Involving radiographers in mammography image interpretation and reporting in symptomatic breast clinics: a realist evaluation.

Breast cancer is most often diagnosed using x-ray imaging (mammography). Images are traditionally interpreted and reported by medically qualified practitioners, 'radiologists'; due to radiologist workforce shortages in recent years, the non-medical practitioners producing the images, radiographers, have become involved in their interpretation. This study used realist evaluation (RE) methodology and qualitative research methods to explore the change. The aims of the study were to explain how and why mammography image interpretation and reporting (MIIR) could be transferred from radiologists to radiographers and identify what the consequences of this might be for patients, practitioners and service providers. In Stage 1 of the study literature was reviewed to generate a series of ‘programme theories’ that hypothesised how responsibility for MIIR might be transferred from radiologists to radiographers, how radiographers could acquire the necessary knowledge and skills and how real-life situated factors might influence their practice. Stage 2 of the study field-tested these theories and demonstrated that: • involving radiographers in double reporting roles could improve diagnostic accuracy but required additional resource, did not always streamline the diagnostic journey and did not address local radiologist shortages; • task substitution of trained and experienced radiographers could release radiologists for other duties in symptomatic clinics; • role substitution of radiographers for radiologists might enable services to maintain and / or increase symptomatic service provision. Stage 3 of the study re-tested and refined programme theories about ‘role substitution’. In addition to confirming that radiographers could achieve the expertise necessary to replace radiologists in diagnostic breast clinics, Stage 3 identified that: • developing expertise required both the development of competence across a wide range of cases and the development of confident decision making; • the multidisciplinary team operated as a ‘community of practice’ and provided radiographers with a social learning environment within which they improved their MIIR performance and gained acceptance as radiologist substitutes

Clinical reasoning in image guided radiotherapy: A multimethod study

Introduction 3D Image Guided Radiotherapy (IGRT) using cone beam computer tomography has been implemented into the UK over the last decade. There is evidence to suggest that the training of therapeutic radiographers and the development of departmental processes may not have kept pace with the implementation. A literature review highlighted a paucity of evidence relating to how therapeutic radiographers make clinical decisions during image interpretation in the IGRT processes. Purpose The study aimed to investigate the types of decision-making processes used by therapeutic radiographers during image interpretation in IGRT. In addition, the study aimed to investigate the factors that impact on the decision-making processes of therapeutic radiographers during IGRT. Method A multimethod research design was adopted that utilised a think-aloud observational method with follow-up interviews. Thirteen participants were observed and interviewed across three United Kingdom (UK) radiotherapy centres. Participants were observed reviewing and making clinical decisions in a simulated environment using clinical scenarios developed in partnership with each centre’s Clinical Imaging Lead. Protocol analysis was used to analyse the observational data. Thematic analysis was used to analyse the interview data. Member checking was carried out using an online presentation and questionnaire, along with periodic peer debriefing by the supervisory team. Findings from the observations and semi-structured interviews were then combined using a triangulation protocol. Results Therapeutic radiographers were observed using one of three decision-making processes. These assume the titles simple linear process, linear repeating process and intuitive process. Participants were found to prioritise the target volume to be treated over the organs at risk. There were notably mixed opinions on the impact of overall therapeutic radiographer experience on decision-making. The findings of the study align with general principles of expert performance, which claims that expertise is only improved by seeking out particular kinds of experience and carrying out deliberate practice in this specific task or specific area of practice. A descriptive module was developed to demonstrate the factors that impact on decision-making. The centre structure, training and the wider involvement of the multidisciplinary team were all found to be key factors that impacted on the decision-making process during IGRT. Staffing levels and communication patterns between the multidisciplinary team were found to be highly variable across the three centres. Greater communication and involvement of the multidisciplinary team was found to improve therapeutic radiographers’ confidence in making clinical decisions. Issues in relation to pre-registration training were highlighted, with a consensus that recent graduates do not always demonstrate the skills and experience required to make clinical decisions. A lack of education in relation to clinical decision-making was highlighted at both pre-registration and post-qualification levels. A conceptual model to improve clinical decision-making in image interpretation during IGRT was developed and is presented in the thesis. Conclusion This research has provided new and original insight into the decision-making processes of therapeutic radiographers. It has demonstrated that therapeutic radiographers utilise complex processes during image interpretation in IGRT. It has shown that numerous factors affect the decisions that therapeutic radiographers routinely make, and that with improvements in education and radiotherapy centre infrastructure, therapeutic radiographers can be better placed to make safer, more effective decisions during the IGRT process

An experimental investigation of existential concerns in point-of-care testing for cardiovascular disease using a terror management theory framework

Recent research in Terror Management Theory (TMT) has found that mortality reminders below conscious awareness can lead to avoidant responses towards cancer-screening. Following this, the current research programme used a TMT framework to evaluate if mortality reminders could result in analogous responses towards a novel device for indicating Cardiovascular Disease (CVD) risk; the ―CVD Risk Biochip‖. Three central studies (Studies 1, 2 and 4) were designed to examine if various mortality reminders would elicit more avoidant responses towards the ―CVD Risk Biochip‖ than control topics. The third of these studies (Study 4) also investigated whether or not the nature of the device itself served to dissociate an individual towards CVD, thereby moderating existential concerns. An additional study (Study 3) examined whether or not one of the mortality reminders from the first two studies (Heart Attack Salience) leads to the suppression of death-related thoughts. When taken together, the results of these studies demonstrate that devices like the CVD Risk Biochip may have a beneficial effect on the potential uptake of screening behaviours generally and highlight the potential for cross-cultural variability in responses towards TMT methodologies. The findings of the programme also suggest some unique recommendations for the future study of TMT, including the performance of initial qualitative investigations of the cultural worldviews of a particular cohort before examining TMT processes and the necessity of controlling for the confounding effects of word frequency and word ambiguity in future "death-thought accessibility" research

Psychological Engagement in Choice and Judgment Under Risk and Uncertainty

Theories of choice and judgment assume that agents behave rationally, choose the higher expected value option, and evaluate the choice consistently (Expected Utility Theory, Von Neumann, & Morgenstern, 1947). However, researchers in decision-making showed that human behaviour is different in choice and judgement tasks (Slovic & Lichtenstein, 1968; 1971; 1973). In this research, we propose that psychological engagement and control deprivation predict behavioural inconsistencies and utilitarian performance with judgment and choice. Moreover, we explore the influences of engagement and control deprivation on agent’s behaviours, while manipulating content of utility (Kusev et al., 2011, Hertwig & Gigerenzer 1999, Tversky & Khaneman, 1996) and decision reward (Kusev et al, 2013, Shafir et al., 2002)

Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis

Overall, community engagement interventions are effective in improving health behaviours, health consequences, participant self-efficacy and perceived social support for disadvantaged groups. There are some variations in the observed effectiveness, suggesting that community engagement in public health is more likely to require a ‘fit for purpose’ rather than ‘one size fits all’ approach. We identified trends in the evidence that could provide useful directions for future intervention design and evaluation. Although there is a trend to suggest that there is greater effectiveness of peer-/lay-delivered interventions than interventions that take an empowerment approach or those that involve community members in the design of the intervention, this finding was not statistically significant. We cannot, therefore, conclude that one particular model of community engagement or theory of change is clearly more effective than any other. Albeit from a small number of studies, there also appear to be gains to human and social capital. There is evidence of benefits for engagees, including skills acquisition and future employment. Also, there is evidence that interventions improve participants’ perceived social support. There is weak but inconsistent evidence that different types of community engagement interventions can be cost-effective, and that implementation factors may affect intervention success. The new conceptual framework and the identification of three main theories of change can be used in intervention design and evaluation. Community engagement interventions need evaluations to include long-term assessment; the full range of potential beneficiaries; rigorous process evaluation; and collection of costs and resources data. We anticipate that these additions will help to disentangle the relative effectiveness of different models of community engagement and encourage sustainable initiatives with a lasting health legacy for the community

Adviser\u27s Guide to Health Care, Volume 1: An Era of Reform—The Four Pillars

https://egrove.olemiss.edu/aicpa_guides/2720/thumbnail.jp