Search

Aim: Axillary lymph node dissection(AND) is a common treatment for breast cancer. An important side effect of the surgery is lymphoedema (LO). The primary aims of this study were to assess the local prevalence of LO in patients who had undergone AND and how the subjective symptoms described by patients compare with objective measurements. Secondary aims were to investigate the relationship between risk factors and the prevalence of LO and to establish an easy and convenient way to detect LO patients in surgical clinics., Method: Eligible women after AND for breast cancer underwent three circumference measurements on the operated and non operated (control) arm. LO was defined as one or more measurements with an increase ≥7.5% than control after dominant arm correction. Questionnaires were used to assess severity of symptoms related to lymphoedema. 73 patients also had serial measurements in arms and change in arm volume in operated arm was calculated using Casley-Smith method and LO was defined as ≥20% increase in volume., Results: 193 women with AND were analysed. Mean age was 61 years and mean time since surgery was 56 months. The overall prevalence of LO was 23.3%. LO prevalence by arm volume was 8.2%. Using volume as the standard, an arm circumference increase of ≥7.5% and ≥10% showed a sensitivity and specificity of 83% and 81%, and 66% and 89% respectively. Significant risk factors for LO were age, radiotherapy and infection to the operated arm, Conclusion: Circumference measures are a simple office method of screening for LO. A patient history and ≥10% increase in any circumference is optimal for determining LO after AND.

Aim: To understand the views of general practitioners on the utility of diagnostic schema as used by specialist psychiatrists and principles that would increase the value of diagnostic schema to general practitioners., Method: A postal survey of 1000 vocationally registered general practitioners in New Zealand, Results: Diagnostic schema such as the DSM-IV and ICD-10 are seldom used by general practitioners due primarily to their complexity and a lack of familiarity with them. Providing decision support on pharmaceutical treatment, appropriate secondary care referrals and improving communication across the primary/secondary care divide are principles that should guide the development of future diagnostic schema. Integration of schema into existing computerised practice management systems is considered a key success factor., Conclusion: Specialist devised schema fit uncomfortably into general practice. There is need for management orientated diagnostic schema that meet the requirements of general practitioners.

Evidence and argument for the allocation of funds to forensic psychiatric services to take account of the ethnic disparities in the use of the Justice System is presented. This would reflect the reality of the distribution of Service demand.