Title: Journal of General Internal Medicine

Title: Journal of General Internal Medicine

ISO Abbreviated Title:

JCR Abbreviated Title: J Gen Intern Med

ISSN: 0884-8734

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? Frayne, S.M., Burns, R.B., Hardt, E.J., Rosen, A.K. and Moskowitz, M.A. (1996), The exclusion of non-English-speaking persons from research. Journal of General Internal Medicine, 11 (1), 39-43.

Abstract: OBJECTIVE: We sought to determine how often non-English-speaking (NES) persons are excluded from medical research.

DESIGN: Self-administered survey.

PARTICIPANTS: A Medline search identified all original investigations on provider-patient relations published in major U.S. journals from 1989 through 1991, whose methodologies involved direct interaction between researcher and subject (N = 216). Each study’s corresponding author was surveyed; 81% responded.

MEASUREMENTS and MAIN RESULTS: Of the 172 respondents, 22% included NES persons; among these includers, 16% had not considered the issue during the study design process, and 32% thought including the NES had affected their study results. Among the 40% who excluded the NES (excluders), the most common reason was not having thought of the issue (51%), followed by translation issues and recruitment of bilingual staff. The remaining 35% (others) indicated that there were no NES persons in their study areas.

CONCLUSIONS: NES persons are commonly excluded from provider-patient communication studies appearing in influential journals, potentially limiting the generalizability of study findings. Because they are often excluded through oversight, heightened awareness among researchers and granting institutions, along with the development of valid instruments in varied languages, may increase representation of non-English-speaking subjects in research.

Keywords: Subjects, Non-English-Speaking, Ethnic Groups, Language, Research Protocols, Clinical, Health Priorities, Methodological Issues, Mexican-Americans, Clinical-Trials, Language, Hispanics, Aids, Translation, Interview, Validity, Behavior

? Badgett, R.G., Mulrow, C.D., Otto, P.M. and Ramirez, G. (1996), How well can the chest radiograph diagnose left ventricular dysfunction? Journal of General Internal Medicine, 11 (10), 625-634.

Abstract: OBJECTIVES: To review the diagnostic utility of the chest radiograph for left ventricular dysfunction.

DATA SOURCES: Structured MEDLINE searches, citation reviews of relevant primary research, review articles, and textbooks, personal files, and data from experts.

STUDY SELECTION Studies of patients without valvular disease that allowed calculation of the sensitivity and specificity of selected radiographic signs compared with a criterion standard of increased left ventricular preload or reduced ejection fraction.

DATA EXTRACTION: Two independent readers reviewed 29 studies, Studies were pooled after stratification by radiographic finding, criterion standard, and clinical setting.

MAIN RESULTS: Redistribution best diagnosed increased preload with a sensitivity of 65% (95% confidence interval (CI) 55%, 75%) and specificity 67% (95% CI 53%, 79%), Cardiomegaly best diagnosed decreased ejection fraction with a sensitivity of 51% (95% CI 43%, 60%) and specificity of 79% (95% CI 71%, 85%), Interrater reliability was fair to moderate for redistribution and moderate for cardiomegaly. The clinical setting affected results by decreasing the specificity of cardiomegaly to 8% in detecting increased preload in patients with severe systolic dysfunction. The absence of redistribution could only exclude increased preload in situations hn which the suspicion (pretest probability) of disease was less than 9%. whereas redistribution could confirm increased preload when the pretest probability was greater than 91%. The absence of cardiomegaly could only exclude a reduced ejection fraction if the pretest probability was less than 8%, whereas cardiomegaly could confirm a reduced ejection fraction if the pretest probability was greater than 87%.

CONCLUSIONS: Redistribution and cardiomegaly are the best chest radiographic findings tor diagnosing increased preload and reduced ejection fraction, respectively Unfortunately, neither finding alone can adequately exclude or confirm left ventricular dysfunction in usual clinical settings. Redistribution is not always reliably interpreted.

Keywords: Chest Radiograph, Congestive Heart Failure, Systolic Dysfunction, Left Ventricular Preload, Left Ventricular Ejection Fraction, Congestive-Heart-Failure, Acute Myocardial-Infarction, Pulmonary Venous Hypertension, Ejection Fraction, Systolic Function, Radionuclide Ventriculography, Prognostic Implications, Diastolic Dysfunction, Valsalva Maneuver, X-Ray

Azoulay, A., Garzon, P. and Eisenberg, M.J. (2001), Comparison of the mineral content of tap water and bottled waters. Journal of General Internal Medicine, 16 (3), 168-175.

Full Text: J\J Gen Int Med16, 168.pdf

Abstract: OBJECTIVES: Because of growing concern that constituents of drinking water may have adverse health effects, consumption of tap water in North America has decreased and consumption of bottled water has increased. Our objectives were to 1) determine whether North American tap water contains clinically important levels of calcium (Ca²⁺), magnesium (Mg²⁺), and sodium (Na⁺) and 2) determine whether differences in mineral content of tap water and commercially available bottled waters are clinically important.

DESIGN: We obtained mineral analysis reports from municipal water authorities of 21 major North American cities. Mineral content of tap water was compared with published data regarding commercially available bottled waters and with dietary reference intakes (DRIs).

MEASUREMENTS and MAIN RESULTS: Mineral levels varied among tap water sources in North America and among bottled waters. European bottled waters generally contained higher mineral levels than North American tap water sources and North American bottled waters. For half of the tap water sources we examined, adults may fulfill between 8% and 16% of their Ca²⁺ DRI and between 6% and 31% of their Mg²⁺ DRI by drinking 2 liters per day. One liter of most moderate mineralization European bottled waters contained between 20% and 58% of the Ca²⁺ DRI and between 16% and 41% of the Mg²⁺ DRI in adults. High mineralization bottled waters often contained up to half of the maximum recommended daily intake of Na⁺.

CONCLUSION: Drinking water sources available to North Americans may contain high levels of Ca²⁺, Mg²⁺, and Na⁺ and may provide clinically important portions of the recommended dietary intake of these minerals. Physicians should encourage patients to check the mineral content of their drinking water, whether tap or bottled, and choose water most appropriate for their needs.

Keywords: Tap Water, Bottled Water, Calcium, Magnesium, Sodium, Magnesium-Deficiency, Drinking-Water, Sudden-Death, Disease, Calcium, Health

? Lustig, A.J. and Redelmeier, D.A. (2002), Analysis of citation records of notables from yesteryear’s Medline: The acronym study. Journal of General Internal Medicine, 17 (S1), 203.

Full Text: 2002\J Gen Int Med17, 203.pdf

? Uybico, S.J., Pavel, S. and Gross, C.P. (2007), Recruiting vulnerable populations into research: A systematic review of recruitment interventions. Journal of General Internal Medicine, 22 (6), 852-863.

Full Text: 2007\J Gen Int Med22, 852.pdf

Abstract: BACKGROUND: Members of vulnerable populations are underrepresented in research studies. OBJECTIVE: To evaluate and synthesize the evidence regarding interventions to enhance enrollment of vulnerable populations into health research studies. DATA SOURCES: Studies were identified by searching MEDLINE, the Web of Science database, personal sources, hand searching of related journals, and article references. Studies that contained data on recruitment interventions for vulnerable populations (minority, underserved, poor, rural, urban, or inner city) and for which the parent study (study for which recruitment was taking place) was an intervention study were included. A total of 2,648 study titles were screened and 48 articles met inclusion criteria, representing 56 parent studies. Two investigators extracted data from each study. RESULTS: African Americans were the most frequently targeted population (82% of the studies), while 46% targeted Hispanics/Latinos. Many studies assessed 2 or more interventions, including social marketing (82% of studies), community outreach (80%), health system recruitment (52%), and referrals (28%). The methodologic rigor varied substantially. Only 40 studies (71%) incorporated a control group and 21% used statistical analysis to compare interventions. Social marketing, health system, and referral recruitment were each found to be the most successful intervention about 35-45% of the studies in which they were attempted, while community outreach was the most successful intervention in only 2 of 16 studies (13%) in which it was employed. People contacted as a result of social marketing were no less likely to enroll than people contacted through other mechanisms. CONCLUSIONS: Further work with greater methodologic rigor is needed to identify evidence-based strategies for increasing minority enrollment in research studies; community outreach, as an isolated strategy, may be less successful than other strategies.

Keywords: Analysis, Cancer Clinical-Trials, Clinical Trials, Community-Based Research, Control, Disparities, Health Research Studies, Health-Promotion Research, Intervention, Interventions, Journals, Medline, Minorities, Minority Recruitment, Older African-Americans, Parent, Prevention Trial, Prostate-Cancer, Race, Randomized-Trial, Recruitment, Research, Research Participation, Review, Science, Social, Statistical, Strategy, Systematic, Systematic Review, Underrepresented Populations, Urban, Vulnerable Populations, Web of Science

? McDermott, K.A., Helfrich, C.D., Sales, A.E., Rumsfeld, J.S., Ho, P.M. and Fihn, S.D. (2008), A review of interventions and system changes to improve time to reperfusion for ST-segment elevation myocardial infarction. Journal of General Internal Medicine, 23 (8), 1246-1256.

Full Text: 2008\J Gen Int Med23, 1246.pdf

Abstract: OBJECTIVE: Identify and describe interventions to reduce time to reperfusion for patients with ST-segment elevation myocardial infarction (STEMI). DATA SOURCE: Key word searches of five research databases: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Web of Science, and Cochrane Clinical Trials Registry. INTERVENTIONS: We included controlled and uncontrolled studies of interventions to reduce time to reperfusion. One researcher reviewed abstracts and 2 reviewed full text articles. Articles were subsequently abstracted into structured data tables, which included study design, setting, intervention, and outcome variables. We inductively developed intervention categories from the articles. A second researcher reviewed data abstraction for accuracy. MEASUREMENTS AND MAIN RESULTS: We identified 666 articles, 42 of which met inclusion criteria. We identified 11 intervention categories and classified them as either process specific (e.g., emergency department administration of thrombolytic therapy, activation of the catheterization laboratory by emergency department personnel) or system level (e.g., continuous quality improvement, critical pathways). A majority of studies (59%) were single-site pre/post design, and nearly half (47%) had sample sizes less than 100 patients. Thirty-two studies (76%) reported significantly lower door to reperfusion times associated with an intervention, 12 (29%) of which met or exceeded guideline recommended times. Relative decreases in times to reperfusion ranged from 15 to 82% for door to needle and 13-64% for door to balloon. CONCLUSIONS: We identified an array of process and system-based quality improvement interventions associated with significant improvements in door to reperfusion time. However, weak study designs and inadequate information about implementation limit the usefulness of this literature.

Keywords: Accuracy, Articles, Cardiac Reperfusion, Care-Unit, Catheterization, Cochrane, Critical Pathway, Databases, Embase, Emergency Department, Emergency-Department, Health, Information, Intervention, Interventions, Literature, Medline, Myocardial Infarction, National-Registry, Needle Times, Nurse Initiated Thrombolysis, Nursing, Outcome, Percutaneous Coronary Intervention, Primary Angioplasty, Quality Improvement, Reduces Door, Research, Review, Science, Systematic Review, Therapy, To-Balloon Time, Web of Science

? Kravitz, R.L. and Feldman, M.D. (2011), From the editors’ desk: Self-plagiarism and other editorial crimes and misdemeanors. Journal of General Internal Medicine, 26 (1), 1.

Full Text: 2011\J Gen Int Med26, 1.pdf

? Van Meter, M.E.M., Mckee, K.Y. and Kohlwes, R.J. (2011), Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: A systematic review. Journal of General Internal Medicine, 26 (1), 70-76.

Full Text: 2011\J Gen Int Med26, 70.pdf

Abstract: BACKGROUND: Malignant pleural effusions (MPE) are a frequent cause of dyspnea and discomfort at the end of cancer patients’ lives. The tunneled indwelling pleural catheter (TIPC) was approved by the FDA in 1997 and has been investigated as a treatment for MPE. OBJECTIVE: To systematically review published data on the efficacy and safety of the TIPC for treatment of MPE. DESIGN: We searched the MEDLINE, EMBASE, and ISI Web of Science databases to identify studies published through October 2009 that reported outcomes in adult patients with MPE treated with a TIPC. Data were aggregated using summary statistics when outcomes were described in the same way among multiple primary studies. MAIN MEASURES: Symptomatic improvement and complications associated with use of the TIPC. KEY RESULTS: Nineteen studies with a total of 1,370 patients met criteria for inclusion in the review. Only one randomized study directly compared the TIPC with the current gold standard treatment, pleurodesis. All other studies were case series. Symptomatic improvement was reported in 628/657 patients (95.6%). Quality of life measurements were infrequently reported. Spontaneous pleurodesis occurred in 430/943 patients (45.6%). Serious complications were rare and included empyema in 33/1168 patients (2.8%), pneumothorax requiring a chest tube in 3/51 (5.9%), and unspecified pneumothorax in 17/439 (3.9%). Minor complications included cellulitis in 32/935 (3.4%), obstruction/clogging in 33/895 (3.7%) and unspecified malfunction of the catheter in 11/121 (9.1%). The use of the TIPC was without complication in 517/591 patients (87.5%). CONCLUSIONS: Based on low-quality evidence in the form of case series, the TIPC may improve symptoms for patients with MPE and does not appear to be associated with major complications. Prospective randomized studies comparing the TIPC to pleurodesis are needed before the TIPC can be definitively recommended as a first-line treatment of MPE.

Keywords: Adult, Adults, Cancer, Case Series, Databases, Design, Doxycycline, Drainage, Efficacy, Embase, Insertions, ISI, Malignant Pleural Effusion, Medline, Outcomes, Outpatient Management, Palliative Care, Pleurodesis, Primary, Quality, Quality of Life, Review, Safety, Science, Single-Center Experience, Small-Bore Catheter, Statistics, Symptoms, Systematic, Systematic Review, Talc Pleurodesis, Treatment, Tunneled Catheter, Web of Science

? Lie, D.A., Lee-Rey, E., Gomez, A., Bereknyei, S. and Braddock, C.H. (2011), Does cultural competency training of health professionals improve patient outcomes? A systematic review and proposed algorithm for future research. Journal of General Internal Medicine, 26 (3), 317-325.

Full Text: 2011\J Gen Int Med26, 317.pdf

Abstract: Cultural competency training has been proposed as a way to improve patient outcomes. There is a need for evidence showing that these interventions reduce health disparities. The objective was to conduct a systematic review addressing the effects of cultural competency training on patient-centered outcomes; assess quality of studies and strength of effect; and propose a framework for future research. The authors performed electronic searches in the MEDLINE/PUBMED, ERIC, PsycINFO, CINAHL and Web of Science databases for original articles published in English between 1990 and 2010, and a bibliographic hand search. Studies that reported cultural competence educational interventions for health professionals and measured impact on patients and/or health care utilization as primary or secondary outcomes were included. Four authors independently rated studies for quality using validated criteria and assessed the training effect on patient outcomes. Due to study heterogeneity, data were not pooled; instead, qualitative synthesis and analysis were conducted. Seven studies met inclusion criteria. Three involved physicians, two involved mental health professionals and two involved multiple health professionals and students. Two were quasi-randomized, two were cluster randomized, and three were pre/post field studies. Study quality was low to moderate with none of high quality; most studies did not adequately control for potentially confounding variables. Effect size ranged from no effect to moderately beneficial (unable to assess in two studies). Three studies reported positive (beneficial) effects; none demonstrated a negative (harmful) effect. There is limited research showing a positive relationship between cultural competency training and improved patient outcomes, but there remains a paucity of high quality research. Future work should address challenges limiting quality. We propose an algorithm to guide educators in designing and evaluating curricula, to rigorously demonstrate the impact on patient outcomes and health disparities.

Keywords: Analysis, Assessment, Authors, Bibliographic, Care, Confounding, Control, Cultural Competency Curriculum, Databases, Disparities, Elaboration, Ethnic Disparities, Explanation, Health, Health Care, Health Disparities, Impact, Interventions, Medical-Education Research, Mental Health, Outcomes, Patient Outcomes, Physicians, Primary, Provider, Quality, Recommendations, Research, Review, Science, Students, Systematic, Systematic Review, Training, Utilization, Web of Science