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The Lancet. Oncology Sep 2020The appropriate age range for breast cancer screening remains a matter of debate. We aimed to estimate the effect of mammographic screening at ages 40-48 years on breast... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The appropriate age range for breast cancer screening remains a matter of debate. We aimed to estimate the effect of mammographic screening at ages 40-48 years on breast cancer mortality.
METHODS
We did a randomised, controlled trial involving 23 breast screening units across Great Britain. We randomly assigned women aged 39-41 years, using individual randomisation, stratified by general practice, in a 1:2 ratio, to yearly mammographic screening from the year of inclusion in the trial up to and including the calendar year that they reached age 48 years (intervention group), or to standard care of no screening until the invitation to their first National Health Service Breast Screening Programme (NHSBSP) screen at approximately age 50 years (control group). Women in the intervention group were recruited by postal invitation. Women in the control group were unaware of the study. The primary endpoint was mortality from breast cancers (with breast cancer coded as the underlying cause of death) diagnosed during the intervention period, before the participant's first NHSBSP screen. To study the timing of the mortality effect, we analysed the results in different follow-up periods. Women were included in the primary comparison regardless of compliance with randomisation status (intention-to-treat analysis). This Article reports on long-term follow-up analysis. The trial is registered with the ISRCTN registry, ISRCTN24647151.
FINDINGS
160 921 women were recruited between Oct 14, 1990, and Sept 24, 1997. 53 883 women (33·5%) were randomly assigned to the intervention group and 106 953 (66·5%) to the control group. Between randomisation and Feb 28, 2017, women were followed up for a median of 22·8 years (IQR 21·8-24·0). We observed a significant reduction in breast cancer mortality at 10 years of follow-up, with 83 breast cancer deaths in the intervention group versus 219 in the control group (relative rate [RR] 0·75 [95% CI 0·58-0·97]; p=0·029). No significant reduction was observed thereafter, with 126 deaths versus 255 deaths occurring after more than 10 years of follow-up (RR 0·98 [0·79-1·22]; p=0·86).
INTERPRETATION
Yearly mammography before age 50 years, commencing at age 40 or 41 years, was associated with a relative reduction in breast cancer mortality, which was attenuated after 10 years, although the absolute reduction remained constant. Reducing the lower age limit for screening from 50 to 40 years could potentially reduce breast cancer mortality.
FUNDING
National Institute for Health Research Health Technology Assessment programme.
Topics: Adult; Age Factors; Aged; Breast; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammaplasty; Mammography; Middle Aged; Registries; United Kingdom
PubMed: 32800099
DOI: 10.1016/S1470-2045(20)30398-3 -
Nursing Outlook 2020The delivery of emergency, trauma, critical, and intensive care services requires coordination among all members of the care team. Perceived teamwork and role clarity...
BACKGROUND
The delivery of emergency, trauma, critical, and intensive care services requires coordination among all members of the care team. Perceived teamwork and role clarity may vary among physicians (MDs) and nurse practitioners (NPs).
PURPOSE
To examine differences in perceived roles and responsibilities of NPs and MDs practicing in emergency, trauma, critical, and intensive care.
METHODS
Secondary Analysis of the National Survey of Emergency, Intensive, and Critical Care Nurse Practitioners and Physicians, a cross-sectional national survey of clinicians. Mail survey of randomly selected stratified cross-sectional samples of MDs and NPs drawn from national lists of clinicians in eligible specialties working in emergency, trauma, intensive, and critical care units in the United States. 814 clinicians (351 NPs and 463 MDs) were recruited from national by postal mail survey. Our initial sample included n = 2,063 clinicians, n = 1,031 NPs and n = 1,032 MDs in eligible specialties. Of these, 63.5% of NPs and 70.1% of MDs completed and returned the survey excluding those who were ineligible due to lack of current practice in a relevant specialty.
FINDINGS
NPs in ICU/CCU are more likely to be female and report working fewer hours than do MDs and provide direct care to more patients. 55% of NPs and 82% of MDs agree that their individual role in their unit is clear (p < .001); 34% of MDs and 42% of NPs agree that their unit is an example of excellent team work among professionals (p = 0.021); 41% of MD and 37% of NP clinicians (p = 0.061) agree that their teams are "prepared to provide outstanding care in a crisis or disaster." Perceived role clarity was significantly associated with increased perceptions of excellent teamwork and disaster preparedness.
DISCUSSION
At the time of this survey, and majority of NPs and MDs working in emergency, critical and intensive care did not agree that their teams were prepared for a crisis or disaster. Leaders of health organizations should encourage teamwork and professional role clarity to assist units to perform effectively in emergency and disaster preparedness.
Topics: Adult; Critical Care; Cross-Sectional Studies; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Nurse Practitioners; Nurse's Role; Physicians; Surveys and Questionnaires; United States
PubMed: 32622648
DOI: 10.1016/j.outlook.2020.04.010 -
Journal of Neuroradiology = Journal de... May 2022
Topics: Forensic Medicine; Humans; Neuroimaging
PubMed: 35436565
DOI: 10.1016/j.neurad.2022.04.001 -
Global Health & Medicine Dec 2021In Japan, HIV testing has been offered anonymously and free-of-charge at local public health centers, together with pre- and post-test counseling since 1993. Since then,...
In Japan, HIV testing has been offered anonymously and free-of-charge at local public health centers, together with pre- and post-test counseling since 1993. Since then, the number of HIV tests increased steadily to reach a peak in 2008 but has since decreased by 30% during the last decade. The number of tests further decreased in 2020 during the COVID-19 pandemic and steeply by 50% this year compared with the previous year, mostly due to a shift in the workload at these centers to COVID-19-related services. To deal with this decline and thinking beyond the current pandemic, more options for HIV testing are needed, such as self-testing/postal delivery of dried blood spot specimen, a method that is yet to be approved in Japan, in addition to the conventional plasma/serum-based HIV testing.
PubMed: 35036615
DOI: 10.35772/ghm.2021.01103 -
Biotechnology and Bioengineering Nov 2022As opposed to remarkable advances in the cell therapy industry, research reveal inexplicable difficulties associated with preserving and post-thawing cell death. Post... (Review)
Review
As opposed to remarkable advances in the cell therapy industry, research reveal inexplicable difficulties associated with preserving and post-thawing cell death. Post cryopreservation apoptosis is a common occurrence that has attracted the attention of scientists to use apoptosis inhibitors. Transporting cells without compromising their survival and function is crucial for any experimental cell-based therapy. Preservation of cells allows the safe transportation of cells between distances and improves quality control testing in clinical and research applications. The vitality of transported cells is used to evaluate the efficacy of transportation strategies. For many decades, the conventional global methods of cell transfer were not only expensive but also challenging and had adverse effects. The first determination of some projects is optimizing cell survival after cryopreservation. The new generation of cryopreservation science wishes to find appropriate and alternative methods for cell transportation to ship viable cells at an ambient temperature without dry ice or in media-filled flasks. The diversity of cell therapies demands new cell shipping methodologies and cryoprotectants. In this review, we tried to summarize novel improved cryopreservation methods and alternatives to cryopreservation with safe and viable cell shipping at ambient temperature, including dry preservation, hypothermic preservation, gel-based methods, encapsulation methods, fibrin microbeads, and osmolyte solution compositions.
Topics: Cell Survival; Cryopreservation; Cryoprotective Agents; Dry Ice; Fibrin; Postal Service
PubMed: 35898166
DOI: 10.1002/bit.28197 -
Health Security Jan 2020In Mali, qualified laboratories for testing of dangerous pathogens are centralized in Bamako. Creating a specimen transport system respecting timeline, specimen quality,... (Comparative Study)
Comparative Study
In Mali, qualified laboratories for testing of dangerous pathogens are centralized in Bamako. Creating a specimen transport system respecting timeline, specimen quality, biosafety, and biosecurity standards is a challenge. The current ad hoc system that relies on untrained public transport companies carries risks of spoilage, accidental release of pathogens, and delays, which compromise specimen quality. This pilot study aimed to evaluate the effectiveness (ie, timeline, quality of specimen, and cost) of using the trained postal service for sample transportation from district to central level, compared with the current system. The postal service intervention ran from mid-2016 to mid-2017 and covered 3 districts. Data were collected in the same districts during the same period of the preceding year for comparison. In all, 41 specimens were shipped using public transportation and 51 were shipped using the postal service. These included suspected meningitis, measles, yellow fever, and polio samples. Only 46% of samples sent by public transportation were received in Bamako within 72 hours of collection, compared to 71% of samples shipped via the postal service ( < .05). Further, 93% of samples shipped by public transportation arrived in good condition at the receiving laboratory, compared to 98% by postal service. Although cost comparisons were difficult (flat fee vs per-specimen fare), the average cost per specimen was 8 times higher with the postal service. Shipment of specimens from districts to central level using the postal service was feasible and appeared to be faster than public transportation, thus allowing specimen quality to be preserved. Further analysis regarding the most efficient costing mechanism is needed.
Topics: Communicable Diseases; Humans; Mali; Pilot Projects; Postal Service; Specimen Handling; Time Factors; Transportation
PubMed: 32004128
DOI: 10.1089/hs.2019.0061 -
International Journal of Environmental... Oct 2022The COVID-19 pandemic has limited healthcare services for patients with non-communicable diseases (NCDs). Hospital pharmacy departments in Thailand apply a new normal...
The COVID-19 pandemic has limited healthcare services for patients with non-communicable diseases (NCDs). Hospital pharmacy departments in Thailand apply a new normal pharmacy service known as "telepharmacy" to serve remote pharmacy practice and deliver medication to patients. Current knowledge clearly shows the benefit of each medicine delivery method, but the study of patient's desires and attitudes towards all drug delivery methods is still limited. To fill the gap, this study aims to investigate desires and attitudes about drug delivery methods among Thai patients living with NCDs who need regular and continuous care. The sample was included by accidentally randomized technique at NCD clinics of the southern Thailand tertiary care hospital. Data were collected between January and March 2021 by a questionnaire that contained three sections: the currently received medicine delivery method, the desires and attitudes about the medicine delivery system, and patients' demographic information. The majority of patients were women aged 60 years who earned less than 10,000 THB (263.85 USD), were enrolled in the Civil Servant Medical Benefit Scheme (CSMBS), lived 0-15 km from the hospital, living with hypertension, had 1-4 prescribed medications, visited the doctor every 3 months, and received the conventional drug delivery method. The result showed that only the subdistrict health promotion hospital (SHPH) medicine delivery method was at a high level of desire, while the rest including conventional, drug store, postal pharmacy, and drive-thru medicine delivery methods were at medium. Attitudes toward the quality of medicine delivery methods consisted of five dimensions: confidence, timeliness, reliability, empathy, and facilities. Thai NCD patients had positive attitudes toward SHPH and drug store medicine delivery methods that could be seen from the high level of attitude score across all dimensions, while postal pharmacy and drive-thru delivery methods received medium-level attitude scores across all five dimensions.
Topics: Humans; Female; Male; Pandemics; Noncommunicable Diseases; Reproducibility of Results; Delivery of Health Care; COVID-19 Drug Treatment
PubMed: 36294151
DOI: 10.3390/ijerph192013571 -
Clinical Nursing Research May 2023The purpose of this article is to describe the protocol development, feasibility, and lessons learned in the postal mail delivery of sleep monitoring devices to study...
The purpose of this article is to describe the protocol development, feasibility, and lessons learned in the postal mail delivery of sleep monitoring devices to study participants. The original study protocol included four in-person visits with distribution of a sleep monitoring device (Actiwatch) and return of the Actiwatch via the postal service in a self-addressed, stamped envelope. The COVID-19 pandemic limited in-person research contact thus requiring a remote study protocol for application and return of the Actiwatches using postal delivery. While there were postal delivery and return challenges, the overall return rate of 94.4% confirmed remote protocol feasibility. Key lessons learned were: consistent and frequent communication via telephone calls and/or text; confirming required postage; and use of package tracking labels. All these strategies contributed to successful postal delivery/return and concomitantly decreased the potential loss of data and valuable research equipment.
Topics: Humans; Surveys and Questionnaires; Polysomnography; Pandemics; COVID-19; Communication
PubMed: 36633042
DOI: 10.1177/10547738221146603 -
Journal of Public Administration... Oct 2022Studies of representative bureaucracy (RB) argue public organizations reflective of the public they serve exhibit better outcomes, especially when serving...
Studies of representative bureaucracy (RB) argue public organizations reflective of the public they serve exhibit better outcomes, especially when serving underrepresented groups. RB theory attributes improved outcomes either to the actions representative bureaucrats take (active representation), or a greater perception of trust and legitimacy toward them by service recipients (symbolic representation), largely treating active and symbolic representation as separate phenomena. We explore the intricate relationship between bureaucracies and the populations they serve by observing the cross-influence between active and symbolic representation, as revealed by self-reported outcomes in discrimination complaints ( = 1,372) referred for voluntary mediation in the United States Postal Service, the REDRESS© program, a context in which mediators are highly limited in representing a claimant's interests given the requirement of impartiality. In exit surveys measuring employee perceptions of organizational justice, we observed the impact of race and gender representation by gauging changes in reported satisfaction when a mediator's race or gender matched the nature of the complaint in cases of race or sex discrimination and sexual harassment, via multivariate regression estimation. These analyses support RB theory regarding sexual harassment complaints, where complainants rated outcomes significantly more favorably for female mediators. We found a negative correlation between female mediators and sex discrimination complaints, as well as African American mediators and race discrimination complainants. To explain this discrepancy, we argue that interactions between symbolic and active representation determine the expectations and perceptions placed on bureaucrats. When a bureaucrat does not meet those expectations, service recipients tend to have a more negative view of organizational justice outcomes.
PubMed: 36147878
DOI: 10.1093/jopart/muab044