Publications by authors named "Marjorie A Bowman"

123 Publications

Multiple Research Methodologies Can Advance the Science of Family Medicine.

J Am Board Fam Med 2019 Mar-Apr;32(2):123-125

This issue of the evidences the wide variety of research methods that can effectively answer questions important to the practice of family medicine. For example, this issue includes 4 highly informative reports from qualitative or mix-methods research, plus surveys, a meta-analysis, a case report, and more. Mixed-methods were used to look at practice changes and to compare advance directive tools. Surveys were used to identify practical, but addressable, issues for mailed colon cancer screening tests, and the prevalence of atopic dermatitis, and emollient use in young children. Secondary analyses of national surveys were used to identify low-value patient requests, and how diabetes and prediabetes are being treated. Retrospective chart analysis of patients with frequent hospital admissions identified important characteristics of the patients and their problems. Meta-analysis methodology was used to stratify risks for pneumonia. And, a randomized trial was used to compare ways to train patients to use medical record patient portals.
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http://dx.doi.org/10.3122/jabfm.2019.02.190005DOI Listing
April 2020

Conversations, Communication and Counseling Are Key Family Medicine Tactics to Improve Patient Health.

J Am Board Fam Med 2019 Jan-Feb;32(1):1-3

This issue includes research on conversations, communication and counseling regarding depression treatment, the diagnosis of prediabetes, the topics of diversity and inclusion in medicine on Twitter, asthma treatment outcomes, muscle strengthening as an important form of exercise, multiple hospital readmissions, as well as after-visit summaries and advance care planning.
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http://dx.doi.org/10.3122/jabfm.2019.01.180320DOI Listing
March 2020

Physician Advance Care Planning Experiences and Beliefs by General Specialty Status and Sex.

South Med J 2018 12;111(12):721-726

From the Departments of Family Medicine, Population and Public Health Sciences, and Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.

Objectives: Advance care planning (ACP) involvement could be substantially different by physician specialty or sex group, with implications for training and methods to increase ACP activities. The objective of this article is to compare primary care physicians (PCPs) and other specialty physicians and female compared with male physicians' views and interactions surrounding ACP.

Methods: This was a secondary analysis of an online anonymous survey distributed through a survey link to healthcare providers in hospital, ambulatory, and hospice settings in the greater Dayton, Ohio area in preparation for a community-wide advance care planning multitiered intervention. The measures included demographic data and questions regarding personal ACP decisions/experiences, opinions surrounding ACP in healthcare settings, and willingness to facilitate ACP with patients.

Results: There were 129 physician respondents, of which 39 (30.2%) were PCPs, and 33 (25.6%) were women. Most expressed interest in ACP, responding positively to a desire for more training, and approximately 25% were willing to be trained to teach others. The respondents by specialty group were similar in age and race, the presence or absence of religious affiliation, and stated frequency of ACP conversations. More than half (52.5%) reported having ACP conversations at least twice per month. The female physicians were younger and more likely to be in primary care. Female physicians also were more likely to discuss ACP with patients ( = 0.017), report formal training for ACP ( = 0.025), and be more willing to permit other healthcare provider types to be involved with ACP. PCPs reported time as a barrier more frequently than specialty physicians ( = 0.012). Other barriers to ACP were reported, including space, personal discomfort, and concerns about patient or family distress or disagreement.

Conclusions: Many physicians, regardless of specialty type or sex, are interested in undertaking more ACP conversations and being trained to do so. Overall, more female physicians than male physicians were involved and interested in various aspects of ACP, and they were more accepting of the involvement of nonphysician healthcare professionals in ACP. Multiple barriers for clinicians, patients, and families were identified that will need to be addressed by work settings or through education to increase ACP.
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http://dx.doi.org/10.14423/SMJ.0000000000000903DOI Listing
December 2018

Beware of Predatory Journals: A Caution from Editors of Three Family Medicine Journals.

J Am Board Fam Med 2018 Sep-Oct;31(5):671-676

From Department of Family Medicine and Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Kettering OH (MAB); Oregon Health & Science University, Portland, OR (JWS); University of Washington, Seattle, WA (WRP).

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http://dx.doi.org/10.3122/jabfm.2018.05.180197DOI Listing
October 2019

Health Care Integration and Coordination with Emphasis on Mental Health, but Not for Medical Marijuana.

J Am Board Fam Med 2018 Sep-Oct;31(5):667-670

Care coordination and behavioral health care integration are the subject of 4 of this month's articles. Patients with significant illness report that care coordination provides great challenges to them, and they expect family physicians to assist with the referrals and communication between the doctors. Patients' primary care providers were usually not the prescribers of patients' medical marijuana and were often unaware of its use, indicating lack of health care integration and coordination. Two articles provide insight into medication adherence. Also, how are family physicians addressing patient engagement at the practice level? Clinical topics in this issue include the following: specific exercises were not the answer to restless legs; epidural anesthesia may be associated with fewer, not more, vaginal lacerations; and fecal incontinence is less discussed but not necessarily less problematic than urinary incontinence. On the popular culture front, opioid mentions in top 100 songs are increasing. Lastly, what does it mean for the field of family medicine that some of us choose to become hospitalists?
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http://dx.doi.org/10.3122/jabfm.2018.05.180189DOI Listing
October 2019

A beginner's guide to avoiding Protected Health Information (PHI) issues in clinical research - With how-to's in REDCap Data Management Software.

J Biomed Inform 2018 09 12;85:49-55. Epub 2018 Jul 12.

Department of Obstetrics & Gynecology at the Wright State University Boonshoft School of Medicine, Dayton, OH, United States. Electronic address:

Protecting personally identifiable information is important in clinical research. The authors, two faculty members involved in developing and implementing research infrastructure for a medical school, observed challenges novice researchers encountered in recognizing, collecting, and managing Protected Health Information (PHI) for clinical research. However, we had difficulty finding resources that provide practical strategies for novice clinical researchers for this topic. Common issues for beginners were: 1. Recognition of PHI, e.g. lack of recognition of 'indirect' PHI, i.e., that the combination of two or more non-PHI data types or other specific information could result in identifiable data requiring protection; 2. Collection of PHI, e.g., proposed collection of data not necessary for fulfillment of the project's objectives or potential inadvertent collection of PHI in free text response items; and 3. Management of PHI, e.g., proposed use of coding systems that directly included PHI, or proposed data collection techniques, electronic data storage, or software with inadequate protections. From these observations, the authors provide the following in this paper: 1. A brief review of the elements of PHI, particularly 'indirect' PHI; 2. Sample data management plans for common project types relevant to novice clinical researchers to ensure planning for data security; 3. Basic techniques for avoiding issues related to the collection of PHI, securing and limiting access to collected PHI, and management of released PHI; and 4. Methods for implementing these techniques in the Research Electronic Data Capture (REDCap) system, a commonly used and readily available research data management software system.
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http://dx.doi.org/10.1016/j.jbi.2018.07.008DOI Listing
September 2018

The Potpourri of Family Medicine, in Sickness and in Health.

J Am Board Fam Med 2018 Jul-Aug;31(4):495-498

Some aspects of the health of Americans are declining, and family medicine is addressing these ailments. Obesity is one factor, and family physicians provide nutrition counseling. Despite new models such as direct primary care, we have not found an ideal method for providing primary care to everyone in our health system. Not all family physicians report burnout: what is their secret? Scribes: some positives and negatives from one group. Rural America is in need of more family physicians who provide prenatal and natal care, and the proof is in the infant mortality rate. We also have 2 articles on improving pediatric care, and research on the relationship of thrush to mode of infant delivery. We have reviews of new cancer and cholesterol drugs, raising awareness of important knowledge for the primary care clinicians seeing the patients who take these drugs. In addition: tick bites and delayed anaphylaxis-when and how, culture-related skin findings, and helping male perpetrators of domestic violence.
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http://dx.doi.org/10.3122/jabfm.2018.04.180136DOI Listing
October 2019

Real-Life Observational Studies Provide Actionable Data for Family Medicine.

J Am Board Fam Med 2018 Mar-Apr;31(2):171-173

This issue includes several excellent observational studies prompted by physicians' clinical questions. Many people use lots of menthol cough drops-does the menthol overall lengthen the cough duration? When should we intensify treatment of older individuals with diabetes? Do occipital nerve blocks work for acute migraine headaches? Did you know that the plantar fascia can rupture? What happens to those patients with chest pain but low pretest probability for serious cardiac disease who are admitted to the hospital? Acupuncture can work well-for the patients-but how can we incorporate it into the usual pace of the family medicine office? Is it a win-lose situation when medical assistant roles are expanded? How many practice sites do physicians have and does that make a difference in the number or type of health personnel shortage areas? What would you guess on the presence of humor in the medical office-more or less than half of the visits; introduced by doctors or patients; primary care or specialty doctors?
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http://dx.doi.org/10.3122/jabfm.2018.02.180005DOI Listing
September 2019

Interventions Must Be Realistic to Be Useful and Completed in Family Medicine.

J Am Board Fam Med 2018 Jan-Feb;31(1):1-4

Being realistic while helping our patients is this issue's theme. Given the volume of tasks required in family medicine, recommendations for improvements in direct care or care measurement cannot just be evidence-based but must also be realistic. On the list of realistic: ordering antipsychotics for symptoms of dementia in the elderly, despite recommendations to not do so; ordering antidepressants without fear that the patient could develop hypertension; mental health care providers in primary care offices; forced choice for opioid management; plus agenda setting for visit efficiency. Not yet realistic: trigger tools to identify adverse events, and pharmacist recommendations related to pain management before opioid visits. Pneumococcal vaccine compliance is only realistic if recommendations are not recurrently changed, are paid for, and if prior immunizations are known. Increasing task delegation to prevent clinician burnout is not realistic if it burns out the nurses, or if the helpful scribes cannot be afforded. Helpful, yet questionably realistic: Primary care clinician involvement for patients in intensive care units and their families, and problem-solving therapy by family physicians. And, let us add 'frightening': few international medical school graduates to serve the underserved. The most frequent diagnoses and most critical diagnoses in family medicine are elucidated.
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http://dx.doi.org/10.3122/jabfm.2018.01.170422DOI Listing
August 2019

Multiple Practical Facts and Ideas to Improve Family Medicine Care.

J Am Board Fam Med 2017 Nov-Dec;30(6):687-690

Seconds count in a study on the best electronic health note format to reduce medical record charting time and increase accuracy. Directly observed family physician work is compared with Current Procedural Terminology (CPT) coding examples and notably under-recognized. This issue contains articles from single practices that that implemented new methods of care and other reports on practice innovations that can be more broadly implemented. We have articles on opioid medication use for acute low back pain in primary care, an electronic chronic pain consult service, a key question to identify potential opioid misuse risk, and newly implemented screening for other substances of abuse. Omissions (or gaps) in care are also highlighted: from the common types of omissions identified by primary care clinicians, self-reported low levels of substance use screening by family medicine prenatal care providers, and inadequate and inadequately available hospital discharge summaries. In addition, the most important alarm symptoms for a cancer diagnosis are reported.
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http://dx.doi.org/10.3122/jabfm.2017.06.170372DOI Listing
July 2018

In This Issue: Opiates, Tobacco, Social Determinants of Health, Social Accountability for Non-Profit Hospitals, More on PCMH, and Clinical Topics.

J Am Board Fam Med 2017 Jul-Aug;30(4):399-401

This issue contains several articles about the factors contributing to the complex and deadly interplay between social determinants of health, pain, mental illness, and addictive substances such as opioids and tobacco. One article clearly is a call to action: more than half of opioid prescriptions in the United States are given to patients with mental health problems. Two articles report work on the next steps for social determinants of health in health care settings. Social accountability based on community health needs assessments required of community hospitals should lead to the creation of more family medicine residency positions. Patient-centered medical home (PCMH) recognition can be costly. A new typology for PCMHs is proposed. Other topics include group advance care planning visits, the interaction of dental and primary care, free clinics, a fix for a squeaking wrist, adherence to latent tuberculosis treatment, and more.
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http://dx.doi.org/10.3122/jabfm.2017.04.170192DOI Listing
February 2018

Research on Clinical Decisions Made Daily in Family Medicine.

J Am Board Fam Med 2017 May-Jun;30(3):269-271

This issue presents research on the types of decisions that are required daily in family medicine. Patients often make these health decisions, and family physicians help patients with these decisions daily. Patients and their family physicians discuss when to quit screening for colon cancer, which treatment to choose for localized prostate cancer, when to test for pertussis when a cough is present, whether to take prescribed medications, how to complete more preventive services, and how to understand the "new genetics", and family physician use of telehealth.
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http://dx.doi.org/10.3122/jabfm.2017.03.170125DOI Listing
January 2018

Family Medicine Research in the United States From the late 1960s Into the Future.

Fam Med 2017 Apr;49(4):289-295

Departments of Family Medicine and Population and Public Health Sciences, Boonshoft School of Medicine.

Background: When the new field of family medicine research began a half century ago, multiple individuals and organizations emphasized that research was a key mission. Since the field's inception, there have been notable research successes for which family medicine organizations, researchers, and leaders-assisted by federal and state governments and private foundations-can take credit. Research is a requirement for family medicine residency programs but not individual residents, and multiple family medicine departments offer research training in various forms for learners at all levels, including research fellowships. Family physicians have developed practice-based research networks (PBRNs) to conduct investigations and generate new knowledge. The field of family medicine has seen the creation of new journals to support the publication of research relevant to practicing family physicians. Nonetheless, in spite of much growth and many successes, family physicians and their research have been underrepresented in research funding. Clinical presentations in family medicine are often complex, poorly-differentiated, and exist as one of several patient complaints and diagnoses, and are not well-covered by the narrow basic-science and specialty research that defines most of the biomedical research enterprise. Overall health in the United States would benefit from a more robust research participation and greater support for family medicine research.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5407380PMC
April 2017

Improving Family Medicine with Thoughtful Research.

J Am Board Fam Med 2017 Mar-Apr;30(2):117-120

This issue is about improving primary health care outcomes, from behavioral health to opioid issues to diagnosing hypertension to providing hope for childhood obesity. It includes hints for integrating behavioral health and care managers into family medicine practices. Opiate prescribing practices vary considerably between Japan and the United States, with helpful insights for our opiate abuse epidemic. Suicidality is high among patients taking opiates. Diagnosing hypertension the recommended way is not easily accomplished. Primary care clinicians are important in infertility and prostate cancer treatment, and in support of men who commit interpersonal violence and people with cognitive impairment who wander. The "July effect" seems to persist. Parents' views on obesity in children can be changed-for the better. Family physicians have less burnout than has been previously reported, and many provide palliative care. Doctors think diseases, patients think about how well they feel. Do we find healthy lifestyles in retirement?
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http://dx.doi.org/10.3122/jabfm.2017.02.170028DOI Listing
December 2017

Bread and Butter of Family Medicine: Guidelines, Population Screening, Diagnostic Evaluations, and Practice Models.

J Am Board Fam Med 2016 11;29(6):639-641

This issue of JABFM is full of evidence and thoughtful articles on topics central to family medicine. These articles critically examine what family physicians do on a daily basis. Reports in this issue provide new evidence regarding guidelines, screening programs, evaluation procedures, and practice models. Clinical articles report that the sensitivity of mailed Fecal Immunochemical Testing changes with the weather; a dermatoscope and a simple algorithm can help differentiate malignant from benign skin lesions; and that a few almonds can alter blood glucose levels in response to a glucose tolerance test. Readers will find an excellent discussion about whether, and how, the growing number of clinical guidelines should be overseen going forward. We also have a first-hand account of the Inaugural Starfield Summit, a meeting of family medicine leaders working to improve primary care for all. These topics, and plenty of additional new evidence pertinent to the daily practice of family physicians can be found in this issue.
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http://dx.doi.org/10.3122/jabfm.2016.06.160290DOI Listing
November 2016

Practice Innovation for Care Integration, Opioid Management, and Quality Measurement in Family Medicine.

J Am Board Fam Med 2017 01;30(1):1-3

Ringing in the new year 2017! This may finally be the year of real practice improvement after many false starts. Research into practice transformation has informed both local work and national policy. Human factors and payment structures are key. And payment structures depend on how quality is measured. Large gaps between practicing physician recommendations for the most important quality measures and those currently imposed externally are exposed in this issue. Also see information on in-practice social work consultations and their outcomes and recommendations from innovators in integrated care, and for chronic opioid therapy management based on visits to many family medicine offices. Visit entropy is negative for hospital readmissions. Another article reaffirms the importance of family physicians in rural obstetrics, including Cesarean deliveries. Two articles address changing Latino health care access. New Mexico's innovative health extension agent implementation now includes research in ways that benefit all. And a glass half-full: the growth in the diversity of family medicine faculty is above average, but is not occurring as quickly as in the general population.
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http://dx.doi.org/10.3122/jabfm.2017.01.160349DOI Listing
January 2017

Research in Family Medicine by Family Physicians for the Practice of Family Medicine.

J Am Board Fam Med 2016 Jul-Aug;29(4):427-9

This issue lays out challenges for family medicine researchers. Each article increases our understanding of solutions to common problems in family medicine, yet with each, one can readily see the next challenge based on the newly gained knowledge. One of the goals of the JABFM is to encourage research in family medicine for family medicine. Here we combine our usual editors' notes with thoughts about what the next research studies could, and hopefully will, be.
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http://dx.doi.org/10.3122/jabfm.2016.04.160159DOI Listing
November 2017

Social Determinants of Health and Beyond: Information to Help Family Physicians Improve Patient Care.

J Am Board Fam Med 2016 May-Jun;29(3):295-6

Social determinants of health (SDOHs) are a theme in this issue. In addition, we include a series of clinical articles to inform family medicine. One helps to demystify the process of obtaining hearing care. Another provides a case report of how a vanishing twin can confuse a newly available test. We also share articles on the early symptoms and signs of femoral insufficiency fractures and a simple test to help diagnose basal cell carcinomas. Family physicians provide their views on point-of-care tests. Positive outcomes are reported for behavioral health integration into family medicine offices and for diabetes education among patients cared for within patient-centered medical homes. A questionnaire can help family physicians identify and facilitate conversations with their patients about adverse childhood experiences.
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http://dx.doi.org/10.3122/jabfm.2016.03.160099DOI Listing
November 2017

Outcomes of Health System Structures, Highly Pertinent Clinical Information, Idea Stimulators, Clinical Reviews, and Prediction Tools: JABFM Exemplified.

J Am Board Fam Med 2016 Mar-Apr;29(2):171-2

This issue exemplifies the types of articles that JABFM publishes to advance family medicine. We have articles on the implications of health system organizational structures. Three of these are international articles at the level of the national health system (1 from China) and systematic local health interventions (1 from Canada and 1 from Netherlands). Inside the United States, where there are more family physicians, there is less obesity, and designation as a Patient Centered Medical Home is related to increased rates of colorectal cancer screening. Review articles on common clinical topics discuss treatments that are changing (acne in pregnancy) or lack consensus (distal radial fractures). We have articles on making life easier in the office, such as for predicting Vitamin D levels, osteoporosis, and pre-diabetes in normal weight adults. There are articles to raise awareness of the "newest" testing or treatments, that is, auditory brainstem implants. "Reminder" articles highlight known entities that need to be reinforced to prevent over-/underdiagnosis or treatment, for example, "cotton fever." Another article discusses the increased risk for postoperative complications with sleep apnea. We also provide "thought" pieces, in this case about the terminology we are using to extend our concept of patient-centered medical homes.
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http://dx.doi.org/10.3122/jabfm.2016.02.160027DOI Listing
December 2016

Family Medicine Research That Provides Compelling, Urgent Data to Improve Patient Care.

J Am Board Fam Med 2016 Jan-Feb;29(1):1-3

Herein is positive, mixed, and negative news-albeit all useful-on family medicine topics. The time to depression remission can be dramatically reduced. There is compelling evidence on how to improve medication reconciliation. There is a major underestimated determinant of the length of intrauterine device use. Data on the convoluted nature of the International Classification of Diseases, 10th Revision, transition could cause heart sink for doctors. Another article notes how family physicians can improve the usability of electronic health records by working with vendors. Targeting abstinence for patients with alcohol dependency and daily use may help. Charlson comorbidity scores plus a polypharmacy measure are useful to estimate readmission risk. This issue also includes excellent reviews on pre-exposure prophylaxis for HIV prevention and breast milk oversupply. The Robert Graham Center provides data on the types of medical professionals working with family physicians in their offices. See the related commentary on page 4 by Rosenthal for a discussion on the patient-centered medical home articles also published in this issue.
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http://dx.doi.org/10.3122/jabfm.2016.01.150349DOI Listing
December 2016

New Tools and Approaches for Family Physicians.

J Am Board Fam Med 2015 Nov-Dec;28(6):689-92

This issue of the journal is filled with useful information for practicing family physicians. Several articles introduce new ideas for family physicians to use in the care of their patients, whereas other articles cover new approaches to old problems. Several studies report on procedures performed by family physicians: battlefield acupuncture, colonoscopy, and ultrasound. Some unique alternative care models are described and evaluated. An innovative method of delivering diabetes education seems to work well. Ways to use technology to improve patient care, an update on chronic hepatitis B, and a novel use of social media to understand a rare disease are also included. Readers will come away from this issue with many ideas to consider implementing in their own practices.
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http://dx.doi.org/10.3122/jabfm.2015.06.150298DOI Listing
September 2016

Electroacupuncture Versus Gabapentin for Hot Flashes Among Breast Cancer Survivors: A Randomized Placebo-Controlled Trial.

J Clin Oncol 2015 Nov 24;33(31):3615-20. Epub 2015 Aug 24.

Jun J. Mao, Sharon X. Xie, Angela DeMichele, and John T. Farrar, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Marjorie A. Bowman, Wright State University Boonshoft School of Medicine, Dayton, OH; and Deborah Bruner, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA.

Purpose: Hot flashes are a common and debilitating symptom among survivors of breast cancer. This study aimed at evaluating the effects of electroacupuncture (EA) versus gabapentin (GP) for hot flashes among survivors of breast cancer, with a specific focus on the placebo and nocebo effects.

Patients And Methods: We conducted a randomized controlled trial involving 120 survivors of breast cancer experiencing bothersome hot flashes twice per day or greater. Participants were randomly assigned to receive 8 weeks of EA or GP once per day with validated placebo controls (sham acupuncture [SA] or placebo pills [PPs]). The primary end point was change in the hot flash composite score (HFCS) between SA and PP at week 8, with secondary end points including group comparisons and additional evaluation at week 24 for durability of treatment effects.

Results: By week 8, SA produced significantly greater reduction in HFCS than did PP (-2.39; 95% CI, -4.60 to -0.17). Among all treatment groups, the mean reduction in HFCS was greatest in the EA group, followed by SA, GP, and PP (-7.4 v -5.9 v -5.2 v -3.4; P = < .001). The pill groups had more treatment-related adverse events than did the acupuncture groups: GP (39.3%), PP (20.0%), EA (16.7%), and SA (3.1%), with P = .005. By week 24, HFCS reduction was greatest in the EA group, followed by SA, PP, and GP (-8.5 v -6.1 v -4.6 v -2.8; P = .002).

Conclusion: Acupuncture produced larger placebo and smaller nocebo effects than did pills for the treatment of hot flashes. EA may be more effective than GP, with fewer adverse effects for managing hot flashes among breast cancer survivors; however, these preliminary findings need to be confirmed in larger randomized controlled trials with long-term follow-up.
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http://dx.doi.org/10.1200/JCO.2015.60.9412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4622101PMC
November 2015

Timely and/or Controversial Information for Family Physicians.

J Am Board Fam Med 2015 Jul-Aug;28(4):435-7

Plan to spend some time reading this information-dense issue with a large amount of new material and ideas. From the humanoid behavioral health coach to tackling the controversial topic of environmental causes of autism spectrum disorders, this issue encompasses a broad range of topics. New anticoagulants for an extremely common entity, atrial fibrillation, are discussed. Learn about the shocking increase in oropharyngeal cancers with a changing epidemiology: younger patients with a different clinical presentations. Researchers evaluate changes after new or revised guidelines. "Near miss" reporting can facilitate quality improvement. Pets can make humans ill, yet they are beloved and can improve the health of their human owners.
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http://dx.doi.org/10.3122/jabfm.2015.04.150147DOI Listing
April 2016

Expectancy in real and sham electroacupuncture: does believing make it so?

J Natl Cancer Inst Monogr 2014 Nov;2014(50):302-7

Division of Hematology/Oncology (JB, AD), Center for Clinical Epidemiology and Biostatistics (SXX, JTF, AD, JJM), Department of Anesthesia and Critical Care (JTF), Department of Family Medicine and Community Health (SQL, JJM), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (JB, AD); Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA (JB, AD, JJM); Center for Clinical Epidemiology and Biostatistics (SXX, JTF, AD, JJM) and Department of Anesthesia and Critical Care (JTF), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Boonshoft School of Medicine, Wright State University, Dayton, OH (MAB); Nell Hodgson School of Nursing, Emory University, Atlanta, GA (DB).

Background: The large placebo effect observed in prior acupuncture trials presents a substantial challenge for interpretation of the efficacy of acupuncture. We sought to evaluate the relationship between response expectancy, a key component of the placebo effect over time, and treatment outcome in real and sham electroacupuncture (EA).

Methods: We analyzed data from a randomized controlled trial of EA and sham acupuncture (SA) for joint pain attributable to aromatase inhibitors among women with breast cancer. Responders were identified using the Patient Global Impression of Change instrument at Week 8 (end of intervention). The Acupuncture Expectancy Scale (AES) was used to measure expectancy four times during the trial. Linear mixed-effects models were used to evaluate the association between expectancy and treatment response.

Results: In the wait list control group, AES remained unchanged over treatment. In the SA group, Baseline AES was significantly higher in responders than nonresponders (15.5 vs 12.1, P = .005) and AES did not change over time. In the EA group, Baseline AES scores did not differ between responders and nonresponders (14.8 vs 15.3, P = .64); however, AES increased in responders compared with nonresponders over time (P = .004 for responder and time interaction term) with significant difference at the end of trial for responders versus nonresponders (16.2 vs 11.7, P = .004).

Conclusions: Baseline higher response expectancy predicts treatment response in SA, but not in EA. Divergent mechanisms may exist for how SA and EA influence pain outcomes, and patients with low expectancy may do better with EA than SA.
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http://dx.doi.org/10.1093/jncimonographs/lgu029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411535PMC
November 2014

Data supporting key components of family medicine-scope, continuity, interprofessional care, and more.

J Am Board Fam Med 2015 Mar-Apr;28(2):163-5

This issue contains multiple articles supporting key components of family medicine, either evidence that these components are important, or strategies to implement them in practice. For examples, see the articles on interprofessional care,(1-5) continuity,(6) cultural competence,(7) continuing competence,(8,9) and provision of essential care to the underserved.(10) We provide additional insight into how different physicians interpret similar data on older patients.(11) We have broad physician input into potential items to be considered in the national Choosing Wisely campaign, with many excellent interventions identified that should be performed less often.(12) However, choosing wisely for the United States population should also require adequate payment to encompass the breadth of what family physicians can and want to do to improve health for and with their patients.(13) All the articles relate to improving quality and cost of health care.
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http://dx.doi.org/10.3122/jabfm.2015.02.150018DOI Listing
December 2015
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