The impact of the ‘hub and spoke’ model of care for lung cancer and equitable access to surgery

Objectives: To determine the influence of where a patient is first seen (either surgical or non-surgical centre) and patient features on having surgery for non-small cell lung cancer (NSCLC). Design: Cross-sectional study from individual patients, between 1January 2008 and 31March 2012. Setting: Linked National Lung Cancer Audit and Hospital Episode Statistics datasets. Participants: 95 818 English patients with a diagnosis of NSCLC, of whom 12 759 (13%) underwent surgical resection. Main outcome measure: Odds of having surgery based on the empirical catchment population of the 30 thoracic surgical centres in England and whether the patient is first seen in a surgical centre or a non-surgical centre. Results: Patients were more likely to be operated on if they were first seen at a surgical centre (OR 1.37; 95% CI 1.29 to 1.45). This was most marked for surgical centres with the largest catchment populations. In these surgical centres with large catchment populations, the resection rate for local patients was 18% and for patients first seen in a non-surgical centre within catchment was 12%. Conclusions: Surgical centres that serve the largest catchment populations have high resection rates for patients first seen in their own centre but, in contrast, low resection rates for patients first seen at the surrounding centres they serve. Our findings demonstrate the importance of going further than relating resection rates to hospital volume or surgeon number, and show that there is a pressing need to design lung cancer services which enable all patients, including those first seen at non-surgical centres, to have equal access to lung cancer surgery

Small-cell lung cancer in England: trends in survival and chemotherapy using the National Lung Cancer Audit

Background: The purpose of this study was to identify trends in survival and chemotherapy use for individuals with smallcell lung cancer (SCLC) in England using the National Lung Cancer Audit (NLCA). Methods: We used data from the NLCA database to identify people with histologically proven SCLC from 2004–2011. We calculated the median survival by stage and assessed whether patient characteristics changed over time. We also assessed whether the proportion of patients with records of chemotherapy and/or radiotherapy changed over time. Results: 18,513 patients were diagnosed with SCLC in our cohort. The median survival was 6 months for all patients, 1 year for those with limited stage and 4 months for extensive stage. 69% received chemotherapy and this proportion changed very slightly over time (test for trends p = 0.055). Age and performance status of patients remained stable over the study period, but the proportion of patients staged increased (p-value,0.001), mainly because of improved data completeness. There has been an increase in the proportion of patients that had a record of receiving both chemotherapy and radiotherapy each year (from 19% to 40% in limited and from 9% to 21% in extensive stage from 2004 to 2011). Patients who received chemotherapy with radiotherapy had better survival compared with any other treatment (HR 0.24, 95% CI 0.23–0.25). Conclusion: Since 2004, when the NLCA was established, the proportion of patients with SCLC having chemotherapy has remained static. We have found an upward trend in the proportion of patients receiving both chemotherapy and radiotherapy which corresponded to a better survival in this group, but as it only applied for a small proportion of patients, it was not enough to change the overall survival

Chronic Obstructive Pulmonary Disease and Risk of Lung Cancer: The Importance of Smoking and Timing of Diagnosis

Introduction:The majority of cases of both lung cancer and chronic obstructive pulmonary disease (COPD) are attributable to cigarette smoking, but whether COPD is an independent risk factor for lung cancer remains unclear.Methods:We used The Health Improvement Network, a U.K. general practice database, to identify incident cases of lung cancer and controls matched on age, sex, and practice. Using conditional logistic regression, we assessed the effects of timing of first diagnoses of COPD, pneumonia, and asthma on the odds of lung cancer, adjusting for smoking habit.Results:Of 11,888 incident cases of lung cancer, 23% had a prior diagnosis of COPD compared with only 6% of the 37,605 controls. The odds of lung cancer in patients who had COPD diagnosed within 6 months of their cancer diagnosis were 11-fold those of patients without COPD (odds ratio 11.47, 95% confidence interval 9.38–14.02). However, when restricted to earlier COPD diagnoses, with adjustment for smoking, the effect markedly diminished (for COPD diagnoses >10 years before lung cancer diagnosis, odds ratio: 2.18, 95% confidence interval: 1.87–2.54). The pattern was similar for pneumonia. The effect of COPD on lung cancer remained after excluding patients who had a codiagnosis of asthma.Conclusion:A diagnosis of COPD is strongly associated with a diagnosis of lung cancer, however, this association is largely explained by smoking habit, strongly dependent on the timing of COPD diagnosis, and not specific to COPD. It seems unlikely, therefore, that COPD is an independent risk factor for lung cancer

The cost-effectieveness of cognitive behavior therapy for borderline personality disorder: results from the BOSCOT trial

Borderline personality disorder places a significant burden on healthcare providers and other agencies. This study evaluated the cost-effectiveness of cognitive behavior therapy plus treatment as usual compared to treatment as usual alone for patients with borderline personality disorder. The economic analysis was conducted alongside a multi-center, randomized controlled trial. The costs of primary and secondary healthcare utilization, alongside the wider economic costs, were estimated from medical records and patient self-report. The primary outcome measure used was the quality-adjusted life year (QALY), assessed using EuroQol. On average, total costs per patient in the cognitive behavior therapy group were lower than patients receiving usual care alone (−£689), although this group also reported a lower quality of life (−0.11 QALYs). These differences were small and did not approach conventional levels of statistical significance. The use of cognitive therapy for borderline personality disorder does not appear to demonstrate any significant cost-effective advantage based on the results of this study

Penyuluhan zat pewarna alami makanan dan minuman: Indonesia

Baground: Food color is one of the factors that consumers consider when choosing and evaluating food. Therefore, the use of colorants in food seems to have become an obligation for all food manufacturers. The health effects of using synthetic dyes is why we have to go back to nature by using natural dyes. Indonesia is a country rich in natural dyes such as carotenoids, anthocyanins, betalains and chlorophyll. Natural dyes are not only dyes that can be used for food, but also have the ability to maintain health and prevent and reduce the occurrence of various diseases such as diabetes, hypercholesterolemia and cancer. Therefore, the concept of returning to natural dyes, although with some disadvantages, still has advantages, namely safe and beneficial for health. Perpose: Develop natural dyes to be safe and also delicious to use in food. Methode: This activity is carried out using qualitative methods with interviews as well as observations and filling out questionnaires conducted to the general public, whether students, students, or the general public. Results: The use of synthetic dyes in food is beneficial for both producers and consumers. Conclusion: Indonesia as a source of natural dyes, namely carotenoids, anthocyanins, betalains and chlorophyll is very large. Pendahuluan: Warna makanan merupakan salah satu faktor yang dipertimbangkan konsumen saat memilih dan menilai makanan. Oleh karena itu, penggunaan pewarna pada makanan sepertinya sudah menjadi kewajiban bagi semua produsen makanan. Efek kesehatan dari penggunaan pewarna sintetis adalah mengapa kita harus kembali ke alam dengan menggunakan pewarna alami. Indonesia merupakan negara yang kaya akan zat warna alami seperti karotenoid, antosianin, betalain dan klorofil. Pewarna alami bukan hanya pewarna yang dapat digunakan untuk makanan, tetapi juga memiliki kemampuan untuk menjaga kesehatan serta mencegah dan mengurangi terjadinya berbagai penyakit seperti diabetes, hiperkolesterolemia dan kanker. Oleh karena itu konsep kembali ke pewarna alami meskipun dengan beberapa kekurangan namun tetap memiliki kelebihan yaitu aman dan bermanfaat bagi kesehatan. Tujuan: Mengembangkan Zat pewarna alami agar aman dan juga enak untuk digunakan pada makanan. Metode: Kegiatan ini dilakukan dengan menggunakan metode kualitatif dengan wawancara dan juga observasi serta pengisian angket yang dilakukan kepada para masyarakat umun baik itu secara mahasiswa, siswa, atau warga umum. Hasil: Penggunaan pewarna sintetis dalam makanan bermanfaat bagi produsen dan konsumen. Simpulan: Indonesia sebagai sumber pewarna alami yaitu karotenoid, anthosianin, betalain dan klorofil sangat besar

Profile of red blood cell morphologies and causes of anaemia among pregnant women at first clinic visit in the mount Cameroon area: a prospective cross sectional study

Abstract Objective Anaemia is a serious problem in pregnancy in malaria-endemic countries. This study investigated red cell morphologies and possible causes of anaemia among pregnant women at first clinic visit. Venous blood samples from consented women were used to determine haemoglobin (Hb) levels, mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH) using an automated haematology analyzer. Malaria parasitaemia was diagnosed by microscopy. Definitions were as follows: anaemia (Hb  101 fl), hypochromasia (MCH < 27 pg), microcytic hypochromia or normocytic hypochromia with anaemia [iron deficiency anaemia (IDA)], normocytic normochromia with anaemia in the absence of malaria parasitaemia (physiological anaemia of pregnancy). Results Of the 279 pregnant women enrolled, 57% had anaemia. Malaria parasitaemia was associated with 23.3% of anaemic cases while 76.7% were non-malaria related. The distribution of red cell alterations was as follows: hypochromasia (32.6%), microcytosis (14.7%) and macrocytosis (1.1%). The co-occurrence of malaria parasitaemia, iron deficiency and anaemia was seen in 23.3% of the women, iron deficiency anaemia only occurred in 35.9% while physiological anaemia of pregnancy was 40.9%. Iron deficiency and physiological anaemia of pregnancy contribute to a greater proportion of anaemia in the study area

Kaplan-Meier curve estimates adjusted for age, sex, PS and co-morbidity by treatments received: (a) for whole cohort, (b) for SCLC limited and (c) for SCLC Extensive.

<p>Kaplan-Meier curve estimates adjusted for age, sex, PS and co-morbidity by treatments received: (a) for whole cohort, (b) for SCLC limited and (c) for SCLC Extensive.</p