The effect of individual radiographers on rates of attendance to breast screening: A 7-year retrospective study

AIM: To establish whether individual radiographers had significantly different rescreening rates whilst controlling for other known confounding factors. MATERIALS AND METHODS: Women aged 50e69 years were identified from a state-wide screening database at their first screening attendance during the study period (2007e2013). The radiographer performing this index screen and potential confounding factors were recorded and subsequent screening behaviour was assessed. Clients with abnormal screens and those known to have died during the time period were excluded. A univariate analysis of the data from 160,028 women was assessed using the chi-square test to compare those women who attended their next mammography with non-re-attenders. Logistic regression was used to calculate the likelihood of “re-attendance success” across a range of variables. The probability of re-attendance for 11 randomly selected radiographers was determined from the logistic regression model, whilst controlling for other variables. RESULTS: Comparison of non-re-attenders (n¼49,698) with 110,330 (69%) women attending the next round of screening revealed significant differences, including radiographer (Wald statistics¼1188, p\u3c0.000) even when all other known factors were controlled. CONCLUSION: This large, population-level study demonstrates that individual radiographer factors appear to influence a women’s decision to return for their next screening round. Further research is required to identify reasons for differing rescre

Opting into breast screening over the age of 70 years : seeking evidence to support informed choice

AIM: To provide evidence specific to the Scottish population regarding the risk-benefit balance of women >70 years opting into continued breast screening, which may be used as a basis for patient information documentation. MATERIALS AND METHODS: The present study consisted of a parallel, retrospective data analysis of breast cancer mortality data for breast cancer cases diagnosed between 2009 and 2013 (n=22,013) followed up to 31/12/18, and breast screening programme data from 2010 and 2015 (n=47,235). Screening outcome measures included recall for assessment, oncome of assessment, and tumour features. Tumours were classified as high, intermediate, or low risk according to grade and presence of invasion. Mortality data were linked to age at diagnosis and cause of death was recorded. RESULTS: The proportion of all deaths due breast cancer is inversely related to age at diagnosis. From 77 years, women are more likely to die with breast cancer, than directly due to breast cancer. Mammographic screening accurately identifies breast cancer in older women; however, many of the cancers detected were considered intermediate or low risk. CONCLUSIONS: Harms may outweigh the benefits of continued breast screening in older women. This information should be available to all older women.Peer reviewe

Study of Peri-Articular Anaesthetic for Replacement of the Knee (SPAARK): study protocol for a patient-blinded, randomised controlled superiority trial of liposomal bupivacaine

Background: Optimising the management of peri-operative pain and recovery following knee replacement has been identified as a patient priority. Current pain relief strategies use opiate-based analgesia; however, up to 50% of patients experience significant side effects. Local anaesthetic incisional infiltration is one alternative. The length of the duration of action is a major limiting factor of current local anaesthetic techniques. Liposomal bupivacaine has been reported to be effective for up to 72 h. This randomised controlled trial will evaluate the clinical and cost effectiveness of liposomal bupivacaine. Methods: SPAARK is a patient-blinded, multi-centre, active comparator, superiority, two-arm, parallel-group randomised controlled trial. Five hundred patients undergoing knee replacement will be recruited and randomised to liposomal bupivacaine plus bupivacaine hydrochloride or bupivacaine hydrochloride alone. The co-primary outcomes are the Quality of Recovery 40 measured at 72 h post-surgery and also cumulative pain measured daily using a 0–10 visual analogue scale for the first 3 days following surgery. Secondary outcomes include cumulative opioid consumption, fitness for discharge, functional outcomes assessed using the Oxford Knee Score and American Knee Society Score, the EuroQol five dimensions instrument and complications. A cost utility analysis is also planned. Discussion: The clinical effectiveness and cost effectiveness of liposomal bupivacaine have yet to be evaluated in the National Health Service, making this trial appropriate and timely. Trial registration: ISRCTN registry, ISRCTN54191675. Registered on 14 November 2017

Effect of Ibandronate on Bending Strength and Toughness on Rodent Cortical bone; possible implications for fracture prevention

OBJECTIVES: There remains conflicting evidence regarding cortical bone strength following bisphosphonate therapy. As part of a study to assess the effects of bisphosphonate treatment on the healing of rat tibial fractures, the mechanical properties and radiological density of the uninjured contralateral tibia was assessed. METHODS: Skeletally mature aged rats were used. A total of 14 rats received 1µg/kg ibandronate (iban) daily and 17 rats received 1 ml 0.9% sodium chloride (control) daily. Stress at failure and toughness of the tibial diaphysis were calculated following four-point bending tests. RESULTS: Uninjured cortical bone in the iban group had a significantly greater mean (standard deviation (sd)), p < 0.001, stress at failure of 219.2 MPa (sd 45.99) compared with the control group (169.46 MPa (sd 43.32)) following only nine weeks of therapy. Despite this, the cortical bone toughness and work to failure was similar. There was no significant difference in radiological density or physical dimensions of the cortical bone. CONCLUSIONS: Iban therapy increases the stress at failure of uninjured cortical bone. This has relevance when normalising the strength of repair in a limb when comparing it with the unfractured limb. However, the 20% increase in stress at failure with iban therapy needs to be interpreted with caution as there was no corresponding increase in toughness or work to failure. Further research is required in this area, especially with the increasing clinical burden of low-energy diaphyseal femoral fractures following prolonged use of bisphosphonates. Cite this article: Bone Joint Res 2015;4:99–10

Could parenchymal enhancement on contrast-enhanced spectral mammography (CESM) represent a new breast cancer risk factor? Correlation with known radiology risk factors

Aim To compare background parenchymal enhancement (BPE) on contrast-enhanced (CE) spectral mammography (CESM) with CE magnetic resonance imaging (MRI), and evaluate how these relate to hormonal status, mammographic breast density (MBD) and MRI fibroglandular tissue volume (FGTV). Methods and materials Between June 2012 to October 2015, participants in a cancer staging study underwent full-field digital mammography (FFDM), CEMRI, and CESM. Two readers independently rated FGTV, MBD, and BPE using the Breast Imaging-Reporting and Data System (BI-RADS) criteria. Inter-reader reliability was estimated using weighted kappa (k) and correlations between BPE, MBD, and FGTV calculated using Spearman's correlation coefficient. Associations with hormonal status were evaluated using multilevel ordinal regression analysis. Results Of the 96 eligible participants, 66 women (35–77 years) underwent CESM and CEMRI. Reasons for exclusion were declined or withdrawn consent (n=18), inadequate renal function (n=2), claustrophobia (n=2), previous reaction to contrast medium (n=2), mild reaction to contrast medium following CESM (n=2), lack of vascular access (n=1), neoadjuvant chemotherapy (n=1), CESM equipment failure (n=1), and unclear in one case. Inter-reader agreement was substantial (k=0.67) for CESM BPE, slight (k=0.19) for CEMRI BPE, moderate (k=0.57) for MRI FGTV and fair (k=0.35) for MBD. CESM BPE showed significant correlation with MBD (rho=0.36, p&lt;0.0001), FGTV (rho=0.52, p&lt;0.0001), and MRI BPE (rho=0.49, p&lt;0.0001). BPE was significantly reduced in the post-menopausal group for CEMRI and CESM (p&lt;0.05). CESM BPE did not significantly fluctuate during the menstrual cycle. Conclusion CESM BPE is correlated with MBD, FGTV, and CEMRI BPE, has better inter-reader reliability than CEMRI, and is not influenced by the menstrual cycle. Grading the degree of BPE on CESM could be a useful addition to breast cancer risk assessment tools.</p

Opting into breast screening over the age of 70 years:seeking evidence to support informed choice

AIM: To provide evidence specific to the Scottish population regarding the risk-benefit balance of women &gt;70 years opting into continued breast screening, which may be used as a basis for patient information documentation.MATERIALS AND METHODS: The present study consisted of a parallel, retrospective data analysis of breast cancer mortality data for breast cancer cases diagnosed between 2009 and 2013 (n=22,013) followed up to 31/12/18, and breast screening programme data from 2010 and 2015 (n=47,235). Screening outcome measures included recall for assessment, oncome of assessment, and tumour features. Tumours were classified as high, intermediate, or low risk according to grade and presence of invasion. Mortality data were linked to age at diagnosis and cause of death was recorded.RESULTS: The proportion of all deaths due breast cancer is inversely related to age at diagnosis. From 77 years, women are more likely to die with breast cancer, than directly due to breast cancer. Mammographic screening accurately identifies breast cancer in older women; however, many of the cancers detected were considered intermediate or low risk.CONCLUSIONS: Harms may outweigh the benefits of continued breast screening in older women. This information should be available to all older women.</p