What is known about this topic?• Advances in breast screening services have led to improvements in early detection, reduced mortality and better management of breast cancer.• Low uptake of the national breast screening programme and delayed presentation of breast cancer symptoms means that mortality from breast cancer continues to be high among Black African women.• Reasons for low uptake of the breast screening services among Black African women are poorly understood. What this paper adds?• This paper presents salient factors leading to low uptake of the NHS Breast Screening programme by Black African women in England.• There is need for culturally relevant interventions to improve knowledge on cancer, cancer screening and treatments options for Black African women.• These interventions should be delivered through community social networks, community media (TV, Radio, newspapers, workshops) and faith settings such as Churches and Mosques.• Offering appropriate and culturally sensitive pre-screening and post-screening counselling services could also help increase Black African women's awareness about breast cancer, reduce their perceptions of the stigma associated with cancer and allay their fears of fatal breast cancer outcomes. ABSTRACTBreast cancer is the most common cancer among women in the United Kingdom (UK) accounting for about 15% of cancer deaths. The National Breast Cancer Screening Programme in the UK was introduced in 1988 to assist with early detection and better management of breast cancer. Black and Minority Ethnic (BME) women however have a low uptake of the National Breast Screening programme when compared to their White counterparts. Within the BME group, Black African women have the lowest uptake of screening services and are more likely to have an advanced stage of the disease at diagnosis, leading to poorer survival rates than White women. This study aimed to explore the factors that lead to low uptake of the National Breast Cancer Screening Programme among Black African women living in Luton, UK and present action points to local breast cancer services. Using a qualitative research design, six focus groups were conducted with a total of twenty-five Black African women residing in Luton between May and June in 2013. Data was analysed thematically using the framework approach. Four main themes emerged across the focus group discussions: awareness and beliefs about breast cancer and risk factors, prevention of breast cancer and awareness of the NHS breast screening programme, low uptake of the NHS breast screening service and suggestions for improving information on breast cancer and the NHS breast cancer screening programme. The findings from this study suggest the need for more targeted information on breast cancer and screening services for Black African women. This could help improve the uptake of the NHS breast screening programme, promote early help-seeking behaviour and improve breast cancer outcomes for this ethnic group.
This article provides an analysis of the skills that health professionals and patients employ in reaching diagnosis and decision-making in telemedicine consultations. As governmental priorities continue to emphasize patient involvement in the management of their disease, there is an increasing need to accurately capture the provider–patient interactions in clinical encounters. Drawing on conversation analysis of 10 video-mediated consultations in 3 National Health Service settings in England, this study examines the interaction between patients, General Practitioner (GPs), nurses, and consultants during diagnosis and decision-making, with the aim to identify the range of skills that participants use in the process and capture the interprofessional communication and patient involvement in the diagnosis and decision-making phases of telemedicine consultations. The analysis shows that teleconsultations enhance collaborative working among professionals and enable GPs and nurses to develop their skills and actively participate in diagnosis and decision-making by contributing primary care–specific knowledge to the consultation. However, interprofessional interaction may result in limited patient involvement in decision-making. The findings of this study can be used to inform training programs in telemedicine that focus on the development of effective skills for professionals and the provision of information to patients.
BackgroundBlack, Asian and minority ethnic (BAME) groups have a high need for organ transplantation but deceased donation is low. This restricts the availability of well-matched organs and results in relatively long waiting times for transplantation, with increased mortality risks.ObjectiveTo identify barriers to organ donor registration and family consent among the BAME population, and to develop and evaluate a training intervention to enhance communication with ethnic minority families and identify impacts on family consent.MethodsThree-phase programme comprising (1) community-based research involving two systematic reviews examining attitudes and barriers to organ donation and effective interventions followed by 22 focus groups with minority ethnic groups; (2) hospital-based research examining staff practices and influences on family consent through ethics discussion groups (EDGs) with staff, a study on intensive care units (ICUs) and interviews with bereaved ethnic minority families; and (3) development and evaluation of a training package to enhance cultural competence among ICU staff.SettingCommunity focus group study in eight London boroughs with high prevalence of ethnic minority populations. Hospital studies at five NHS hospital trusts (three in London and two in Midlands).Participants(1) Community studies: 228 focus group participants; (2) hospital studies: 35 nurses, 28 clinicians, 19 hospital chaplains, 25 members of local Organ Donation Committees, 17 bereaved family members; and (3) evaluation: 66 health professionals.Data sourcesFocus groups with community residents, systematic reviews, qualitative interviews and observation in ICUs, EDGs with ICU staff, bereaved family interviews and questionnaires for trial evaluation.Review methodsSystematic review and narrative synthesis.Results(1) Community studies: Organ Donor Register – different ethnic/faith and age groups were at varying points on the ‘pathway’ to organ donor registration, with large numbers lacking knowledge and remaining at a pre-contemplation stage. Key attitudinal barriers were uncertainties regarding religious permissibility, bodily concerns, lack of trust in health professionals and little priority given to registration, with the varying significance of these factors varying by ethnicity/faith and age. National campaigns focusing on ethnic minorities have had limited impact, whereas characteristics of effective educational interventions are being conducted in a familiar environment; addressing the groups’ particular concerns; delivery by trained members of the lay community; and providing immediate access to registration. Interventions are also required to target those at specific stages of the donation pathway. (2) Hospital studies: family consent to donation – many ICU staff, especially junior nurses, described a lack of confidence in communication and supporting ethnic minority families, often reflecting differences in emotional expression, faith and cultural beliefs, and language difficulties. The continuing high proportion of family donation discussions that take place without the collaboration of a specialist nurse for organ donation (SNOD) reflected consultants’ views of their own role in family consent to donation, a lack of trust in SNODs and uncertainties surrounding controlled donations after circulatory (or cardiac) death. Hospital chaplains differed in their involvement in ICUs, reflecting their availability/employment status, personal interests and the practices of ICU staff. (3) Evaluation: professional development package – a digital versatile disc-based training package was developed to promote confidence and skills in cross-cultural communication (available at:www.youtube.com/watch?v=ueaR6XYkeVM&feature=youtu.be). Initial evaluation produced positive feedback and significant affirmative attitudinal change but no significant difference in consent rate over the short follow-up period with requirements for longer-term evaluation.LimitationsParticipants in the focus group study were mainly first-generation migrants of manual socioeconomic groups. It was not permitted to identify non-consenting families for interview with data regarding the consent process were therefore limited to consenting families.ConclusionsThe research presents guidance for the effective targeting of donation campaigns focusing on minority ethnic groups and provides the first training package in cultural competence in the NHS.Future workGreater evaluation is required of community interventions in the UK to enhance knowledge of effective practice and analysis of the experiences of non-consenting ethnic minority families.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
Objectives: This study presents the use of our original contactless interface as a plug-in application for OsiriX-DICOM-viewer platform using a hardware sensor devicecontroller that supports hand/finger motions as input, with no hand contact, touching, or voice navigation. It would be possible to modify standard surgical parameters in the fly gesture-controlled incisionless surgical interventions. Methods:The accuracy of computer-generated models was analyzed according to T. Galeta/2017. Our original special plug-in-application provided different types of gestures for three-dimensional-virtual reality navigation. Our hardware sensor device controlling the system without touching any other device served as an interface for camera positioning in three-dimensional virtual endoscopy-views. The impression of panoramic three-dimensional volume rendering-viewing was given by pivoting the camera around a focus fixed on the object.Results: This novel technique enables surgeons to get complete and aware orientation in the operative field, where 'overlapping' of the real and virtual anatomic models is inevitable. Our human mind and understanding of this new surgery work by creating completely new models of human behavior and understanding spatial relationships, along with devising assessment that will provide an insight into our human nature. Any model and/or virtual model of the surgical field is defined as it actually exists in its natural surroundings. Conclusion:We offer an alternative to closed software systems for visual tracking, with an initiative for developing the software framework that will interface with depth cameras, with a set of standardized methods for medical applications such as hand gestures and tracking, face recognition, navigation, etc. This software should be an
Tight-fitting FFP3 facemasks are ideal respiratory protective equipment during aerosol generating procedures in Covid-19 environment, and require a Fit Test (FT) to assess mask-face seal competency. Facial hair is considered to be an impediment for achieving a competent seal. We are describing an under-mask beard cover called Singh Thattha technique which obtained a pass rate of 25/27 (92.6%) by qualitative and 5/5 (100%) by quantitative FT in full-bearded individuals. Sturdier versions of FFP3 were more effective. Individuals for whom shaving is not possible, the Singh Thattha technique could offer an effective solution to safely don respirator masks.
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