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Biomedical subjects

H Potts

Publications and source records attributed to H Potts.

14 recordsLinked to original sources
PubMed2005

Increasing the diagnosis of multifocal primary breast cancer by the use of bilateral whole-breast ultrasound.

AIM: The aim of this study was to evaluate the contribution of bilateral whole-breast ultrasound (BBUS) to the diagnosis and management of women with newly diagnosed breast cancer. METHODS: Over a period of 6 months, 102 women presenting with breast cancer underwent BBUS. Data were collected on clinical findings, radiology, histology and surgical outcome. These women were compared with a control group of 124 women presenting over a similar 6-month period 1 year previously, who had undergone targeted breast ultrasound. RESULTS: Multicentric/multifocal tumours were demonstrated in 35 (34%) of the 102 participants and in 18 (15%) of the 124 controls, a statistically significant difference (Fisher's exact test, p = 0.001). Multiple tumours were diagnosed preoperatively in 18% of the study population compared with 8% of the controls, and BBUS identified invasive multifocal/multicentric tumours in significantly more women in the study population (11 versus 1 control) (Fisher's exact test, p = 0.019). Contralateral cancer was diagnosed in 4 women in the study population and none in the control population (Fisher's exact test, p = 0.040). Surgical review showed that the surgical management changed significantly in 8% (95% confidence interval 4 to 14%) of cases in the study population following BBUS. The increase in the number of women undergoing benign biopsies in the study population (10 versus 5 controls) was not statistically significant (Fisher's exact test, p = 0.11). CONCLUSION: BBUS increased the preoperative diagnosis of multiple tumours in women presenting with primary breast cancer, resulting in a management change in 8% of cases.

Adult↗
PubMed2005

Impact of computer-aided detection prompts on the sensitivity and specificity of screening mammography.

OBJECTIVES: To determine the value of computer-aided detection (CAD) for breast cancer screening. DESIGN: Two sets of mammograms with known outcomes were used in two studies. Participants in both studies read the films with and without the benefit of a computer aid. In both studies, the order of reading sessions was randomised separately for each reader. The first set of 180 films, used in study 1, included 20 false-negative interval cancers and 40 screen-detected cancers. The second set of 120 films, used in study 2, was designed to be favourable to CAD: all 44 cancer cases had previously been missed by a film reader and cancers prompted by CAD were preferentially included. SETTING: The studies were conducted at five UK screening centres between January 2001 and April 2003. PARTICIPANTS: Thirty radiologists, five breast clinicians and 15 radiographers participated. INTERVENTIONS: All cases in the trial were digitised and analysed using the R2 ImageChecker version 2.2. Participants all received training on the use of CAD. In the intervention condition, participants interpreted cases with a prompt sheet on which regions of potential abnormality were indicated. MAIN OUTCOME MEASURES: The sensitivity and specificity of participants were measured in both intervention and control conditions. RESULTS: No significant difference was found for readers' sensitivity or specificity between the prompted and unprompted conditions in study 1 [95% confidence index (CI) for sensitivity with and without CAD is 0.76 to 0.80, for specificity it is 0.81 to 0.86 without CAD and 0.81 to 0.87 with CAD]. No statistically significant difference was found between the sensitivity and specificity of different groups of film reader (95% CI for unprompted sensitivity of radiologists was 0.75 to 0.81, for radiographers it was 0.71 to 0.81, prompted sensitivity was 0.76 to 0.81 for radiologists and 0.69 to 0.79 for radiographers). Thirty-five readers participated in study 2. Sensitivity was improved in the prompted condition (0.81 from 0.78) but the difference was slightly below the threshold for statistical significance (95% CI for the difference -0.003 to 0.064). Specificity also improved (0.87 from 0.86); again, the difference was not significant at 0.05 (95% CI -0.003 to 0.034). A cost-effectiveness analysis showed that computer prompting increases cost. CONCLUSIONS: No significant improvement in film readers' sensitivity or specificity or gain in cost-effectiveness was established in either study. This may be due to the system's low specificity, its relatively poor sensitivity for subtle cancers or the fact the prompts cannot serve as aids to decision-making. Readers may have been better able to make use of the prompts after becoming more accustomed to working with them. Prompts may have an impact in routine use that is not detectable in an experimental setting. Although the case for CAD as an element of the NHS Breast Screening Programme is not made here, further research is required. Evaluations of new CAD tools in routine use are underway and their results should be given careful attention.

Diagnosis, Computer-Assisted↗
PubMed2003

Health service utilisation among Filipino women in remote Queensland, Australia.

INTRODUCTION: This paper will discuss health issues among Filipinas (women born in the Philippines) living in remote and rural environments in Queensland in comparison to Filipinas living in other parts of the state. The sample was recruited as part of the University of Queensland component of the Australian Longitudinal Study of Women's Health. Access to health services will be discussed in terms of the framework outlined by McKinley et al: (i) Knowledge (Availability) is measured in terms of consumers' knowledge about the services and consumers' confidence in being able to use the medical care they require; (ii) Accessibility is considered in terms of their location to the consumers in relation to the services (distance) and being able to physically get to them (transport); (iii) Affordability is measured in terms of the extent to which cost is seen as a barrier to service use; (iv) Accommodation is measured in terms of the extent to which service delivery arrangements are able to accommodate consumers' needs and the extent to which doctors' attitudes are seen to be accommodating of those needs. It would be expected that cultural and linguistic issues would primarily affect Knowledge and Accommodation. Differences in Accessibility and Affordability would be expected to be affected by location. Access to services in rural areas may be more difficult and dependent on personal transport. METHODS: The sample, consisting of women born in the Philippines, was recruited though community organizations as part of the University of Queensland component of the Australian Longitudinal Study of Women's Health. Most of the women lived in urban or semi-urban areas (391) and 90 lived in areas designated as rural or remote areas by Queensland Health. The overall response rate was 87% and 83%. RESULTS: There were no differences between urban and rural and remote women in terms of knowledge. However women living in rural and remote areas had greater difficulty getting their information needs met. Consequently problems caused by structural limitations of health service delivery were often exacerbated by differences in expectations of health services and lack of understanding of methods to optimise access to care. CONCLUSION: Many of the barriers experienced by migrant women in rural/ remote areas mirror those of other Australian women. However the results suggest that better information about health services and self-management may improve the interface between service providers and their clients.

Journal Article↗
PubMed2001

Health issues among Filipino women in remote Queensland.

This paper discusses health issues among Filipinas (women born in the Philippines) living in remote and rural environments in Queensland. The sample was recruited as part of the University of Queensland component of the Australian Longitudinal Study of Women's Health (ALSWH). Most of the women lived in an urban or semi-urban area (391), whereas 90 lived in rural or remote areas. Community perceptions had a much greater impact on health service utilisation in rural and remote areas than in urban areas. The transition between newcomer and old-timer is more difficult for Filipinas than for other rural women because they are visibly different from other members of the community and suffer from stigmatisation associated with perceptions of Filipinas as mail order brides. For these women, concerns about confidentiality and a reluctance to ask for support are major barriers to health service utilisation. The area of greatest concern is mental health, particularly in relation to parenting issues. Improving access may involve providing a greater awareness of what services are available and allowing women to access services in a way that does not require them to label themselves or be labelled by others.

Acculturation↗
PubMed2000

Indigenous women's perceptions of breast cancer diagnosis and treatment in Queensland.

OBJECTIVE: To identify social, structural and personal factors among indigenous women in Queensland associated with the detection of breast cancer, and the treatment and post-treatment care and support of cancer. METHODS: Qualitative research including interviews, case studies and focus group discussions were conducted, among Aboriginal women and service providers in urban, rural and remote areas of Queensland over nine months in 1998/99. RESULTS: A range of factors were identified as influencing women's willingness to perform BSE, receive screening mammograms, and receive and complete treatment compared to the non-indigenous population. Personal history of health services, provision of information about mammography, the cost of treatment and care, and availability of personal support, all influenced women's willingness to access services and maintain treatment. Indigenous women in Queensland experience various barriers to effective and appropriate detection, treatment and care of breast cancer. CONCLUSION: Barriers to diagnosis, treatment and care can be addressed by increasing women's awareness of breast cancer and the benefits of preventative health behaviour, and improving the quality and appropriateness of health care and counselling services for Indigenous women and their families. IMPLICATIONS: Indigenous women's knowledge and practice relating to the early diagnosis and prevention of breast cancer may improve through outreach work with women, to encourage their confidence in preventative health. Women's commitment to preventive health will also be enhanced by improved quality and access to health care, and improved relationships between practitioners and patients.

Adult↗
PubMed1999

The Transtheoretical Model and cervical screening: its application among culturally diverse communities in Queensland, Australia.

OBJECTIVES: To apply the Transtheoretical Model of Behaviour Change (TTM) to cervical cancer screening to determine and report on the level of support required by different language and cultural groups in Queensland to enhance participation. The model consists of six stages: Pre-contemplation (no intention to be screened, no past action), Contemplation (intention to be screened, no past action), Action (intention to be screened, initial screening), Maintenance (intention to be screened, regular screening), Relapse (no intention to be screened, initial screening) and Relapse Risk (no intention to be screened, regular screening). DESIGN: Focus groups and structured interviews were used to classify women in terms of the model and collect information regarding knowledge, health service contact barriers and enhancing factors and sources of information in relation to cervical cancer screening. The sample was recruited by bi-cultural workers for each community using snowball techniques. RESULTS: The interview sample consisted of Australian South Sea Islanders, Chinese, German, Greek and Moslem women. There was no evidence of significant differences in TTM stage according to ethnicity. Women who intended to be screened in the future were more likely to have positive decisional balance scores and higher knowledge scores than women who did not. Women who had had Pap tests were significantly more likely to have received information from their general practitioner (GP) than women who had not had Pap tests. Women in Action and Maintenance were also more likely to have had their last Pap test by a female GP compared to women in relapse categories. Women in Pre-contemplation were more likely than women who had Pap tests to agree that they would travel a long way to see a practitioner who spoke their own language. CONCLUSION: Classification based on the model was supported both by the decisional balance scale and measures of knowledge. Women in earlier stages of the model were more likely to express preferences for the provision of services in their own language and by a female. Cervical cancer screening among women in Action and Maintenance appeared to be better supported by GPs. Cervical cancer screening promotion for women of diverse cultures and ethnicities has tended to focus on Pre-contemplation and Contemplation stages, however, as most women in this sample were in Action or Maintenance, as are most Australian-born women, structuring cervical cancer screening promotion in terms of the TTM may significantly improve the effectiveness of interventions for women of diverse cultures and ethnicities.

Adult↗
PubMed1999

"Part and parcel of being a woman": female urinary incontinence and constructions of control.

This article draws on extensive interviews with middle-aged Australian women experiencing urinary incontinence. Our discussion derives from the difficulties women face in seeking advice on the management of incontinence, as a consequence of their perception that the condition is an inevitability, a "normal" part of being female. Women do not, on the whole, support a single cause for incontinence but, rather, explain its incidence in terms of personal history, which may include childbearing and parturition, menopause and aging, and early socialization. In addition, women link their own continence problems with perceived personal failings (e.g., lack of exercise, being overweight) and, hence, see the condition as a symbol of their lack of moral worth. Following this, women's understandings of the relationship of incontinence to their social membership extend far beyond the difficulties of disguising their physical problems.

Adult↗