scholarly journals Quality of the diagnostic process in patients presenting with symptoms suggestive of bladder or kidney cancer: a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e029143 ◽  
Author(s):  
Yin Zhou ◽  
Marije van Melle ◽  
Hardeep Singh ◽  
Willie Hamilton ◽  
Georgios Lyratzopoulos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urinary Tract ◽  
Kidney Cancer ◽  
Cancer Diagnosis ◽  
Data Extraction ◽  
Diagnostic Delay ◽  
Diagnostic Process ◽  
Tract Infections ◽  
Sex Disparity

ObjectivesIn urological cancers, sex disparity exists for survival, with women doing worse than men. Suboptimal evaluation of presenting symptoms may contribute.DesignWe performed a systematic review examining factors affecting the quality of the diagnostic process of patients presenting with symptoms of bladder or kidney cancer.Data sourcesWe searched Medline, Embase and the Cochrane Library from 1 January 2000 to 13 June 2019.Eligible criteriaWe focused on one of the six domains of quality of healthcare: timeliness, and examined the quality of the diagnostic process more broadly, by assessing whether guideline-concordant history, examination, tests and referrals were performed. Studies describing the factors that affect the timeliness or quality of the assessment of urinary tract infections, haematuria and lower urinary tract symptoms in the context of bladder or kidney cancer, were included.Data extraction and synthesisData extraction and quality assessment were independently performed by two authors. Due to the heterogeneity of study design and outcomes, the results could not be pooled. A narrative synthesis was performed.Results28 studies met review criteria, representing 583 636 people from 9 high-income countries. Studies were based in primary care (n=8), specialty care (n=12), or both (n=8). Up to two-thirds of patients with haematuria received no further evaluation in the 6 months after their initial visit. Urinary tract infections, nephrolithiasis and benign prostatic conditions before cancer diagnosis were associated with diagnostic delay. Women were more likely to experience diagnostic delay than men. Patients who first saw a urologist were less likely to experience delayed evaluation and cancer diagnosis.ConclusionsWomen, and patients with non-cancerous urological diagnoses just prior to their cancer diagnosis, were more likely to experience lower quality diagnostic processes. Risk prediction tools, and improving guideline ambiguity, may improve outcomes and reduce sex disparity in survival for these cancers.

scholarly journals Quality of the Diagnostic Process, Treatment Decision, and Predictors for Antibiotic Use in General Practice for Nursing Home Residents with Suspected Urinary Tract Infection

Antibiotics ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 316
Author(s):  
Stine Dyhl Sommer-Larsen ◽  
Sif Helene Arnold ◽  
Anne Holm ◽  
Julie Aamand Olesen ◽  
Gloria Cordoba
Keyword(s):  
General Practice ◽  
Nursing Home ◽  
Urinary Tract ◽  
Urine Culture ◽  
Treatment Decision ◽  
Antibiotic Use ◽  
Diagnostic Process ◽  
Urinary Tract Symptoms ◽  
Tract Infections

Urinary tract infections (UTIs) are common in nursing home (NH) residents and Denmark is one of the countries with the highest antibiotic use in NHs. The aim of this study was to assess the quality of the diagnostic process and treatment decision on the day of the first contact from NHs to general practice and assess predictors for prescription of antibiotics in NH residents without an indwelling urinary catheter. The study was a prospective observational study in general practice in the Capital Region of Denmark; 490 patients were included; 158 out of 394 (40.1%, 95% CI 35; 45) patients with suspected UTI had urinary tract symptoms; 270 out of 296 (91.2%, 95% CI 87; 94) patients without urinary tract symptoms had a urine culture performed. Performing urine culture in the general practice was inversely associated to prescription of antibiotics on day one (OR 0.27, 95% CI 0.13; 0.56). It is imperative to support the implementation of interventions aimed at improving the quality of the diagnostic process on day one, as less than half of the patients given the diagnosis “suspected UTI” had urinary tract symptoms, and most patients without urinary tract symptoms had a urine culture performed.

scholarly journals Physician Associate/Assistant Impacts on Cancer Diagnosis in Primary Care: A Systematic Review

2021 ◽  
Author(s):  
Jessica Sheringham ◽  
Angelos Kassianos ◽  
Ruth Plackett ◽  
Anwar Khan ◽  
Angela King ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Cancer Diagnosis ◽  
Diagnostic Tests ◽  
Primary Care Physicians ◽  
Physician Assistants ◽  
Diagnostic Process ◽  
Advisory Group ◽  
And Performance

Abstract Background: Symptom recognition and timely referral in primary care are crucial for the early diagnosis of cancer. Physician assistants or associates (PAs) have been introduced in 15 healthcare systems across the world, with numbers increasing to address primary care physician shortages. Little is known about their impact on suspected cancer recognition and referral. This review sought to summarise findings from international observational studies on PAs’ competence and performance on processes concerned with the quality of recognition and referral of suspected cancer in primary care. Method: A rapid systematic review of international peer-reviewed literature was performed (PROSPERO reference: CRD42019154114). Searches were undertaken on OVID, EMBASE, Web of Science, and CINAHL databases (2009-2019). Studies were eligible if they reported on PA skills, processes and outcomes relevant to suspected cancer recognition and referral. Title and abstract screening was followed by full paper review and data extraction. synthesis of qualitative and quantitative findings was undertaken on three themes: deployment, competence, and performance. Preliminary findings were discussed with an expert advisory group to inform interpretation. Results: From 876 references, 15 eligible papers were identified, of which 13 were from the USA. Seven studies reported on general clinical processes in primary care that would support cancer diagnosis, most commonly ordering of diagnostic tests (n=6) and referrals to specialists (n=4). Fewer papers reported on consultation processes, such as examinations or history taking (n=3) Six papers considered PAs’ competence and performance on cancer screening. PAs performed similarly to primary care physicians on rates of diagnostic tests ordered, referrals and patient outcomes (satisfaction, malpractice, emergency visits). No studies reported on the timeliness of cancer diagnosis. Conclusion: This review of peer-reviewed literature combined with advisory group interpretation suggests the introduction of PAs into primary care may maintain the quality of referrals and diagnostic tests needed to support cancer diagnosis. It also highlights the lack of research on several aspects of PAs’ roles, including outcomes of the diagnostic process.

scholarly journals Factors Affecting Diagnostic Timeliness and Safety in Symptomatic Patients Subsequently Diagnosed With Bladder and Kidney Cancer: A Systematic Review

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 40s-40s
Author(s):  
Y. Zhou ◽  
M. van Melle ◽  
G. Lyratzopoulos ◽  
F. Walter
Keyword(s):  
Systematic Review ◽  
Urinary Tract ◽  
Early Diagnosis ◽  
Kidney Cancer ◽  
Diagnostic Delay ◽  
Nice Guidelines ◽  
Targeted Interventions ◽  
Timely Diagnosis ◽  
Urological Cancers ◽  
System Factors

Background: Timely diagnosis of cancer is important for good clinical outcomes and patient experience. Bladder and kidney cancer, being two relatively common cancers, can pose diagnostic challenges. Symptoms such as hematuria and urinary tract infections in some patients have a higher than 3% positive predictive value for cancer, a threshold above which English GPs are advised to consider the referral of patients for, under the 2015 NICE guidelines. However, the majority of patients with these symptoms will end up not having cancer. Therefore, the decision to perform further investigations or refer patients with these common urinary symptoms may differ despite the existence of guidelines. Studying in whom, and why, some patients may experience a longer than average time to diagnosis is important to understanding how avoidable diagnostic delay can be reduced, so that targeted interventions to improve early diagnosis can be developed to improve, ultimately, the outcome of these cancers. Aim: A systematic review was therefore performed to identify the factors that affect the diagnostic timeliness and safety of patients with urological symptoms that may be suggestive of kidney and bladder cancer. Methods: We searched Embase and Medline (Ovid) between 2000 and January 2018, for publications on symptoms/conditions including hematuria and urinary tract infection (UTI). We focused on clinical features that are listed in the English 2015 NICE guidelines for suspected cancer to examine the population that are most likely to have cancer, and in whom a timely diagnosis is the most crucial for outcomes. We also included symptoms that might be suggestive of a UTI (including dysuria, urinary frequency, urgency, incontinence and nocturia) to be overinclusive in our search. Results: Our initial search identified 7787 articles. Following title and abstract screening, 37 full texts were assessed for eligibility. A final 23 relevant studies were included. Our preliminary findings include evidence on patient, clinician and system factors contributing to diagnostic timeliness and safety issues (such as completeness of evaluation/investigations and referrals) in patients with possible urological cancer. These include patient sociodemographic factors (age, gender, ethnicity), clinician type (generalist, urologist vs gynecologist) and experience, and system factors such as delay in specialist appointment scheduling and patient no-shows. Conclusion: Our findings will provide a granular understanding of the factors contributing to avoidable diagnostic delay of patients with possible urological cancers globally. This is particularly important so that targeted interventions can be developed to help clinicians and health systems to better identify and manage at-risk patients with symptoms, so as to improve early diagnosis and outcomes of urological cancers.

scholarly journals Physician associate/assistant contributions to cancer diagnosis in primary care: a rapid systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jessica Sheringham ◽  
Angela King ◽  
Ruth Plackett ◽  
Anwar Khan ◽  
Michelle Cornes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Cancer Diagnosis ◽  
Diagnostic Tests ◽  
Primary Care Physicians ◽  
Physician Assistants ◽  
Diagnostic Process ◽  
Advisory Group ◽  
And Performance

Abstract Background Symptom recognition and timely referral in primary care are crucial for the early diagnosis of cancer. Physician assistants or associates (PAs) have been introduced in 18 healthcare systems across the world, with numbers increasing in some cases to address primary care physician shortages. Little is known about their impact on suspected cancer recognition and referral. This review sought to summarise findings from observational studies conducted in high income countries on PAs’ competence and performance on processes concerned with the quality of recognition and referral of suspected cancer in primary care. Method A rapid systematic review of international peer-reviewed literature was performed. Searches were undertaken on OVID, EMBASE, Web of Science, and CINAHL databases (2009–2019). Studies were eligible if they reported on PA skills, processes and outcomes relevant to suspected cancer recognition and referral. Title and abstract screening was followed by full paper review and data extraction. Synthesis of qualitative and quantitative findings was undertaken on three themes: deployment, competence, and performance. Preliminary findings were discussed with an expert advisory group to inform interpretation. Results From 883 references, 15 eligible papers were identified, of which 13 were from the USA. Seven studies reported on general clinical processes in primary care that would support cancer diagnosis, most commonly ordering of diagnostic tests (n = 6) and referrals to specialists (n = 4). Fewer papers reported on consultation processes, such as examinations or history taking (n = 3) Six papers considered PAs’ competence and performance on cancer screening. PAs performed similarly to primary care physicians on rates of diagnostic tests ordered, referrals and patient outcomes (satisfaction, malpractice, emergency visits). No studies reported on the timeliness of cancer diagnosis. Conclusion This review of peer-reviewed literature combined with advisory group interpretation suggests the introduction of PAs into primary care may maintain the quality of referrals and diagnostic tests needed to support cancer diagnosis. It also highlights the lack of research on several aspects of PAs’ roles, including outcomes of the diagnostic process.

90: A Systematic Review of Urinary Tract Infections Following Transposition of Bowel Segments into Urinary Tract

2004 ◽  
Vol 171 (4S) ◽  
pp. 24-24 ◽  
Author(s):  
Nabi Ghulam ◽  
Sze M. Yong ◽  
Eng Ong ◽  
Adrian Grant ◽  
Gladys C. McPherson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Tract Infections ◽  
Bowel Segments

scholarly journals Effectiveness of Antalgic Therapies in Patients with Vertebral Bone Metastasis: A Protocol for a Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (8) ◽  
pp. 3991
Author(s):  
Antonio Jose Martin-Perez ◽  
María Fernández-González ◽  
Paula Postigo-Martin ◽  
Marc Sampedro Pilegaard ◽  
Carolina Fernández-Lao ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Metastasis ◽  
Data Extraction ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Pharmacological Intervention ◽  
Vertebral Metastasis ◽  
Randomized Controlled Clinical Trials

There is no systematic review that has identified existing studies evaluating the pharmacological and non-pharmacological intervention for pain management in patients with bone metastasis. To fill this gap in the literature, this systematic review with meta-analysis aims to evaluate the effectiveness of different antalgic therapies (pharmacological and non-pharmacological) in the improvement of pain of these patients. To this end, this protocol has been written according to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) and registered in PROSPERO (CRD42020135762). A systematic search will be carried out in four international databases: Medline (Via PubMed), Web of Science, Cochrane Library and SCOPUS, to select the randomized controlled clinical trials. The Risk of Bias Tool developed by Cochrane will be used to assess the risk of bias and the quality of the identified studies. A narrative synthesis will be used to describe and compare the studies, and after the data extraction, random effects model and a subgroup analyses will be performed according to the type of intervention, if possible. This protocol aims to generate a systematic review that compiles and synthesizes the best and most recent evidence on the treatment of pain derived from vertebral metastasis.

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