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Chambers D, Booth A, Baxter SK, Johnson M, Dickinson KC, Goyder EC. Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BackgroundCurrent NHS policy favours the expansion of diagnostic testing services in community and primary care settings.ObjectivesOur objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community.Review methodsWe performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion.ResultsWe identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed.ConclusionsIn the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control.LimitationsWe have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers.Future workThere is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Susan K Baxter
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Maxine Johnson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katherine C Dickinson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth C Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Lan ZJ, Hu Y, Zhang S, Li X, Zhou H, Ding J, Klinge CM, Radde BN, Cooney AJ, Zhang J, Lei Z. GGNBP2 acts as a tumor suppressor by inhibiting estrogen receptor α activity in breast cancer cells. Breast Cancer Res Treat 2016; 158:263-76. [PMID: 27357812 DOI: 10.1007/s10549-016-3880-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/20/2016] [Indexed: 01/01/2023]
Abstract
Gametogenetin-binding protein 2 (GGNBP2) is encoded in human chromosome 17q12-q23, a region known as a breast and ovarian cancer susceptibility locus. GGNBP2, also referred to ZFP403, has a single C2H2 zinc finger and a consensus LxxLL nuclear receptor-binding motif. Here, we demonstrate that GGNBP2 expression is reduced in primary human breast tumors and in breast cancer cell lines, including T47D, MCF-7, LCC9, LY2, and MDA-MB-231 compared with normal, immortalized estrogen receptor α (ERα) negative MCF-10A and MCF10F breast epithelial cells. Overexpression of GGNBP2 inhibits the proliferation of T47D and MCF-7 ERα positive breast cancer cells without affecting MCF-10A and MCF10F. Stable GGNBP2 overexpression in T47D cells inhibits 17β-estradiol (E2)-stimulated proliferation as well as migration, invasion, anchorage-independent growth in vitro, and xenograft tumor growth in mice. We further demonstrate that GGNBP2 protein physically interacts with ERα, inhibits E2-induced activation of estrogen response element-driven reporter activity, and attenuates ER target gene expression in T47D cells. In summary, our in vitro and in vivo findings suggest that GGNBP2 is a novel breast cancer tumor suppressor functioning as a nuclear receptor corepressor to inhibit ERα activity and tumorigenesis.
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Affiliation(s)
- Zi-Jian Lan
- Division of Life Sciences, Center for Nutrigenomics & Applied Animal Nutrition, Alltech Inc., Nicholasville, KY, 40356, USA
| | - YunHui Hu
- The 3rd Department of Breast Cancer, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute & Hospital, 500 South Preston Street, Hu-Xi District, 300060, Tianjin, People's Republic of China
| | - Sheng Zhang
- The 3rd Department of Breast Cancer, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute & Hospital, 500 South Preston Street, Hu-Xi District, 300060, Tianjin, People's Republic of China
| | - Xian Li
- Department of OB/GYN & Women's Health, University of Louisville Health Sciences Center, 500 South Preston Street, Louisville, KY, 40292, USA
| | - Huaxin Zhou
- Birth Defects Center, Department of Molecular, Cellular and Craniofacial Biology, University of Louisville Health Sciences Center, Louisville, KY, 40292, USA
| | - Jixiang Ding
- Birth Defects Center, Department of Molecular, Cellular and Craniofacial Biology, University of Louisville Health Sciences Center, Louisville, KY, 40292, USA
| | - Carolyn M Klinge
- Department of Biochemistry & Molecular Genetics, University of Louisville Health Sciences Center, Louisville, KY, 40292, USA
| | - Brandie N Radde
- Department of Biochemistry & Molecular Genetics, University of Louisville Health Sciences Center, Louisville, KY, 40292, USA
| | - Austin J Cooney
- Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin, TX, 78712, USA
| | - Jin Zhang
- The 3rd Department of Breast Cancer, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute & Hospital, 500 South Preston Street, Hu-Xi District, 300060, Tianjin, People's Republic of China.
| | - Zhenmin Lei
- Department of OB/GYN & Women's Health, University of Louisville Health Sciences Center, 500 South Preston Street, Louisville, KY, 40292, USA.
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Loerzel VW, Hunt D, Rash E. A Pap test does not screen for everything: nurse practitioner knowledge of ovarian cancer. J Am Assoc Nurse Pract 2014; 27:124-30. [PMID: 25044820 DOI: 10.1002/2327-6924.12151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/14/2013] [Indexed: 11/11/2022]
Abstract
PURPOSE Nurse practitioners (NPs) are in a prime position to educate women about initial signs and symptoms of ovarian cancer (OC) and perform appropriate screening tests. However, little is known about NPs knowledge regarding OC. This article's purpose is to present the outcomes of a focused OC awareness program for NP students. DATA SOURCES NP students (N = 104) participated in this longitudinal one group pre-post study. Knowledge was calculated based on the number of correct answers for a total knowledge score and subscales related to OC incidence, risk, screening, symptoms, and treatment. An item related to the effectiveness of the Pap test to screen for OC was evaluated separately. CONCLUSION Knowledge deficits continue to exist related to OC, emphasizing the need for NPs to be aware of risk factors, symptoms, and early detection options for women with average risk. Many NP students erroneously believed a Pap test was an effective screening tool for OC. IMPLICATIONS FOR PRACTICE Many NPs are inadequately prepared to assess risk, detect early symptoms, and perform screening tests for OC. Continuing education and reinforcement about OC is essential if NPs are to provide appropriate education to clients and detect this deadly disease as early as possible.
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