Cozens N J A
Derbyshire Royal Infirmary, Derby Acute Hospitals NHS Foundation Trust, Derby, UK.
Clin Otolaryngol. 2009 Feb;34(1):6-11. doi: 10.1111/j.1749-4486.2008.01817.x.
The National Institute of Clinical Excellence guidance on cancer services produced the Improving Outcomes in Head and Neck Cancers in 2004. One of the seven 'key recommendations' is the stipulation that 'diagnostic clinics should be established for patients with neck lumps'.
The objective of this review was to examine the basis on which the Improving Outcomes Guidance (IOG) makes its specific recommendation for the establishment of neck lump clinics.
This review analyses the original explicit questions asked by the NICE review team, cross references the guidance and evidence documents to examine the strength of the supporting evidence.
'One stop clinic' and 'neck lump' were used as search terms, from 1996 to 2008 to include relevant papers, whether cited by IOG or not.
Original articles of all potentially relevant papers were obtained and analysed with respect to the IOG key recommendation above.
Evaluation of both IOG cited and additional evidence does not corroborate the specific key recommendation that one-stop neck lump clinics staffed by a surgeon and pathologist must be established in all Cancer networks.
Overall, the specific NICE IOG guidance does not have the weight of objective evidence to justify such a categorical and specific recommendation. Alternative models of provision of diagnostic clinics may offer equally or more effective patient care than their stipulated 'one-stop' surgeon and pathologist model.
英国国家临床优化研究所（National Institute of Clinical Excellence）发布的癌症服务指南于2004年制定了《改善头颈癌治疗效果》。七项“关键建议”之一是规定“应为颈部肿块患者设立诊断诊所”。
本综述的目的是研究《改善治疗效果指南》（Improving Outcomes Guidance，IOG）做出设立颈部肿块诊所这一具体建议的依据。
本综述分析了英国国家卫生与临床优化研究所（NICE）综述团队最初提出的明确问题，交叉引用指南和证据文件以审查支持证据的力度。
使用“一站式诊所”和“颈部肿块”作为检索词，检索1996年至2008年的相关论文，无论是否被IOG引用。
获取所有潜在相关论文的原始文章，并根据上述IOG关键建议进行分析。
对IOG引用的证据和其他证据的评估均未证实必须在所有癌症网络中设立由外科医生和病理学家配备的一站式颈部肿块诊所这一具体关键建议。
总体而言，NICE的IOG具体指南没有客观证据的支持来证明这样一个绝对和具体的建议是合理的。提供诊断诊所的替代模式可能比规定的“一站式”外科医生和病理学家模式提供同等或更有效的患者护理。
