Research Tools and Resources

Lung cancer screening program factors that influence psychosocial outcomes: A systematic review

Sun, 01 Jan 2023 00:00:00 GMT

Lung cancer screening program factors that influence psychosocial outcomes: A systematic review McFadden, Kathleen; Rankin, Nicole; Nickel, Brooke; Li, Tong; Jennett, Chloe; Sharman, Ashleigh; Quaife, Samantha; Dodd, Rachael; Houssami, Nehmat Lung cancer screening (LCS) programs are being designed and implemented globally. Early data suggests that the psychosocial impacts of LCS are influenced by program factors, but evidence synthesis is needed. This systematic review aimed to elucidate the impact of service-level factors on psychosocial outcomes to inform optimal LCS program design and future implementation. Certain program factors are reportedly associated with psychosocial impacts of LCS, but study heterogeneity and quality necessitate more real-world studies. Future work should examine (a) implementation of targeted interventions and high-value discussion during LCS, and (b) optimal methods and timing of risk and result communication, to improve psychosocial outcomes while reducing time burden for clinicians.

Artificial Intelligence-Driven Mammography-Based Future Breast Cancer Risk Prediction: A Systematic Review

Mon, 01 Jan 2024 00:00:00 GMT

Artificial Intelligence-Driven Mammography-Based Future Breast Cancer Risk Prediction: A Systematic Review Schopf, Cody; Ramwala, Ojas; Lowry, Kathryn; Hofvind, Solveig; Marinovich, Luke; Houssami, Nehmat; Elmore, Joann; Dontchos, Brian; Lee, Janie; Lee, Christoph The purpose of this review was to summarize the literature regarding the performance of mammography-image based artificial intelligence (AI) algorithms, with and without additional clinical data, for future breast cancer risk prediction. Sixteen studies met inclusion and exclusion criteria, of which 14 studies provided AUC values. The median AUC performance of AI image-only models was 0.72 (range 0.62-0.90) compared with 0.61 for breast density or clinical risk factor–based tools (range 0.54-0.69). Of the seven studies that compared AI image-only performance directly to combined image + clinical risk factor performance, six demonstrated no significant improvement, and one study demonstrated increased improvement. Early efforts for predicting future breast cancer risk based on mammography images alone demonstrate comparable or better accuracy to traditional risk tools with little or no improvement when adding clinical risk factor data. Transitioning from clinical risk factor–based to AI image-based risk models may lead to more accurate, personalized risk-based screening approaches.

Bigger margins are not better in breast conserving surgery

Sun, 01 Jan 2012 00:00:00 GMT

Bigger margins are not better in breast conserving surgery Dixon, Michael J; Houssami, Nehmat Letter to editor in response to Jeevan R, Cromwell DA, Trivella M, Lawrence G, Kearins O, Pereira J, et al. Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics. BMJ2012;345:e4505. (12 July.)

Interval and Subsequent Round Breast Cancer in a Randomized Controlled Trial Comparing Digital Breast Tomosynthesis and Digital Mammography Screening

Fri, 01 Jan 2021 00:00:00 GMT

Interval and Subsequent Round Breast Cancer in a Randomized Controlled Trial Comparing Digital Breast Tomosynthesis and Digital Mammography Screening Hofvind, Solveig; Moshina, Nataliia; Holen, Åsne S.; Danielsen, Anders S; Lee, Christoph I; Houssami, Nehmat; Aase, Hildegunn S; Akslen, Lars A; Haldorsen, Ingfrid S Prevalent digital breast tomosynthesis (DBT) has shown higher cancer detection rates and lower recall rates compared with those of digital mammography (DM). However, data are limited on rates and histopathologic tumor characteristics of interval and subsequent round screen-detected cancers for DBT. Purpose To follow women randomized to screening with DBT or DM and to investigate rates and tumor characteristics of interval and subsequent round screen-detected cancers. Materials and Methods To-Be is a randomized controlled trial comparing the outcome of DBT and DM in organized breast cancer screening. The trial included 28 749 women, with 22 306 women returning for subsequent DBT screening 2 years later (11 201 and 11 105 originally screened with DBT and DM, respectively). Differences in rates, means, and distribution of histopathologic tumor characteristics between women prevalently screened with DBT versus DM were evaluated with Z tests, t tests, and χ2 tests. Relative risk (RR) with 95% CIs was calculated for the cancer rates. Results Interval cancer rates were 1.4 per 1000 screens (20 of 14 380; 95% CI: 0.9, 2.1) for DBT versus 2.0 per 1000 screens (29 of 14 369; 95% CI: 1.4, 2.9; P = .20) for DM. The rates of subsequent round screen-detected cancer were 8.1 per 1000 (95% CI: 6.6, 10.0) for women originally screened with DBT and 9.1 per 1000 (95% CI: 7.4, 11.0; P = .43) for women screened with DM. The distribution of tumor characteristics did not differ between groups for either interval or subsequent screen-detected cancer. The RR of interval cancer was 0.69 (95% CI: 0.39, 1.22; P = .20) for DBT versus DM, whereas RR of subsequent screen-detected cancer for women prevalently screened with DBT versus DM was 0.89 (95% CI: 0.67, 1.19; P = .43). Conclusion Rates of interval or subsequent round screen-detected cancers and their tumor characteristics did not differ between women originally screened with digital breast tomosynthesis (DBT) versus digital mammography. The analysis suggests that the benefits of prevalent DBT screening did not come at the expense of worse downstream screening performance measures in a population-based screening program.

Understanding women’s choices for management of cervical intraepithelial neoplasia 2 (CIN2): Qualitative analysis of a randomised experimental study

Fri, 01 Jan 2021 00:00:00 GMT

Understanding women’s choices for management of cervical intraepithelial neoplasia 2 (CIN2): Qualitative analysis of a randomised experimental study Keers, Gemma; Yamada, Kozue; Pickles, Kristn; Bell, Katy J.L.; Black, Kirsten; Bateson, Deborah; Dodd, Rachael H. Active surveillance for cervical intraepithelial neoplasia 2 (CIN2) would allow time for most cases to regress naturally and in turn avoid potentially unnecessary and harmful treatment. Aim To determine reasons for choosing active surveillance over surgery among women given a hypothetical diagnosis of CIN2. Materials and Methods Women residing in Australia aged 25–40 years with no prior diagnosis of cervical cancer, cervical abnormality CIN2 or above, and/or previous hysterectomy, were randomised to one of four identical hypothetical scenarios of testing human papillomavirus (HPV)-positive: high-grade cytology and a diagnosis of CIN2 that used alternate terminology to describe resolution of abnormal cells and/or inclusion of an overtreatment statement. Participants selected active surveillance or surgery after viewing the scenario and free-text reason/s for their choice were thematically analysed.

Electronic and animal noses for detecting SARS-CoV-2 infection

Fri, 01 Jan 2021 00:00:00 GMT

Electronic and animal noses for detecting SARS-CoV-2 infection Bell, Katy J.L.; Leeflang, Mariska MG; Deeks, Jonathan J; Dinnes, Jacqueline; Doust, Jenny; Korevaar, Daniel A; Lord, Sarah J; Spijker, Rene This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To assess the diagnostic test accuracy of eNoses to screen for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in public places, such as airports. To assess the diagnostic test accuracy of sniffer animals, and more specifically dogs, to screen for SARS‐CoV‐2 infection in public places, such as airports. To assess the diagnostic test accuracy of eNoses for SARS‐CoV‐2 infection or COVID‐19 in symptomatic people presenting in the community, or in secondary care. To assess the diagnostic test accuracy of sniffer animals, and more specifically dogs, for SARS‐CoV‐2 infection or COVID‐19 in symptomatic people presenting in the community, or in secondary care.

Estimating the potential impact of interventions to reduce over‐calling and under‐calling of melanoma

Fri, 01 Jan 2021 00:00:00 GMT

Estimating the potential impact of interventions to reduce over‐calling and under‐calling of melanoma Gibson, Matthew W; Scolyer, Richard; Soyer, Peter H; Ferguson, Peter M; McGeechan, Kevin; Irwig, Les; Bell, Katy J.L. Pathologists sometimes disagree over the histopathologic diagnosis of melanoma. ‘Over‐calling’ and ‘under‐calling’ of melanoma may harm individuals and healthcare systems. The objective of this study was to estimate the extent of ‘over‐calling’ and ‘under‐calling’ of melanoma for a population undergoing one excision per person and to model the impact of potential solutions. In this epidemiological modelling study, we undertook simulations using published data on the prevalence and diagnostic accuracy of melanocytic histopathology in the U.S. population. We simulated results for 10 000 patients each undergoing excision of one melanocytic lesion, interpreted by one community pathologist. We repeated the simulation using a hypothetical intervention that improves diagnostic agreement between community pathologist and a specialist dermatopathologist. We then evaluated four scenarios for how melanocytic lesions judged to be neither clearly benign (post‐test probability of melanoma < 5%), nor clearly malignant (post‐test probability of melanoma > 90%) might be handled, before sending for expert dermatopathologist review to decide the final diagnosis.

A stepped wedge cluster randomised trial of nurse-delivered Teach-Back in a consumer telehealth service.

Mon, 01 Jan 2018 00:00:00 GMT

A stepped wedge cluster randomised trial of nurse-delivered Teach-Back in a consumer telehealth service. Morony, Suzanne; Weir, Kristie R; Bell, Katy J.L.; Biggs, Janice; Duncan, Gregory; Nutbeam, Don; McCaffery, Kirsten Objective: To evaluate the impact of Teach-Back on communication quality in a national telephone-based telehealth service, for callers varying in health literacy. Setting: An Australian national pregnancy and parenting telephone helpline. Design: Cross-sectional stepped wedge cluster randomised trial with continuous recruitment, short (fixed) exposure and blinded outcome assessors. Nurses were stratified by hours worked and randomised into training groups using a computer generated sequence.

Sydney Health Literacy Lab (SHLL) Health Literacy Editor

Thu, 11 Mar 2021 00:00:00 GMT

Sydney Health Literacy Lab (SHLL) Health Literacy Editor Ayre, Julie; Muscat, Danielle; Bonner, Carissa; Mouwad, Dana; Dalmazzo, Jason; Eliza, Harrison; Aslani, Parisa; Dunn, Adam; McCaffery, Kirsten An online real-time editor to improve the health-literate design of written materials that assesses text for health literacy principles (e.g. readability, complex language (use of uncommon words, medical or health jargon, and acronyms), complex structure (sentences or paragraphs), passive voice, lexical density, and use of patient-centred language). The editor draws on existing national and international resources such as the the CDC’s Everyday Words for Public Health Communication, National Adult Literacy Agency’s Simply Put (Irish government), the University of Michigan’s Plain Language Medical Dictionary, and the Diabetes Australia language position statement. Feedback is provided directly on the text itself (for example, by highlighting the text), and through summary statements (for example, Grade reading score, number of uncommon words). Users can then use this feedback iteratively to revise and refine the text, and print a summary report that will summarise assessment items.