The NICE primary care referral guideline for suspected bladder or renal cancer

Mia Schmidt-Hansen; William Hamilton

doi:10.1002/tre.512

Gender inequalities in the promptness of diagnosis of bladder and renal cancer after symptomatic presentation: evidence from secondary analysis of an English primary care audit survey

BMJ Open ◽

10.1136/bmjopen-2013-002861 ◽

2013 ◽

Vol 3 (6) ◽

pp. e002861 ◽

Cited By ~ 50

Author(s):

Georgios Lyratzopoulos ◽

Gary A Abel ◽

Sean McPhail ◽

Richard D Neal ◽

Gregory P Rubin

Keyword(s):

Primary Care ◽

Renal Cancer ◽

Secondary Analysis ◽

Gender Inequalities

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Accuracy of a referral guideline for patients with chronic hepatitis B in primary care to select patients eligible for evaluation by a specialist

Gut ◽

10.1136/gut.2007.122333 ◽

2007 ◽

Vol 56 (7) ◽

pp. 1027-1028 ◽

Cited By ~ 9

Author(s):

I. K Veldhuijzen ◽

M. C Mostert ◽

H. G M Niesters ◽

J. H. Richardus ◽

R. A de Man

Keyword(s):

Primary Care ◽

Chronic Hepatitis ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Referral Guideline

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Identifying opportunities for timely diagnosis through patterns of primary care tests in patients with bladder and renal cancer: a longitudinal linked data study

British Journal of General Practice ◽

10.3399/bjgp.2021.0282 ◽

2021 ◽

pp. BJGP.2021.0282

Author(s):

Yin Zhou ◽

Fiona M Walter ◽

Luke Timothy Allan Mounce ◽

Gary A Abel ◽

Hardeep Singh ◽

...

Keyword(s):

Primary Care ◽

Cancer Patients ◽

Renal Cancer ◽

Population Level ◽

Full Blood Count ◽

Blood Tests ◽

Cancer Registry Data ◽

Organ Specific ◽

Diagnostic Window ◽

Test Use

Background: Understanding pre-diagnostic test use could reveal diagnostic windows where more timely evaluation for cancer may be indicated. Aim: To examine pre-diagnostic patterns of results of abnormal blood tests in bladder and renal cancer patients. Design and setting: Retrospective cohort study using primary care and cancer registry data on bladder and renal cancer patients diagnosed between 2012-2015 in England. Method: We examined the rates of patients with a first abnormal result in the year before diagnosis, for “generic” (full blood count components, inflammatory markers, calcium) and “organ-specific” blood tests (creatinine, liver function test components) which may lead to subsequent detection of incidental cancers. We used Poisson regression, to detect the month during which the cohort’s rate of each abnormal test started to increase from baseline, and examined the proportion of patients with a test found in the first half of the window, as these ‘early’ tests might represent opportunities where further evaluation could be initiated. Results: Data from 4,533 bladder and renal cancer patients were analysed. The monthly rate of patients with a first abnormal test increased towards the time of cancer diagnosis. Abnormalities of both generic and organ-specific tests started to increase from 6-8 months pre-diagnosis, with 25-40% of these patients having an abnormal test in the “early half” of the diagnostic window. Conclusion: Population-level signals of bladder and renal cancer can be observed in abnormalities in commonly performed primary care blood tests up to 8 months before diagnosis, indicating the potential for earlier diagnosis in some patients.

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Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

American Journal of Law & Medicine ◽

10.1017/s0098858800002586 ◽

2003 ◽

Vol 29 (4) ◽

pp. 489-524

Author(s):

Brent Pollitt

Keyword(s):

Primary Care ◽

Mental Illness ◽

Nurse Practitioners ◽

Primary Care Physicians ◽

American Psychological Association ◽

The United States ◽

Psychotropic Medications ◽

American Psychological ◽

Training Requirements ◽

Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

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