Characteristics Of Mammography Facilities Associated Accuracy Defined

Four characteristics of mammography facilities have been found to be associated with higher overall levels of accuracy in screening, reports a study published in Journal of National Cancer Institute ( online June 10 ) . The study showed that higher interpretative accuracy is seen with facilities offering only screening mammography, which have breast imaging specialists to interpret mammograms, which undertake single readings ( as opposed to double ) and which undertake independent audits at least twice yearly.

" These findings are important because a referring physician or patient herself is much more likely to have the opportunity to choose the facility where mammogram is performed and interpreted than they're to choose radiologist who will interpret mammogram, " write the authors, Stephen Taplin and colleagues from the National Cancer Institute ( Bethesda, Maryland, USA ) .

With more than 27 million women undergoing screening mammography world-wide each year, there's growing concern to improve technique performance. The two main factors known to influence interpretation of mammograms are characteristics of women being screened ( factors like breast density, age and time since their last mammogram ) and the experience of interpreting radiologist ( things like years on the job and reading volumes ) . However, studies have suggested that these characteristics account for only 10 % of variations in performance.

In the current observational study, Taplin and colleagues set out to determine extent to which screening performance varies according to the characteristics of different screening facilities. The cross-sectional survey based study involved 484, 463 screening mammograms, taking place between January 1996 and December 2001, that were performed on 237 669 women at 44 facilities.

Breast cancer outcomes for participants in study were ascertained by linking data with regional surveillance registries, local tumour registries and breast pathology databases. Results show that on average, the facilities identified cancer when it was present ( sensitivity ) in 79. 6 % of breast cancer cases that occurred within one year and correctly categorised a mammogram as cancer-free ( specificity ) 90. 2 % of time.

The authors used area under the curve ( AUC ) method to look for differences between facilities in terms of overall accuracy. This statistical method is routinely used to flag up differences between different sets of data. The AUC was higher among facilities that offered screening mammograms alone versus those that offered screening and diagnostic mammograms ( 0. 943 vs 0. 911, P = . 006 ) , had a breast imaging specialist interpreting mammograms compared to those who didn't ( 0. 932 vs 0. 905, P = . 004 ) , that didn't perform double reading versus independent double reading versus consensus double reading ( 0. 925 vs 0. 915 vs 0. 887, P = . 034 ) , or conducted audit reviews two or more times per year versus annually versus at an unknown frequency ( 0. 929 vs 0. 904 vs 0. 900, P = . 018 ) .

The authors were surprised that neither facility volume, nor method of audit review, were found to be associated with greater interpretive accuracy. Furthermore, double reading methods did not show any advantages.

One of limitations of study design, they say, was that it did not take account different methods of double reading that are used in different centres. Other limitations included possible unaccounted differences among women and radiologists. The authors took account of breast density, age and time since last mammogram in women, and years of experience and reading volumes in radiologists, but say there may be other factors that were not taken into account.

" Understanding how facility characteristics influence interpretive accuracy could allow women and physicians to choose a mammography facility based on characteristics that are more likely to be associated with higher quality. Radiologists could also change facilities' structures or processes to include practices that improve interpretive accuracy, " conclude authors, adding that the associations identified require further prospective evaluation.

Reference

Mammography Facility Characteristics Associated With Interpretive Accuracy of Screening Mammography Taplin S, Abraham L, Barlow WE et al. Journal of National Cancer Institute 2008, 100: 876-887

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Avandia: uses

Avandia is an anti-diabetic drug ( thiazolidinedione-type, also called " glitazones " ) used with a proper diet and exercise program to control high blood sugar in patients with type 2 diabetes ( non-insulin-dependent diabetes ) . Avandia works by helping to restore your body's proper response to insulin, thereby lowering your blood sugar. Effectively controlling high blood sugar helps prevent heart disease, strokes, kidney disease, blindness, and circulation problems, as well as sexual function problems ( impotence ) .

Avandia is used either alone or in combination with other anti-diabetic medications ( e. g. , metformin, sulfonylureas, insulin ) .

Avandia: how to use

Read Patient Information Leaflet available from your pharmacist before you start taking Avandia and each time we get a refill. If we have any questions, consult your doctor or pharmacist.

Take Avandia by mouth, with or without food, usually once or twice daily, or as directed by your doctor. Dosage is based on your medical condition, response to therapy, and if you are taking other anti-diabetic drugs.

Use Avandia regularly in order to get the most benefit from it. Remember to use it at same time ( s ) each day. Monitor blood glucose levels on a regular basis.

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Avandia: side effects

See also Warning section.

Headache or cough may occur while use Avandia. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

Remember that your doctor has prescribed Avandia because he or she has judged that benefit to we is greater than the risk of side effects. Many people using Avandia don't have serious side effects.

Tell your doctor immediately if any of these unlikely but serious side effects occur:

Tell your doctor immediately if any of these highly unlikely but very serious side effects occur:

Avandia usually does not cause low blood sugar ( hypoglycemia ) , but this effect may occur while use Avandia if we don't consume enough calories ( from food, juices, fruit, etc. ) . The symptoms include chills, cold sweat, dizziness, drowsiness, shaking, rapid heart rate, weakness, headache, fainting, tingling of the hands or feet, or hunger. It is a good habit to carry glucose tablets or gel to treat low blood sugar. If we are in a situation where you don't have these reliable forms of glucose, eat a quick source of sugar such as table sugar, honey, or candy, or drink a glass of orange juice or non-diet soda to quickly raise your blood sugar level. Tell your doctor immediately about reaction. To help prevent hypoglycemia, eat meals on a regular schedule and don't skip meals.

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This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Avandia: precautions

Before taking Avandia, tell your doctor or pharmacist if we are allergic to it; or to other " glitazones " such as pioglitazone; or if we have any other allergies.

Promptly talk with your doctor or pharmacist about the benefits and possible risks of Avandia, even if we have been taking it for awhile, especially if we have heart problems. Don't stop taking it unless directed to do so.

Avandia should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if we have:

Before using Avandia, tell your doctor or pharmacist your medical history, especially of:

We may experience blurred vision, dizziness, or drowsiness due to extremely low or high blood sugar levels; use caution engaging in activities requiring alertness such as driving or using machinery.

Limit alcohol while taking Avandia because it can increase risk of your blood sugar getting too low ( hypoglycemia ) .

During times of stress, such as fever, infection, injury or surgery, it may be more difficult to control your blood sugar. Consult your doctor, as additional medication may be required.

Avandia may increase the risk of bone fracture ( upper arm, hand, foot ) in female patients. To lower chance of getting injured, use caution when doing activities such as contact sports.

Avandia can cause changes in menstrual cycle ( ovulation ) in women with certain fertility problems. Consult your doctor or pharmacist about the use of reliable birth control while taking this medication.

Avandia should be used only when clearly needed during pregnancy. Discuss risks and benefits with your doctor. Your doctor may substitute insulin for Avandia during your pregnancy. Follow all instructions carefully.

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Avandia: interactions

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Before using Avandia, tell your doctor or pharmacist of all prescription and nonprescription/herbal products we may use, especially of:

Beta-blocker medications ( e. g. , metoprolol, propranolol, glaucoma eye drops such as timolol ) may prevent fast/pounding heartbeat you would usually feel when your blood sugar level falls too low ( hypoglycemia ) . Other symptoms of low blood sugar such as dizziness, hunger, or sweating are unaffected by these drugs.

This document doesn't contain all possible interactions. Therefore, before using Avandia, tell your doctor or pharmacist of all products we use. Keep a list of all your medications with you, and share list with your doctor and pharmacist.

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