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Introduction: To contribute to addressing diagnostic health inequalities in the United Kingdom, this review aimed to investigate determinants of diagnostic service use amongst people experiencing high deprivation in the United Kingdom. Methods: A systematic review was conducted using three databases (EBSCO, Web of Science and SCOPUS) to search studies pertaining to diagnostic service use amongst people experiencing high deprivation. Search terms related to diagnostics, barriers and facilitators to access and deprivation. Articles were included if they discussed facilitators and/or barriers to diagnostic service access, contained participants' direct perspectives and focussed on individuals experiencing high deprivation in the United Kingdom. Articles were excluded if the full text was unretrievable, only abstracts were available, the research did not focus on adults experiencing high deprivation in the United Kingdom, those not including participants' direct perspectives (e.g., quantitative studies) and papers unavailable in English. Results: Of 14,717 initial papers, 18 were included in the final review. Determinants were grouped into three themes (Beliefs and Behaviours, Emotional and Psychological Factors and Practical Factors), made up of 15 sub‐themes. These were mapped to a conceptual model, which illustrates that Beliefs and Behaviours interact with Emotional and Psychological Factors to influence Motivation to access diagnostic services. Motivation then influences and is influenced by Practical Factors, resulting in a Decision to Access or Not. This decision influences Beliefs and Behaviours and/or Emotional and Psychological Factors such that the cycle begins again. Conclusion: Decision‐making regarding diagnostic service use for people experiencing high deprivation in the United Kingdom is complex. The conceptual model illustrates this complexity, as well as the mediative, interactive and iterative nature of the process. The model should be applied in policy and practice to enable understanding of the factors influencing access to diagnostic services and to design interventions that address identified determinants. Patient or Public Contribution: Consulting lived experience experts was imperative in understanding whether and how the existing literature captures the lived experience of those experiencing high deprivation in South England. The model was presented to lived experience experts, who corroborated findings, highlighted significant factors for them and introduced issues that were not identified in the review. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis in the UK is more prevalent in people with social risk factors– e.g. previous incarceration, homelessness - and in migrants from TB endemic countries. The management of TB infection is part of TB elimination strategies, but is challenging to provide to socially excluded groups and the evidence base for effective interventions is small. Methods: We evaluated a TB infection screening and treatment programme provided by a peer-led service (Find&Treat) working in inclusion health settings (e.g. homeless hostels) in London. IGRA (interferon-gamma release assay) testing and TB infection treatment were offered to eligible adults using a community-based model. The primary outcome was successful progression through the cascade of care. We also evaluated socio-demographic characteristics associated with a positive IGRA. Results: 42/312 (13.5%) participants had a positive IGRA and no one had evidence of active TB. 35/42 completed a medical evaluation; 22 started treatment, and 17 completed treatment. Having a positive IGRA was associated with previous incarceration and being born outside of the UK. Discussion: Provision of TB infection diagnosis and management to this socially excluded population has several challenges including maintaining people in care and drug-drug interactions. Peer-support workers provided this service safely and effectively with appropriate support. Further work to generate data to inform risks and benefits of treatment for TB infection in this group is needed to facilitate joint decision making. [ABSTRACT FROM AUTHOR]

After 75 years of reformed practice, general practitioners (GPs) in the UK have transformed from health gatekeepers who simply provide medical decision-making such as diagnostic and treatment services and referral services, to health agents who proactively provide more relevant health services such as immunizations, health monitoring and health management, etc. In order to discuss this transformation of the role of the general practitioner and the conditions for the evolution of the role, this study chose the documentary analysis method to provide a comprehensive overview of the legal and normative documents related to the general practitioner. Furthermore, this study uses a comparative analysis method to conclude the definition and role characteristics of GPs as health agents. This study summarises the general pattern of evolution of GPs into health agents. The transformation into a health agent relies on the interpersonal trust and rigorous institutional of society on the general practitioner system. The expansion of GPs' clientele and range of services, together with the motivation to proactively provide services, have combined to push for a "qualitative change" in the GP's role as health agent. The transformation of the role of the general practitioner to a health agent is a historical necessity. It responds to the evolution of society's understanding of health and the need for higher levels of health. Therefore, recognizing the role of GPs as health agents is important for optimizing the use of health care resources and improving the health of society by taking advantage of this role. [ABSTRACT FROM AUTHOR]

The use of molecular testing to direct diagnosis and treatment options in ovarian tumours has rapidly expanded in recent years, in particular with regard to the recommendation for routine homologous recombination deficiency (HRD) testing in all patients with high-grade ovarian epithelial tumours. The implications of this increased level of testing upon the pathologist is significant in terms of increased workload, the provision of adequate tumour samples for molecular testing, and the interpretation of complex molecular pathology reports. In order to optimise the quality of reports generated, it is important to establish clear pathways of communication on both a local and national level between clinicians, pathology lab staff, and medical scientists. On a national level, in the United Kingdom, Genomic Laboratory Hubs (GLHs) have been established to provide a uniform high-quality molecular diagnostics service to all patients with ovarian tumours within the National Health services in the country. On a local level, there are a number of small steps that can be taken to improve the quality of tissues available for testing and to streamline the processes involved in generating requests for molecular testing. This article discusses these factors from the perspective of the clinical histopathologist. [ABSTRACT FROM AUTHOR]

The guidance available for tailoring mental health services for autistic people is limited and dispersed. Practitioners attempting to appropriately adapt mental healthcare and therapy provision report low confidence and inconsistency in their approach. This study contributes to the guidance by providing a shortlist of usable and priority adaptations for diagnostic and therapy services as described by multidisciplinary staff members responsible for the design and delivery of a specialist autism service in the UK. Individual freelisting interviews were conducted with 15 staff, who were asked to list the ways that they adapt their practice individually, within therapy, and collectively as a service. Salience and cultural consensus analyses demonstrated the following agreed priority service adaptations: ensuring the suitability of the service environment with consideration of sensory demands, adapting communication, knowing individual gender identity preferences and minimising client uncertainty. Detailed examples are given for flexibly adapting therapy to individual needs to inform general and specialist services. The findings require replication and evaluation. [ABSTRACT FROM AUTHOR]

Objectives: In response COVID‐19, re‐establishing safe elective services was prioritised in the UK. We assess the impact on face‐to‐face hospital attendance, cost and efficiency of implementing a virtual sleep clinic (intervention 1) to screen for children requiring level 3 ambulatory sleep studies using newly implemented ENT‐UK guidelines for obstructive sleep apnoea (OSA) investigation (intervention 2). Objectives: (1) compare the proportion of children attending sleep clinic undertaking a sleep study before and after implementation of these interventions; (2) compare clinic cancellations and first‐time success rates of sleep studies before and after intervention. Design: Retrospective analysis. Setting: District general hospital paediatric sleep clinic. Participants: Children aged 3 months to 16 years referred to sleep clinic by ENT for investigation of OSA over 3 months immediately following interventions (1 June 2020 – 1 September 2020) to the same period in the previous year (1 June 2019 – 1 September 2019). Main outcome measures: Number of children attending sleep clinic, date of birth/age of children attending sleep clinic, number of children undergoing sleep study, diagnostic outcomes, number of appointment cancellations, number of first‐time sleep study failures. Results: Post intervention, there was a significant reduction in the proportion of children undertaking ambulatory sleep studies, and nonsignificant reductions in appointment cancellations and in first‐time sleep study failures. Conclusions: The introduction of the virtual sleep clinic meant that only those children requiring a sleep study attended a face‐to‐face appointment, which led to reduced face‐to‐face attendance. There were also unintended cost‐effectiveness and efficiency benefits, with potential longer‐term learning implications for the wider sleep community and other diagnostic services. [ABSTRACT FROM AUTHOR]

Background: Photodiagnostic investigations are essential for the accurate diagnosis of abnormal cutaneous photosensitivity and provide important information for the management of patients with photodermatoses (cutaneous photosensitivity disorders). Although photodiagnosis has been undertaken since the early 1970s, specialist services in the United Kingdom (UK) and Republic of Ireland are limited and there is no formal guidance on diagnostic approach. Indeed, there is a limited literature in this area of methodology and diagnostic practice. Objectives: The primary objective was to undertake a British Photodermatology Group Workshop to review the role and activities of specialist centres in the UK and Republic of Ireland in order to ascertain whether there were consensus practices. Secondary objectives were to identify key priorities for service, training and research. Methods: An initial detailed survey review of current activities was undertaken prior to the Workshop and data from this survey were used to inform discussion at the Workshop, which was attended by key photodermatology experts from the UK and Republic of Ireland. Results/Conclusions: We have undertaken a detailed review of current Photodiagnostic Services in the UK and Republic of Ireland and report on our findings from the 12 centres and we have identified key areas of consensus practice. This is an important step in the process of standardising and optimising procedures and protocols and defining minimum clinical standards for photodiagnostic investigations, which are of such diagnostic importance in Dermatology. [ABSTRACT FROM AUTHOR]

The SARS-CoV-2 pandemic presented healthcare providers with an extreme challenge to provide cancer services. The impact upon the diagnostic and treatment capacity to treat pancreatic cancer is unclear. This study aimed to identify national variation in treatment pathways during the pandemic. A survey was distributed to all United Kingdom pancreatic specialist centres, to assess diagnostic, therapeutic and interventional services availability, and alterations in treatment pathways. A repeating methodology enabled assessment over time as the pandemic evolved. Responses were received from all 29 centres. Over the first six weeks of the pandemic, less than a quarter of centres had normal availability of diagnostic pathways and a fifth of centres had no capacity whatsoever to undertake surgery. As the pandemic progressed services have gradually improved though most centres remain constrained to some degree. One third of centres changed their standard resectable pathway from surgery-first to neoadjuvant chemotherapy. Elderly patients, and those with COPD were less likely to be offered treatment during the pandemic. The COVID-19 pandemic has affected the capacity of the NHS to provide diagnostic and staging investigations for pancreatic cancer. The impact of revised treatment pathways has yet to be realised. [ABSTRACT FROM AUTHOR]

Objectives: Young onset dementia is associated with distinctive support needs but existing research on service provision has been largely small scale and qualitative. Our objective was to explore service use, cost and satisfaction across the UK. Methods: Information about socio‐demographic characteristics, service use and satisfaction were gathered from people with young onset dementia (YOD) and/or a family member/supporter via a national survey. Results: Two hundred and thirty‐three responses were analysed. Diagnosis was most commonly received through a Memory Clinic or Neurology. The type of service delivering diagnosis impacted on post‐diagnostic care. Those diagnosed in specialist YOD services were more likely to receive support within the first 6 weeks and receive ongoing care in the service where they were diagnosed. Ongoing care management arrangements varied but generally care was lacking. Around 42% reported no follow‐up during 6‐weeks after diagnosis; over a third reported seeing no health professional within the previous 3 months; just over a third had a key worker and just under a third had a care plan. Satisfaction and quality of care were highest in specialist services. Almost 60% of family members spent over 5 h per day caring; median costs of health and social care, 3 months, 2018, were £394 (interquartile range £389 to 640). Conclusions: Variation across diagnostic and post‐diagnostic care pathways for YOD leads to disparate experiences, with specialist young onset services being associated with better continuity, quality and satisfaction. More specialist services are needed so all with YOD can access age‐appropriate care. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of calprotectin to diagnose inflammatory bowel disease (IBD) in children in whom general practitioners (GPs) suspected IBD.Design: Prospective observational cohort study of a new calprotectin-based primary care referral pathway.Setting: 48 GP practices and gastroenterology secondary care services at the Royal Devon and Exeter NHS Foundation Trust in the South-West of England, UK.Patients: 195 children aged between 4 and 18 years referred on the pathway between January 2014 and August 2017 for investigation of gastrointestinal symptoms were included.Interventions: Primary-care-driven faecal calprotectin testing. Primary and secondary care records over 12 months from the point of calprotectin testing were used as the reference standard.Main Outcome Measures: Diagnostic accuracy of calprotectin testing to detect IBD.Results: 7% (13/195) tested patients were diagnosed with IBD. Using our prespecified cut-off of 100 µg/g, calprotectin had a diagnostic accuracy of 91% (95% CI 86% to 95%) with a sensitivity for distinguishing IBD from non-IBD of 100% (95% CI 75% to 100%), a specificity of 91% (95% CI 85% to 94%), a positive predictive value of 43% (95% CI 25% to 63%) and a negative predictive value of 100% (95% CI 98% to 100%). Calprotectin testing had no effect on the time to diagnosis, but a negative test contributed to saved referrals and was associated with fewer diagnostic tests in secondary care.Conclusions: Calprotectin testing of children with suspected IBD in primary care accurately distinguishes IBD from a functional gut disorder, reduces secondary care referrals and associated diagnostic healthcare utilisation. [ABSTRACT FROM AUTHOR]

Approximately 70% of all healthcare decisions affecting diagnosis and treatment involve the use of tests performed within pathology laboratories. The utilisation of diagnostic laboratory services continues to increase, with growth both in volume of tests requested, as well as in the breadth of test repertoire. Every year in the United Kingdom, approximately 1 billion tests are run in hospital laboratories, equivalent to 14 tests per person. Fifty million tests are requested in primary care. Accordingly, there is an inevitable increase in the number of unexpected laboratory results which clinicians review. This is an important, and potentially time-consuming, issue, which we considered to merit a more detailed discussion. Unexpected laboratory results may be critical or non-critical in nature. They may be absolutely genuine, reflecting a clinical change in the patient's condition, a differential diagnosis not previously considered, or an additional test specifically added by the laboratory. However, such results may also occur due to a variety of different circumstances, including much more rarely laboratory error. As there is little published evidence or guidance available, herein we discuss aspects of the clinical approach for physicians after receiving an unexpected laboratory test result. [ABSTRACT FROM AUTHOR]

Background: Low participation in clinical trials is a major challenge to advancing clinical Alzheimer's disease (AD) research and care. Factors influencing recruitment to AD trials are not fully understood.Objective: To identify barriers to, and facilitators of, recruitment in a UK multi-center, secondary care AD trial (Reducing pathology in Alzheimer's Disease through Angiotensin TaRgeting (RADAR) trial) and implications for improving recruitment to AD trials.Methods: Semi-structured qualitative telephone interviews with a purposive sample of 17 trial site staff explored the RADAR trial recruitment pathway and views and experiences of recruitment. Interviews were analyzed thematically.Results: Diagnostic and care pathways hindered identifying patients with mild-moderate AD, with a lack of up-to-date patient records and data access problems affecting screening. Research is not routinely embedded in AD care but facilitated recruitment when it was. Clinicians' and patients' favorable view of the trial purpose facilitated recruitment, although the complexity of participant information sheets and requirement for study companion created challenges.Conclusion: These findings have important implications for the design of future AD trials and for planning how to best interface with clinical commitments to ensure sufficient and timely recruitment. Challenges to AD trial recruitment can occur at care pathway, clinician, and patient and companion levels. Recruitment can be facilitated by: improving diagnostic processes and systems for recording and sharing patient information, embedding research into routine patient care, collaborating with a range of services to identify and approach eligible patients, training and engaging trial staff, and providing patients with clear and concise study information. [ABSTRACT FROM AUTHOR]

Background West African governments, the WHO and wider international community were caught unprepared for the world's largest Ebola outbreak of 2014–16. This was an unprecedented challenge to local services and international agencies, since the emergency required high-tech molecular diagnostic services operated by specialist staff and a coordinated emergency response in addition to humanitarian support, which was not available at the beginning of the outbreak. Public Health England (PHE), as a new national public health agency was well placed to provide support for these needs. After the outbreak, PHE supported reconstruction to ensure diagnostic and emergency planning capability remained in place in the immediate aftermath of the outbreak and build necessary public health infrastructure for the future. The article describes the role PHE played as a national public health agency supporting reconstruction and long-term development through the UK Government (Department for International Development) programme called 'Resilient Zero'. Sources of data Public Health England (PHE), UK Government's Department for International Development, WHO, US Centers for Communicable Diseases (CDC), China Centre for Communicable Diseases (China CDC). Areas of agreement The need for reliable, sustainable, in country molecular diagnostics, together with a programme to strengthen in country Emergency Planning, Preparedness and Response (EPRR). Areas of controversy Providing high tech molecular capability in a resource-poor West African country with variable provision of basic diagnostic equipment, intermittent power supply, ineffective supply chains and maintaining training capacity for emergency planning in the long term. Emergency planning models from the West needed to be adapted for the countries' context. Short term aid projects as a model did not suite this development requirement. Growing points PHE had strong local and international political support to reconstruct three Government regional laboratories and deploy molecular technology. Significant learning by PHE as a national public health agency and sharing this will be of benefit to other national public health agencies. UK staff reported increased levels of satisfaction and experience relevant to public health practice. The Sierra Leonean Government and officials requested long-term levels of commitment. It is important for agencies such as PHE to constantly learn, develop long-term institutional partnerships and play a bigger role with other similar agencies internationally. Areas timely for developing research How best to support sustainable high-tech molecular technology in West Africa and modules for emergency planning relevant to the context; evidence for long term versus short-term support for highly complex diagnostic capabilities; relevance to maintaining individual country public health infrastructure to ensuring global health security; benefits of overseas work for employee of a national agency. [ABSTRACT FROM AUTHOR]

Since 1989, hundreds of thousands of lives have been saved worldwide by the widespread use of screening mammography alongside new developments in breast cancer treatment [1]. The ability of screening mammography to detect cancer early, when treatment is most effective, is optimized when it is performed in the highest quality manner and accessed by all eligible candidates. Currently, worldwide, there are over 14 guidance documents for mammographic quality [2]. Some countries, such as the United Kingdom (UK), monitor quality through a national screening program. In the United States (US), where 39 million mammograms are performed annually [3] , there is not a national screening program, but the federal government mandates minimum quality standards for the performance of mammography. Among a consortium of European countries, the European Reference Organisation for Quality Assured Breast Screening and Diagnostic Services (EUREF) promotes voluntary adherence to European mammography quality standards. Setting quality standards at national or international levels ensures the uniformity of practice and identifies substandard practices in need of improvement, ultimately maximizing the benefit of screening mammography. [ABSTRACT FROM AUTHOR]

January 2016 was one of the most difficult months for emergency departments since the four-hour waiting time standard was introduced by the government in 2004. Patient demand was high and the percentages of people admitted or discharged within four hours fell to some of its lowest levels in all UK countries. This article gives an overview of the situation across the four nations and explores the reasons behind the statistics. It also outlines what hospitals and local authorities are doing to relieve pressures and cope with unprecedented demand. [ABSTRACT FROM AUTHOR]

The association between vascular Ehlers-Danlos Syndrome (vEDS) and amniotic band sequence (ABS) has been previously reported in the literature, mostly in single patient case reports. Here, we aim to extend the current knowledge of this association through a case series of five unrelated individuals with ABS in association with molecularly confirmed vEDS, in addition to undertaking a comprehensive literature review. All the individuals were recruited through the EDS national diagnostic service in the UK following appropriate history, physical examination and genetic investigations. Clinical presentation ranged from a single constriction ring to complex craniofacial clefts to limb reduction deformities, reflecting the spectrum of ABS presentation. vEDS was inherited paternally (n = 2), maternally (n = 2) and de novo (n = 1). Previously, maternal vEDS was considered the risk factor for ABS, but our findings suggest that it may be the disease status of the fetus which poses the main risk. It is established that amniotic membrane is derived from fetal tissue, which supports our conclusions. Our observations suggest the increased risk of ABS in fetuses with vEDS. Therefore, exploring family history and features that may suggest vEDS diagnosis in patients with ABS might be useful. We also recommend that a collaborative international study would be useful to help gain a better insight into this association. [ABSTRACT FROM AUTHOR]

This paper analyses the politics of regulatory expansion within the diagnostics sector. Since 1990, an informal, clinician-led process of diagnostic innovation within the UK NHS has been challenged by new mechanisms for the evaluation of diagnostics. We describe these diagnostic reforms as a process of fragmented regulatory expansion. New governance mechanisms function as regulatory niches : discrete spaces within an overarching sociotechnical regime. The boundaries of regulatory niches are organisational and epistemological. Organisational boundaries map onto established communities of practice that constitute the regulatory target; epistemological boundaries are defined by distinctive evaluation frameworks. Niches are also distinguished by their outcomes (rate of positive decisions) and their origins. Niche formation was triggered by five drivers: public scandal; technological change; marketisation; institutional isomorphism; and transnational policy transfer. Each niche was triggered by a unique confluence of these drivers, but common to all were historic shifts in healthcare politics, as the rise of evidence-based medicine intersected with the centralising impulse of the regulatory state, which encroached on clinical autonomy in a contest for power that is increasingly mediated by influential non-governmental organisations. • Regulation of diagnostics in the UK has undergone a process of fragmented expansion. • Three "regulatory niches" have emerged since the 1990s. • Regulatory niches are discrete spaces within the overarching sociotechnical regime. • Each niche has specific organisational and epistemological boundaries. • They differ in outcomes (rates of regulatory approval) and origins. [ABSTRACT FROM AUTHOR]

Introduction: The Multi-Agency Autism Team (MAAT) diagnose Autism Spectrum Disorder (ASD) in children and young people using a multi-stage assessment process. In March 2020, the UK went into lockdown due to the COVID-19 pandemic, affecting the MAAT's ability to continue their typical diagnostic pathway. Objectives: This qualitative study aimed to assess the effectiveness and feasibility of a virtual ASD diagnostic pathway. Methods: From March - September; one hundred detailed developmental history assessments were conducted over the telephone, fifteen socially-distanced BOSA (Brief Observation of Symptoms of Autism) assessments were piloted, twenty-five multi-disciplinary formulation meeting were held over a video platform, and sixty diagnosis feedback consultations were conducted via telephone or video call. Structured interviews were conducted with clinicians and service-users. Results: revealed that telephone developmental history assessments were generally preferable over face-to-face appointments, and video-based formulation meetings were effective, productive and resulted in higher clinician attendance. The qualitative data on feedback appointments was mixed. Clinicians felt that telephone appointments were less personable and ethical; whereas, videobased feedback appointments allowed for more empathy. However, the majority of service-users opted for tele-calls over video-calls for these appointments. Socially-distanced BOSAs obtained positive clinician feedback in general. Service-user feedback was mixed; some found the experience uncomfortable and unfamiliar, whilst others enjoyed the experience. Overall, service-users were content with the knowledge that it may support a diagnostic outcome for their child. Conclusions: Weconcluded that the overall experience of the virtual ASD diagnostic pathway was a positive and informative process, identifying opportunities for permanent change to the service. [ABSTRACT FROM AUTHOR]

Abstract: Background: Eligibility for thrombolysis as an acute stroke treatment is determined through the use of unenhanced noncontrast computed tomography (CT), time since stroke onset, and patient history. Assessing penumbral patterns, which can be examined only through the use of diagnostic technologies such as magnetic resonance imaging (MRI) and perfusion CT (CTP), may be able to better select patients for thrombolysis. However, trade-offs in terms of administration time and cost may affect the value of using these diagnostic studies. Objective: We examined the trade-offs among patient selection via usual care with CT, usual care plus MRI using diffusion-weighted and perfusion imaging, and usual care plus CTP for their effect on costs and outcomes when diagnosing stroke and selecting candidates for thrombolysis in the United Kingdom. Methods: A decision-analytic model was developed. Efficacy and utilities were obtained from published studies. Costs were obtained from standard UK costing sources and were supplemented with data from the published literature. Outcomes included a favorable outcome (modified Rankin Scale score <2), costs, life-years, quality-adjusted life-years, and incremental cost-effectiveness ratios. Results: Compared with usual care selection, adding CTP or MRI to better select patients for thrombolysis reduced the number of patients receiving thrombolysis by 9 and 14.6 per 1000 patients treated, respectively, while improving favorable outcome (19.2 and 17.6 per 1000 patients treated, respectively). In both scenarios, costs were decreased slightly. Both CTP and MRI selection were cost saving (more efficacious and less costly) compared with unenhanced CT selection; CTP selection was found to dominate MRI selection. Conclusions: Adding diagnostic tests such as CTP and MRI to select UK patients for thrombolysis may be a good value for the money and may improve patient outcomes. If a preferred diagnostic test had to be chosen based on economic value, CTP might be the best compromise between unenhanced CT selection and MRI selection. [Copyright &y& Elsevier]

The article discusses the use of tongue examinations in nineteenth and early twentieth century British medicine. It comments on the inspection of the tongue as a diagnostic and clinical test by physicians. The author examines the possible origins of the tongue examination and suggests explanations for its prevalence, examining doctor-patient relations and questions of medical authority. He notes that his research is based on notes and case reports from St. Bartholomew’s Hospital in London, England.

Ireland R (2011) Histopathology 145-154 The National Institute for Clinical Excellence (NICE) defined the process of care for haematological malignancies in Improving outcomes in haematological cancers. The manual in 2003. The most challenging recommendation has been the requirement to develop integrated laboratory services for accurate diagnosis. This is an aim that has not been fully achieved. The unified concept of haematological malignancy is recent and based on an understanding of the cellular pathology of the bone marrow and immune systems. Historical UK pathology practice has previously resulted in the separation of laboratory haematology from histopathology and of liquid and tissue specimens. Proposals for reintegration and centralization with specialist-led, centralized diagnostic and reporting services challenge the fragmented historical model. Accuracy and certainty of diagnosis remains problematic, particularly for lymphomas, with evidence that the accuracy of diagnosis is slowly improving but still only approaches 85%. There is a potentially significant human and financial cost of diagnostic errors. No nationwide, validated and comparable epidemiology/population-based data exist for accurate and complete ascertainment of new cases of haematological cancer, service planning or clinical outcomes monitoring. This article examines the original rationale behind the NICE guidance and outlines the key components and processes of an integrated diagnostic service. [ABSTRACT FROM AUTHOR]

The article discusses a ring-trial involving 7 European testing centers in Great Britain, Sweden and Germany to compare several real-time polymerase chain reaction (PCR) methods in the detection of Coxiella burnetii. Ten nucleic acid samples were received by each testing center. It indicates that real-time PCR assays that target multiple copy genes are more sensitive than those targeting single-copy genes and the additional use of a PCR targeting a single-copy gene can allow accurate quantification of the bacterial load present within a sample.

Achieving adequate levels of uptake in cancer screening requires a variety of approaches that need to be shaped by the characteristics of both the screening programme and the target population. Strategies to improve uptake typically produce only incremental increases. Accordingly, approaches that combine behavioural, organisational and other strategies are most likely to succeed. In conjunction with a focus on uptake, providers of screening services need to promote informed decision making among invitees. Addressing inequalities in uptake must remain a priority for screening programmes. Evidence informing strategies targeting low-uptake groups is scarce, and more research is needed in this area. Cancer screening has the potential to make a major contribution to early diagnosis initiatives in the United Kingdom, and will best be achieved through uptake strategies that emphasise wide coverage, informed choice and equitable distribution of cancer screening services. [ABSTRACT FROM AUTHOR]

The article analyzes prevalence of prostate cancer in the United Kingdom (UK). It is noted that prostate cancer is the most common cancer among males and it is estimated there are 52300 new prostate cancer cases annually. All four UK countries set their own screening policy based on the recommendations of the UK National Screening Committee. Based on its last review of prostate cancer, the UK National Screening Committee decided not to recommend a screening programme for the disease.Vendor created [ABSTRACT FROM PUBLISHER]

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Aim: To assess whether there are differences in the pathological features or survival between the new National Health Service Breast Screening Programme (NHSBSP) interval cancer classification system category of type 1 interval cancers, and the previously used, separate categories of occult, unclassified, and true interval cancers. Materials and methods: The prognostic pathological features (grade, lymph node stage, size, vascular invasion, oestrogen receptor status, and histological type) and survival of 428 type 1 interval invasive breast cancers were analysed by subgroup (occult, unclassified and true interval). Results: Occult cancers compared with other type 1 interval cancers were of significantly lower grade [38 of 52 (73%) versus 151 of 340 (44%) grade 1 or 2, p =0.0005], more likely to be smaller size [37 of 51 (73%) versus 158 of 341 (46%) <20mm, p =0.0003] and more frequently of lobular type at histology [14 of 42 (32%) versus 50 of 286 (17%), p =0.03]. There was no significant difference in pathological features of unclassified tumours compared with other type 1 tumours. There was no significant survival difference between different type 1 subgroups (p =0.12). Conclusion: The NHSBSP type 1 interval cancers are a heterogeneous grouping with markedly differing pathological features. However, no significant survival difference is seen between the different type 1 subgroups. [Copyright &y& Elsevier]

We present a method to increase the utilization of and reduce the waiting times for an under-capacitated diagnostic resource in the presence of uncertain demand with several priority levels. We consider the case of a computed tomography (CT) scanning department that services both high-priority in-patients and lower priority outpatients. Current practice calls for all in-patient demand to be met on the day of the request. Our proposal looks at the benefit of reserving space for carrying over a percentage of non-emergency in-patient demand to the next day and utilizing a pool of on-call outpatients who can respond quickly to available capacity. We formulate and solve an optimization problem that returns a reservation policy that minimizes unused capacity subject to an overtime constraint. We use a simulation to demonstrate a significant reduction in the growth rate of outpatient waiting time resulting from using the proposed method and investigate the sensitivity of results to several model assumptions. [ABSTRACT FROM AUTHOR]

Background There is increasing need for accessible information about familial breast cancer for those facing complex decisions around genetic testing, screening and treatment. Information currently includes leaflets and computerized decision aids, offering interactive interfaces to clarify complex choices. Objective Exploration of users’ views and reactions to three decision aids for genetic testing for breast cancer using focus groups. Setting A regional cancer genetics service in the UK. Participants Women over 18 years of age who had been referred to Cancer Genetics Service for Wales (CGSW) and had received a risk assessment for familial breast cancer. Methods Qualitative study involving one pilot and six extended focus groups with 39 women at high, moderate and population risk. Two CD-ROMs and one paper-based aid evaluated for: clarity of presentation, ease of handling, emotive response, increased knowledge and greater informed choice. Results Women reported variable preferences for different types of decision aids and mixed emotions, indicating the sensitivity of raising issues in decision support tools, lack of consensus over the most appropriate aid and no systematic differences between risk groups. Women remarked that aids increased their knowledge, particularly about breast cancer genes and risk and wanted a decision aid designed within the context of the NHS, in both paper-based and CD-ROM formats from an authoritative source. Mixed views about presentation styles suggest decision aids would be most effective with a user-selected range of formats. Conclusions Decision aid development should be informed by users and should meet the needs of those concerned about their risk of breast cancer in the UK. Without such aids, patients will continue to search for information from a variety of sources of varying quality. [ABSTRACT FROM AUTHOR]

This article examines the effectiveness of screening programs designed to detect depression in patients. It overviews the employment of depression screening as a national health policy in the U.S. and in Australia. However, it discusses difficulty in gauging the effectiveness of these screenings. The ratio of cost factors to benefits continues to remain too high. The article does suggest that measures need to be taken to address the inadequate depression management in Great Britain.

In October 2003, the British Society of Audiology instigated the development of a Special Interest Group to study auditory processing disorder (APD) in the UK, and a steering committee was appointed. There is limited epidemiological information on APD, mainly because there is no general agreement on diagnostic markers. This is exacerbated by the potential overlap between the symptomatology of APD and other developmental conditions that impact on differential diagnosis. Children are referred for and receive clinical labels of APD but no clear evidence existed of service provision for those identified with APD in the UK. The APD Steering Committee aimed to check the Care Pathway for children currently identified with, or suspected of having, APD. A short questionnaire was developed which comprised 25 items. The questions addressed care pathway issues from screening and referral route, through diagnosis and management. The questionnaire was sent via email to practitioners in audiology ( n?=? 407) and speech language therapy, SLT ( n?=? 350) for whom an email address was available from datasets easily accessible to the steering committee. There was an overall response rate of 46% with only a minimal response from respondents who provide services only for adults. Hence this article reports on the survey outcomes for paediatric services only. Comparison with the number of paediatric hearing services trained by the Modernising Children's Hearing Aid Services (MCHAS) team and the identified geographical coverage over England, suggests these data can be generalized across England for audiology services but not for SLT. Only a small percentage of respondents provide a screen (9.6%) or diagnostic (11.1%) service for this condition. Over half the respondents report being at best ‘not well’ informed about APD. Perhaps the most interesting finding is that only a minimal number of respondents who offer to diagnose APD consider they are ‘very well informed’ about the condition. This raises a question on the confidence of diagnoses provided by such services. [ABSTRACT FROM AUTHOR]

Aims: The National Pathology Alliance benchmarking review has completed six years of data collection and analysis of the workload and organisation of haematology laboratories in the UK. This study audits national practice of routine thrombophilia screening against the current standards, as set out in the British committee for standards in haematology (BCSH) guidelines on investigation of heritable thrombophilia. Methods: Each laboratory completed a standard data collection questionnaire about the number of routine thrombophilia assays performed each year. Information was collected on which thrombophilia tests were performed as part of a routine thrombophilia screen. These results were then compared against the BCSH guidelines on investigation of heritable thrombophilia. Results: Of the 57 National Health Service trusts that submitted data for review in 2002/2003, 47 performed a routine thrombophilia screen. Ten laboratories complied with the guidelines but 37 laboratories did not. Conclusion: There was variation in practice in the tests used in routine thrombophilia screens. There is evidence that some laboratories deviate from what may be regarded as "evidence based practice". The lack of compliance with the guidelines was in general associated with the performance of additional tests not recommended in the guideline. In a minority of laboratories, a clinically significant diagnosis would be missed by the failure to include one or more tests in a thrombophilia screen. [ABSTRACT FROM AUTHOR]

This review examines the evidence for screening for autism spectrum disorders in the general population and the information needed to inform screening policy. The UK National Screening Committee criteria are taken as the framework. These criteria cover the condition, the screening test, the treatment and the screening programme as a whole. With respect to the condition, reasons for variation in prevalence estimates for autism spectrum disorders need to be resolved and there are few longitudinal studies to describe the natural history of autism spectrum disorders that include data on children identified at an early age. There is no screening test suitable for use in a population setting that has been fully validated. There is insufficient evidence regarding the effectiveness of interventions. This review supports the current policy position of the National Screening Committee, that on the basis of existing evidence, screening for autism spectrum disorders cannot be recommended. [ABSTRACT FROM AUTHOR]

Background This study investigates the breast and cervical screening status of women with moderate to severe learning disability and whether uptake could be improved by one to one counselling. [ABSTRACT FROM PUBLISHER]

The implementation of the two-week wait initiative for cancer referrals in the NHS has had a major impact on outpatient services. A low clinical detection rate among GPs for neurological cancer has resulted in a large number of urgent referrals with a low yield of positive diagnoses. We have devised a strategy for minimizing the impact on outpatient clinics: patients are scanned prior to clinical review and those with normal scans are referred back to the GP without a clinic appointment. Out of 69 referrals of suspected CNS cancer made in 2003, 61 were scanned and six resulted in a positive diagnosis. The equivalent of 10 clinics was saved, and an increased speed of diagnosis and treatment was achieved with no compromise in patient care. Our study illustrates the consequences of the 2-week wait initiative on the neurosurgical service, and proposes an effective and safe solution. [ABSTRACT FROM AUTHOR]

Background Health care services traditionally offered in a secondary setting are increasingly being offered in a primary setting. There has been little assessment of quality and efficiency of diagnostic services such as ultrasound delivered in primary settings and no studies have looked at independently provided services. [ABSTRACT FROM PUBLISHER]

The article presents information on the aid provided by government towards controlling the disease of Bowel cancer. It is a major cause of morbidity and mortality (1,2) and requires over 50% of a specialist colorectal surgeons' time in Great Britain. A Department of Health Bowel Cancer Advisory Group chaired by Professor Michael Richards, National Cancer Director, aims to streamline the diagnostic services, improve surgical and adjuvant treatment, advise on the introduction of bowel cancer screening in the next two to three years, and improve the availability of lower gastrointestinal endoscopies, which may become the bottleneck preventing the achievement of some of these aims.

The article examines the rationale and supporting evidence for a program for screening diabetic retinopathy, and the arguments for and against the screening modalities being applied in Great Britain. There is no single modality that can satisfy all the requirements for a screening program. However, the preferred technique for screening is a retinal photographic service using digital systems.

Objective: To determine UK orthodontic consultants' attitudes to the provision of orthodontic advice to general dental practitioners by electronic means. Design: Questionnaire. Setting: Conducted by email and surface mail as appropriate in August 2000. Subjects: All those UK NHS orthodontic consultants contained in the membership lists of the Consultant Orthodontists Group of the British Orthodontic Society. Outcome: An 86 per cent response was obtained from the 231 consultants. Results: More than half (58 per cent) of the consultants were interested in providing an electronic diagnostic service for the general dental practitioners in their locality and 70 per cent were in favour of further research into this possibility. Provided this was mediated through their GDP, only 26% would oppose consultant advice being given electronically from a centralized source. Conclusions: A majority of UK orthodontic consultants support the concept of using teledentistry to make their advice more accessible to dentists and patients. [ABSTRACT FROM AUTHOR]

Focuses on a multidisciplinary genetic assessment service for familial breast cancer patients in Great Britain. Benefit and goal of the genetic assessment service; Impact of the service on the emotional well-being and satisfaction of at-risk women; Comparison on costs of a multidisciplinary genetic and surgical assessment service with existing service provisions.

Presents research which sought to assess the extent to which surgery for congenital dislocation of the hip is the result of a failure of detection through screening. Screening for hip instability in neonates introduced in 1969; Methods; Findings; Incidence of first operative procedure similar to that before screening began; Screening's failure to detect congenital dislocation in children who received surgery; Need to evaluate screening policies.

Reports developments in medicine in Great Britain as of September 1993. Improvement of the cervical screening service; Issuance of ultimatum to doctors failed to reach the national health insurance fund; Inspection of nursing homes twice a year under the 1984 Registered Home Act.

Gonorrhoea in the UK is now a highly focal problem that is localized to certain inner city areas where it presents a significant public health concern. However, the majority of men and a proportion of women infested with Neisseria gonorrhoeae do not experience symptoms of sufficient intensity to prompt them to seek medical advice and the current strategy of treating symptomatic individuals in specialist clinics with subsequent tracing of sexual partners is therefore failing to control the spread of infection in these areas. One method for addressing this problem would be the extension of effective diagnostic services into the clinical environments most likely to be accessed by these high-risk individuals. This paper reviews the scientific literature examining the various methodologies available for the identification of N. gonorrhoeae and assesses their suitability for the diagnosis of gonorrhoea in these alternative clinical settings. [ABSTRACT FROM AUTHOR]

A national survey of the current methods used by specialists to evaluate pituitary function in the UK was performed by postal questionnaire. Seventy-three respondents, of whom 89% were consultants and 80% clinical endocrinologists, returned the questionnaire. Fifty per cent routinely used the insulin stress test (IST) to evaluate the hypothalamo-pituitary-adrenal (HPA) axis, while 50% routinely used tetracosactrin stimulation, there being little overlap between the two groups. This represents a significant change in clinical practice since the last survey in 1988. In those who used ACTH stimulation there was almost an equal split into those who administered the tetracosactrin intramuscularly (45%) or intravenously (47%). Furthermore, either the peak or 60 min cortisol value was used by 71% when interpreting the result of the test, despite the fact that in previous studies only the 30 min cortisol value has been shown to correlate with the IST result. The IST remains the most frequently used method to assess growth hormone reserve in adult subjects. The thyrotrophin-releasing-hormone and gonadotrophin-releasing-hormone tests are still used routinely by approximately a quarter of clinicians. These results provide data that could be used to develop guide-lines for the use of tests to investigate pituitary function. [ABSTRACT FROM AUTHOR]

The article focuses on the English National Chlamydia Screening programme in Great Britain. The programme, which was launched in 1998, is offered to people less than 25 years old of both sexes who are sexually active. The tests are available in a wide range of settings including general practices, family planning clinics, pharmacies and a variety of community initiatives.

The article discusses the lack of proper implementation of the NHS Health Check programme leading to missed diagnosis of thousands of people with Type 2 diabetes in England. It states the need for the Government to ensure proper implementation of the NHS Health Check. Also emphasizes on a public awareness campaign to educate people aged 40 to 74 on the importance of the NHS Health Check programme.

The article focuses on the Medical Futures Innovation Awards, an award based in Great Britain aimed to discover the next breakthroughs in healthcare and help healthcare professionals and academics deliver them to the market. It says that the winners of the award get a bespoke package of support to turn ideas into viable propositions that have credibility with investors. It mentions the criteria for selecting winners such as novelty, impact on patient care, and viability. Moreover, it cites several novel products and services to win the 2008 Medical Futures Innovation Awards including a point of care test for diagnosing bladder cancer from UroSens Ltd., a electronic patient record system from Medisoft, and the Moorfields Motion Displacement Test (MDT) for glaucoma detection.