Rupert Suckling - Academia.edu (original) (raw)

Papers by Rupert Suckling

Background Poor UK lung cancer survival rates may, in part, be due to late diagnosis. Objectives ... more Background Poor UK lung cancer survival rates may, in part, be due to late diagnosis. Objectives To evaluate the effectiveness of a mixed-method community-based social marketing intervention on lung cancer diagnoses. Methods A public awareness campaign in conjunction with brief intervention training in general practices was piloted in six localities with a high lung cancer incidence. End points were self-reported awareness of lung cancer symptoms; intention to seek healthcare; chest x-ray referral rates in primary care; secular trends in the incidence of lung cancer and stage at diagnosis, compared before and after the intervention. Results 21 % (128/600) (95 % CI 18 % to 25%) of the targeted population recalled something about the campaign. Compared with a responder in the control area, the odds of a responder in the intervention area saying that they would visit their general practitioner and request a chest x-ray for a cough was 1.97 times (95 % CI 1.18 to 3.31, p0.01). Primary c...

Health Services Management Research, 2004

Health Improvement Programmes (HImPs) are a means of documenting the health needs of a population... more Health Improvement Programmes (HImPs) are a means of documenting the health needs of a population and are intended to be translated into commissioning decisions by the Strategic and Financial Framework (SaFF). This paper examines some major influences on the process of translating the HImP into the SaFF. The Directors of Public Health in two Health Authorities were concerned that the development of the SaFF did not always represent a clear progression from the HImP. An audit to pinpoint where commissioning decisions did not match the identified health improvement needs in two Health Authorities was carried out between November 2000 and February 2001. The overall findings confirmed that needs identified in the HImPs were not fully reflected in the service provision described in the final SaFFs. The audit provided evidence that was useful in identifying major issues and influences that facilitated or hindered the development of the SaFF from the HImP. Some of the ways in which HImP priorities disappeared from the SaFF and non-HImP priorities appeared in it were also distinguished. The conclusion is that a clear, criterion-based process should enable health and social care communities and Primary Care Trusts to develop a more responsible commissioning process in future, and specific recommendations to that effect are made.

Evidence & Policy: A Journal of Research, Debate and Practice, 2008

ABSTRACT Early intervention is part of policy concerning educational, health and social inequalit... more ABSTRACT Early intervention is part of policy concerning educational, health and social inequalities but whether programmes reach those for whom they are intended is under-researched. This article reports on a case study of one programme within the national Sure Start initiative in England, 1999-2005. Reach was conceptualised as having two aspects: contact and use. It was found that, conceptualised as contact, programme reach was virtually 100%. Conceptualised as use, it varied according to services within the programme and to some extent according to family characteristics. The relatively more disadvantaged families were reached almost as much as other families. Implications for practice and policy are discussed.

British Journal of Clinical Psychology, 2009

Behaviour Research and Therapy, 2009

Recently the UK Government announced an unprecedented, large-scale initiative for Improving Acces... more Recently the UK Government announced an unprecedented, large-scale initiative for Improving Access to Psychological Therapies (IAPT) for depression and anxiety disorders. Prior to this development, the Department of Health established two pilot projects that aimed to collect valuable information to inform the national roll-out. Doncaster and Newham received additional funds to rapidly increase the availability of CBT-related interventions and to deploy them in new clinical services, operating on stepped-care principles, when appropriate. This article reports an evaluation of the new services (termed 'demonstration sites') during their first thirteen months of operation. A session-by-session outcome monitoring system achieved unusually high levels of pre to post-treatment data completeness. Large numbers of patients were treated, with low-intensity interventions (such as guided self-help) being particularly helpful for achieving high throughput. Clinical outcomes were broadly in line with expectation. 55-56% of patients who had attended at least twice (including the assessment interview) were classified as recovered when they left the services and 5% had improved their employment status. Treatment gains were largely maintained at 10 month follow-up. Opening the services to self-referral appeared to facilitate access for some groups that tend to be underrepresented in general practice referrals. Outcomes were comparable for the different ethnic groups who access the services. Issues for the further development of IAPT are discussed.

E ARE GRATEFUL to both the editor and the commentators for the opportunity to test the temperatur... more E ARE GRATEFUL to both the editor and the commentators for the opportunity to test the temperature of the reception to the Doncaster model. Not surprisingly, that temperature varies from warm, through tepid to icy cold. Before responding to specific themes raised by commentators we would like to acknowledge Peter Bower (personal communication, 2007) for reminding us that im proving mental health services, particularly in primary care, has five dimensions. Firstly, we must improve access such that service provision should meet the need for services in every community independent of geographic location. Secondly, that such services should effectively improve people’s lives in terms of health status, function and quality of life. Thirdly, we must distribute resources efficiently to maximise health gains to society. Fourthly, resources should be distributed equitably across the population independent of culture, creed, class or other social identifier. Finally, what we deliver should be...

Scottish medical journal, 1995

Between 25 and 50% of all term newborns develop clinical jaundice, and a serum bilirubin level ab... more Between 25 and 50% of all term newborns develop clinical jaundice, and a serum bilirubin level above 260 microml/l (15 mg/dl) is found in 3% of normal term infants. In the United Kingdom many newborn infants with clinical jaundice have blood samples sent to biochemistry laboratories for assessment of the plasma bilirubin concentration. We planned to assess the cost in terms of finance, medical staff time, numbers of blood samples, and family delay in leaving hospital. We demonstrated that reflectance bilirubinometry is a reliable screening method for identifying which caucasian infants require to have plasma bilirubin concentrations measured in the laboratory. The Minolta Airshields transcutaneous bilirubinometer provided reproducible data, saved time and costs, and often spared infants a capillary or venous blood sample. The transcutaneous bilirubinometer provides a digital assessment of skin pigmentation by xenon reflectance. It has previously been shown to be possible to derive a...

GIS in Public Health Practice, 2004

BMJ, 2000

This new form of treatment might benefit millions Editor-Fano has written a response in the eBMJ ... more This new form of treatment might benefit millions Editor-Fano has written a response in the eBMJ (and published here, the third letter) commenting on Vanderpool's article on xenotransplantation. 1 2 He advocates a ban on xenotransplantation, largely on the grounds of the risk of the transfer of infection. Cells taken from carefully screened pigs have been used in the treatment of patients with diabetes, certain neurological diseases, and liver failure. There has been no definite evidence of the transfer of a porcine infection to human recipients. Nevertheless, as with almost every medical or scientific advance, it will be impossible to exclude all risk, even if this is related only to hitherto unknown pig bacteria or viruses. The ultimate decision whether to use any new therapeutic agent or procedure rests on an assessment of the risk to benefit ratio. As the potential benefits to individuals or society increase, the acceptance of slightly increased risk becomes warranted. We must not reduce our obligation to take all possible steps to minimise any perceived risk to society, but we have a moral obligation to accept a small risk to the community if the new treatment leads to great benefit to many individuals in that community. The potential benefits of xenotransplantation are immense. Many millions of people with such diverse conditions as diabetes and degenerative brain disease may have the quality of their lives vastly improved, and in those with advanced organ failure xenotransplantation will be lifesaving. In the United States over 60 000 people currently await a human donor organ but only 20 000 organs will become available this year. At least 10 people die every day while waiting. Similar figures could be quoted for other regions of the developed world. This new form of treatment may ultimately benefit millions of patients. Rather than calling for a ban on it we suggest that support should be given to the great efforts being made to ensure that it will be not only successful but also safe.

Lung Cancer, 2009

To study the prevalence of detected brain metastases within 12 months of patients having Surgery ... more To study the prevalence of detected brain metastases within 12 months of patients having Surgery for NSCLC at our institution, to evaluate the effectiveness of our staging investigations. Materials and Methods: This is a retrospective study. All patients entered on the local lung cancer database having had surgery for NSCLC in 2006 and 2007 were evaluated. The Radiology Information system was checked and all patients with cerebral metastases were captured. A review of their pre operative staging investigations, pre and surgical operative stage and details of adjuvant treatment was noted. Local guidelines (modified NICE) of patients to be scanned for occult metastases are: Stage I, II and IIIA (T3,N1) not routinely imaged unless clinical symptoms and signs. Stage IIIA (T1 3,N2 and T4,N0 1) being considered for multi modality treatment should have contrast enhanced MRI and CT-PET. Results: 7/150 patients included in the study. The prevalence of patients with image detected brain metastases is 4.66 % within 12 months of the operation. 85.34% (128/150) patients survived to 12 months. 3/7 patients = 43% had pre-operative staging of IIB (CT-PET). 1/7 had staging IA = 14.2% (No PET). 1/7 (14.2%) had suspicious lesion in the parotid (Stage IV) negative on FNA. The decision was made therefore to proceed with surgery. He was found to be unresectable on table. 1/7 (14.2%) had indeterminate CT-PET, confirmed malignant on pathology. 1/7 (14.2%) Had preoperative stage of IIIB. Conclusions: The rationale for not routinely imaging patients with NSCLC is based on cost effectiveness. The present protocol gives an acceptable rate but this could be improved. Further work is required to evaluate whether the new IASCL staging system should modify this staging guideline to include all stage IIIA disease (including T3, N1 disease).

Lung Cancer, 2011

We retrospectively analysed a prospectively captured database on all patients assessed and treate... more We retrospectively analysed a prospectively captured database on all patients assessed and treated for presumed lung cancer in our unit. Data was reviewed for patients who underwent lung cancer surgery with curative intent between January 2006 and August 2010. Pre-operative clinical staging was compared with histological findings after lung resection and lymph node dissection. Results: A total of 312 pathologically confirmed lung cancer resections were performed (Mean age 68 y (range 42 86), Male:Female ratio 1.14:1). Table 1: Despite thorough pre-operative evaluation, 26.3% of patients had change in nodal status. 13.7% of T1N0M0 patients were upstaged, compared to 27.6% with T2N0M0 disease. Occult N2 disease was detected in 9.9% of patients, of which 24/37 (65%) were small or micrometastatic deposits. Conclusion: Despite optimal systematic pre-operative staging there remains a relatively high rate of stage migration. When considering treatments for early stage lung cancer the impact of this discrepancy should be considered to avoid errors in prognosis and determining candidates suitable for adjuvant treatment. 40 Improved resection rates following a campaign to raise awareness of cough as an early lung cancer symptom

Journal of Public Health, 2003

Background The continuing identification, assessment and management of risks are key themes for c... more Background The continuing identification, assessment and management of risks are key themes for clinical governance. These themes are being integrated into both primary and secondary care practice; however, integration into public health practice appears much slower. This paper describes the recent approach that we have taken in Sheffield, and proposes a model for public health departments to identify, assess and manage risks, which complements other risk management processes and is transferable to other settings. It assumes that public health practice is not a risk-free activity and holds that the process of identifying, assessing and managing risks is a key component to raising standards. Methods A number of risk 'management' models were reviewed and a primary care approach was applied to public health practice. A list of potential risks was identified using a number of methods including reflective practice, information from complaints and/or critical incidents. Risks were assessed by likelihood and impact, and were captured in a risk framework. Results By March 2002, 21 risks had been identified and characterized, and progress had been made to manage 11 of these risks. Conclusion This process, and the development of a risk framework, was useful in identifying a prioritized work programme to improve standards of public health practice in this department. This model can also be used not only for planning risk management activities, continual identification and assessment of risks but also to provide inspiration for other clinical governance activities including public health audit.

European Oncology & Haematology, 2010

Lung cancer is a major global health burden with high incidence rates but poor long-term survival... more Lung cancer is a major global health burden with high incidence rates but poor long-term survival. Currently, the majority of cases are diagnosed at an advanced stage when surgical resection is not feasible. Screening for lung cancer has been a major focus of research for the last 40 years. Despite this, there is still a lack of evidence to promote its use outside clinical trials. More recently, interest has focused on promoting earlier recognition of symptomatic disease among both the general public and primary care physicians in order to encourage more timely investigation and referral to secondary care. The hope is that this approach may increase the proportion of disease identified in the early stages, allowing more surgical resections and improved five-year survival rates. This article provides an overview of the current evidence base in terms of early diagnosis of lung cancer and provides some examples of innovations to promote this.