[Health education in radiology service: orientations for breast and thyroid aspiration puncture]. / Educação em saúde no serviço de radiologia: orientações para punção aspirativa de mama e tireóidea.

This is a convergent care research developed in a school hospital's radiology service whose purpose is to learn about the concerns and expectations of clients submitted to breast and thyroid Fine Needle Aspiration Puncture. Data collection was conducted from September 2010 to April 2011, through 10 educational meetings in the waiting room interviewing 88 clients. The results show: clients' perception of the test, cancer as a stigma and healthcare education as a confrontation strategy. In addition, they revealed fear of both the procedure and the diagnosis of cancer. Educational practice in the waiting room is a space to decrease anxiety and allows the exchange of experiences and knowledge between professional and client, it also fosters a support network among clients. It is characterized as important space of action to the nurse within radiology service.

Educação em saúde no serviço de radiologia: orientações para punção aspirativa de mama e tireóide / Educación en Salud en el Servicio de Radiología: orientaciones para punción de mama y tiroides / Health education in radiology service: orientations for breast and thyroid aspiration puncture

Trata-se de pesquisa convergente assistencial desenvolvida no Serviço de Radiologia de hospital-escola, cujo objetivo é conhecer as expectativas e dúvidas dos clientes submetidos à Punção Aspirativa por Agulha Fina de mama e tireoide. A coleta de dados ocorreu de setembro de 2010 a abril de 2011, por meio de 10 encontros educativos em sala de espera e entrevistas com 88 clientes. Os resultados apresentam: percepção dos clientes em face do exame, o câncer como estigma e a educação em saúde como estratégia de enfrentamento. Revelaram também presença de sentimento de medo do procedimento e do diagnóstico de câncer. A prática educativa em sala de espera é um espaço que minimiza a ansiedade e permite a troca de experiências e conhecimentos entre profissional e cliente, bem como favorece uma rede de apoio entre os clientes. Caracteriza-se como espaço importante de atuação do enfermeiro no Serviço de Radiologia.

Una investigación convergente asistencial desarrollada en el Servicio de Radiología del hospital docente, cuyo objetivo es conocer las dudas y expectativas de los clientes sometidos a la Punción Aspirativa por Aguja Fina de mama y tiroides. La recolección de datos se realizó desde setiembre de 2010 hasta abril de 2011, por medio de 10 encuentros educativos con formato de sala de espera y entrevistas con 88 clientes. Los resultados revelaron: la percepción de clientes antes del examen, cáncer como estigma y educación para la salud como una estrategia para confrontación. Además, se revelaron el miedo tanto al procedimiento como al diagnóstico. La práctica educativa en la sala de espera es un espacio privilegiado para disminuir la ansiedad y permite una red de apoyo entre los clientes y un campo importante para la enfermera en el servicio de radiología.

This is a convergent care research developed in a school hospital's radiology service whose purpose is to learn about the concerns and expectations of clients submitted to breast and thyroid Fine Needle Aspiration Puncture. Data collection was conducted from September 2010 to April 2011, through 10 educational meetings in the waiting room interviewing 88 clients. The results show: clients' perception of the test, cancer as a stigma and healthcare education as a confrontation strategy. In addition, they revealed fear of both the procedure and the diagnosis of cancer. Educational practice in the waiting room is a space to decrease anxiety and allows the exchange of experiences and knowledge between professional and client, it also fosters a support network among clients. It is characterized as important space of action to the nurse within radiology service.

Current recommendations for levothyroxine treatment of differentiated thyroid cancer patients are not properly implemented in clinical practice.

BACKGROUND: Levothyroxine (L-T4) treatment aims to minimize the risk of differentiated thyroid cancer (DTC) recurrence and should be tailored to patient risk stratification and potential morbidity from adverse effects. AIM: To evaluate the effectiveness of current recommendations on L-T4 treatment of DTC patients in clinical practice. MATERIAL AND METHODS: We submitted to in-person interviews and revised the charts of 139 low-risk (LR) and 57 not-low-risk (NLR) DTC patients. A second evaluation made 24-60 months after surgery reclassified 131 patients who maintained (thyroglobulin) Tg≤2 ng/dl with no evidence of relapse/recurrence as LR, whereas the remaining 65 cases were considered NLR. RESULTS: Only 27% LR patients were appropriately controlled; 18% were kept suppressed; 49% maintained serum TSH levels between 0.11-0.4 mU/l; 21% had TSH=2.5- 4.5 mU/l; and 12% TSH>4.5 mU/l. Among the NLR patients, 24 (37%) of the patients presented serum TSH levels above goal, including 13 (20%) patients with TSH>4.5 mU/l. There were 4 NLR elders whose TSH levels were kept between 0.41 and 4.5 for medical reasons; likewise, 28 NLR patients maintained with low but not undetectable serum TSH levels had cardiovascular and/or bone risk factors, but all the remaining 24 NLR patients were not adequately controlled because of poor treatment compliance. On the other hand, 45% of 152 inappropriately controlled patients presented risks for bone fractures, including 33 patients kept with low serum TSH levels without medical indication. CONCLUSION: We concluded that guidelines are not adequately applied and alternative strategies aiming to increase adherence are urgently needed for DTC patients.

Psychological well-being and quality of life in patients treated for thyroid cancer after surgery / Relación entre bienestar psicológico y calidad de vida en pacientes con tratamiento para el cáncer de tiroides con condición postquirúrgica

The main goal is to assess psychological well-being and quality of life in 75 patients with post-surgical treatment for thyroid cancer. A descriptive co relational methodology was used in order to perform this task. Psychological well-being was assessed with the index of Psychological Well-being developed by Dupuy et al., (1984) and Quality of Life was assessed with the Quality of Life Questionnaire SF-36 Health (Ware & Sherbourne, 1992). The instruments were applied to each patient during an interview. Results suggested a high, positive and directly proportional correlation between time after thyroidectomy and the degree of Psychological Well-being and Quality of Life reported by patients. Results also showed a high correlation (significant at the 99 percent level) between the two instruments used.

Se evaluó el bienestar psicológico y la calidad de vida en 75 pacientes posquirúrgicos y con tratamiento para el cáncer de tiroides. Con una metodología descriptiva correlacional. El bienestar psicológico se evaluó con el índice del Bienestar psicológico desarrollado por Dupuy et al., (1984) y la calidad de vida se evaluó con el Cuestionario de Calidad de Vida en Salud SF-36 (Ware & Sherbourne, 1992). Cada paciente se entrevistó personalmente en una sesión, en la cual se aplicaron los dos instrumentos. En los resultados se encontró una alta correlación positiva y directamente proporcional entre el tiempo después de la tiroidectomía y el grado de bienestar psicológico y calidad de vida que reportan los pacientes, también se evidenció una correlación alta (significativa al 99 por ciento) entre los dos instrumentos utilizados, en general.

Clinical predictors of quality of life in patients with initial differentiated thyroid cancers.

BACKGROUND: Patients with differentiated thyroid cancer (DTC) usually have a good prognosis. Traditionally, treatment success in patients with cancer has been evaluated by survival time. Recently, it has been observed that the diagnosis and treatment of cancer also have a strong effect on the quality of life (QOL) of these patients. OBJECTIVE: To assess the QOL of patients with DTC and its potential clinical predictors. DESIGN: Cross-sectional analysis. SETTING: A tertiary cancer institution. PATIENTS: One hundred fifty-four patients submitted to thyroidectomy (1997-2006) were evaluated using the University of Washington Quality of Life questionnaire. MAIN OUTCOME MEASURES: Descriptive analysis of the results was done, as bivariate and multivariate analyses to compare each independent variable with each of 13 QOL domains. RESULTS: Patients 45 years or younger had better recreation scores than did patients older than 45 years (P = .04). Thirty-eight patients were submitted to neck dissection. Patients submitted to modified radical neck dissection reported worse chewing and shoulder scores than did patients submitted to selective paratracheal lymph node dissection only and those without neck dissection (P = .003 and P = .004, respectively). Patients who received more than 150 mCi of radioactive iodine therapy (RIT) reported significantly worse pain, swallowing, chewing, speech, taste, anxiety, and composite scores. Comorbidities showed significant effect on recreation, activity, speech, saliva, and composite scores (P = .02, P = .046, P = .02, P = .01, and P = .008, respectively). In multivariate analysis, RIT is the only variable associated with a worse composite score (P = .003). CONCLUSION: Although QOL after treatment of thyroid cancer can be considered good for most patients, those submitted to RIT at doses higher than 150 mCi are at risk for poor QOL and, therefore, may need more intensive follow-up and treatment.