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Glioblastoma: clinical presentation, diagnosis, and management
Disease progression is expected in all cases and consideration of further treatment should take into account the patient’s performance status, tumour size, tumour location, and time since first treatment. Because of the incurable and rapidly progressive nature of glioblastoma, close collaboration between multidisciplinary teams in tertiary care hospitals and primary care services is recommended. Approximately half of patients are diagnosed after an emergency hospital presentation.14 Most will have attended their GP with symptoms before diagnosis, often on multiple occasions.1516 Despite this, only 2% of patients in England are currently diagnosed via the “suspected cancer” pathway, which provides GPs with direct access to magnetic resonance imaging (MRI) brain scans within two weeks.1416 This reflects the significant challenge of identifying suspected cases of brain tumours in primary care, where early symptoms often overlap with common benign conditions. Adapted from Ozawa et al 18 Seizures are a presenting symptom in approximately 20% of patients with glioblastoma, and an additional 20% develop seizures later in the disease.1123 Although a less common presentation in primary care, new onset seizure in adulthood has the greatest positive predictive value (PPV) of all individual symptoms (1.6%), followed by motor weakness (1.5%), and confusion (1.4%).18 Various other presenting symptoms have been linked to brain tumours (fig 1), but each has a PPV of <1%.18 Combinations of symptoms, especially if progressive in nature, significantly increase the likelihood of an intracranial tumour being identified on MRI.2425 What to cover on initial assessment? A collateral history from family members, friends, or work colleagues can be informative since patients are often unaware of subtle changes in their personality or behaviour over time.26 A recent qualitative study of patient experiences of brain tumour diagnosis found that most patients and family members had noticed multiple mild symptoms or “changes” (for example, “My head felt fuzzy,” “You weren’t quite yourself”) at least six months before their initial presentation.16 It is therefore important to review recent consultation records and empower patients who are not referred to keep a symptom diary and return if they feel something is still wrong.1618 For patients presenting with headache, inquire about high risk clinical features which raise suspicion of a possible brain tumour (box 1).
Journal Article
Soccer for dummies
Learn the basics, improve your game knowledge, and reach your soccer playing goals. This guide gives you the history, stats, and rules of this popular sport.
Book
Interactive data visualization for the web : an introduction to designing with D3
Author Scott Murray teaches you the fundamental concepts and methods of D3, a JavaScript library that lets you express data visually in a web browser.
Book
Palliative care from diagnosis to death
Evidence is growing that people can benefit from palliative care earlier in their illness, say Scott Murray and colleagues, but care must be tailored to different conditions
Journal Article
Report of the Lancet Commission on the Value of Death: bringing death back into life
Climate change, the COVID-19 pandemic, environmental destruction, and attitudes to death in high-income countries have similar roots—our delusion that we are in control of, and not part of, nature. Palliative care can provide better outcomes for patients and carers at the end of life, leading to improved quality of life, often at a lower cost, but attempts to influence mainstream health-care services have had limited success and palliative care broadly remains a service-based response to this social concern. Income, education, gender, race, ethnicity, sexual orientation, and other factors influence how much people suffer in death systems and the capacity they possess to change them. The five principles are: the social determinants of death, dying, and grieving are tackled; dying is understood to be a relational and spiritual process rather than simply a physiological event; networks of care lead support for people dying, caring, and grieving; conversations and stories about everyday death, dying, and grief become common; and death is recognised as having value. The five principles are: the social determinants of death, dying, and grieving are tackled; dying is understood to be a relational and spiritual process rather than simply a physiological event; networks of care lead support for people dying, caring, and grieving; conversations and stories about everyday death, dying, and grief become common; and death is recognised as having value.
Journal Article
استخدام نتائج التقييم الوطني للتحصيل التعليمي
يتناول كتاب (استخدام نتائج التقييم الوطني للتحصيل التعليمي) والذي قام بتأليفه (توماس كليغان، فينسنت غريني، ت. سكوت موري) في حوالي (163) صفحة من القطع المتوسط المحتويات التالية : الفصل الأول : العوامل المؤثرة على استخدام وعدم استخدام نتائج التقييم الوطني، الفصل الثاني : الإبلاغ عن التقييم الوطني : التقرير الرئيسي، الفصل الثالث : الإبلاغ عن التقييم الوطني : أدوات أخرى لإبلاغ نتائج التقييم ... إلخ.
Book
Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixed-methods study
To refine and evaluate a practical, clinical tool to help multidisciplinary teams in the UK and internationally, to identify patients at risk of deteriorating and dying in all care settings.
We used a participatory research approach to refine the 2010 Supportive and Palliative Care Indicators Tool (SPICT) and evaluate its use in clinical practice. We conducted an ongoing peer review process for 18 months via an open access webpage, and engaged over 30 clinicians from the UK and internationally in developing an effective tool. Secondly, we carried out a prospective case-finding study in an acute hospital in SE Scotland. Four multidisciplinary teams identified 130 patients with advanced kidney, liver, cardiac or lung disease following an unplanned hospital admission.
The SPICT was refined and updated to consist of readily identifiable, general indicators relevant to patients with any advanced illness, and disease-specific indicators for common advanced conditions. Hospital clinicians used the SPICT to identify patients at risk of deteriorating and dying. Patients who died had significantly more unplanned admissions, persistent symptoms and increased care needs. By 12 months, 62 (48%) of the identified patients had died. 69% of them died in hospital, having spent 22% of their last 6 months there.
The SPICT can support clinical judgment by multidisciplinary teams when identifying patients at risk of deteriorating and dying. It helped identify patients with multiple unmet needs who would benefit from earlier, holistic needs assessment, a review of care goals, and anticipatory care planning.
Journal Article