What factors empower general practitioners for early cancer diagnosis? A 20-country European Delphi Study.

BACKGROUND: Some symptoms are recognised as red flags for cancer, causing the General Practitioner (GP) to refer the patient for investigation without delay. However, many early symptoms of cancer are vague and unspecific, and in these cases, a delay in referral risks a diagnosis of cancer that is too late. Empowering GPs in their management of patients that may have cancer is likely to lead to more timely cancer diagnoses. AIM: To identify the factors that affect European GPs' empowerment in making an early diagnosis of cancer. METHODS: This was a Delphi study involving GPs in 20 European countries. We presented GPs with 52 statements representing factors that could empower GPs to increase the number of early cancer diagnoses. Over three Delphi rounds, we asked GPs to indicate the clinical relevance of each statement on a Likert scale.The final list of statements indicated those that were considered by consensus to be the most relevant. RESULTS: In total, 53 GPs from 20 European countries completed the Delphi process, out of the 68 GPs who completed round one. Twelve statements satisfied the pre-defined criteria for relevance. Five of the statements related to screening and four to the primary/secondary care interface. The other selected statements concerned information technology (IT) and GPs' working conditions. Statements relating to training, skills and working efficiency were not considered priority areas. CONCLUSION: GPs consider that system factors relating to screening, the primary-secondary care interface, IT and their working conditions are key to enhancing their empowerment in patients that could have cancer. These findings provide the basis for seeking actions and policies that will support GPs in their efforts to achieve timely cancer diagnosis.

Update of diagnostic medical and dental x-ray exposures in Romania.

This national study, the third in the last 15 years, updates the magnitude of medical radiation exposure from conventional x-ray examinations, in order to optimise the radiological protection to the population in a cost-effective manner. Effective doses from diagnostic radiology were estimated for adult and paediatric patients undergoing the 20 most important types of x-ray examination. Data were collected from 179 x-ray departments, selected by their annual workload, throughout the country. Estimates were made using two dosimetric quantities: entrance surface dose, derived from the absorbed dose in air measured by simulation of radiographic examinations, and dose-area product, measured during fluoroscopic examinations performed on adult and paediatric patients. Conversion coefficients to effective dose of the UK National Radiological Protection Board (NRPB) have been used in all calculations. The effective dose per patient from all medical x-ray examinations was 0.74 mSv and the resulting annual collective effective dose was 6930 man Sv, with annual effective dose per caput of 0.33 mSv. The current size of population exposure from diagnostic radiology is lower than the previous one by 40%, but could be about 30% higher by taking into account the estimated contribution from computed tomography (CT) procedures.

Covered stent implantation for the treatment of an aneurysm involving a coronary bifurcation.

We report the percutaneous treatment of an aneurysm of the mid-segment of the left anterior descending artery involving a bifurcation with a diagonal branch in a patient with three-vessel disease. Due to the nonavailability of a dedicated device, we used a V-configured bifurcation system consisting of a polytetrafluoroethylene-covered stent for the main vessel and a baremetal stent for the side branch. The angiographic result was optimal and the patient remained symptom-free at 1-year follow up when the stress test was negative. The follow-up coronary angiography showed no restenosis of the coronary segments treated by stent implantation.

Microcoil embolisation for ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy.

BACKGROUND AND AIM: Percutaneous transcatheter occlusion with ethanol injection of septal arteries is an efficient treatment procedure of hypertrophic obstructive cardiomyopathy (HOCM). The aim of our study was to evaluate the feasibility and efficiency of septal artery embolisation with microcoils. METHODS: Microcoils were delivered through the guide-wire lumen of a 2mm-diameter coaxial balloon positioned inside the target vessel as distally as possible. One or more 0.018"-straight microcoils (Hilal straight coils, Cook, USA) were used for each target vessel until complete flow obstruction was achieved. The intraventricular pressure gradient was measured before, during and after the procedure. Septal branch occlusion was finally documented by coronary angiography. RESULTS: We treated 7 patients (5 males; mean age: 48 +/- 10 years). All patients were symptomatic (NYHA class III or IV). The target vessels were successfully occluded in all patients without complications. Moderate pain was recorded during and after the procedure and the CK level increased five- to ten-fold. The pressure gradient diminished during the procedure from 72 +/- 21 mmHg to 30 +/- 15 mmHg. The number of coils delivered ranged from 3 to 7 per patient. The embolised septal branches included 1 vessel in 5 patients, 2 vessels in 1 patient and 3 vessels in 1 case. After the procedure, the pressure gradient, evaluated by transthoracic echocardiography, was 34 +/- 16 mmHg and 42 +/- 12 mmH at 3 month-follow-up. Clinical improvement was recorded in all patients after the procedure (NYHA class I or II). Temporary pacing was necessary in 3 patients during and immediately after the procedure but no patient needed permanent pacing. CONCLUSIONS: Microcoil embolisation is an efficient and safe approach for transcatheter ablation of septal hypertrophy in HOCM. This technique induced myocardial necrosis without the toxic effects of alcohol, reducing the risk of complications such as permanent pacemaker implantation or ethanol flow to other myocardial regions.