Comment: blind peer review of journal articles.
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Peer Review↗
Biomedical subjects
A F Shaughnessy
Publications and source records attributed to A F Shaughnessy.
Ambulatory care pharmacy services at the Family Medicine Center of the Medical University of South Carolina.
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Ambulatory Care↗
Nicotine chewing gum: effectiveness and the influence of patient education in a family practice.
The effectiveness of nicotine chewing gum in a family practice setting was evaluated. Ninety-nine subjects who were given a prescription for nicotine chewing gum were evaluated after one year to determine smoking status. Forty-nine subjects received only the gum, and 50 received the gum along with extensive personal instruction regarding its use. The two groups were compared with a third control group of 40 smokers who expressed no desire to stop smoking. At the end of one year, 12.2 percent of those receiving only gum and 10 percent receiving gum and instruction had stopped smoking, compared with a 20 percent cessation rate for the control group. The observed difference was not statistically significant (P greater than .05). Results of this study suggest that the use of nicotine gum alone may not be a viable alternative for family physicians whose patients desire to quit smoking.
Adult↗
It's Medspeak to us, but Greek to them.
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Communication↗
Potential uses for metoclopramide.
Metoclopramide, a dopamine antagonist, is approved in the U.S. for the treatment of various gastrointestinal disorders. Its use has been investigated in a wide variety of diseases, including those not involving the intestinal tract. Although more study is required before routine clinical use of metoclopramide can be advocated, it may be effective in the treatment of tardive dyskinesia, in decreasing the risk factors associated with anesthetic-related aspiration, and as an adjunct in the treatment of gastric bezoars. It also may be used safely in patients with Parkinson's disease. The use of metoclopramide in the treatment of neurogenic bladder, orthostatic hypotension, tumor-associated gastroparesis, nonprolactinemic amenorrhea, failure to thrive, Tourette's syndrome, anorexia nervosa, and hiccups, as well as an adjunct to migraine therapy, has been investigated, but sufficient evidence has not been accumulated to advocate the use of metoclopramide in these disorders.
Anorexia Nervosa↗
Auxiliary label use by pharmacists in South Carolina.
This study shows the variability in auxiliary labeling recommendations among reference sources as well as the variability in auxiliary label selection by pharmacists. Pharmacists' responses matched the Pharmex, USP DI, and Facts and Comparisons recommendations 6.1, 2.4, and 0.9 percent of the time, respectively. Pharmacists' use of auxiliary labels was correlated to professional setting, computer software, and years of pharmacy practice, but the interaction of these variables was not determined by our study. Finally, pharmacists are not satisfied with current auxiliary reference sources, including computer software programs.
Drug Labeling↗
Family practice patients' attitudes toward firearm safety as a preventive medicine issue: a HARNET Study. Harrisburg Area Research Network.
BACKGROUND: Firearm-related deaths are expected to outnumber motor-vehicle-related deaths within the next 5 years. The goal of this project was to document gun ownership and safety habits among patients of family physicians and to determine patients' attitudes toward physician counseling about firearm safety. METHODS: We conducted a cross-sectional survey of patients of 11 family practices affiliated with a research network. Patients (or parents of children) were asked to complete a 23-item questionnaire that asked about gun ownership, storage, sources of information about gun safety, and attitudes about gun safety, and the role of their physician. RESULTS: Of the 1359 questionnaires distributed, 1214 (89%) were returned. Gun ownership varied by location (urban, suburban, and rural) and ranged from 16% to 59%. Only 8% of respondents believed that their physician has a responsibility to discuss firearm safety. Most (91%) patients did not view their physician as a source of firearm safety information, and only 14% thought their physician was knowledgeable regarding gun safety. Most gun owners (71%) did not think they would follow their physicians' advice about gun storage. Most patients (5%) responded that gun safety should not be discussed during the office visit. CONCLUSION: With regard to firearm safety, family physicians lack credibility in the eyes of their patients. These patients do not appear to be receptive to information about firearm safety, and efforts to decrease firearm-related injury might be more effective if focused elsewhere.
Adult↗
Teaching information mastery: creating informed consumers of medical information.
BACKGROUND: The concepts of evidence-based medicine are permeating all specialties, including family practice. This article describes a curriculum to teach residents the principles and practices of information mastery, a derivation of evidence-based medicine that is more relevant to family physicians. METHODS: The curriculum is a 2-year longitudinal experience consisting mainly of didactic presentations and demonstrations in the first year followed by small-group sessions in the second year. Residents are taught the concepts of the previously described approach of information mastery and the application of these concepts to the variety of information resources available to them. Specifically, residents are taught how to find, evaluate, and apply information available from original research literature, review articles, meta-analyses, translation (controlled-circulation) journals, continuing education lectures, experts and colleagues, pharmaceutical representatives, and clinical experience. RESULTS: Using a before-after design at two institutions, the curriculum improved residents' attitudes, confidence regarding the medical literature, their perceptions of their ability to evaluate the published literature, and their use of information sources. CONCLUSIONS: Offering a structured curriculum to family practice residents creates dynamic, confident, and independent clinicians skilled in the art of information mastery.
Curriculum↗
Family physicians' use of medical abstracts to guide decision making: style or substance?
BACKGROUND: Many physicians rely on the abstracts of research articles to guide their clinical decision making. This need for expediency is one basis for many journals to reformat their abstracts. METHODS: To determine whether the format of medical abstracts affects physician decision making, we surveyed family physicians in Michigan, Pennsylvania, and Virginia. All participants were members of the American Academy of Family Physicians. The survey included three case scenarios (corneal abrasion, fibromyalgia, and hyperlipidemia) followed by structured and open-ended assessments of usual management. After assessing their usual management in each scenario, the respondents were provided with an abstract of a valid research paper. The format of abstracts (unstructured, IMRAD [introduction, methods, results, and discussion], structured, and POEM [patient-oriented evidence that matters]) were randomly assigned. After reading the abstract, we assessed changes in management of the case scenario. RESULTS: Two hundred eighty-nine family physicians responded to the survey. At baseline, 187 (65%) of physicians patched corneal abrasions. After reading the abstract, 142 (76%) would no longer use eye patches. Two hundred forty-five (83%) of physicians did not use the combination of fluoxetine and amitriptyline for managing fibromyalgia. After reading the abstract, 179 (73%) would use combination therapy. Two hundred thirty-four (84%) of physicians used "statins" when managing hyperlipidemia. After reading the abstract, 211 (90%) would continue using statins. The format of abstract had no significant effect on physicians' decision making. CONCLUSIONS: Whereas the format of abstract in this study had no effect on physician decision making, having valid information available in the context of a clinical scenario appeared to influence decisions.
Abstracting and Indexing↗
Survey and evaluation of newsletters marketed to family physicians.
BACKGROUND: Newsletters are marketed to physicians to provide a concise, accurate, and timely overview of the medical literature. The goal of these newsletters seems to be to present information that can be a suitable substitute for reading the original article. The purpose of this paper is to describe and evaluate newsletters pertinent to family physicians. METHODS: Newsletters appropriate for family physicians were selected by collecting newsletter advertisements and by searching newsletter directories. A 3-month sample and pertinent data were collected from the publishers. Evaluation criteria included accuracy and completeness of the abstracts, scope of coverage of the medical literature, and relevance of article sources. RESULTS: Eight newsletters were collected and evaluated. Accuracy was high for the evaluated abstracts. Abstract completeness averaged only 70 percent (range 55 percent to 92 percent). The type and source of abstracted articles varied widely among the newsletters. CONCLUSION: Newsletters available to family physicians vary widely; personal evaluation should supplement the results of the evaluation.
Costs and Cost Analysis↗
Prolonged delirium tremens requiring massive doses of medication.
Delirium tremens might last for weeks and treatment requires massive benzodiazepine doses, yet it is possible to manage patients with this condition successfully. In this case of delirium tremens, standard agents at the usual recommended doses were not sufficient to achieve control of confusion and agitation or to stabilize neurologic and cardiovascular parameters. The patient required extraordinarily high doses of central nervous system depressants for an extended period. Midazolam, a short-acting benzodiazepine, was used but was associated with metabolic acidosis and was extremely expensive. Although high-dose midazolam should probably be avoided, extremely high dose benzodiazepine use for an extended period might be necessary in some cases. In this circumstance we advise diazepam because of its low cost and relative safety. The tendencies to withhold large doses for fear of side effects or to give up in cases requiring prolonged intensive support must be resisted to minimize the mortality from this severe illness.
Aged↗
AIDS case definition.
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Acquired Immunodeficiency Syndrome↗
Salary survey of ambulatory care clinical pharmacists.
To determine salary and selected fringe benefits of members of the Ambulatory Care Practice and Research Network of the American College of Clinical Pharmacy, we developed a self-administered questionnaire that surveyed demographic information, schooling and training, academic appointments, yearly salary (as of February 1, 1995), source of salary, outside income, annual raise, vacation time, financial support for continuing education, and board certification. Ninety-nine surveys were returned (return rate 46%). Respondents were mostly women (58%), their average age was 34 years (range 25-51 yrs), and they had a median of 5 years in the work force. Most respondents (67%) had residency training, whereas only 21% had fellowship experience. Board certification was reported by 46%. The median salary was $53,500 (average $55,861, range $35-90 k), with progression for academic rank. The last salary increase averaged 3.7%. Most (93%) respondents received an average of $1509 for travel. The survey represents a young work force. The salaries vary but show progression for accomplishment.
Ambulatory Care↗