Selection bias in enrollment to a programme aimed at the secondary prevention of ischaemic heart disease in general practice: a cohort study.

OBJECTIVE: To evaluate differences between adults who participated in a secondary prevention of ischaemic heart disease (IHD) programme and those who did not. DESIGN: Population-based cohort study. SETTING: A random selection of 12 Irish general practices. PARTICIPANTS: A total of 493 adults with IHD identified in 2000/2001. INTERVENTION: Medical records search and postal questionnaires in 2000/2001 and 2005/2006. MAIN OUTCOME MEASURES: Differences in demographic characteristics and indicators of process of care and risk factor management between participants and non-participants. RESULTS: Multiple logistic regression confirmed that female gender was associated with a reduced likelihood of participation in the secondary prevention programme [odds ratio (OR) 0.53 (95% CI: 0.32-0.87)], while an adequately controlled total cholesterol level was associated with an increased likelihood of enrollment [OR 1.82 (95% CI: 1.18-2.80)]. CONCLUSIONS: There is limited evidence that biases, which have been shown to affect participation in research, also affect participation in care programmes in everyday practice. A gender bias appears to have affected the enrollment of participants for the secondary preventive programme considered by this study, with enrollment favouring men with well-managed cholesterol. Reimbursement dependent upon patient adherence may incentivise the enrollment of adherent patients, although the influence of patient choice is unclear: the need to maintain records relating to patients who opt out of such interventions is thus highlighted.

Fine-needle aspiration in the diagnosis of metastatic ovarian cancer to the breast.

Metastatic ovarian cancer to the breast is a rare condition. The diagnosis must be made quickly and efficiently to minimize patients' physical and emotional trauma. Three patients with metastatic ovarian cancer to the breast are presented. Fine-needle aspiration of the breast was used in all patients in an attempt to obtain a diagnosis. Correlation of the cytomorphology from the primary tumor and metastatic lesion allowed proper diagnosis in two of the three patients. This study shows that it is imperative for the clinician to work closely with the cytopathologist to obtain a correct diagnosis.

Abnormal fetal presentations.

Current trends in the obstetrical management of abnormal fetal presentations have contributed to the sharp rise in the overall use of cesarean section for delivery. Recent literature questions this need. Many investigators are re-evaluating this shift from more traditional approaches.