The NHS Cancer Plan sets out targets for the diagnosis and treatment of cancer. Ideally, there should be a maximum of a 2-week wait from a referral for suspected cancer to an outpatient appointment. A fast track referral system has been established nationally, with general practitioners given guidelines as to appropriate referrals. In the South Essex region, we audited all such referrals using this system for a 12-month period and also all new patients diagnosed with head and neck cancer during the same period. We found that 71% of patients diagnosed with cancer were not referred using the fast track system and that only 15% of patients who were referred by the fast track system were subsequently found to have cancer. For patients with cancer who were referred using standard letters, the time from referral to initial consultation was generally much longer than the recommended period of 2 weeks. We conclude that improvements in utilizing the fast track system need to be made if it is to bring about an improvement in early diagnosis of head and neck cancer. As things stand, it may actually be detrimental for most cancer patients.
Letter to the Editor The use of a temporal bone log book in otological training Dear Sirs, Temporal bone dissection is a vital part of otological training, as an appreciation of the normal anatomical relationships within the temporal bone is the prelude to safe and successful temporal bone surgery. However, a previously plentiful supply of cadaveric temporal bones has become the exception 1 as the political fallout from 'scandals' such as Alder Hey has dramatically reduced the number of post mortems being performed. An alternative training tool, the plastic temporal bone has considerable merit as an adjunct to the cadaveric bone (www.temporalbone.com). Nevertheless, the cost of these bones tends to limit their supply. There are certainly many pressures, ethical, political and legal, that are increasing the need to use simulators to teach and assess trainees. 2 With this current situation it is therefore desirable that these training opportunities are maximized and that each bone, arti cial or cadaveric, is utilized to its full potential. At present, it is mandatory that trainees record all operations performed and these are assessed both on an annual basis as well as at the nal assessment leading to granting of the Certi cate of Completion of Specialist Training. However, this does not apply to learning from temporal bones. We would therefore suggest that a temporal bone log book is a highly desirable addition to the assessment armamentarium. Suggested procedures can be amended depending upon the year of the trainee. Consultant feedback on each procedure carried out is incorporated and it is hoped that these comments will
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