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Introduction Medical care for older adults is often quite complex, as individuals may have multiple health concerns that require medications, therapy, and a variety of treatment modalities. Medical conditions are often associated with psychosocial, cultural, cognitive, nutritional, financial and functional issues. To achieve positive health outcomes, care for older adults must be coordinated and comprehensive, and this often requires effective interprofessional collaboration. This means that health professional students need to learn how to provide care that exemplifies good communication, collaboration, and teamwork. In addition, there is increasing awareness that competence in geriatric care needs to be improved for almost all health care team members through enhanced training programs. Methods This case study is designed to be used with a team of any mix of interprofessional health care students and one standardized patient as a stand-alone activity or as a part of a larger interprofessional course. The standardized patient encounter utilizes three documents: the standardized patient script, the introduction, and the physical exam and laboratory findings. Each team is instructed to develop a team-oriented care plan based on the script, introduction, and the team assessment. Instructor assessment tools are also included with this resource. Results In order to determine if we are meeting our course and activity objectives, we collect pre- and postsurvey data on geriatric and interprofessional team perceptions. At the conclusion of the course the students complete a team effectiveness survey. Student written feedback on the course has consistently commented that the standardized patient assessments are the best portion of the course. Their feedback has also indicated that they feel more confident with evaluating geriatric patients and working as an interprofessional team. The students also learn more about each other's professional roles. Discussion This course has led to development of curricular changes and additional patient care services. Interprofessional faculty teaching together in this course led to the development of additional coordinated interprofessional clinical patient care service at the university's senior health primary care clinic. Additional service learning is now also being provided to under-served geriatric populations in the community. The occupational therapy program is now developing a geriatric curricular track that would include this course as a required element.

The acceptance of age-appropriate cancer screening as an integral part of primary care has grown among physicians over the past decade. We conducted a mailed survey of all primary care physicians in New Mexico in order to better understand their current cancer screening practices. We found a high rate of self-reported screening, particularly for prostate and colorectal cancer. The screening rates were influenced only slightly by the introduction of evidence-based guidelines, with younger physicians and those with university affiliations more likely to follow recommendations. Female physicians and obstetrician-gynecologists endorsed breast and cervical cancer screening among all age groups and were less likely to follow recommendations for less frequent screening in women as they age. Since a physician's practice beliefs influence his/her attitude toward testing, tailoring education by physician specialty may be more effective than using generic messages in encouraging compliance with the most recent evidence-based guidelines.

This study discusses the findings from a survey of the knowledge, attitudes, and clinical practice regarding cancer prevention and early detection of 101 nurse practitioners (NPs) working in the 87 county public health departments in North Carolina. Results show that nurse practitioners provide breast and cervical cancer screening services for most women over age 40 but are less likely to provide other types of cancer prevention, such as smoking cessation counseling or education about diet and cancer. NPs tended to rate their clinical skills in providing cancer screening as excellent but rate their skills in educating clients about cancer risk lower. Most NPs were interested in practice related to cancer control, especially learning more about the latest recommendations on cancer. However, in this study they indicated the least interest in learning more about smoking cessation methods or cancer prevention issues for men. These findings suggest that NPs in public health need further education and skills training related to cancer control, in addition to breast and cervical cancer screening.

OBJECTIVE: To compare three approaches for improving compliance with influenza and pneumococcal vaccination of elderly patients. DESIGN: Randomized controlled trial using three parallel group practices at a public urban teaching hospital. SETTING: Public teaching hospital. SUBJECTS: All patients 65 years of age and older (n = 1202) seen by resident physicians (n = 66) attending three ambulatory medical practices from October 1, 1989 to March 31, 1990. INTERVENTIONS: All three provider groups received intensive education in immunization standards. The control group received no further intervention. Staff in the second group offered education to patients at their visits. In the third group, the prevention team, a flowsheet was used, patient education offered, and staff had their tasks redefined to facilitate compliance; for vaccinations, eg, nurses could vaccinate independent of MD initiative. MEASUREMENTS AND MAIN RESULTS: Medical records were reviewed for the 1202 patients seen, including 756 patients seen during both the 1988-89 and 1989-90 influenza seasons, to determine documented offering and receipt of vaccinations. During the intervention period (1989-90), influenza vaccinations were offered significantly more frequently to prevention team patients (68.3%) than to patients in either the patient education (50.4%) or control (47.6%) groups (P = 0.006), even after adjusting for the patients' prior vaccination status, age, gender, race, and high-risk co-morbidity and for physicians' level of training. Likewise, pneumococcal vaccinations were offered more frequently to previously unvaccinated prevention team patients (28.3%) than to patient education (6.5%) or control (5.4%) group patients (P = 0.001), even after adjusting for the factors using multivariate analysis. Compliance rates did not differ between patient education and control subjects for either vaccine. Pre-intervention physician surveys documented higher perceived than actual compliance for both vaccines, with 89.0% and 52.8% of physicians believing that they complied with influenza and pneumococcal vaccination guidelines, respectively. CONCLUSIONS: The results of this trial provide strong support for organizational changes that involve non-physician personnel to enhance vaccination rates among older adults.

Issues related to women’s health, and particularly to menopause, have been major priorities over the past decade for agencies of the U.S. Department of Health and Human Services (DHHS). In order to prevent morbidity and mortality in perimenopausal and postmenopausal women, an unprecedented concentration of resources and attention has been directed toward menopause. This has included funding of new research to elucidate the menopausal transition and to prevent morbidity, as well as support of studies of associated pharmacological, clinical, and epidemiological aspects and prevention research.

This study discusses the findings from two surveys of 459 nurses working in public health about their knowledge and perception of counseling and clinical skills related to breast and cervical cancer control. The first survey was conducted in 1993 before professional education efforts with the Breast and Cervical Cancer Control Program (BCCCP) began in North Carolina. The second survey was carried out in 1996. The results show a significant increase from 1993 to 1996 in recognition of increasing age, nulliparity, late childbearing, and family history as risk factors for breast cancer, and for smoking and early age at first sexual intercourse as risk factors for cervical cancer. Nurses' skills were more likely to be rated as excellent or very good in 1996 as compared with ratings in 1993 for educating women about mammography, performing a clinical breast examination, teaching breast self-examination by demonstration, performing a Papanicolaou (Pap) smear and bimanual examination, and counseling women about abnormal Pap tests. Nurses who took a BCCCP-sponsored adult physical assessment course were more likely to know correct risk factors for breast and cervical cancer, and to show improvement in teaching breast self-examination, performing a Pap smear, and counseling women about abnormal Pap tests.

Over 600,000 hysterectomies are performed each year in the United States, the majority of which are to improve quality of life for perimenopausal women. Hysterectomy rates for common conditions differ between African American and white women, and African American women undergo surgery at a younger age for most diagnoses. Many hysterectomies are accompanied by elective oophorectomy, and hormone replacement therapy (HRT) is commonly used, especially among women experiencing surgical menopause, despite questions about its long-term benefits and risks. Despite the high rates of hysterectomy in the United States, little is known about how women make decisions regarding this surgery and, in particular, how ethnic and cultural factors may influence these decisions. This article provides a review of what is currently known about the epidemiology of hysterectomy, oophorectomy, and HRT use and identifies gaps in knowledge about women's decision making, with a special focus on ethnic variations and cultural influences, issues addressed by the Ethnicity, Needs, and Decisions of Women (ENDOW) project.

Physicians play an important role in recommending and doing cancer screening for their patients. In 1991, the North Carolina Department of Environment, Health and Natural Resources and the Centers for Disease Control and Prevention conducted a survey to determine the counseling and referral practices of primary care physicians practicing in North Carolina. Physicians were asked to report the percentage of patients in various age groups that they recommended receive a clinical breast examination, referral for mammography screening, or a Pap test and at what intervals they recommended each study. They were also asked their perceived barriers to cervical cancer screening. Obstetrician-gynecologists recommended annual Pap smear screening more frequently than did physicians in other specialties for patients of all ages. For mammography, variation existed for recommended screening intervals for all specialties by patient age (35 to 39 years, 40 to 49 years, 50 to 64 years, and over age 65). Recommendations for mammography also differed significantly according to physicians' age and sex. The medical community and the public need a consistent and clear message to promote effective screening maneuvers.

Purpose This pilot study compared usual care alone with usual care plus meditation in relation to anxiety, depression, pain, and quality of life in community-dwelling older adults with postherpetic neuralgia (PHN). PHN may occur after shingles, and has been described as one of the most intractable neuropathic pain disorders. Older adults develop PHN more often than younger adults. Mindfulness meditation, found to be beneficial in the management of some chronic pain conditions, has not been specifically examined in older adults with PHN.

This article describes training programs instituted in 1992 by the North Carolina Breast and Cervical Cancer Control Program (BCCCP) to improve skills of public health nurses in breast and cervical cancer education and clinical services. Public health nurses traditionally serve as primary health care providers in medically underserved communities and are the main providers of BCCCP services. The training programs were evaluated by a statewide survey of public health nurses in 1996. The authors discuss the findings of this survey, its limitations, and the goals it has led the authors to set for improving the education program in the future.