A lateral neck mass can be the initial presentation of a papillary thyroid carcinoma. A 24-year-old female presented with a 2.0 x 2.0 cm, non-erythematous, non-tender, right lateral neck mass. A neck ultrasound showed an enlarged right jugulodigastric (Level II) lymph node and a normal-sized thyroid gland exhibiting mild parenchymal disease with no nodules. Positron emission tomography-computed tomography scan (PET-CT) showed an enlarged intensely fluorodeoxyglucose (FDG)-avid right level III lymph node, which may be primary versus metastatic. Fine-needle aspiration biopsy (FNAB) of the lymph node showed the presence of atypical cells that are highly suspicious for metastatic carcinoma. A cervical lymph node excision biopsy was performed and histopathology showed metastatic papillary thyroid carcinoma. The patient underwent total thyroidectomy with neck dissection. The final histopathologic examination of the thyroid gland revealed chronic lymphocytic thyroiditis with the lymph nodes negative for metastasis. She eventually underwent radioactive iodine ablation (RAI) with a dose of 30mCi. Post-RAI whole-body scan showed functioning thyroid tissue remnants with no distant metastasis. This case adds to the limited data that ectopic thyroid carcinoma can be present in patients who initially present with neck masses.
Thyroid Gland ; Carcinoma, Papillary

BACKGROUND

Rolling out palliative pain management had been challenging in the wards due to the hesitancy of nurses in carrying out opioid administration. Studies and daily practices in the hospital show that lack of knowledge, fear of handling opioids and low confidence are some of the barriers in managing palliative care patients efficiently. Through coaching and appropriate training, nursing knowledge, and confidence level in patient care are bolstered.

OBJECTIVE

This study determined the effect of physician’s coaching in addressing hesitancy in opioid administration among QMMC nurses involved in palliative care.

METHODS

This action research study utilized convergent parallel, mixed methods design with 28 ward nurses handling palliative care referrals. Participants were randomly assigned in the control (lecture only) and intervention (lecture with coaching) groups. Both groups answered a self-administered questionnaire and underwent interviews pre- and post-interventions. The intervention group had additional coaching prior to post-test and final interview.

RESULTS

Baseline characteristics were similar. The control (lecture only) and intervention (lecture with coaching) groups showed a significant difference in improved practices (p < 0.01) and increase in knowledge (p < 0.00) post-interventions. Qualitative analysis of post-intervention responses indicated increased confidence, reduced doubts, and a better understanding of opioid administration.

CONCLUSION

It is critical to remove the barriers to opioid administration in order to expand patients’ access to effective drugs. Increased knowledge and understanding resulted in a confident and informed attitude towards opioid administration. Continuing education with coaching can effectively minimize nurses’ hesitation to administer opioids.

Human ; Perception ; Palliative Care

BACKGROUND: The Covid-19 pandemic caused educational institutions to shift from traditional to distance learning. Higher educational institutions offering bachelor’s degrees in Physical Therapy (PT) adapted to the situation by employing various strategies to facilitate learning online. One of the strategies employed is inviting family members as simulated patients in various performance-based assessments (PBA). In the Philippines, the PT department at the University of Santo Tomas made similar changes in the delivery of its courses. Given that family members are one of the primary stakeholders of PT education, it is important to know their experience, insights, and knowledge gained about the profession of PT after playing as a simulated patient (SP) during online performance-based assessments. OBJECTIVES: This study aims to explore how family members describe their experiences playing the role of patients in PT PBAs. METHODS: This study will utilize a phenomenological explorative research design. Family members, including parents, siblings, grandparents, cousins, and household helpers who played the role of a patient in any PT PBAs such as case presentation, case discussion, and practical examination, will be invited to participate. Semi-structured one-on-one interviews will be used for data gathering. Qualitative data from interview transcriptions will be analyzed using thematic analysis using NVivo 12 plus program. EXPECTED RESULTS Family Members will offer experiences in role-playing as patients in PBAs. Main themes and findings will be generated from their sharing that will provide insights regarding the improvement of remote PT PBAs.