The US categories were significantly correlated with final diagnosis in the benign (p=0.014) and suspicious for malignancy (p<0.001) cytological result groups, but not in the inadequate and indeterminate cytological results groups. The false positive and negative rates of cytological results were 1.9% and 3.2%. CONCLUSION: Sonographic findings can be useful when used alongside cytological results, especially in nodules with cytological results that are benign or suspicious for malignancy.ope

Power, empowerment, and person-centred care: using ethnography to examine the everyday practice of unregistered dementia care staff

The social positioning and treatment of persons with dementia reflects dominant biomedical discourses of progressive and inevitable loss of insight, capacity, and personality. Proponents of person-centred care, by contrast, suggest that such loss can be mitigated within environments that preserve rather than undermine personhood. In formal organisational settings, person-centred approaches place particular responsibility on ‘empowered’ direct-care staff to translate these principles into practice. These staff provide the majority of hands-on care, but with limited training, recognition, or remuneration. Working within a Foucauldian understanding of power, this paper examines the complex ways that dementia care staff engage with their own ‘dis/empowerment’ in everyday practice. The findings, which are drawn from ethnographic studies of three National Health Service (NHS) wards and one private care home in England, are presented as a narrative exploration of carers’ general experience of powerlessness, their inversion of this marginalised subject positioning, and the related possibilities for action. The paper concludes with a discussion of how Foucault’s understanding of power may help define and enhance efforts to empower direct-care staff to provide person-centred care in formal dementia care settings

Mindfulness-based coping with university life: a non-randomized wait-list-controlled pilot evaluation

The aim of this study was to explore the feasibility of implementing a new 8-week mindfulness-based programme, ‘Mindfulness-Based Coping with University Life’ (MBCUL), specifically tailored to the needs and demand of students and to explore its impact in a pilot evaluation. Participants were drawn from the University of Northampton (MBCUL N?=?10; control N?=?6). A non-randomized wait-list-controlled design was employed. Measures examined anxiety and depression, perceived stress, mindfulness and personally relevant change before and immediately after the programme. The diurnal profile of salivary cortisol and alpha-amylase level was collected for two consecutive days. No significant intergroup differences were observed on any of the measures at either time point. However, significant change was observed for the MBCUL group in terms of perceived stress (d?=?1.06; z?=??2.25, p?=?0.03), anxiety (d?=?1.04; z?=??2.14, p?=?0.03), depression (d?=?0.52; z?=??0.69, p?=?0.5) and personally relevant change (d?=?2.63; z?=??2.68, p?=?0.01), along with an increase in mindfulness (d?=?1.06; z?=??1.89, p?=?0.06). In contrast, no significant change was found in the daily profiles of cortisol and alpha-amylase. The data from this pilot tentatively suggest that MBCUL appears to be a promising programme that warrants further evaluation using a randomized study with a larger sample size