Implementing supplementary breast cancer screening in women with dense breasts: Insights from European radiographers and radiologists.

INTRODUCTION: In response to the critical need for enhancing breast cancer screening for women with dense breasts, this study explored the understanding of challenges and requirements for implementing supplementary breast cancer screening for such women among clinical radiographers and radiologists in Europe. METHOD: Fourteen (14) semi-structured online interviews were conducted with European clinical radiologists (n = 5) and radiographers (n = 9) specializing in breast cancer screening from 8 different countries: Denmark, Finland, Greece, Italy, Malta, the Netherlands, Switzerland, United Kingdom. The interview schedule comprised questions regarding professional background and demographics and 13 key questions divided into six subgroups, namely Supplementary Imaging, Training, Resources and Guidelines, Challenges, Implementing supplementary screening and Women's Perspective. Data analysis followed the six phases of reflexive thematic analysis. RESULTS: Six significant themes emerged from the data analysis: Understanding and experiences of supplementary imaging for women with dense breasts; Challenges and requirements related to training among clinical radiographers and radiologists; Awareness among radiographers and radiologists of guidelines on imaging women with dense breasts; Challenges to implement supplementary screening; Predictors of Implementing Supplementary screening; Views of radiologists and radiographers on women's perception towards supplementary screening. CONCLUSION: The interviews with radiographers and radiologists provided valuable insights into the challenges and potential strategies for implementing supplementary breast cancer screening. These challenges included patient and staff related challenges. Implementing multifaceted solutions such as Artificial Intelligence integration, specialized training and resource investment can address these challenges and promote the successful implementation of supplementary screening. Further research and collaboration are needed to refine and implement these strategies effectively. IMPLICATIONS FOR PRACTICE: This study highlights the urgent need for specialized training programs and dedicated resources to enhance supplementary breast cancer screening for women with dense breasts in Europe. These resources include advanced imaging technologies, such as MRI or ultrasound, and specialized software for image analysis. Moreover, further research is imperative to refine screening protocols and evaluate their efficacy and cost-effectiveness, based on the findings of this study.

Conceptualizing Sexual Wellbeing: A Qualitative Investigation to Inform Development of a Measure (Natsal-SW).

Despite increasing scientific and policy interest in sexual wellbeing, it remains poorly conceptualized. Many studies purporting to measure it instead measure related but distinct concepts, such as sexual satisfaction. This lack of conceptual clarity impedes understanding, measuring, and improving sexual wellbeing. We present qualitative research from multi-stage, mixed-methods work to develop a new measure of sexual wellbeing (Natsal-SW) for the fourth British National Survey of Sexual Attitudes & Lifestyles. Literature review and discussion generated a conceptual framework with seven proposed domains: respect, self-esteem, comfort, self-determination, safety and security, forgiveness, and resilience. Semi-structured interviews with 40 adults aged 18-64 then explored whether and how these domains aligned with participants' own understandings, experiences, and language of sexual wellbeing. Data were analyzed thematically. Participants conceptualized sexual wellbeing as distinct from sexual satisfaction and sexual health and as multidimensional, dynamic, and socially and structurally influenced. All seven proposed domains resonated with accounts of sexual wellbeing as a general construct. The personal salience of different domains and their dimensions varied between individuals (especially by gender and sexual orientation) and fluctuated individually over time. This study clarifies dimensions of domains that participants considered important, providing an empirical basis to inform development of a new measure of sexual wellbeing.

An exploration of factors involved in the roll out of a digital application in breast services: A case study approach.

INTRODUCTION: Acceptance of new technologies in health care, by those who use them as part of their role, is challenging with confounding contextual factors surrounding the acceptance of technology. As healthcare is rapidly digitising, stakeholder groups should be included in each stage of evaluation and implementation to allow opportunities to influence and contribute to digital health policies. This research employed a case study methodology to initiate an exploration into the factors associated with implementing a digital application into a mammography service. It examined the initial implementation and subsequent impact of the rollout of a digital application (VA) within a breast service in South Australia. METHODS: Stakeholders' opinions on team performance and feedback mechanisms of the digital application were evaluated through a staff questionnaire distributed through an online survey JISC. RESULTS: The incorporation of digitised technology into a service is evidently met with challenges. Although there is potential value in utelising automated feedback for workflow improvement and patient services, it appears imperative to provide targeted and developmental resources for educational development and staff well-being during the implementation phase. CONCLUSION: This case study approach delves into key discussion areas and serves as the initial insight into the implementation of a digital application. It could be regarded as a foundational reference for future evaluations of digital applications. IMPLICATIONS FOR PRACTICE: Research around digital fluency within the radiography profession requires further consideration. Under-utilisation or resistance may result in missed opportunities to enhance patient experiences and care outcomes and support staff wellbeing. Therefore, continued engagement and the encouragement of user feedback during the implementation phase are crucial to demonstrate future acceptance of digital applications in clinical settings.

Assessing the impact of binaural and non-binaural auditory beat intervention to pain and compression in mammography.

INTRODUCTION: Pain and discomfort has a negative impact on a patient's overall experience and may impact on subsequent re-attendance to mammography. Pain during mammography remains a significant issue. Assessment of interventions to reduce levels of pain associated with mammography are essential to increase attendance to breast services and improve user experience. METHODS: Participants (n = 60) were invited to take part in the study at one hospital Trust within the UK. Postal invitations were sent 2 weeks prior to appointment to patients older than 40 years with previous mammography attendance at the same Trust to allow for comparison of previous and current pain scores/compression values. Patients were randomised into 3 groups: Binaural music (BM), non-binaural music (NBM) and standard care (C). A numerical rating scale (NRS) was used to rate pain. RESULTS: Patient tolerance is increased by the application of both the non-binaural and binaural music. Binaural music was most effective in improving patient tolerance (p = 0.02). When applied compression increased some patients recorded less pain, which may have implications to image quality and radiation dose for patients. Binaural music reduces the perception of mammographic pain within this data set. CONCLUSION: 5 min exposure to binaural music improves patient experience and tolerance for mammography which could be utilised to improve attendance rates in screening and symptomatic services. IMPLICATIONS FOR PRACTICE: There is an indication for further research looking at application prior and during interventional biopsies. Music intervention can be offered to patients in the severe pain category who refuse mammography. It is acknowledged from these findings that the introduction of BM and NBM prior to mammography would be a low risk, cost effective intervention within the hospital setting.

Associations with sub-optimal clinic attendance and reasons for missed appointments among heterosexual women and men living with HIV in London.

Poor engagement in HIV care is associated with poorer health outcomes and increased mortality. Our survey examined experiential and circumstantial factors associated with clinic attendance among women (n = 250) and men (n = 106) in London with heterosexually-acquired HIV. While no associations were found for women, among men, sub-optimal attendance was associated with insecure immigration status (25.6% vs. 1.8%), unstable housing (32.6% vs. 10.2%) and reported effect of HIV on daily activities (58.7% vs. 40.0%). Among women and men on ART, it was associated with missing doses of ART (OR = 2.96, 95% CI:1.74-5.02), less belief in the necessity of ART (OR = 0.56, 95% CI:0.35-0.90) and more concern about ART (OR = 3.63, 95% CI:1.45-9.09). Not wanting to think about being HIV positive was the top reason for ever missing clinic appointments. It is important to tackle stigma and the underlying social determinants of health to improve HIV prevention, and the health and well-being of people living with HIV.

Feasibility and acceptability of a whole-school social-marketing intervention to prevent unintended teenage pregnancies and promote sexual health: evidence for progression from a pilot to a phase III randomised trial in English secondary schools.

BACKGROUND: Reducing unintended teenage pregnancy and promoting adolescent sexual health remains a priority in England. Both whole-school and social-marketing interventions are promising approaches to addressing these aims. However, such interventions have not been rigorously trialled in the UK and it is unclear if they are appropriate for delivery in English secondary schools. We developed and pilot trialled Positive Choices, a new whole-school social marketing intervention to address unintended teenage pregnancy and promote sexual health. Our aim was to assess the feasibility and acceptability of the intervention and trial methods in English secondary schools against pre-defined progression criteria (relating to randomisation, survey follow-up, intervention fidelity and acceptability and linkage to birth/abortion records) prior to carrying out a phase III trial of effectiveness and cost-effectiveness. METHODS: Pilot RCT with integral process evaluation involving four intervention and two control schools in south-east England. The intervention comprised a student needs survey; a student/staff-led school health promotion council; a classroom curriculum for year-9 students (aged 13-14); whole-school student-led social-marketing activities; parent information; and a review of local and school-based sexual health services. Baseline surveys were conducted with year 8 (aged 12-13) in June 2018. Follow-up surveys were completed 12 months later. Process evaluation data included audio recording of staff training, surveys of trained staff, staff log books and researcher observations of intervention activities. Survey data from female students were linked to records of births and abortions to assess the feasibility of these constituting a phase III primary outcome. RESULTS: All six schools were successfully randomised and retained in the trial. Response rates to the survey were above 80% in both arms at both baseline and follow-up. With the exception of the parent materials, the fidelity target for implementation of essential elements in three out of four schools was achieved. Student surveys indicated 80% acceptability among those who reported awareness of the programme and interviews with staff suggested strong acceptability. Linkage to birth/abortion records was feasible although none occurred among participants. CONCLUSIONS: The criteria for progression to a phase III trial were met. Our data suggest that a whole-school social-marketing approach may be appropriate for topics that are clearly prioritised by schools. A phase III trial of this intervention is now warranted to establish effectiveness and cost-effectiveness. Births and terminations are not an appropriate primary outcome measure for such a trial. TRIAL REGISTRATION: ISRCTN65324176.

Salivary Testosterone and Sexual Function and Behavior in Men and Women: Findings from the Third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3).

Using data from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) we examined associations between salivary testosterone (Sal-T) and sexual function and behavior. Single morning saliva samples were self-collected from a subsample of participants aged 18-74 years and analyzed using mass spectrometry. 1,599 men and 2,123 women were included in the analysis (40.6% of those invited to provide a sample). We adjusted for confounders in a stepwise manner: in model 1 we adjusted for age only; model 2 for age, season and relationship status, and model 3 we added BMI and self-reported health. In the fully adjusted models, among men, Sal-T was positively associated with both partnered sex (vaginal sex and concurrent partners) and masturbation. Among women, Sal-T was positively associated with masturbation, the only association with partnered sex was with ever experience of same-sex sex. We found no clear association between Sal-T and sexual function. Our study contributes toward addressing the sparsity of data outside the laboratory on the differences between men and women in the relationship between T and sexual function and behavior. To our knowledge, this is the first population study, among men and women, using a mass spectrometry Sal-T assay to do so.

The association between use of chemsex drugs and HIV clinic attendance among gay and bisexual men living with HIV in London.

OBJECTIVES: To investigate the association between chemsex drug use and HIV clinic attendance among gay and bisexual men in London. METHODS: A cross-sectional survey of adults (> 18 years) diagnosed with HIV for > 4 months, attending seven London HIV clinics (May 2014 to August 2015). Participants self-completed an anonymous questionnaire linked to clinical data. Sub-optimal clinic attenders had missed one or more HIV clinic appointments in the past year, or had a history of non-attendance for > 1 year. RESULTS: Over half (56%) of the 570 men who identified as gay or bisexual reported taking recreational drugs in the past 5 years and 71.5% of these men had used chemsex drugs in the past year. Among men reporting chemsex drug use (past year), 32.1% had injected any drugs in the past year. Sub-optimal clinic attenders were more likely than regular attenders to report chemsex drug use (past year; 46.9% vs. 33.2%, P = 0.001), injecting any drugs (past year; 17.1% vs. 8.9%, P = 0.011) and recreational drug use (past 5 years; 65.5% vs. 48.8%, P < 0.001). One in five sub-optimal attenders had missed an HIV clinic appointment because of taking recreational drugs (17.4% vs. 1.8%, P < 0.001). In multivariable logistic regression, chemsex drug use was significantly associated with sub-optimal clinic attendance (adjusted odds ratio = 1.71, 95% confidence interval: 1.10-2.65, P = 0.02). CONCLUSIONS: Our findings highlight the importance of systematic assessment of drug use and development of tools to aid routine assessment. We suggest that chemsex drug use should be addressed when developing interventions to improve engagement in HIV care among gay and bisexual men.

The role of the advanced clinical practitioner in breast diagnosis: A systematic review of the literature.

INTRODUCTION: Increasing prevalence in breast cancers, workforce shortages and technological advancements have increased the need to further develop advanced practice in breast diagnosis. The Advanced Clinical Practitioner training programme has been introduced to support this need. The aim of this work was to systematically review studies that explore advanced practice in mammography to assess the potential impact of the introduction of a specific Advanced Clinical Practitioner training programme in breast diagnosis within the UK. METHODS: A systematic PRISMA review of the literature published between 1999 and January 2020 was carried out. A total of 17 studies were included in the review. RESULTS: Four themes were identified in the literature in relation to advanced practice in breast imaging: multidisciplinary practice; roles and responsibilities associated with advanced practice; development and progression; embedding and sustaining advanced practice. It was evident across all themes that advanced practice is vital in supporting better care for patients attending breast imaging in light of workforce shortages. Although advanced practice and its benefits are well established in breast imaging, persistent barriers were acknowledged such as role ambiguity, recruitment issues, lack of support from some radiologists and poor funding. CONCLUSION: Findings suggest that introducing a more formalised pathway to advanced practice into breast imaging through the implementation of a specific Advanced Clinical Practitioner apprenticeship training programme may overcome many of the challenges evidenced in this review. IMPLICATIONS FOR PRACTICE: The findings of this review will help inform the development of the Advanced Clinical Practitioner apprenticeship programme specific to breast diagnosis.

A comparative study of pain experienced during successive mammography examinations in patients with a family history of breast cancer and those who have had breast cancer surgery.

INTRODUCTION: To measure mammography-related pain in two groups of women undergoing regular surveillance as a baseline for future care. METHODS: Following ethical approval, two hundred and forty two women aged 32-84 years (mean 54), were invited by written invitation to participate in the study. Two hundred women accepted the invitation, 100 women had a family history (FH) of breast cancer, 100 had undergone conservative surgery (FU) for breast cancer and were currently asymptomatic. A validated pain scale was used to score the participants' perceived pain before compression based on memory, immediately after compression and one week later. A series of baseline parameters were also captured including compression force, breast size/density, menstrual history and any adverse events following mammography to allow the investigation of relationships. RESULTS: There was a strong correlation (r = 0.79, p < 0.001) between previous pain scores and current pain scores, no significant correlations were found between breast size, breast density or total compression force and pain. Pain scores reduced between previous and current examinations and there was consistency in overall pain scores, despite variations in the compression forces applied. CONCLUSION: Physical side effects from mammography can develop and extend beyond the examination period. Patients' prior experience of pain was the only significant predictor of current pain in this study. IMPLICATIONS FOR PRACTICE: Data on past mammography experiences are essential to improve future pain outcomes. Post-mammography aftercare should be a routine feature of the examination.

Learning to look: Evaluating the student experience of an interactive image appraisal activity.

INTRODUCTION: Student radiographers have expressed difficulty in performing image appraisal tasks. The purpose of this study was to investigate the value of a workshop delivered to level 4 undergraduate students. All students completed an image appraisal activity, inputting their appraisal into software that displayed their response alongside an expert opinion. They were asked to identify and discuss any discrepancy. METHODS: All Level 4 students participated in an image appraisal workshop and were subsequently invited to take part in a focus group immediately after the activity. Twenty-three students took part in three focus groups (n = 7; n = 8; n = 8). A thematic analysis of transcripts was performed alongside validation from observations during the image appraisal activity. RESULTS: Findings demonstrate that despite teaching and resources being available, students had focused on learning a generic checklist for image appraisal, had not appreciated the application of projection specific criteria and felt underprepared. The use of specific criteria and repetition within the task was considered useful. They identified learning needs and misconceptions through peer discussion and via the expert opinion, highlighting the value of feedback. Students enjoyed the workshop and made suggestions for implementation into the curriculum. CONCLUSION: Educators must not assume that the provision of resources will result in students developing deep knowledge. Teaching and learning strategies that are task specific are recommended to avoid a surface approach to learning. Time, repetition and appropriate feedback are essential to enable learners to develop competence and confidence for complex visual tasks, such as image appraisal.

Association between knowledge, risk behaviours, and testing for sexually transmitted infections among men who have sex with men: findings from a large online survey in the United Kingdom.

OBJECTIVES: In the UK, men who have sex with men (MSM) bear a disproportionate sexually transmitted infection (STI) burden. We investigated MSM's STI knowledge; whether their STI testing behaviour met national guidelines (annually if sexually active; 3-monthly if engaging in STI risk behaviours); and the relationship between STI testing in the last 3 months, STI knowledge and STI risk behaviours by HIV status. METHODS: Sexually active (in the last year) men aged > 15 years who were UK residents and were recruited from gay-orientated online dating platforms completed an anonymous online survey about STI knowledge, STI risk behaviours, and STI testing (March-May 2017). This included 11 true statements about STIs. Respondents scored 1 for each statement they 'knew', with those scoring < 6 overall treated as having 'poor' STI knowledge. Descriptive and multivariable analyses were conducted, separately by HIV status, to test our hypothesis and calculate adjusted odds ratios (AORs) with 95% confidence intervals (CIs). RESULTS: Compared to HIV-positive men (n = 489), the proportion of HIV-negative/unknown-status men (n = 3157) with 'poor' STI knowledge was significantly higher (46.4% versus 22.9% for HIV-positive men) and the proportion with STI testing in the last 12 months was lower (71.6% versus 87.2%, respectively). In the last 3 months, 56.9% of HIV-negative/unknown-status and 74.1% of HIV-positive men reported STI risk behaviours, of whom 45.8% and 55.1%, respectively, had been tested for STIs during this time. Among HIV-negative/unknown-status men, those reporting STI risk behaviours were more likely (AOR 1.52; 95% CI 1.26-1.84) and those with poor STI knowledge less likely (AOR 0.73; 95% CI 0.61-0.89) to have been tested during the last 3 months. However, neither factor was independently associated with 3-monthly testing among HIV-positive men. CONCLUSIONS: Improving STI knowledge, especially among HIV-negative/unknown-status men, and promoting frequent STI testing among men engaging in STI risk behaviours are vital to address the poor sexual health of MSM.

Has Chlamydia trachomatis prevalence in young women in England, Scotland and Wales changed? Evidence from national probability surveys.

We evaluate the utility of the National Surveys of Attitudes and Sexual Lifestyles (Natsal) undertaken in 2000 and 2010, before and after the introduction of the National Chlamydia Screening Programme, as an evidence source for estimating the change in prevalence of Chlamydia trachomatis (CT) in England, Scotland and Wales. Both the 2000 and 2010 surveys tested urine samples for CT by Nucleic Acid Amplification Tests (NAATs). We examined the sources of uncertainty in estimates of CT prevalence change, including sample size and adjustments for test sensitivity and specificity, survey non-response and informative non-response. In 2000, the unadjusted CT prevalence was 4.22% in women aged 18-24 years; in 2010, CT prevalence was 3.92%, a non-significant absolute difference of 0.30 percentage points (95% credible interval -2.8 to 2.0). In addition to uncertainty due to small sample size, estimates were sensitive to specificity, survey non-response or informative non-response, such that plausible changes in any one of these would be enough to either reverse or double any likely change in prevalence. Alternative ways of monitoring changes in CT incidence and prevalence over time are discussed.

mTOR kinase inhibition reduces tissue factor expression and growth of pancreatic neuroendocrine tumors.

Essentials Tissue factor (TF) isoforms are expressed in pancreatic neuroendocrine tumors (pNET). TF knockdown inhibits proliferation of human pNET cells in vitro. mTOR kinase inhibitor sapanisertib/MLN0128 suppresses TF expression in human pNET cells. Sapanisertib suppresses TF expression and activity and reduces the growth of pNET tumors in vivo. SUMMARY: Background Full-length tissue factor (flTF) and alternatively spliced TF (asTF) contribute to growth and spread of pancreatic ductal adenocarcinoma. It is unknown, however, if flTF and/or asTF contribute to the pathobiology of pancreatic neuroendocrine tumors (pNETs). Objective To assess TF expression in pNETs and the effects of mTOR complex 1/2 (mTORC1/2) inhibition on pNET growth. Methods Human pNET specimens were immunostained for TF. Human pNET cell lines QGP1 and BON were evaluated for TF expression and responsiveness to mTOR inhibition. shRNA were used to knock down TF in BON. TF cofactor activity was assessed using a two-step FXa generation assay. TF promoter activity was assessed using transient transfection of human TF promoter-driven reporter constructs into cells. Mice bearing orthotopic BON tumors were treated with the mTORC1/2 ATP site competitive inhibitor sapanisertib/MLN0128 (3 mg kg-1 , oral gavage) for 34 days. Results Immunostaining of pNET tissue revealed flTF and asTF expression. BON and QGP1 expressed both TF isoforms, with BON exhibiting higher levels. shRNA directed against TF suppressed BON proliferation in vitro. Treatment of BON with sapanisertib inhibited mTOR signaling and suppressed TF levels. BON tumors grown in mice treated with sapanisertib had significantly less TF protein and cofactor activity, and were smaller compared with tumors grown in control mice. Conclusions TF isoforms are expressed in pNETs. Sapanisertib suppresses TF mRNA and protein expression as well as TF cofactor activity in vitro and in vivo. Thus, further studies are warranted to evaluate the clinical utility of TF-suppressing mTORC1/2 inhibitor sapanisertib in pNET management.

Effective lifetime radiation risk for a number of national mammography screening programmes.

BACKGROUND AND PURPOSE: The performance of mammography screening programmes is focussed mainly on breast cancer detection rates. However, when the benefits and risks of mammography are considered, the risk of radiation-induced cancer is calculated for only the examined breast using Mean Glandular Dose (MGD). The risk from radiation during mammography is often described as low or minimal. This study aims to evaluate the effective lifetime risk from full field digital mammography (FFDM) for a number of national screening programmes. MATERIAL AND METHODS: Using an ATOM phantom, radiation doses to multiple organs were measured during standard screening mammography. Sixteen FFDM machines were used and the effective lifetime risk was calculated across the female lifespan for each machine. Once the risks were calculated using the phantom, the total effective lifetime risk across 48 national screening programmes was then calculated; this assumed that all these programmes use FFDM for screening. RESULTS: Large differences exist in effective lifetime risk, varying from 42.21 [39.12-45.30] cases/106 (mean [95% CI]) in the Maltese screening programme to 1099.67 [1019.25-1180.09] cases/106 for high breast cancer risk women in the United States of America. These differences are mainly attributed to the commencement age of screening mammography and the time interval between successive screens. CONCLUSIONS: Effective risk should be considered as an additional parameter for the assessment of screening mammography programme performance, especially for those programmes which recommend an early onset and more frequent screening mammography.

Deriving a clinical prediction rule to target sexual healthcare to women attending British General Practices.

Some women attending General Practices (GPs) are at higher risk of unintended pregnancy (RUIP) and sexually transmitted infections (STI) than others. A clinical prediction rule (CPR) may help target resources using psychosocial questions as an acceptable, effective means of assessment. The aim was to derive a CPR that discriminates women who would benefit from sexual health discussion and intervention. Participants were recruited to a cross-sectional survey from six GPs in a city in South-East England in 2016. On arrival, female patients aged 16-44 years were invited to complete a questionnaire that addressed psychosocial factors, and the following self-reported outcomes: 2+ sexual partners in the last year (2PP) and RUIP. For each sexual risk, psychosocial questions were retained from logistic regression modelling which best discriminated women at risk using the C-statistic. Sensitivity and specificity were established in consultation with GP staff. The final sample comprised N = 1238 women. 2PP was predicted by 11 questions including age, binge-drinking weekly, ever having a partner who insulted you often, current smoking, and not cohabiting (C-statistic = 0.83, sensitivity = 73% and specificity = 77%). RUIP was predicted by 5 questions including sexual debut <16 years, and emergency contraception use in the last 6 months (C-statistic = 0.70, sensitivity = 69% and specificity = 57%). 2PP was better discriminated than RUIP but neither to a clinically-useful degree. The finding that different psychosocial factors predicted each outcome has implications for prevention strategies. Further research should investigate causal links between psychosocial factors and sexual risk.

Staging and surgical approaches in gastric cancer: A systematic review.

BACKGROUND: Gastric adenocarcinoma accounted for 6.8% of new cancer cases and 8.8% of cancer deaths worldwide in 2012. Although resection is the cornerstone for cure, several aspects of surgical intervention remain controversial or sub-optimally applied at the population level. These include staging, extent of lymph node dissection (LND), optimal requirements of LN assessment, minimum resection margins, surgical technique (laparoscopic vs. open), relationship between surgical volumes and patient outcomes, and resection of stage IV gastric cancer. METHODS: A systematic review was conducted to inform surgical care. RESULTS: The evidence included in this systematic review consists of one guideline, seven systematic reviews and 48 primary studies. CONCLUSIONS: All patients should be discussed at a multidisciplinary team meeting and a staging CT of the chest and abdomen should always be performed. Diagnostic laparoscopy should be performed in patients at risk for stage IV disease. A D2 LND is preferred for curative-intent resection in advanced non-metastatic gastric cancer. At least 16 LNs should be assessed for adequate staging of curative-resected gastric cancer. Gastric cancer surgery should aim to achieve an RO resection margin. In the metastatic setting, surgery should only be considered for palliation of symptoms. Patients should be referred to higher volume centres, and those with adequate support to manage potential complications. Laparoscopic resections should be performed to the same standards as open resections.

Staging and surgical approaches in gastric cancer: a clinical practice guideline.

BACKGROUND: Resection is the cornerstone of cure for gastric adenocarcinoma; however, several aspects of surgical intervention remain controversial or are suboptimally applied at a population level, including staging, extent of lymphadenectomy (lnd), minimum number of lymph nodes that have to be assessed, gross resection margins, use of minimally invasive surgery, and relationship of surgical volumes with patient outcomes and resection in stage iv gastric cancer. METHODS: Literature searches were conducted in databases including medline (up to 10 June 2016), embase (up to week 24 of 2016), the Cochrane Library and various other practice guideline sites and guideline developer Web sites. A practice guideline was developed. RESULTS: One guideline, seven systematic reviews, and forty-eight primary studies were included in the evidence base for this guidance document. Seven recommendations are presented. CONCLUSIONS: All patients should be discussed at a multidisciplinary team meeting, and computed tomography (ct) imaging of chest and abdomen should always be performed when staging patients. Diagnostic laparoscopy is useful in the determination of M1 disease not visible on ct images. A D2 lnd is preferred for curative-intent resection of gastric cancer. At least 16 lymph nodes should be assessed for adequate staging of curative-resected gastric cancer. Gastric cancer surgery should aim to achieve an R0 resection margin. In the metastatic setting, surgery should be considered only for palliation of symptoms. Patients should be referred to higher-volume centres and those that have adequate support to manage potential complications. Laparoscopic resections should be performed to the same standards as those for open resections, by surgeons who are experienced in both advanced laparoscopic surgery and gastric cancer management.

An exploration of mammographers' attitudes towards the use of social media for providing breast screening information to clients.

INTRODUCTION: Increasingly patients and clients of health services are using social media to locate information about medical procedures and outcomes. There is increasing pressure for health professionals to engage in on-line spaces to provide clear and accurate information to their patient community. Research suggests there are some anxieties on the part of practitioners to do this. This study aimed to explore the attitudes of the NHS breast screening programme workforce towards engaging in online discussions with clients about breast screening. METHOD: 78 practitioners, representing a range of professional roles within the NHS Breast Screening Programme, attended one of 4 workshops. We used a Nominal Group Technique to identify and rank responses to the question: "What are the challenges that practitioners face in using SoME as part of their role?" Responses were categorised into themes. Participants were also asked to identify solutions to these challenges. RESULTS: Challenges: We identified two overarching themes: (1) Working within boundaries: which was further categorised into (a) Professional/legal accountability; (b) Information accuracy and (c)Time as a boundary, and (2) Support: further categorised into (a) Employer and (b) Manager. Solutions: These included: training in technical and interactional aspects of on-line communication and a responsibility to better understand employer and professional body SoMe policies. CONCLUSION: The study participants appeared willing and motivated to engage in SoMe. However, in keeping with the literature from other disciplines, a number of challenges need to be overcome for its use to be adopted more widely by breast screening professionals.