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In people with and without PAD who have impaired lower extremity performance, reduced physical activity levels may contribute to subsequent disability. Future study is needed to determine whether interventions to increase physical activity can prevent functional decline in persons with a low SPS.

By standardizing results notification, the Mammography Quality Standards Reauthorization Act improved patient satisfaction and reporting timeliness among screening examination patients, but did little to improve anxiety or recollection of recommendations. Future quality improvement efforts should focus on improving patients' understanding of follow-up recommendations.

OBJECTIVE:To assess factors associated with patient satisfaction with communication of mammography results and their understanding and ability to recall these results. DESIGN:Cross-sectional telephone survey. SETTING: Academic breast imaging center.PATIENTS: Two hundred ninety-eight patients who had either a screening or diagnostic mammogram. MEASUREMENTS AND MAIN RESULTS:Survey items assessed waiting time for results, anxiety about results, satisfaction with several components of results reporting, and patients' understanding of results and recommendations. Women undergoing screening exams were more likely to be dissatisfied with the way the results were communicated than those who underwent diagnostic exams and received immediate results (20% vs 11%, P = .05). For these screening patients, waiting for more than two weeks for notification of results, difficulty getting in touch with someone to answer questions, low ratings of how clearly results were explained, and considerable or extreme anxiety about the results were all independently associated with dissatisfaction with the way the results were reported, while age and actual exam result were not. CONCLUSIONS:Patients undergoing screening mammograms were more likely to be dissatisfied with the way the results were communicated than were those who underwent diagnostic mammograms. Interventions to reduce the wait time for results, reduce patients' anxiety, and improve the clarity with which the results and recommendations are given may help improve overall satisfaction with mammography result reporting. This report focuses on women's satisfaction with communication of mammography results and follow-up recommendations at one institution, prior to the implementation of the Mammography Quality Standards Act on April 28, 1999. We summarize the results of a telephone survey of 298 women undergoing screening and diagnostic mammography at an academic breast-imaging center in April 1999. The purposes of the study were 1) to describe satisfaction with communication of results among patients with documented normal and abnormal screening and diagnostic mammogram results; 2) to measure the effect of patient age, mammography results, time it took to receive the results, patient reported anxiety about the results, and satisfaction with components of communication of results (staff and physician time spent communicating, clarity of explanation, comfort level, access, and how well questions were answered) on overall satisfaction with results reporting; and 3) to evaluate patients' understanding of their mammogram results and recommendations by determining the prevalence of inability to recall results and recommendations and rates of discordance between patient-reported results and follow-up recommendations and the results and recommendations documented in radiology reports. METHODS Current PracticesDuring the study period, screening and diagnostic mammograms were performed at two locations, located one block apart. Both, however, were part of same mammography center with centr...

To assess factors associated with patient satisfaction with communication of mammography results and their understanding and ability to recall these results. DESIGN: Cross-sectional telephone survey. SETTING: Academic breast imaging center. PATIENTS: Two hundred ninety-eight patients who had either a screening or diagnostic mammogram.MEASUREMENTS AND MAIN RESULTS: Survey items assessed waiting time for results, anxiety about results, satisfaction with several components of results reporting, and patients' understanding of results and recommendations. Women undergoing screening exams were more likely to be dissatisfied with the way the results were communicated than those who underwent diagnostic exams and received immediate results (20% vs 11%, P = .05). For these screening patients, waiting for more than two weeks for notification of results, difficulty getting in touch with someone to answer questions, low ratings of how clearly results were explained, and considerable or extreme anxiety about the results were all independently associated with dissatisfaction with the way the results were reported, while age and actual exam result were not. CONCLUSIONS:Patients undergoing screening mammograms were more likely to be dissatisfied with the way the results were communicated than were those who underwent diagnostic mammograms. Interventions to reduce the wait time for results, reduce patients' anxiety, and improve the clarity with which the results and recommendations are given may help improve overall satisfaction with mammography result reporting.

CorrespondenceAccelerated atherosclerosis in a patient with post-BMT nephropathy BMT has been associated with a 20% incidence of renal failure (BMT-nephropathy), with or without hypertension, the combination of which is associated with a high morbidity and mortality.1 Few studies discuss long-term survival with this syndrome.We recently evaluated a patient who had received an HLA-identical sibling T cell-depleted allogeneic BMT for CLL in 1987 following a preparative regimen of cytarabine, cyclophosphamide and whole-body radiation (1375 cGy; delivered in nine fractions over 3 days). He developed BMT-nephropathy 6 months post-transplant, and became hemodialysis-dependent in 1995. He also had a history of well-controlled hypertension for the last 5 years. Family history was negative for premature atherosclerosis or cardiovascular diseases. He smoked around five cigarettes a day for the last 15 years. He was hospitalized in midDecember 1997 for diarrhea and abdominal pain. His stool was positive for Clostridium difficile-toxin and he was treated with metronidazole. Sigmoidoscopy was performed due to worsening of his abdominal pain and fever, which revealed no evidence of pseudomembranes, but patchy necrotic areas and ischemic changes on biopsy. He underwent an exploratory laparotomy resulting in a right hemicolectomy and colostomy, for treatment of his hemorrhagic necrosis. A second exploratory laparotomy ending in a left hemicolectomy and ileostomy, was performed 1 week later because of extension of the hemorrhagic necrosis which was confirmed on post-operative colonoscopy. Colonic biopsies showed full thickness ischemic necrosis without pseudomembranes, with no vasculitis. Computed tomographic (CT) scans done pre-operatively demonstrated focal splenic infarction, extensive arterial atherosclerosis involving the renal, splenic, iliac arteries, vas deferens, and mitral annular calcifications. Studies to evaluate a hypercoagulable status were negative. An embolic source was ruled out by transesophageal echocardiogram. His blood glucose and plasma lipid profile were normal. Bone marrow showed panhypoplasia, with no evidence of lymphoid aggregates or tumor. His hospital course was further complicated by unstable angina, enterococcal septicemia, and progressive multi-organ failure. Six weeks after his admission, life-support measures were discontinued.Autopsy showed: lungs, bilateral organizing bronchopneumonia and CMV was isolated; heart, left ventricular myocardial infarction and biventricular hypertrophy; bowels, ischemic small intestine but no infarction; kidneys, end-