From evidence to practice: factors affecting the specialist breast nurse's detection of psychological morbidity in women with breast cancer.

Psychological morbidity is high for women with breast cancer and is often undetected and untreated. Encouragingly, there are well-evaluated strategies to help improve psychological outcomes, but the challenge remains as to how to transfer these to routine care settings. The National Health and Medical Research Council (NHMRC) National Breast Cancer Centre used evidence-based psychosocial clinical practice guidelines and breast cancer treatment guidelines to develop a comprehensive specialist breast nurse (SBN) model of care and conducted a feasibility study to observe its implementation in diverse clinical conditions. Seven SBNs at four Australian cancer treatment centres implemented the model of care to support 196 women with a new diagnosis of early or locally advanced breast cancer. The SBN role in detecting women's psychological difficulties is reported here. Two months after diagnosis, 36% of women had a likely psychological disorder on the General Health Questionnaire 12-item (GHQ12) version. The SBNs detected as many as 85% and as few as 20% of high GHQ12 scorers, depending upon a woman's psychosocial risk factors and consultation factors. Few women were referred to psychological services, suggesting other barriers to care. More specific communication skills training, psychological symptom screening questionnaires and better access to psychological services may help the implementation of the model of care.

Using your voice: speech recognition technology in medicine and surgery.

Data entry and control of equipment are existing applications of speech recognition technology in medicine and surgery. Specialized dictation tasks, such as radiographic reporting, are feasible using isolated speech, speaker dependent, large vocabulary devices. General dictation will be possible using an automatic dictation device. Vocabulary size varies from a few to many thousand words, but most data entry, command, and control applications require 200 words or less, whereas specialized dictation tasks require about 1000 words and general dictation for a given user requires on the order of 10,000 words.