PubMed · 15997899
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Rhoda Lillystone. Easing the pain.. https://doi.org/10.7748/ns.19.41.67.s55
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As knowledge on the causation of cancers advances and new treatments are developed, early recognition and accurate diagnosis becomes increasingly important. This review focused on identifying factors influencing patient and primary care practitioner delay for upper gastrointestinal cancer. A systematic methodology was applied, including extensive searches of the literature published from 1970 to 2003, systematic data extraction, quality assessment and narrative data synthesis. Included studies were those evaluating factors associated with the time interval between a patient first noticing a cancer symptom and presenting to primary care, between a patient first presenting to primary care and being referred to secondary care, or describing an intervention designed to reduce those intervals. Twenty-five studies were included in the review. Studies reporting delay intervals demonstrated that the patient phase of delay was greater than the practitioner phase, whilst patient-related research suggests that recognition of symptom seriousness is more important than recognition of the presence of the symptom. The main factors related to practitioner delay were misdiagnosis, application and interpretation of tests, and the confounding effect of existing disease. Greater understanding of patient factors is required, along with evaluation of interventions to ensure appropriate diagnosis, examination and investigation.
With respect to health risk behaviours, many people are unaware of their own risk behaviour and regard their behaviour as more healthy than it really is. This article studied differences between people with and without misperception of their physical activity with respect to several reference points: the social comparison style of people (upward, equal and downward); the body self-image with regard to their weight [body mass index (BMI) and self-rated weight]; and linkages of physical activity with different outcome expectancies (health, appearance, weight, feeling fit, relaxation and stress relief). Results from 516 respondents (response 52%; 56% women) with a mean age of 53.7 years found that respondents who incorrectly think that their physical activity is adequate (overestimators) tend to rate their physical activity more often in comparison to others. Furthermore, overestimators and people who correctly think they exercise enough more often use downward comparison, while underestimators and people who know they exercise too little mostly use upward comparison. People who, rightly or not, think their weight is adequate or who have a lower BMI, more often assume that their physical activity is sufficient or high. People who, rightly or not, think that their physical activity is adequate more often score higher on other reasons to be physically active besides health. Increasing the accuracy of people's self-perceptions of physical activity may be important to incorporate into strategies to promote physical activity in populations at risk of inactivity.
OBJECTIVES: To determine the true potential for solid organ donation from deceased heartbeating donors and the reasons for non-donation from potential donors. DESIGN: An audit of all deaths in intensive care units, 1 April 2003 to 31 March 2005. The study was hierarchic, in that information was sought on whether or not brain stem testing was carried out; if so, whether or not organ donation was considered; if so whether or not the next of kin were approached; if so, whether or not consent was given; if so, whether or not organ donation took place. SETTING: 341 intensive care units in 284 hospitals in the United Kingdom. PARTICIPANTS: 46,801 dead patients, leading to 2740 potential heartbeating solid organ donors and 1244 actual donors. MAIN OUTCOME MEASURES: Proportion of potential deceased heartbeating donors considered for organ donation, proportion of families who denied consent, and proportion of potential donors who became organ donors. RESULTS: Over the two years of the study, 41% of the families of potential donors denied consent. The refusal rate for families of potential donors from ethnic minorities was twice that for white potential donors, but the age and sex of the potential donor did not affect the refusal rate. In 15% of families of potential donors there was no record of the next of kin being approached for permission for organ donation. CONCLUSIONS: Intensive care units are extremely good in considering possible organ donation from suitable patients. The biggest obstacle to improving the organ donation rate is the high proportion of relatives who deny consent.