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OtherEditors' Notes

Inside the March/April 2008 Issue and the Most Frequently-Read Articles in 2007

Marjorie A. Bowman, Anne Victoria Neale and Phillip Lupo
The Journal of the American Board of Family Medicine March 2008, 21 (2) 87-90; DOI: https://doi.org/10.3122/jabfm.2008.02.080013
Marjorie A. Bowman
MD, MPA
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Anne Victoria Neale
PhD, MPH
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Phillip Lupo
MLIS
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  • Article
  • Figures & Data
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Unraveling the Mysteries of Patient Complaints

The 2008 March/April issue of the Journal of the American Board of Family Medicine (JABFM) highlights new data about several common yet disturbing symptoms we see in family medicine for which medical care has not yet provided adequate solutions.

Night Sweats

We have a long way to go to understand both sleep disorders and night sweats. Reporting sweating at night is rarely related to fevers, as many of us learned in medical school, but people with night sweats have many sleep complaints and feel sleepier. Yet, as Mold1 reports, these sleep complaints are not associated with verifiable sleep disturbances by traditional measures in formal sleep studies. Something is happening for these people, and more effort should go toward truly measuring and understanding the meaning of their symptoms and to help them get relief. Is this depression talking? If so, what aspects of sleep studies could help verify this?

Sleep

A big problem. Sometimes simple answers. Often not. As Sorscher2 found, family physicians often do not include sleep questions on routine intake questionnaires. Do we fear the potential “yes” answer? The major apparent choices: 1) controlled, potentially addictive medicines which physicians are berated for using, and for which insurance companies make us fill out extra forms or make more phone calls; or 2) difficult life changes by patients. To make matters worse, “insomnia” is not always considered a reimbursable service for family physicians (apparently, it is considered a mental health diagnosis that some insurers say requires a mental health professional). Sometimes simple answers. Often not.

Chest Pain

We admit many patients with acute chest pain who are subsequently not found to have an acute cardiac event, and various attempts have been made to make this sorting process more accurate and rapid. Despite new laboratory studies plus more and more data on risk factors, occasionally patients are still sent home who later have an event and die. Crawford et al3 evaluated the utility of the American College of Cardiology/American Heart Association guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. Conducted in a military hospital with a low percentage of patients having positive troponins and high likelihood of follow-up the finding that a major clinical practice guideline did not perform better than routine clinical judgment suggests no significant benefit to requiring the specific validated guideline in their setting.

Chronic Pain Treated with Opioids

Fleming and coauthors4 provide data on an enigmatic population—patients with chronic pain that family physicians have decided to treat with long-term opioids. They report that low to medium dosing is associated with higher quality of life than high dosing. Finding the happy medium between improved pain control and side effects of the medicines is an important but not always simple task.

Counseling to Increase Exercise

Carroll5 reminds us of the need to be specific in our counseling for physical activity, yet it was uncommon for family physicians to include all 5 “A's”: Ask, Advise, Agree, Assist, and Arrange. The daunting challenge of helping patients incorporate routine exercise into their lives suggest that this more comprehensive approach would be useful.

Eating Behaviors Associated with Obesity

Greenwood et al6 suggest that we help patients with obesity by emphasizing a few simple known items about food behaviors that contribute to obesity. By providing a limited number of easily understood and actionable facts, the message may be clearer and more effective.

Antibiotics without a Prescription

As noted in our recent Global Theme Issue on Poverty and Human Development,7 patients unnecessarily taking antibiotics without a prescription may well contribute to worldwide antibiotic resistance.8 In a focus group study, Mainous et al9 found Latino adults, particularly those from countries with fewer restrictions on antibiotics, regularly took unprescribed antibiotics and were not aware of the potential problems. Patients often perceived it as easier to obtain antibiotics than go to the doctor especially when they believed the antibiotics would improve their symptoms.

This JABFM issue also provides interesting clinical discussions of a case of large and recurrent keloids,10 the lack of an apparent relationship between serum chromium levels and the development of diabetes during pregnancy,11 and brucellosis with sacroiliitis.12

The relevance of articles in this current issue seem particularly high—every single article can be related to at least one patient seen in the office on one routine day.

Top 20 JABFM Online Articles in 2007

Table 1 shows the 20 JABFM articles most frequently read in 2007. Rankings are based on hits received by articles archived on the JABFM website only. Remarkably, 12 of these 20 were also on the 2006 list of most frequently accessed articles.13 The 12 articles with impressive staying power (on both the 2006 and 2007 list of the top 20 most frequently read articles) were by Eberl et al14; Mork et al15; Ely et al16; another Ely et al17; Astin et al18; Oh19; Dominguez20; Pejic and Lee21; Ringdahl et al22; Douglass and Bope23; Rives and Douglass24; and Gjerdingen.25

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Table 1.

The 20 Most Frequently Read* Articles in the JABFM during January 2007 through December 2007†

Lee Dresang had an evidence-based colposcopy update in the JABFM top 20 in 200626 and another article on molar pregnancy on the 2007 top 20 list (both were published in 2005).27

Three papers published in 2003 or 2004 and most read in 2007 were not on the 2006 most read list; some papers seem to regain interest, probably because of other events in medicine. They were: the Lijoi and Brady28 article on vasa previa diagnosis and management; the Geyman29 commentary on the corporate transformation of medicine and its impact on costs and access to care; and the Holland and Prodan30 study of peripheral neuropathy and “borderline” diabetes.

Several more recent articles attracted heavy readership in 2007. These included a review article by Kassab31 on transcranial dopplers. Clinical case reports with literatures reviews by family medicine authors continue to attract readers: Desai32 on addiction to dextromethorphan; Dresang27 on a molar pregnancy; Lijoi28 on vasa previa; and Lopez33 on choroid plexus cysts. Readers also enjoyed a brief report on maternal shoe size and infant birth weight (Stephens).34

Content Usage

Figure 1 illustrates online content usage for 2007. With an average of 117,000 requests for content per month, this is the first year the JABFM has reached the 1 million mark in total content access events. Even with the rise in content usage over the last year, the JABFM experienced a 32% decrease (since 2006) in homepage viewings, which suggests that users are accessing content by using different methods (ie, e-mail alerts of new issue table of contents, or via indexing services and search engines).

Figure 1.
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Figure 1.

Data source: “Year-to-Date Usage Summary” for the JABFM, HighWire Press, produced January 8, 2008 (accessed January 14, 2008).

Notes

  • Conflict of interest: The authors are editors and staff of the JABFM.

References

  1. ↵
    Mold JW, Goodrich S, Orr W. Associations between subjective night sweats and sleep study findings. J Am Board Fam Med 2008; 21(2): 96–100.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    Sorscher AJ. How's your sleep?: a neglected topic for health care screening. J Am Board Fam Med 2008; 21(2): 141–8.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    Hagberg SM, Woitalla F, Crawford P. 2002 ACC/AHA guideline vs. clinician judgment as diagnostic tests for chest pain. J Am Board Fam Med 2008; 21(2): 101–7.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    Sullivan-Dillie K, Fleming MF, Mundt MP, French MT. Quality of life associated with daily opioid therapy in a primary care chronic pain sample. J Am Board Fam Med 2008; 21(2): 108–17.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    Carroll J, Fiscella K, Meldrum SC, et al. Clinician-patient communication about physical activity in an underserved population. J Am Board Fam Med 2008; 21(2): 118–27.
    OpenUrlAbstract/FREE Full Text
  6. ↵
    Greenwood JL, Stanford JB. Preventing or improving obesity by addressing specific eating patterns. J Am Board Fam Med 2008; 21(2): 135–40.
    OpenUrlAbstract/FREE Full Text
  7. ↵
    Global Theme Issue on Poverty and Human Development. J Am Board Fam Med 2007; 20(6).
  8. ↵
    Planta MB. The role of poverty in antimicrobial resistance. J Am Board Fam Med 2007; 20(6): 533–9.
    OpenUrlAbstract/FREE Full Text
  9. ↵
    Mainous AG, Diaz VA, Carnemolla M. Factors affecting Latino adults’ use of antibiotics for self-medication. J Am Board Fam Med 2008; 21(2): 128–34.
    OpenUrlAbstract/FREE Full Text
  10. ↵
    Studdiford J, Stonehouse A, Altshuler M, Rinzler E. The management of keloids: hands-on vs. hands-off. J Am Board Fam Med 2008; 21(2): 149–52.
    OpenUrlAbstract/FREE Full Text
  11. ↵
    Woods SE, Ghodsi V, Engel A, Miller J, James S. Serum chromium and gestational diabetes. J Am Board Fam Med 2008; 21(2): 153–7.
    OpenUrlAbstract/FREE Full Text
  12. ↵
    Priest JR, Low D, Wang C, Bush T. Brucellosis and sacroiliitis: a common presentation of an uncommon pathogen. J Am Board Fam Med 2008; 21(2): 158–61.
    OpenUrlAbstract/FREE Full Text
  13. ↵
    Neale AV, Bowman MA, Rose CA. Journal of the American Board of Family Medicine online use on the upswing. J Am Board Fam Med 2007; 20(2): 232–4.
    OpenUrlFREE Full Text
  14. ↵
    Eberl MM, Fox CH, Edge SB, Carter CA, Mahoney MC. BI-RADS classification for management of abnormal mammograms. J Am Board Fam Med 2006; 19(2): 161–4.
    OpenUrlAbstract/FREE Full Text
  15. ↵
    Mork AA, Haufe SMW, Yancey WB. Sometimes (what seems to be) a heart attack is (really) a pain in the neck. J Am Board Fam Pract 2004; 17(1): 74–7.
    OpenUrlPubMed
  16. ↵
    Ely JW, Kennedy CM, Clark EC, Bowdler NC. Abnormal uterine bleeding: a management algorithm. J Am Board Fam Med 2006; 19(6): 590–602.
    OpenUrlAbstract/FREE Full Text
  17. ↵
    Ely JW, Osheroff JA, Chambliss ML, Ebell MH. Approach to leg edema of unclear etiology. J Am Board Fam Med 2006; 19(2): 148–60.
    OpenUrlAbstract/FREE Full Text
  18. ↵
    Astin JA, Shapiro SL, Eisenberg DM, Forys KL. Mind-body medicine: state of the science, implications for practice. J Am Board Fam Pract 2003; 16(2): 131–47.
    OpenUrlCrossRefPubMed
  19. ↵
    Oh R. Practical applications of fish oil (Ω-3 fatty acids) in primary care. J Am Board Fam Pract 2005; 18(1): 28–36.
    OpenUrlCrossRefPubMed
  20. ↵
    Dominguez TJ. It's not a spider bite, it's community-acquired methicillin-resistant staphylococcus aureus. J Am Board Fam Pract 2004; 17(3): 220–6.
    OpenUrlCrossRefPubMed
  21. ↵
    Pejic RN, Lee DT. Hypertriglyceridemia. J Am Board Fam Med 2006; 19(3): 310–16.
    OpenUrlAbstract/FREE Full Text
  22. ↵
    Ringdahl EN, Pereira SL, Delzell JE. Treatment of primary insomnia. J Am Board Fam Pract 2004; 17(3): 212–9.
    OpenUrlCrossRefPubMed
  23. ↵
    Douglass AB, Bope ET. Evaluation and treatment of posterior neck pain in family practice. J Am Board Fam Pract 2004; 17(S1): 13–22.
    OpenUrl
  24. ↵
    Rives PA, Douglass AB. Evaluation and treatment of low back pain in family practice. J Am Board Fam Pract 2004; 17(S1): 23–31.
    OpenUrl
  25. ↵
    Gjerdingen, D. The effectiveness of various postpartum depression treatments and the impact of antidepressant drugs on nursing infants. J Am Board Fam Pract 2003; 16(5): 372–82.
    OpenUrlCrossRefPubMed
  26. ↵
    Dresang LT. Colposcopy: an evidence-based update. J Am Board Fam Pract 2005; 18(5): 383–92.
    OpenUrlPubMed
  27. ↵
    Dresang LT. A molar pregnancy detected by following β-human chorionic gonadotropin levels after a first trimester loss. J Am Board Fam Pract 2005; 18(6): 570–3.
    OpenUrlPubMed
  28. ↵
    Lijoi AF, Brady J. Vasa previa diagnosis and management. J Am Board Fam Pract 2003; 16(6): 543–8.
    OpenUrlPubMed
  29. ↵
    Geyman JP. The corporate transformation of medicine and its impact on costs and access to care. J Am Board Fam Pract 2003; 16(5): 443–54.
    OpenUrlPubMed
  30. ↵
    Holland NR, Prodan CI. Peripheral neuropathy and “borderline” diabetes. J Am Board Fam Pract 2004; 17(2): 127–30.
    OpenUrlPubMed
  31. ↵
    Kassab MY, Majid A, Farooq MU, et al. Transcranial doppler: an introduction for primary care physicians. J Am Board Fam Med 2007; 20(1): 65–71.
    OpenUrlAbstract/FREE Full Text
  32. ↵
    Desai S, Aldea D, Daneels E, Soliman M, Braksmajer AS, Kopes-Kerr CP. Chronic addiction to dextromethorphan cough syrup: a case report. J Am Board Fam Med 2006; 19(3): 320–3.
    OpenUrlAbstract/FREE Full Text
  33. ↵
    Lopez JA, Reich D. Choroid plexus cysts. J Am Board Fam Med 2006; 19(4): 422–5.
    OpenUrlAbstract/FREE Full Text
  34. ↵
    Stephens MB, Manning DA, Arnold-Canuso A, Haas DM. Maternal shoe size and infant birth weight: correlation or fiction?. J Am Board Fam Med 2006; 19(4): 426–8.
    OpenUrlAbstract/FREE Full Text
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The Journal of the American Board of Family Medicine: 21 (2)
The Journal of the American Board of Family Medicine
Vol. 21, Issue 2
March-April 2008
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Inside the March/April 2008 Issue and the Most Frequently-Read Articles in 2007
Marjorie A. Bowman, Anne Victoria Neale, Phillip Lupo
The Journal of the American Board of Family Medicine Mar 2008, 21 (2) 87-90; DOI: 10.3122/jabfm.2008.02.080013

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Inside the March/April 2008 Issue and the Most Frequently-Read Articles in 2007
Marjorie A. Bowman, Anne Victoria Neale, Phillip Lupo
The Journal of the American Board of Family Medicine Mar 2008, 21 (2) 87-90; DOI: 10.3122/jabfm.2008.02.080013
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