scholarly journals Fit for Cancer Treatment: a prospective feasibility study of primary care initiated prehabilitation for patients with suspected cancer

BJGP Open ◽  
2018 ◽  
Vol 2 (4) ◽  
pp. bjgpopen18X101608
Author(s):  
Rachael C Barlow ◽  
David Sheng Yi Chan ◽  
Sharon Mayor ◽  
Ceri Perkins ◽  
Helen L Lawton ◽  
...  
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Treatment Plan ◽  
Curative Treatment ◽  
Healthcare Intervention ◽  
Study Cohort ◽  
Patients With Cancer ◽  
Care Assessment ◽  
Assessment And Treatment ◽  
Pre Treatment

BackgroundRisk profile assessment and corrective interventions using optimisation of health status and prehabilitation represent an important strategy in the management of patients with a suspected cancer diagnosis.AimTo determine the feasibility of pre-treatment optimisation and prehabilitation commenced at index primary care consultation, to improve patients’ preparation for treatment by maximising the time available.Design & settingBetween January 2015 and May 2016, 195 patients presenting to 12 GP practices were deemed eligible to enter the study, of which 189 (96.9%, median age 60 [21–91] years and 65 months; 124 female) were recruited and consented to the prehabilitation bundle.MethodAll patients were simultaneously referred to secondary care using urgent suspected cancer (USC) pathways. The primary outcome measures were definitive diagnosis and treatment plan.ResultsFifteen patients (7.9%) were diagnosed with cancer (three breast, three colon, two lung, two skin [one melanoma, one sarcoma], one tonsil, one vocal cord, one pancreas, one prostate, one ependymoma) and 62 were diagnosed with other significant medical conditions (47 gastrointestinal, 13 sepsis, two respiratory) requiring secondary care assessment and treatment. Of the 15 patients with cancer, 11 (73.3%) underwent potentially curative treatment, and four (26.7%) palliative treatment. Of the total study cohort, 84 (44%) required a form of optimisation in primary care, and patients with cancer were more likely to require optimisation than others (n = 10 [63%] versus n = 74 [43%], χ2 9.384, P = 0.002).ConclusionOne in 12 primary care USC patients had cancer (5.6% receiving potentially curative treatment), one in three had other systemic health issues, and overall two in five benefited from healthcare intervention. Primary care optimisation was feasible and associated with important allied health benefits.

Burden of child and adolescent obesity on health services in England

2017 ◽  
Vol 103 (3) ◽  
pp. 247-254 ◽  
Author(s):  
Russell M Viner ◽  
Sanjay Kinra ◽  
Dasha Nicholls ◽  
Tim Cole ◽  
Anthony Kessel ◽  
...  
Keyword(s):  
Primary Care ◽  
Childhood Obesity ◽  
Young People ◽  
Secondary Care ◽  
Service Use ◽  
Lifestyle Modification ◽  
Glycated Haemoglobin ◽  
Obesity Management ◽  
Care Assessment ◽  
The Uk

ObjectiveTo assess the numbers of obese children and young people (CYP) eligible for assessment and management at each stage of the childhood obesity pathway in England.DesignPathway modelling study, operationalising the UK National Institute for Health and Care Excellence guidance on childhood obesity management against national survey data.SettingData on CYP aged 2–18 years from the Health Survey for England 2006 to 2013.Main outcome measuresClinical obesity (body mass index (BMI) >98th centile), extreme obesity (BMI ≥99.86th centile); family history of cardiovascular disease or type 2 diabetes; obesity comorbidities defined as primary care detectable (hypertension, orthopaedic or mobility problems, bullying or psychological distress) or secondary care detectable (dyslipidaemia, hyperinsulinaemia, high glycated haemoglobin, abnormal liver function).Results11.2% (1.22 million) of CYP in England were eligible for primary care assessment and for community lifestyle modification. 2.6% (n=283 500) CYP were estimated to be likely to attend primary care. 5.1% (n=556 000) were eligible for secondary care referral. Among those aged 13–18 years, 8.2% (n=309 000) were eligible for antiobesity drug therapy and 2.4% (90 500) of English CYP were eligible for bariatric surgery. CYP from the most deprived quintile were 1.5-fold to 3-fold more likely to be eligible for obesity management.ConclusionsThere is a mismatch between population burden and available data on service use for obesity in CYP in England, particularly among deprived young people. There is a need for consistent evidence-based commissioning of services across the childhood obesity pathway based on population burden.

Erectile dysfunction

2018 ◽  
Vol 11 (5) ◽  
pp. 269-276 ◽  
Author(s):  
Patricia Schartau ◽  
Irwin Nazareth ◽  
Asif Muneer ◽  
Mike Kirby
Keyword(s):  
Primary Care ◽  
Erectile Dysfunction ◽  
Early Recognition ◽  
Treatment Options ◽  
Poor Mental Health ◽  
Warning Sign ◽  
Referral Criteria ◽  
Early Warning Sign ◽  
Care Assessment ◽  
Assessment And Treatment

Erectile dysfunction is a common, but treatable, condition. Where appropriate, modification of lifestyle factors, medication optimisation and oral pharmacotherapies can be initiated in primary care. Early recognition and management will improve the quality of life of affected individuals and partners, and may avert relationship problems, negative body image and poor mental health. Erectile dysfunction is also an important early warning sign for conditions such as cardiovascular disease. This article considers the aetiology and risk factors for erectile dysfunction, identifies common clinical features, outlines primary care assessment and treatment, and discusses referral criteria. Treatment options available in secondary care are also reviewed.

Oncology beyond the hospital: 7 years taking care of cancer patients from the very begining until the last consequences.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 75-75
Author(s):  
Alberto Jacobo Cunquero Tomas ◽  
Claudio Dario Avila Andrade ◽  
Ferri Pep ◽  
Lauren Condori Farfan ◽  
Amaya Belen Fernandez Diaz ◽  
...  
Keyword(s):  
Primary Care ◽  
High Resolution ◽  
Cancer Patients ◽  
Primary Care Physicians ◽  
Treatment Plan ◽  
Breast Disease ◽  
Care Physician ◽  
Patients With Cancer ◽  
Continuous Care

75 Background: Comprehensive and continuous care is esential for the correct management of cancer patients. To achieve this, specific programs for early diagnosis and long survivor care are needed. Since 2007, within the project “Oncology beyond the Hospital: Oncologic assistance at the Universitary General Hospital of Valencia”, the Oncologist Liaison was created. Methods: Two tracks were designed: High-resolution track for patients with suspicion of non-diagnosed cáncer; and Oncologist Liaison track, to organize the follow-up of cáncer long survivors. We present a descriptive and retrospective study by reviewing medical records of patients referred to the high-resolution diagnostic consultation; and long survivors followed up by the Oncologist Liaison from May 2007 to September 2015 (2016 data under review). Results: High-resolution track: 1,596 patients with suspected cancer were visited. The mean time between the primary care physician consultation and the oncologist visit was 4.32 days. Main reasons for consultation were: breast disease (25.4%), blood test disorders (16.4%), enlarged lymph nodes (11.1%) and radiological suspicion of tumor (12%). 424 cancers were diagnosed (26.5%) all having been studied in Oncologic Committee: 22.6% lung; 17% lung; 16.2% breast; 11.8% lymphomas; 12.5% superior dighestive tract; and19.8% miscelanea. Long-survivors track: 1406 patienst free from disease were referred for surveillance of recurrence and treatment sequelae: 44% breast; 20% gastrointestinal; 17% gynecological; 7% double neoplasia; 4% of lung cancer and other tumors, 8%. Conclusions: With the integration of the Oncologist Liaison in the continuum of care, we have achieved: Normalization of oncologic approach among patients and primary care physicians; implementation of a fast-track for patients with cancer suspicion: access to the oncologist in less tan a week; case study in the Oncologic Comittee in the following week; and consensus in diagnosis and treatment plan in each case. Ensure control over long-survivors.

Pain Management for Patients With Advanced Cancer in the Opioid Epidemic Era

2019 ◽  
pp. 24-35 ◽  
Author(s):  
Shalini Dalal ◽  
Eduardo Bruera
Keyword(s):  
At Risk ◽  
Advanced Cancer ◽  
Treatment Plan ◽  
Opioid Epidemic ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Patients With Cancer ◽  
Assessment And Treatment ◽  
The Face ◽  
Risk Patients

Use of opioids for the treatment of pain is necessary for the majority of patients with advanced cancer, however its use has become challenging in the face of the opioid epidemic and the emerging evidence that patients with cancer are also at risk for nonmedical opioid use. This article proposes an assessment and treatment plan that incorporates universal screening with monitoring for all patients with cancer who are considered for opioid treatment to assess their risk for opioid misuse and harm. Timely identification with appropriate management, including referral of at-risk patients, will allow oncology professionals to optimize the risk-to-benefit and support the safe use of opioids for patients with cancer.

scholarly journals Preventing unnecessary referrals into specialist mental health services: an interrupted time-series evaluation of a new primary care-linked mental health service

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Andrew Healey ◽  
Alexandra Melaugh ◽  
Len Demetriou ◽  
Tracey Power ◽  
Nick Sevdalis ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
Secondary Care ◽  
Interrupted Time Series ◽  
Content Type ◽  
Care Assessment

Purpose Many patients referred by their GP for an assessment by secondary mental health services are unlikely to ever meet eligibility thresholds for specialist treatment and support. A new service was developed to support people in primary care. “the authors evaluate” whether the phased introduction of the Lambeth Living Well Network (LWN) Hub to a population in south London led to: a reduction in the overall volume of patients referred from primary care for a secondary mental health care assessment; and an increase in the proportion of patients referred who met specialist service eligibility criteria, as indicated by the likelihood of being accepted in secondary care. Design/methodology/approach The evaluation applied a quasi-experimental interrupted time series design using electronic patient records data for a National Health Service (NHS) provider of secondary mental health services in south London. Findings Scale-up of the Hub to the whole of the population of Lambeth led to an average of 98 fewer secondary care assessments per month (95% CI −118 to −78) compared to an average of 203 assessments per month estimated in the absence of the Hub; and an absolute incremental increase in the probability of acceptance for specialist intervention of 0.20 (95% CI; 0.14 to 0.27) above an average probability of acceptance of 0.57 in the absence of the Hub. Research limitations/implications Mental health outcomes for people using the service and system wide-service impacts were not evaluated preventing a more holistic evaluation of the effectiveness and cost-effectiveness of the LWN Hub. Practical implications Providing general practitioners with access to service infrastructure designed to help people whose needs cannot be managed within specialist mental health services can prevent unnecessary referrals into secondary care assessment teams. Social implications Reducing unnecessary referrals through provision of a primary-care linked mental health service will reduce delay in access to professional support that can address specific mental-health related needs that could not be offered within the secondary care services and could prevent the escalation of problems. Originality/value The authors use NHS data to facilitate the novel application of a quasi-experimental methodology to deliver new evidence on whether an innovative primary care linked mental health service was effective in delivering on one of its key aims.

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