Preferences for cancer investigation:a vignette-based study of primary-care attendees

SummaryBackgroundThe UK lags behind many European countries in terms of cancer survival. Initiatives to address this disparity have focused on barriers to presentation, symptom recognition, and referral for specialist investigation. Selection of patients for further investigation has come under particular scrutiny, although preferences for referral thresholds in the UK population have not been studied. We investigated preferences for diagnostic testing for colorectal, lung, and pancreatic cancers in primary-care attendees.MethodsIn a vignette-based study, researchers recruited individuals aged at least 40 years attending 26 general practices in three areas of England between Dec 6, 2011, and Aug 1, 2012. Participants completed up to three of 12 vignettes (four for each of lung, pancreatic, and colorectal cancers), which were randomly assigned. The vignettes outlined a set of symptoms, the risk that these symptoms might indicate cancer (1%, 2%, 5%, or 10%), the relevant testing process, probable treatment, possible alternative diagnoses, and prognosis if cancer were identified. Participants were asked whether they would opt for diagnostic testing on the basis of the information in the vignette.Findings3469 participants completed 6930 vignettes. 3052 individuals (88%) opted for investigation in their first vignette. We recorded no strong evidence that participants were more likely to opt for investigation with a 1% increase in risk of cancer (odds ratio [OR] 1·02, 95% CI 0·99–1·06; p=0·189), although the association between risk and opting for investigation was strong when colorectal cancer was analysed alone (1·08, 1·03–1·13; p=0·0001). In multivariable analysis, age had an effect in all three cancer models: participants aged 60–69 years were significantly more likely to opt for investigation than were those aged 40–59 years, and those aged 70 years or older were less likely. Other variables associated with increased likelihood of opting for investigation were shorter travel times to testing centre (colorectal and lung cancers), a family history of cancer (colorectal and lung cancers), and higher household income (colorectal and pancreatic cancers).InterpretationParticipants in our sample expressed a clear preference for diagnostic testing at all risk levels, and individuals want to be tested at risk levels well below those stipulated by UK guidelines. This willingness should be considered during design of cancer pathways, particularly in primary care. The public engagement with our study should encourage general practitioners to involve patients in referral decision making.FundingThe National Institute for Health Research Programme Grants for Applied Research programme

Chronostratigraphy of an eroding complex Atlantic Round House, Baile Sear, Scotland

The excavation team would like to thank Historic Scotland (now Historic Environment Scotland) and the University of St Andrews for providing funding.A high-resolution chronostratigraphy has been established for an eroding Atlantic round house at Sloc Sàbhaidh (North Uist, Scotland), combining detailed OSL profiling and dating of sediments encompassing the main bracketing events associated with the monument, radiocarbon AMS dates on bone recovered from excavated features and fills within it, and TL dates on pottery and burnt clay. Concordant OSL and radiocarbon evidence place construction of the wheelhouse in the first to second centuries AD, contemporary with dates from the primary occupation. Beneath the wheelhouse, clay deposits containing burnt material, attest to cultural activity in vicinity to the monument in the preceding second to first centuries BC. At a later date, the southern wall collapsed, was rebuilt, and the interior spaces to the monument re-structured. The chronology for the later horizons identified from the sediment luminescence dates extends to the second half of the first millennium AD, which goes beyond the range of the radiocarbon dates obtained. The data from ceramics encompass both periods. The juxtaposition of the dating evidence is discussed relative to short and longer chronologies for this Iron Age monument. Corollaries of this research are the implications that based on the long chronology, some of the ecofacts (bone) appear to be residual, and that the temporal duration of Hebridean Coarse Ware may extend into the second half of the first millennium AD.Publisher PDFPeer reviewe

Progress in Lithotripsy Research

Shock wave lithotripsy (SWL) for the non-invasive treatment of kidney stones was introduced in the United States in 1984. SWL virtually eliminated the need for open surgery to remove kidney stones, and it did not take long for physicians and patients to endorse this revolutionary technology. Early reports told of the efficient removal of even the most troublesome stones without apparent complications, and SWL quickly became the "treatment modality of choice." It was not long, however, before concerned physicians began to report the occurrence of adverse effects in SWL, particularly involving vascular trauma and including cases of severe hemorrhage in the kidney and acute renal failure — significant side effects of serious consequence. Researchers quickly recognized the challenge and opportunity to determine the mechanisms of shock wave action in lithotripsy, and in 1988, the Acoustical Society of America held the first in a series of popular sessions devoted to the topic of shock waves in medicine. The goal of the inaugural session was to improve the fundamental understanding of lithotripsy — to bring better devices and treatments to patients. The goal of this paper is to report on progress in this effort

Using willingness-to-pay to establish patient preferences for cancer testing in primary care.

BACKGROUND: Shared decision making is a stated aim of several healthcare systems. In the area of cancer, patients' views have informed policy on screening and treatment but there is little information about their views on diagnostic testing in relation to symptom severity. METHODS: We used the technique of willingness-to-pay to determine public preferences around diagnostic testing for colorectal, lung, and pancreatic cancer in primary care in the UK. Participants were approached in general practice waiting rooms and asked to complete a two-stage electronic survey that described symptoms of cancer, the likelihood that the symptoms indicate cancer, and information about the appropriate diagnostic test. Part 1 asked for a binary response (yes/no) as to whether they would choose to have a test if it were offered. Part 2 elicited willingness-to-pay values of the tests using a payment scale followed by a bidding exercise, with the aim that these values would provide a strength of preference not detectable using the binary approach. RESULTS: A large majority of participants chose to be tested for all cancers, with only colonoscopy (colorectal cancer) demonstrating a risk gradient. In the willingness-to-pay exercise participants placed a lower value on an X-ray (lung cancer) than the tests for colorectal or pancreatic cancer and X-ray was the only test where risk was clearly related to the willingness-to-pay value. CONCLUSION: Willingness-to-pay values did not enhance the binary responses in the way intended; participants appeared to be motivated differently when responding to the two parts of the questionnaire. More work is needed to understand how participants perceive risk in this context and how they respond to questions about willingness-to-pay. Qualitative methods could provide useful insights

Making gains sustainable: partnering with WASH to stop the transmission of trachoma

Partnering with the WASH sector is essential if face washing and environmental improvement components of SAFE are to succeed

Mapping the substructure in the Galactic halo with the next generation of astrometric satellites

We run numerical simulations of the disruption of satellite galaxies in a Galactic potential to build up the entire stellar halo, in order to investigate what the next generation of astrometric satellites will reveal by observing the halo of the Milky Way. We generate artificial DIVA, FAME and GAIA halo catalogues, in which we look for the signatures left by the accreted satellites. We develop a method based on the standard Friends-of-Friends algorithm applied to the space of integrals of motion. We find this simple method can recover about 50% of the different accretion events, when the observational uncertainties expected for GAIA are taken into account, even when the exact form of the Galactic potential is unknown. The recovery rate for DIVA and FAME is much smaller, but these missions, like GAIA, should be able to test the hierarchical formation paradigm on our Galaxy by measuring the amount of halo substructure in the form of nearby kinematically cold streams with for example, a two-point correlation function in velocity space.Comment: 10 pages, 9 figures, submitted to MNRAS. High resolution color figures available from http://www.strw.leidenuniv.nl/~ahelmi/astrom.htm