Journal Of General Internal Medicine Research Articles

Improving the Pathway From Cardiovascular Medication Prescribing to Longer-Term Adherence

tion, and Treatment of High Blood Pressure (JNC 7) recommendations and an equal proportion of patients eligible for aspirin based on American Heart Association (AHA) guidelines were not receiving these therapies. Although the study time period overlapped with the publication dates of these guidelines, basic recommendations for primary prevention have not changed dramatically for many years, and therefore the results of Nasir et al are very consistent with the existing literature about missed opportunities for prevention. This study also demonstrates the somewhat fine balance between “underuse” and “overuse” of medical therapies and thus has implications for efforts to improve health care quality. As expected, the use of primary prevention increased over time in patients who were considered appropriate candidates for treatment. However, after receiving CACS results, a substantial proportion of patients for whom guidelines do not recommend therapy were also started on these treatments.

PLoS Medicine Issue Image | Vol. 7(4) April 2010

This month's Editorial, a collaborative statement by editors from Medical Decision Making, Trials, The Cochrane Library, Journal of Clinical Epidemiology, and PLoS Medicine, calls for standards in the conduct and reporting of comparative effectiveness research (CER). To optimize health outcomes within the constraints of inevitably limited resources, low- and high-income countries alike require unbiased means of assessing health care interventions for their relative effectiveness. Providing specific principles and standards for CER, the journal editors emphasize that researchers must adopt stringent methods, and medical journals must maintain high criteria for ethics, scientific rigor, and reporting, in order to fulfill the potential of research to improve decision making in health care. This statement has also been endorsed by the editors of Journal of General Internal Medicine, The American Journal of Managed Care, Clinical and Translational Science, and Croatian Medical Journal, and will be co-published in Medical Decision Making, Croatian Medical Journal, The Cochrane Library, Trials, The American Journal of Managed Care, and Journal of Clinical Epidemiology. Image Credit: Collage created by Katie Hickling, PLoS. Original images by southerntabitha, taberandrew, FeatheredTar, Seattle Municipal Archives, VinceHuang, jen_rab, isafmedia, and dbdbrobot, all on flickr.com.

Editorial Peer Reviewers' Recommendations at a General Medical Journal: Are They Reliable and Do Editors Care?

BackgroundEditorial peer review is universally used but little studied. We examined the relationship between external reviewers' recommendations and the editorial outcome of manuscripts undergoing external peer-review at the Journal of General Internal Medicine (JGIM).Methodology/Principal FindingsWe examined reviewer recommendations and editors' decisions at JGIM between 2004 and 2008. For manuscripts undergoing peer review, we calculated chance-corrected agreement among reviewers on recommendations to reject versus accept or revise. Using mixed effects logistic regression models, we estimated intra-class correlation coefficients (ICC) at the reviewer and manuscript level. Finally, we examined the probability of rejection in relation to reviewer agreement and disagreement. The 2264 manuscripts sent for external review during the study period received 5881 reviews provided by 2916 reviewers; 28% of reviews recommended rejection. Chance corrected agreement (kappa statistic) on rejection among reviewers was 0.11 (p<.01). In mixed effects models adjusting for study year and manuscript type, the reviewer-level ICC was 0.23 (95% confidence interval [CI], 0.19–0.29) and the manuscript-level ICC was 0.17 (95% CI, 0.12–0.22). The editors' overall rejection rate was 48%: 88% when all reviewers for a manuscript agreed on rejection (7% of manuscripts) and 20% when all reviewers agreed that the manuscript should not be rejected (48% of manuscripts) (p<0.01).Conclusions/SignificanceReviewers at JGIM agreed on recommendations to reject vs. accept/revise at levels barely beyond chance, yet editors placed considerable weight on reviewers' recommendations. Efforts are needed to improve the reliability of the peer-review process while helping editors understand the limitations of reviewers' recommendations.

Viewing the Future Through the Lens of the Past: A Personal Reflection on Disparities Education in Medicine and Public Health

As we move into the second decade of the millennium, we face the continuing challenge of educating medical students and health care providers about health disparities. In my recollection, this journey, which has mostly taken shape over the past 25 years, has faced all the challenges that come with an emerging body of knowledge that must be interpreted, synthesized and translated to effective action. This special supplement to the Journal of General Internal Medicine presents promising research and practice to inform how we educate present and future health care providers in this critical field.

Defensive Medicine and Tort Reform: A Wide View

Defensive Medicine and Tort Reform: A Wide View

Electronic Record Systems Often Fail to Meet Lofty Goals

Back to table of contents Previous article Next article Government NewsFull AccessElectronic Record Systems Often Fail to Meet Lofty GoalsRich DalyRich DalySearch for more papers by this authorPublished Online:5 Feb 2010https://doi.org/10.1176/pn.45.3.psychnews_45_3_007AbstractPsychiatrists using available electronic medical records may not see much improvement in patient care coordination, according to a recent report.Improved patient care coordination has been highlighted as one of the likely benefits of widespread physician adoption of electronic medical records (EMR). An interview-based survey of physician experiences with ambulatory care EMRs found, however, that they do little to improve care coordination between clinicians who are not in the same practice or health system. Psychiatrists who have moved to EMRs often adapt ambulatory care systems, which are closest to a mental health–specific program.The research, based on interviews with 52 physicians and staff from 26 practices across the country that have used a commercial ambulatory EMR system for at least two years, found current EMRs offer electronic message functions to facilitate intraoffice communication. However, most clinicians still rely on faxes for inter-office communications with other clinicians treating the same patient.The research was led by Ann O'Malley, M.D., M.P.H., a senior researcher at the Center for Studying Health Change. The results appeared in the December 22, 2009, Journal of General Internal Medicine.“If [physicians] have an EMR system, they may take the fax and scan it into their EMR program,” O'Malley told Psychiatric News.Patient care coordination—vitally important to many psychiatrists whose patients often have co-occurring nonpsychiatric illnesses—should improve with the finalization of emerging federal performance and interoperability standards. Those standards stem from a $19 billion program to reimburse physicians for the cost of installing an EMR system in their practices (see EHR Reimbursement Proposal Troubles Psychiatrists).Those federal standards aim to help facilitate better physician sharing of basic patient information, such as medication lists. Federal regulators will take longer to develop standards on sharing more complex but critical information, such as summaries of patient problems that are very helpful in care coordination, O'Malley said.Psychiatrists should not interpret the lack of finalized federal standards or O'Malley's findings as reasons to drop plans to buy a commercial EMR system, she said. However, they should proceed cautiously.It is important that physicians ensure that the manufacturer of the commercial EMR system that the clinician intends to buy will commit in writing to provide all future upgrades needed to meet emerging federal guidelines.O'Malley also noted that despite problems with system interoperability, the clinicians interviewed for her research reported that their practice was improved after adopting an EMR system.Additionally, she noted that even after fully interoperable EMR systems are in widespread use, clinicians will still need to call other clinicians treating the same patient when there is a need for urgent “real-time communications.”Another barrier to the adoption of EMRs is the payment systems for most public and private insurance programs, which currently do not provide physician reimbursement for the time that such care coordination requires.“Are Electronic Medical Records Helpful for Care Coordination? Experiences of Physician Practices” is posted at <www.commonwealthfund.org/Content/Publications/In-the-Literature/2009/Dec/Are-Electronic-Medical-Records-Helpful-for-Care-Coordination-Experiences-of-Physician-Practices.aspx>. ISSUES NewArchived

GENERATING THE KNOWLEDGE NEEDED TO MAKE THE PATIENT-CENTERED MEDICAL HOME A REALITY: A COLLABORATIVE PROJECT OF THE PRIMARY CARE SPECIALTIES

GENERATING THE KNOWLEDGE NEEDED TO MAKE THE PATIENT-CENTERED MEDICAL HOME A REALITY: A COLLABORATIVE PROJECT OF THE PRIMARY CARE SPECIALTIES

Improving the Performance of Performance Measurement

Improving the Performance of Performance Measurement

Five Years Before the Masthead: Our Journey with the Journal of General Internal Medicine

As in Richard Henry Dana’s classic American seafaring novel, Two Years Before the Mast1, our time at the helm of the Journal of General Internal Medicine (JGIM) has been filled with adventure. We have charted our course with specific goals and objectives while navigating the shoals of increasing time commitments for editors and reviewers while facing the rising storm of e-publishing. In this five-year retrospective, we reflect upon this journey, assess the degree to which we met our goals, and discuss lessons learned from which our successors may build and sail a stouter ship. In 2004, we were pleased to be chosen as the fifth set of editors of JGIM. In our proposal to the Council of the Society of General Internal Medicine (SGIM), we listed five specific goals and objectives we would attempt to achieve during our tenure (Table 1). Attacking these goals has been a challenge, a significant learning experience, and quite rewarding for all three of us. Because this is the last issue of the Journal to be published during our tenure as editors, we wanted to take this opportunity to document the degree to which we have met those initial goals and speculate upon JGIM’s future. Table 1 Original Goals and Objectives in 2004 Proposed by the JGIM Co-Editors GOAL 1: INCREASE THE NUMBER OF PEER-REVIEWED ARTICLES PUBLISHED During the five years prior to the current editorship (2000–2004), the mean number of manuscripts received per year was 694 (increasing from 480 to 937). The mean number of “regular articles” (i.e., excluding editorials, reflections, book and media reviews, and letters to the editor) was 594, increasing from 381 in 2000 to 788 in 2004 (Fig. 1). By comparison, during the five years of our editorship (July 1, 2004 through June 30, 2009), we received 4,879 manuscripts (not counting manuscripts submitted to supplements or special issues), a mean of 976 per year, a 41% increase over the prior five years. A total of 4,273 “regular articles” were submitted during the past five years, a mean of 855 per year, a 44% increase over the prior five years. Figure 1 Manuscripts received and articles published by year from 2000 through 2008. The current editors began accepting manuscripts July 1, 2004. The blue bars represent all manuscripts and the red bars represent “regular” manuscripts, which excludes ... From 2000 through 2004, a mean of 126 articles (range 107 to 134) were published per year in regular issues of JGIM (i.e., not including supplements). This increased by 121% to 271 per year (range 201 to 279) during the first four years of our editorship. (Data for 2009 are incomplete at this time.) We reached this goal of increasing published articles through a number of planned objectives aimed at making the most of JGIM’s page budget, including 1) reducing the maximum number of words per article from 3,500 to 3,000 for most article types; 2) making greater use of Brief Reports; 3) publishing appendices online only; and 4) improving the formatting of JGIM articles to reduce the amount of white space. We were also able to increase the number of published articles when, in 2007, JGIM changed its publisher to Springer who raised JGIM’s page budget dramatically. Maximizing space and increasing JGIM’s page budget allowed us to increase the acceptance rate for regular articles (excluding editorials, reflections, book reviews, and letters to the editor) from 20% during the final year of our predecessors to 25–26% from 2005 through 2007. Increasing the acceptance rate was not a stated goal. Rather, we told our Deputy Editors to accept for publication all articles they felt were worthy of publication in JGIM.

Shared Decision Making Is an Ethical Imperative

Shared Decision Making Is an Ethical Imperative

Patient Assistance Programs: Information Is Not Our Enemy

Perspective Health AffairsVol. 28, No. 3: Mental Health Care: Better, Not Best PERSPECTIVEPatient Assistance Programs: Information Is Not Our EnemyNiteesh K. Choudhry, Joy L. Lee, Jessica Agnew-Blais, Colleen Corcoran, and William H. ShrankPUBLISHED:May/June 2009No Accesshttps://doi.org/10.1377/hlthaff.28.3.843AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View article"Patient Assistance Programs: Information Is Not Our Enemy." Health Affairs, 28(3), pp. 843–844TOPICSPharmaceuticalsPrescription drugsAccess to careSystems of careRegulationPrescription drug costsCost reductionHealth reform Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 3 History Published online 1 May 2009 InformationCopyright 2009 by Project HOPE - The People-to-People Health Foundation, Inc.PDF downloadCited ByPharmaceutical assistance programs for cancer patients in the era of orally administered chemotherapeutics17 July 2017 | Journal of Oncology Pharmacy Practice, Vol. 24, No. 6Use of Prescription Drug Samples and Patient Assistance Programs, and the Role of Doctor–Patient Communication13 July 2011 | Journal of General Internal Medicine, Vol. 26, No. 12Promising therapies, prohibitive costs: a qualitative assessment of the effects of the Medicare Part D doughnut hole on access to costly cancer medicationsCommunity Oncology, Vol. 8, No. 3

Making good research useful: Another step on the journey

Making good research useful: Another step on the journey

The Diabetes Prevention Program: How The Participants Did It

Report From The Field Health AffairsVol. 28, No. 1: The Crisis In Chronic Disease REPORT FROM THE FIELDThe Diabetes Prevention Program: How The Participants Did ItSusan BrinkPUBLISHED:January/February 2009No Accesshttps://doi.org/10.1377/hlthaff.28.1.57AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleTOPICSDiabetesExerciseMetforminDiseasesCost savingsCost-effectivenessDietary habitsPharmaceuticalsType 2 diabetesCost reduction Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 10 History Published online 1 January 2009 InformationCopyright 2009 by Project HOPE - The People-to-People Health Foundation, Inc.PDF downloadCited byBarriers and Facilitators to Real-world Implementation of the Diabetes Prevention Program in Large Healthcare Systems: Lifestyle Coach Perspectives6 April 2020 | Journal of General Internal Medicine, Vol. 35, No. 6Implementation of a group-based diabetes prevention program within a healthcare delivery system15 October 2019 | BMC Health Services Research, Vol. 19, No. 1New Directions in Chronic Disease ManagementEndocrinology and Metabolism, Vol. 30, No. 2Worksite Translation of the Diabetes Prevention Program22 October 2012 | Health Promotion Practice, Vol. 14, No. 4A Comparative Approach to Using the Diabetes Prevention Program to Reduce Diabetes Risk in a Worksite Setting3 July 2012 | Health Promotion Practice, Vol. 14, No. 2Weight loss/maintenance as an effective tool for controlling type 2 diabetes: novel methodology to sustain weight reduction8 March 2012 | Diabetes/Metabolism Research and Reviews, Vol. 28, No. 3How Effective Were Lifestyle Interventions In Real-World Settings That Were Modeled On The Diabetes Prevention Program?Mohammed K. Ali, Justin B. Echouffo-Tcheugui, and David F. Williamson2 August 2017 | Health Affairs, Vol. 31, No. 1Importance and Benefits of Lifestyles Changes Versus Diabetes Drugs in Effective Management of Diabetes1 November 2010Potential National and State Medical Care Savings From Primary Disease PreventionAmerican Journal of Public Health, Vol. 101, No. 1Chronic Disease Prevention Across the LifespanThe Journal for Nurse Practitioners, Vol. 6, No. 1

BODY MASS INDEX: PITFALLS IN ELDERLY PEOPLE

BODY MASS INDEX: PITFALLS IN ELDERLY PEOPLE

A Better Measure of Patients’ Need for Interpreter Services

As Karliner and colleagues discuss in their article “Identification of Limited English Proficient Patients in Clinical Care”1 in the current issue of the Journal of General Internal Medicine, the matter of knowing whether or not patients need the assistance of language access services is an important one. The limited English proficient (LEP) population in the US is large and growing2 and, as has been well documented, language barriers to access to medical care contribute to poor outcomes and health disparities in the LEP population.3,4 Unfortunately, many LEP patients still go without the help of interpreters and other language access services in their health care interactions.5 There are many reasons for this, but an important one is that many health care organizations do not know that their patients need these services and therefore cannot plan accordingly, either for the provision of interpreter services or for planning efficient use of existing services. The work by Karliner and her colleagues documents a practical, accurate method for screening patients for their need for linguistic access services that will make it easier for health care organizations to collect the data they need to adequately plan for and provide linguistic access services to their LEP populations. Their results will also likely become more valuable in the future if the Joint Commission on the Accreditation of Healthcare Organizations establishes standards regarding the provision of culturally competent patient-centered care, which is currently being explored.6 A necessary first step towards providing culturally competent care is knowing the population being served within a health care organization and the needs of that population Knowing a patient’s English proficiency prior to walking into the exam room is also valuable to individual physicians. Most physicians have had the experience where a patient “gets by” with the English that they know and somewhere in the encounter it becomes clear that the communication is not adequate. Worse yet, the physician may erroneously think the communication is adequate when it is not because the patient does not really understand what is being said. The patient may be reluctant to reveal his or her lack of understanding because of embarrassment, lack of awareness of what is being missed in the interaction, fear of being discriminated against or stigmatized because they don’t speak English, or desire to avoid a delay as an interpreter is accessed. In these situations communication is impaired and both the patient and physician are at risk. If patients needing an interpreter or other linguistic access services could be identified before an encounter, the physician could enter into that encounter with the power of that knowledge and take steps optimize communication. Research involving patients with LEP would also benefit from an accurate, practical method of identifying such patients. One of the barriers to conducting high quality studies of the impact on health and health care of language barriers and interpreter services is the lack of good data on who is LEP, especially patients identified through large clinical and administrative databases.7 Two short questions together have high specificity and sensitivity in identifying patients who would benefit from interpreter and other linguistic access services. These questions could be easily incorporated into surveys and clinical and administrative database, creating valuable resources for research. Clearly, knowing the language proficiency of patients is important and the two-question combined measure of English proficiency described in this issue of JGIM is an important contribution. This measure could be used at the policy, administrative, and health care delivery levels to plan for and improve the care delivered to LEP patients and, if incorporated into clinical and administrative databases, could enhance our ability to conduct quality research in LEP populations. This does not mean that the research is not without limitations. It would be important to see how well this measure holds up against patients’ actual English proficiency when tested, rather than their reported quality of communication and understanding, but it is an important first step towards the development of practical, short tools to identify LEP patients and those who would benefit from linguistic access services. Such a tool will go a long way in efforts to provide adequate care to the growing LEP population in the US and to evaluate the quality of that care.

Text Messaging in Healthcare: The Elephant Knocking at the Door

Telemedicine and e-HealthVol. 14, No. 6 MEDICAL CONNECTIVITYText Messaging in Healthcare: The Elephant Knocking at the DoorMark TerryMark TerrySearch for more papers by this authorPublished Online:26 Aug 2008https://doi.org/10.1089/tmj.2008.8495AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byText Messages in the Field of Mental Health: Rapid Review of the Reviews24 June 2022 | Frontiers in Psychiatry, Vol. 13Impact of mhealth messages and environmental cues on hand hygiene practice among healthcare workers in the greater Kampala metropolitan area, Uganda: study protocol for a cluster randomized trial26 January 2021 | BMC Health Services Research, Vol. 21, No. 1Outcome of reminder text messages intervention on completion of routine immunization in rural areas, Nigeria15 October 2020 | Health Promotion International, Vol. 36, No. 3Text4Support Mobile-Based Programming for Individuals Accessing Addictions and Mental Health Services—Retroactive Program Analysis at Baseline, 12 Weeks, and 6 Months28 May 2021 | Frontiers in Psychiatry, Vol. 12Factors Influencing Interprofessional Collaboration in Healthcare EnvironmentmHealth2 December 2021“The flu… is a little more complicated than a cold”: Knowledge, beliefs, and practices related to influenza and influenza vaccination among at-risk populations and health professionals in PeruVaccine, Vol. 38, No. 48The Effects of Lifestyle Intervention using Modified BASNEF Model in Hypertension Management: A Quasi-Experimental Study (Preprint)15 May 2020 | JMIR CardiomHealth30 May 2020Changes in Stress, Anxiety, and Depression Levels of Subscribers to a Daily Supportive Text Message Program (Text4Hope) During the COVID-19 Pandemic: Cross-Sectional Survey Study18 December 2020 | JMIR Mental Health, Vol. 7, No. 12mHealth20 May 2019Increasing Perioperative Communication With Automated Mobile Phone Messaging in Total Joint ArthroplastyThe Journal of Arthroplasty, Vol. 33, No. 1Mobile phone messaging for illicit drug and alcohol dependence: A systematic review of the literature5 May 2017 | Drug and Alcohol Review, Vol. 36, No. 4Impact of Trust and Technology on Interprofessional Collaboration in Healthcare SettingsInternational Journal of e-Collaboration, Vol. 13, No. 2Developing a mHealth intervention to promote uptake of HIV testing among African communities in the UK: a qualitative study28 July 2016 | BMC Public Health, Vol. 16, No. 1Short Text Messages (SMS) as an Additional Tool for Notifying Medical Staff in Case of a Hospital Mass Casualty Incident12 October 2015 | Disaster Medicine and Public Health Preparedness, Vol. 10, No. 1New Directions for Engaging Patients on Weight Management for General Pediatricians3 April 2015 | Current Treatment Options in Pediatrics, Vol. 1, No. 2User preferences for text message-delivered skin cancer prevention and early detection19 February 2015 | Journal of Telemedicine and Telecare, Vol. 21, No. 4Beyond mobile populations: a critical review of the literature on malaria and population mobility and suggestions for future directions9 August 2014 | Malaria Journal, Vol. 13, No. 1Recommendations for Professional Use of Social Media, Digital Technology, and the InternetM-Health Technology as a Transforming Force for Population HealthMobile Health in China: A Review of Research and Programs in Medical Care, Health Education, and Public HealthJournal of Health Communication, Vol. 18, No. 11Enterprise Transformation Through Mobile ICT: a Framework and Case Study in HealthcareJournal of Enterprise Transformation, Vol. 2, No. 2Mobile Phone Text Messaging: Tool for Malaria Control in Africa21 February 2012 | PLoS Medicine, Vol. 9, No. 2Mobile Teledermatology12 October 2011Using Mobile Health to Support the Chronic Care Model: Developing an Institutional InitiativeInternational Journal of Telemedicine and Applications, Vol. 2012A Re-conceptualization of Access for 21st Century Healthcare12 October 2011 | Journal of General Internal Medicine, Vol. 26, No. S2Feasibility and Usability of a Text Message-Based Program for Diabetes Self-Management in an Urban African-American Population1 September 2011 | Journal of Diabetes Science and Technology, Vol. 5, No. 5The effect of mobile phone text-message reminders on Kenyan health workers' adherence to malaria treatment guidelines: a cluster randomised trialThe Lancet, Vol. 378, No. 9793Text4Baby: Using Text Messaging to Improve Maternal and Newborn HealthNursing for Women's Health, Vol. 15, No. 3Counseling Young Cannabis Users by Text Message1 July 2010 | Journal of Computer-Mediated Communication, Vol. 15, No. 4Text Messaging as a Tool for Behavior Change in Disease Prevention and Management30 March 2010 | Epidemiologic Reviews, Vol. 32, No. 1Promoting Self‐Management Through Technology: SMART Solutions for Long‐Term Health ConditionsJournal of Integrated Care, Vol. 17, No. 6Impact of Trust and Technology on Interprofessional Collaboration in Healthcare Settings Volume 14Issue 6Aug 2008 InformationCopyright 2008, Mary Ann Liebert, Inc.To cite this article:Mark Terry.Text Messaging in Healthcare: The Elephant Knocking at the Door.Telemedicine and e-Health.Aug 2008.520-524.http://doi.org/10.1089/tmj.2008.8495Published in Volume: 14 Issue 6: August 26, 2008PDF download

Sodium Intake and Mortality: The Debate Continues

Dietary patterns have long been recognized as a key factor in the association of disease patterns and health outcomes. Pellagra, as an example, was prevalent among the poor in the American South in the early 1900s and was basically eradicated with nutritious diets and vitamin-enriched flour.1,2 Other conditions such as scurvy are well recognized as associated with diet and malnutrition, and recognized currently in developing countries.3 Similarly, the high intake of dietary cholesterol and fats was found decades ago to be associated with increased risks of cardiovascular disease. 4,5 These findings have led to public health interventions and policies designed to improve dietary patterns in an effort to promote health and prevent disease. The dietary intake of salt and sodium represents another major lifestyle and behavior associated with disease prevalence. The associations of sodium intake and adverse cardiovascular outcomes have long been recognized, with reduction in salt consumption considered a major public health intervention. Reduction in sodium intake is a recommended lifestyle modification of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: (JNC 7 report)6 for all stages of elevated blood pressure. In many clinical investigations, sodium reduction was associated with blood pressure lowering among hypertensives, both alone and as a complement to medical treatment.7 The information regarding the risks of high sodium intake and the potential benefit of a lower sodium diet has been conveyed effectively to the public. In a study of older Americans regarding attitudes on lifestyle and blood pressure level, 90% of the respondents reported that a reduction in salt intake was effective for treating and controlling high blood pressure, with 14% indicating sodium restriction as the most effective lifestyle factor.8 However, with a society skeptical of strategies that fail to yield proclaimed benefits, it is prudent for clinical investigators and epidemiologists to quantify accurate risks and benefits. In this issue of the Journal of General Internal Medicine, Cohen and colleagues continue the debate regarding the risks and benefits of salt intake.9 In particular, the authors assess cardiovascular disease and all-cause mortality in the Third National Health and Nutrition Examination Survey (NHANES III) determining modest and non-significant association of sodium intake and higher mortality risks. Further, they concluded from the analyses that higher sodium intake was unlikely to be an independent predictor of high cardiovascular or all-cause mortality.9 While the analyses are reasonable and take advantage of a valuable epidemiologic data base, several issues should be considered when evaluating the results. First, these results are based on a secondary data analysis. While such results are valuable in developing hypotheses, conclusions are better based on randomized clinical trials.10 The assessment of sodium intake is another limitation of the study, as indicated by the authors. The use of a single measure of sodium intake as an indication of salt consumption may indeed not be representative of the true diet. Likewise, this concern is multiplied as there are no sodium excretion measures to validate the intake values. A third issue regards the potential sampling issues of the NHANES III, which was not designed specifically for the measurement of sodium intake in the population. While this is an excellent study cohort, inclusion of individuals with varying geographic and cultural use of salt may not be adequately sampled. These parameters were not included in the statistical models. When Alderman and colleagues presented earlier work in 1998 with similar findings using the first National Health and Nutrition Examination Survey,11 conflicting views were expressed. The spirited exchange of letters identified many of the limitations and cautions described with the current paper, with the references to numerous epidemiological studies reporting the benefits of salt reduction. Thus, the debate continues. However, as the clinical guidelines for disease management and policies regarding sodium are updated, it is imperative these documents be based on actuate information. While the debate is “healthy” for the progress of science, it can be confusing when affecting prevention and disease management strategies.

Proposed standards for medical education submissions to the Journal of General Internal Medicine.

To help authors design rigorous studies and prepare clear and informative manuscripts, improve the transparency of editorial decisions, and raise the bar on educational scholarship, the Deputy Editors of the Journal of General Internal Medicine articulate standards for medical education submissions to the Journal. General standards include: (1) quality questions, (2) quality methods to match the questions, (3) insightful interpretation of findings, (4) transparent, unbiased reporting, and (5) attention to human subjects’ protection and ethical research conduct. Additional standards for specific study types are described. We hope these proposed standards will generate discussion that will foster their continued evolution.Electronic supplementary materialThe online version of this article (doi:10.1007/s11606-008-0676-z) contains supplementary material, which is available to authorized users.

Predictive Validity Evidence for Medical Education Research Study Quality Instrument Scores: Quality of Submissions to JGIM’s Medical Education Special Issue

BackgroundDeficiencies in medical education research quality are widely acknowledged. Content, internal structure, and criterion validity evidence support the use of the Medical Education Research Study Quality Instrument (MERSQI) to measure education research quality, but predictive validity evidence has not been explored.ObjectiveTo describe the quality of manuscripts submitted to the 2008 Journal of General Internal Medicine (JGIM) medical education issue and determine whether MERSQI scores predict editorial decisions.Design and ParticipantsCross-sectional study of original, quantitative research studies submitted for publication.MeasurementsStudy quality measured by MERSQI scores (possible range 5–18).ResultsOf 131 submitted manuscripts, 100 met inclusion criteria. The mean (SD) total MERSQI score was 9.6 (2.6), range 5–15.5. Most studies used single-group cross-sectional (54%) or pre-post designs (32%), were conducted at one institution (78%), and reported satisfaction or opinion outcomes (56%). Few (36%) reported validity evidence for evaluation instruments. A one-point increase in MERSQI score was associated with editorial decisions to send manuscripts for peer review versus reject without review (OR 1.31, 95%CI 1.07–1.61, p = 0.009) and to invite revisions after review versus reject after review (OR 1.29, 95%CI 1.05–1.58, p = 0.02). MERSQI scores predicted final acceptance versus rejection (OR 1.32; 95% CI 1.10–1.58, p = 0.003). The mean total MERSQI score of accepted manuscripts was significantly higher than rejected manuscripts (10.7 [2.5] versus 9.0 [2.4], p = 0.003).ConclusionsMERSQI scores predicted editorial decisions and identified areas of methodological strengths and weaknesses in submitted manuscripts. Researchers, reviewers, and editors might use this instrument as a measure of methodological quality.Electronic supplementary materialThe online version of this article (doi:10.1007/s11606-008-0664-3) contains supplementary material, which is available to authorized users.

Where We’re Headed: A New Wave of Scholarship on Educating Medical Professionalism

Ah yes, another editorial on professionalism. This topic has certainly been one of accelerating interest. For example, a PubMed search on the title word “professionalism” finds 1331 articles as outlined in Table 1; approximately 100 articles per year have appeared since the 2002 publication of the physician charter.1 While much of the past literature has focused on the definition of professionalism, increasingly, the field is moving in the needed direction of discovering and building processes that foster professional attitudes and behaviors among physicians and physicians in training. In this education issue of The Journal of General Internal Medicine, at least six articles focus on the subject.2–7 While all six add to the literature in their own right, taken collectively, they contain several powerful messages that provide a beacon for future work in this field: Table 1 English Language Articles Published With the Word ‘Professionalism’ in the Title*