scholarly journals Endocrine therapy in the years following a diagnosis of breast cancer: A proof of concept study using the primary care prescription database linked to cancer registration data

2019 ◽  
Vol 61 ◽  
pp. 185-189
Author(s):  
Gabrielle Emanuel ◽  
Katherine E. Henson ◽  
John Broggio ◽  
Jackie Charman ◽  
Kieran Horgan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Endocrine Therapy ◽  
Cancer Registration ◽  
Prescription Database ◽  
Proof Of Concept ◽  
Concept Study ◽  
Registration Data

scholarly journals Using in situ simulation to improve care of the acutely ill patient by enhancing interprofessional working: a qualitative proof of concept study in primary care in England

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e028572
Author(s):  
Amy Halls ◽  
Mohan Kanagasundaram ◽  
Margaret Lau-Walker ◽  
Hilary Diack ◽  
Simon Bettles
Keyword(s):  
Primary Care ◽  
Training Session ◽  
Medical Emergency ◽  
Future Research ◽  
Proof Of Concept ◽  
In Situ Simulation ◽  
Concept Study ◽  
Interprofessional Working ◽  
General Practices

ObjectiveAcutely unwell patients in the primary care setting are uncommon, but their successful management requires involvement from staff (clinical and non-clinical) working as a cohesive team. Despite the advantages of interprofessional education being well documented, there is little research evidence of this within primary care. Enhancing interprofessional working could ultimately improve care of the acutely ill patient. This proof of concept study aimed to develop an in situ simulation of a medical emergency to use within primary care, and assess its acceptability and utility through participants’ reported experiences.SettingThree research-active General Practices in south east England. Nine staff members per practice consented to participate, representing clinical and non-clinical professions.MethodsThe intervention of an in situ simulation scenario of a cardiac arrest was developed by the research team. For the evaluation, staff participated in individual qualitative semistructured interviews following the in situ simulation: these focused on their experiences of participating, with particular attention on interdisciplinary training and potential future developments of the in situ simulation.ResultsThe in situ simulation was appropriate for use within the participating General Practices. Qualitative thematic analysis of the interviews identified four themes: (1) apprehension and (un)willing participation, (2) reflection on the simulation design, (3) experiences of the scenario and (4) training.ConclusionsThis study suggests in situ simulation can be an acceptable approach for interdisciplinary team training within primary care, being well-received by practices and staff. This contributes to a fuller understanding of how in situ simulation can benefit both workforce and patients. Future research is needed to further refine the in situ simulation training session.

scholarly journals Cross-sectional study using primary care and cancer registration data to investigate patients with cancer presenting with non-specific symptoms

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033008 ◽  
Author(s):  
Clare Pearson ◽  
Veronique Poirier ◽  
Karen Fitzgerald ◽  
Greg Rubin ◽  
Willie Hamilton
Keyword(s):  
Primary Care ◽  
Cancer Diagnosis ◽  
Cross Sectional Study ◽  
Cancer Registration ◽  
Sectional Study ◽  
Cross Sectional ◽  
Site Specific ◽  
Registration Data ◽  
Referral Criteria ◽  
Specific Symptoms

IntroductionPatients presenting to primary care with site-specific alarm symptoms can be referred onto urgent suspected cancer pathways, whereas those with non-specific symptoms currently have no dedicated referral routes leading to delays in cancer diagnosis and poorer outcomes. Pilot Multidisciplinary Diagnostic Centres (MDCs) provide a referral route for such patients in England.ObjectivesThis work aimed to use linked primary care and cancer registration data to describe diagnostic pathways for patients similar to those being referred into MDCs and compare them to patients presenting with more specific symptoms.MethodsThis cross-sectional study linked primary care data from the National Cancer Diagnosis Audit (NCDA) to national cancer registration and Route to Diagnosis records. Patient symptoms recorded in the NCDA were used to allocate patients to one of two groups - those presenting with symptoms mirroring referral criteria of MDCs (non-specific but concerning symptoms (NSCS)) and those with at least one site-specific alarm symptom (non-NSCS). Descriptive analyses compared the two groups and regression analysis by group investigated associations with long primary care intervals (PCIs).ResultsPatients with NSCS were more likely to be diagnosed at later stage (32% stage 4, compared with 21% in non-NSCS) and via an emergency presentation (34% vs 16%). These patients also had more multiple pre-referral general practitioner consultations (59% vs 43%) and primary care-led diagnostics (blood tests: 57% vs 35%). Patients with NSCS had higher odds of having longer PCIs (adjusted OR: 1.24 (1.11 to 1.36)). Patients with lung and urological cancers also had higher odds of longer PCIs overall and in both groups.ConclusionsDifferences in the diagnostic pathway show that patients with symptoms mirroring the MDC referral criteria could benefit from a new referral pathway.

scholarly journals What are the implications of using individual and combined sources of routinely collected data to identify and characterise incident site-specific cancers? a concordance and validation study using linked English electronic health records data

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e037719
Author(s):  
Helen Strongman ◽  
Rachael Williams ◽  
Krishnan Bhaskaran
Keyword(s):  
Primary Care ◽  
Gold Standard ◽  
Cancer Registration ◽  
Data Sets ◽  
Death Registration ◽  
Case Definitions ◽  
Predictive Values ◽  
Site Specific ◽  
Registration Data ◽  
Electronic Health

ObjectivesTo describe the benefits and limitations of using individual and combinations of linked English electronic health data to identify incident cancers.Design and settingOur descriptive study uses linked English Clinical Practice Research Datalink primary care; cancer registration; hospitalisation and death registration data.Participants and measuresWe implemented case definitions to identify first site-specific cancers at the 20 most common sites, based on the first ever cancer diagnosis recorded in each individual or commonly used combination of data sources between 2000 and 2014. We calculated positive predictive values and sensitivities of each definition, compared with a gold standard algorithm that used information from all linked data sets to identify first cancers. We described completeness of grade and stage information in the cancer registration data set.Results165 953 gold standard cancers were identified. Positive predictive values of all case definitions were ≥80% and ≥94% for the four most common cancers (breast, lung, colorectal and prostate). Sensitivity for case definitions that used cancer registration alone or in combination was ≥92% for the four most common cancers and ≥80% across all cancer sites except bladder cancer (65% using cancer registration alone). For case definitions using linked primary care, hospitalisation and death registration data, sensitivity was ≥89% for the four most common cancers, and ≥80% for all cancer sites except kidney (69%), oral cavity (76%) and ovarian cancer (78%). When primary care or hospitalisation data were used alone, sensitivities were generally lower and diagnosis dates were delayed. Completeness of staging data in cancer registration data was high from 2012 (minimum 76.0% in 2012 and 86.4% in 2014 for the four most common cancers).ConclusionsAscertainment of incident cancers was good when using cancer registration data alone or in combination with other data sets, and for the majority of cancers when using a combination of primary care, hospitalisation and death registration data.

Multiple Primary Neoplasms in the Western Hospital Region, Scotland: A Survey Based on Cancer Registration Data

1972 ◽  
Vol 17 (4) ◽  
pp. 143-152 ◽  
Author(s):  
A. J. Haddow ◽  
J. F. Boyd ◽  
A. C. Graham
Keyword(s):  
Breast Cancer ◽  
Bilateral Breast Cancer ◽  
Cancer Registration ◽  
Multiple Primary Neoplasms ◽  
Western Hospital ◽  
Registration Data ◽  
Multiple Primaries ◽  
Multiple Primary ◽  
Primary Neoplasms ◽  
Genital Neoplasms

A study of multiple primary neoplasms in the Western Hospital Region of Scotland {which covers about 3,000,000 inhabitants) has been carried out, using cancer registration data, for the period July 1958–66. The total registrations were 61,288. (1) After elimination of doubtful cases, 428 cases of multiple primary neoplasms remained for study, 0.73 per cent of the sample. (2) Multiple primaries occurred most commonly in people in whom the first malignant lesion appeared late in life. (3) In only a few sites did the relative prevalence of cancers in the multiple primaries (M.P.) series differ from that in the single primaries (S.P.) series. The incidence of bilateral breast cancer was less than 1 per cent. This figure is much lower than those reported by other workers. About half were cases of ‘simultaneous’ bilateral breast cancer, and of the others, about one quarter occurred within one year of discovery of the first neoplasm. Genital neoplasms were very common in the female M.P. series (40%), but in males, the M.P. and S.P. series showed identical prevalence of genital neoplasms. (4) Associations between pairs of cancers sufficiently pronounced to be statistically significant were few, occurring in 4 pairs of sites in males and in 5 in females. Skin cancers featured in all male and 2 of the female pairings, and genital cancers in three female pairings. (5) There was a very marked likelihood for cancers of the larynx, uterus (all types), bladder and skin to be the first primary to appear (70% of cases or over). (6) Almost one third of second primaries occurred within a year of the first and after this the number declined rapidly. This held good when the figures were related to the number of survivors and to the number of survival-months.

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