27 research outputs found
Symptoms that predict chest X-ray results suspicious for lung cancer in UK primary care: results from a prospective study
No full textBackground/introduction:?Predictive values of lung cancer (LC) symptoms that inform UK LC referral guidelines have been calculated from GP records and databases, with the potential for recording bias by GPs. The Identifying Symptom Predictors of Chest and Respiratory Disease (IPCARD) self-completion questionnaire was designed, for use in prospective studies, to obtain accurate positive predictive values (PPVs) of patient-elicited potential LC symptoms. The IPCARD Feasibility Study provides the first prospectively collected, patient-elicited comprehensive symptom data to identify PPVs of potential LC symptoms in UK primary care.Research question:?Which patient-elicited symptoms predict chest X-rays (CXR) suspicious for LC in a GP-referred CXR population (LC incidence 1%)?Methods:?GP-referred CXR attendees (1414) at three UK sites completed IPCARD before CXR; LC diagnosis was obtained 6 months post-CXR. Multiple logistic regression was used to calculate PPVs of symptoms for abnormal CXR, adjusting for age and sex; and stratifying by smoking status and COPD.Results:?Common chest symptoms – cough for longer than 3 weeks, generic chest aches/pains, and breathlessness – did not predict suspicious CXR. Weight loss and less common variants of chest pain (pain in side of chest/ribs, severe pain, and pain that ‘feels like indigestion – not associated with eating’ in patients with non-progressive/less severe pain) predicted CXR suspicious for LC in this high risk, referred population.Discussion/conclusion:?Common chest systems, identified as referral criteria by NICE, and included in UK ‘Be Clear about Cancer’ public awareness campaigns, although potentially predicting LC in a lower risk pre-referral population, did not predict CXR suspicious for LC in this referred population with higher rates of non-malignant chest and respiratory disease. The possibility that weight loss, and variants of chest pain, might also predict LC in pre-referral primary care populations with chronic respiratory disease will be investigated in ongoing studies using IPCARD
A Low-Power Simplified-MEWS Scoring device for Patient Monitoring
No full textThe Modified Early Warning System is a paper based system used in general wards of hospitals to monitor patients health during the duration of the patient stay. Using this system, patient deterioration/improvement can rapidly be detected so as to assist and alert healthcare providers. In this paper we describe a simplified MEWS device which assists healthcare providers in assessing several of the patients vitals quantitatively, so as to allow the provider to focus on a qualitative assessment of the patient
Eliciting symptoms interpreted as normal by patients with early-stage lung cancer: could GP elicitation of normalised symptoms reduce delay in diagnosis? Cross-sectional interview study
No full textObjectives: To investigate why symptoms indicative of early-stage lung cancer (LC) were not presented to general practitioners (GPs) and how early symptoms might be better elicited within primary care.Design, setting and participants: A qualitative cross-sectional interview study about symptoms and help-seeking in 20 patients from three south England counties, awaiting resection of LC (suspected or histologically confirmed). Analysis drew on principles of discourse analysis and constant comparison to identify processes involved in interpretation and communication about symptoms, and explain nonpresentation.Results: Most participants experienced health changes possibly indicative of LC which had not been presented during GP consultations. Symptoms that were episodic, or potentially caused by ageing or lifestyle, were frequently not presented to GPs. In interviews, open questions about health changes/symptoms in general did not elicit these symptoms; they only emerged in response to closed questions detailing specific changes in health. Questions using disease-related labels, for example, pain or breathlessness, were less likely to elicit symptoms than questions that used non-disease terminology, such as aches, discomfort or ‘getting out of breath’. Most participants described themselves as feeling well and were reluctant to associate potentially explained, nonspecific or episodic symptoms with LC, even after diagnosis.Conclusions: Patients with early LC are unlikely to present symptoms possibly indicative of LC that they associate with normal processes, when attending primary care before diagnosis. Faced with patients at high LC risk, GPs will need to actively elicit potential LC symptoms not presented by the patient. Closed questions using non-disease terminology might better elicit normalised symptoms
Preinvasive Lesions of the Bronchus
No full textAbstractPreinvasive lesions are considered the precursors of squamous cell carcinoma of the bronchus. Treatment at the preinvasive stage, before the potential for metastasis, may improve survival from squamous cell carcinoma. An understanding of the natural history and outcome of preinvasive lesions is essential for the accurate interpretation studies of their treatment, and decisions regarding the management of individual lesions. The natural history of preinvasive lesions has only been reported in a small number of highly selected patients and uses different inclusion criteria, treatment criteria. and time-periods of follow-up, making it difficult to draw definitive conclusions. High-grade preinvasive lesions carry a risk of progression to carcinoma but most patients have multiple lesions and a significant probability of developing new lesions over time. Distinguishing lesions with malignant potential, the targets for therapy, from those that will regress or remain indolent is difficult. The American College of Chest Physicians guidelines recommend bronchoscopic follow-up of severe dysplasia and carcinoma-in situ. This review of the evidence regarding the natural history and outcome of preinvasive lesions supports this view, but also shows that further studies in individuals at risk for lung cancer are necessary before guidelines for the management of preinvasive lesions can be developed
A Model to Predict Sun Gear Radial Orbit of a Planetary Gear Set having Manufacturing Errors
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