Self-reported colorectal cancer screening of Medicare beneficiaries in family medicine vs. internal medicine practices in the United States: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>The benefit of screening for decreasing the risk of death from colorectal cancer (CRC) has been shown, yet many patients in primary care are still not undergoing screening according to guidelines. There are known variations in delivery of preventive health care services among primary care physicians. This study compared self-reported CRC screening rates and patient awareness of the need for CRC screening of patients receiving care from family medicine (FPs) vs. internal medicine (internists) physicians.</p> <p>Methods</p> <p>Nationally representative sample of non-institutionalized beneficiaries who received medical care from FPs or internists in 2006 (using Medicare Current Beneficiary Survey). The main outcome was the percentage of patients screened in 2007. We also examined the percentage of patients offered screening.</p> <p>Results</p> <p>Patients of FPs, compared to those of internists, were less likely to have received an FOBT kit or undergone home FOBT, even after accounting for patients' characteristics. Compared to internists, FPs' patients were more likely to have heard of colonoscopy, but were less likely to receive a screening colonoscopy recommendation (18% vs. 27%), or undergo a colonoscopy (43% vs. 46%, adjusted odds ratios [AOR], 95% confidence interval [CI]-- 0.65, 0.51-0.81) or any CRC screening (52% vs. 60%, AOR, CI--0.80, 0.68-0.94). Among subgroups examined, higher income beneficiaries receiving care from internists had the highest screening rate (68%), while disabled beneficiaries receiving care from FPs had the lowest screening rate (34%).</p> <p>Conclusion</p> <p>Patients cared for by FPs had a lower rate of screening compared to those cared for by internists, despite equal or higher levels of awareness; a difference that remained statistically significant after accounting for socioeconomic status and access to healthcare. Both groups of patients remained below the national goal of 70 percent.</p

Use of atypical antipsychotics in nursing homes and pharmaceutical marketing

OBJECTIVES: To describe the current extent and type of pharmaceutical marketing in nursing homes (NHs) in one state and to provide preliminary evidence for the potential influence of pharmaceutical marketing on the use of atypical antipsychotics in NHs. DESIGN: Nested mixed-methods, cross-sectional study of NHs in a cluster randomized trial. SETTING: Forty-one NHs in Connecticut. PARTICIPANTS: NH administrators, directors of nursing, and medical directors (n = 93, response rate 75.6%). MEASUREMENTS: Quantitative data, including prescription drug dispensing data (September 2009-August 2010) linked with Nursing Home Compare data (April 2011), were used to determine facility-level prevalence of atypical antipsychotic use, facility-level characteristics, NH staffing, and NH quality. Qualitative data, including semistructured interviews and surveys of NH leaders conducted in the first quarter of 2011, were used to determine encounters with pharmaceutical marketing. RESULTS: Leadership at 46.3% of NHs (n = 19) reported pharmaceutical marketing encounters, consisting of educational training, written and Internet-based materials, and sponsored training. No association was detected between level of atypical antipsychotic prescribing and reports of any pharmaceutical marketing by at least one NH leader. CONCLUSION: NH leaders frequently encounter pharmaceutical marketing through a variety of ways, although the impact on atypical antipsychotic prescribing is unclear. Geriatrics Society

Pós-colheita de copo-de-leite: efeito de diferentes conservantes comerciais e armazenamento a frio Calla lily postharvest: effect of different commercial preservative solutions and cold storage

As inflorescências de copo-de-leite, apesar de bastante utilizadas na composição de arranjos florais, apresentam pequena durabilidade. Com o objetivo de analisar a qualidade e o processo de abertura e murcha de inflorescências de copo-de-leite após a colheita, avaliaram-se o efeito de diferentes conservantes florais e sistemas de armazenamento. Para o experimento estudaram-se duas condições de armazenamento em câmara fria a 4ºC: a seco ou em solução com os conservantes comerciais Crystal Clear&#174;, Flower&#174;, Original Floralife&#174; e o pré-tratamento com Hydraflor-100&#174;. O armazenamento em solução, com os conservantes estudados, não influenciou o processo de abertura e murcha das inflorescências de copo-de-leite, dentro e fora da câmara fria. Também não houve diferença, entre os produtos testados, para melhorar a conservação das inflorescências, quando estas foram retiradas da câmara fria. O período de armazenamento por 10 dias com os tratamentos utilizados não foi eficiente, pois apesar da qualidade das inflorescências, observada dentro da câmara fria, quando estas foram retiradas, não apresentaram durabilidade para comercialização. O armazenamento a seco foi eficiente quando se realizou o pré-tratamento com Hydraflor-100&#174;, entretanto, as inflorescências apresentaram maior longevidade total quando armazenadas em solução.<br>Inflorescences of calla lily have reduced durability after harvest despite their constant use in the composition of floral arrangements. With the objective to analyze the postharvest quality and the process of opening and wilt of calla lily, the effect of different floral conservers and storage systems were evaluated. Two storage conditions in a cold chamber at 4º C, dry or solution containing the commercial preservative Crystal Clear&#174;, Flower&#174;, Original Floralife&#174; and pre-treatment with Hydraflor-100&#174; were studied. The storage in solution with conservers had no influence on the opening and closure of inflorescence, despite its maintenance inside or outside the cold chamber. No difference was observed on the inflorescence conservation when their removal from the cold chamber regarding the different products tested. Inflorescences stored for 10 days on all tested treatments presented no commercial durability, after their removal, despite their quality inside the cold chamber. Dry storage was efficient using the pre-treatment with Hydraflor-100&#174;; however, the inflorescences presented higher longevity when stored in solution