266 research outputs found
How easy and confident do patients feel about using an iPad to complete the Patient Concerns Inventory without assistance in a busy head and neck oncology outpatient review clinic
Balancing patients fears of recurrence and fears of COVID-19 when considering their preference for review consultations
Health-related quality of life at 3 months following head and neck cancer treatment is a key predictor of longer-term outcome and of benefit from using the patient concerns inventory
INTRODUCTION: During clinical followâup it can be difficult to identify those head and neck cancer (HNC) patients who are coping poorly and could benefit from additional support. Healthârelated quality of life (HRQOL) questionnaires and prompt lists provide a means by which patients can express their perceived outcomes and raise concerns. The first aim of this secondary analysis following a randomized trial was to explore which patient characteristics, at around 3Â months following treatment completion (baseline), best predict HRQOL 12Â months later. The second aim was to attempt to ascertain which patients were most likely to benefit from using prompt list. METHODS: Clusterâcontrolled pragmatic trial data were analyzed. HRQOL was measured by the University of Washington Quality of life questionnaire (UWâQOLv4). The prompt list was the Patient Concerns Inventory (PCIâHN). RESULTS: The trial involved 15 eligible consultants and a median (interâquartile range) of 16 (13â26) primary HNC patients per consultant, with 140 PCI patients and 148 controls. Baseline HRQOL was the dominant predictor of 12âmonth HRQOL with other predictors related to social, financial, and lifestyle characteristics as well as clinical stage and treatment. Although formal statistical tests for interaction were nonâsignificant the trend in analyses over a range of outcomes suggested that patients with worse baseline HRQOL could benefit more from the PCIâHN. DISCUSSION: HRQOL early postâtreatment is a key predictor of longerâterm outcome. Measuring and using HRQOL and the PCIâHN are not only surrogates for predicting HRQOL at 15Â months postâtreatment, but also tools to help guide interventions
Social determinants of health-related quality of life outcomes for head and neck cancer patients
The influence of area-based and individual indicators of socioeconomic status (SES) on health-related quality of life (HRQOL) and patient concerns following head and neck cancer is complex and under-reported. The aim of this study is to use baseline data collected as part of a randomised controlled trial to provide greater detail on the attribution of SES to University of Washington Quality of Life version 4 (UWQOL v4), Distress Thermometer and European Quality of Life Five-Dimension Five-Level (EQ-5D-5L) outcomes. A total of 288 trial patients attended baseline clinics a median (Interquartile (IQR)) of 103 (71â162) days after the end of treatment. Area-based SES was assessed using the Index of Multiple Deprivation (IMD) 2019. Thirty-eight per cent (110/288) of patients lived in the most deprived IMD rank quintile. Less than good overall quality of life (31% overall) was associated with current working situation (p = 0.008), receipt of financial benefits (p < 0.001), total household income (p = 0.003) and use of tobacco (p = 0.001). Income and employment were significant patient level indicators predictors of HRQOL outcomes after case-mix adjustment. The number of Patient Concerns Inventory items selected varied significantly by overall clinical tumour clinical stage (p < 0.001) and by treatment (p < 0.001) but not by area IMD or patient-level deprivation indicators. In conclusion, interventions to improve employment and finance could make a substantial positive effect on HRQOL outcomes and concerns
Incidence, timing, presentation, treatment, and outcomes of second primary head and neck squamous cell carcinoma after oral cancer
Anaemia and patient blood management in patients having neck dissections or free flaps for head and neck cancer
The impact of the UKâtwo-week ruleâon stage-on-diagnosis of oral cancer and the relationship to socio-economic inequalities
Variability in the organisation and management of hospital care for COPD exacerbations in the UK
SummaryPrevious smaller UK audits have demonstrated wide variation in organisation, resources, and process of care for acute chronic obstructive pulmonary disease (COPD) admissions. Smallest units appeared to do less well.UK acute hospitals supplied information on (1) resources and organisation of care, (2) clinical data on process of care and outcomes for up to 40 consecutive COPD admissions. Comparisons were made against national recommendations.Eight thousand and thirteen admissions involved 7529 patients from 233 units (93% of UK acute Trusts). Twenty-six percent of units had at most one whole-time equivalent respiratory consultant while 12% had at least four. Thirty percent patients were admitted under a respiratory specialist and 48% discharged under their care whilst 28% had no specialist input at all. Variation in care provision was wide across all hospitals but patients in smaller hospitals had less access to specialist respiratory or admission wards, pulmonary rehabilitation programs, speciality triage or an early discharge scheme. Six percent of units did not have access to NIV and 18% to invasive ventilatory support.There remains wide variation in all aspects of acute hospital COPD care in the UK, with smaller hospitals offering fewest services. Those receiving specialist input are more likely to be offered interventions of proven effect. Management guidelines alone are insufficient to address inequalities of care and a clear statement of minimum national standards for resource provision and organisation of COPD care are required. This study provides a unique insight into the current state of care for patients admitted with COPD exacerbations in the UK
Co-option of an anteroposterior head axis patterning system for proximodistal patterning of appendages in early bilaterian evolution
AbstractThe enormous diversity of extant animal forms is a testament to the power of evolution, and much of this diversity has been achieved through the emergence of novel morphological traits. The origin of novel morphological traits is an extremely important issue in biology, and a frequent source of this novelty is co-option of pre-existing genetic systems for new purposes (Carroll et al., 2008). Appendages, such as limbs, fins and antennae, are structures common to many animal body plans which must have arisen at least once, and probably multiple times, in lineages which lacked appendages. We provide evidence that appendage proximodistal patterning genes are expressed in similar registers in the anterior embryonic neurectoderm of Drosophila melanogaster and Saccoglossus kowalevskii (a hemichordate). These results, in concert with existing expression data from a variety of other animals suggest that a pre-existing genetic system for anteroposterior head patterning was co-opted for patterning of the proximodistal axis of appendages of bilaterian animals
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