Background: Fine-needle aspiration biopsy (FNAB) is the most accurate and cost-effective method to evaluate thyroid nodule for possible malignancy. However, an adequate specimen is required for proper examination by a pathologist. Rapid on-site evaluation (ROSE), a service typically provided by pathologists, is the real-time evaluation for adequacy of FNAB smears which can help improve adequacy rates by allowing the submission of additional thyroid samples when the submitted samples are inadequate. This study aims to investigate if ROSE done by trained Endocrinologists can improve specimen adequacy in our patients. Methods: A total of 192 patients were included in this study and were divided in two groups: a ROSE group (n=96) and a non-ROSE group (n=96). In the ROSE group, the smear of thyroid aspirate was evaluated for adequacy by a trained Endocrinologist in real time. In the non-ROSE group, specimens are directly sent to the Pathologist. Results: ROSE done by Endocrinologists had 94% sensitivity, 46% specificity and 82% accuracy compared to a Pathologist. The adequacy rate under the ROSE group was 84.38% and 81.25% in non-ROSE group. Conclusion Our study showed that ROSE can improve adequacy rate in our center. ROSE can also be used by physicians in the provinces who are performing FNAB of the thyroid without ultrasound guidance to improve specimen adequacy and lessen repeat biopsy.
Rapid On-site Evaluation

Blood from 2100 women attending the antenatal clinic of the Port Moresby General Hospital (PMGH) and the 9 Mile urban clinic of Port Moresby was tested for syphili using the laboratory-based Venereal Disease Research Laboratory (VDRL) syphilis serology test and two clinic-based syphilis tests, Abbot Determine and Abbot Syfacard-RR (Rapid Plasma Reagin (RPR) card test). The Abbot Determine and the Syfacard-R tests were compared with the VDRL test, the gold standard in this study. The validation test results of Determine versus VDRL were as follows: sensitivity 92.0%; specificity 94.6%; the predictive value of a positive test 42.6%; and the predictive value of a negative test 99.6%. The validation tests for RPR versus VDRL were as follows: sensitivity 56.3% specificity 96.5%; predictive value of a positive test 41.2%; and the predictive value of a negative test 98.1%. The RPR test costs 3.5 kina (about one US dollar) a test, the VDRL less than 1 kina a test whilst the Determine test kit costs about 5 kina a test. When laboratory time, salaries and other supplies are costed the Determine test is expected to cost relatively much less. Our recommendation is that the Determine test be made available in areas of the country where VDRL is unavailable or where logistics do not allow for test results to be available early enough to make a difference to the care of th pregnant woman and her fetus.
VDRL test ; Rapid plasma reagin ; predictive ; Clinic ; Rapid

A 20-years-old man was referred to our hospital in September 2003. He complained of fatigue and headache at the time of getting up, daytime sleepiness, sudden sleep attacks and dozing off at the wheel. He became aware of insomnia at night and severe sleepiness in the daytime at the age of 13. Since he was 17 years old, he had been seized with an uncontrollable desire for sleep. The total night's sleep has often been reduced to two hours at the longest, interrupted by arousal 10 times (maximal) since he got a job. His Epworth Sleepiness Scale was 13 points. In polysomnography, the first REM period occurred immediately after onset of sleep, and the apnea-hypopnea index was 1.0 per hour. In multiple sleep latency tests, his sleep latency and REM latency were less than 2 minutes. The sleep onset REM period was found in all sessions of MSLT. HLA-DR2 and HLA-DQ1 were positive. His case was diagnosed as narcolepsy, and methylphenidate was taken in the morning and at noon, and naps were taken in the morning and in the afternoon, and the sleep diary was started. The times of daytime's naps and sleep attacks decreased, and his condition was improved.
Sleep ; rapid eye movement ; Narcolepsy ; seconds ; night

Carcinosarcoma of the bladder is a rare malignancy characterized by an intimate admixture of malignant epithelial elements (carcinoma) and malignant soft tissue elements (sarcoma). Patients with carcinosarcoma usually present with high-stage malignancy. Cystectomy or transurethral resection of the bladder tumor (TUR-Bt) is the preferred treatment, often followed by radiation therapy, but the prognosis is very poor1-7). To our knowledge, almost 80 cases have been reported in Japan, usually as case reports or small series6, 7). In almost all cases, the chief complaint was gross hematuria. We herein report a case of carcinosarcoma of the urinary bladder in a patient whose chief complaint was abdominal pain. His pain worsened, and the occurrence of hydronephrosis indicated that extremely rapid tumor growth may have occurred. No evidence of recurrence was noted 30 months after the performance of cystectomy.
Carcinosarcoma ; Bladder ; Malignant Neoplasms ; Rapid ; Case Report

Humans ; Hospital Rapid Response Team ; Attitude of Health Personnel ; Perception

A cross-sectional study was conducted on 116 male pre-cast construction workers in Sipitang, Sabah to evaluate the association between Ergonomic Risk Level exposure and their working performances for 6 months (June to November 2014). Initially, a structured interview using a modified-Standardized Nordic Questionnaire was conducted on each study subject to determine the prevalence of Musculoskeletal Disorders (MSDs). The results showed that 93 out of 116 subjects (80.17%) complained of experiencing ache, pain or body discomfort during and after work with high percentage of MSDs prevalence affecting the wrist (78.5%), shoulder (73.1%), and lower leg (71.0%) regions of the body. Pictures and videos of workers performing their routine tasks were analyzed using Rapid Entire Body Assessment (REBA) tool to generate individual Ergonomic Risk Level classification. The results showed that all subjects were exposed to Medium (56.90%), High (29.31%) and Very High (13.79%) level of Ergonomic Risk. Pearson Correlation and One-way ANOVA test was conducted to determine the association between Ergonomic Risk Level and the subjects’ individual working performances. The results indicated that there was a significant negative association between Ergonomic Risk Level and the workers' performances in terms of tendency to work overtime (p<.001, r=-.55) and the frequency of taking unpaid leaves (p=.038, r=.56). In conclusion, continuous exposure to significant Ergonomic Risk Level among the pre-cast construction workers has triggered the development of MSDs which eventually affected their working performances.
Pre-cast construction ; Ergonomic Risk Level ; Rapid Entire Body Assessment ; Musculoskeletal Disorders ; Working Performances.

BACKGROUND: A rapid response system (RRS) aims to prevent unexpected patient death due to clinical errors and is becoming an essential part of intensive care. We examined the activity and outcomes of RRS for patients admitted to our institution's department of internal medicine. METHODS: We retrospectively reviewed patients detected by the RRS and admitted to the medical intensive care unit (MICU) from October 2012 through August 2013. We studied the overall activity of the RRS and compared patient outcomes between those admitted via the RRS and those admitted conventionally. RESULTS: A total of 4,849 alert lists were generated from 2,505 medical service patients. The RRS was activated in 58 patients: A (Admit to ICU), B (Borderline intervention), C (Consultation), and D (Do not resuscitate) in 26 (44.8%), 21 (36.2%), 4 (6.9%), and 7 (12.1%) patients, respectively. Low oxygen saturation was the most common criterion for RRS activation. MICU admission via the RRS resulted in a shorter ICU stay than that via conventional admission (6.2 vs. 9.9 days, p = 0.018). CONCLUSIONS: An RRS can be successfully implemented in medical services. ICU admission via the RRS resulted in a shorter ICU stay than that via conventional admission. Further study is required to determine long-term outcomes.
Hospital Rapid Response Team ; Humans ; Critical Care ; Intensive Care Units ; Internal Medicine* ; Oxygen ; Retrospective Studies

INTRODUCTION: Evidence regarding the efficacy of high-flow nasal cannula (HFNC) oxygenation for preoxygenation and apnoeic oxygenation is conflicting. Our objective is to evaluate whether HFNC oxygenation for preoxygenation and apnoeic oxygenation maintains higher oxygen saturation (SpO₂) during rapid sequence intubation (RSI) in ED patients compared to usual care. METHODS: This was a multicentre, open-label, randomised controlled trial in adult ED patients requiring RSI. Patients were randomly assigned 1:1 to either intervention (HFNC oxygenation at 60L/min) group or control (non-rebreather mask for preoxygenation and nasal prongs of at least 15L/min oxygen flow for apnoeic oxygenation) group. Primary outcome was lowest SpO₂ during the first intubation attempt. Secondary outcomes included incidence of SpO₂ falling below 90% and safe apnoea time. RESULTS: One hundred and ninety patients were included, with 97 in the intervention and 93 in the control group. Median lowest SpO₂ during the first intubation attempt was 100% in both groups. Incidence of SpO₂ falling below 90% was lower in the intervention group (15.5%) compared to the control group (22.6%) (adjusted relative risk=0.68, 95% confidence interval [CI] 0.37-1.25). Post hoc quantile regression analysis showed that the first quartile of lowest SpO₂ during the first intubation attempt was greater by 5.46% (95% CI 1.48-9.45%, P=0.007) in the intervention group. CONCLUSION Use of HFNC for preoxygenation and apnoeic oxygenation, when compared to usual care, did not improve lowest SpO₂ during the first intubation attempt but may prolong safe apnoea time.
Adult ; Cannula ; Emergency Service, Hospital ; Humans ; Intubation, Intratracheal ; Rapid Sequence Induction and Intubation ; Respiration, Artificial

BACKGROUND: Rapid on-site evaluation (ROSE) is a technique used for simultaneous evaluation of biopsy specimens through rapid cytology staining. Diff-Quik (DQ) staining is the most commonly employed method for cytological rapid on-site evaluation (C-ROSE). However, the utilization of DQ staining for on-site cytological interpretation remains uncommon among pathologists in China, posing challenges to the implementation of C-ROSE. This study aims to assess the application of rapid hematoxylin-eosin (HE) staining and DQ staining for C-ROSE during percutaneous needle biopsy of peripheral lung cancer and evaluate the value of rapid HE staining in C-ROSE. METHODS: Computed tomography (CT)-guided lung biopsies were conducted on 300 patients diagnosed with peripheral lung cancer. The patients were randomly assigned to two groups for C-ROSE using either rapid HE staining or DQ staining, and subsequently the two methods were compared and evaluated. RESULTS: The concordance rate between C-ROSE and histopathological diagnosis was 96.7%. The median staining time for rapid HE staining was 160 s, while that for DQ staining was 120 s, representing a significant difference between the two groups (P<0.001). However, there were no significant differences observed in terms of total biopsy time, concordance rate with histopathology, cytology specimen peeling rate, and incidence of serious adverse reactions between the two groups (P>0.05). CONCLUSIONS Both staining methods comply with C-ROSE criteria in the biopsy setting of peripheral lung cancer. Rapid HE staining is more aligned with domestic clinical requirements and holds potential for further promotion and adoption in C-ROSE.
Humans ; Lung Neoplasms/pathology* ; Eosine Yellowish-(YS) ; Rapid On-site Evaluation ; Biopsy, Needle/methods* ; Staining and Labeling

PURPOSE: A review was performed to determine the frequency of activating medical emergency teams (MET) in surgical wards, so that resource allocation could be optimized.METHODS: A retrospective observational study was performed to determine the time and frequency when MET were deployed (N = 465) to patients (n = 387) who were admitted to the surgical ward, from March 2013 to July 2016 due to emergency situations.RESULTS: Of the 465 MET activations, 8 did not incur any further intervention. The review showed an average of 151 minutes from onset of symptoms to MET activation, and an average of 110 minutes until intervention (additional diagnosis / treatment). The number of MET activations increased year by year from 2013 to 2016. The transfer of patients to the intensive care units also increased from 34 in 2013, to 82 in 2016. The lowest number of MET activations occurred between 04:00 and 05:00, but there was no difference in the number of MET activations between day and night. However, MET activation in response to acute respiratory distress was significantly higher during the nighttime (p = 0.003).CONCLUSION: Patients admitted to a surgical ward have more serious complications. This study showed that the use of MET in surgical wards has increased year by year, and the frequency of calls between day and night was not different, except higher MET activations observed at night in patients with acute respiratory distress.
Diagnosis ; Emergencies ; Hospital Mortality ; Hospital Rapid Response Team ; Humans ; Intensive Care Units ; Observational Study ; Resource Allocation ; Retrospective Studies