Recognising testicular cancer: new guidance for GPs

Shephard and Hamilton from the University of Exeter analysed nearly 1400 cases of testicular cancer and found that the presence of a testicular lump or swelling had a risk estimate for cancer of more than 2%, and this increased to 10% when the lump was associated with testicular pain. Testicular pain associated with groin pain or blood tests showing inflammation had a PPV for cancer above the NICE 3% threshold for urgent referral. Results support current UK recommendations and provide additional information about the symptoms or symptom combinations that warrant further investigation. They also identify possible sources of delay in diagnosis, such as misdiagnosing cancer as a hydrocele, or considering a painful testicular mass to be low risk. Contrary to traditional medical teaching, painful testicular enlargement may signify cancer.

After Gosport

When Bishop James Jones stood in Portsmouth Cathedral before the relatives and friends of the many patients who had died in Gosport War Memorial Hospital, he said "You were right". His inquiry had confirmed another episode of egregious behaviour by a medical practitioner. Just as the exact scale of the destruction is unknown, so the ramifications for the provision of palliative and terminal care will only become clear with the passage of time. Lucy Pocock and colleagues from the University of Bristol explore these deeply worrying issues in their editorial, published online ahead of print in the BJGP.

GP relationships matter most to patients

Using data from the GP Patient Survey, Cowling from London School of Hygiene and Tropical Medicine and colleagues at Imperial College London, analysed responses of 2.9 million patients from over 8000 practices in the UK. Overall experience was most strongly associated with the interpersonal quality of care provided by GPs. Experiences of making appointments and satisfaction with opening hours were only modestly associated with overall experience, suggesting that policymakers should not expect large improvements in overall experiences with short-term improvements in these areas. The researchers also suggest that while new technologies, such as e- and video-consultations, might improve access, they may also have the unintended consequence of reducing the quality of the important GP–patient interaction.

Why patients don't take their statins

Adherence to statin treatment is no more than 50-75%. Ju and colleagues from Sydney, Australia analysed the findings of 32 studies, involving 888 people in 8 countries, to understand why patients may be reluctant to take these drugs. Barriers to accepting and taking statins include: side effects, lack of perceptible symptoms, the 'sick identity', fear of causing additional bodily harm, costs, and concerns about long-term dependence. Some also questioned the motives of clinicians in prescribing them. Dealing with patients’ concerns and priorities by explaining reasons for prescribing statins and risks involved, informing possible ways to manage side effects, and helping to make medication taking more routine may improve patient satisfaction and continuation of statins, and may lead to better outcomes in the prevention of cardiovascular disease.