The effect of the new GMS contract on GP appointment provision in Wales: postal questionnaire survey of practice managers

<p>Abstract</p> <p>Background</p> <p>Access to health professionals is a key UK NHS priority, and meeting access targets is rewarded through the new General Medical Services (GMS) contract in the UK. We sought to determine the current state of appointment provision in Wales and any changes resulting from the need to meet indicators in the new GMS contract. We undertook a postal questionnaire study of practice managers in all general practices in Wales.</p> <p>Findings</p> <p>Valid responses were received from 396/505 (78.4%) practice managers. 361 (93.1%) practices reported that they had achieved the target for 2004/05. 104 (26%) practices reported that they were 100% open access/advanced access. The most frequent changes reported in response to the new GMS contract were offering more open or advanced access slots (237, 60%), more GP phone consultations (167, 42%), introducing a telephone triage system (100, 25%), introducing a minor illness clinic (76, 19%), and employing or training a nurse practitioner (59, 15%). 83% practice managers believed that patients were able to get an appointment at the time they need it either 'all of the time' or 'most of the time', and 70% that patients were able to get an appointment with the GP of choice either 'all of the time' or 'most of the time'.</p> <p>Conclusion</p> <p>This survey has demonstrated the current extent of appointment provision in Wales, and how changes have been driven by incentives. Whether these changes are in the best interests of either patients or doctors, or both, remains to be seen.</p

Cumulative burden of 144 conditions, critical care hospitalisation and premature mortality across 26 adult cancers

A comprehensive evaluation of the total burden of morbidity endured by cancer survivors remains unavailable. This study quantified the burden of 144 health conditions and critical care admissions across 26 adult cancers and treatment modalities in 243,767 adults. By age 60, top conditions ranked by fold difference (cumulative burden in survivors divided by cumulative burden in controls) were haematology, immunology/infection and pulmonary conditions. Patients who had all three forms of treatment (chemotherapy, radiotherapy and surgery) experienced a high cumulative burden of late morbidities compared with patients who received radiotherapy alone. The top five cancers with the highest cumulative burden of critical care admissions by age 60 were bone (12.4 events per 100 individuals [CI: 11.6-13.1]), brain (9.0 [7.5-10.5]), spinal cord and nervous system (7.2 [6.7-7.8]), testis (6.7 [4.9-8.4]) and Hodgkin lymphoma (4.4 [3.6-5.1]). Conditions that were associated with high excess years-of-life-lost were haematological conditions (9.6 years), pulmonary conditions (8.6 years) and immunological conditions or infections (7.8 years). As the population of cancer survivors continues to grow, our results indicate that it is important to tackle long-term health consequences through enacting data-driven policies

Acute Sensitivity of Landslide Rates to Initial Soil Porosity

Some landslides move imperceptibly downslope, whereas others accelerate catastrophically. Experimental landslides triggered by rising pore water pressure moved at sharply contrasting rates due to small differences in initial porosity. Wet sandy soil with porosity of about 0.5 contracted during slope failure, partially liquefied, and accelerated within 1 second to speeds over 1 meter per second. The same soil with porosity of about 0.4 dilated during failure and slipped episodically at rates averaging 0.002 meter per second. Repeated slip episodes were induced by gradually rising pore water pressure and were arrested by pore dilation and attendant pore pressure decline

The Assignment of Scale to Object-Oriented Software Measures

In order to improve productivity (and quality), measurement of specific aspects of software has become imperative. As object oriented programming languages have become more widely used, metrics designed specifically for object-oriented software are required. Recently a large number of new metrics for object- oriented software has appeared in the literature. Unfortunately, many of these proposed metrics have not been validated to measure what they purport to measure. In this paper fifty (50) of these metrics are analyzed

A Plant-Based Dietary Intervention Improves Beta-Cell Function and Insulin Resistance in Overweight Adults: A 16-Week Randomized Clinical Trial.

The aim of this study was to test the effect of a plant-based dietary intervention on beta-cell function in overweight adults with no history of diabetes. Participants (n = 75) were randomized to follow a low-fat plant-based diet (n = 38) or to make no diet changes (n = 37) for 16 weeks. At baseline and 16 weeks, beta-cell function was quantified with a mathematical model. Using a standard meal test, insulin secretory rate was calculated by C-peptide deconvolution. The Homeostasis Model Assessment (HOMA-IR) index was used to assess insulin resistance while fasting. A marked increase in meal-stimulated insulin secretion was observed in the intervention group compared with controls (interaction between group and time, Gxt, p \u3c 0.001). HOMA-IR index fell significantly (p \u3c 0.001) in the intervention group (treatment effect −1.0 (95% CI, −1.2 to −0.8); Gxt, p = 0.004). Changes in HOMA-IR correlated positively with changes in body mass index (BMI) and visceral fat volume (r = 0.34; p = 0.009 and r = 0.42; p = 0.001, respectively). The latter remained significant after adjustment for changes in BMI (r = 0.41; p = 0.002). Changes in glucose-induced insulin secretion correlated negatively with BMI changes (r = −0.25; p = 0.04), but not with changes in visceral fat. Beta-cell function and insulin sensitivity were significantly improved through a low-fat plant-based diet in overweight adult

Using the XMM Optical Monitor to Study Cluster Galaxy Evolution

We explore the application of XMM-Newton Optical Monitor (XMM-OM) ultraviolet (UV) data to study galaxy evolution. Our sample is constructed as the intersection of all Abell clusters with z < 0.05 and having archival XMM-OM data in either the UVM2 or UVW1 filters, plus optical and UV photometry from the Sloan Digital Sky Survey and GALEX, respectively. The eleven resulting clusters include 726 galaxies with measured redshifts, 520 of which have redshifts placing them within their parent Abell clusters. We develop procedures for manipulating the XMM-OM images and measuring galaxy photometry from them, and confirm our results via comparison with published catalogs. Color magnitude diagrams (CMDs) constructed using the XMM-OM data along with SDSS optical data show promise for evolutionary studies, with good separation between red and blue sequences and real variation in the width of the red sequence that is likely indicative of differences in star formation history. This is particularly true for UVW1 data, as the relative abundance of data collected using this filter and its depth make it an attractive choice. Available tools that use stellar synthesis libraries to fit the UV and optical photometric data may also be used, thereby better describing star formation history within the past Gyr and providing estimates of total stellar mass that include contributions from young stars. Finally, color-color diagrams that include XMM-OM UV data appear useful to the photometric identification of both extragalactic and stellar sources.Comment: 44 pages with 14 figures, to appear in PAS

Determining patient and primary care delay in the diagnosis of cancer – lessons from a pilot study of patients referred for suspected cancer

<p>Abstract</p> <p>Background</p> <p>There is no validated way of measuring diagnostic delay in cancer, especially covering patient and primary care delays. An instrument is needed in order to determine the effect of potential interventions to reduce delay and improve cancer morbidity and mortality.</p> <p>Methods</p> <p>Development of a postal questionnaire tool to measure patient and primary care time responses to key symptoms and signs. The pilot questionnaire was sent to 184 patients with suspected cancer.</p> <p>Results</p> <p>The response rate was only 85/184 (46.2%). Anxiety was cited as one reason for this low response. Patients returning questionnaires were more likely to be women and more likely to be younger. 84/85 (98.8%) provided consent to access medical records, and questions regarding health profile, smoking and socio-economic profile were answered adequately. Outcome data on their cancer diagnosis was linked satisfactorily and the question about GP-initiated investigations was answered well. Estimated dates for symptom duration were preferred for patient delays, but exact dates were preferred for primary care delays; however there was a significant amount of missing data.</p> <p>Conclusion</p> <p>A more personal approach to the collection of data about the duration of symptoms in this group of people is needed other than a postal questionnaire. However elements of this piloted questionnaire are likely to figure strongly in future development and evaluation of this tool.</p

Patient perspectives on delays in diagnosis and treatment of cancer: a qualitative analysis of free-text data

Background: Earlier cancer diagnosis is crucial in improving cancer survival. The International Cancer Benchmarking Partnership Module 4 (ICBP4) is a quantitative survey study that explores the reasons for delays in diagnosis and treatment of breast, colorectal, lung, and ovarian cancer. To further understand the associated diagnostic processes, it is also important to explore the patient perspectives expressed in the free-text comments. Aim: To use the free-text data provided by patients completing the ICBP4 survey to augment the understanding of patients’ perspectives of their diagnostic journey. Design and setting: Qualitative analysis of the free-text data collected in Wales between October 2013 and December 2014 as part of the ICBP4 survey. Newly-diagnosed patients with either breast, ovarian, colorectal, or lung cancer were identified from registry data and then invited by their GPs to participate in the survey. Method: A thematic framework was used to analyse the free-text comments provided at the end of the ICBP4 survey. Of the 905 patients who returned a questionnaire, 530 included comments. Results: The free-text data provided information about patients’ perspectives of the diagnostic journey. Analysis identified factors that acted as either barriers or facilitators at different stages of the diagnostic process. Some factors, such as screening, doctor–patient familiarity, and private treatment, acted as both barriers and facilitators depending on the context. Conclusion: Factors identified in this study help to explain how existing models of cancer diagnosis (for example, the Pathways to Treatment Model) work in practice. It is important that clinicians are aware of how these factors may interact with individual clinical cases and either facilitate, or act as a barrier to, subsequent cancer diagnosis. Understanding and implementing this knowledge into clinical practice may result in quicker cancer diagnoses

Impact of the COVID-19 global pandemic on symptomatic diagnosis of cancer - the view from primary care

The entire landscape of cancer management in primary care, from case identification to the management of those living with and beyond cancer, is evolving rapidly in the face of the coronavirus (COVID-19) pandemic.1 In a climate of fear and mandated avoidance of all but essential clinical services, delays in patient, population and healthcare system responses to suspected cancer symptoms seem inevitable