Reliability of the ultrasound classification system of thyroid nodules in predicting malignancy

Aim: This study aims to evaluate the reliability of theUltrasound (U) Classification system in predicting thyroidmalignancy by using pathology diagnosis as the referencestandard.Methods: It was a cross-sectional study carried out atUniversiti Kebangsaan Malaysia Medical Centre (UKMMC),Malaysia. Records of patients with focal thyroid nodules onultrasound (US) for which US-guided fine needle aspirationcytology (FNAC) was performed and pathology results wereavailable, from January 2014 to May 2016 were selected forreview. Correlation of the U Classification with pathologyresults was assessed. Sensitivity, specificity, positivelikelihood ratio, negative likelihood ratio, predictive value,negative predictive value and accuracy were calculated in aconservative and non-conservative method. The thresholdfor statistical performance was set at 0.05. Eachsonographic feature was also compared with its pathologyresults.Results: A total of 91 patients with 104 nodules were eligible.12 nodules out of 104 (11.5%) were malignant. Thesensitivity, specificity, positive likelihood ratio, negativelikelihood ratio, positive predictive value, negativepredictive value and accuracy were 100%, 91.3%, 11.5, 0.0,60%, 100% and 92.3%, and 100%, 91.4%, 11.7%, 0.0, 78.6%,100% and 93.5%, for the non-conservative and conservativemethod of calculations respectively.Conclusion: The U Classification is reliable in predictingthyroid malignancy. More evidence is neverthelessnecessary for widespread adaptation and use.

Clinical Pathways: Development and Implementation at a Tertiary Hospital in Malaysia

Clinical pathways have been implemented in many healthcare systems with mix results in improving the quality of care and controlling the cost. CP is a methodology used for mutual decision making and organization of care for a well-defined group of patients within a well-defined period. In developing the CPs for a medical centre, several meetings had been carried out involving expert teams which consist of physicians, nurses, pharmacists and physiotherapists. The steps used to develop the pathway were divided into 5 phases. Phase 1: the introduction and team development, Phase II: determining the cases and information gathering, Phase III: establishing the draft of CP, Phase IV: is implementing and monitoring the effectiveness of CP while Phase V: evaluating, improving and redesigning of the CP. Four CPs had been developed: Total Knee Replacement (TKR), ST Elevation Myocardial Infarction (AMI), Chronic Obstructive Airways Diseases (COAD) and elective Lower Segment Caesarean Section (LSCS). The implementation of these CPs had supported the evidence-based medicine, improved the multidisciplinary communication, teamwork and care planning. However, the rotation of posts had resulted in lack of document ownership, lack of direction and guidance from senior clinical staff, and problem of providing CPs prior to admission. The development and implementation of CPs in the medical centre improved the intra and inter departmental communication, improved patient outcomes, promote patient safety and increased patient satisfaction. However, accountability and understanding of the CPs must be given more attention.