Identification of factors associated with diagnostic performance variation in reporting of mammograms: A review.

OBJECTIVES: This narrative review aims to identify what factors are linked to diagnostic performance variation for those who interpret mammograms. Identification of influential factors has potential to contribute to the optimisation of breast cancer diagnosis. PubMed, ScienceDirect and Google Scholar databases were searched using the following terms: 'Radiology', 'Radiologist', 'Radiographer', 'Radiography', 'Mammography', 'Interpret', 'read', 'observe' 'report', 'screen', 'image', 'performance' and 'characteristics.' Exclusion criteria included articles published prior to 2000 as digital mammography was introduced at this time. Non-English articles language were also excluded. 38 of 2542 studies identified were analysed. KEY FINDINGS: Influencing factors included, new technology, volume of reads, experience and training, availability of prior images, social networking, fatigue and time-of-day of interpretation. Advancements in breast imaging such as digital breast tomosynthesis and volume of mammograms are primary factors that affect performance as well as tiredness, time-of-day when images are interpreted, stages of training and years of experience. Recent studies emphasised the importance of social networking and knowledge sharing if breast cancer diagnosis is to be optimised. CONCLUSION: It was demonstrated that data on radiologist performance variability is widely available but there is a paucity of data on radiographers who interpret mammographic images. IMPLICATIONS FOR PRACTICE: This scarcity of research needs to be addressed in order to optimise radiography-led reporting and set baseline values for diagnostic efficacy.

Social and emotional wellbeing assessment instruments for use with Indigenous Australians: A critical review.

RATIONALE: There is growing recognition that in addition to universally recognised domains and indicators of wellbeing (such as population health and life expectancy), additional frameworks are required to fully explain and measure Indigenous wellbeing. In particular, Indigenous Australian wellbeing is largely determined by colonisation, historical trauma, grief, loss, and ongoing social marginalisation. Dominant mainstream indicators of wellbeing based on the biomedical model may therefore be inadequate and not entirely relevant in the Indigenous context. It is possible that "standard" wellbeing instruments fail to adequately assess indicators of health and wellbeing within societies that have a more holistic view of health. OBJECTIVE: The aim of this critical review was to identify, document, and evaluate the use of social and emotional wellbeing measures within the Australian Indigenous community. METHOD: The instruments were systematically described regarding their intrinsic properties (e.g., generic v. disease-specific, domains assessed, extent of cross-cultural adaptation and psychometric characteristics) and their purpose of utilisation in studies (e.g., study setting, intervention, clinical purpose or survey). We included 33 studies, in which 22 distinct instruments were used. RESULTS: Three major categories of social and emotional wellbeing instruments were identified: unmodified standard instruments (10), cross-culturally adapted standard instruments (6), and Indigenous developed measures (6). Recommendations are made for researchers and practitioners who assess social and emotional wellbeing in Indigenous Australians, which may also be applicable to other minority groups where a more holistic framework of wellbeing is applied. CONCLUSION: It is advised that standard instruments only be used if they have been subject to a formal cross-cultural adaptation process, and Indigenous developed measures continue to be developed, refined, and validated within a diverse range of research and clinical settings.

How to research the mechanisms of non-pharmacological cardiac interventions.

OBJECTIVE: To discuss research into the mechanisms of non-pharmacological interventions for cardiac populations. METHODS: Overview of past research and theory. RESULTS: Non-pharmacological interventions for cardiac patients (including: cardiac rehabilitation, heart failure disease management programs and psychosocial interventions) have never been so common or diverse, but also have never been subject to so much scrutiny and skepticism. Better understanding of outcomes of these interventions is an urgent global priority. Mechanisms are the "underlying entities, processes, or structures which operate in particular contexts to generate outcomes of interest." PRACTICE: Research into the mechanisms of non-pharmacological interventions offers useful and robust knowledge of how and why cardiac interventions work that can be vital to explaining outcomes from interventions and inconsistencies in results. CONCLUSIONS: Research into intervention mechanisms can inform the design and optimization of interventions. IMPLICATIONS: We recommend that future research into the mechanisms of non-pharmacological interventions for cardiac population 1) view effectiveness as 'somewhat' patterned, 2) conceptualize mechanisms adequately, 3) assume they are hidden, 4) examine how context affects mechanisms, and 6) address what works for whom, when, and why.

The prevalence and recognition of major depression among low-level aged care residents with and without cognitive impairment.

Previous research has demonstrated a high level of depression in nursing homes. The current study was designed to determine the prevalence of depression, using a structured diagnostic interview, among older people with and without mild-moderate cognitive impairment residing in low-level care facilities. The results demonstrated that, consistent with previous research in nursing homes, 16.9% of older people were diagnosed with major depressive disorder. Less than half of these cases had been detected or treated. Individuals with moderate cognitive impairment were more likely to be depressed, but cognitive impairment did not appear to act as a strong impediment to the detection of depression by general practitioners. A low awareness of their use of antidepressant medications was demonstrated among older people prescribed this treatment, including those with normal cognitive function. Reasons for the poor recognition of depression among older people are discussed.