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To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2008.01964.x Byline: Julie M. Kapp (*), Joseph W. LeMaster (*), Steven C. Zweig (*), David R. Mehr (*) Keywords: mammography; mass screening; practice guidelines; breast neoplasms; geriatrics Abstract: OBJECTIVES: To estimate the percentage of U.S. women aged 70 and older who reported a recent mammography recommendation and to identify whether factors suggesting limited life expectancy, such as comorbidities, are associated with a lower probability of a reported recommendation. DESIGN: A national, population-based, cross-sectional survey. SETTING: United States. PARTICIPANTS: There were 1,782 screen-eligible women 70 and older who responded to the National Health Interview Survey in 2005 and met eligibility criteria, including reporting at least one doctor visit in the previous 12 months. Weighted, these women represented almost 9.3 million women nationally. MEASUREMENTS: Multiple logistic regression was used to examine the relationship between demographic, comorbidity, and health services utilization variables on self-reported physician recommendation for a mammogram. RESULTS: More than half (58.9%) of the sample reported a recent mammography recommendation (63.0% of those aged 70 to 79 and 51.5% of those aged 80 and older). The strongest multivariable association suggested that women who reported a recent clinical breast examination (CBE) had 5.9 times greater odds of reporting a mammography recommendation than women who reported never having a CBE. CONCLUSION: This study failed to find negative associations between factors suggesting limited life expectancy and a recent mammography recommendation. Instead, findings revealed a strong positive association between a recent CBE and mammography recommendation. Findings may suggest that recent clinical interactions weigh more heavily on a decision to recommend mammography to older, screen-eligible women than considerations for the woman's overall long-term health or may reflect a greater perceived or actual recall of physician recommendations from women with a recent CBE. Author Affiliation: (*)Department of Family and Community Medicine, University of Missouri, Columbia, Missouri Article note: Address correspondence to Julie M. Kapp, MPH, PhD, Department of Family and Community Medicine, University of Missouri-Columbia, MA306 Medical Sciences Bldg, 1 Hospital Drive, Columbia, MO 65212. E-mail: kappj@health.missouri.edu

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BACKGROUND. Lower respiratory infections (LRI) are an important cause of morbidity, mortality, and hospitalization of nursing home residents, yet treatment recommendations have primarily been based on the minority who are [...]

Characteristics of do-not-resuscitate (DNR) orders and effect of DNR orders on hospitalization of acutely ill nursing home (NH) residents with lower respiratory tract infections (LRI) are analyzed. The results reveal that DNR orders independently reduce the risk of hospitalization for LRI.

Residents accompany attending physicians around the hospital in order to be trained as physicians. Verbal teaching and learning behaviors in the interaction between residents and attending physicians were observed, classified and recorded in order to evaluate clinical teaching methods. Over the course of one year, 125 observations of the interaction between residents and attending physicians were recorded. The average length of the interaction lasted for four minutes; three quarters of the average meeting was spent discussing patient care issues, allowing very little time for teaching. The contribution of the resident-attending physician interaction in the training of a resident is questioned., Clinical teaching does not fit neatly into traditional teaching-learning models. The interaction between a resident and an attending physician is of particular interest because it has several functions including education, supervision, socialization, and quality control. The purpose of this study was to observe, classify, and record verbal teaching and learning behaviors in the resident-attending physician interaction. During a 12-month period, 125 observations of resident-attending physician interactions were recorded; the average length of the interactions was 4.27 minutes. The six most frequent resident verbal behaviors compared by postgraduate year level did not vary significantly. Only one of the six most frequent attending physician verbal behaviors varied significantly. In the average interaction of about 4 minutes, three fourths of the interaction was on patient care issues, leaving the little time for teaching. There are many unanswered questions about the resident-attending physician interaction and its contribution to the training of a physician., Analysis of Resident and Attending Physician Interactions in Family Medicine There has been increasing interest in defining, describing, and analyzing clinical teaching, particularly in the ambulatory setting. Most clinical teaching [...]