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McNALLY O.M., WAREHAM V., FLEMMING D.J., CRUICKSHANK M.E. & PARKIN D.E. (2003) European Journal of Cancer Care 12, 327–330 The impact of the introduction of a fast track clinic on ovarian cancer referral patterns The aim of this study is to review the referral patterns for ovarian cancer in the Grampian region of Scotland and assess the impact of a ‘fast track’ clinic on the patient journey. Population-based retrospective analysis of a gynaecological cancer database and patient case notes were used. After its inception, 13.5% of patients were referred through the fast track clinic and 83% were seen within 2 weeks. Thirty-six per cent of patients were admitted as emergencies, mainly surgical or medical. The median general practitioner-to-specialist time was 3 days (range 0–188 days). The median time to diagnosis prior to the fast track clinic was 23 days and 17.5 days after its introduction ( P = 0.003). A population-based ovarian cancer referral pattern is presented . Median waiting times are short but do influence time to diagnosis as do referral through a non-cancer specialty and patient performance status. Rapid access through a gynae-oncology clinic has some impact but is underused. [ABSTRACT FROM AUTHOR]

Skin metastasis is a rare form of ovarian carcinoma spread and is associated with widespread disease and a poor prognosis. The authors present a case of a patient, with a past history of ovarian clear cell carcinoma, who presented with subcutaneous nodules as the first sign of recurrent metastatic disease. [ABSTRACT FROM AUTHOR]

Objective: To define the role and responsibilities of the sports medicine specialist using a recognised research technique. Methods: A Delphi technique was employed using anonymous postal questionnaires sent to a random sample of 300 members of the British Association of Sport and Exercise Medicine. The questionnaire of 300 putative attributes was developed in a pilot study and the Delphi technique used allowed participants to modify their responses according to the responses of other participants. Results: There was a 53% response to both rounds of the study with 75.6% of the respondents being male, 39% having a higher qualification in sports medicine, and 45.6% being general practitioners. Some 86.3% strongly agreed that sport and exercise medicine should be a recognised speciality and 90% strongly agreed that it should be available on the National Health Service (NHS). The most important specialist attributes were orthopaedic and soft tissue medicine (83.6% strongly agreed) and emergency medical management (79.7% strongly agreed). More than 75% of respondents did not agree that either research or personal playing experience were relevant. Conclusion: Sports and exercise medicine is an evolving speciality in the United Kingdom. We believe this is the first systematic attempt to define the role and responsibilities of the sports medicine specialist and the findings are of relevance to the future development of a career pathway. [ABSTRACT FROM AUTHOR]

Identifying malignant ovarian masses preoperatively in young women can prove difficult due to their nonspecific presentation in this population (1). To describe (i) the clinicopathological predictors of malignancy in surgically removed ovarian masses in women ≤ 21 years of age; (ii)the ability of three risk models to distinguish malignant (including borderline) from benign tumours. A 30-year retrospective analysis of surgically removed ovarian masses in females ≤ 21 years at the Royal Children's Hospital and the Royal Women's Hospital Melbourne. External validation of risk of malignancy scores were undertaken. These included RMI2 (Risk of Malignancy Index 2, [menopausal status, CA125 and ultrasound features]); the Papic-method (tumour markers, maximum diameter of lesion and solid component) and the PRMI (Paediatric Risk of Malignancy Index, sex hormone related symptoms, maximum diameter of largest solid component, enhancement or flow in a septum or solid papillary projection). For each model the positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and area under the curve (AUC) were calculated. We examined 460 masses of which 383 were benign, 20 were borderline and 57 frankly malignant. Factors significantly associated with frank malignancy (compared to benign masses) were the presence of a palpable mass (73.9% versus 24.2%), precocious puberty, a larger mean diameter of the mass (15.1 cm versus 8.3 cm), presence of a solid component (91.3% versus 44.4%), multilocularity (66.7% versus 40.4%), ascites (42.9% versus 2.4%) respectively (all p < 0.05). Those with borderline tumours had an older median age compared to frankly malignant tumours (14.4 vs 18.5 years respectively) and were less likely to have a solid component or ascites (p < 0.005). Tumour markers were undertaken in 52 borderline and frankly malignant masses, and were positive in 92.0% (23/25) of germ cell malignancies, 42.8% (3/7) of sex cord stromal tumours, 80% of frankly malignant epithelial tumours (4/5) and 30.8% (4/13) of borderline tumours. The risk models RMI2 and the Papic-method had good discriminatory value in differentiating benign from malignant disease (area under the curve [AUC] 0.83 and 0.84 respectively). However, the PRMI was less discriminatory (AUC 0.62). The RMI2 model with a cut off score of 112 provided the highest predictive odds for malignancy in this population out of all three models (OR 25.3 [95% C.I. 9.0-71.1]). Pre-existing risk of malignancy indices (RMI2) and Papic show good reliability for detection of malignant ovarian disease in young females. [ABSTRACT FROM AUTHOR]

A case of midgut volvulus forty eight hours following laparoscopic cholecystectomy is reported. [ABSTRACT FROM AUTHOR]

School sport is a major cause of injury in the post-primary age group. The importance of primary prevention in sport has been identified; however secondary prevention of school related sport injury has not been described in Ireland. A random sample of 450 schools in Northern Ireland and the Republic of Ireland was studied using a postal questionnaire. Current management of sport injury, with particular interest in the expertise and training of teachers and coaches, was explored. Replies were received from 333 (74%) schools. There was no physical education teacher with up to date first aid training in 37% schools. Immediate care in terms of mechanisms and equipment to deal with injury was available in 35%-81% of schools responding. Correct response ranged from 65%-90% to four scenarios: commonly presenting yet potentially serious management problems. This study demonstrated deficiencies in sport injury care. In addition to concern about current training, a need for basic life support training is highlighted. These findings have implications for the prevention of school sports injuries. [ABSTRACT FROM AUTHOR]

BACKGROUND: Compared with other developed countries, the United Kingdom has exhibited less of an increase in life expectancy over the past 30 years. METHODS: We compared the chronological changes in the age-adjusted mortality rates (AMRs) from all causes or major causes, and in life expectancy in the United Kingdom and Japan between 1970 and 1997. RESULTS: In both 1970 and 1997 the AMRs for most major causes were higher in the United Kingdom than in Japan; the difference in the AMR between countries was smaller in 1970 than in 1997. The difference in the AMR from all causes between the United Kingdom and Japan in 1997 was mainly due to differences in the AMR for heart diseases. The trend for an increasing difference over time between the United Kingdom and Japan in the AMR from all causes was due to the decreased rate of AMR from heart diseases from 1970 to 1997 in the United Kingdom being lower than those from cerebrovascular diseases in same period in Japan. CONCLUSIONS: These data suggest that mortality rates could be reduced by a change in focus of the National Health Service toward an emphasis on primary rather than secondary prevention and associated clinical interventions. The greatest priority should be placed on reducing the incidence of heart disease by aggressively improving primary prevention. [ABSTRACT FROM AUTHOR]