Mechanical and ultimate properties of injection molded cellulose acetate/plasticizer materials.

The mechanical properties of injection molded plasticized cellulose acetate polymers processed with two different plasticizers (Triacetine and Diethyl phthalate) and various weight fractions comprised between 15 and 30 wt % have been investigated. Plasticized cellulose acetate exhibit a brittle-to-ductile transition from a low impact strength to a high impact strength of order 40 kJ/m². Obtaining a high impact resistance at room temperature requires plasticizer content larger than 25 wt.%. An important strain hardening is obtained for samples with both plasticizers during tensile experiment. At 15 wt.% plasticizer content, the measured strain hardening modulus is around 148 MPa at 60 °C. Different parameters influencing the strain hardening behavior have been identified: the tensile direction as compared to that of the injection flow, the temperature and the plasticizer, consistent with studies on pre-strained samples of synthetic amorphous polymers.

Overuse of mammography during the first round of an organized breast cancer screening programme.

OBJECTIVES: We examined the frequency of mammography screening among women who had had a screening mammogram recently and therefore generally did not need to repeat the examination. METHODS: A population-based sample of 50- to 69-year-old women were surveyed immediately before and 8 months after they received an invitation to participate in the first round of screening of the newly organized mammography screening programme in Geneva, Switzerland. These women also received a booklet that included the recommendation to have screening mammograms at 2-year intervals. RESULTS: The baseline survey identified 660 women who had had a mammogram within the previous 12 months. Of these, 23.2% [95% confidence interval (CI), 20.0-26.6] had an opportunistic mammogram and 4.1% (95% CI, 2.7-5.9) had an organized mammogram during follow-up. Women who had had their last mammogram 6-12 months prior to baseline (vs. more recently), intended to have a mammogram within the next 6 months, wished to receive more information on mammography screening, and had a history of surgical breast biopsy were more likely to have an unnecessary screening mammogram (either organized or opportunistic) during follow-up. Compared with women who had an opportunistic mammogram, women who had an organized mammogram were more likely to be of lower socioeconomic status, to have made their own screening decision and to have anticipated the date of their next mammogram by no more than a few months. CONCLUSIONS: Opportunistic mammography screening in excess of recommendation is common, and persists despite explicit advice about recommended screening frequency.

A systematic review of information in decision aids.

OBJECTIVE: We completed a systematic review of information reported as included in decision aids (DAs) for adult patients, to determine if it is complete, balanced and accurate. SEARCH STRATEGY: DAs were identified using the Cochrane Database of DAs and searches of four electronic databases using the terms: 'decision aid'; shared decision making' and 'patients'; 'multimedia or leaflets or pamphlets or videos and patients and decision making'. Additionally, publications reporting DA development and actual DAs that were reported as publicly available on the Internet were consulted. Publications were included up to May 2006. DATA EXTRACTION: Data were extracted on the following variables: external groups consulted in development of the DA, type of study used, categories of information, inclusion of probabilities, use of citation lists and inclusion of patient experiences. MAIN RESULTS: 68 treatment DAs and 30 screening DAs were identified. 17% of treatment DAs and 47% of screening DAs did not report any external consultation and, of those that did, DA producers tended to rely more heavily on medical experts than on patients' guidance. Content evaluations showed that (i) treatment DAs frequently omit describing the procedure(s) involved in treatment options and (ii) screening DAs frequently focus on false positives but not false negatives. About 1/2 treatment DAs reported probabilities with a greater emphasis on potential benefits than harms. Similarly, screening DAs were more likely to provide false-positive than false-negative rates. CONCLUSIONS: The review led us to be concerned about completeness, balance and accuracy of information included in DAs.

Who gets screened, and where: a comparison of organised and opportunistic mammography screening in Geneva, Switzerland.

It is unclear whether introducing organised mammography screening programmes in a population where opportunistic screening is prevalent results in the two types of screening mainly competing against each other or attracting different groups of women. To compare women who participate in organised screening and those who prefer opportunistic screening, we conducted a prospective study of 932 women followed for 8 months after an invitation to participate in the first round of an organised screening programme in Geneva, Switzerland. All women were aged 50-69 years and were due for a mammogram according to local guideline. Of the 932 participants, 11.6% had an organised and 39.4% an opportunistic mammogram during follow-up. Women who were in the stage of contemplation, had favourable attitude toward mammography screening, and perceived their risk of breast cancer to be high were more likely to have a mammogram (either organised or opportunistic). Compared to women who had an opportunistic mammogram, women with an organised mammogram were less positive about screening, less likely to be in maintenance at baseline (adjusted odds ratio (OR), 3.0; 95% confidence interval (CI), 1.7-5.5), to have a history of benign breast disease (OR, 2.4; 95% CI, 1.2-5.1) and to perceive their financial situation as comfortable (OR, 1.7; 95% CI, 1.1-2.8). Although screening uptake was low, the programme appeared to attract women in lower socio-economic strata who did not usually undergo mammography screening.

Self-reported management of pain in hospitalized patients: link between process and outcome.

PURPOSE: Hospitalized patients commonly experience pain. We investigated the association between patients' reported use of recommended pain management practices and overall pain relief. METHODS: All adult patients discharged during a 1-month period from a Swiss teaching hospital were invited to complete a mailed survey that included the Picker patient experience questionnaire, questions on pain relief during hospitalization, and questions on various procedures that are recommended as standards of pain management. RESULTS: Of 2156 eligible patients, 1518 (70%) participated. Sixty-nine percent (n = 1050) had experienced pain during their hospital stay, of whom 71% (n = 697/978) reported complete pain relief. After adjustment for sex, age, general health, and hospital department, pain relief was associated independently with availability of physicians (odds ratio [OR] = 11; 95% confidence interval [CI]: 3.3 to 36 for excellent vs. poor availability), having received information about pain and its management (OR = 2.8; 95% CI: 1.8 to 4.2), regular pain assessment (OR = 1.8; 95% CI: 1.2 to 2.8), modification of pain treatment when ineffective (OR = 3.0; 95% CI: 1.6 to 5.6), and waiting less than 10 minutes for pain medications (OR = 3.5; 95% CI: 1.9 to 6.6). CONCLUSION: Patient reports that recommended pain management procedures had been used were associated with better self-reported pain relief among hospitalized patients.

Women's preferences for doctor's involvement in decisions about mammography screening.

OBJECTIVES: To assess women's preferences for doctor's involvement in mammography screening decisions. METHODS: Mail survey of 50- to 69-year-old women residing in Geneva, Switzerland (N = 2216). RESULTS: Women considered that the decision to undergo mammography screening should be made by the doctor alone (5.6%), doctor primarily (42.6%), shared equally between woman and doctor (45.0%), woman primarily (4.2%), and woman alone (2.4%). These subgroups differed considerably. Compared to women in the shared equally group, doctor alone respondents were more likely to be older, to be born outside Switzerland, and to wish to know as late as possible about having cancer. In contrast, woman alone respondents were more likely to report no previous mammogram, to expect bad news from mammograms, and to feel nervous about screening. CONCLUSIONS: Most women wished to see their doctor involved in the decision to undergo a screening mammogram. Nevertheless, notable minorities held other opinions.