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The retrospective observational study compared information on gastroscopy in the UKs Hospital Episode Statistics (HES) dataset (20062008) with death certificate records. The researchers identified 22,488 incident cases of esophagogastric (EG) cancer from 6,513 general practices. Researchers wrote that current British practice guidelines restrict referral for gastroscopy to dyspepsia patients with alarm symptoms that may signify advanced disease and thus affect EG cancer outcomes. Those symptoms, they said, were not developed specifically as possible cancer indicators. The study also found wide variations in gastroscopy rates among general practices, suggesting differing guideline interpretations. Older adults in socioeconomically disadvantaged regions were the least likely to be referred for gastroscopy. Those patients also had disproportionately poorer EG cancer outcomes. When adjusted for patient age, gender, comorbidity, poverty and socioeconomic status, practices in the lowest tertile for gastroscopy referral had the lowest patient rate of major surgery (aOR=0.87; 95% CI, 0.79-0.95), highest rate of emergency admission (aOR=1.73; 95% CI, 1.6-1.88) and highest mortality (aOR=1.14; 95% CI, 1.06-1.22 within 12 months of gastroscopy) among EG cancer patients. The researchers suggested that British gastroscopy guidelines be revised and that primary care practices with low gastroscopy referral rates undertake targeted efforts to ensure that at-risk patients for EG cancer specifically, socioeconomically disadvantaged older adults undergo the procedure. These findings suggest that initiatives or current guidelines aimed at limiting the use of gastroscopy may adversely affect cancer outcomes, the researchers concluded. If the situation is to improve, current referral guidelines and strategies to support compliance require urgent attention. Disclosure: The researchers report no relevant financial disclosures.
Nurse specialists are a vital part of the multidisciplinary team, said BSG president professor Chris Hawkey at the end of last month. High-quality care is built around multidisciplinary teams, and specialist nurses are a really key component of these teams, professor Hawkey told a meeting to raise awareness of gastroenterological conditions at 11 Downing Street. Specialist nurses are the interface that patients most value, and they play a predominant role in patient care. Although many hospitals do have them, we want every hospital in the UK to have a nurse specialist, he said. The specialists will be needed to play a key role in delivering six new minimum standards of care for patients with inflammatory bowel disease. The standards have been developed by seven stakeholder organisations including the BSG and the RCN s Crohns and Colitis special interest group. The stakeholder group wants all UK commissioners to implement the standards by October 2010. They include maintaining a patient-centred service, providing patient education and support, and delivering high-quality care to all UK patients with IBD. We want every strategic health authority to be aware of these standards, and all 161 commissioning bodies to adopt these standards of care as the norm for their local community, said professor Hawkey. The call for more specialist nurses was also backed by the National Association for Colitis and Crohns disease , which launched a campaign in 2005 to increase the number of inflammatory bowel disease (IBD) nurse specialists. The campaign was started after a NACC survey revealed that just 26% of UK colitis and Crohns patients had the support of an IBD nurse specialist. According to data from the UK IBD national audits, this figure increased quite dramatically to 56% in 2006, and to 62% by 2008. But this still falls short of the number of nurse specialists required to deliver effective patient care, said NACC chief executive Richard Driscoll, who also attended the Downing Street meeting. There has been real progress and real recognition of the value of the IBD nurse specialist, but we still have a long way to go, Mr Driscoll told Nursing Times. We are still well short of our target of one and a half whole time equivalent [IBD nurse specialists], and a lot of nurse specialists are still working solo, with a lack of cover and support, he added.