Introduction
Because of their many advantages, faecal immunochemical tests (FIT) are superseding traditional guaiac-based faecal occult blood tests in bowel screening programmes.
Methods
A ...quantitative FIT was adopted for use in two evaluation National Health Service (NHS) Boards in Scotland using a cut-off faecal haemoglobin concentration chosen to give a positivity rate equivalent to that achieved in the Scottish Bowel Screening Programme. Uptake and clinical outcomes were compared with results obtained contemporaneously in two other similar NHS Boards and before and after the evaluation in the two evaluation NHS Boards.
Results
During the evaluation, uptake was 58.5%. This was higher than in the same NHS Boards both before and after the evaluation, higher than in the other two NHS Boards and higher than the 53.7% achieved overall in Scotland. The overall positivity rate was higher in men than in women and increased with age in both genders. Positive predictive values for cancer (4.8%), high-risk adenoma (23.3%), all adenoma (38.2%) and all neoplasia (43.0%) in the two test NHS Boards were similar in all groups.
Conclusions
In summary, this evaluation of the FIT supports the introduction of FIT as a first-line test, even when colonoscopy capacity is limited.
To assess whether pre-notification is effective in increasing uptake of colorectal cancer screening for all demographic groups.
Scottish national colorectal cancer screening programme.
Males and ...females aged 50-74 years received a faecal occult blood test by post to complete at home. They were randomized to receive in addition: the pre-notification letter, the pre-notification letter + information booklet, or the usual invitation. Overall, 59,953 subjects were included in the trial between 13/04/09 and 29/05/09 and followed to 27/11/09. Pre-notification letters were posted two weeks ahead of the screening test kit. Uptake was defined as the return of a screening test and chi-squared tests compared uptake between the trial arms. Logistic regression assessed the impact of the letter and letter + booklet on uptake independently of gender, age, deprivation and screening round.
Uptake was higher with both the letter (59.0%) and the letter + booklet (58.5%) compared with the usual invitation (53.9%, p < 0.0001). This increased uptake was seen for males, females, all age groups and all deprivation categories including least deprived females (letter 69.9%, usual invitation 66.6%) and most deprived males (42.6% vs. 36.1%), the groups with the highest and lowest levels of uptake respectively in the pilot screening rounds conducted prior to the roll out of the programme. Uptake with the pre-notification letter compared with the usual invitation was higher both unadjusted and adjusted for demographic factors (odds ratio 1.24, 95% CI 1.193-1.294).
Pre-notification is an effective method of increasing uptake in colorectal cancer screening for both genders and all age and deprivation groups.
Background: In recent years, there has been a move to deliver rheumatology clinics outside the traditional hospital setting, but there is insufficient information regarding its impact on standards of ...care delivered such as appropriate access to health professionals. At its inception in 2005, our department took over an existing cohort from a visiting consultant and has since delivered some clinics in a hospital setting, but the majority from a large PCT resource centre (currently >60% of doctor-led clinics and all Advanced Practitioner/Specialist nurse clinics including Biologics clinics). We aimed to audit the experience of inflammatory arthritis patients in our department with respect to published ARMA Standards of Care guidance. Methods: An adapted, scannable version of the ARMA inflammatory arthritis audit tool (patient questionnaire) was developed in house. 100 anonymized forms were printed and distributed to consecutive consenting patients identified by clinicians in rheumatology clinics. Returned forms were scanned using the SNAP software and retrieved data was summarized using descriptive statistics. Results: Of 92 responders, 90 were suitable for analysis (average age 74 years). 80% had rheumatoid arthritis, 7% psoriatic arthritis and 8% ankylosing spondylitis, with 80% having the disease for > 2yrs. Within first 6 months of diagnosis 81% reported seeing a Rheumatologist, 24% a Nurse Specialist, 13% an Advanced Practitioner, 19% a Podiatrist, 23% a Physiotherapist, 20% an Occupational Therapist. 86% reported being reviewed annually or more often by a Rheumatologist. Within first 6 months, 49% recollected being offered DMARDs, 47% an anti-inflammatory, 46% a pain killer, 32% steroid injections and 18% steroid tablets. 83% of patients felt that they had been involved in decisions about their treatment. Written information offered/given was reported by 53% about disease and treatments and by 37% about support organizations. 49% reported being offered information on exercise programmes in the department at initial diagnosis. Of 32 free text comments, 28 were positive, 2 neutral and 2 negative about aspects of current service. Conclusions: Patients seem to have had appropriate access to health professionals similar to a service delivered in a traditional hospital setting. Specifically, most were being reviewed by a rheumatologist annually or more often and most felt they were involved in decisions about their treatment. Several responders had the first diagnosis before the inception of our department, when there was a limited service in the district, reflected in the responses to questions pertaining to the first 6 months from diagnosis. The overall perception of current care delivered seems to be positive and this is probably no worse than a traditional service delivered from a hospital setting. We conclude that comprehensive patient-centred Rheumatology clinics can be effectively delivered outside the traditional hospital setting. Disclosure statement: All authors have declared no conflicts of interest.
The elderly patient Birrell, Fraser; O’Connell, Janice
Oxford Textbook of Rheumatology,
10/2013
Book Chapter
In this chapter, we describe how the process of ageing can itself affect the diagnosis and treatment of musculoskeletal conditions. We outline general principles concerning the clinical presentation ...of rheumatological diseases in older patients, as well as providing specific guidance on the diagnosis and management of the commoner conditions encountered in practice in the United Kingdom.
In this chapter, we describe how the process of ageing can itself affect the diagnosis and treatment of musculoskeletal conditions. We outline general principles concerning the clinical presentation ...of rheumatological diseases in older patients, as well as providing specific guidance on the diagnosis and management of the commoner conditions encountered in practice in the United Kingdom.
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