Decision making and referral from primary care for possible lung and colorectal cancer: a qualitative study of patients’ experiences

Background

The challenge for GPs when assessing whether to refer a patient for cancer investigation is that many cancer symptoms are also caused by benign self-limiting illness. UK National Institute for Health and Care Excellence (NICE) referral guidelines emphasise that the patient should be involved in the decision-making process and be informed of the reasons for referral. Research to date, however, has not examined the extent to which these guidelines are borne out in practice.

Aim

To assess the degree to which patients are involved in the decision to be referred for investigation for symptoms associated with cancer and their understanding of the referral.

Design and setting

Qualitative interview study of patients referred to secondary care for symptoms suspicious of lung and colorectal cancer. Patients were recruited from two regions of England using maximum variation sampling.

Method

Transcribed interviews were analysed thematically.

Results

The analysis was based on 34 patient interviews. Patients in both symptom pathways reported little involvement in the decision to be referred for investigation. This tended to be accompanied by a patient expectation for referral, however, to explain ongoing and un-resolving symptoms. It was also found that reasons for referral tended to be couched in non-specific terms rather than cancer investigation, even when the patient was on a cancer-specific pathway.

Conclusion

GPs should consider a more overt discussion with patients when referring them for further investigation of symptoms suspicious of cancer. This would align clinical practice with NICE guidelines and encourage more open discussion between GPs and primary care patients around cancer.     

2019年 NICE《成人原发性高血压管理指南》解读

高血压是脑卒中、心脏病、慢性肾衰竭等疾病的主要危险因素,高血压的及时治疗和综合管理具有重要意义。2019年8月英国国家卫生与临床优化研究所（NICE）发布了成人高血压诊断和管理指南,这是距2004年NICE高血压诊断和管理指南发布后的第３次更新,既沿用了以往的一些理念,又补充了许多新的内容,新版高血压管理指南在血压测量、高血压诊断、心血管风险、靶器官损害评估、降压治疗、血压监测及哪些患者需要专科医生诊治等方面均进行了全面而详细的阐述,尤其在高血压药物治疗的启动时机、治疗方案的选择及综合管理的治疗理念方面,值得临床医生借鉴与学习。     

从某大型公立三甲医院门诊疾病构成分析看“分级诊疗”

分级诊疗是解决百姓看病难、看病贵的核心制度之一,其理念聚焦于"小病在基层、大病到医院、康复回基层"。作者选取一所大型公立三甲医院,对其门诊病人量及构成进行分析,发现大型医院的门诊量增长率显著高于全国平均水平,医生人均接诊量仍在增长;接诊疾病范围广、复杂、重症病人多,但是慢性病、常见病占其接诊病人比例仍较高,且以慢性病为主的专科病人增长率显著高于医院平均值。研究结果提示:分级诊疗的实质落地仍然需要更进一步强有力的约束措施。     

基于云服务的影像传输与远程会诊系统研究与设计

分析系统功能需求及云服务技术优势,从功能架构、网络接入方式、网络安全管理几方面阐述基于云服务的影像传输与远程会诊系统设计,介绍系统实际应用情况,指出该系统有助于充分发挥医联体内核心医院优势,提高联盟医院医学影像诊断水平。     

基于专家咨询法的医用超声诊断设备服务体系评价指标筛选研究

目的筛选医用超声诊断设备服务的评价指标,构建评价体系,对比评价不同品牌服务商的服务水平。方法邀请专家开展问卷咨询,在企业服务、产品服务和客户服务三个层面的一级指标,经前期专家头脑风暴设定的28项二级指标的基础上进行指标筛选,构建服务体系。结果所有二级指标重要性评分均>3.5分;变异系数<0.25的二级指标共22项,且所有重要性评分>4分的指标变异系数均<0.25;变异系数>0.3的仅1项。结论经过专家咨询,医用超声设备服务评价指标选择方面意见逐步趋同,公司文化、技术创新与推广等6项指标仍存在争议,需要通过第二轮咨询或进一步理论和实证研究加以检验。     

Role of consultation–liaison psychiatry toward shortening of length of stay for medically ill patients with depression

Depression in physically ill patients is often encountered in consultation– liaison psychiatry. First, this investigation examined the relationship between length of stay (LOS) and depression comorbidity. Physically ill patients with depression stayed significantly longer than those without. Second, the change of LOS with and without antidepressant treatment for depression in medically ill patients has been investigated, which showed that LOS in physically ill patients with depression could be shortened by effective antidepressant treatment. This study also revealed that the early detection and antidepressant treatment are important for physically ill patients with depression that could lead to the shortening of LOS.     

Ultrasound as visual feedback in speech habilitation: Exploring consultative use in rural British Columbia,Canada

Ultrasound has shown promise as a visual feedback tool in speech therapy. Rural clients, however, often have minimal access to new technologies. The purpose of the current study was to evaluate consultative treatment using ultrasound in rural communities. Two speech‐language pathologists (SLPs) trained in ultrasound use provided consultation with ultrasound in rural British Columbia to 13 school‐aged children with residual speech impairments. Local SLPs provided treatment without ultrasound before and after the consultation. Speech samples were transcribed phonetically by independent trained listeners. Eleven children showed greater gains in production of the principal target // after the ultrasound consultation. Four of the seven participants who received more consultation time with ultrasound showed greatest improvement. Individual client factors also affected outcomes. The current study was a quasi‐experimental clinic‐based study. Larger, controlled experimental studies are needed to provide ultimate evaluation of the consultative use of ultrasound in speech therapy.     

三甲医院缓和医疗会诊服务实践存在的问题分析

目的 探究三甲医院院内缓和医疗会诊服务在实践过程中遇到的障碍,针对这些困难提出意见和建议,为院内缓和医疗会诊服务的进一步开展提供参考。方法 对北京协和医院17名请求过缓和医疗会诊服务的医护人员进行半结构式访谈,对相关资料进行整理、分析。结果 院内缓和医疗会诊服务开展中的障碍因素包括患者及家属对缓和医疗了解不够深入、医护人员对缓和医疗的认知不够深刻、临床诊疗团队对会诊意见落实不够全面、缓和医疗会诊团队提供服务的精力有限、缓和医疗的开展难以创造所谓的经济效益5个方面。同时,针对院内缓和医疗会诊服务开展过程中的障碍和不足,提出工作改进的建议包括增加患者及其家属对缓和医疗的接受程度、提高医护人员对缓和医疗知识水平、建立会诊团队与医护人员的新型合作模式、增强医院对缓和医疗发展的制度保障和建立健全缓和医疗相关法律政策等。结论 三甲医院院内缓和医疗会诊服务在实践过程中虽然遇到很多困难和障碍,但是医护人员对缓和医疗的需求和期望仍在提高。     

临床药师参与新生儿重症监护室抗感染会诊69例回顾性分析

目的:总结临床药师参与新生儿重症病房抗感染会诊的经验和效果。方法:对2014年7月-2017年6月间临床药师参与某院新生儿重症监护室会诊病例资料进行回顾性分析。结果:2014-2017年共参与新生儿重症病房会诊69例。会诊时患者平均日龄为26.85d,申请药师会诊理由以指导选择、调整抗菌药物为主,64例,占92.75%;病原学检查结果阳性患儿共32例;追踪观察病情转归情况,临床药师参与会诊的治疗总有效率为86.96%。结论:新生儿属于临床用药的特殊人群,临床药师参与用药实践,对促进患者的合理用药具有重要意义。