Objectives:The roles of Allied Health Care Professionals (AHPs) in Head and Neck Cancer (HNC) are wide ranging but not clearly defined. Inter-regional variability in practice results from a lack of standardisation in approaches to the Multidisciplinary Team (MDT) make-up and structure. Traditionally, the follow-up of HNC patients is clinician led with multiple scheduled follow-up appointments. The increasing population of HNC patients provides logistical, monetary and efficiency challenges. This systematic review presents the roles of the multiple AHP sub-groups in HNC with the aim of presenting how their differing skill sets can be integrated to modernise our approach in follow-up.
Objectives: We aimed to audit current United Kingdom (UK) practice of Head and Neck Cancer (HNC) post-treatment surveillance against national guidelines and determine the outcomes of these practices in detecting recurrence. Design: National cross-sectional study of current HNC surveillance practice. Setting: UK HNC outpatient departments. Participants: HNC patients reviewed for post-treatment surveillance. Main outcome measures: Compliance with UK multidisciplinary guidelines and rates of cancer recurrence detection by time, clinic type and symptoms. Results: Data were analysed from 5,123 consultations across 89 UK centres. 30% of consultations were in dedicated multidisciplinary clinics, with input from allied health professionals (AHPs) available on the day in 23% of all consultations. Recurrence was suspected in 344 consultations and investigated with MRI in 29.6% (n = 102) and PET-CT in 14.2% (n = 49). Patient education regarding recurrence symptoms, and smoking and alcohol advice, was provided in 20.4%, 6.2% and 5.3% of cases, respectively. Rates of recurrence detected were 35% in expedited appointments and 5.2% in planned follow-ups (P = .0001). Of the expedited appointments, 63% were initiated by patients and 37% by clinicians. Recurrence was higher in those with new symptoms (7.1% versus 2.2%). The strongest predictors of recurrence were dyspnoea (positive predictive value (PPV)=16.2%), neck pain (PPV = 10.4%) and mouth/throat pain (PPV = 9.2%). Conclusions: Dedicated multidisciplinary clinics comprise a minority of consultations for HNC surveillance in the UK, with low availability of AHPs. PET-CT and MRI were underutilised for the investigation of suspected recurrence. There may be scope for greater emphasis on patient education and consequent patient-initiated symptomdriven follow-up.
Objective:Epistaxis is a common ENT emergency in the UK; however, despite the high incidence, there are currently no nationally accepted guidelines for its management. This paper seeks to recommend evidence-based best practice for the hospital management of epistaxis in adults.Methods:Recommendations were developed using an Appraisal of Guidelines for Research and Evaluation (‘AGREE II’) framework. A multifaceted systematic review of the relevant literature was performed and a multidisciplinary consensus event held. Management recommendations were generated that linked the level of supporting evidence and a Grading of Recommendations Assessment, Development and Evaluation (‘GRADE’) score explaining the strength of recommendation.Recommendations:Despite a paucity of high-level evidence, management recommendations were formed across five management domains (initial assessment, cautery, intranasal agents, haematological factors, and surgery and radiological intervention).Conclusion:These consensus recommendations combine a wide-ranging review of the relevant literature with established and rigorous methods of guideline generation. Given the lack of high-level evidence supporting the recommendations, an element of caution should be used when implementing these findings.
Epistaxis is a common acute disorder, with approximately 25 000 patients presenting to National Health Service (NHS) hospitals every year in the UK. 1 Patients with epistaxis, who fail to respond to simple first aid management, undergo varied treatment from nasal cautery and insertion of intranasal packs to surgery or interventional radiology. These strategies often require admission to hospital and can be associated with pain, infection or necessity for blood transfusion. In 2017, the British Rhinology Society published the UK management recommendations, describing a stepwise approach to epistaxis management. 2 The INTEGRATE (UK ENT trainee research network) 2016
BackgroundEpistaxis is a common emergency presentation to ENT. The ‘Epistaxis 2016: national audit of management’ collected prospective data over a 30-day audit window in 113 centres. A 30-day all-cause mortality rate of 3.4 per cent was identified. This study examines in more detail the subgroup of patients who died during the audit period.MethodsThere were 985 eligible patients identified. Of these, 33 patients died within the audit period. World Health Organization bleeding score, Modified Early Warning System score, haemostasis time, source of referral, co-morbidities and cause of death were investigated from the dataset.ResultsPatients who died were more likely to come from a ward environment, have co-existing cardiovascular disease, diabetes or a bleeding diathesis, be on antithrombotic medication, or have received a blood transfusion. Patients did not die from exsanguination.ConclusionEpistaxis may be seen as a general marker of poor health and a poor prognostic sign.
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