Measuring patient experience of diagnostic care and acceptability of testing

A positive patient experience has been long recognised as a key feature of a high-quality health service, however, often assessment of patient experience excludes diagnostic care. Experience of diagnostic services and the acceptability of diagnostic tests are often conflated, with lack of clarity about when and how either should be measured. These problems contrast with the growth in the development and marketing of new tests and investigation strategies. Building on the appraisal of current practice, we propose that the experience of diagnostic services and the acceptability of tests should be assessed separately, and describe distinct components of each. Such evaluations will enhance the delivery of patient-centred care, and facilitate patient choice

Symptom Awareness Measures for Breast and Cervical Cancer in Sub-Saharan Africa: A Scoping Review

Background: In Sub-Saharan Africa (SSA) breast cancer is the most commonly diagnosed cancer among women, whilst cervical cancer remains the leading cause of cancer death. Women often fail to recognise or misinterpret possible symptoms, so breast and cervical cancer symptom awareness information can promote timely help-seeking behaviour, diagnosis and start of treatment. Aim: To identify tools which have been utilised to measure breast and cervical cancer symptom awareness in SSA. Methods: A scoping review of articles published between January 1997 and February 2017, written in English, and describing primary research in breast and/or cervical cancer symptom awareness-related topics in SSA contexts, was undertaken across five databases. The approach was supported by Colquhoun et al’s methodological framework for scoping reviews. Results: 41 studies were included from 11 SSA countries. Almost half (20/41) used breast and/or cervical cancer symptom awareness tools but did not report on tool validation processes. The rest (21/41) made reference to some tool validation, yet only two reported a detailed account of their tool validation processes. One explored lay perceptions of breast cancer, while the other sought to establish the validity and reliability of a UK tool in a Kenyan context. Conclusion: The findings point to the dearth of comprehensively validated and culturally relevant tools to measure breast and cervical cancer symptom awareness in the SSA context. They have informed the development and validation of an African Women Awareness of CANcer [AWACAN] tool, which can support development and evaluation of interventions relevant to the SSA context

Australian water consumer outlook 2015

Executive Summary Do we think and talk about water only when we are in drought? Do we complain about the price of water, but are happy to pay $3 a bottle for it at the shop? Do urban residents think differently about water to people living in rural and regional areas? Do consumers know enough about our water resources to understand if governments and industry are protecting our water supply in the future? These questions and more are explored in the Australian Water Consumer Outlook. As the driest inhabited continent on earth, it’s critical we engage with and understand the attitudes of water consumers, water industry and government, and make water policy a priority. Although many utilities undertake customer satisfaction surveys they often don’t ask broader questions to gain an understanding of the consumer make-up and leadership of the industry. Further, each of these surveys is conducted independently of each other, making it difficult to identify trends and variances of perceptions nationally. The Australian Water Consumer Outlook presents the findings of the Australian Water Consumer Survey. The Survey was conducted online between 27 July and 3 September 2015 and received 3948 responses. The data gathered for the Australian Water Consumer Outlook provides a basis for further community-informed policy debate. • State based reports are also available at AWA\u27s websit

Preferences for cancer investigation:a vignette-based study of primary-care attendees

SummaryBackgroundThe UK lags behind many European countries in terms of cancer survival. Initiatives to address this disparity have focused on barriers to presentation, symptom recognition, and referral for specialist investigation. Selection of patients for further investigation has come under particular scrutiny, although preferences for referral thresholds in the UK population have not been studied. We investigated preferences for diagnostic testing for colorectal, lung, and pancreatic cancers in primary-care attendees.MethodsIn a vignette-based study, researchers recruited individuals aged at least 40 years attending 26 general practices in three areas of England between Dec 6, 2011, and Aug 1, 2012. Participants completed up to three of 12 vignettes (four for each of lung, pancreatic, and colorectal cancers), which were randomly assigned. The vignettes outlined a set of symptoms, the risk that these symptoms might indicate cancer (1%, 2%, 5%, or 10%), the relevant testing process, probable treatment, possible alternative diagnoses, and prognosis if cancer were identified. Participants were asked whether they would opt for diagnostic testing on the basis of the information in the vignette.Findings3469 participants completed 6930 vignettes. 3052 individuals (88%) opted for investigation in their first vignette. We recorded no strong evidence that participants were more likely to opt for investigation with a 1% increase in risk of cancer (odds ratio [OR] 1·02, 95% CI 0·99–1·06; p=0·189), although the association between risk and opting for investigation was strong when colorectal cancer was analysed alone (1·08, 1·03–1·13; p=0·0001). In multivariable analysis, age had an effect in all three cancer models: participants aged 60–69 years were significantly more likely to opt for investigation than were those aged 40–59 years, and those aged 70 years or older were less likely. Other variables associated with increased likelihood of opting for investigation were shorter travel times to testing centre (colorectal and lung cancers), a family history of cancer (colorectal and lung cancers), and higher household income (colorectal and pancreatic cancers).InterpretationParticipants in our sample expressed a clear preference for diagnostic testing at all risk levels, and individuals want to be tested at risk levels well below those stipulated by UK guidelines. This willingness should be considered during design of cancer pathways, particularly in primary care. The public engagement with our study should encourage general practitioners to involve patients in referral decision making.FundingThe National Institute for Health Research Programme Grants for Applied Research programme

Total skin self-examination at home for people treated for cutaneous melanoma : development and pilot of a digital intervention

This work was funded by the RCUK Digital Economy award to the dot.rural Digital Economy Hub, University of Aberdeen; award reference: EP/G066051/1. The Experience Laboratory event was supported in part by a separate award from the University of Aberdeen Knowledge Exchange and Transfer Fund; award reference: GP057 UZZ0101.Peer reviewedPublisher PD

Effects of Bulk and Surface Conductivity on the Performance of CdZnTe Pixel Detectors

We studied the effects of bulk and surface conductivity on the performance of high-resistivity CdZnTe (CZT) pixel detectors with Pt contacts. We emphasize the difference in mechanisms of the bulk and surface conductivity as indicated by their different temperature behaviors. In addition, the existence of a thin (10-100 A) oxide layer on the surface of CZT, formed during the fabrication process, affects both bulk and surface leakage currents. We demonstrate that the measured I-V dependencies of bulk current can be explained by considering the CZT detector as a metal-semiconductor-metal system with two back-to-back Schottky-barrier contacts. The high surface leakage current is apparently due to the presence of a low-resistivity surface layer that has characteristics which differ considerably from those of the bulk material. This surface layer has a profound effect on the charge collection efficiency in detectors with multi-contact geometry; some fraction of the electric field lines originated on the cathode intersects the surface areas between the pixel contacts where the charge produced by an ionizing particle gets trapped. To overcome this effect we place a grid of thin electrodes between the pixel contacts; when the grid is negatively biased, the strong electric field in the gaps between the pixels forces the electrons landing on the surface to move toward the contacts, preventing the charge loss. We have investigated these effects by using CZT pixel detectors indium bump bonded to a custom-built VLSI readout chip

Measuring the Cosmic X-ray Background accurately

Synthesis models of the diffuse Cosmic X-ray Background (CXB) suggest that it can be resolved into discrete sources, primarily Active Galactic Nuclei (AGNs). Measuring the CXB accurately offers a unique probe to study the AGN population in the nearby Universe. Current hard X-ray instruments suffer from the time-dependent background and cross-calibration issues. As a result, their measurements of the CXB normalization have an uncertainty of the order of $\sim$15%. In this paper, we present the concept and simulated performances of a CXB detector, which could be operated on different platforms. With a 16-U CubeSat mission running for more than two years in space, such a detector could measure the CXB normalization with $\sim$1% uncertainty

Identifying novel biomarkers ready for evaluation in low-prevalence populations for the early detection of upper gastrointestinal cancers: a systematic review

Introduction: Detecting upper gastrointestinal (GI) cancers in primary care is challenging as cancer symptoms are common, often non-specific, and most patients presenting with these symptoms will not have cancer. Substantial investment has been made to develop biomarkers for cancer detection, but few have reached routine clinical practice. We aimed to identify novel biomarkers for upper GI cancers which have been validated sufficiently to be ready for evaluation in low-prevalence populations. Methods: We systematically searched MEDLINE, Embase, Emcare, and Web of Science for studies published in English from January 2000 to October 2019 (PROSPERO registration CRD42020165005). Reference lists of included studies were assessed. Studies had to report on second measures of diagnostic performance (beyond discovery phase) for biomarkers (single or in panels) used to detect pancreatic, oesophageal, gastric, and biliary tract cancers. We included all designs and excluded studies with less than 50 cases/controls. Data were extracted on types of biomarkers, populations and outcomes. Heterogeneity prevented pooling of outcomes. Results: We identified 149 eligible studies, involving 22,264 cancer cases and 49,474 controls. 431 biomarkers were identified (183 microRNAs and other RNAs, 79 autoantibodies and other immunological markers, 119 other proteins, 36 metabolic markers, 6 circulating tumour DNA and 8 other). Over half (n=231) were reported in pancreatic cancer studies. Only 35 biomarkers had been investigated in at least two studies, with reported outcomes for that individual marker for the same tumour type. Apolipoproteins apoAII-AT and apoAII-ATQ and pepsinogens PGI and PGII were the most promising biomarkers for pancreatic and gastric cancer respectively. Conclusion: Most novel biomarkers for the early detection of upper GI cancers are still at an early stage of matureness. Further evidence is needed on biomarker performance in low-prevalence populations, in addition to implementation and health economic studies, before extensive adoption into clinical practice can be recommended.Cancer Research UK C8640/A23385) Paige Druce, Kristi Milley and Jon Emery are supported by the Cancer Australia Primary Care Collaborative Cancer Clinical Trials Group (PC4). Mike Messenger is funded by the NIHR Leeds In Vitro Diagnostic Co-operative (UK

Low-noise custom VLSI for CdZnTe pixel detectors

A custom analog VLSI chip is being developed for the readout of pixellated CdZnTe detectors in the focal plane of an astronomical hard X-ray telescope. The chip is intended for indium bump bonding to a pixel detector having pitch near 0.5 mm. A complete precision analog signal processing chain, including charge sensitive preamplifier, shaping amplifiers and peak detect and hold circuit, is provided for each pixel. Here we describe the circuitry and discuss the performance of a functional prototype fabricated in a 1.2um CMOS process at Orbit Semiconductor. Dynamic performance is found to be close to SPICE model predictions over a self-triggering range extending from 1 to 150 keV (200 to 30000 electrons). Integral nonlinearity (1 %) and noise (0.25 keV or 50 electrons FWHM with 200 fF input capacitance) while acceptable are not as good as predicted. Power consumption is only 250 uW per pixel. Layout and design techniques are discussed which permit successful self-triggering operation at the low 1 keV threshold