Taylor-Phillips S.,University of Warwick |
Wallis M.G.,Cambridge Universities Foundation Trust |
Jenkinson D.,University of Warwick |
Adekanmbi V.,University of Warwick |
And 9 more authors.
JAMA - Journal of the American Medical Association | Year: 2016
Importance: Interpreting screening mammograms is a difficult repetitive task that can result in missed cancers and false-positive recalls. In the United Kingdom, 2 film readers independently evaluate each mammogram to search for signs of cancer and examine digital mammograms in batches. However, a vigilance decrement (reduced detection rate with time on task) has been observed in similar settings. Objective: To determine the effect of changing the order for the second film reader of batches of screening mammograms on rates of breast cancer detection. Design, Setting, and Participants: A multicenter, double-blind, cluster randomized clinical trial conducted at 46 specialized breast screening centers from the National Health Service Breast Screening Program in England for 1 year (all between December 20, 2012, and November 3, 2014). Three hundred sixty readers participated (mean, 7.8 readers per center)-186 radiologists, 143 radiography advanced practitioners, and 31 breast clinicians, all fully qualified to report mammograms in the NHS breast screening program. Interventions: The 2 readers examined each batch of digital mammograms in the same order in the control group and in the opposite order to one another in the intervention group. Main Outcomes and Measures: The primary outcomewas cancer detection rate; secondary outcomes were rates of recall and disagreements between readers. Results: Among 1 194 147 women (mean age, 59.3; SD, 7.49) who had screening mammograms (596 642 in the intervention group; 597 505 in the control group), the images were interpreted in 37 688 batches (median batch size, 35; interquartile range [IQR]; 16-46), with each reader interpreting a median of 176 batches (IQR, 96-278). After completion of all subsequent diagnostic tests, a total of 10 484 cases (0.88%) of breast cancer were detected. There was no significant difference in cancer detection rate with 5272 cancers (0.88%) detected in the intervention group vs 5212 cancers (0.87%) detected in the control group (difference, 0.01% points; 95% CI, -0.02% to 0.04% points; recall rate, 24 681 [4.14%] vs 24 894 [4.17%]; difference, -0.03% points; 95% CI, -0.10% to 0.04% points; or rate of reader disagreements, 20 471 [3.43%] vs 20 793 [3.48%]; difference, -0.05% points; 95% CI, -0.11% to 0.02% points). Conclusions and Relevance: Interpretation of batches of mammograms by qualified screening mammography readers using a different order vs the same order for the second reading resulted in no significant difference in rates of detection of breast cancer. Copyright © 2016 American Medical Association. All rights reserved.
Gill R.B.S.,The Royal Veterinary College |
Day A.,The Royal Veterinary College |
Barstow A.,The Royal Veterinary College |
Liu H.,Cambridge Universities Foundation Trust |
And 2 more authors.
Biochemical and Biophysical Research Communications | Year: 2011
SULF2 enzyme regulates the activities of a number of signalling pathways that in many tissues are up-regulated during development and disease. As we recently showed for avian Sulf1, the present study demonstrates that mammalian Sulf2 gene can also generate functionally distinct splice variants that would regulate normal development and tumour growth differentially. It is thus important to distinguish SULF1/SULF2 isoforms in mammalian tissues to understand their functional and clinical relevance to disease. This study demonstrates that unlike normal adult lung with little or no SULF2 expression, this enzyme is expressed at high levels in most lung tumours showing differential cellular distribution of full length and shorter SULF2 variants in such tumours. Furthermore, we show that the short SULF2 splice variants are associated with those signalling pathways that are inhibited by full length SULF1/SULF2 variants and therefore could promote growth in such lung tumours. © 2011 Elsevier Inc.
Sarker A.,Cambridge Universities foundation trust |
Meek C.L.,Cambridge Universities foundation trust |
Meek C.L.,University of Cambridge |
Park A.,Cambridge Universities foundation trust
Annals of Clinical Biochemistry | Year: 2016
Obesity, defined as a body mass index over 30 kg/m2 for adults, poses a major healthcare challenge with important economic, personal and social consequences. Although public health measures, lifestyle change and pharmacological therapies have an important role in the management of obesity, patients with established morbid obesity (body mass index over 40 kg/m2) may also require bariatric surgery. Bariatric or metabolic surgery is associated with effective and enduring weight loss but is also known to improve glucose homeostasis, blood pressure and dyslipidaemia. Patients who have bariatric surgery need lifelong clinical follow-up to identify and prevent nutritional deficiencies and other complications. Clinical biochemistry laboratories have an important role in the nutritional assessment of obese patients and in the identification of complications following bariatric surgery. The aim of this article is to review the different bariatric procedures available and to summarize their complications, especially nutrient deficiencies and those of particular relevance to clinical biochemistry laboratories. © 2015, The Author(s) 2015.