A comparison of colorectal neoplasia screening tests: a multicentre community-based study of the impact of consumer choice.
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Australia↗
Biomedical subjects
Allan D Spigelman
Publications and source records attributed to Allan D Spigelman.
Frequency and spectrum of cancers in the Peutz-Jeghers syndrome.
BACKGROUND: Although an increased cancer risk in Peutz-Jeghers syndrome is established, data on the spectrum of tumors associated with the disease and the influence of germ-line STK11/LKB1 (serine/threonine kinase) mutation status are limited. EXPERIMENTAL DESIGN: We analyzed the incidence of cancer in 419 individuals with Peutz-Jeghers syndrome, and 297 had documented STK11/LKB1 mutations. RESULTS: Ninety-six cancers were found among individuals with Peutz-Jeghers syndrome. The risk for developing cancer at ages 20, 30, 40, 50, 60, and 70 years was 2%, 5%, 17%, 31%, 60%, and 85%, respectively. The most common cancers represented in this analysis were gastrointestinal in origin, gastroesophageal, small bowel, colorectal, and pancreatic, and the risk for these cancers at ages 30, 40, 50, and 60 years was 1%, 9%, 15%, and 33%, respectively. In women with Peutz-Jeghers syndrome, the risk of breast cancer was substantially increased, being 8% and 31% at ages 40 and 60 years, respectively. Kaplan-Meier analysis showed that cancer risks were similar in Peutz-Jeghers syndrome patients with identified STK11/LKB1 mutations and those with no detectable mutation (log-rank test of difference chi2 = 0.62; 1 df; P = 0.43). Furthermore, the type or site of STK11/LKB1 mutation did not significantly influence cancer risk. CONCLUSIONS: The results from our study provide quantitative information on the spectrum of cancers and risks of specific cancer types associated with Peutz-Jeghers syndrome.
AMP-Activated Protein Kinase Kinases↗
Surgical accountability: a framework for trust and change.
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Australia↗
Mutation analysis of the MYH gene in an Australian series of colorectal polyposis patients with or without germline APC mutations.
The MYH gene has recently been shown to be associated with a recessive form of colorectal adenomatous polyposis. Two common mutations in the MYH gene have been identified that lend themselves to rapid screening. We have examined a series of 302 individuals comprising 120 control subjects, 120 patients diagnosed with adenomatous polyposis but without germline mutations in the APC gene and 62 patients diagnosed with familial adenomatous polyposis all harbouring confirmed causative APC germline mutations. The results reveal that MYH accounts for 16 percent of polyposis patients without germline mutations in the APC gene and that it does not appear to be a modifier gene in FAP patients diagnosed with APC germline mutations.
Adenomatous Polyposis Coli↗
Skin antiseptics and the risk of operating theatre fires.
BACKGROUND: Following press reports of patients catching fire or receiving chemical burns in the operating theatre, a review was conducted on the flammability of skin antiseptics. The purpose of the paper was to clarify confusion regarding povidine-iodine (Betadine), which had been reported as being flammable, and also to determine the use of alcohol-based solutions in the Hunter Area Health Service. A risk assessment was conducted and risk reduction strategies outlined. METHODS: Risk assessment was made following a literature review and an audit of 10 operating theatres in the Hunter Area Health Service. RESULTS: Risk for operating room fires from alcohol-based skin antiseptics was confirmed. Antiseptics in aqueous solutions only smoulder. The Hunter Health survey indicated that although alcohol-based solutions were not used in operating theatres, they were used in anaesthetic bays for insertion of epidural and central line catheters. Strategies to reduce the risk of fire include discontinuation of use of alcohol-based skin antiseptics in operating theatres; using fire retardant surgical drapes; installing over-current protection devices on electrical equipment; minimizing flammable conditions by avoiding nitrous oxide and using the lowest required concentration of inspired oxygen; use of non-flammable cuffed endotracheal tubes; education and training of operating theatre personnel in fire hazards. CONCLUSIONS: Operating theatre fires continue to be a major risk for patient safety. In order to reduce this risk, the strategies outlined here should be followed.
Alcohols↗
Review of the Australian incident monitoring system.
BACKGROUND: A survey was conducted to assess the benefits and limitations of the Australian Incident Monitoring System (AIMS) as a programme to improve patient safety. METHODS: A 12-point questionnaire was sent to 12 current users of AIMS in November 2002. RESULTS: The AIMS provides a consistent system of coding, trending and monitoring of incident data. It promotes a patient safety culture and an awareness of system error. Other benefits include the building of teamwork and the implementation of strategies to reduce the prevalence and severity of incidents. The majority of respondents (83%) reported that AIMS investigations resulted in significant changes to equipment usage, medication prescribing or administration, clinical protocols, training programmes and falls risk assessment tools. Although 75% of users reported improvements in patient outcomes, these were difficult to measure. A major limitation of AIMS was the low rate of incident reporting by medical staff. Voluntary reporting systems did not capture all incident data and the information was often too generic for root cause analysis. There were difficulties benchmarking data and concerns were raised regarding the ownership of information. The programme requires ongoing resources to implement change strategies and to maintain incident reporting levels. On a scale of 1 (poor rating) to 10 (excellent rating) the mean benefit rating was 7.6. CONCLUSION: The Australian Incident Monitoring System is beneficial as a component of a clinical risk management strategy. Usefulness could be improved by increased participation by medical staff. The level of resources required should not be underestimated if the programme is to demonstrate improvements to patient outcomes. More recent versions of AIMS promise improved capabilities and will require similar evaluation.
Australia↗
Surgeon and hospital volume and the management of colorectal cancer patients in Australia.
BACKGROUND: The evidence for a relationship between patient outcomes and clinician and hospital volume is increasing. The National Colorectal Cancer Care Survey was undertaken to determine the management patterns in Australia for individuals newly diagnosed with colorectal cancer in a 3 month period in the year 2000. METHODS: All new cases of colorectal cancer registered at each Australian State Cancer Registry were entered into the survey. This generated a questionnaire that was sent to the treating surgeon. Chi-squared tests and logistic regression analyses were used to determine levels of statistical significance. RESULTS: Of 2,383 surgical questionnaires generated, 2,015 (85%) were completed. The majority (58%) of surgeons treated one or two patients with colorectal cancer over the 3 months of the survey. There was variation across surgeon cohorts for preoperative measures including the use of deep vein thrombosis prophylaxis. Patients seen by low volume surgeons were most likely to be given a permanent stoma (P < 0.0001). Patients with rectal cancer who were operated on by high volume surgeons were significantly more likely to receive a colonic pouch (P < 0.0001). CONCLUSION: This nationwide population-based survey of the treatment of colorectal cancer patients suggests that the delivery of care by surgeons (the majority) who treat patients with rectal cancer infrequently should be evaluated.
Adolescent↗
Is there a link between work-related stress and colorectal cancer?
The South Australian Workers Compensation Tribunal has found that stress contributed to a man's colorectal cancer. The medical evidence for this is very limited, and the case highlights the difference between scientific and legal proof.
Causality↗
Relative frequency and morphology of cancers in STK11 mutation carriers.
BACKGROUND & AIMS: There is limited data on the spectrum and risk for cancer associated with germline serine/threonine protein kinase 11 (STK11) mutations that cause Peutz-Jeghers syndrome (PJS). METHODS: We analyzed the incidence of cancer in 240 individuals with PJS possessing germline mutations in STK11. RESULTS: Fifty-four cancers were found among carriers. Overall, the risk for developing cancer at ages 20, 30, 40, 50, 60, and 70 years was 1%, 3%, 19%, 32%, 63%, and 81%, respectively. Kaplan-Meier analysis showed similar cancer risks between missense and truncating mutation carriers (log-rank chi(2) = 2.48; P = 0.12). There was some evidence that mutations in exon 3 of STK11 were associated with a higher cancer risk than mutations within other regions of the gene. We found no difference in overall cancer risk between male and female carriers (log-rank chi(2) = 1.31; P = 0.25) or between familial and sporadic cases (log-rank chi(2) = 1.16, with 1 df; P = 0.28). The most common cancers represented were gastrointestinal in origin--gastroesophageal, small bowel, colorectal, and pancreatic--and the risk for these cancers at ages 30, 40, 50, and 60 years was 1%, 10%, 18%, and 42%, respectively. In women, the risk for breast cancer was substantially increased, being 32% by age 60 years. CONCLUSIONS: These results quantitatively show the spectrum of cancer risk associated with STK11 germline mutations in the context of PJS and provide a valuable reference for defining surveillance regimens.
AMP-Activated Protein Kinase Kinases↗
People with colorectal cancer: can we help them do better?
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Colorectal Neoplasms↗
The effect of indole-3-carbinol and sulforaphane on a prostate cancer cell line.
BACKGROUND: Cruciferous vegetable consumption is inversely related to the incidence of prostate cancer. We examined the effect of indole-3-carbinol (I3C) and of sulforaphane (constituents of cruciferous vegetables) on cell proliferation of a PC-3 prostate cancer cell line, in order to observe if an inhibitory effect might be detected in vitro. METHODS: PC-3 prostate cancer cells were cultured in 96-well microtitre plates. Indole-3-carbinol concentrations ranging from 0.1 mmol/L to 0.8 mmol/L or sulforaphane concentrations ranging from 0.01 mmol/L to 0.06 mmol/L were added to the wells. Cell proliferation was measured by colorimetric assay and results were based on the mean value of triplicate experiments. Data are -presented as medians and interquartile ranges and were analysed using the Mann-Whitney U-test. RESULTS: Cell proliferation in PC-3 prostate cancer cells was significantly inhibited by I3C and sulforaphane at media concentrations of 0.2 mmol/L and 0.02 mmol/L, respectively. CONCLUSION: Both compounds inhibited the proliferation of prostate cancer cells in a dose-dependent manner. These findings may help explain the observed protective effect of cruciferous vegetables in relation to prostate cancer.
Anticarcinogenic Agents↗
Titanic surgical waiting lists: what lies beneath?
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Arthroplasty, Replacement, Hip↗
Measuring clinical audit and peer review practice in a diverse health care setting.
BACKGROUND: A measurement system was devised to determine the extent of clinical audit and peer review across the Hunter Area Health Service, to compare changes over time and to assess the effect of the implementation of a policy on the conduct of patient safety meetings. METHODS: Two surveys were conducted over consecutive years (2001, 2002). A scoring system was developed based on a 12 point questionnaire. Ten points were given for a 'yes' response and zero for a 'no' response. Points were also given for frequency of meetings. Statistical analysis was by the Mann-Whitney U-test. The questionnaire included items on clinical indicators, management of issues arising and whether meetings are multidisciplinary, chaired and points for action minuted and followed up. RESULTS: One-hundred and five units provided data for the 2001 survey (100% response rate) and 109 units provided data for the 2002 survey (100% response rate). There was a significant increase in the median score in the 2002 survey (median 101; interquartile range 72-113) when compared with the 2001 Survey (median 91; interquartile range 51-110; P = 0.016). There was an improvement of 9% in units scoring in the highest quartile (90-120 points) and a decrease of 5% in units scoring in the lowest quartile (0-29 points). CONCLUSIONS: This methodology allows for the quantitative measurement of audit and peer review activities across clinical units. It might assist clinicians, professional colleges and departments of health in the further development of the recertification\revalidation process.
Australia↗
Novel strategy to stop cigarette smoking by surgical patients: pilot study in a preadmission clinic.
BACKGROUND: Evidence-based guidelines suggest that all services, wards and clinics within hospitals consider smoking status a vital sign and routinely provide cessation care. Despite this, such opportunities are currently under-utilized. The aim of the present pilot study was to determine the potential effectiveness, feasibility and acceptability of computer delivery of smoking cessation advice to surgical preadmission patients. METHODS: All smokers attending a non-cardiac surgical preadmission clinic at the John Hunter Hospital, New South Wales, completed a brief computerized smoking cessation intervention programme. Nine months following completion of the programme, patients completed a follow-up telephone interview that assessed their smoking status and the acceptability of the programme. RESULTS: At follow up, 22 of the 37 participants (60.0%) reported that they had stopped smoking prior to their surgery 9 months previously. Of the 37 participants at follow up, five reported that they were no longer smokers at that time, a cessation rate of 13.5%. Among those patients still smoking, a trend toward smoking fewer cigarettes was evident. Of the 56 smokers at baseline, all completed the computerized smoking cessation programme, with an average completion time of 21 min. A large majority of the smokers (80%) and non-smokers (88%) found that the provision of smoking cessation advice by the computer was appropriate and acceptable. Extrapolation of the results to a full year suggests a cost per quitter of $443. CONCLUSIONS: An interactive computerized smoking cessation programme is an acceptable and feasible method of routinely encouraging surgical preadmission clinic patients to stop or reduce their smoking. Further development and testing of the efficacy of this approach is required.
Admitting Department, Hospital↗
Management of colorectal cancer patients in Australia: the National Colorectal Cancer Care Survey.
BACKGROUND: The National Colorectal Cancer Care Survey was undertaken to determine the management patterns for individuals newly diagnosed with colorectal cancer in Australia. METHODS: Between 1 February and 30 April 2000, all new cases of colorectal cancer registered at each Cancer Registry within Australia were entered into the survey. This generated a questionnaire that was sent to the treating surgeons. Chi-squared and logistic regression analyses were used to determine levels of statistical significance for the various comparisons of interest. RESULTS: Of 2383 surgical questionnaires generated, 2015 (85%) were completed. A total of 1911 patients (95% of those who responded to the questionnaire) had an operation. Of the 86 guidelines for the management of colorectal cancer published by the National Health and Medical Research Council, the survey allowed for comparison between 18 of these, which covered a spectrum of surgical management. Thromboembolic prophylaxis was given to 1843 patients (96.4%) undergoing surgery. Prophylactic antibiotics were commonly used, but there appear to be issues regarding the best regimen to use. Curative resections were carried out in 1563 patients (81.8%), with anterior resections being the most commonly performed procedure. Adjuvant therapy was regularly used, but not all eligible patients were offered such treatment. CONCLUSION: With the considerable resources required to develop clinical practice guidelines, studies like this are essential to monitor the impact of the guidelines. To ensure that the guidelines are in line with current evidence, regular reviews of the guideline recommendations are required.
Adolescent↗
Governance and innovation: experience with a policy on the introduction of new interventional procedures.
BACKGROUND: Changing consumer expectations, particularly in the area of informed consent, coupled with a history of an unanticipated rise in adverse events following the introduction of some new interventional procedures, have produced a need for the more formal evaluation of such procedures before their introduction into a health-care facility. Moreover, a need exists to ensure that the outcomes of such procedures are monitored. Descriptions of such formal evaluation processes were lacking before 2000. The experience of a large regional health service with the implementation of a brief but comprehensive evaluation process for the introduction of new interventional procedures is described. METHODS: A policy outlining the approval and monitoring processes, including a simple, 15-point checklist, was developed in consultation with clinicians and managers and was implemented in 2000. The experience with this policy between January 2001 and December 2004 (inclusive) is described. RESULTS: Twenty-nine applications for the introduction of new procedures, from a range of clinical disciplines, were submitted and approved. Some required significant modification, particularly in the areas of clinical risk description and other data required to facilitate the provision of informed consent. CONCLUSIONS: Innovation can be protected and encouraged by processes that allow for appropriate scrutiny of the benefits and requirements for the successful introduction of new interventional procedures. The approach described has since been used as the basis for the New South Wales Health Department statewide policy on this matter and as a model policy by the Royal Australasian College of Surgeons.
Australia↗