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Biomedical subjects

E M Hewer

Publications and source records attributed to E M Hewer.

7 recordsLinked to original sources
PubMed2003

Examination for the Certificate in Advanced Practice in Cervical Cytology--the first year's experience.

Following the decision to establish an Advanced Biomedical Scientist Practitioner grade for senior biomedical scientists in the NHS Cervical Screening Programme, a conjoint examination board has been appointed by the Royal College of Pathologists and Institute of Biomedical Science to oversee the Certificate in Advanced Practice in Cervical Cytology examination. The examination consists of a multiple-choice paper, short-answer written questions and practical microscopy sections covering screening of unmarked slides, and more complex discussion cases. In the first year there were 58 entries with 29 successful candidates, a pass rate of 50%. The standard of performance in the examination showed a wide range, and some candidates appear to have underestimated the degree of preparation, knowledge or level of microscopy skill required.

Cell Biology↗
PubMed2002

External quality assessment in gynaecological cytology: The Trent Region experience. The Trent Regional Gynaecological Pathology Quality Assurance Group for the National Health Service Cervical Screening Programme.

A Department of Health Executive Letter stated in 1998 that the principal function of external quality assessment (EQA) is educational. Subsequently, in England, it has no longer been acceptable to assess performance in gynaecological cytology by proficiency testing. This paper describes the EQA scheme in gynaecological cytology that has been run by the Trent Regional Gynaecological Pathology Quality Assurance Group for the NHS Cervical Screening Programme (NHSCSP) since 1998. It conforms as closely as possible to the recommendations published by the Department of Health Working Group on Histopathology EQA Accreditation, and replaced the national proficiency testing protocol. The educational value of the scheme is derived predominantly from a numerical score which provides confidential and quantitative feedback to all participants. Personal performance monitoring occurs as a secondary function. For primary screeners and checkers, this is based purely on the distinction between negative, inadequate and abnormal smears. For pathologists, personal performance monitoring also includes grading of abnormalities. The EQA has been designed so that all professional groups participate in a manner that closely mimics normal practice. Only slides that have achieved an 80% consensus amongst participants are used in the EQA. Substandard performance has been defined as those participants with scores falling below the 2.5%ile. The paper describes the EQA in detail and illustrates its use by means of the second round results. The EQA protocol developed within Trent and described in this paper has contributed to proposals contained in the current national EQA in gynaecological cytology for the NHSCSP. In particular this paper highlights the effectiveness of the scoring system contained within the Trent and National EQA protocols.

Education↗
PubMed2001

Rapid screening: a comparative study.

Although rapid screening of negative and inadequate cervical smears is a quality assurance requirement for all UK laboratories, there has been little attempt to standardize the method and laboratories make use of a number of different techniques and times. The aim of this study was to assess the sensitivity of these various techniques by measuring their ability to pick out known false-negative smears. Completed questionnaires from 123 laboratories across England revealed that 52% of laboratories use a "step" technique, 19% use "turret", 15% use random paths and 34% attempt to rescreen the whole slide quickly. Twenty-two percent of laboratories use a mixture of techniques. Timings are also variable, with the majority of laboratories allowing screeners to review slides at a pace decided by themselves but usually between 1 and 2 min. The study involved 120 participants who performed a total of 24 000 rapid screens. The results showed that, of the 90 abnormal slides used in the study, 62 cases (69%) were identified as abnormal or needing review by more than 50% of participants. Overall rapid screening picked out 58% of high-grade squamous abnormalities, 59% of low-grade abnormalities and 72% of glandular lesions. Step screening performed best, followed by whole slide/random and then turret. One minute was the optimum time and there was a significant fall in performance once individuals attempted to rescreen large numbers (>50). The most significant finding was the marked variation in the performance of individuals using the same slide sets.

Diagnostic Errors↗
PubMed2000

The effect of nonscreening smears on screening smear results: a statistical analysis with its implications for the NHS cervical screening programme.

This is a statistical analysis of individual NHS Cervical Screening Programme laboratories screening smear 'pick-up' rates (defined here as percentage low grade and percentage high grade of total adequate smears for ages 20-64 years derived from general practitioners and community clinics) in relation to their nonscreening smear workload proportion (here defined as percentage nonscreening smears of total laboratory workload from all sources for all ages). This was achieved by the use of three one way ANOVA models in order to receive a complete overview of the results. The models were applied to the following: (1) Laboratories with a total workload of less than 15000 general practitioner (GP) and community clinic smears; (2) laboratories with a total workload of greater than 15000 GP and community smears and; (3) all laboratories (i.e. a combination of 1 and 2). The 'test' groups within each of these models comprised three subgroups based on the percentage of laboratory workload that consisted of smears from a nonscreening source. This figure ranged from 2.8% to 82.6%. The subgroups were divided so as to contain approximately the same number of laboratories in each one (172 laboratories in total, 42 with workload < 15000 and 130 with > 15000). The results show that laboratories high and low grade pick-up rates have a positively correlated but variable relationship with the proportion of their workload that consists of nonscreening smears. The results show significance overall at the 5% level for high grade and the 10% level for low grade (high grade at P = 0.045 and low grade at P = 0.071). Significance for laboratories viewing less than 15000 screening smears at the 1% level (high grade P = 0.006 and low grade P = 0.005). They show no significance, however, for laboratories viewing more than 15000 screening smears (high grade P = 0.457 and low grade P = 0.622). There is an intriguing possibility that a greater exposure to abnormal smears results in a greater tendency to detect them. The current data provides no evidence to support the NHS Executive's use of 15000 as a designated figure when quality monitoring and service provision becomes a specific issue. The closure or amalgamation of laboratories with workloads less than this would appear to have no scientific evidence base.

Adult↗
PubMedDate not supplied

Competency assessment and proficiency testing.

Competency assessment is an ongoing, continuous process of monitoring individuals' abilities to perform their specific job functions. A variety of methods are useful in monitoring cytology competency, including rescreening studies, descriptive monitors (abnormality rates), discrepancy rates, workload patterns, competency-based educational programs and programs using unknown slide challenges. The goal of proficiency testing (PT) is to ascertain and assess the ability of individuals beyond the particular items or challenges presented. However, cytology PT faces many challenges for implementation as it cannot duplicate normal working conditions, and there is often no gold standard to define the truth. PT is just one measure of performance and should be considered in conjunction with other quality assessment monitors. There is no consensus on the value or validity of a large-scale regulatory PT program. Any regulatory PT program should be field tested prior to implementation, and the grading system should be scientifically defensible. Scoring of performance on PT should occur in a timely fashion, and there should be an opportunity for educational feedback. The ultimate aim of both competency assessment and PT is to positively affect laboratory procedures and improve the cervical cancer screening process.

Cell Biology↗