Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review

<p>Abstract</p> <p>Background</p> <p>Bowel symptoms are often considered an indication to perform colonoscopy to identify or rule out colorectal cancer or precancerous polyps. Investigation of bowel symptoms for this purpose is recommended by numerous clinical guidelines. However, the evidence for this practice is unclear. The objective of this study is to systematically review the evidence about the association between bowel symptoms and colorectal cancer or polyps.</p> <p>Methods</p> <p>We searched the literature extensively up to December 2008, using MEDLINE and EMBASE and following references. For inclusion in the review, papers from cross sectional, case control and cohort studies had to provide a 2×2 table of symptoms by diagnosis (colorectal cancer or polyps) or sufficient data from which that table could be constructed. The search procedure, quality appraisal, and data extraction was done twice, with disagreements resolved with another reviewer. Summary ROC analysis was used to assess the diagnostic performance of symptoms to detect colorectal cancer and polyps.</p> <p>Results</p> <p>Colorectal cancer was associated with rectal bleeding (AUC 0.66; LR+ 1.9; LR- 0.7) and weight loss (AUC 0.67, LR+ 2.5, LR- 0.9). Neither of these symptoms was associated with the presence of polyps. There was no significant association of colorectal cancer or polyps with change in bowel habit, constipation, diarrhoea or abdominal pain. Neither the clinical setting (primary or specialist care) nor study type was associated with accuracy.</p> <p>Most studies had methodological flaws. There was no consistency in the way symptoms were elicited or interpreted in the studies.</p> <p>Conclusions</p> <p>Current evidence suggests that the common practice of performing colonoscopies to identify cancers in people with bowel symptoms is warranted only for rectal bleeding and the general symptom of weight loss. Bodies preparing guidelines for clinicians and consumers to improve early detection of colorectal cancer need to take into account the limited value of symptoms.</p

Trends in the specialist workforce in paediatrics in Australia, 1981-1997

Objective: The Royal Australasian College of Physicians has conducted periodic workforce censuses of Fellows practising paediatric medicine in Australia since 1981. The aim of this study was to document trends in the supply of paediatricians and project these trends into the early 21st century. Methodology: Time series analysis using least squares regression. Result: The peadiatric consultant workforce in Australia increased in a linear manner from 374 in 1981 to 777 in 1997. If this trend persists, the number of paediatricians will grow by 62% to 1255 in 2016. The ratio of population aged 0.-14 years per paediatrician fell from 9960:1 in 1981 to 5040:1 in 1997. The projected national decline in the child population will result in a ratio of 3050 children per paediatrician in the year 2016. The proportion of women in the paediatric workforce was 22.4% in 1997 and is projected to rise to at least 36% by 2016. The proportion aged 50 years and older rose from 22% in 1981 to 33.6% in 1997 and is projected to be 45% by the year 2016. The average total weekly working hours fell from 58.2 in 1984 to 53.4 in 1997. The proportion practising in regional centres rose from 12 to 17.9%. Conclusions: The paediatric workforce in Australia has grown rapidly over the past 16 years. If this trend continues the ratio of child population per paediatrician will continue to fall, accentuated by the projected decline in the child population. The trends towards an ageing workforce with an increasing proportion of women, declining working hours and rising proportion practising in regional centres are expected to continue unless workforce intake or retirement change dramatically

Trends in the specialist workforce in internal medicine in Australia, 1981-1995

Objective: To describe trends over the period 1981 to 1995 in the supply of consultant physicians in adult medicine in Australia, and to project these trends into the early part of the 21st century. Design: Analysis of workforce data collected by the Royal Australasian College of Physicians in censuses of Fellows in 1981, 1984, 1986, 1988, 1990, 1993 and 1995. Main outcome: Number of physicians and ratio of population aged 50 years and older per physician. Results: The workforce increased linearly from 1641 in 1981 to 2701 in 1995, while the population/physician ratio fell from 2180:1 to 1720:1, with a decreasing rate of decline. The ratio is projected to rise after 1996 to 1780:1 in 2016. Among the States and Territories, the higher the population/physician ratio in 1981 the greater the rate of subsequent decline. The proportion of women physicians rose linearly from 4.8% in 1981 to 10.6% in 1995. The age structure changed from a youthful triangular profile in 1981 towards a rectangular profile characteristic of an aged population. All specialty fields displayed a decreasing rate of decline in the population/physician ratio. The proportion of physicians practising in regional centres increased steadily from 9.3% in 1981 to 12.9% in 1995. Conclusions: Although the number of physicians has risen markedly since 1981 and the ratio of population aged 50 years and older per physician has fallen, trends suggest that the ratio will rise again early in the 21st century. Any deliberate attempt to limit the growth of the physician workforce might result in a deficit in the future when the demand for physicians is growing rapidly due to population ageing

First year clinical tutorials: students&rsquo; learning experience

Annette Burgess,1 Kim Oates,2 Kerry Goulston,2 Craig Mellis1 1Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; 2Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Background: Bedside teaching lies at the heart of medical education. The learning environment afforded to students during clinical tutorials contributes substantially to their knowledge, thinking, and learning. Situated cognition theory posits that the depth and breadth of the students&#39; learning experience is dependent upon the attitude of the clinical teacher, the structure of the tutorial, and the understanding of tutorial and learning objectives. This theory provides a useful framework to conceptualize how students&#39; experience within their clinical tutorials impacts their knowledge, thinking, and learning. Methods: The study was conducted with one cohort (n=301) of students who had completed year 1 of the medical program at Sydney Medical School in 2013. All students were asked to complete a three-part questionnaire regarding their perceptions of their clinical tutor&#39;s attributes, the consistency of the tutor, and the best features of the tutorials and need for improvement. Both quantitative and qualitative data were collected and analyzed using descriptive statistics. Results: The response rate to the questionnaire was 88% (265/301). Students perceived that their tutors displayed good communication skills and enthusiasm, encouraged their learning, and were empathetic toward patients. Fifty-two percent of students reported having the same communications tutor for the entire year, and 28% reported having the same physical examination tutor for the entire year. Students would like increased patient contact, greater structure within their tutorials, and greater alignment of teaching with the curriculum. Conclusion: Situated cognition theory provides a valuable lens to view students&#39; experience of learning within the clinical environment. Our findings demonstrate students&#39; appreciation of clinical tutors as role models, the need for consistency in feedback, the importance of structure within tutorials, and the need for tutors to have an understanding of the curriculum and learning objectives for each teaching session. Keywords: bedside teaching, clinical tutorials, role modeling, situated cognitio