An empirical study of the ‘underscreened’ in organised cervical screening: experts focus on increasing opportunity as a way of reducing differences in screening rates

Sample interview question route. (PDF 63 kb

Information provision in cervical screening in Australia

• The National Cervical Screening Program, and associated state and territory organisations, are responsible for promoting cervical screening. Communication via multiple media channels encourages women to be screened. • Some communications are not clear about misrepresent the risk of cervical cancer and the protective capacity and reliability of the Pap smear. The potential harms of screening are rarely presented. • Participation is a key performance indicator for the Program. • Women receive Pap tests from clinicians, mostly general practitioners (GPs) who often screen opportunistically during already-busy appointments. Incentive Payments encourage high screening rates. • Consent is an important ethical principle in the delivery of all health care. Provision of material information is one of the elements of valid consent. • The combination of arguably ambiguous misleading communications, screening participation targets, and opportunistic testing under time pressure seems likely to undermine opportunities for women participating in the cervical cancer screening program to be informed. • Of particular concern are women who are less likely to benefit, women who are more likely to experience harm, and some groups of disadvantaged women. • Improved communications could include the absolute risk of cervical cancer and the morbidity and mortality benefits and harms of screening. Screening programs internationally have begun providing such information. • Performance indicators could value evidence of discussion or informing. • Areas for further research include the appropriate roles of the program, screeners, and individuals in providing and seeking information. Such work would identify the optimum method for informing women in the screening process

‘Organised’ cervical screening 45 years on: How consistent are organised screening practices?

Organised screening programmes have been remarkably successful in reducing incidence and mortality from cervical cancer, while opportunistic screening varies in its effectiveness. Experts recommend that cervical screening or HPV testing be carried out only in the context of an organised programme. We sought to answer the following study questions: What does it mean for a cervical screening programme to be organised? Is there a place for opportunistic screening (in an organised programme)? We reviewed 154 peer-reviewed papers on organised and opportunistic approaches to cervical screening published between 1970 and 2014 to understand how the term ‘organised’ is used, formally and in practice. We found that despite broad recognition of a prescriptive definition of organisation, in practice the meaning of organisation is much less clear. Our review revealed descriptions of organised programmes that differ significantly from prescribed norms and from each other, and a variety of ways that opportunistic and organised programmes intersect. We describe the breadth of the variation in cervical cancer screening programmes and examine the relationships and overlaps between organised and opportunistic screening. Implications emerging from the review include the need to better understand the breadth of organisation in practice, the drivers and impacts of opportunistic screening and the impact of opportunistic screening on population programme outcomes. Appreciation of the complexity of cervical screening programmes will benefit both screeners and women as programmes are changed to reflect a partially vaccinated population, new evidence and new technologies

Current utility of the ankle-brachial index (ABI) in general practice: implications for its use in cardiovascular disease screening

Peripheral arterial disease (PAD) is a marker of systemic atherosclerosis and associated with a three to six fold increased risk of death from cardiovascular causes. Furthermore, it is typically asymptomatic and under-diagnosed; this has resulted in escalating calls for the instigation of Primary Care PAD screening via Ankle Brachial Index (ABI) measurement. However, there is limited evidence regarding the feasibility of this and if the requisite core skills and knowledge for such a task already exist within primary care. This study aimed to determine the current utility of ABI measurement in general practices across Wales, with consideration of the implications for its use as a cardiovascular risk screening tool

Job Satisfaction and Burnout Among VA and Community Mental Health Workers

Building on two independent studies, we compared burnout and job satisfaction of 66 VA staff and 86 community mental health center staff in the same city. VA staff reported significantly greater job satisfaction and accomplishment, less emotional exhaustion and lower likelihood of leaving their job. Sources of work satisfaction were similar (primarily working with clients, helping/witnessing change). VA staff reported fewer challenges with job-related aspects (e.g. flexibility, pay) but more challenges with administration. Community mental health administrators and policymakers may need to address job-related concerns (e.g. pay) whereas VA administrators may focus on reducing, and helping workers navigate, administrative policies

On the antecedents of an electrophysiological signature of retrieval mode

It has been proposed that people employ a common set of sustained operations (retrieval mode) when preparing to remember different kinds of episodic information. In two experiments, however, there was no evidence for the pattern of brain activity commonly assumed to index these operations. In both experiments event-related potentials (ERPs) were recorded time-locked to alternating preparatory cues signalling that participants should prepare for different retrieval tasks. One cue signalled episodic retrieval: remember the location where the object was presented in a prior study phase. The other signalled semantic retrieval: identify the location where the object is most commonly found (Experiment 1) or identify the typical size of the object (Experiment 2). In both experiments, only two trials of the same task were completed in succession. This enabled ERP contrasts between 'repeat' trials (the cue on the preceding trial signalled the same retrieval task), and `switch' trials (the cue differed from the preceding trial). There were differences between the ERPs elicited by the preparatory task cues in Experiment 1 only: these were evident only on switch trials and comprised more positive-going activity over right-frontal scalp for the semantic than for the episodic task. These findings diverge from previous outcomes where the activity differentiating cues signalling preparation for episodic or semantic retrieval has been restricted to rightfrontal scalp sites, comprising more positive-going activity for the episodic than for the semantic task. While these findings are consistent with the view that there is not a common set of operations engaged when people prepare to remember different kinds of episodic information, an alternative account is offered here, which is that these outcomes are a consequence of structural and temporal components of the experiment designs