Context: Rural women in the United States experience disparity in breast cancer diagnosis and treatment when compared to their urban counterparts. Given the 11% chance of lifetime occurrence of breast cancer for women overall, the continuum of breast cancer screening, diagnosis, treatment, and recovery are of legitimate concern to rural women and their primary care providers. Purpose: This analysis describes rural primary care providers' perceptions of the full spectrum of breast cancer screening, treatment, and follow-up care for women patients, and it describes the providers' desired role in the cancer care continuum. Method: Focus group interviews were conducted with primary care providers in 3 federally qualified community health centers serving a lower income, rural population. Focus group participants (N = 26) consisted of 11 physicians, 14 nurse practitioners, and 1 licensed clinical psychologist. Data were generated from audiotaped interviews transcribed verbatim and investigator field notes. Data were analyzed using constant comparison and findings were reviewed with a group of rural health professionals to judge the fit of findings with the emerging coding scheme. Findings: Provider relationships were characterized as being with women with cancer and comprised an active behind-the-scenes role in supporting their patients through treatment decisions and processes. Three themes emerged from the interview data: Knowing the Patient; Walking Through Treatment With the Patient; and Sending Them Off or Losing the Patient to the System. Conclusions: These findings should be a part of professional education for rural practitioners, and mechanisms to support this role should be implemented in practice settings.Key words breast cancer care, provider perspectives, rural primary care.Breast cancer is an illness of national concern, with more than 180,000 women diagnosed with the disease yearly in the United States.1 The continuum of breast cancer care flows from prevention and screening through diagnosis, treatment, and posttreatment follow-up.2 Advances in diagnosis and treatment options have expanded, and the emergence of highly specialized cancer treatment centers and multidisciplinary teams of specialists have played a role in increasing survival rates and maximizing positive outcomes for patients. Yet, rural women in the United States experience disparity in breast cancer diagnosis and treatment, with diagnosis occurring at a later stage than their urban counterparts.4 Rural women also have persistently lower mammography screening rates. 5,6 Lack of insurance, geographic inaccessibility of screening mammography, lack

This model demonstrates that faculty practice can work, can meet the evaluation components of guidelines of a major national organization, and can contribute to the improvement of health for vulnerable populations.

‘Care and Responsibility’, previously labelled ‘Control and Restraint’, is a nationally recognized approach to physical restraint. This study explores how 11 nursing staff, who work with people with learning disabilities and behaviour that challenges services, evaluate the method. Whilst there has been a considerable debate in the literature concerning physical restraint methods – and the discussion is often vociferous – there is no consensus about the appropriateness of different approaches. Peculiarly, the opinions of staff are at the periphery, or worse still, absent from the arena. In this qualitative project, this issue is addressed by using intensive, semi-structured interviews to probe the views of the participants. The interviewees discussed a range of topics and identified a number of main themes. This paper details one of these, teamwork, and explores three key elements associated with this category.

The emphasis of mammographic breast screening is to detect small invasive breast cancers at a time in their natural history when early detection and treatment will reduce significantly the risk of death. However, breast screening cannot be absolutely specific in its approach and detects a wide spectrum of breast cancer, ranging from microfocal low-grade ductal carcinoma in situ to large highgrade invasive cancer. It is well recognized that many of the lowgrade, special invasive cancers identified at screening have an excellent prognosis but may be so indolent that they would never have presented clinically or have threatened the life of the patients. It has been proposed alternatively that a proportion of these low-grade invasive tumours might, if not detected, de-differentiate over time into more aggressive, less well-differentiated tumours. Identification and removal of such cancers when they are at a low grade would avoid such progression. Detection of high-grade invasive cancers when they are small is clearly a means by which screening could reduce breast cancer mortality; for example, the Two-County Trial in Sweden has shown that histological grade 3 invasive cancers detected when <10 mm have an excellent prognosis, while it is widely recognized that large high-grade invasive cancers have a poor prognosis. In addition, the presence of vascular invasion and lymph node metastasis, which are associated with development of metastatic disease, are rare in grade 3 tumours <10 mm, grade 2 tumours <10 mm and grade 1 tumours <20 mm, indicating that detecting tumours under a certain size should be beneficial. 3 Ultra-small iron particle-enhanced magnetic resonance imaging of axillary lymph nodes in breast cancer