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In addition, five patients admitted by OOH, one admitted by the hospital at home service, eight patients who presented to the ED and four patients whose source of emergency referral was unclear had short illness timescales in general practice. There were a further eight cases for which we could not discern any primary care contact in the year before EP, and two for which no information on presenting timescale was provided. This leaves 65 patients (29. 3 Adidas Gazelle Og Uk

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In a further 29 cases (13. 1 the practice had been involved in the care of the patient in the year before diagnosis. In only eight cases (3. 6 could it be established that there had been no input from primary care in the year before diagnosis, and there were an additional two cases (0. 9 for which we were unable to determine whether there had been primary care input. As a result, the extent of direct practice involvement in the emergency admission process may be underestimated. Understanding primary care inputThe time interval between initial presentation with a (related) symptom and emergency admission or ED referral was identifiable in almost all of the case accounts. Analysis of the SEA reports has established that 51 of the 222 cases (23. 0 had a one off or short Buy Adidas Gazelle Og Online history of contact with the practice, and had the EP arranged by their GP within 2 weeks of the initial consultation.

´╗┐ed with symptoms related to the metastases rather than to the primary tumour. In addition, a substantial number of patients Adidas Gazelle Mens Trainers Uk

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who had longer contact with the practice before their GP arranged an EP, and 78 cases (35. 1 in which there was input by the practice in the year leading up to the EP, but the source of admission came from elsewhere. In order to better understand the context surrounding EP, the narratives related to these cases have been reviewed in detail to determine whether there may have been Adidas Gazelle White With Black Stripes

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(50. 4 had multiple symptoms at EP, with only a marginal difference in the numbers related to those reported as having advanced disease at presentation and those without (52. 4 and 48. 7 respectively). As was the case with patients whose tumours were identifiable, many of the presenting symptoms for patients with CUP were relatively vague, including abdominal or chest pain and breathlessness. In more than half of the 222 cases (52. 3 the emergency admission was arranged by the patient practice. In an additional 65 cases (29. 3 the practice had been directly involved in managing the episode of illness leading up to the admission, with those patients for the most part subsequently presenting to an emergency department (ED), or being referred there or admitted by other services (including GP out of hours (OOH)).

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an opportunity for the GP to have intervened before the emergency admission and to have initiated a 2WW referral during the patient earlier contact with the practice. Four key themes emerged from analysis of these accounts, relating to complexity of presentation, nature of symptoms, patient factors and system issues. In some cases, multiple explanatory factors were at play, while others involved .

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