Abstract:
OBJECTIVE:To assess the effect on time to diagnosis of recurrence and on quality of life of transferring primary responsibility for follow up of women with breast cancer in remission from hospital to general practice. DESIGN:Randomised controlled trial with 18 month follow up in which women received routine follow up either in hospital or in general practice. SUBJECTS AND SETTING:296 women with breast cancer in remission receiving regular follow up care at district general hospitals in England. MAIN OUTCOME MEASURES:Time between first presentation of symptoms to confirmation of recurrence; quality of life measured by specific dimensions of the SF-36 schedule, the EORTC symptom scale, and hospital anxiety and depression scale. RESULTS:Most recurrences (18/26, 69%) presented as interval events, and almost half (7/16, 44%) of the recurrences in the hospital group presented first to general practice. The median time to hospital confirmation of recurrence was 21 days in the hospital group (range 1-376 days) and 22 days in the general practice group (range 4-64). The differences between groups in the change in SF-36 mean scores from baseline were small: -1.8 (95% confidence interval -7.2 to 3.5) for social functioning, 0.5 (-4.1 to 5.1) for mental health, and 0.6 (-3.6 to 4.8) for general health perception. The change from baseline in the mean depression score was higher in the general practice group at the mid-trial assessment (difference 0.6, 0.1 to 1.2) but there was no significant difference between groups in the anxiety score or the EORTC scales. CONCLUSION:General practice follow up of women with breast cancer in remission is not associated with increase in time to diagnosis, increase in anxiety, or deterioration in health related quality of life. Most recurrences are detected by women as interval events and present to the general practitioner, irrespective of continuing hospital follow up.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Grunfeld E,Mant D,Yudkin P,Adewuyi-Dalton R,Cole D,Stewart J,Fitzpatrick R,Vessey Mdoi
10.1136/bmj.313.7058.665subject
Has Abstractpub_date
1996-09-14 00:00:00pages
665-9issue
7058eissn
0959-8138issn
1756-1833journal_volume
313pub_type
临床试验,杂志文章,随机对照试验abstract:OBJECTIVE:To assess evidence from randomised clinical trials about the effectiveness of extracts of Boswellia serrata (frankincense). DESIGN:Systematic review. DATA SOURCES:Electronic searches on Medline, Embase, Cinahl, Amed, and Cochrane Library. Hand searches of conference proceedings, bibliographies, and departme...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.a2813
更新日期:2008-12-17 00:00:00
abstract:OBJECTIVES:To evaluate current processes by which young children presenting with a febrile illness but suspected of having serious bacterial infection are diagnosed and treated, and to develop and test a multivariable model to distinguish serious bacterial infections from self limiting non-bacterial illnesses. Design T...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.c1594
更新日期:2010-04-20 00:00:00
abstract:OBJECTIVES:To compare "hospital at home" and hospital care as an inpatient in acute exacerbations of chronic obstructive pulmonary disease. DESIGN:Prospective randomised controlled trial with three months' follow up. SETTING:University teaching hospital offering secondary care service to 350 000 patients. PATIENTS:S...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.321.7271.1265
更新日期:2000-11-18 00:00:00
abstract:OBJECTIVES:To study the effects of metformin on the incidence of vitamin B-12 deficiency (<150 pmol/l), low concentrations of vitamin B-12 (150-220 pmol/l), and folate and homocysteine concentrations in patients with type 2 diabetes receiving treatment with insulin. DESIGN:Multicentre randomised placebo controlled tri...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.c2181
更新日期:2010-05-20 00:00:00
abstract:AIM:To compare perinatal morbidity and mortality for babies delivered in water with rates for babies delivered conventionally (not in water). DESIGN:Surveillance study (of all consultant paediatricians) and postal survey (of all NHS maternity units). SETTING:British Isles (surveillance study); England and Wales (post...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.319.7208.483
更新日期:1999-08-21 00:00:00
abstract:OBJECTIVE:To investigate the association between birth weight of offspring and mortality among fathers and mothers in the west of Scotland. DESIGN:Prospective observational study. PARTICIPANTS:794 married couples in Renfrew district of the west of Scotland. MAIN OUTCOME MEASURES:Mortality from all causes and from ca...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.315.7117.1189
更新日期:1997-11-08 00:00:00
abstract:OBJECTIVE:To show the influence of variations in case mix on clinical outcome indicators for patients admitted to hospital with acute stroke. DESIGN:"Before and after" cohort study, with prospective, consecutive identification of patients and prospective follow up; multiple logistic regression analyses to correct for ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.312.7045.1503
更新日期:1996-06-15 00:00:00
abstract:OBJECTIVE:To evaluate the relative efficacy of programmed cell death 1 (PD-1) or programmed cell death ligand 1 (PD-L1) inhibitors versus conventional drugs in patients with cancer that were PD-L1 positive and PD-L1 negative. DESIGN:Meta-analysis of randomised controlled trials. DATA SOURCES:PubMed, Embase, Cochrane ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.k3529
更新日期:2018-09-10 00:00:00
abstract:OBJECTIVES:To measure the impact of socioeconomic deprivation on rates of teenage pregnancy and the extent of local variation in pregnancy rates in Scotland, and to examine how both have changed over time. DESIGN:Population study using routine data from hospital records, aggregated for small areas. SUBJECTS:Female te...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.323.7306.199
更新日期:2001-07-28 00:00:00
abstract::Objective To analyse stage specific incidence of breast cancer in the Netherlands where women have been invited to biennial mammography screening since 1989 (ages 50-69) and 1997 (ages 70-75), and to assess changes in breast cancer mortality and quantified overdiagnosis.Design Population based study.Setting Mammograph...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.j5224
更新日期:2017-12-05 00:00:00
abstract:OBJECTIVE:To describe and quantify patterns of injury from antipersonnel mines in terms of distribution of injury, drain on surgical resources, and residual disability. DESIGN:Retrospective analysis. SETTING:Two hospitals for patients injured in war. SUBJECTS:757 patients with injuries from antipersonnel mines. MAI...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.303.6816.1509
更新日期:1991-12-14 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of an integrated care programme, combining a patient directed and a workplace directed intervention, for patients with chronic low back pain. DESIGN:Population based randomised controlled trial. SETTING:Primary care (10 physiotherapy practices, one occupational health service, ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.c1035
更新日期:2010-03-16 00:00:00
abstract:OBJECTIVE:To evaluate the incidence of serious maternal complications after the use of various tocolytic drugs for the treatment of preterm labour in routine clinical situations. DESIGN:Prospective cohort study. SETTING:28 hospitals in the Netherlands and Belgium. PARTICIPANTS:1920 consecutive women treated with toc...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b744
更新日期:2009-03-05 00:00:00
abstract:OBJECTIVE:To determine how length of anticoagulation and clinical presentation of venous thromboembolism influence the risk of recurrence after anticoagulant treatment is stopped and to identify the shortest length of anticoagulation that reduces the risk of recurrence to its lowest level. DESIGN:Pooled analysis of in...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.d3036
更新日期:2011-05-24 00:00:00
abstract::Monocycline is the most widely prescribed systemic antibiotic for acne largely because it needs to be given only once or twice a day and seems not to induce resistance. Up to April 1994 11 cases of minocycline induced systemic lupus erythematosus and 16 cases of hepatitis had been reported to the Committee on Safety o...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.312.7024.169
更新日期:1996-01-20 00:00:00
abstract:OBJECTIVE:To determine the prevalence of sexually transmitted diseases in patients with normal and abnormal cervical smears. DESIGN:A prospective study of asymptomatic women with normal cervical smears attending their general practitioner and newly referred patients with abnormal smears attending a colposcopy clinic. ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.302.6768.82
更新日期:1991-01-12 00:00:00
abstract:OBJECTIVE:To estimate the association between maternal age and fetal death (spontaneous abortion, ectopic pregnancy, stillbirth), taking into account a woman's reproductive history. DESIGN:Prospective register linkage study. SUBJECTS:All women with a reproductive outcome (live birth, stillbirth, spontaneous abortion ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.320.7251.1708
更新日期:2000-06-24 00:00:00
abstract:OBJECTIVE:To determine the prevalence of severe psychological trauma --that is, post-traumatic stress disorder--in children involved in everyday road traffic accidents. DESIGN:12 month prospective study. SETTING:Accident and emergency department, Royal United Hospital, Bath. SUBJECTS:119 children aged 5-18 years inv...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.317.7173.1619
更新日期:1998-12-12 00:00:00
abstract:OBJECTIVE:To describe the mechanism established by Richmond, Twickenham, and Roehampton Health Authority to manage extracontractual referral requests made on behalf of its resident population and to examine its working in the first three months of the new arrangements. DESIGN:Description of the procedures for managing...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.303.6801.499
更新日期:1991-08-31 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.312.7023.97
更新日期:1996-01-13 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.325.7370.925
更新日期:2002-10-26 00:00:00
abstract:OBJECTIVE:To assess the risk of hyperglycaemia with two standard oral rehydration solutions that contain carbohydrate compared with a carbohydrate free solution during rehydration of diabetic patients with acute diarrhoea. DESIGN:Prospective randomised allocation to one of three oral rehydration solutions (World Healt...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.308.6929.624
更新日期:1994-03-05 00:00:00
abstract:OBJECTIVE:To compare whether differences exist between alternating pressure overlays and alternating pressure mattresses in the development of new pressure ulcers, healing of existing pressure ulcers, and patient acceptability. DESIGN:Pragmatic, open, multicentre, randomised controlled trial. SETTING:11 hospitals in ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.38849.478299.7C
更新日期:2006-06-17 00:00:00
abstract:OBJECTIVE:To cost the relation between socioeconomic status and various measures of primary care workload and assess the adequacy of current "deprivation" payments in relation to actual costings for patients living in qualifying areas. DESIGN:Retrospective data on primary care were collected over a 4.5 year period fro...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.314.7073.38
更新日期:1997-01-04 00:00:00
abstract:OBJECTIVE:To estimate the risk of acute myocardial infarction (AMI) or stroke in adults with non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH). DESIGN:Matched cohort study. SETTING:Population based, electronic primary healthcare databases before 31 December 2015 from four European coun...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.l5367
更新日期:2019-10-08 00:00:00
abstract:OBJECTIVE:To evaluate the effect of intensive geriatric rehabilitation on demented patients with hip fracture. DESIGN:Preplanned subanalysis of randomised intervention study. Settting: Jyväskylä Central Hospital, Finland. PARTICIPANTS:243 independently living patients aged 65 years or older admitted to hospital with ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.321.7269.1107
更新日期:2000-11-04 00:00:00
abstract:OBJECTIVE:To compare direct and indirect costs of day and inpatient treatment of acute psychiatric illness. DESIGN:Randomised controlled trial with outcome and costs assessed over 12 months after the date of admission. SETTING:Teaching hospital in an inner city area. SUBJECTS:179 patients with acute psychiatric illn...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.314.7091.1381
更新日期:1997-05-10 00:00:00
abstract:OBJECTIVES:To investigate trends in the incidence of acute pancreatitis resulting in admission to hospital, and mortality after admission, from 1963 to 1998. DESIGN:Analysis of hospital inpatient statistics for acute pancreatitis, linked to data from death certificates. SETTING:Southern England. SUBJECTS:5312 people...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.328.7454.1466
更新日期:2004-06-19 00:00:00
abstract:OBJECTIVE:To determine how the UK National Health Service (NHS) is performing relative to health systems of other high income countries, given that it is facing sustained financial pressure, increasing levels of demand, and cuts to social care. DESIGN:Observational study using secondary data from key international org...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.l6326
更新日期:2019-11-27 00:00:00
abstract::The UN has reported that five multinational pharmaceutical companies would cut down HIV drug prices in the developing world. One of these drug companies is GlaxoWellcome, which has promised to reduce the price of zidovudine and lamivudine to US$2 in the poorest nations, a fifth of its price in the US. Although Peter ...
journal_title:BMJ (Clinical research ed.)
pub_type: 新闻
doi:10.1136/bmj.320.7246.1357
更新日期:2000-05-20 00:00:00