Spring 2007 - Volume 11 Number 2

Original Articles

Adverse Childhood Experiences and Smoking Persistence in Adults with Smoking-Related Symptoms and Illness
Valerie J Edwards, PhD; Robert F Anda, MD, MS; David Gu, PhD; Shanta R Dube, PhD, MPH; Vincent J Felitti, MD, FACP
Using data from the Adverse Childhood Experiences Study, researchers explore the reasons adults continue to smoke after diagnosis of diseases and conditions that contraindicate smoking.

MyChartA New Mode of Care Delivery: 2005 Personal Health Link Research Report
Carl A Serrato, PhD; Sally Retecki, MBA; David E Schmidt, MD
A secure member Web site where registered patients may view portions of their medical record and exchange secure messages with their primary care physicians was evaluated on the basis of a survey, content analysis, and physicians logs.

Implementing the Electronic Medical Record in the Exam Room: The Effect on Physician-Patient Communication and Patient Satisfaction
Vivian Tong Nagy, PhD; Michael H Kanter, MD
Introducing the computer into the exam room raises important questions about physician-patient communication and patient satisfaction. Patient satisfaction scores were compared to evaluate how scores changed as physicians started using computers in the exam room.

Obesity in the Kaiser Permanente Patient Population and Positive Outcomes of Online Weight-Management Programs
Keith H Bachman, MD; Trina M Histon, PhD; Carol Remmers, MPH
The effects of obesity in the Kaiser Permanente population are reviewed and two nationally available online self-care weight management programs are discussed with assessments of potential problems and recommendations.

Decreasing Medication Discrepancies Between Outpatient and Inpatient Care Through the Use of Computerized Pharmacy Data
Charles S Salemi, MD, MPH; Norvella Singleton, BS
This study provides an example of a positive impact of modern computer technology and upon the quality of medical care.

Perioperative Tight Glycemic Control: The Challenge of Bariatric Surgery Patients and the Fear of Hypoglycemic Events
Bellal Joseph, MD; Jeff Genaw, MD; Arthur Carlin, MD; Jack Jordan, MS; Jean Talley, RN, BSN, MSN, APRN; Ilan Rubinfeld, MD, MBA
Although tight glycemic control has resulted in improved outcomes, fear of hypoglycemia has been an important barrier to implementation. This triple arm prospective trial demonstrates improved hyperglycemic control in bariatric surgery patients with no increase in hypoglycemia.

Review Articles

Caring for the Adult with Congenital Heart Disease: Management of Common Defects
Reema Chugh, MD, FACC
Congenital heart defects are common. Advances in pediatric medicine and surgery have made it possible for nearly 85% of infants born with congenital heart defects to survive into adulthood. This article reviews some of the challenges of adults with congenital heart disease and offers practice guidelines for clinicians.

Systems Approaches to Improve Quality, Performance, and Efficiency in the Care of Older Adults
David B Reuben, MD
Using the Assessing Care of the Vulnerable Elderly study (1 and 2), Reuben reviews the current state of health care to identify barriers and to explore individual and systems efforts to improve outpatient care.

Heart Failure
Anthony E Steimle, MD, FACC
An overview, with vignette, of the recently updated Care Management Institute's Heart Failure Management Guidelines which addresses this major public health challenge.

Case Studies

Presentation of Osteitis and Osteomyelitis Pubis as Acute Abdominal Pain

Ethnographic Studies in the Principles of Clinical Medicine -- In Search of Home: From Home to Homeless to Housing

Clinical Medicine

Hemorrhoids: Modern Remedies for an Ancient Disease
Herman Villalba, MD; Maher A Abbas, MD, FACS, FASCRS
A case study explores the pathophysiology, presentation, evaluation and management of hemorrhoids with recommendations for conservative treatment and when aggressive treatment is indicated.

Commentary

How Much Is Enough? The Continuing Debate on the Axillary Lymph Node Dissection in Breast Cancer

Critical Appraisal of Clinical Studies: An Example from Computed Tomography Screening for Lung Cancer

On The Use of Rapid Diagnostic Test Kits for Malaria

The Future of Employer-Based Health Insurance

Editorial Overview

Doctors and Patients Using an Electronic Health and Medical Record: Research Studies Offer Multiple Views of 21st Century Health Care
Tom Janisse, MD

Editorials

Is Abstinence from Red Wine Hazardous to Your Health?
Arthur L Klatsky, MD

Book Reviews

The Physician's Guide to Intimate Partner Violence and Abuse

What Price Better Health? Hazards of the Research Imperative

Soul of the Healer

Grounded in Richness
Angelique B Sow

Frontiers in Hematology
Suresh K Joishy, MD

At Home in the Clouds, Picos de Europa, Spain
David Clarke, MD

Atardecer
Dario Sanchez, LISW, IMFT

Little Things Mean a Lot
Calvin L Weisberger, MD, FACC, FACP

The Walk-In Patient
Gary Huffaker, MD

On the Cover