Kombucha: a systematic review of the empirical evidence of human health benefit.

Purpose: Kombucha tea, a fermented beverage, has recently become popular in the United States as part of the functional food movement. This popularity is likely driven by its touted health benefits, coupled with the recent scientific movement investigating the role of the microbiome on human health. The purpose of this systematic review is to describe the literature related to empirical health benefits of kombucha as identified from human subjects research.

Quantifying Worry in the Face of Uncertainty: Radiation Exposure from Medical Imaging.

Background: The degree to which people worry about radiation exposure from medical imaging has not been quantified. Such concern is important for clinical decision making and policy generation.

Objective: The aim of this study was to quantify the degree of worry as a consequence of radiation exposure.

A randomized controlled trial of directive and nondirective smoking cessation coaching through an employee quitline.

Background: Telephone quitlines can help employees quit smoking. Quitlines typically use directive coaching, but nondirective, flexible coaching is an alternative. Call-2-Quit used a worksite-sponsored quitline to compare directive and nondirective coaching modes, and evaluated employee race and income as potential moderators.

Electronic cigarettes: The nicotyrine hypothesis.

There are conflicting reports about the efficacy of electronic cigarettes (e-cigs) as nicotine delivery devices and smoking cessation products. In addition, smokers' responses to some nicotine dependence questions often change as they transition to exclusive e-cig use. Nicotyrine may explain these observations.

On-Line Chemical Composition Analysis of Refillable Electronic Cigarette Aerosol-Measurement of Nicotine and Nicotyrine.

Introduction: Electronic cigarettes (e-cigs) generate aerosols that users inhale. Analyses of e-liquids inconsistently report nicotyrine, a nicotine analog that could impede nicotine metabolism, raising questions about nicotyrine formation.

Methods: E-cig aerosols were analyzed on-line using a Thermal Desorption Aerosol Gas Chromatograph.

Analysis of comments in a petition defending electronic cigarettes.

Introduction: A 2009 petition opposing a Food and Drug Administration (FDA) ban on electronic cigarettes (e-cigs) garnered international attention from e-cig users (vapers). Petitioners' comments described the perceived benefits of vaping.

Methods: We conducted a qualitative and quantitative analysis of petitioners' comments.

Beliefs, experience, and interest in pharmacotherapy among smokers with HIV.

Objectives: To examine beliefs, prior use, and interest in using pharmacotherapy among people living with HIV/AIDS (PLWHA).

Methods: Cross-sectional survey of smokers in a midwestern HIV clinic.

Results: The sample (N = 146) included 69% men, 82% African Americans, 45% were in precontemplation for quitting, and 46% were interested in using pharmacotherapy.

Methods for Performing Survival Curve Quality-of-Life Assessments.

Background: Many medical decisions involve an implied choice between alternative survival curves, typically with differing quality of life. Common preference assessment methods neglect this structure, creating some risk of distortions.

Methods: Survival curve quality-of-life assessments (SQLA) were developed from Gompertz survival curves fitting the general population's survival.

Rural, suburban, and urban differences in factors that impact physician adherence to clinical preventive service guidelines.

Purpose: Rural-urban disparities in provision of preventive services exist, but there is sparse research on how rural, suburban, or urban differences impact physician adherence to clinical preventive service guidelines. We aimed to identify factors that may cause differences in adherence to preventive service guidelines among rural, suburban, and urban primary care physicians.

Methods: This qualitative study involved in-depth semistructured interviews with 29 purposively sampled primary care physicians (10 rural, 10 suburban, 9 urban) in Missouri.

Adding flexible temporal constraints to identify chronic comorbid conditions in ambulatory claims data.

Chronic comorbid conditions are important predictors of primary care outcomes, provide context for clinical decisions, and are potential complications of diseases and treatments. Comorbidity indices and multimorbidity categorization strategies based on administrative claims data enumerate diagnostic codes in easily modifiable lists, but usually have inflexible temporal requirements, such as requiring two claims greater than 30 days apart, or three claims in three quarters. Table structures and claims data search algorithms were developed to support flexible temporal constraints.

Diuretic of choice in ABFM hypertension self-assessment module simulations.

Background: Evidence suggests that chlorthalidone has therapeutic advantages over hydrochlorothiazide, perhaps because of a longer antihypertensive effect. Although guidelines such as the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure treat diuretics as a class, some experts believe chlorthalidone is the diuretic of choice in hypertension management. We evaluated diplomates' use of chlorthalidone and hydrochlorothiazide as first-choice diuretics in virtual patient simulations of hypertension in the American Board of Family Medicine Maintenance of Certification for Family Physicians self-assessment modules.

In vitro particle size distributions in electronic and conventional cigarette aerosols suggest comparable deposition patterns.

Introduction: Electronic cigarette users ("vapers") inhale aerosols of water, nicotine, and propylene glycol (PG) or vegetable glycerin (VG). Aerosol particle sizes should affect deposition patterns in vapers and bystanders.

Methods: Aerosols were generated by a smoking machine and an electronic cigarette filled with 16mg/ml nicotine in aqueous PG or VG solution.

Family physicians' completion of scoring criteria in Virtual Patient encounters.

The American Board of Family Medicine (ABFM) has used a 60-item Multiple Choice Question (MCQ) section followed by a Virtual Patient (VP) exercise in Maintenance Of Certification (MOC) since 2004, and has had an asthma module since 2005. The original asthma VP criteria anticipated some Expert Panel Report-3 recommendations, such as home peak flow monitoring and a written plan, that were added to the MCQ section only when the guideline was updated in 2007. VP completion rates for these criteria improved markedly with the MCQ update, while other criteria completion rates were stable.

Variation over time in preventable hospitalization rates across counties.

Background: The Agency for Health Care Research and Quality developed 14 prevention quality indicators (PQIs), including four PQIs related to preventable hospitalizations for diabetes and one to asthma. Quality indicators vary across counties, but variation over time has not been described.

Methods: The Kentucky Cabinet for Health and Family Services published PQI data for each county in Kentucky in each of the 3 years from 2006 to 2008.

Interviews with "vapers": implications for future research with electronic cigarettes.

Introduction: Awareness and use of electronic cigarettes (e-cigs) has increased dramatically. Electronic Nicotine Delivery Devices deliver an aerosol comprised usually of water, propylene glycol and/or glycerin, nicotine, and flavorings. Scant research exists to evaluate the efficacy and safety of such devices, and only one quantitative survey of European users (N = 81) has been published.

Health and life insurance as an alternative to malpractice tort law.

Background: Tort law has legitimate social purposes of deterrence, punishment and compensation, but medical tort law does none of these well. Tort law could be counterproductive in medicine, encouraging costly defensive practices that harm some patients, restricting access to care in some settings and discouraging innovation.

Discussion: Patients might be better served by purchasing combined health and life insurance policies and waiving their right to pursue malpractice claims.

Area-level poverty is associated with greater risk of ambulatory-care-sensitive hospitalizations in older breast cancer survivors.

Objectives: To estimate the frequency of ambulatory care-sensitive hospitalizations (ACSHs) and to compare the risk of ACSH in breast cancer survivors living in high-poverty with that of those in low-poverty areas.

Design: Prospective, multilevel study.

Setting: National, population-based 1991 to 1999 National Cancer Institute Surveillance, Epidemiology, and End Results Program data linked with Medicare claims data throughout the United States.

Using county-level public health data to prioritize medical education topics.

Introduction: Medical education topics might be locally prioritized using public health data on health outcomes and risk factors unrelated to quality of care.

Methods: The Missouri Information for Community Assessment (MICA) supplied preventable hospitalization rates (PHRs) for asthma, chronic obstructive pulmonary disease (COPD), diabetes, heart failure, and hypertension in 114 counties from 1998 to 2002. For each disease, a linear regression model predicted PHR from behavior, access, and disease prevalence data from MICA and other public data sources.

An electronic encounter log's failure to scale.

We have developed a series of Electronic Student Encounter Log (ESEL) programs intended to introduce medical students to promising medical informatics concepts. We attempted to expand ESELs scope from ambulatory settings to all hospital venues and to track progress toward educational goals. Students were confused and frustrated by a previously fast interface and delayed feedback.

Value of information in virtual patients portraying pharyngitis.

The American Board of Family Medicine (ABFM) uses virtual patients (VP) in Maintenance of Certification. Theoretically, the ABFM could score users on the value of information (VOI) in their queries. Pharyngitis, a prototypical primary care topic, appears practically intractable to VOI scoring.

Value of information in virtual patient performance evaluations.

The American Board of Family Medicine (ABFM) uses virtual patients (VP) in Maintenance of Certification. User queries might be evaluated by calculating diagnostic value of information (VOI). Typical primary care queries address concerns far beyond efficient diagnosis.

Modeling relief.

The American Board of Family Medicine deployed virtual patient simulations in 2004 to evaluate Diplomates' diagnostic and management skills. A previously reported dynamic process generates general symptom histories from time series data representing baseline values and reactions to medications. The simulator also must answer queries about details such as palliation and provocation.

The impact of anchor point on utilities for 5 common ophthalmic diseases.

Purpose: To elicit utilities on a perfect health and perfect vision scale for 5 common eye diseases.

Design: Cross-sectional observational preference study.

Participants: We included 434 patients: 58 with diabetic retinopathy, 99 with glaucoma, 44 with age-related macular degeneration (AMD), 124 with cataract; 109 with refractive error.

Mapping students' clinical experiences to pediatric clerkship goals.

In anticipation of new LCME accreditation requirements, our third year clerkship students began tracking pediatric clinical experiences using a hand-held Electronic Student Encounter Log (ESEL) in June 2005. ESEL was tailored to support rapid documentation of diseases seen at a pediatric tertiary care hospital, while retaining access to primary care diagnoses. We matched encounters that 37 students documented to experiences that fulfill the pediatric clerkship's 19 educational goals.