Mobile Versus Fixed Facility: Latinas' Attitudes and Preferences for Obtaining a Mammogram.

PURPOSE: Mobile mammographic services have been proposed as a way to reduce Latinas' disproportionate late-stage presentation compared with white women by increasing their access to mammography. The aims of this study were to assess why Latinas may not use mobile mammographic services and to explore their preferences after using these services. METHODS: Using a mixed-methods approach, a secondary analysis was conducted of baseline survey data (n = 538) from a randomized controlled trial to improve screening mammography rates among Latinas in Washington. Descriptive statistics and bivariate regression were used to characterize mammography location preferences and to test for associations with sociodemographic indices, health care access, and perceived breast cancer risk and beliefs. On the basis of these findings, a qualitative study (n = 18) was used to explore changes in perceptions after using mobile mammographic services. RESULTS: More Latinas preferred obtaining a mammogram at a fixed facility (52.3% [n = 276]) compared with having no preference (46.3% [n = 249]) and preferring mobile mammographic services (1.7% [n = 9]). Concerns about privacy and comfort (15.6% [n = 84]) and about general quality (10.6% [n = 57]) were common reasons for preferring a fixed facility. Those with no history of mammography preferred a fixed facility (P < .05). In the qualitative study, Latinas expressed similar initial concerns but became positive toward the mobile mammographic services after obtaining a mammogram. CONCLUSIONS: Although most Latinas preferred obtaining a mammogram at a fixed facility, positive experiences with mobile mammography services changed their attitudes toward them. These findings highlight the need to include community education when using mobile mammographic service to increase screening mammography rates in underserved communities.

Eye-movement study and human performance using telepathology virtual slides: implications for medical education and differences with experience.

A core skill in diagnostic pathology is light microscopy. Remarkably little is known about human factors that affect the proficiency of pathologists as light microscopists. The cognitive skills of pathologists have received relatively little attention in comparison with the large literature on human performance studies in radiology. One reason for this lack of formal visual search studies in pathology has been the physical restrictions imposed by the close positioning of a microscope operator's head to the microscope's eyepieces. This blocks access to the operator's eyes and precludes assessment of the microscopist's eye movements. Virtual slide microscopy now removes this barrier and opens the door for studies on human factors and visual search strategies in light microscopy. The aim of this study was to assess eye movements of medical students, pathology residents, and practicing pathologists examining virtual slides on a digital display monitor. Whole histopathology glass slide digital images, so-called virtual slides, of 20 consecutive breast core biopsy cases were used in a retrospective study. These high-quality virtual slides were produced with an array-microscope equipped DMetrix DX-40 ultrarapid virtual slide processor (DMetrix, Tucson, Ariz). Using an eye-tracking device, we demonstrated for the first time that when a virtual slide reader initially looks at a virtual slide his or her eyes are very quickly attracted to regions of interest (ROIs) within the slide and that these ROIs are likely to contain diagnostic information. In a matter of seconds, critical decisions are made on the selection of ROIs for further examination at higher magnification. We recorded: (1) the time virtual slide readers spent fixating on self-selected locations on the video monitor; (2) the characteristics of the ways the eyes jumped between fixation locations; and (3) x and y coordinates for each virtual slide marking the sites the virtual slide readers manually selected for zooming to higher ROI magnifications. We correlated the locations of the visually selected fixation locations and the manually selected ROIs. Viewing profiles were identified for each group. Fully trained pathologists spent significantly less time (mean, 4.471 seconds) scanning virtual slides when compared to pathology residents (mean, 7.148 seconds) or medical students (mean, 11.861 seconds), but had relatively prolonged saccadic eye movements (P < .0001). Saccadic eye movements are defined as eye movements between fixation locations. On the other hand, the pathologists spent significantly more time than trainees dwelling on the 3 locations they subsequently chose for zooming. Unlike either the medical students or the residents, the pathologists frequently choose areas for viewing at higher magnification outside of areas of foveal (central) vision. Eye movement studies of scanning pathways (scan paths) may be useful for developing eye movement profiles for individuals and for understanding the difference in performances between novices and experts. They may also be useful for developing new visual search strategies for rendering diagnoses on telepathology virtual slides.

Vaginal shape at resting pelvic MRI: predictor of pelvic floor weakness?

OBJECTIVE: The objective was to determine if alteration in vaginal shape seen on nonstraining pelvic magnetic resonance (MR) scans is associated with pelvic floor weakness. METHODS: Two readers classified the shape of the middle third of the vagina on resting T2-weighted axial images as normal or abnormal for 76 women with and without pelvic floor weakness. RESULTS: The sensitivity and specificity for diagnosing pelvic floor dysfunction were 84% and 68% for reader A and 41% and 91% for reader B. Interobserver agreement was fair (kappa=0.39). CONCLUSIONS: Architectural distortion of vaginal shape on routine pelvic MR imaging may suggest pelvic floor dysfunction but is not diagnostic.

Online social networking for radiology.

Online social networking services have changed the way we interact as a society and offer many opportunities to improve the way we practice radiology and medicine in general. This article begins with an introduction to social networking. Next, the latest advances in online social networking are reviewed, and areas where radiologists and clinicians may benefit from these new tools are discussed. This article concludes with several steps that the interested reader can take to become more involved in online social networking.

An evaluation of the impact of clinically embedded reading rooms on radiologist-referring clinician communication.

The aim of this study was to investigate whether locating reading rooms in clinical areas at a large tertiary care, academic hospital in the United States corresponds with increased rates of direct communication between radiologists and clinicians. Data recorded included the frequency, form, duration, and general purpose of communications. Two-tailed Fisher's exact tests were used to determine the statistical significance of differences between the frequencies of communication methods for the reading rooms included in the study. During the observation period, there were a total of 175 episodes of communication between radiologists and referring providers in the 4 study reading rooms. There was a highly significant difference (P < .0001) in the percentage of visits and critical test result management messages sent between embedded and nonembedded reading rooms, while the differences in the proportion of calls both to and from referring providers was not significant (P = .4468). Although the purpose of this study was to assess the impact of reading room location on radiologists' communications with referring providers, several alternative hypotheses could also explain the results. The value of this study emerges from the documentation of the high degree of variability among institutions in communication practices among different kinds of radiologists and referring physicians. The extent of these different practices among the 4 reading rooms has important implications for future studies of communication patterns between radiologists and referring providers as well as for designing effective interventions to enhance the role of radiologists as consultants.

Elder care as "frustrating" and "boring": understanding the persistence of negative attitudes toward older patients among physicians-in-training.

OBJECTIVES: This study explores the attitudes of physicians-in-training toward older patients. Specifically, we examine why, despite increasing exposure to geriatrics in medical school curricula, medical students and residents continue to have negative attitudes toward caring for older patients. METHODS: This study used ethnography, a technique used by anthropologists that includes participant-observation, semi-structured interviews, and facilitated group discussions. Research was conducted at two tertiary-care academic hospitals in urban Northern California, and focused on eliciting the opinions, beliefs, and practices of physicians-in-training toward geriatrics. RESULTS: We found that the majority of physicians-in-training in this study expressed a mix of positive and negative views about caring for older patients. We argue that physicians-in-trainings' attitudes toward older patients are shaped by a number of heterogeneous and frequently conflicting factors, including both the formal and so-called "hidden" curricula in medical education, institutional demands on physicians to encourage speed and efficiency of care, and portrayals of the process of aging as simultaneously as a "problem" of inevitable biological decay and an opportunity for medical intervention. DISCUSSION: Efforts to educate medical students and residents about appropriate geriatric care tend to reproduce the paradoxes and uncertainties surrounding aging in biomedicine. These ambiguities contribute to the tendency of physicians-in-training to develop moralizing attitudes about older patients and other patient groups labeled "frustrating" or "boring".