Thrombocytosis helps to stratify risk of colorectal cancer in patients referred on a 2-week-wait pathway.

PURPOSE: Primary care studies suggest that thrombocytosis (platelet counts > 400 × 109/L) is associated with an increased risk of colorectal cancer (CRC). We aimed to establish whether this marker has significant stratification value in patients seen in secondary care. METHODS: A retrospective review of 2991 patients referred to our colorectal 2-week-wait (2WW) pathway between August 2014 and August 2017. Patient demographics were recorded prospectively, and local electronic records systems were used to retrieve full blood counts (FBC) and cancer diagnoses. Patients with no recent platelet count at the time of referral or incomplete records were excluded. RESULTS: 2236 patients were included in this evaluation. There was no significant difference in the age distribution of those with thrombocytosis and those without. There were significantly more females in the thrombocytosis group (72.1% vs 53.9%, chi-squared 24.63, p < 0.0001). 130 CRCs were detected (5.8%) and patients with thrombocytosis were more likely to have CRC (OR 2.62, 95% CI 1.60-4.30). The CRC diagnosis rate was significantly higher in females with thrombocytosis (10.3% vs 2.9%, chi-squared 19.41, p < 0.0001) and males with thrombocytosis (16.1% vs 7.9%, chi-squared 4.62, p = 0.032). CONCLUSION: Thrombocytosis appears to have stratification value in the 2WW population. Further evaluation of its value alone or in combination with other stratification tests is required.

What are the significant factors associated with burnout in doctors?

BACKGROUND: Burnout syndrome is well established as a condition that affects a significant proportion of practising doctors. Although much literature exists on the prevalence of burnout, only specific variables associated with this condition have been analysed. AIMS: To identify and categorize key factors that are associated with burnout across various medical specialities and geographical locations. METHODS: Three electronic databases were searched for literature on the factors associated with burnout published in the past 5 years. Inclusion and exclusion criteria were applied in three stages. We analysed and critically appraised each paper individually, identifying the common themes. RESULTS: Forty-seven papers were included from the 395 identified by our primary search. Younger age, female sex, negative marital status, long working hours and low reported job satisfaction were found to be predictive of burnout syndrome across the literature. Participation in 'wellness programmes' was related to lower burnout incidence. Causation could not be established however, due to the limited number of longitudinal studies. CONCLUSIONS: More prospective studies are required to assess causation. Despite this, our thematic analysis revealed consistent findings across many papers. This information can be used to inform prevention and interventions to tackle burnout. The associated factors should not be addressed individually, as they are inter-related.