A service evaluation of an occupational health Covid-19 referral pathway.

BACKGROUND: A rapid management referral pathway was established by a private UK occupational health (OH) provider to offer assessments and advice on managing individual risk relating to Covid-19 in the workplace. AIMS: The aim of this service evaluation was to assess the utilization and effectiveness of the pathway in supporting referrers during a pandemic. METHODS: Referrals between March-August 2020 were analysed by date and industry to assess service utilization. A survey was sent to a convenience sample of referrers throughout this period, requesting feedback on whether the report led to a change in how the worker was managed, and whether it increased referrer confidence in managing the worker. RESULTS: Five hundred and seventy referrals were made, predominantly from wholesale and retail; professional, scientific and technical; and food and drink production. There was a small peak of referrals from manufacturing in April and a larger peak in July-August from wholesale and retail, and food and drink production. Of 166 surveys sent, 58 were completed (35% response rate). In 71% of cases, referrers indicated that the report led to change in how the worker was managed, and in 86% of cases, referrers reported being more confident in managing the worker. CONCLUSIONS: The pathway was well-utilized. OH assessments and advice have an important role to play in a pandemic, with useful impact on how workers are managed and how confident managers feel in managing workers.

[Ultrasonographic assessment and differentiation of spontaneous degenerating cystic thyroid nodules and papillary thyroid carcinomas].

Objective: To analyze the features of degenerating cystic thyroid nodules (DCTN) on conventional ultrasound and contrast-enhanced ultrasound (CEUS), and to explore the differentiation between DCTN and papillary thyroid carcinomas (PTC). Methods: A total of 46 DCTN (39 cases, including 12 males and 27 females, with an age range of 25 to 76 years) and 36 PTC (32 cases, including 8 males and 24 females, with an age range of 23 to 68 years) diagnosed via fine- needle aspiration (FNA) or surgery from February 2019 to January 2020 in the First Affiliated Hospital of Nanchang University were enrolled. The size, shape, margin, echogenicity, presence of shadowing, calcification and vascularity of DCTN and PTC were retrospectively evaluated, and 28 DCTN and 30 PTC underwent CEUS were separately analyzed and compared.The t test, χ² test or Fisher's exact test were implemented to compare the features of ultrasound among the two groups. The binary Logistic regression test was performed to determine whether the feature whose difference was statistically significant was an independent predictive risk factor. Results: A univariate analysis indicated that DCTN more frequently showed wider-than-tall shapes, marked hypoechogenicity, well-defined margin and no or dot-lined enhancement (wider-than-tall shapes: 36 vs. 17, χ2=8.511; well-defined margin: 30 vs. 15, χ2=4.523; marked hypoechogenicity: 27 vs. 9, χ2=9.310; no or dot-lined enhancement: 24 vs. 3, χ2=33.369; all P＜0.05). A multivariate analysis demonstrated that wider-than-tall shapes, well-defined margin and marked hypoechogenicity were independent predictors for DCTN (OR values were 5.204, 3.134 and 5.042, P values were 0.003, 0.031, and 0.003, respectively). Among 28 DCTN, 15 showed a decrease in mean maximum diameter (24.3±11.4 mm) with a mean time span of (18.6±10.5) months between the presence and absence of suspicious ultrasound features. Conclusions: Compared with PTC, DCTN shows the ultrasound characteristics of wider-than-tall shapes, well-defined margin, marked hypoechogenicity and no or dot-lined enhancement pattern. Ultrasound follow-up can help to identify spontaneous DCTN.