Understanding patient options, utilization patterns, and burdens associated with breast cancer screening

Despite ongoing awareness, educational campaigns, and advances in technology, breast cancer screening remains a complex topic for women and for the health care system. Lack of consensus among organizations developing screening guidelines has caused confusion for patients and providers. The psychosocial factors related to breast cancer screening are not well understood. The prevailing algorithm for screening results in significant rates of patient recall for further diagnostic imaging or procedures, the majority of which rule out breast cancer rather than confirming it. For women, the consequences of the status quo range from unnecessary stress to additional out-of-pocket expenses to indirect costs that are more difficult to quantify. A more thoughtful approach to breast cancer screening, coupled with a research agenda that recognizes the indirect and intangible costs that women bear, is needed to improve cost and quality outcomes in this area.

Migration from can coatings: Part 1. A size-exclusion chromatographic method for the simultaneous determination of overall migration and migrating substances below 1000 Da

The Council of Europe Resolution on coatings suggests a limit of 10 mg dm-2 for the sum of substances migrating into food simulants from an internal can coating. The Scientific Committee on Food differentiates the migrants into the substances with a molecular weight below 1000 Da, potentially being of toxicological concern, and the less toxicologically relevant species above 1000 Da. Hitherto, the determination of overall migration was based on a gravimetric method. A new method is described for the simultaneous determination of both overall migration and the migration of substances below 1000 Da based on separation by size exclusion chromatography (SEC) followed by ultraviolet detection (UVD) and evaporative light scattering detection (ELSD). The method is suitable for all volatile extraction media and simulants recommended by the European Union. For statistical comparison of both methods, the slightly modified reference method was validated in-house and extended to an additional gravimetric measurement of the migrants below 1000 Da. For the determination of the overall migration, both methods provided similar reproducibility (validated gravimetry: standard deviation (SD) = 0.16 mg dm-2; SEC-ELSD/UVD: SD = 0.12 mg dm-2) but significantly better results were obtained by the SEC-ELSD/UVD method. For migrating substances below 1000 Da, the gravimetric determination provides a poor sensitivity (limit of detection = 0.35 mg dm-2) compared with the SEC-ELSD/UVD method (limit of detection = 0.04 mg dm-2). The new method offers a lower limit of detection and higher precision as well as being less time consuming and easier to use.

Effect of feedback on obstetrics and gynecology residents' teaching performance and attitudes

OBJECTIVE

To evaluate obstetrics and gynecology residents' teaching performance, perception of the importance of teaching and satisfaction with their evaluations after the institution of an oral or written medical student feedback and award system.

STUDY DESIGN

Residents at a single, university-based obstetrics and gynecology program were assigned to receive either oral, written or no medical student feedback on their teaching skills in a prospective, randomized, controlled trial. Students rated resident performance in seven teaching categories. Residents' scores per six-week block were evaluated for one year. Questionnaires addressing resident attitudes toward feedback were collected at baseline and at 6 and 12 months. All residents then received written feedback and public awards for high scores for an additional year.

RESULTS

After 12 months of feedback there were trends toward improvement in several of the teaching categories and overall evaluations. None of the controls, 29% of residents receiving oral feedback and 50% of residents receiving written feedback rated teaching as more important than before. None of the controls, 57% of those receiving oral feedback (P = NS) and 88% of those receiving written feedback (P = .009), for a total of 73% of residents receiving any feedback (P = .001), thought that the amount of feedback was adequate at 12 months. Follow-up of 15 residents after one year of written feedback with an award for high evaluations showed that 60% improved their overall scores. The mean overall group score improved.

CONCLUSION

A feedback and award system can lead to improved resident teaching performance as well as enhanced perception of residents' role as teachers and greater resident satisfaction.

An ACOG-affiliated medical student obstetrics and gynecology club

An ACOG-affiliated obstetrics and gynecology club for medical students was developed at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School to introduce medical students to the specialty early in their careers, to educate them about obstetrician-gynecologists effect on women's health, and to guide them through exploration of the field. With ACOG District III Fellow and Junior Fellow support and collaboration, the club was formed and operational within 6 months. Because of this club students feel included in the district and national organizations by participating in Junior Fellow and Fellow activities. Through Junior Fellow activities, medical students get first-hand exposure to numerous obstetrics and gynecology residency programs. Through workshops and noncredit electives, medical students receive personal mentoring by Fellows and Junior Fellows. Students participate in community projects and from those programs can better understand the needs of women, especially women with inadequate or no health insurance. The collaboration between Junior Fellows, Fellows, and medical students is the most important component in establishing a student-run club affiliated with ACOG. This project has effectively introduced students to the field of women's health early in their careers and could provide a model for implementation at other medical schools.

Coronal computed tomography: indications and accuracy

The application of wide aperture scanners to neuroradiology permits improved anatomic definition and localization of intracranial and intraorbital lesions. Coronal scans are most useful in demonstrating lesions of the skull base and apex, distinguishing between infra- and supratentorial lesions, and in determining if a lesion is intra- or extraaxial. Limitations of coronal scans include discomfort in positioning, high spatial frequency artifacts, and additional radiation exposure.