This trial examined the optimal setting for follow-up of patients after treatment for colon cancer by either general practitioners or surgeons. In all, 203 consenting patients who had undergone potentially curative treatment for colon cancer were randomised to follow-up by general practitioners or surgeons. Follow-up guidance recommended three monthly clinical review and annual faecal occult blood tests (FOBT) and were identical in both study arms. Primary outcome measures (measured at baseline, 12 and 24 months were (1) quality of life, SF-12; physical and mental component scores, (2) anxiety and depression: Hospital Anxiety and Depression Scale and (3) patient satisfaction: Patient Visit-Specific Questionnaire. Secondary outcomes (at 24 months) were: investigations, number and timing of recurrences and deaths. In all, 170 patients were available for follow-up at 12 months and 157 at 24 months. At 12 and 24 months there were no differences in scores for quality of life (physical component score, P=0.88 at 12 months; P=0.28 at 24 months: mental component score, P=0.51, P=0.47; adjusted), anxiety (P=0.72; P=0.11) depression (P=0.28; P=0.80) or patient satisfaction (P=0.06, 24 months). General practitioners ordered more FOBTs than surgeons (rate ratio 2.4, 95% CI 1.4–4.4), whereas more colonoscopies (rate ratio 0.7, 95% CI 0.5–1.0), and ultrasounds (rate ratio 0.5, 95% CI 0.3–1.0) were undertaken in the surgeon-led group. Results suggest similar recurrence, time to detection and death rates in each group. Colon cancer patients with follow-up led by surgeons or general practitioners experience similar outcomes, although patterns of investigation vary.

Objective: To assess the reliability of physical examination of the osteoarthritic (OA) knee by rheumatologists, and to evaluate the benefits of standardization.Methods: Forty‐two physical signs and techniques were evaluated using a 6 × 6 Latin square design. Patients with mild to severe knee OA, based on physical and radiographic signs, were examined in random order prior to and following standardization of techniques. For those signs with dichotomous scales, agreement among the rheumatologists was calculated as the prevalence‐adjusted bias‐adjusted kappa (PABAK), while for the signs with continuous and ordinal scales, a reliability coefficient (R_c) was calculated using analysis of variance. A PABAK of >0.60 and an R_c of >0.80 were considered to indicate adequate reliability.Results: Adequate poststandardization reliability was achieved for 30 of 42 physical signs/techniques (71%). The most highly reliable signs identified by physical examination of the OA knee included alignment by goniometer (R_c = 0.99), bony swelling (R_c = 0.97), general passive crepitus (R_c = 0.96), gait by inspection (PABAK = 0.78), effusion bulge sign (R_c = 0.97), quadriceps atrophy (R_c = 0.97), medial tibiofemoral tenderness (R_c = 0.94), lateral tibiofemoral tenderness (R_c = 0.85), patellofemoral tenderness by grind test (R_c = 0.94), and flexion contracture (R_c = 0.95). The standardization process resulted in substantial improvements in reliability for evaluation of a number of physical signs, although for some signs, minimal or no effect of standardization was noted. After standardization, warmth (PABAK = 0.14), medial instability at 30° flexion (PABAK = 0.02), and lateral instability at 30° flexion (PABAK = 0.34) were the only 3 signs that were highly unreliable.Conclusion: With the exception of physical examinations for instability, a comprehensive knee examination can be performed with adequate reliability. Standardization further improves the reliability for some physical signs and techniques. The application of these findings to future OA studies will contribute to improved outcome assessments in OA.

Health promotion provides a key opportunity to empower young people to make informed choices regarding key health-related behaviours such as tobacco and alcohol use, sexual practices, dietary choices and physical activity. This paper describes the evaluation of a pilot School Youth Health Nurse (SYHN) Program, which aims to integrate a Registered Nurse into school communities to deliver health promotion through group education and individual sessions. The evaluation was guided by the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. The objectives were to explore: 1) whether the Program was accessible to the high school students; 2) the impacts of the Program on key stakeholders; 3) which factors affected adoption of the Program; 4) whether implementation was consistent with the Program intent; and 5) the long-term sustainability of the Program. Research included retrospective analysis of Program records, administration of a survey of student experiences and interviews with 38 stakeholders. This evaluation provided evidence that the SYHN Program is reaching students in need, is effective, has been adopted successfully in schools, is being implemented as intended and could be maintained with sustained funding. The nurses deliver an accessible and acceptable primary health care service, focused on health promotion, prevention and early intervention. After some initial uncertainty about the scope and nature of the role, the nurses are a respected source of health information in the schools, consulted on curriculum development and contributing to whole-of-school health activities. Findings demonstrate that the SYHN model is feasible and acceptable to the students and schools involved in the pilot. The Program provides health promotion and accessible primary health care in the school setting, consistent with the Health Promoting Schools framework.

Health-related quality of life has become an important outcome in cancer treatment. Detailed health-related quality of life measures were taken as part of a trial of follow-up of patients with colon cancer by general practitioners and surgeons. This study was designed as a longitudinal assessment of health-related quality of life after treatment for carcinoma of the colon and patient satisfaction with two different settings of follow-up (general practitioners vs. surgeons). A total of 338 patients were recruited into randomized (n = 203) and patient preference (n = 135) follow-up groups. Prospectively assessed physical and mental health-related quality of life measures and patient satisfaction are reported during two years. Elderly and less educated patients prefer follow-up by general practitioners over surgeons. Overall, physical health-related quality of life is reduced early after treatment; however, this returns to normal levels at one year. Mental quality of life, anxiety, and depression are at or above population levels throughout the two-year follow-up period. There were no differences in physical or psychologic health-related quality of life measures between general practitioner and surgeon groups at any time during follow-up. Overall, more advanced Dukes stage is associated with a trend to improved mental health-related quality of life. Patients' ability to choose the setting of follow-up has no influence on health-related quality of life compared with random allocation to general practitioner or surgeon. Patients are equally highly satisfied with follow-up by general practitioner or surgeon. After recovery from treatment for colon cancer, health-related quality of life is similar to the general population. Good health-related quality of life outcomes and high patient satisfaction are as well provided by general practitioners in the community setting as by surgeon review.