One-stop diagnostic breast clinics: how often are breast cancers missed?

The aim of this study was to estimate the number of patients discharged from a symptomatic breast clinic who subsequently develop breast cancer and to determine how many of these cancers had been ‘missed' at initial assessment. Over a 3-year period, 7004 patients were discharged with a nonmalignant diagnosis. Twenty-nine patients were subsequently diagnosed with breast cancer over the next 36 months. This equates to a symptomatic ‘interval' cancer rate of 4.1 per 1000 women in the 36 months after initial assessment (0.9 per 1000 women within 12 months, 2.6 per 1000 women within 24 months). The lowest sensitivity of initial assessment was seen in patients of 40–49 years of age, and these patients present the greatest imaging and diagnostic challenge. Following multidisciplinary review, a consensus was reached on whether a cancer had been missed or not. No delay occurred in 10 patients (35%) and probably no delay in 7 patients (24%). Possible delay occurred in three patients (10%) and definite delay in diagnosis (i.e., a ‘missed' cancer) occurred in only nine patients (31%). The overall diagnostic accuracy of ‘triple' assessment is 99.6% and the ‘missed' cancer rate is 1.7 per 1000 women discharged

No, Prime Minister:Explaining the House of Commons’ Vote on Intervention in Syria

On 29 August 2013, the UK House of Commons inflicted the first defeat on a Prime Minister over a matter of war and peace since 1782. Recalled to debate and vote on UK intervention in Syria, the Commons humbled the government and crucially impacted the development of UK foreign policy. This article places that vote, and the developments leading to it, in the context of the role of parliaments in security policy and explores the relationships between parliamentary influence, leadership, intra-party and intra-coalition politics, and public opinion. From an in-depth analysis of leaders’ statements and parliamentary debate, we find a combination of intra-party politics and party leadership were most significant. An additional factor–the role of historical precedent–was also important. Our analysis explores the fluidity and interconnectedness of the various factors for parliamentary influence in foreign policy and offers directions for future theoretical development and empirical research.</p

Why Parliament Now Decides on War: Tracing the Growth of the Parliamentary Prerogative through Syria, Libya and Iraq

Research Highlights and Abstract: Precedents set in debates over Iraq, Libya and Syria established a new parliamentary prerogative, that MPs must vote before military action can legitimately be launched. Tony Blair conceded the Iraq vote to shore up Labour back-bench support, because he was convinced he would win, and because he was unwilling to change course regardless. David Cameron allowed a vote on Libya because he believed parliament should have a say, because UN support meant he was certain to win, and to gain plaudits for not being Blair. Cameron then had to allow a vote on Syria despite its greater political sensitivity. He mishandled the vote, and lost, and felt constrained to pull out of mooted military action. Collectively these three precedents comprise a new constitutional convention, which will constrain the executive in future whether the law is formally changed or not. Parliament now decides when Britain goes to war. The vote against military intervention in Syria on 29 August 2013 upheld a new parliamentary prerogative that gradually developed through debates over earlier actions in Iraq and Libya. While the academic community and much of the British political elite continue to focus on the free rein granted to prime ministers by the historic royal prerogative, this article argues it is critically constrained by its parliamentary counterpart. It traces the way political conditions, individual policymaker preferences, and the conventional nature of the unwritten British constitution allowed parliament to insert itself into the policymaking process without the consent of successive governments. It concludes that MPs will in future expect the right to vote on proposals to deploy the armed forces overseas, and that the legitimacy of military action will depend on the government winning such a vote