The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

Public service leaders as change agents - for whom?:mediatory responses to leadership development in England

This article examines how far senior staff in English educational and health service organizations view themselves as leaders who are "change agents" for government-driven reform and independent change agendas. The contribution of external leadership development provision to shaping these self-perceptions is explored. Special attention is paid to national leadership development bodies with different degrees of formal association with government. Whatever this relationship, such provision and other development support apparently reinforced a strong sense of personal agency (choice of action) associated with being a leader, empowering senior staff to adopt a modestly mediatory stance towards both reform and leadership development provision

The ‘post-bureaucratic’ public sector organization. New organizational forms and HRM in ten UK public sector organizations

This paper evaluates the extent to which ‘post-bureaucratic’ organizational forms have been introduced to the UK public sector and the implications for human resource management policies and practices in the sector. The study draws from interview data at ten public sector organizations including local authorities, the National Health Service, the Civil Service, police authorities, broadcasting and transport. It concludes that certain structural changes have been made, but that older functional lines of authority still exist and thus post-bureaucratic claims are misleading. However, a harsher working environment has arisen for managers in these public sector organizations, with longer hours and a more complex working environment. Older certainties such as job security, a safe career path and seniority-based pay have all been eroded