Higher risk breast screening: cancer detection rates, recall rates, and attendance rates in Northern Ireland.

AIM: To evaluate the outcomes of higher risk screening in Northern Ireland (NI) and compare with the UK National Health Service Breast Screening Programme (NHSBSP). MATERIALS AND METHODS: Higher risk breast screening commenced in NI in April 2013. Data on the programme were audited retrospectively through the Higher Risk screening centre. As there are no national standards for attendance rates and cancer detection rates, screening data and standards from the NHSBSP were used as a baseline for comparison. RESULTS: Attendance rates for the higher risk screening population have increased each of the last 3 years up to 77.7%. Recall rates have improved year on year from initial 14.2%-8.6%. Cancer detection rates have varied each year with a range from 21.5 per 1,000 women screened to 30.9 per 1,000 women screened. CONCLUSION: The Higher Risk Breast Screening Programme in NI represents a success story in risk stratified screening. Performance outcomes are excellent. The data outcomes may be used to inform standards of acceptable practice in the wider NHSBSP.

Phase II trial of weekly nab (nanoparticle albumin-bound)-paclitaxel (nab-paclitaxel) (Abraxane) in combination with gemcitabine in patients with metastatic breast cancer (N0531).

Nanoparticle albumin-bound (nab)-paclitaxel has better efficacy and practically eliminates the risk of hypersensitivity reactions associated with solvent-based paclitaxel. We studied weekly nab-paclitaxel and gemcitabine combination in an open-label one-stage, phase II trial in patients with previously untreated metastatic breast cancer (MBC). Nab-paclitaxel (125 mg/m(2)) and gemcitabine (1000 mg/m(2)) were administered on days 1 and 8 of a 21-day cycle until disease progression. Fifty patients were enrolled. Forty (80%) had visceral organ involvement and 30 (60%) had >or= 3 sites of metastases. Four (8%) and 21 (42%) patients had complete and partial responses by Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Median duration of response was 6.9 months [95% confidence interval (CI) 5.7, not reached], median progression-free survival (PFS) 7.9 months (95% CI 5.4-10 months), and median overall survival (OS) was not reached. PFS and OS at 6 months were 60% (95% CI 48% to 76%) and 92% (95% CI 85% to 100%), respectively. Therapy was well tolerated. Neutropenia was commonest toxicity (42% and 12% grades 3 and 4 neutropenia). Only one patient developed febrile neutropenia. Significant activity and favorable toxicity profile provides a basis for considering this regimen for further evaluation in phase III trials or in combination with biologic agents.

Factor XI and contact activation as targets for antithrombotic therapy.

The most commonly used anticoagulants produce therapeutic antithrombotic effects either by inhibiting thrombin or factor Xa (FXa) or by lowering the plasma levels of the precursors of these key enzymes, prothrombin and FX. These drugs do not distinguish between thrombin generation contributing to thrombosis from thrombin generation required for hemostasis. Thus, anticoagulants increase bleeding risk, and many patients who would benefit from therapy go untreated because of comorbidities that place them at unacceptable risk for hemorrhage. Studies in animals demonstrate that components of the plasma contact activation system contribute to experimentally induced thrombosis, despite playing little or no role in hemostasis. Attention has focused on FXII, the zymogen of a protease (FXIIa) that initiates contact activation when blood is exposed to foreign surfaces, and FXI, the zymogen of the protease FXIa, which links contact activation to the thrombin generation mechanism. In the case of FXI, epidemiologic data indicate this protein contributes to stroke and venous thromboembolism, and perhaps myocardial infarction, in humans. A phase 2 trial showing that reduction of FXI may be more effective than low molecular weight heparin at preventing venous thrombosis during knee replacement surgery provides proof of concept for the premise that an antithrombotic effect can be uncoupled from an anticoagulant effect in humans by targeting components of contact activation. Here, we review data on the role of FXI and FXII in thrombosis and results of preclinical and human trials for therapies targeting these proteins.

Cardiovascular correlates of behavioral dominance and hostility during dyadic interaction.

The present study examined cardiovascular correlates of expression of, and exposure to, naturally occurring behavioral dominance and hostility during dyadic social interaction. Unacquainted men and women undergraduates participated in three mixed-gender interactions with the same partner while their blood pressure and heart rate were assessed. Videotaped records of the interactions were coded for behavioral dominance and hostility. Exposure effects were apparent for women's systolic blood pressure and men's heart rate, with significantly greater reactivity shown by participants whose partners exhibited more dominance or hostility, respectively. Also, women's expression of dominance was positively and significantly associated with their heart rate reactivity. In addition to providing further evidence that emotion-related features of the social environment contribute to cardiovascular reactivity, these results illustrate that dominance merits attention as a correlate of cardiac stress reactivity, independent of hostility.

Development of a pregnancy-tailored decisional balance measure for smoking cessation.

The Transtheoretical Model suggests that perception of pros and cons of smoking (decisional balance) is related to quitting. This study examined the underlying structure of decisional balance items to aid in development of a pregnancy-tailored measure. A sample of 281 low-income, pregnant women attending public maternity clinics who smoked or had recently quit smoking completed a decisional balance measure. The measure included items from the general decisional balance scale plus pregnancy-related decisional balance items. Confirmatory factor analysis examining the general-plus-pregnancy-related items suggested a four-factor solution, with factors representing general pros, pregnancy-related pros, cons related to disapproval from others, and health-related cons. Perceptions of pregnancy-related pros and disapproval-related cons differed significantly across stages of change. Findings suggest that inclusion of pregnancy-related items could provide additional information about concerns that are salient during pregnancy.

Adhesion reduction as a new treatment innovation.

A new treatment option, an antiadhesion device, has proved effective in the reduction of postoperative adhesion formation and is now approved for use in the United States. The device is a thin, filmy membrane composed of two organic substances that are resorbed by the body. The device is inserted intraoperatively between apposing tissue surfaces that are potentially adhesiogenic. It proved effective in reducing the incidence of adhesions after both abdominal and pelvic surgery.

Rheumatologists' judgements about the efficacy of anti-TNF therapy in two neighbouring regions.

OBJECTIVES: The requirement in Northern Ireland to prescribe biological agents according to National Institute for Clinical Excellence/British Society for Rheumatology (NICE/BSR) guidelines and within a fixed budget has created a waiting list for treatment that has no parallel in the Republic of Ireland. The study investigated the bearing this situation may have had on consultants' judgements in the respective areas. METHODS: Seventy-eight case vignettes created from the data on real patients with RA treated with biologicals in the north and south of Ireland were appraised by nine southern and eight northern consultants, who judged the clinical benefit and significance of the patients' condition after a trial of therapy. Quantitative (clinical judgement analysis) and qualitative (focus groups) techniques were used. RESULTS: Northern consultants perceived a slightly greater degree of clinical benefit after a trial of therapy than southern consultants. Judgement models of northern and southern consultants were broadly comparable. The latter tended to be more uniform in their judgements than the southern group. Focus group discussions with consultants largely validated the findings of the quantitative analysis but revealed how clinical judgement analysis might be misled by gaming strategies. CONCLUSIONS: Despite the absence of overt rationing in the south of Ireland, as far as the judgement of therapeutic benefit from biologicals was concerned, the clinical judgement policies of practitioners were very similar to those in the north. The adoption of NICE/BSR guidelines in the north may have improved the uniformity of clinical practice in Northern Ireland.

Dominance, gender, and cardiovascular reactivity during social interaction.

Associations between trait dominance and cardiovascular reactivity were examined in previously unacquainted healthy men and women. Subjects participated in three mixed-gender dyadic interactions with the same partner while their cardiovascular responses were assessed. Among men, but not women, trait dominance was positively and significantly associated with systolic blood pressure reactivity. For men and women, diastolic blood pressure reactivity was positively and significantly associated with trait dominance while participants prepared to interact and with partner's trait dominance while they interacted. All effects held after controlling for trait hostility. Dominance merits attention as a correlate of cardiovascular reactivity, a finding that parallels emerging patterns in the cardiovascular disease literature. Gender and gender-related social factors as potential moderators of this relationship are discussed.