Males referred with iron deficiency anemia have a significant risk of having colon cancer. The risk seems lower in females; this gender difference has been observed in other studies and further evidence should be sought before advising any change in referral practice.
INTRODUCTION Electronic booking of out-patient appointments is being rolled out in England under the 'Choose and Book' programme. We set up and ran a local electronic surgical referral service before this. This paper assesses the effect of the electronic surgical referral service on patient waiting times and attendance rates.PATIENTS AND METHODS The study included 54 patients referred electronically and 189 referred on paper to a single colorectal surgical service over the same period. RESULTS The appointment booking was achieved on the same day as the referral was made for the majority of electronic referrals whereas it took an average of 7 days for paper referrals. There was no significant difference in the time from referral to being seen in clinic between the two groups. Patients referred electronically were much more likely to attend for their appointment. CONCLUSIONS This study shows that an electronic surgical referral system can improve efficiency. This may be because this system allows enhanced patient choice of appointment date and time.
If CEA is measured after surgery for colorectal cancer, a rise of >1 in the patient's postoperative value is predictive for recurrence or metastases with an overall sensitivity of 80% and specificity of 86%. Previous studies have recognized the role of large rises in CEA in predicting recurrence but this study shows that small changes in CEA may be significant even if these levels would be traditionally within 'normal' limits.
BackgroundTo evaluate NHS England London region’s approach to the revalidation appraisal of responsible officers in London, exploring perceptions of the quality and impact of the appraisal process. Revalidation is the process which aims to ensure doctors in the UK are up-to-date and fit to practice medicine thus improving the quality of patient care. Revalidation recommendations are largely premised on the documentation included in annual appraisals, which includes the professional development a doctor has undertaken and supporting information about their practice.MethodsA pan-London qualitative study exploring the views of responsible officers and their appraisers about the revalidation appraisal process. The study aimed to gain an in-depth understanding of the experiences and perceptions of the participants. Responsible officers were purposefully sampled to represent the broadest range of designated bodies. Data analysis generated themes pertaining to quality and impact of appraisal for revalidation with the potential to feed into and shape the evolving system under investigation.ResultsThe central importance of highly skilled appraisers was highlighted. Both groups reported educational opportunities embedded within the appraisal process. Independent appraisers, not matched by clinical speciality or place of work, were considered to take a more objective view of a responsible officer’s practice by providing an ‘outsider perspective’. However, covering the breadth of roles, in sufficient depth, was challenging. Participants reported a bias favouring the appraisal of the responsible officer role above others including clinical work. Appraisal and revalidation was perceived to have the potential to improve the healthcare standards and support both personal development and institutional quality improvement.ConclusionsResponsible officers play a central role in the revalidation process. Getting responsible officer appraisal right is central to supporting those individuals to in turn support doctors and healthcare organisations in continuous quality improvement. The complexity and importance of the role of responsible officer may make achieving an appraisal of all roles of such individuals problematic. This evaluation suggests responsible officer appraisal was perceived as educational and effective.
More CRC patients were referred urgently in 2003. Most, but not all of these were referred as target waits. The time taken for the patient's journey did not improve between the two cohorts, possibly in part, because more complex treatments are now provided. Further work and perhaps new thinking are needed in order to achieve Cancer Waiting Time targets.
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