International experiences with the hospital anxiety and depression scale- a review of validation data and clinical results

OBJECTIVE: To compare the experiences of patients with breast cancer who were conventionally monitored with those in whom routine follow up was restricted to the time of mammography. DESIGN: Randomisation to conventional schedule of clinic visits or to visits only after mammography. Both cohorts received identical mammography and were invited to telephone for immediate appointments if they detected symptoms. SETTING: Combined breast clinic, Chelsea and Westminster Hospital. SUBJECTS: 211 eligible outpatients with a history of breast cancer. MAIN OUTCOME MEASURES: Acceptability of randomisation, interim use of telephone and general practitioner, satisfaction with allocation to follow up. RESULTS: Of 211 eligible patients, 196 (93%) opted for randomisation in the study. Of these, 55 were under 50 years, 78 were diagnosed fewer than five years before, 90 had stage T2-4 tumours, and 71 had involved axillary nodes. Patients who did not participate were more likely to be under 50 years, to be two to five years after diagnosis, and to have had aggressive primary disease. Twice as many patients in both groups expressed a preference for reducing rather than increasing follow up. No increased use of local practitioner services or telephone triage was apparent in the cohort randomised to less frequent follow up by specialists. CONCLUSIONS: Reducing the frequency of routine follow up has so far proved popular among patients with breast cancer at standard risk in this cohort. A multicentre study is needed to determine the effectiveness and cost-effectiveness of routine follow up with respect to disease outcomes.

Popularity of less frequent follow up for breast cancer in randomised study: initial findings from the hotline study.

Weight loss among older people, often due to conditions such as cancer and heart disease, has been associated with increased risks of disability and mortality.1 Alzheimer's disease may be a more important source of weight loss than previously recognised, and we examined this issue in a community sample of older adults from a population based, longitudinal study.

We collected data during five annual structured clinical evaluations of subjects from a stratified random sample of the population aged 65 years and older of East Boston, Massachusetts, a geographically defined community. We measured weight and height, with participants wearing light clothing, without shoes. Body mass index (weight (kg)/height (m)2) was used to standardise weight for height. Of the 467 clinical evaluation subjects, 338 survived and underwent follow up assessments and 280 (83%) had two or more weight measurements. We diagnosed Alzheimer's disease on the basis …

https://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1293&context=meyers_pp

Weight loss in people with Alzheimer's disease: a prospective population based analysis

Objectives: To study the ictal phenomenology, aetiology, and outcome of convulsions occurring within seconds of impact in violent collision sport. Design: Retrospective identification of convulsions associated with concussive brain injury from case records from medical officers of football clubs over a 15 year period. Subjects: Elite Australian rules and rugby league footballers. Main outcome measures: Neuroimaging studies, electroencephalography, neuropsychological test data, and statistics on performance in matches to determine presence of structural or functional brain injury. Clinical follow up and electroencephalography for evidence of epilepsy. Results: Twenty two cases of concussive convulsions were identified with four events documented on television videotape. Convulsions began within 2 seconds of impact and comprised an initial period of tonic stiffening followed by myoclonic jerks of all limbs lasting up to 150 seconds. Some asymmetry in the convulsive manifestations was common, and recovery of consciousness was rapid. No structural or permanent brain injury was present on clinical assessment, neuropsychological testing, or neuroimaging studies. All players returned to elite competition within two weeks of the incident. Epilepsy did not develop in any player over a mean (range) follow up of 3.5 (1-13) years. Conclusions: These concussive or impact convulsions are probably a non-epileptic phenomenon, somewhat akin to convulsive syncope. The mechanism may be a transient traumatic functional decerebration. In concussive convulsions the outcome is universally good, antiepileptic treatment is not indicated, and prolonged absence from sport is unwarranted. Key messages Concussive or impact convulsions are a non-epileptic phenomenon They are not associated with structural brain injury Antiepileptic treatment is not indicated In the case of sporting injury, prolonged absence from sport is unwarranted Treatment entails the appropriate management of the associated concussive injury

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Retrospective study of concussive convulsions in elite Australian rules and rugby league footballers: phenomenology, aetiology, and outcome.

Increasing numbers of cancer survivors and the tradition of long-term follow-up in the outpatient clinic has resulted in overcrowded oncology clinics and long waiting times. Little is known about patients' perceptions of their clinic attendance. This survey of 252 oncology patients investigated patients' satisfaction with the clinic, anxiety associated with clinic attendance and the strengths and weaknesses of the oncology service. Results demonstrated high levels of satisfaction. Far from being perceived as anxiety-provoking, the clinic was looked upon as a valuable source of reassurance, 92% of patients reporting they were 'always' or 'usually' reassured as a consequence of their visit. Qualitative data showed that clinic staff were the most important source of satisfaction. Waiting was overwhelmingly the worst aspect of the clinic, described by 27% of patients as 'excessively long'. One-fifth of the total sample had attended the clinic for 10 years or more and over a third of this group reported they would be worried at the prospect of being discharged to the care of their general practitioners. Despite disadvantages associated with long waits, the clinic was perceived as providing a valuable source of reassurance which a proportion of patients were clearly reluctant to be without.

Is it worth the wait? A survey of patients' satisfaction with an oncology outpatient clinic

Non-surgical Management of Early Breast Cancer in the United Kingdom: Follow-up

Community based cancer support groups: An undervalued resource?

The role of a radiographer counsellor in a large centre for cancer treatment: a discussion paper based on an audit of the work of a radiographer counsellor

E.J. Maher

Papers

Non-surgical Management of Early Breast Cancer in the United Kingdom: Follow-up

Community based cancer support groups: An undervalued resource?

The role of a radiographer counsellor in a large centre for cancer treatment: a discussion paper based on an audit of the work of a radiographer counsellor

Group on guidelines for the management of women with adverse effects following radiotherapy for breast cancer.