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In the past, British general practitioners (GPs) have referred patients to individual consultants. There is now a trend towards generic referral, whereby the specialist team is consulted via a single point of access. We examined the impact of this innovation on the relationship between GPs and specialists in mental health care. Sixteen groups of randomly selected GPs and mental health professionals (MHPs) in England discussed clinical scenarios involving the use of mental health interventions for patients with functional somatic symptoms. The meetings were audiotaped, transcribed and analysed to the point at which no major new themes were emerging. The final analysis was confined to a purposive sample of six of the sixteen groups, comprising 54 GPs and 15 MHPs. Although the rationale for the single point of access was clear to both GPs and MHPs, the approach erected boundaries because it impeded the establishment of professional relationships and transfer of knowledge. GPs thought the system reduced their capacity to be accountable to their patients and limited the potential for their own professional development. MHPs did not seem to be aware of GPs' concerns. Effective interprofessional management of individual patients depends upon confidence in colleagues' skills and good communication. Factors that hamper these must be addressed in the development of this system of referral. [ABSTRACT FROM AUTHOR]

Purpose. Clear cell chondrosarcoma is a rare variant of chondrosarcoma. Six cases are herein reported. Subjects. We have treated six patients with clear cell chondrosarcoma in the past 28 years, representing 1.6% of all chondrosarcomas seen in this time period. Results and Discussion. Half the patients had been initially underdiagnosed and inappropriately treated. Conclusions. Our results and our review of the literature highlight the fact that inadequate initial treatment leads to a high rate of both local recurrence and metastasis whilst wide initial excision is usually curative. [ABSTRACT FROM AUTHOR]

Purpose Paget's osteosarcoma has a fearful reputation with a quoted survival of at best 5% at 5 years. We therefore reviewed our experience of 26 patients treated over the last 25 years using modern staging and limb salvage techniques to see if there had been any improvement in survival. Subjects: We identified 26 patients on the Royal Orthopaedic Hospital Oncological database with a diagnosis of sarcoma secondary to Paget's disease. Results: The survival rate was 53% at 1 year, 25% at 2 years and no patient survived for 5 years. The median survival was 21 months for those treated with curative intent and 7 months for those treated palliatively. Four of the five patients treated with limb-sparing surgery developed local recurrence between 5 and 12 months, the fifth died at 14 months. There was no difference in survival between amputation and limb salvage. Discussion: The development of sarcomatous change in Paget's disease is well recognised. It represents an important segment of primary bone tumours in patients over 40 years of age. The prognosis is appalling. Indeed only 15 of 368 cases (4%) from a number of historical series have survived more than 5 years. Our results are similarly disappointing with no survivors at 5 years despite modern methods of management of bone tumours. While there is no difference in local recurrence rates or survival between limb reconstruction and limb ablation the poor prognosis for both means that neither can be recommended at present. Sarcomatous change in Pagetoid bone should therefore be regarded as a different disease to primary osteosarcoma. It remains an incurable disease with a poor prognosis. [ABSTRACT FROM AUTHOR]

Background and Objectives: Shared decision making in patients with glomerular disease remains challenging because outcomes important to patients remain largely unknown. We aimed to identify and prioritize outcomes important to patients and caregivers and to describe reasons for their choices., Design: , setting, participants, & measurements We purposively sampled adult patients with glomerular disease and their caregivers from Australia, Hong Kong, the United Kingdom, and the United States. Participants identified, discussed, and ranked outcomes in focus groups using the nominal group technique; a relative importance score (between zero and one) was calculated. Qualitative data were analyzed thematically., Results: Across 16 focus groups, 134 participants (range, 19-85 years old; 51% women), including 101 patients and 33 caregivers, identified 58 outcomes. The ten highest-ranked outcomes were kidney function (importance score of 0.42), mortality (0.29), need for dialysis or transplant (0.22), life participation (0.18), fatigue (0.17), anxiety (0.13), family impact (0.12), infection and immunity (0.12), ability to work (0.11), and BP (0.11). Three themes explained the reasons for these rankings: constraining day-to-day experience, impaired agency and control over health, and threats to future health and family., Conclusions: Patients with glomerular disease and their caregivers highly prioritize kidney health and survival, but they also prioritize life participation, fatigue, anxiety, and family impact., (Copyright © 2020 by the American Society of Nephrology.)