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Objective-To identify the nature of pain and discomfort experienced during mammography and how it can be ameliorated.Design-Questionnaire survey before invitation for mammography and immediately after mammography. Responses before screening were related to experience of discomfort.Setting-Health district in South East Thames region.Subjects-1160 women aged 50-64 invited routinely for screening; 774 completed first questionnaire, of whom 617 had mammography. 597 completed the second questionnaire.Main outcome measures-Reported discomfort and pain, comparisons of discomfort with that experienced during other medical procedures, qualitative description of pain with adjective checklist.Results-35% (206/597) of the women reported discomfort and 6% (37/595) pain. 10 minutes after mammography these figures were 4% (24/595) and 0.7% (4/595) respectively. More than two thirds of women ranked having a tooth drilled, having a smear test, and giving blood as more uncomfortable than mammography. The most important predictor of discomfort was previous expectation of pain (discomfort was reported by 21/32 (66%) women who expected pain and 186/531 (35%) who did not). Discomfort had little effect on satisfaction or intention to reattend.Conclusions-The low levels of reported pain and discomfort shortly after mammography and the favourable comparisons with other investigations suggest that current procedures are acceptable. Since two thirds of the women experienced less pain than expected health education and promotion must ensure that accurate information is made available and publicised. IntroductionThe national breast screening programme is nearing the end of its first three year cycle. The success of the programme largely hinges on a high level of uptake and continued compliance by the target population, which in turn depends on whether the population finds the service acceptable. The University of Kent at Canterbury breast screening group recently completed a prospective study of more than 3000 women in three centres in the South East Thames region to examine users' responses to and satisfaction with the service.'

OBJECTIVE: To examine the influence of an individually derived versus modal subjective norm component of the Theory of Planned Behaviour (TPB) in predicting attendance at breast screening. DESIGN: A prospective, longitudinal design was employed using a postal questionnaire at Time 1 and objective attendance data from screening records at Time 2. METHOD: Questionnaires were sent to 1000 women from East Kent due to be invited for X-ray mammography under the UK's National Health Service Breast Screening Programme. The TPB constructs were used to predict attendance, with a focus on subjective norm. Two versions of the questionnaire were distributed: one assessed subjective norm using individually generated normative beliefs (individual condition) and the other provided a list of modal referents (modal condition). RESULTS: The mean number of normative referents in the individual condition was just two, almost all of whom were family members, in contrast to the modal condition where 'GP' led the rank table. The results suggest that a more senstive measure of subjective norm is attained using individually derived beliefs. Structural equation modelling revealed that, contrary to theoretical prediction, the effect on attendance of the individually derived subjective norm was not entirely mediated by intention: an independent contribution to attendance was shown. In the modal condition the construct was entirely mediated by intention. CONCLUSIONS: For health behaviours that have implications for others as well as self, measuring individually salient normative beliefs may both improve theoretical prediction and yield information of potential value for designing intervention programmes.

Results-There was a significant reduction in the time spent in A&E when no radiograph was requested (P << 0-001). The mean time saved in the "Doctor First" (DF) group was 51 min, and in the "Nurse First" (NF) group 36 min. For those who were sent for an x ray 14 min was saved by getting the patient to see the nurse first. However, because the overall referral rate for x rays was greater in the NF group, (78% ofpatients compared with 74% of the DF group, a significant 40/o increase (P=0.05) this potential benefit was largely lost. Overall the average waiting time in the DF group of 92*5 min (95% confidence interval: 89-2 to 96-1 min) was reduced to 88'5 min (95% CI: 85 2 to 91-8 min) in the NF group, a non-significant saving of 4 min. There was no overall difference between the proportion of relevant abnormalities reported by the radiologists for the DF or NF groups (G2 = 0-739, ldf, P = 0-30); however, there was a significant association between the number of relevant abnormalities reported by the radiologists and the different hospitals (G2 = 9'7626, 3df, P = 0-02).Hospital C had the highest abnormality rate reported by the radiologists in both the DF (450/o) and the NF (51%) groups.The most time saved in A&E was in the DF category when comparing those who did not have an x ray [58][59][60][61][62][63] (_Accid Emerg Med 1996;13:86-89)

et al.The costeffectiveness of magnetic resonance imaging for investigation of the knee joint. Health Technol Assess 2001;5(27). Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA website (see opposite). NHS R&D HTA Programme T he NHS R&D Health Technology Assessment (HTA) Programme was set up in 1993 to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS. Initially, six HTA panels (pharmaceuticals, acute sector, primary and community care, diagnostics and imaging, population screening, methodology) helped to set the research priorities for the HTA Programme. However, during the past few years there have been a number of changes in and around NHS R&D, such as the establishment of the National Institute for Clinical Excellence (NICE) and the creation of three new research programmes: Service Delivery and Organisation (SDO); New and Emerging Applications of Technology (NEAT); and the Methodology Programme. This has meant that the HTA panels can now focus more explicitly on health technologies ('health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care) rather than settings of care. Therefore the panel structure has been redefined and replaced by three new panels: Pharmaceuticals; Therapeutic Procedures (including devices and operations); and Diagnostic Technologies and Screening. The HTA Programme will continue to commission both primary and secondary research. The HTA Commissioning Board, supported by the National Coordinating Centre for Health Technology Assessment (NCCHTA), will consider and advise the Programme Director on the best research projects to pursue in order to address the research priorities identified by the three HTA panels. The research reported in this monograph was funded as project number 93/26/16. The views expressed in this publication are those of the authors and not necessarily those of the HTA Programme or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for any recommendations made by the authors. Criteria for inclusion in the HTA monograph series Reports are published in the HTA monograph series if (1) they have resulted from work commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.