Breast cancer recurrence: follow up after treatment for primary breast cancer

Background: Breast cancer will affect one in 12 Australian women in their lifetime. After potentially curative treatment, it is usual for patients to be followed up for many years. However, controversies surround follow up, and its value is uncertain. Aim: This study reviews the evidence and describes the role of routine follow up in the management of breast cancer in a tertiary hospital. By establishing how recurrence of breast cancer presents and identifying the proportion of patients with recurrence who were diagnosed as a consequence of regular follow up, the value of this system in detecting recurrence can be indirectly assessed. Design: A retrospective review was undertaken of all patients attending the radiotherapy outpatient clinic for treatment of invasive breast cancer in 1997. Hospital records were reviewed to ascertain patient and tumour characteristics, treatment received, site of recurrence and its mode of detection, whether patients were symptomatic at the time of recurrence, and whether they presented at a scheduled appointment. Results: Out of 286 patients who presented to the radiotherapy outpatient clinic, 220 were entered into the study. Recurrence was recorded in 42 patients (a complete dataset was available for 38 of these patients). In total, 74% (31/42) of recurrences were symptomatic, and 76% (32/42) presented at unscheduled appointments, the majority (17/32) of which were initiated by the patient. Only seven patients had asymptomatic recurrences. Conclusion: Based on current evidence, long term routine hospital follow up after treatment for breast cancer appears to be inefficient in detecting recurrence

Patients with dementia and their carers in general practice

In 2004, 6.5% of Australians over 65 years of age were estimated to have dementia and the prevalence of dementia is rising asa result of ouraging population. There is evidence to show that carer wellbeing is important for the wellbeing of the patient. Increasing burden of care may lead to depression, anxiety, and more frequent physical illness in the carer, and earlier institutionalisation of patient

Impact of the Presence of Medical Equipment in Images on Viewers' Perceptions of the trustworthines of an Individual on-Screen

Background: It is now common practice for doctors to consult patients by means other than face-to-face, often appearing before the patient on a computer screen. Also, many websites are using depictions of health professionals to increase the credibility of their services. Being trustworthy is an essential attribute for successful ehealth services. Little is known about which depicted accessories make a health professional appear more trustworthy. Objective: To estimate the odds of an individual on-screen being rated trustworthy when viewed in a static image holding or wearing specific items of medical equipment.Methods: We surveyed consecutive people attending community pharmacies to collect prescriptions in Western Australia. Respondents were presented with a series of 10 photographs, generated at random, of a man with varying numbers and combinations of medical equipment: stethoscope, reflex hammer, surgical scrubs, otoscope, and pen. They were then invited to rate the man as honest, trustworthy, honorable, moral, ethical, or genuine, or a combination of these, on the Source Credibility Scale.Results: A total of 168 of 250 people gave informed consent, for a participation rate of 67.2%. There were 102 female and 66 male respondents. Of the 168 respondents, 96 (57%) were born in Australia and 102 (60.7%) were attending medical practices with more than one general practitioner. The mean age of respondents was 47 (SD 16) years (range 26–92 years). When only 1 item was present in an image, the stethoscope was associated with the highest odds for the person being considered honest (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.6–4.3), trustworthy (OR 2.3, 95% CI 1.4–3.8), honorable (OR 2.7, 95% CI 1.6–4.5), moral (OR 2.4 95% CI 1.4–4.1), ethical (OR 2.6, 95% CI 1.5–4.6), and genuine (OR 1.8, 95% CI 1.0–3.1). The presence of a stethoscope increased the odds of the person being rated in a positive light in all photographs in which it was included. Conclusions: When an individual is portrayed in a static image, concurrent presentation of 3 or more items of medical equipment, and especially a stethoscope, is likely to exert a positive influence on the viewers’ perceptions of the qualities of the person depicted