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Biomedical subjects

L MacDonald

Publications and source records attributed to L MacDonald.

44 records · Page 3Linked to original sources
PubMed1977

Behavioral therapy: its application to reduce disruptive behaviors of the elderly in nursing homes.

Nurses who care for the elderly in nursing homes and auxiliary hospitals have many goals. They provide for the health, recreational, social and emotional needs of their patients. They also strive to increase their patients' levels of self-care and self-respect. Unfortunately, because many patients exhibit disruptive behaviors--striking staff or other patients, throwing temper tantrums, lying on the floor in corridors, refusing to take medication and so on, these desirable goals cannot always be met. What nurses need, in addition to their specialized, medically oriented training, is training in a consistent strategy for handling these problems. Behavioral therapy provides this strategy.

Aged↗
PubMedDate not supplied

Fine needle aspiration biopsy of Hashimoto's thyroiditis. Sources of diagnostic error.

OBJECTIVE: To determine the accuracy of cytologic interpretation in the diagnosis of Hashimoto's thyroiditis (HT). STUDY DESIGN: At Ottawa Hospital from 1987 to 1994, 1,638 fine needle aspiration biopsies (FNABs) from thyroid were performed. HT was suggested in 184 FNAB samples taken from 157 patients. Of the 184 aspirates diagnosed with HT, 39 had corresponding surgical specimens taken from 31 patients. A retrospective review of these FNABs and surgical pathology slides formed the basis of this study. RESULTS: In 27 (69%) aspirates, HT was diagnosed on both the FNAB and surgical specimens. In 10 of 27 FNABs an associated lesion was not sampled by FNAB. In four of these 10 aspirates some of the cellular features of HT were misinterpreted, and the possibility of an associated neoplasm could not be ruled out. This resulted in four false positive diagnoses. In 12 (31%) FNABs from nine patients, the cytologic diagnosis of HT was not confirmed histologically. These cases included five Hürthle cell adenomas and one case each of follicular adenoma, nodular goiter, macrofollicular adenoma and malignant lymphoma. This resulted in five false negative diagnoses. CONCLUSION: These results support the value of FNAB in the diagnosis of HT. The presence of hyperplastic follicular cells on FNAB samples from HT may mimic a follicular neoplasm and result in a false positive interpretation. Adequate sampling of the thyroid is important, particularly when there is an associated lesion. The diagnosis of lymphocytic thyroiditis should not be made when only a few lymphocytes are present. Finally, pleomorphic Hürthle cells may be present in aspirates from Hürthle cell neoplasms and underdiagnosed as HT, especially when they are associated with a few lymphocytes.

Adult↗
PubMedDate not supplied

Nondiagnostic fine needle aspiration biopsy of the thyroid gland: a diagnostic dilemma.

OBJECTIVE: To evaluate all nondiagnostic fine needle aspiration biopsy (FNAB) specimens from the thyroid gland with subsequent histopathologic diagnoses at Ottawa Civic Hospital. The criterion for specimen adequacy used in our institution was also reexamined to determine if it was too stringent. STUDY DESIGN: Review of 114 nondiagnostic FNAB samples from 91 patients with subsequent histopathologic diagnoses formed the basis of this study. Specimen adequacy was determined by the presence of 8-10 fragments of well-preserved follicular cells on at least two smears. RESULTS: Review of the 91 surgical specimens found 50 nodular goiters, 23 follicular adenomas, 6 macrofollicular adenomas, 5 cases of thyroiditis, 5 true cysts, 1 papillary carcinoma and 1 minimally invasive follicular carcinoma. Forty-two percent of lesions showed cystic change. In addition, nine cases of papillary microcarcinoma were diagnosed. A considerable difference in the rate (22% vs. 45%) of inadequate thyroid FNAB samples was identified among different groups of physicians at our institution. CONCLUSION: Ninety-eight percent of the patients with nondiagnostic FNAB of the thyroid gland had benign lesions. This finding encouraged us to continue using our criteria for adequacy because of the importance of a negative report. The higher rate of nondiagnostic thyroid aspiration in our series may reflect the varied experience of the different aspirators at our institution and/or the cystic nature of many of the lesions.

Adenoma↗