Early Welsh cervical screening programme learning as a consequence of the coronavirus pandemic.

BACKGROUND: The coronavirus pandemic has had a profound impact on the cervical screening programme in Wales for the eligible women, sample takers, and laboratory and colposcopy services. AIMS: To explore what changes due to the pandemic have adversely affected screening outcomes in Wales and what lessons can be learned to improve cervical screening in Wales and elsewhere. METHODS: A review of the screening performance in 2020 and the first quarter of 2021 in Wales as well as a comparison with other cervical screening programme responses to the pandemic. RESULTS: A 3 month pause of screening together with a change in a variety of working practices, including social distancing, use of personal protective equipment, use of virtual meetings, and home working have been implemented. The combination of a pause to the issuing of invitations, plus reduced services in primary and secondary care, together with population lockdown, have contributed to longer waiting times for colposcopy and potentially delayed cancer diagnoses. Some programme changes which were being evaluated prior to the pandemic could be developed now to mitigate the impact of the pandemic such as improved information, increased screening intervals for human papillomavirus-based screening programmes, and home working for call and recall staff. CONCLUSIONS: Despite a considerable short-term interruption to the cervical screening programme, some changes introduced as a result of the coronavirus pandemic could provide key lessons learnt for improvement for cervical cancer prevention services.

Untutored discrimination training on paired cell images influences visual learning in cytopathology.

BACKGROUND: Cytologists must learn how to discriminate cells that might be visually very similar but have different neoplastic potential. The mechanism by which trainees learn this task is poorly researched and is the focus of the current investigation. Cognitive science offers a theoretical platform from which to design meaningful experiments that could lead to novel training strategies. METHODS: The interpretation of a cell image is a category-discrimination task, and the process by which discrimination improves with practice is called perceptual learning. The study authors operationalized this concept by training 150 naive observers on paired cell images without providing explicit tuition, employing cervical cytology as a model system. Six strategies were tested, which differed according to the diagnostic category and level of interpretive difficulty of each image. Participants were tested before and after training to determine the extent to which visual learning had occurred. RESULTS: Diagnostic accuracy improved for participants who were trained on normal/abnormal image pairs in which at least one member of the pair was "easy" to interpret (P < .05). Training was not effective when image pairs were drawn from the same diagnostic category or when both members of the pair were "difficult" to interpret (P > .05). CONCLUSIONS: Training on paired cell images without explicit tuition can be an efficient and effective means of visual learning in cytopathology, but only if care is taken to avoid image pairs from category boundaries. Training on same-category image pairs is ineffective. This study is a step toward the development of perceptual learning modules for cytopathology.

To what extent does nonanalytic reasoning contribute to visual learning in cytopathology?

BACKGROUND: Acquisition of visual interpretation skills in cytopathology may involve 2 strategies. Analytic strategies require trainees to base their interpretive decisions on carefully considered and often exhaustive cytomorphologic feature lists, a process that can be time-consuming and inefficient. In contrast, nonanalytic pattern recognition strategies are rarely encouraged during training, even though this approach is characteristic of expert diagnostic behavior. This study evaluated the potential role of nonanalytic learning in cytopathology as an efficient alternative to analytic training. METHODS: Forty-nine cytology novice participants undertook an initial image interpretation test to obtain baseline diagnostic accuracy (test 1). Twenty-four participants subsequently received training in basic cervical cytomorphology and were given a list of cell features for future reference (the "analytic" group). The remaining 25 participants were simply shown 20 nonannotated paired images of normal and abnormal cervical cells (the "nonanalytic" group). Following a practice phase, both groups were retested (test 2). Prior to a final test (test 3), participants in both groups were instructed to adopt a combined analytic/nonanalytic diagnostic strategy. Diagnostic accuracy and response times were measured in each test. RESULTS: Diagnostic accuracy in both groups improved significantly between tests 1 and 2 (P<.001) but decreased between tests 2 and 3 (P<.05). Speed of response to test images was generally faster under nonanalytic than under analytic conditions. CONCLUSIONS: Nonanalytic reasoning in cytopathology image interpretation can be as accurate as traditional feature-based reasoning. Encouraging trainees to adopt pattern recognition strategies may help to expedite the acquisition of visual interpretation skills in cytopathology training programs, yet combining analytic and nonanalytic reasoning do not appear to be effective.

Prevalence of abnormalities influences cytologists' error rates in screening for cervical cancer.

CONTEXT: Medical screening tasks are often difficult, visual searches with low target prevalence (low rates of disease). Under laboratory conditions, when targets are rare, nonexpert searchers show decreases in false-positive results and increases in false-negative results compared with results when targets are common. This prevalence effect is not due to vigilance failures or target unfamiliarity. OBJECTIVE: To determine whether prevalence effects could be a source of elevated false-negative errors in medical experts. DESIGN: We studied 2 groups of cytologists involved in cervical cancer screening (Boston, Massachusetts, and South Wales, UK). Cytologists evaluated photomicrographs of cells at low (2% or 5%) or higher (50%) rates of abnormality prevalence. Two versions of the experiment were performed. The Boston, Massachusetts, group made decisions of normal or abnormal findings using a 4-point rating scale. Additionally, the group from South Wales localized apparent abnormalities. RESULTS: In both groups, there is evidence for prevalence effects. False-negative errors were 17% (higher prevalence), rising to 30% (low prevalence) in the Boston, Massachusetts, group. The error rate was 27% (higher prevalence), rising to 42% (low prevalence) in the South Wales group. (Comparisons between the 2 groups are not meaningful because the stimulus sets were different.) CONCLUSIONS: These results provide the first evidence, to our knowledge, that experts are not immune to the effects of prevalence even with stimuli from their domain of expertise. Prevalence is a factor to consider in screening for disease by human observers and has significant implications for cytology-based cervical cancer screening in the post-human papillomavirus vaccine era, when prevalence rates of high-grade lesions in the population are expected to decline.

Understanding cholesterol and its role in heart disease.

This article looks at cholesterol and its function in the body. It explores cholesterol's role in cardiovascular disease and the factors that contribute to high levels in the blood.

Hypothermia: risk factors and guidelines for nursing care.

Hypothermia occurs when heat loss from the body exceeds heat gain and the core temperature of the body falls below 35 degrees C. Although death from hypotheRmia is rare, 80 per cent of associated mortalities are in older people. There are many underlying conditions that increase a person's susceptibility to cold and this includes not having the ability to make appropriate environmental adjustments to maintain body temperature. The nursing management of a patient with hypothermia depends upon the severity of the condition. The nurse's primary concern is to treat the symptoms and re-warm the patient appropriately.