The straight to test endoscopy service for suspected colorectal cancer: meeting national targets but are we meeting our patients' expectations?

AIM

The NHS Cancer Plan describes initiatives to improve patient care in the UK, including the two-week rule cancer referral pathway. To meet this target a straight to test (STT) endoscopy service was devised to expedite diagnosis of suspected colorectal cancer. Our novel study aimed to determine patient satisfaction with this new approach to rapid access investigation.

METHOD

An anonymized questionnaire was posted to 300 patients who had undergone STT endoscopy in our unit between January and June 2010. It assessed satisfaction with the service overall, time from referral to investigation, pre-test information, bowel preparation instructions and time to results as well as preference for a traditional pre-test or post-test outpatient appointment and awareness that the referral was for suspected bowel cancer.

RESULTS

In all, 174 questionnaires were obtained (58% yield; mean age 68.8; 44.8% men). 82.2% of patients were 'very satisfied' with the service overall, 82.8% with time from referral to test, 75.2% with time from test to results, 73% with endoscopy information and 69.5% with bowel preparation instructions. Eight per cent would rather have seen a specialist prior to endoscopy, 31.6% would have preferred a post-test appointment and 68.4% of patients were aware that referral was for suspected bowel cancer.

CONCLUSION

Straight to test is popular with patients. It offers a fast and cost effective service in the diagnosis of colorectal cancer and meets national targets whilst reducing the volume burden on outpatient clinics. However, its success heavily relies on accurate communication between general practitioner, patient and secondary care.

The UK national study of magnetic resonance imaging as a method of screening for breast cancer (MARIBS)

The UK national study of magnetic resonance imaging as a method of screening for breast cancer (MARIBS) is in progress. The study design, accrual to date, and related research projects are described. Revised accrual rates and expected recruitment are given. 15 cancers have been detected to date, from a total of 1236 screening measurements. This event rate and the tumour grades reported are compared with recent reports from other studies in women at high risk of breast cancer.

Proton magnetic resonance spectroscopy and morphometry of the hippocampus in chronic fatigue syndrome

Seven patients with chronic fatigue syndrome (CFS) were matched with ten healthy control subjects of similar age. Hippocampal volume, obtained from magnetic resonance images using an unbiased method, showed no difference between the two groups, whereas proton magnetic resonance spectroscopy showed a significantly reduced concentration of N-acetylaspartate in the right hippocampus of CFS patients (p = 0.005).

Brimonidine and postoperative pressure spikes in cataract surgery

PURPOSE

To evaluate the efficacy of brimonidine in controlling postoperative pressure spikes following clear corneal cataract outpatient day surgery, in private practice in Australia.

METHODS

A prospective randomized trial was performed on 123 patients. Brimonidine 0.2% was instilled in the eyes 15 min prior to surgery, and intraocular pressure was checked 6 hours postoperatively.

RESULTS

Mean postoperative intraocular pressures at 6 hours were 30.33 mmHg in the treated group and 30.76 mmHg in the control group.

CONCLUSION

Brimonidine 0.2% instilled preoperatively offered no significant reduction in postoperative intraocular pressure spikes.

Effect of lens style on postoperative refractive astigmatism after small incision cataract surgery

PURPOSE

To evaluate the astigmatic results of two popular foldable intraocular lenses when standard surgical approaches are used in rural private practice in Australia.

METHODS

Four hundred consecutive cataract operations were followed in a prospective study. The refractive results of patients receiving the Alcon Acrysof MA30 lens were compared to those receiving the Allergan silicone S140 lens. All patients were over 60 years of age and had no intercurrent ocular disease. Refractive and keratometric astigmatism was analysed both by vector analysis and as an absolute measure.

RESULTS AND CONCLUSION

The Acrysof lens is associated with less postoperative astigmatism (P = 0.01), than the Silicone S140 lenses.

The pathology of the lower leg muscles in pure forefoot pes cavus

Enlargement of the peroneus longus muscle is a common occurrence in patients with forefoot pes cavus, and may contribute to the cavus deformity. The present study compares the morphology of up to five lower leg muscles from 17 patients with forefoot pes cavus with those of normal muscles. Eight cases had an identifiable neurogenic cause for the cavus. In four cases of hereditary motor-sensory neuropathy, the tibialis anterior showed more severe damage than the peroneus longus. In two cases of cerebral palsy, fibre atrophy and increased oxidative enzyme activity were observed. In nine clinically idiopathic cases, the histological appearances ranged from normal to generalised fibre atrophy or hypertrophy in individual muscles. There was a trend for the mean fibre area to be greater in peroneus longus than in tibialis anterior in six of the idiopathic group of patients. The muscle cross-sectional area on magnetic resonance imaging was correlated closely with the mean fibre area measured on tissue sections. In idiopathic forefoot pes cavus, fibre hypertrophy in peroneus longus (relative to tibialis anterior) may contribute to the cavus deformity. Muscle fibre hyperplasia may contribute to the peroneal muscle enlargement in Friedreich's ataxia. In none of the cases was peroneus longus enlargement due to fat or fibrous tissue replacement.

Refractive keratoplasty for post-graft astigmatism

Refractive keratoplasty using modified relaxing incisions with compression sutures was performed on 33 patients with high post-keratoplasty astigmatism. The mean reduction in keratometric astigmatism was 8.38 dioptres from a preoperative mean of 12.21 dioptres (SD, 3.59) to 3.93 dioptres (SD, 2.13). All patients noted a marked functional improvement. Two patients required reoperation. One patient required resuturing. Our modification of undercutting the relaxing incisions greatly increases the range of astigmatism that can be treated with this technique.

Corneal biopsy in microbial keratitis

Presumed microbial keratitis in the absence of a specific microbiological diagnosis is a particularly difficult clinical problem. Corneal biopsy may provide the diagnosis when corneal scrapings have been negative. We present two cases in which corneal biopsy was helpful and discuss the role of corneal biopsy in the management of chronic keratitis.

A comparison between iotrolan, a non-ionic dimer, and a hyperosmolar contrast medium, Urografin, in hysterosalpingography

For hysterosalpingography, there were no significant differences between the non-ionic dimeric contrast medium iotrolan (300 mgI/%) and Urografin (370 mgI/%) with regard to ease of application or radiographic quality, and both agents were equally suitable. There were no significant differences between two groups of patients with regard to pain due to instrumentation, pain at the time of injection and pain up to 2 h after the procedure. There was a significant difference (p = 0.04) between the two groups with respect to delayed pain, when iotrolan was associated with a lower incidence and decreased severity of delayed pain. There were no differences in the incidence of nausea, vomiting, headache and syncope. No allergic phenomena were seen in either group.

Subjective experiences of magnetic resonance imaging

Clinical experience with the new technology of magnetic resonance imaging (MRI) has indicated that the procedure may produce anxiety in a number of patients, to the extent that occasionally a patient may be unwilling to undergo the procedure. A study of patients' subjective experiences of MRI was therefore conducted and these were compared with those of patients undergoing computed tomography (CT). Initial interviews with 15 MRI and 15 CT patients led to the development of a questionnaire which was administered to a further 40 patients in each setting. No significant differences were found between those factors identified as unpleasant in MRI and those of CT, with the exception of the confined space of MRI; 40% of the MRI patients found this unpleasant by comparison with only 15% of the CT patients. Principal components analysis of the concerns expressed suggested three factors, to do with the machine itself, the environment of the machine, and the social interactions involved. Patients finding the procedures unpleasant tended to be those with high initial levels of anxiety, little experience of diagnostic procedures, and believing themselves to have cancer.