Publications by authors named "Meena Rafiq"
Background: Presenting to primary care with fatigue is associated with a wide range of conditions, including cancer, although their relative likelihood is unknown.
Aim: To quantify associations between new-onset fatigue presentation and subsequent diagnosis of various diseases, including cancer.
Design And Setting: A cohort study of patients presenting in English primary care with new-onset fatigue during 2007-2017 (the fatigue group) compared with patients who presented without fatigue (the non-fatigue group), using Clinical Practice Research Datalink data linked to hospital episodes and national cancer registration data.
Article Synopsis
- The study examines discrepancies in cancer case status and diagnosis dates between cancer registry (CR) data and electronic health records (EHRs) for five types of cancer over a period from 1999 to 2018.
- Among the findings, agreement in cancer diagnoses varied significantly between datasets, with combined CPRD-HES data confirming 84% to 92% of diagnoses compared to CR, but lower rates for individual data sources like HES and CPRD.
- The research concludes that while combined primary and secondary care data may often reflect case status accurately, inconsistencies in diagnosis dates could affect cancer risk estimates and diagnostic pathways in studies.
Introduction: Use of investigations can help support the diagnostic process of patients with cancer in primary care, but the size of variation between patient group and between practices is unclear.
Methods: We analysed data on 53 252 patients from 1868 general practices included in the National Cancer Diagnosis Audit 2018 using a sequence of logistic regression models to quantify and explain practice-level variation in investigation use, accounting for patient-level case-mix and practice characteristics. Four types of investigations were considered: any investigation, blood tests, imaging and endoscopy.
The platelet count, a component of the full blood count, has been identified as a useful diagnostic marker for cancer in primary care. The reference range for the platelet count is 150 to 400 or 450 × 10/L; this range does not account for natural variation in platelet count by age and sex. This study used three primary care cohorts from England, Canada, and Australia.
View Article and Find Full Text PDFObjectives: To investigate the role of comorbid chronic obstructive pulmonary disease (COPD) and symptom type on general practitioners' (GP's) symptom attribution and clinical decision-making in relation to lung cancer diagnosis.
Design: Vignette survey with a 2×2 mixed factorial design.
Setting: A nationwide online survey exploring clinical decision-making in primary care.
Background: Presenting to primary care with fatigue is associated with a wide range of conditions, including cancer, although their relative likelihood is unknown.
Aim: To quantify associations between new-onset fatigue presentation and subsequent diagnosis of various diseases, including cancer.
Design And Setting: A cohort study of patients presenting in English primary care with new-onset fatigue during 2007-2017 (the fatigue group) compared with patients who presented without fatigue (the non-fatigue group), using Clinical Practice Research Datalink data linked to hospital episodes and national cancer registration data.
Background: Identifying patients presenting with nonspecific abdominal symptoms who have underlying cancer is a challenge. Common blood tests are widely used to investigate these symptoms in primary care, but their predictive value for detecting cancer in this context is unknown. We quantify the predictive value of 19 abnormal blood test results for detecting underlying cancer in patients presenting with 2 nonspecific abdominal symptoms.
View Article and Find Full Text PDFArticle Synopsis
- Abnormal blood test results can be detected months before a lung cancer (LC) or colorectal cancer (CRC) diagnosis, indicating the potential for earlier detection in patients.
- A study analyzed data from 855 LC and 399 CRC patients, revealing that requests and abnormal results for common blood tests increased up to seven months before diagnosis.
- Findings suggest that recognizing specific blood test abnormalities could assist general practitioners in prioritizing patients for timely cancer investigations.
Background: Increased time to diagnosis in sarcoma is associated with poor prognosis and patient outcomes. Research is needed to identify whether opportunities to expedite the diagnosis of sarcoma in general practice exist.
Aim: To examine pre-diagnostic GP clinical activity before sarcoma diagnosis.
Background: Guidelines recommend urgent chest X-ray for newly presenting dyspnoea or haemoptysis but there is little evidence about their implementation.
Methods: We analysed linked primary care and hospital imaging data for patients aged 30+ years newly presenting with dyspnoea or haemoptysis in primary care during April 2012 to March 2017. We examined guideline-concordant management, defined as General Practitioner-ordered chest X-ray/CT carried out within 2 weeks of symptomatic presentation, and variation by sociodemographic characteristic and relevant medical history using logistic regression.
Article Synopsis
- The study investigates how often patients with undiagnosed lung cancer (LC) who presented with dyspnoea (shortness of breath) were prescribed relevant medications in the year before their diagnosis, using data from the UK.
- Over 63% of the 5434 patients analyzed received one or more prescriptions, with inhaled medications most common in those with pre-existing chronic obstructive pulmonary disease (COPD), while antibiotics were more frequently prescribed to COPD-free and new-onset COPD patients.
- The findings suggest that there is a significant window of opportunity for earlier lung cancer diagnosis, as medication prescribing rates increased notably in the months leading up to diagnosis, especially for patients with pre-existing COPD.*
Objectives: Type 2 diabetes is associated with a higher risk of colorectal cancer (CRC) and advanced-stage cancer diagnosis. To help diagnose cancer earlier, this study aimed at examining whether diabetes might influence patient symptom attribution, help-seeking, and willingness to undergo investigations for possible CRC symptoms.
Methods: A total of 1307 adults (340 with and 967 without diabetes) completed an online vignette survey.
Background: Steroid use is associated with increased risk of Hodgkin lymphoma (HL). However, allergic symptoms commonly treated with steroids are also presenting features of HL in some patients, thereby introducing protopathic bias in estimates of aetiological associations. It is therefore important to examine steroid prescribing patterns pre-diagnosis to understand timing of associations and when healthcare use increases before cancer diagnosis to inform future epidemiological study design.
View Article and Find Full Text PDFBackground: Proinflammatory conditions are associated with increased risk of Hodgkin lymphoma, although the neoplastic process often induces an inflammatory response.
Aim: To examine pre-diagnostic inflammatory marker test use to identify changes that may define a 'diagnostic window' for potential earlier diagnosis.
Design And Setting: This was a matched case-control study in UK primary care using Clinical Practice Research Datalink data (2002-2016).
Background: The impact on primary care workload of case-management interventions to reduce emergency department (ED) attendances is unknown.
Aim: To examine the impact of a telephone-based case-management intervention targeting people with high ED attendance on primary care use.
Design And Setting: A single-site data extract from a larger randomised control trial, using the patient-level data from primary care electronic health records (2015-2020), was undertaken.
Background: The management of adults presenting with fatigue presents a diagnostic challenge, particularly regarding possible underlying cancer.
Methods: Using electronic health records, we examined cancer risk in patients presenting to primary care with new-onset fatigue in England during 2007-2013, compared to general population estimates. We examined variation by age, sex, deprivation, and time following presentation.
Background: It has been proposed that changes in healthcare use before cancer diagnosis could signal opportunities for quicker detection, but systematic appreciation of such evidence is lacking. We reviewed studies examining pre-diagnostic changes in healthcare utilisation (e.g.
View Article and Find Full Text PDFBackground: The diagnostic assessment of abdominal symptoms in primary care presents a challenge. Evidence is needed about the positive predictive values (PPVs) of abdominal symptoms for different cancers and inflammatory bowel disease (IBD).
Methods And Findings: Using data from The Health Improvement Network (THIN) in the United Kingdom (2000-2017), we estimated the PPVs for diagnosis of (i) cancer (overall and for different cancer sites); (ii) IBD; and (iii) either cancer or IBD in the year post-consultation with each of 6 abdominal symptoms: dysphagia (n = 86,193 patients), abdominal bloating/distension (n = 100,856), change in bowel habit (n = 106,715), rectal bleeding (n = 235,094), dyspepsia (n = 517,326), and abdominal pain (n = 890,490).
General Practice in the Time of COVID-19: A Mixed-Methods Service Evaluation of a Primary Care COVID-19 Service.
Int J Environ Res Public Health
March 2021
Primary care coronavirus disease 2019 (COVID-19) clinics were rapidly introduced across the UK to review potentially infectious patients. Evaluation of these services is needed to guide future implementation. This mixed-methods study evaluates patient demographics, clinical presentation, co-morbidities, service usage, and outcomes for the Islington COVID-19 service (London, UK) and from April to May 2020 and thematically analyses survey responses from 29 service clinicians and 41 GP referrers on their service experience.
View Article and Find Full Text PDFBackground: Immunodeficiency syndromes (acquired/congenital/iatrogenic) are known to increase Hodgkin lymphoma (HL) risk, but the effects of allergic immune dysregulation and corticosteroids are poorly understood.
Objective: We sought to assess the risk of HL associated with allergic disease (asthma, eczema, and allergic rhinitis) and corticosteroid use.
Methods: We conducted a case-control study using the United Kingdom Clinical Practice Research Datalink (CPRD) linked to hospital data.
Background: In primary care there is uncertainty about which patients with acute exacerbations of COPD (AECOPD) benefit from antibiotics.
Objectives: To identify which types of COPD patients get the most antibiotics in primary care to support targeted antibiotic stewardship.
Methods: Observational study of COPD patients using a large English primary care database with 12 month follow-up.
Objectives: Hodgkin's lymphoma (HL) is the the most common cancer in teenagers and young adults. This nationwide study conducted over a 25-year period in the UK investigates variation in HL incidence by age, sex, region and deprivation to identify trends and high-risk populations for HL development.
Design: Population-based cohort study.
Objective: To identify risk factors for falls and generate two screening tools: an opportunistic tool for use in consultation to flag at risk patients and a systematic database screening tool for comprehensive falls assessment of the practice population.
Study Design And Setting: This multicenter cohort study was part of the quality improvement in chronic kidney disease trial. Routine data for participants aged 65 years and above were collected from 127 general practice (GP) databases across the UK, including sociodemographic, physical, diagnostic, pharmaceutical, lifestyle factors, and records of falls or fractures over 5 years.