A clinic for the rapid processing of patients with neck masses

Vowles, Richard H.; Ghiacy, Sabour; Jefferis, A. F.

doi:10.1017/s002221510014246x

Cited by 20 publications

(22 citation statements)

References 17 publications

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“…Recent papers have shown the benefits of a dedicated neck lump clinic [21][22][23][24][25] and found that neck nodes represented the commonest single reason for referral. Nodes accounted for 46 of 100 consecutive neck lumps in one study 25 and 43 of 110 in a second study, 26 but neither paper presented the context of pre-existing care in the absence of such a service.…”

Section: Discussionmentioning

confidence: 99%

“…[17][18][19][20] There have also been reports on the value of generic neck lump clinics. [21][22][23][24][25] The scale and nature of the problem of referral and management of patients with enlarged superficial lymph nodes, both those in the neck or elsewhere, has however not been closely investigated. We, therefore, examined the records of all patients who underwent superficial lymph node biopsy in our hospital over a 3-year period in order to characterise: (i) the patterns of referral from primary to secondary care; and (ii) the patient's pathway of care from the time of referral to being informed of a diagnosis.…”

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confidence: 99%

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Diagnostic Biopsy of Lymph Nodes of the Neck, Axilla and Groin: Rhyme, Reason or Chance?

Moor

Murray

Inwood

et al. 2008

annals

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INTRODUCTION Improving patient pathways of care is becoming increasingly important in the delivery of timely, appropriate surgical care. With this aim, we analysed the referral and management pathway of patients undergoing diagnostic superficial lymph node biopsy.PATIENTS AND METHODS A retrospective review of case notes of patients undergoing diagnostic superficial lymph node biopsy over 3 years, 1998-2000 at the Bradford Hospitals NHS Trust. Indication for surgical biopsy was based on clinical suspicion following assessment in the out-patient clinic for the majority, and arrangement of investigations as deemed appropriate. There were no clinical algorithms in use during the study period.RESULTS There was no evidence for the use of explicit protocols for referral or management. Biopsy was often delayed. Of 268 patients referred from primary care, referral was made to any of 14 hospital departments with 39% (105 of 268) attending more than one outpatient appointment, and 155 (41 of 268) attending more than one department. Eighteen percent (47 of 268) of patients were informed of their diagnosis within 6 weeks of referral and 42% (113 of 268) within 3 months of referral. Nine percent (24 of 268) underwent pre-operative fine needle aspiration cytology. Of patients with enlarged neck nodes, 29% (52/180) had examination of the upper aero-digestive tract.CONCLUSIONS The study supports the introduction of co-ordinated problem-based referral and management pathways for the management of patients with enlarged superficial lymph nodes supported by regular audits of practice.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Diagnostic Biopsy of Lymph Nodes of the Neck, Axilla and Groin: Rhyme, Reason or Chance?

Moor

Murray

Inwood

et al. 2008

annals

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“…The original systematic review by Gagliardi et al 12 included twenty articles that described outcomes related to specific disease-site assessment units: eleven for breast cancer 4,[15][16][17][18][19][20][21][22][23][24] , three for colorectal cancer 7,25,26 , and six for head-and-neck cancer [31][32][33][34][35][36] . There were seventeen case series that involved 38-3119 patients, two rcts that included 478 and 791 patients, and one case-control study that included 177 cases and 162 controls 4,7,[15][16][17][18][19][20][21][22][23][24][25][26][31][32][33][34][35][36] .…”

Section: Search Resultsmentioning

confidence: 99%

“…There were seventeen case series that involved 38-3119 patients, two rcts that included 478 and 791 patients, and one case-control study that included 177 cases and 162 controls 4,7,[15][16][17][18][19][20][21][22][23][24][25][26][31][32][33][34][35][36] . The update of the literature search identified 823 citations in which patient outcomes related to diagnostic assessment units were described for colorectal cancer in four studies [27][28][29][30] , head-and-neck cancer in two studies 37,38 , lung cancer in two studies 39,40 , gynecologic cancers in three studies [41][42][43] , neurologic cancers in one study 44 , lymph node cancers in one study 45 , and upper gastrointestinal cancers in one study 46 .…”

Section: Search Resultsmentioning

confidence: 99%

Cancer Diagnostic Assessment Programs: Standards for the Organization of Care in Ontario

et al. 2009

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BackgroundImproving access to better, more efficient, and rapid cancer diagnosis is a necessary component of a highquality cancer system. How diagnostic services ought to be organized, structured, and evaluated is less understood and studied. Our objective was to address this gap. MethodsAs a quality initiative of Cancer Care Ontario's Program in Evidence-Based Care, the Diagnostic Assessment Standards Panel, with representation from clinical oncology experts, institutional and clinical administrative leaders, health service researchers, and methodologists, conducted a systematic review and a targeted environmental scan of the unpublished literature. Standards were developed based on expert consensus opinion informed by the identified evidence. Through external review, clinicians and administrators across Ontario were given the opportunity to provide feedback. ResultsThe body of evidence consists of thirty-five published studies and fifteen unpublished guidance documents. The evidence and consensus opinion consistently favoured an organized, centralized system with multidisciplinary team membership as the optimal approach for the delivery of diagnostic cancer assessment services. Independent external stakeholders agreed (with higher mean values, maximum 5, indicating stronger agreement) that dap standards are

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“…19 Reviews of other multi-disciplinary clinics have found them to be an effective way of dealing with complex problems with multiple underlying aetiologies and simplifying the patient's diagnostic pathway. [20][21][22] The case studies clearly illustrate that patients with atypical presentations of neurodegenerative disease with or without exacerbating concomitant eye pathology frequently visited many clinics before reaching a diagnosis. The aim of the Visual Perception Clinic is to prevent this continuing re-referral by acting as a one-stop service where comprehensive evaluation may be made and a representative diagnosis given.…”

Section: Discussionmentioning

confidence: 99%

A novel, multidisciplinary clinic for complex visual problems in older people

Han

Jefferis

Archibald

et al. 2012

Eye

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Background Visual symptoms in older people can be complex and inadequately explained by eye pathology alone. Psychological and neurodegenerative processes may manifest as complex visual symptoms, and thus some patients may be poorly served by a purely ophthalmic approach. We have developed a novel multidisciplinary clinic with input from neurology, ophthalmology, and psychiatric specialists. Here, we describe the patient population, disease prevalence, and potential impact of this new clinic. Methods A retrospective audit of paper and electronic records from June 2010 to February 2012 and selected case reports. Results Between June 2010 and February 2012 48 patients attended the clinic. Notes were available for 47 (98%). Mean age was 76.2 (range 48-92). The main presenting complaints were hallucinations, followed by nonspecific visual deficit, double vision, blurred vision, and visuospatial deficit. Cognitive impairment was noted in 68% (32/47) of patients, of which 16/32 (50%) were new diagnoses. We were able to give a diagnosis to 98% (46/47) of patients; of these, 74% (35/46) were new diagnoses. A total of 6% (3/47) were felt to have presentations attributable to eye pathology alone, whereas 89% (42/47) were felt to have a neuropsychiatric component. Management included referral to other clinics for continuing care in 43% (20/47) and initiation of therapy in 36% (17/47). The three case reports demonstrate cases, where our multidisciplinary approach aided diagnosis and management of patients with complex visual symptoms. Conclusion A combined clinic with neurological, ophthalmic, and psychiatric

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A clinic for the rapid processing of patients with neck masses

Cited by 20 publications

References 17 publications

Diagnostic Biopsy of Lymph Nodes of the Neck, Axilla and Groin: Rhyme, Reason or Chance?

Diagnostic Biopsy of Lymph Nodes of the Neck, Axilla and Groin: Rhyme, Reason or Chance?

Cancer Diagnostic Assessment Programs: Standards for the Organization of Care in Ontario

A novel, multidisciplinary clinic for complex visual problems in older people

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