CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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Randomized Controlled Trial Multicenter Study Clinical Trial
Fetal health surveillance: a community-wide approach versus a tailored intervention for the implementation of clinical practice guidelines.
The decreased use of electronic fetal monitoring (EFM) for healthy women in labour and the increased provision of professional support to all women in labour is recommended by experts. We evaluated the effectiveness of a community-wide approach to transferring research results to practice using a regional committee, newsletter articles and annual conference presentations compared with an additional tailored hospital intervention involving workshops to enhance self-efficacy for nurses, policy review, multidisciplinary meetings, rounds and unit discussions. ⋯ The results are mixed, and the tailored intervention thus appeared to have limited effects. No association was found between the reduction in the use of EFM and an increase in nurses' time spent providing labour support.
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This article describes contemporary understanding of fine-needle aspiration (FNA) biopsy of the thyroid gland, with particular reference to its triage role in the investigation of thyroid nodules. A team approach involving the pathologist and the clinician is crucial for its success. A nonsuction technique with a 25- or 27-gauge needle is recommended. ⋯ The size of the nodule may be important in determining the need for surgery in some patients. Decisions regarding surgery that are based on the size of the nodule and the specific cytologic features are discussed. A standardized terminology for reporting is proposed.