2005-06-23
Annals of Internal Medicine
Educators have recognized the need to apply evidence-based approaches to medical training. To do so, medical educators must have access to reliable evidence on the impact of educational interventions. This paper describes 5 methodologic challenges to performing systematic reviews of educational interventions for health care professionals: finding reports of medical education interventions, assessing quality of study designs, assessing the scope of interventions, assessing the evaluation of interventions, and synthesizing the results of educational interventions. We offer suggestions for addressing these challenges and make recommendations for reporting, reviewing, and appraising interventions in medical education.
Read more...Black Enterprise
By LEE BOWMAN
Scripps Howard News Service
June 27, 2005
- Professional guidelines don't endorse them, but a new survey of family doctors shows that most still see value in adults getting an annual checkup even if the patients have no specific symptoms.
The survey, published Monday in the Archives of Internal Medicine, showed that 65 percent of respondents believe an annual physical examination is necessary, and 88 percent said they do them for at least some patients.
The study, done in 2002, was based on responses of a random sample of 763 primary-care doctors in and around Boston, Denver and San Diego. Dr. Allan Prochazka and colleagues at the University of Colorado Health Sciences Center and the Denver Veterans Affairs Medical Center led the research.
Read more...Scripps Howard News Service
CHICAGO – Although the quality of outpatient care in the United States has improved over the last decade, greater use of evidence-based medicine is needed, however, and quality of care is not significantly associated with the patient's racial or ethnic background, according to a study in the June 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
The recently released National Healthcare Quality Report (NHQR) identified a variety of areas where health care has markedly improved across time and is now reaching or surpassing national performance goals, as well as many more areas where the quality of health care delivery is suboptimal, according to background information in the article. Its companion document, the National Healthcare Disparities Report, demonstrated that racial, ethnic, and socioeconomic disparities in health care are national problems. However, the authors suggest, limited use has been made of readily available national survey data to measure quality of care and racial disparities in outpatient settings.
Jun Ma, M.D., Ph.D., and Randall S. Stafford, M.D., Ph.D., of Stanford University School of Medicine, Stanford, Calif., used data from the two national surveys of outpatient care to assess overall performance and racial/ethnic disparities in private physician offices and hospital outpatient departments in 1992 and 2002. The researchers examined 23 outpatient quality indicators, including appropriate antibiotic use, treatment of depression, avoiding unnecessary screening and avoiding inappropriate medications in the elderly. Quality indicator performance was defined as the percentage of applicable visits receiving appropriate care.
Read more...Eureka Alert
By Suzanne LeighTue Jun 21, 7:09 AM ET
It was my sixth attempt to reach my doctor by phone, with a simple query about a prescription. "The doctor is with a patient right now," intoned the receptionist - again.
I took a deep breath. "Would it be possible to reach him by e-mail?"
There was a pause. "The doctor doesn't have an e-mail address."
No e-mail address? My doctor practices in the shadow of Silicon Valley.
"He'll try to call between patients," she said.
And so I waited, held hostage by the phone, like most patients who need to make contact with their doctors but don't require a face-to-face consultation.
In a 2002 survey by Harris Interactive, 90% of adults with Internet access indicated they want to communicate with their physicians via e-mail. But a survey last year by Manhattan Research, a marketing information and services firm, found that less than 20% of physicians communicate via e-mail.
The top reason doctors give for withholding their e-mail address is the fear that it will lead to "too much access" and they will be barraged with messages about "trivial matters," according to a Journal of Family Practice article in 2001.
In other words, patients can't be trusted not to abuse our doctors' time. But if doctors finally moved into the high-tech age, they'd soon discover that many of their concerns about e-mail are misplaced.
Last month, the journal Pediatrics confirmed what disgruntled patients have known for a long time: E-mail can save the doctor's time, too. Researchers evaluated e-mails sent between two pediatricians and 54 parents of patients over six weeks. They found that of the 81 e-mails generated by parents, 70 required just one e-mail response. Most focused mostly on medical questions. And far from being deluged, the physicians said they spent an average 30 minutes a day responding to e-mails. Parents, as a result, reported fewer phone calls and appointments.
Read more USA Today
Many of the medications widely used to manage chronic insomnia have not yet been rigorously evaluated for long-term use, according to an independent scientific panel convened this week by the National Institutes of Health. This is a critical consideration because for many patients, insomnia can persist for decades. The panel also stressed that many chronic insomnia sufferers could benefit from currently underused behavioral and cognitive therapies.
Read more NIH News
Glenn Howatt, Star Tribune
June 16, 2005
A heart drug developed by Minnesota researchers appears headed for approval by federal regulators as the country's first race-based medicine.
Food and Drug Administration staff members Wednesday recommended that BiDil be approved as a heart medicine for black patients.
Critics say the race designation is a marketing ploy because there's scant scientific evidence that the drug is a better treatment for blacks compared to whites.
The drug was originally developed by Dr. Jay Cohn, a cardiologist at the University of Minnesota. Recent research showing promising results in blacks was led by a colleague, Dr. Anne Taylor, a heart specialist and associate dean of the university medical school.
In that study, BiDil increased survival rates and improved quality of life for 1,050 black patients with heart failure, which is a slow deterioration of the heart. The drug cut the rate of hospitalization by about one-third, according to results released last November.
NitroMed Inc. of Lexington, Mass., is the drug's manufacturer. Its publicly traded stock price has soared on news of the drug's effectiveness. Stock analysts have predicted that if approved, the drug would be successful for the company because blacks have a higher rate of heart failure than whites.
BiDil is a combination of two generic drugs that have been used for decades to treat chest pain and high blood pressure. The drug combo is easier to administer than separate generic pills.
Developed by Cohn 30 years ago, the drug was turned down by the FDA. NitroMed took up the drug after Cohn discovered that it tended to work better in blacks in the studies he had conducted.
But still, no research study has proved that the racial differences affect the drug's performance.
Jonathan Kahn, a law professor at Hamline University in St. Paul, has criticized the effort to repackage BiDil along racial lines.
"BiDil did not begin as an ethnic drug," he wrote in a critique in the Yale Journal of Health Policy, Law and Ethics last year. It only became one because it failed to win wider approval, he said.
Critics contend that FDA approval would reinforce disproved beliefs of significant genetic differences between the races.
If the medicine is approved, doctors would be free to prescribe it regardless of a patient's race. Indeed, drug founder Cohn has used the drug for patients of all races.
An FDA advisory panel will meet today to review the drug and is expected to issue a final recommendation by week.
Glenn Howatt is at howatt@startribune.com.
More than 90 percent of surveyed physicians in Pennsylvania reported defensive medicine practices such as over-ordering of diagnostic tests, unnecessary referrals and avoidance of high-risk patients, according to a study in the June 1 issue of JAMA.
Read more...iNewswire.com