Effects of Rapid On-Site Evaluation on Diagnostic Accuracy of Thyroid Fine-Needle Aspiration.

INTRODUCTION: Fine-needle aspiration (FNA) is well-established for the evaluation of suspicious thyroid nodules. However, a significant proportion is nondiagnostic. Rapid on-site evaluation (ROSE) has been proposed to improve the overall adequacy of FNA. METHODS: Retrospective cohort study comparing adequacy of thyroid FNA findings pre- and postimplementation of ROSE at a tertiary center in Switzerland. Patients undergoing thyroid FNA from January 2016 to December 2019 were included. The primary outcome was the rate of nondiagnostic findings (Bethesda System for Reporting Thyroid Cytopathology category I). RESULTS: In total, 410 thyroid nodule FNAs were performed. Of those, 309 with standard FNA and 101 with ROSE. The majority of patients were female (71%), with a median age of 56 years (IQR 46-68) and a nodule diameter of 1.9 cm (IQR 1.2-2.9). Implementation of ROSE led to a decrease in nondiagnostic findings from 41.1% to 23.8%, with an odds ratio of 0.42 (95% CI: 0.24-0.72; p = 0.002). Implementation of ROSE was associated with significantly higher rates of Bethesda category III (27.7% vs. 19.1%), category IV (15.8% vs. 5.5%), and Bethesda category VI (6.9% vs. 2.3%). Repeated FNA was performed in 29.1% before and 20.8% after implementation of ROSE (p = 0.18). The mean number of FNA per nodule was reduced from 1.4 (0.6) to 1.2 (0.4) with ROSE (p = 0.04). CONCLUSIONS: Implementation of ROSE of thyroid nodule specimen improved diagnostic adequacy of FNA, reducing nondiagnostic findings. However, due to increased equivocal findings (Bethesda category III), there was no significant reduction of repeat FNA.

[How does Home Treatment Work out in Practice? A Qualitative Study Among Patients, Relatives, and Staff]. / Wie gelingt Home Treatment in der Praxis? Eine qualitative Studie unter Einbezug von Patienten, Angehörigen und Mitarbeitenden.

OBJECTIVE: To identify effective components of home treatment (HT) and to evaluate the implementation of a new HT team from a service user perspective. METHODS: Experiences of patients, relatives and staff were assessed using semi-structured interviews and an online questionnaire. Thematic analysis was applied to determine key themes. RESULTS: 25 interviews and 70 questionnaires were analysed. Four key themes emerged: individualisation, proximity to daily life, conceptual aspects, and requirements (for patients and for the service model). Major challenges for the implementation of HT were the suitability for HT, time of referral to HT, and handing over of responsibility from hospital staff to the HT team. CONCLUSION: Essential requirements for HT are no-harm agreements, patients' ability to maintain daily routines, and shared responsibility between patients and staff. Implementing HT within an existing care system should be accompanied by sufficient information on the new service model for other service providers involved. This may be achieved through HT team members visiting hospital wards and outpatient facilities, illustrating functioning and limitations of HT using case reports.