Prediction mode of more than 5 central lymph nodes metastases in clinically node-negative ipsilateral papillary thyroid carcinoma with tumor size 1 to 4 cm.

According to the 2015 American Thyroid Association guidelines, either lobectomy or total thyroidectomy was recommended for patients with papillary thyroid carcinoma (PTC) of 1 to 4 cm without extrathyroidal extension and lymph node metastasis. However, lymph node metastases showed strong association with recurrence and low survival rate, especially in PTC patients with more than 5 metastatic lymph nodes. Therefore, this study aimed to investigate the predictive factors of more than 5 central lymph nodes metastases (CLNM) in PTC patients with tumor sizes of 1 to 4 cm. A total of 382 patients with clinically node-negative (cN0) ipsilateral PTC who underwent thyroidectomy with central neck dissection between January 2012 and December 2016 were retrospectively analyzed. CLNMs of >5 were found in 54 (14.1%) patients, while CLNM was detected in 230 (60.2%) patients. Multivariate logistic regression revealed age < 45 years (P < .001), male gender (P = .013), and tumor sizes of >2 cm (P = .001) as independent predictive factors of >5 CLNMs in cN0 ipsilateral PTC patients with tumor sizes 1 to 4 cm. The prediction equation (Y = 1.694 × age + 0.807 × gender + 1.190 × tumor size - 3.530) was developed, with a sensitivity (57.4%) and a specificity (80.8%), respectively, at an optimal cut-off point of -1.685. Therefore, if the predictive value was higher than -1.685 according to the equation in cN0 ipsilateral PTC patients with tumor sizes 1 to 4 cm, then total thyroidectomy might be considered.

Analysis of daily goal sheets on physician-nurse collaboration attitude.

BACKGROUND: Optimal communication and collaboration between inter-disciplinary health care providers is critical to ensuring high quality patient care. We aimed to quantify the impact on physician-nurse collaboration (PNC) of implementing daily goal sheets (DGSs) in emergency settings. METHODS: The usage of a DGS was administered in morning rounds in an emergency intensive care unit (ICU) for four consecutive months. A Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (JSAPNC) form was used before (n=113) and after (n=107) the intervention to evaluate the attitudes of PNCs from the perspective of both physicians and nurses. RESULTS: There is a significant positive relation between the attitude to PNC and the participant age, educational background, and professional rank and title before DGS application (P<0.01 for each), whereas there was no significant difference observed after the initiation of the DGS. CONCLUSIONS: The use of a DGS improves physician-nurse collaborations in emergency care settings.

Survey of attitudes and behaviors of healthcare professionals on delirium in ICU.

OBJECTIVE: To assess the medical community's awareness and practice regarding delirium in the intensive care unit (ICU). METHODS: One hundred and ten predesigned questionnaires were distributed to ICU practitioners in the affiliated hospitals of Zhejiang University. RESULTS: A total of 105 valid questionnaires were collected. Totally, 55.3% of the clinicians considered that delirium was common in the ICU. Delirium was believed to be a significant or serious problem by 70.5% of respondents, and under-diagnosis was acknowledged by 56.2% of the respondents. The incidence of ICU delirium is even more under-estimated by the pediatric doctors compared with their counterparts in adult ICU (P less than 0.05). Primary disease of the brain (agreed by 82.1% of the respondents) was believed to be the most common risk factor for delirium. None of the ICU professionals screened delirium or used a specific tool for delirium assessment routinely. The vast majority (92.4%) of respondents had little knowledge on the diagnosis and the standard treatment of delirium. CONCLUSIONS: Although delirium is considered as a serious problem by a majority of the surveyed ICU professionals, it is still under-recognized in routine critical care practice. Data from this survey show a disconnection between the perceived significance of delirium and the current practices of monitoring and treatment in ICU in China.