Risk prediction models for symptomatic patients with bladder and kidney cancer: a systematic review

Background: Timely diagnosis of bladder and kidney cancer is key to improving clinical outcomes. Given the challenges of early diagnosis, models incorporating clinical symptoms and signs may be helpful to primary care clinicians when triaging at risk patients. Aim: This review identifies and compares published models that use clinical signs and symptoms to predict the risk of undiagnosed prevalent kidney or bladder cancer. Method: A search identified primary research reporting or validating models predicting the risk of bladder or kidney cancer in Medline and EMBASE. After screening identified studies for inclusion, we extracted data onto a standardised form. The risk models were classified using TRIPOD guidelines and evaluated using the PROBAST assessment tool. Results: The search identified 20,661 articles. Twenty studies (29 models) were identified through screening. All the models included haematuria (visible, non-visible or unspecified), and seven included additional signs and symptoms (such as abdominal pain). The models combined clinical features with other factors (including demographic factors and urinary biomarkers) to predict the risk of undiagnosed prevalent cancer. Most models (n=24) had acceptable-to-good discrimination (AUROC>0.7), however, only six have been externally validated. All of the studies had either high or unclear risk of bias (RoB). Conclusion: Models were identified that could be used in primary care to guide referrals, with potential to identify lower risk patients with visible haematuria and to stratify individuals who present with non-visible haematuria. However, before application in general practise external validations in appropriate populations are required.

Rural Residents’ Perception about the Coverage, Cost and Access of Ambulance Services

Introduction While there are numerous studies investigating use and outcomes of the ambulance service, there are none looking at population attitudes and knowledge about the ambulance service. The aim of this study was to see if education is required for a sample population representative of rural Australia in regards to cost and coverage. Methods This study used a knowledge, attitude and practice survey voluntarily self-completed by a sample population recruited opportunistically from a number of health and public areas in the city of Geraldton, including the Emergency Department, a General Practise Clinic, a Physiotherapy Clinic and a Shopping Centre. Results 229 surveys were completed and showed that 30.1% of the sample population had no coverage in that they were not a pensioner, had no private health insurance and did not posses St John country cover. Aboriginal people were more likely than non-Aboriginal people to be without cover. Although 96% of people believed that everyone should be covered, 56% of participants did not know who administers rural ambulance coverage and 59% did not know the average call out fee for a life threatening call. The majority did not consider costs when using an ambulance. Conclusion The results demonstrated considerable lack of knowledge about ambulance cover and suggested that public education about ambulance services would be beneficial.