Spring 2010 - Volume 14 Number 1

Original Research and Contributions

Patients' Perspectives on Nonadherence to Statin Therapy: A Focus-Group Study
Vicki Fung, PhD; Fiona Sinclair, PA-C, MHS; Huihui Wang, PhD; Diane Dailey, MD; John Hsu, MD, MBA, MSCE; Ruth Shaber, MD
Nonadherence to statin therapy is associated with poor cardiovascular outcomes. Study participants, with a one- to six-month gap in drug supply, identified factors that contributed to their statin therapy nonadherence, including concerns or experiences with adverse effects, uncertainty about the benefits or importance of statins for their overall health, and lack of convenience. Participants desired more information about statins.

Alcohol and Lung Airways Function
Stanton T Siu, MD; Natalia Udaltsova, PhD; Carlos Iribarren, MD, PhD; Arthur L Klatsky, MD
Limited data suggest that moderate alcohol drinkers may have better lung airways function than abstainers. The authors studied the relationship in 177,721 members of a comprehensive health plan. For each measure studied—FEV1, FVC, and FEV1/FVC—persons reporting two or fewer drinks per day or three to five drinks per day had better airways function than nondrinkers (p < 0.001), but heavier drinkers had worse function.

The Extended Surgical Time-Out: Does It Improve Quality and Prevent Wrong-Site Surgery?
Steven L Lee, MD
Using the extended Surgical Time-Out (STO) before anesthesia induction improved communication among the surgical team members and did not disrupt work flow. Broader value includes confirming timely antibiotic administration or other quality measures. The extended STO did not eliminate wrong-site surgery. However, STO placed the responsibility for wrong-site surgery with the whole team and system, rather than with the individual surgeon.

Obesity: Problem, Solution, or Both?
Vincent J Felitti, MD, FACP; Kathy Jakstis; Victoria Pepper, MS; Albert Ray, MD
The authors are convinced that obesity is widely misunderstood, as is the unusual program they have operated safely and effectively for more than a quarter century, involving: prolonged absolute fasting, with the use of a supplement, and a lengthy and complex group program to explore the basis of each participant's unconscious compulsive use of food. Addressed are: safety, observed origins of obesity, treatment program, and outcomes.

Reviewing Manuscripts for Biomedical Journals
Gus M Garmel, MD, FACEP, FAAEM
Writing for publication is a complex task. Authors have varying emotions related to the process of writing for scientific publications. This article discusses the review process within the biomedical literature, the importance of reviewers to the scientific process, responsibilities of reviewers, and qualities of a good review and reviewer. This article also describes essential elements of a submitted manuscript, with the hopes of improving scientific writing.

Case Studies

The Prayer Prescription
Gerald Saliman, MD
Many patients welcome a chance, at the conclusion of their office visit, to say a prayer for their well-being, which is a socially accepted expression of care and, for the internist author, an expression of empathy, hope, and gratitude. The author has prayed with people from various religious backgrounds—Christian, Native American, Hindu, Buddhist, and Jewish.

Clinical Medicine

Image Diagnosis: Interesting Plain Film Radiographs from the Emergency Department
Gus M. Garmel, MD, FACEP, FAAEM
Two traumatic injuries are displayed: an adult distal radius fracture (obvious) and distal radioulnar joint dislocation (often missed); and a common distal radial torus or buckle fracture in a child, often missed because extremely subtle.

The Use of Problem-Knowledge Couplers in a Primary Care Practice
Charles Burger, MD
The unaided human mind has limitations in decision making when faced with a complex set of data. The author describes how he and associates integrated "problem-knowledge couplers"— the clinical decision tool developed by Lawrence Weed, MD—into their Internal Medicine practice in Portland, ME.

The Hoarse Patient: Asking the Right Questions
Ji-Eon Kim, MD; Barry Rasgon, MD
Patients describe hoarseness as a change in the quality of their voices. Common among patients in the ambulatory care setting, its causes— anatomic, functional, neurologic, infectious, environmental, and neoplastic—can be benign and self-limited or life threatening. The management of two cases is presented.

Working with the Noncompliant Patient
Fred Kleinsinger, MD
Compliance here refers to the mutually negotiated physician– patient shared decision and agreement. This article offers practicing clinicians tools for working with the noncompliant patient—mirroring, "I" statements, developing and reinforcing self-efficacy, and enlisting support—and offers approaches to denial, depression, dementia, cultural issues, drug or alcohol dependence, and cost of treatment.


A Physician Prescription for the Nursing Shortage
John H Cochran, MD, FACS
The Colorado Permanente Medical Group, a large multispecialty physician group in Denver and Boulder, embarked upon the "Preferred Clinical Partner Program" to leverage physician leadership to participate in solving the nursing shortage through working clinical partnerships and funding initiatives: nursing scholarships, advanced training, and building and expanding nursing simulation laboratories.

Evidence-Based Medicine and the Physician-Patient Dyad
Howard I Kushner, PhD
Evidence-based medicine (EBM) can serve as a valuable tool when properly understood, but should not be regarded as the all-encompassing panacea for the future of medicine. As with the promiscuous and often exaggerated labeling of a variety of relatively benign behaviors and conditions as risk factors, uncritical reliance on EBM can result in serious side effects.

Sustainable Food: A Conversation with Jamie Harvie—Executive Director, Institute for a Sustainable Future
Brian Raymond, MPH
Motivated by impacts on poor nutrition, increased antibiotic-resistant bacteria, poisoned air and water, food-borne pathogens, and the potential health effects of climate change, leaders from the health sector are backing practices and policies that support sustainable agriculture and a healthier food system. In this interview, sustainable food system advocate, Jamie Harvie, addresses the big stake the health sector has in the way food is produced and distributed.

Narrative Commentary

Exploring Health Care and Medical Tourism in a Modernizing Society: Journey in Chennai, India
Janani Krishnaswami, MD
A young student returns to the site of childhood family vacations to complete a medical "rotation" in the clinic of a renowned physician who blends alternative and allopathic medicine. She gains insight into the dichotomy created by a country that is tackling basic deficiencies in public health indicators while supporting an "extreme makeover" of health care worth nearly 15 billion rupees to support over 150,000 patients who fly in from around the world to receive comparatively lower-price treatment or escape long waiting lists.

Book Reviews

The Heart Speaks: A Cardiologist Reveals the Secret Language of Healing
Harold Braswell; Howard I Kushner, PhD

Strong at the Heart: How it Feels to Heal from Sexual Abuse
Sharon Schuman

Clinical Emergency Medicine Casebook
David Sklar, MD

Health Care Reform
Morris F. Collen, MD

Soul of the Healer

"The Cafe"
Ms Carolyn Shore

"Three Mushrooms, Latourell Creek"
David S Emmons, LCSW

"Tropical Paradise"
Lester DR Thompson, MD and Pamela A Thompson, MFA

"Forest Innocence"

Robert W Hogan, MD

On the Cover

Tall Trees
Suzanne Ackley, MD


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