Publications by authors named "Mike Richards"

37 Publications

Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study.

Lancet Gastroenterol Hepatol 2021 03 15;6(3):199-208. Epub 2021 Jan 15.

Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK.

Background: There are concerns that the COVID-19 pandemic has had a negative effect on cancer care but there is little direct evidence to quantify any effect. This study aims to investigate the impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England.

Methods: Data were extracted from four population-based datasets spanning NHS England (the National Cancer Cancer Waiting Time Monitoring, Monthly Diagnostic, Secondary Uses Service Admitted Patient Care and the National Radiotherapy datasets) for all referrals, colonoscopies, surgical procedures, and courses of rectal radiotherapy from Jan 1, 2019, to Oct 31, 2020, related to colorectal cancer in England. Differences in patterns of care were investigated between 2019 and 2020. Percentage reductions in monthly numbers and proportions were calculated.

Findings: As compared to the monthly average in 2019, in April, 2020, there was a 63% (95% CI 53-71) reduction (from 36 274 to 13 440) in the monthly number of 2-week referrals for suspected cancer and a 92% (95% CI 89-95) reduction in the number of colonoscopies (from 46 441 to 3484). Numbers had just recovered by October, 2020. This resulted in a 22% (95% CI 8-34) relative reduction in the number of cases referred for treatment (from a monthly average of 2781 in 2019 to 2158 referrals in April, 2020). By October, 2020, the monthly rate had returned to 2019 levels but did not exceed it, suggesting that, from April to October, 2020, over 3500 fewer people had been diagnosed and treated for colorectal cancer in England than would have been expected. There was also a 31% (95% CI 19-42) relative reduction in the numbers receiving surgery in April, 2020, and a lower proportion of laparoscopic and a greater proportion of stoma-forming procedures, relative to the monthly average in 2019. By October, 2020, laparoscopic surgery and stoma rates were similar to 2019 levels. For rectal cancer, there was a 44% (95% CI 17-76) relative increase in the use of neoadjuvant radiotherapy in April, 2020, relative to the monthly average in 2019, due to greater use of short-course regimens. Although in June, 2020, there was a drop in the use of short-course regimens, rates remained above 2019 levels until October, 2020.

Interpretation: The COVID-19 pandemic has led to a sustained reduction in the number of people referred, diagnosed, and treated for colorectal cancer. By October, 2020, achievement of care pathway targets had returned to 2019 levels, albeit with smaller volumes of patients and with modifications to usual practice. As pressure grows in the NHS due to the second wave of COVID-19, urgent action is needed to address the growing burden of undetected and untreated colorectal cancer in England.

Funding: Cancer Research UK, the Medical Research Council, Public Health England, Health Data Research UK, NHS Digital, and the National Institute for Health Research Oxford Biomedical Research Centre.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S2468-1253(21)00005-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808901PMC
March 2021

The impact of the COVID-19 pandemic on cancer care.

Nat Cancer 2020 May 20:1-3. Epub 2020 May 20.

Department of Health Policy, London School of Economics and Political Science, London, UK.

The COVID-19 pandemic has disrupted the spectrum of cancer care, including delaying diagnoses and treatment and halting clinical trials. In response, healthcare systems are rapidly reorganizing cancer services to ensure that patients continue to receive essential care while minimizing exposure to SARS-CoV-2 infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s43018-020-0074-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7238956PMC
May 2020

Ancient pigs reveal a near-complete genomic turnover following their introduction to Europe.

Authors:
Laurent A F Frantz James Haile Audrey T Lin Amelie Scheu Christina Geörg Norbert Benecke Michelle Alexander Anna Linderholm Victoria E Mullin Kevin G Daly Vincent M Battista Max Price Kurt J Gron Panoraia Alexandri Rose-Marie Arbogast Benjamin Arbuckle Adrian Bӑlӑşescu Ross Barnett László Bartosiewicz Gennady Baryshnikov Clive Bonsall Dušan Borić Adina Boroneanţ Jelena Bulatović Canan Çakirlar José-Miguel Carretero John Chapman Mike Church Richard Crooijmans Bea De Cupere Cleia Detry Vesna Dimitrijevic Valentin Dumitraşcu Louis du Plessis Ceiridwen J Edwards Cevdet Merih Erek Aslı Erim-Özdoğan Anton Ervynck Domenico Fulgione Mihai Gligor Anders Götherström Lionel Gourichon Martien A M Groenen Daniel Helmer Hitomi Hongo Liora K Horwitz Evan K Irving-Pease Ophélie Lebrasseur Joséphine Lesur Caroline Malone Ninna Manaseryan Arkadiusz Marciniak Holley Martlew Marjan Mashkour Roger Matthews Giedre Motuzaite Matuzeviciute Sepideh Maziar Erik Meijaard Tom McGovern Hendrik-Jan Megens Rebecca Miller Azadeh Fatemeh Mohaseb Jörg Orschiedt David Orton Anastasia Papathanasiou Mike Parker Pearson Ron Pinhasi Darko Radmanović François-Xavier Ricaut Mike Richards Richard Sabin Lucia Sarti Wolfram Schier Shiva Sheikhi Elisabeth Stephan John R Stewart Simon Stoddart Antonio Tagliacozzo Nenad Tasić Katerina Trantalidou Anne Tresset Cristina Valdiosera Youri van den Hurk Sophie Van Poucke Jean-Denis Vigne Alexander Yanevich Andrea Zeeb-Lanz Alexandros Triantafyllidis M Thomas P Gilbert Jörg Schibler Peter Rowley-Conwy Melinda Zeder Joris Peters Thomas Cucchi Daniel G Bradley Keith Dobney Joachim Burger Allowen Evin Linus Girdland-Flink Greger Larson

Proc Natl Acad Sci U S A 2019 08 12;116(35):17231-17238. Epub 2019 Aug 12.

The Palaeogenomics & Bio-Archaeology Research Network, Research Laboratory for Archaeology and History of Art, University of Oxford, Oxford OX1 3TG, United Kingdom;

Archaeological evidence indicates that pig domestication had begun by ∼10,500 y before the present (BP) in the Near East, and mitochondrial DNA (mtDNA) suggests that pigs arrived in Europe alongside farmers ∼8,500 y BP. A few thousand years after the introduction of Near Eastern pigs into Europe, however, their characteristic mtDNA signature disappeared and was replaced by haplotypes associated with European wild boars. This turnover could be accounted for by substantial gene flow from local European wild boars, although it is also possible that European wild boars were domesticated independently without any genetic contribution from the Near East. To test these hypotheses, we obtained mtDNA sequences from 2,099 modern and ancient pig samples and 63 nuclear ancient genomes from Near Eastern and European pigs. Our analyses revealed that European domestic pigs dating from 7,100 to 6,000 y BP possessed both Near Eastern and European nuclear ancestry, while later pigs possessed no more than 4% Near Eastern ancestry, indicating that gene flow from European wild boars resulted in a near-complete disappearance of Near East ancestry. In addition, we demonstrate that a variant at a locus encoding black coat color likely originated in the Near East and persisted in European pigs. Altogether, our results indicate that while pigs were not independently domesticated in Europe, the vast majority of human-mediated selection over the past 5,000 y focused on the genomic fraction derived from the European wild boars, and not on the fraction that was selected by early Neolithic farmers over the first 2,500 y of the domestication process.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1073/pnas.1901169116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6717267PMC
August 2019

Functional Outcomes and Health-Related Quality of Life After Curative Treatment for Rectal Cancer: A Population-Level Study in England.

Int J Radiat Oncol Biol Phys 2019 04 13;103(5):1132-1142. Epub 2018 Dec 13.

Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.

Purpose: There is a growing population of cancer survivors at risk of treatment-related morbidity. This study investigated how potentially curative rectal cancer treatment influences subsequent function and health-related quality of life using data from a large-scale survey of patient-reported outcomes.

Methods And Materials: All individuals 12 to 36 months after receiving a diagnosis of colorectal cancer in England were sent a survey in January 2013. The survey responses were linked with cancer registration, hospital admissions, and radiation therapy data through the National Cancer Registration and Analysis Service. Outcome measures were cancer specific (Functional Assessment of Cancer Therapy and Social Difficulties Inventory items related to fecal incontinence, urinary incontinence, and sexual difficulties) and generic (EuroQol EQ-5D).

Results: Surveys were returned by 6713 (64.2%) of 10,452 patients with rectal cancer. Of these, 3998 patients were in remission after a major resection and formed the final analysis sample. Compared with those who had surgery alone, patients who received preoperative radiation therapy had higher odds of reporting poor bowel control (43.6% vs 33.0%; odds ratio [OR] = 1.55; 95% confidence interval [CI], 1.26-1.91), severe urinary leakage (7.2% vs 3.5%; OR = 1.69; 95% CI, 1.18-2.43), and severe sexual difficulties (34.4% vs 18.3%; OR = 1.73; 95% CI, 1.43-2.11). Patients who received long-course chemoradiotherapy reported significantly better bowel control than those who had short-course radiation therapy, with no difference for other outcomes. Respondents with a stoma present reported significantly higher levels of severe sexual difficulties and worse health-related quality of life than those who had never had a stoma or had undergone stoma reversal.

Conclusions: This study demonstrated the feasibility of a large-scale assessment of patient-reported outcomes and provided "real-world" data regarding the effect of rectal cancer treatment. The results show that patients who receive preoperative radiation therapy reported poorer outcomes, particularly for bowel and sexual function, and highlighted the negative impact of a stoma. We hope that our experience will encourage researchers to perform similar studies in other healthcare systems.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijrobp.2018.12.005DOI Listing
April 2019

Health-related quality of life after treatment for bladder cancer in England.

Br J Cancer 2018 05 14;118(11):1518-1528. Epub 2018 May 14.

Leeds Institute of Cancer and Pathology, University of Leeds, Level 11, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK.

Background: Little is known about quality of life after bladder cancer treatment. This common cancer is managed using treatments that can affect urinary, sexual and bowel function.

Methods: To understand quality of life and inform future care, the Department of Health (England) surveyed adults surviving bladder cancer 1-5 years after diagnosis. Questions related to disease status, co-existing conditions, generic health (EQ-5D), cancer-generic (Social Difficulties Inventory) and cancer-specific outcomes (Functional Assessment of Cancer Therapy-Bladder).

Results: In total, 673 (54%) patients responded; including 500 (74%) men and 539 (80%) with co-existing conditions. Most respondents received endoscopic treatment (60%), while 92 (14%) and 99 (15%) received radical cystectomy or radiotherapy, respectively. Questionnaire completion rates varied (51-97%). Treatment groups reported ≥1 problem using EQ-5D generic domains (59-74%). Usual activities was the most common concern. Urinary frequency was common after endoscopy (34-37%) and radiotherapy (44-50%). Certain populations were more likely to report generic, cancer-generic and cancer-specific problems; notably those with co-existing long-term conditions and those treated with radiotherapy.

Conclusion: The study demonstrates the importance of assessing patient-reported outcomes in this population. There is a need for larger, more in-depth studies to fully understand the challenges patients with bladder cancer face.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41416-018-0084-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5988662PMC
May 2018

Making the Best Use of Our Data.

Authors:
Mike Richards

Health Serv J 2016 Jul;126(6493):16-7

View Article and Find Full Text PDF

Download full-text PDF

Source
July 2016

Mike Richards: "sometimes people can trade too much on reputation".

BMJ 2015 Nov 5;351:h5965. Epub 2015 Nov 5.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmj.h5965DOI Listing
November 2015

Why the Care Quality Commission rated Addenbrooke's as inadequate.

Authors:
Mike Richards

BMJ 2015 Oct 27;351:h5719. Epub 2015 Oct 27.

Care Quality Commission, London SW1W 9SZ

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmj.h5719DOI Listing
October 2015

Identifying Social Distress: A Cross-Sectional Survey of Social Outcomes 12 to 36 Months After Colorectal Cancer Diagnosis.

J Clin Oncol 2015 Oct 17;33(30):3423-30. Epub 2015 Aug 17.

Penny Wright, Amy Downing, Eva J.A. Morris, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals National Health Service Trust, St James's University Hospital, Leeds; Jessica L. Corner, University of Southampton, Highfield, Southampton; Mike A. Richards, Care Quality Commission; and Paul Finan, National Cancer Intelligence Network, London, United Kingdom.

Purpose: To establish the prevalence and determinants of poor social outcomes after a diagnosis of colorectal cancer (CRC).

Patients And Methods: All 12- to 36-month survivors of CRC (International Classification of Diseases [10th revision] codes C18 to C20) diagnosed in 2010 or 2011 and treated in the English National Health Service were identified and sent a questionnaire from their treating cancer hospital. This included the Social Difficulties Inventory, a 16-item scale of social distress (SD) comprising everyday living, money matters, and self and others subscales, plus five single items. Sociodemographic and clinical data were also collected. Analyses using descriptive statistics, χ(2) tests, and logistic regression models were conducted.

Results: Response rate was 63.3% (21,802 of 34,467). Of the 21,802 participants, 17,830 (81.8%) completed all SD items; 2,688 (15.1%) of these 17,830 respondents were classified as experiencing SD (everyday living, 19.5%; money matters, 15.6%; self and others, 18.1%). Multivariable analysis demonstrated having ≥ three long-term conditions was the strongest predictor of SD (odds ratio [OR], 6.64; 95% CI, 5.67 to 7.77 compared with no long-term conditions), followed by unemployment (OR, 5.11; 95% CI, 4.21 to 6.20 compared with being employed), having recurrent or nontreatable disease (OR, 2.75; 95% CI, 2.49 to 3.04 compared with being in remission), and having a stoma (OR, 2.10; 95% CI, 1.86 to 2.36 compared with no stoma). Additional predictors of SD were young age (< 55 years), living in a more deprived area, nonwhite ethnicity, having advanced-stage disease, having undergone radiotherapy, and being a carer.

Conclusion: Although it is reassuring a majority do not experience social difficulties, a minority reported significant SD 12 to 36 months after diagnosis of CRC. The identified clinical and social risk factors are easy to establish and should be used to target support.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1200/JCO.2014.60.6129DOI Listing
October 2015

Health-related quality of life after colorectal cancer in England: a patient-reported outcomes study of individuals 12 to 36 months after diagnosis.

J Clin Oncol 2015 Feb 5;33(6):616-24. Epub 2015 Jan 5.

Amy Downing, Eva J.A. Morris, Penny Wright, David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital; David Sebag-Montefiore, Paul Finan, and Adam W. Glaser, Leeds Teaching Hospitals NHS Trust, St James's University Hospital; Paul Kind, Leeds Institute of Health Sciences, University of Leeds; Richard Feltbower, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds; James Thomas, National Cancer Registration Service (Northern and Yorkshire), Public Health England, St James's University Hospital, Leeds; Mike Richards, Care Quality Commission; Paul Finan, National Cancer Intelligence Network, London; Jessica Corner and Richard Wagland, University of Southampton, Highfield, Southampton; Charlotte Wood and Sarah Lawton, Knowledge and Intelligence Team (Northern and Yorkshire), Public Health England, York; and Sally Vernon, National Cancer Registration Service (Eastern), Public Health England, Cambridge, United Kingdom.

Purpose: This population-level study was conducted to define the health-related quality of life (HRQL) of individuals living with and beyond colorectal cancer (CRC) and to identify factors associated with poor health outcomes.

Patients And Methods: All individuals diagnosed with CRC in England in 2010 and 2011 who were alive 12 to 36 months after diagnosis were sent a questionnaire. This included questions related to treatment, disease status, other long-term conditions (LTCs), generic HRQL (EuroQol-5D), and cancer-specific outcomes (Functional Assessment of Cancer Therapy and Social Difficulties Inventory items).

Results: The response rate was 63.3% (21,802 of 34,467 patients). One or more generic health problems were reported by 65% of respondents, with 10% of patients reporting problems in all five domains. The reporting of problems was higher than in the general population and was most marked in those age less than 55 years. Certain subgroups reported a higher number of problems, notably those with one or more other LTCs, those with active or recurrent disease, those with a stoma, and those at the extremes of the age range (< 55 and > 85 years). Of respondents without a stoma, 16.3% reported no bowel control. Reversal of a stoma resulted in fewer severe bowel problems but more moderate problems than those who had never had a stoma. A quarter of rectal cancer respondents (25.1%) reported difficulties with sexual matters (compared with 11.2% of colon cancer respondents).

Conclusion: This study demonstrates the success of a national patient-reported outcomes survey. The results have the potential to support system-wide improvement in health outcomes through the identification of particular challenges faced by individuals after treatment for CRC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1200/JCO.2014.56.6539DOI Listing
February 2015

Inspection as a driver for quality improvement.

Future Hosp J 2014 Oct;1(2):76-79

Care Quality Commission.

Following publication in 2013 of the report by Robert Francis QC into care at the Mid Staffordshire Foundation Trust, the Care Quality Commission (CQC) has introduced a new and radically different approach to hospital inspection. This involves much larger teams (typically 30 or more people) including clinicians, experts by experience and CQC staff. Eight core services are assessed against five key questions (domains): Are services safe? Effective? Caring? Responsive to patients' needs? Well led? Each domain of each core service is rated on a four point scale: Outstanding, Good, Requires Improvement or Inadequate. To date 65 (40%) of the 160 acute trusts in England have been inspected, the aim being to inspect all trusts by December 2015. The most important single finding is the huge variation in quality of care that the inspection teams have identified within the NHS. Informal feedback suggests that the new approach to inspection represents a significant improvement on previous CQC inspections, though further improvement is imperative.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7861/futurehosp.14.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6438243PMC
October 2014

The International Cancer Benchmarking Partnership: an international collaboration to inform cancer policy in Australia, Canada, Denmark, Norway, Sweden and the United Kingdom.

Health Policy 2013 Sep 18;112(1-2):148-55. Epub 2013 May 18.

Royal Marsden Hospital, Fulham Road, London SW3 6JJ, England, UK; Cancer Research UK, Angel Building, 407 St John Street, London EC1 V 4AD, England, UK. Electronic address:

The International Cancer Benchmarking Partnership (ICBP) was initiated by the Department of Health in England to study international variation in cancer survival, and to inform policy to improve cancer survival. It is a research collaboration between twelve jurisdictions in six countries: Australia (New South Wales, Victoria), Canada (Alberta, British Columbia, Manitoba, Ontario), Denmark, Norway, Sweden, and the United Kingdom (England, Northern Ireland, Wales). Leadership is provided by policymakers, with academics, clinicians and cancer registries forming an international network to conduct the research. The project currently has five modules examining: (1) cancer survival, (2) population awareness and beliefs about cancer, (3) attitudes, behaviours and systems in primary care, (4) delays in diagnosis and treatment, and their causes, and (5) treatment, co-morbidities and other factors. These modules employ a range of methodologies including epidemiological and statistical analyses, surveys and clinical record audit. The first publications have already been used to inform and develop cancer policies in participating countries, and a further series of publications is under way. The module design, governance structure, funding arrangements and management approach to the partnership provide a case study in conducting international comparisons of health systems that are both academically and clinically robust and of immediate relevance to policymakers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.healthpol.2013.03.021DOI Listing
September 2013

Patient-reported outcomes of cancer survivors in England 1-5 years after diagnosis: a cross-sectional survey.

BMJ Open 2013 10;3(4). Epub 2013 Apr 10.

Department of Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

Objectives: To determine the feasibility of collecting population-based patient-reported outcome measures (PROMs) in assessing quality of life (QoL) to inform the development of a national PROMs programme for cancer and to begin to describe outcomes in a UK cohort of survivors.

Design: Cross-sectional postal survey of cancer survivors using a population-based sampling approach.

Setting: English National Health Service.

Participants: 4992 breast, colorectal, prostate and non-Hodgkin's lymphoma (NHL) survivors 1-5 years from diagnosis.

Primary And Secondary Outcome Measures: Implementation issues, response rates, cancer-specific morbidities utilising items including the EQ5D, tumour-specific subscales of the Functional Assessment of Cancer Therapy and Social Difficulties Inventory.

Results: 3300 (66%) survivors returned completed questionnaires. The majority aged 85+ years did not respond and the response rates were lower for those from more deprived area. Response rates did not differ by gender, time since diagnosis or cancer type. The presence of one or more long-term conditions was associated with significantly lower QoL scores. Individuals from most deprived areas reported lower QoL scores and poorer outcomes on other measures, as did those self-reporting recurrent disease or uncertainty about disease status. QoL scores were comparable at all time points for all cancers except NHL. QoL scores were lower than those from the general population in Health Survey for England (2008) and General Practice Patient Survey (2012). 47% of patients reported fear of recurrence, while 20% reported moderate or severe difficulties with mobility or usual activities. Bowel and urinary problems were common among colorectal and prostate patients. Poor bowel and bladder control were significantly associated with lower QoL.

Conclusions: This method of assessing QoL of cancer survivors is feasible and acceptable to most survivors. Routine collection of national population-based PROMs will enable the identification of, and the support for, the specific needs of survivors while allowing for comparison of outcome by service provider.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2012-002317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3641492PMC
April 2013

Cancer recording and mortality in the General Practice Research Database and linked cancer registries.

Pharmacoepidemiol Drug Saf 2013 Feb 13;22(2):168-75. Epub 2012 Dec 13.

Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK.

Purpose: Large electronic datasets are increasingly being used to evaluate healthcare delivery. The aim of this study was to compare information held by cancer registries with that of the General Practice Research Database (GPRD).

Methods: A convenience sample of 101 020 patients aged 40+ years drawn from GPRD formed the primary data source. This cohort was derived from a larger sample originally established for a cohort study of diabetes. GPRD records were linked with those from cancer registries in the National Cancer Data Repository (NCDR). Concordance between the two datasets was then evaluated. For cases recorded only on one dataset, validation was sought from other datasets (Hospital Episode Statistics and death registration) and by detailed analysis of a subset of GPRD records.

Results: A total of 5797 cancers (excluding non-melanomatous skin cancer) were recorded on GPRD. Of these cases, 4830 were also recorded on NCDR (concordance rate of 83.3%). Of the 976 cases recorded on GPRD but not on NCDR, 528 were present also in the hospital records or death certificates. Of the 341 cases recorded on NCDR but not on GPRD, 307 were recorded in these other two datasets. Rates of concordance varied by cancer type. Cancer registries recorded larger numbers of patients with lung, colorectal, and pancreatic cancers, whereas GPRD recorded more haematological cancers and melanomas. As expected, GPRD recorded significantly more non-melanomatous skin cancer. Concordance decreased with increasing age.

Conclusion: Although concordance levels were reasonably high, the findings from this study can be used to direct efforts for better recording in both datasets.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pds.3374DOI Listing
February 2013

Variation in use of the 2-week referral pathway for suspected cancer: a cross-sectional analysis.

Br J Gen Pract 2012 Sep;62(602):e590-7

Trent Cancer Registry, Sheffield.

Background: A 2-Week Wait (2WW) referral pathway for earlier diagnosis of suspected cancer was introduced in England in 2000. Nevertheless, a significant proportion of patients with cancer are diagnosed by other routes (detection rate), only a small proportion of 2WW referrals have cancer (conversion rate) and there is considerable between-practice variation.

Aim: This study examined use by practices of the 2WW referral in relation to all cancer diagnoses.

Design And Setting: A cross-sectional analysis of data extracted from the Cancer Waiting Times Database for all 2WW referrals in 2009 and for all patients receiving a first definitive treatment in the same year.

Method: The age standardised referral ratio, conversion rate, and detection rate were calculated for all practices in England and the correlation coefficient for each pair of measures. The median detection rate was calculated for each decile of practices ranked by conversion rate and vice versa, performing nonparametric tests for trend in each case.

Results: Data for 8049 practices, 865 494 referrals, and 224 984 cancers were analysed. There were significant correlations between referral ratio and conversion rate (inverse) and detection rate (direct). There was also a direct correlation between conversion and detection rates. There was a significant trend in conversion rate for deciles of detection rate, and vice versa, with a marked difference between the lowest and higher deciles.

Conclusion: There is a consistent relationship between 2WW referral conversion rate and detection rate that can be interpreted as representing quality of clinical practice. The 2WW referral rate should not be a measure of quality of clinical care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3399/bjgp12X654551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426597PMC
September 2012

Improving end-of-life care for people with dementia.

Br J Psychiatry 2011 Nov;199(5):357-9

One in three adults over the age of 60 years will die with dementia. Most will have complex physical and psychological needs. Despite this, many people with dementia receive poor-quality end-of-life care. Recent government strategies have highlighted the importance of improved coordination and provision of services.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1192/bjp.bp.111.097030DOI Listing
November 2011

An independent review is under way.

Authors:
Mike Richards

BMJ 2011 Oct 25;343:d6843. Epub 2011 Oct 25.

Department of Health, London.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmj.d6843DOI Listing
October 2011

Extending the age range for breast screening in England: pilot study to assess the feasibility and acceptability of randomization.

J Med Screen 2011 ;18(2):96-102

Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF.

Objective: To assess the feasibility and acceptability of randomizing the phased introduction of the extension of the invited age range in the National Health Service (NHS) Breast Screening Programme in England from 50-70 to 47-73 years.

Setting: Six volunteer breast screening units (BSUs) in England.

Methods: Cluster-randomized trial of invitation versus no invitation for breast screening.

Study Participants: women aged 47-49 and 71-73 years in screening batches randomized between 1 June 2009 and 31 May 2010.

Outcomes: workload, screening uptake among women invited, self-referrals among women not invited, and screening outcomes among women invited.

Results: A total of 312 screening batches (clusters) were randomized including 60,708 women. Screening uptake was 63% in women aged 47-49 and 62% in women aged 71-73. Those who attended screening in the younger age group were more likely to be recalled for assessment than older attendees (7.5% vs. 3.0%) but less likely to be diagnosed with breast cancer (0.5% vs. 1.1%). Among women not invited, 0.2% of those aged 47-49 and 6.8% of those aged 71-73 self-referred for screening. Despite the extra workload BSUs largely coped although there was some slippage in round lengths and other targets.

Conclusion: No major problems of feasibility or acceptability of randomization were found. This pilot study has informed the randomized phasing-in of the age extension across the whole of England.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1258/jms.2011.011065DOI Listing
January 2012

The incidence of deep brain stimulator hardware infection: the effect of change in antibiotic prophylaxis regimen and review of the literature.

Br J Neurosurg 2011 Oct 18;25(5):625-31. Epub 2011 Apr 18.

Department of Neurosurgery, Charing Cross Hospital, London, UK.

The complication of hardware infection related to deep brain stimulator implantation (or revision) varies between 0 and 15.2% in the literature. However, no national guidelines exist at present to define an average or acceptable rate of infection associated with, nor the preferred antibiotic prophylaxis required for, this procedure. The aim of this study was to examine the effect of changing the antibiotic prophylaxis regimen used in a single neurosurgical centre on the incidence and outcome of hardware infection. A prospective cohort of 38 patients undergoing deep brain stimulation (DBS) implantation or internal pulse generator (IPG) replacement and receiving perioperative vancomycin (including intravenous gentamicin on induction) and pouch-installed gentamicin, was compared to a historical cohort of 35 patients receiving perioperative cefuroxime in the same unit. The infection rate over 2 years in the prospective group for DBS surgery was 0 compared to 1 (5.6%) in the historical cohort (p = 0.11, χ(2)); the infection rate for IPG replacements was 1(3.6%) in the prospective cohort, versus 3 (17.6%) in the historical (p = 0.44, χ(2)). In this article, we have also systematically reviewed the literature to date and derived an average infection rate of 4.7% (PI 0.9-22%, Random Effects Meta-analysis, Stata) for 35 studies comprising 3550 patients. There is no significant difference in infection rates between DBS procedures that are primarily internalised (n = 9) compared to those in which there is a period of electrode externalisation (n = 23) (p = 0.9, Meta-regression analysis, Stata).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/02688697.2011.566384DOI Listing
October 2011

National comparisons of lung cancer survival in England, Norway and Sweden 2001-2004: differences occur early in follow-up.

Thorax 2010 May;65(5):436-41

Division of Cancer Studies, King's College London, School of Medicine, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, London SE1 9RT, UK.

BACKGROUND Countries with a similar expenditure on healthcare within Europe exhibit differences in lung cancer survival. Survival in lung cancer was studied in 2001-2004 in England, Norway and Sweden. METHODS Nationwide cancer registries in England, Norway and Sweden were used to identify 250 828 patients with lung cancer from England, 18 386 from Norway and 24 886 from Sweden diagnosed between 1996 and 2004, after exclusion of patients registered through death certificate only or with missing, zero or negative survival times. 5-Year relative survival was calculated by application of the period approach. The excess mortality between the countries was compared using a Poisson regression model. RESULTS In all subcategories of age, sex and follow-up period, the 5-year survival was lower in England than in Norway and Sweden. The age-standardised survival estimates were 6.5%, 9.3% and 11.3% for men and 8.4%, 13.5% and 15.9% for women in the respective countries in 2001-2004. The difference in excess risk of dying between the countries was predominantly confined to the first year of follow-up. The relative excess risk ratio during the first 3 months of follow-up comparing England with Norway 2001-2004 varied between 1.23 and 1.46, depending on sex and age, and between 1.56 and 1.91 comparing England with Sweden. CONCLUSION Access to healthcare and population awareness are likely to be major reasons for the differences, but it cannot be excluded that diagnostic and therapeutic activity play a role. Future improvements in lung cancer management may be seen early in follow-up.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/thx.2009.124222DOI Listing
May 2010

Out of the North Sea: the Zeeland ridges Neandertal.

J Hum Evol 2009 Dec 23;57(6):777-85. Epub 2009 Oct 23.

Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, D-04103 Leipzig, Germany.

In 2001, a portion of human frontal bone was discovered in sediments extracted from the bottom of the North Sea, 15km off the coast of the Netherlands. The extraction zone is located in the so-called Zeeland Ridges area located at 51 degrees 40' northern latitude and 3 degrees 20' eastern longitude. The specimen was dredged up from sediments containing Late Pleistocene faunal remains and Middle Palaeolithic artefacts, including well-finished small handaxes and Levallois flakes. The details of the supraorbital morphology, as well as the quantitative assessment of the shape of the external surface of the squama using traditional and 3D geometric morphometrics, unambiguously assign the Zeeland Ridges frontal bone to Homo neanderthalensis. Carbon and nitrogen isotopic analysis indicate that the Zeeland Ridges hominin, like other Neandertals, was highly carnivorous and does not show evidence for the consumption of aquatic foods. A lesion on the outer table and diploic layer of the bone in the area of the supratoral sulcus can be interpreted as the result of an intradiploic epidermoid cyst, a type of neoplasm diagnosed for the first time in Neandertal remains. So far, the Zeeland Ridges Neandertal is the first Pleistocene fossil hominin found under seawater and the first recorded in the Netherlands.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jhevol.2009.09.001DOI Listing
December 2009

Lateral decubitus positioning for intramedullary nailing of the femur without the use of a fracture table.

Orthopedics 2009 Oct;32(10)

Department of Orthopedics, United States Army, Fort Gordon, Augusta, Georgia, USA.

In closed intramedullary nailing of the femur in the lateral decubitus position without the use of a fracture table, access to the proximal femur is enhanced as compared to supine nailing, especially in large patients. The hip is typically flexed during the nailing, which allows the nail to be placed posterior to the gluteus medius, thus minimizing abductor damage. The deforming forces of flexion and abduction in proximal fracture patterns can be readily overcome by this technique. Proper rotation of the leg can be assessed clinically or with the use of a femoral neck anteversion guide wire. Fluoroscopic visualization of the proximal femur is excellent, including the femoral head, thus facilitating reconstruction nailing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3928/01477447-20090818-05DOI Listing
October 2009

Assessment of the NHS cancer plan in England.

Authors:
Mike Richards

Lancet Oncol 2009 Apr 19;10(4):311. Epub 2009 Mar 19.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S1470-2045(09)70086-5DOI Listing
April 2009

EUROCARE-4 studies bring new data on cancer survival.

Authors:
Mike Richards

Lancet Oncol 2007 Sep;8(9):752-3

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S1470-2045(07)70247-4DOI Listing
September 2007

The incidence and outcome of myeloid malignancies in 2,112 adult patients in southeast England.

Haematologica 2006 Oct;91(10):1400-4

Department of Haematological Medicine, Kings HealthCare NHS Trust, Denmark Hill, London, SE5 9RS, UK.

There is a paucity of epidemiological data on chronic myeloproliferative disorders and myelodysplastic syndromes (MDS), while subtypes of acute myeloid leukemia (AML) are rarely defined. We identified 2,112 adult myeloid malignancies in the South Thames area between 1999 and 2000. The incidence (European standard population) of AML was 3.00/100,000, that of MDS 3.47/100,000, chronic myelomonocytic leukemia (CMML) 0.46/100,000, idiopathic myelofibrosis (IMF) 0.37/100,000, polycythemia vera (PV) 1.08/100,000, primary thrombocythemia (PT) 1.65/100,000 and chronic myeloid leukemia (CML) 1.09/100,000. The 3-year survival for AML was 15%, MDS 45%, CMML 29%, IMF 48%, PV 80%, PT 81% and CML 50% We believe this study reflects the true incidence and outcome of myeloid malignancies in South East England.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2006

A new approach to treatment of resistant gram-positive infections: potential impact of targeted IV to oral switch on length of stay.

BMC Infect Dis 2006 Jun 8;6:94. Epub 2006 Jun 8.

Department of Infectious Diseases and Microbiology, Imperial College, London, UK.

Background: Patients prescribed intravenous (IV) glycopeptides usually remain in hospital until completion of this treatment. Some of these patients could be discharged earlier if a switch to an oral antibiotic was made. This study was designed to identify the percentage of inpatients currently prescribed IV glycopeptides who could be discharged earlier if a switch to an oral agent was used, and to estimate the number of bed days that could be saved. We also aimed to identify the patient group(s) most likely to benefit, and to estimate the number of days of IV therapy that could be prevented in patients who remained in hospital.

Methods: Patients were included if they were prescribed an IV glycopeptide for 5 days or more. Predetermined IV to oral antibiotic switch criteria and discharge criteria were applied. A multiple logistic regression model was used to identify the characteristics of the patients most likely to be suitable for earlier discharge.

Results: Of 211 patients, 62 (29%) could have had a reduced length of stay if they were treated with a suitable oral antibiotic. This would have saved a total of 649 inpatient days (median 5 per patient; range 1-54). A further 31 patients (15%) could have switched to oral therapy as an inpatient thus avoiding IV line use. The patients most likely to be suitable for early discharge were those with skin and soft tissue infection, under the cardiology, cardiothoracic surgery, orthopaedics, general medical, plastic surgery and vascular specialities, with no high risk comorbidity and less than five other regularly prescribed drugs.

Conclusion: The need for glycopeptide therapy has a significant impact on length of stay. Effective targeting of oral antimicrobials could reduce the need for IV access, allow outpatient treatment and thus reduce the length of stay in patients with infections caused by antibiotic resistant gram-positive bacteria.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1471-2334-6-94DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513579PMC
June 2006

Heart surgery in infants with hemophilia.

Ann Thorac Surg 2006 Jan;81(1):336-9

Department of Pediatric Cardiology, Leeds General Infirmary, Leeds, United Kingdom.

We describe 2 infants with hemophilia A who had heart surgery under cardiopulmonary bypass with factor VIII replacement therapy, and we recommend a guideline for factor VIII support for cardiac surgery. One child had repair of total anomalous pulmonary venous connection. The second had cardiac catheterization followed by repair of ventricular septal defect and total anomalous pulmonary venous connection. Close collaboration between hematologist, laboratory, cardiologist, and cardiac surgeon is crucial in successful management of coagulation abnormalities during and after surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.athoracsur.2004.09.001DOI Listing
January 2006