This paper describes the design, implementation and testing of a functional prototype interface which enables primary healthcare teams to access the information system supporting clinical oncology specialists in South Wales, UK. A lack of information sharing has been recognized for some time as a barrier to improving the primary care of cancer patients. This extension to the existing ISCO information system will allow sharing of information about patient management at all levels of cancer patient support (general practitioners, hospital-based clinicians and palliative care teams). The application was designed to allow general practitioners to gain access to the existing system. This will give all healthcare professionals interested in a cancer patient's care the advantage of accessing detailed multiple providers' electronic casenotes in almost real time, thus improving communication of information within a care team. However, no attempt was made to include the much bigger issue of patients and their families or carers in the scope of the project at this stage, as this is an area requiring separate investigation. The pilot also enables general practitioners to determine the information they require and the information they need to be able to communicate with the cancer specialists.

Luminol-enhanced chemiluminescence (CL) was used to examine the response of various leukocyte populations following stimulation with a crude extract of Phaseolus vulgaris, namely phytohaemagglutinin (PHA-C). Populations stimulated included a human peripheral mixed leukocyte preparation (MLP), and purified preparations of lymphocytes, monocytes and polymorphonuclear leukocytes (PMNL). Mouse peritoneal exudate cells and the lymphocytic cells lines Molt #4 and Daudi were also stimulated. Following stimulation, a characteristic three-peaked chemiluminescent response was obtained from the MLP population. Little or no response was obtained from the purified lymphocytes. Monocytes produced a sharp peak corresponding to the second peak of the MLP response and PMNL produced a broad peak corresponding to the third peak of the MLP response. Mouse peritoneal exudate cells containing lymphocytes and monocytes/macrophages showed a two-peaked stimulation which corresponded to the first two peaks of the MLP response. Molt #4 and Daudi showed no chemiluminescence if stimulated individually, but if added to a MLP substantial enhancement of the first and second peaks was observed. These results indicate some form of lymphocyte/monocyte interaction leading to enhanced CL following PHA-C stimulation.

The vision of evidence-based medicine is that of experienced clinicians systematically using the best research evidence to meet the individual patient's needs. This vision remains distant from clinical reality, as no complete methodology exists to apply objective, population-based research evidence to the needs of an individual real-world patient. We describe an approach, based on techniques from machine learning, to bridge this gap between evidence and individual patients in oncology. We examine existing proposals for tackling this gap and the relative benefits and challenges of our proposed, k-nearest-neighbour-based, approach.