ABSTRACT
OBJECTIVES: National Institute for Health and Clinical Excellence (NICE) guidelines were introduced in the UK to ensure that patients with high-risk symptoms of colorectal cancer were reviewed promptly. We assessed the proportion of patients referred to our department's nurse-led 2-week wait (2WW) clinic with high-risk symptoms or signs that met these guidelines and the rate of colorectal cancer pickup. PATIENTS AND METHODS: Patients were identified from a prospectively maintained logbook of 2WW referrals over a 1-year period (1 January 2008-31 December 2008). Computerized notes were reviewed to obtain the following information: referral symptoms or signs and the proportion of patients diagnosed with colorectal cancer. RESULTS: A total of 720 patients were seen in the 2WW clinic over this period. Only 356/720 (49.4%) met the referral criteria. The overall pickup rate of colorectal cancer was 52/720 (7.2%) and was not found to be significantly higher in patients meeting guidelines compared with those who did not exhibit these features (7.6 vs. 6.9%; P=0.771). Over the 5-year follow-up period, no patients discharged from the 2WW pathway subsequently re-presented with colorectal cancer. CONCLUSION: Over half of the referrals did not meet the NICE criteria, suggesting that the system is being used as a rapid access route to investigation. Despite this, there is no significant difference in the pickup rate of colorectal cancer in patients with or without high-risk features. Nurse-led 2WW clinics with subsequent investigation appear to be effective in both the identification and exclusion of colorectal cancer.
Subject(s)
Colorectal Neoplasms/diagnosis , Early Detection of Cancer , Tertiary Care Centers , Waiting Lists , Adult , Aged , Aged, 80 and over , Barium Sulfate , Colonoscopy , Colorectal Neoplasms/epidemiology , Contrast Media , Early Detection of Cancer/methods , Early Detection of Cancer/standards , England/epidemiology , Female , Guideline Adherence , Humans , Male , Middle Aged , Practice Guidelines as Topic , Practice Patterns, Physicians' , Predictive Value of Tests , Program Evaluation , Referral and Consultation , Retrospective Studies , Risk Assessment , Risk Factors , Sigmoidoscopy , Tertiary Care Centers/standards , Time Factors , Tomography, X-Ray Computed , Young AdultABSTRACT
Vertical dislocation of the patella is rare and usually occurs as a result of blunt trauma. The patella rotates around a vertical axis. It can be diagnosed by its typical clinical features. This article presents a case of 2 patients with vertical dislocation who presented with high-impact injuries and had classic signs of a vertically dislocated patella. Unlike lateral patella dislocation, reduction under sedation is usually not possible. This is mainly due to increased tension within the quadriceps mechanism, which makes reduction difficult. The other factor that makes reduction difficult is that the patella could be wedged in the femoral condyles. Both patients underwent multiple unsuccessful attempts at reduction in the emergency department. These were later successfully reduced under general anesthesia and both patients went on to make an uneventful recovery. Multiple attempts without adequate relaxation could not only cause chondral damage but could also could endanger the extensor mechanism.
