Journal of The American Board of Family Practice 

About: Journal of The American Board of Family Practice is an academic journal. The journal publishes majorly in the area(s): Population & Health care. It has an ISSN identifier of 0893-8652. Over the lifetime, 1546 publications have been published receiving 35204 citations.

Guidelines for the diagnosis and management of asthma.

Abstract: Guidelines for the Diagnosis and Management of Asthma were produced by the Expert Panel on the Management of Asthma convened by the National Asthma Education Program under the auspices of the National Heart, Lung, and Blood Institute of the National Institutes of Health. The full report (PHS publication no. 91-3042) and executive summary (pHS publication no. 91-3042A) were released in August and June of 1991, respectively, and mailed directly to family physicians and other practitioners under sponsorship of several pharmaceutical firms whose products are often used in treatment of asthma. Additionally, special issues of the Journal of Allergy and Clinical Immunowgy and Pediatric Allergy reprinted the entire report for their subscribers. In the Foreword to the report, Claude Lenfant, M.D., Director of the National Heart, Lung, and Blood Institute, presents the charge of the panel: \"To develop guidelines to improve the detection and treatment of asthma. \" He goes on to state that the guidelines \" ... are likely to have a profound effect on the way asthma is treated.\" Dr. Albert Sheffer, chair of the expert panel, states in the Preface his hope that with use of these guidelines, \"Patients with asthma can expect to control their symptoms, prevent most acute asthma exacerbations, maintain the activity levels they desire, and attain near normal lung function.\" Clinicians caring for patients with asthma are the intended audience for the guidelines. Dr. Lenfant comments in the Foreword that the report is designed to provide clinicians with new insights into asthma management, but whether

Strength of Recommendation Taxonomy (SORT): A Patient-Centered Approach to Grading Evidence in the Medical Literature

Abstract: A large number of taxonomies are used to rate the quality of an individual study and the strength of a recommendation based on a body of evidence. We have developed a new grading scale that will be used by several family medicine and primary care journals (required or optional), with the goal of allowing readers to learn one taxonomy that will apply to many sources of evidence. Our scale is called the Strength of Recommendation Taxonomy. It addresses the quality, quantity, and consistency of evidence and allows authors to rate individual studies or bodies of evidence. The taxonomy is built around the information mastery framework, which emphasizes the use of patient-oriented outcomes that measure changes in morbidity or mortality. An A-level recommendation is based on consistent and good quality patient-oriented evidence; a B-level recommendation is based on inconsistent or limited quality patient-oriented evidence; and a C-level recommendation is based on consensus, usual practice, opinion, disease-oriented evidence, or case series for studies of diagnosis, treatment, prevention, or screening. Levels of evidence from 1 to 3 for individual studies also are defined. We hope that consistent use of this taxonomy will improve the ability of authors and readers to communicate about the translation of research into practice.

Physician-patient communication in the primary care office: a systematic review.

Abstract: BACKGROUND The physician-patient interview is the key component of all health care, particularly of primary medical care. This review sought to evaluate existing primary-care-based research studies to determine which verbal and nonverbal behaviors on the part of the physician during the medical encounter have been linked in empirical studies with favorable patient outcomes. METHODS We reviewed the literature from 1975 to 2000 for studies of office interactions between primary care physicians and patients that evaluated these interactions empirically using neutral observers who coded observed encounters, videotapes, or audiotapes. Each study was reviewed for the quality of the methods and to find statistically significant relations between specific physician behaviors and patient outcomes. In examining nonverbal behaviors, because of a paucity of clinical outcome studies, outcomes were expanded to include associations with patient characteristics or subjective ratings of the interaction by observers. RESULTS We found 14 studies of verbal communication and 8 studies of nonverbal communication that met inclusion criteria. Verbal behaviors positively associated with health outcomes included empathy, reassurance and support, various patient-centered questioning techniques, encounter length, history taking, explanations, both dominant and passive physician styles, positive reinforcement, humor, psychosocial talk, time in health education and information sharing, friendliness, courtesy, orienting the patient during examination, and summarization and clarification. Nonverbal behaviors positively associated with outcomes included head nodding, forward lean, direct body orientation, uncrossed legs and arms, arm symmetry, and less mutual gaze. CONCLUSION Existing research is limited because of lack of consensus of what to measure, conflicting findings, and relative lack of empirical studies (especially of nonverbal behavior). Nonetheless, medical educators should focus on teaching and reinforcing behaviors known to be facilitative, and to continue to understand further how physician behavior can enhance favorable patient outcomes, such as understanding and adherence to medical regimens and overall satisfaction.

Homocysteine and Cardiovascular Disease

Abstract: After a thorough review of the available literature, it appears that hyperhomocysteinemia is an independent risk factor for CHD. Furthermore, folic acid has been shown to reduce homocysteine concentration. Nevertheless, CHD is a multifactorial process, and many risk factors play a role in its pathogenesis. Several unanswered questions remain regarding the role of folic acid supplementation in hyperhomocysteinemia (Table 3). The absolute homocysteine concentration at which cardiovascular risk increases is not certain, and the magnitude of homocysteine-lowering needed to prevent events is unknown. Consequently, the number needed to treat cannot be calculated for folic acid supplements. Based on these data, the populations in whom to evaluate a homocysteine concentration have yet to be described. Because the POEMs are not yet available, it is unknown whether supplemental folic acid to lower homocysteine concentration will reduce CHD morbidity and mortality. It will take several years before any randomized, controlled trials are done, and primary prevention trials will need to be of very long duration to show any change in outcomes. Widespread use of folic acid supplementation has been recommended, however, and the need for clinical outcomes might be precluded. Even in the absence of outcome data, the potential benefits of using folic acid appear to outweigh any risks. A diet high in folic acid should be encouraged in everyone (Table 4). The FDA-mandated folic acid fortification of enriched grain products is most likely insufficient to lower homocysteine concentrations meaningfully, and a daily multivitamin that contains 400 microg of folic acid should be considered for patients who have documented CHD (especially when other risk factors are absent or in patients with premature atherosclerosis) and men and women who have cardiovascular risk factors, in addition to women of childbearing potential. Folic acid supplementation in the form of a multivitamin once daily is safe and inexpensive and might prevent the development and progression of CHD.

Mind-Body Medicine: State of the Science, Implications for Practice

Abstract: Background: Although emerging evidence during the past several decades suggests that psychosocial factors can directly influence both physiologic function and health outcomes, medicine had failed to move beyond the biomedical model, in part because of lack of exposure to the evidence base supporting the biopsychosocial model. The literature was reviewed to examine the efficacy of representative psychosocial-mind-body interventions, including relaxation, (cognitive) behavioral therapies, meditation, imagery, biofeedback, and hypnosis for several common clinical conditions. Methods: An electronic search was undertaken of the MEDLINE, PsycLIT, and the Cochrane Library databases and a manual search of the reference sections of relevant articles for related clinical trials and reviews of the literature. Studies examining mind-body interventions for psychological disorders were excluded. Owing to space limitations, studies examining more body-based therapies, such as yoga and tai chi chuan, were also not included. Data were extracted from relevant systematic reviews, meta-analyses, and randomized controlled trials. Results: Drawing principally from systematic reviews and meta-analyses, there is considerable evidence of efficacy for several mind-body therapies in the treatment of coronary artery disease (eg, cardiac rehabilitation), headaches, insomnia, incontinence, chronic low back pain, disease and treatment-related symptoms of cancer, and improving postsurgical outcomes. We found moderate evidence of efficacy for mind-body therapies in the areas of hypertension and arthritis. Additional research is required to clarify the relative efficacy of different mind-body therapies, factors (such as specific patient characteristics) that might predict more or less successful outcomes, and mechanisms of action. Research is also necessary to examine the cost offsets associated with mind-body therapies. Conclusions: There is now considerable evidence that an array of mind-body therapies can be used as effective adjuncts to conventional medical treatment for a number of common clinical conditions.