Richard Neill

Journal article content as a predictor of commitment to change among continuing medical education respondents

Background: Journal reading is a time‐tested means of continuing medical education (CME) among physicians. Asking physicians to make a written statement of commitment to change has been shown to increase the likelihood of eventual change in practice behavior when used in conjunction with CME lectures. We describe the type and medical content of articles responsible for commitment to change comments among readers of a large circulation primary care journal. Methods: Response to the question “what change(s) do you plan to make in your practice as a result of reading the articles in this issue?” were analyzed from CME response cards associated with six issues (1 years publication) of the Archives of Family Medicine. Responses indicating a commitment to change were analyzed to characterize the type and content of articles responsible for their generation. Results: During the 1‐year study period, original contributions (reports of research trials) dealing with medicine and preventive medicine content accounted for the greatest number of comments. After adjusting for the frequency of article type and content, special articles and those dealing with complementary medicine accounted for the highest number of comments on a per‐article basis. Findings: Family physicians make commitment to change statements on the basis of a broad range of journal articles. Certain articles are more likely to generate statements of commitment to planned changes in practice.

Diagnosis, Evaluation, and Treatment of the School-Aged Child With Attention Deficit Hyperactivity Disorder

Two guidelines issued by the subcommittee on attention deficit hyperactivity disorder (ADHD) of the Committee on Quality Improvement for the American Academy of Pediatrics provide guidance for primary care clinicians interested in diagnosing and treating ADHD in school aged children. The 11 recommendations in these two guidelines encompass the spectrum of care for children suspected of or diagnosed with ADHD in the primary care setting.

Screening for Osteoporosis in Postmenopausal Women

The US Preventive Services Task Force recommends screening all women age 65 and over for osteoporosis using dual-energy X-ray absorptiometry (DXA) of the femoral neck. Neither the frequency of screening nor the age at which screening may stop are specified. Women at high risk should begin screening at age 60; however, the criteria for determining which women are at high risk are controversial. There is insufficient evidence to recommend for or against screening women younger than 60 or low-risk women aged 60–64. In making their recommendation, the US Preventive Services Task Force reviewed evidence related to five key questions, each of which is summarized next (1).

Prevention of Perinatal Group B Streptococcal Disease

The 2002 Prevention of Perinatal Group B Streptococcal Disease guidelines from the Center for Disease Control (CDC) represents a revision of a prior set of guidelines represented by the CDC in 1996. Group B streptococcus (GBS) remains a leading cause of serious neonatal infection despite the significant efforts in the disease prevention through the 1990s, including recommendations presented by the CDC, the American College of Obstetricians and Gynecologists (ACOG), and by the American Academy of Pediatrics (AAP). The updated 2002 guidelines were based on clinical evidence and expert opinions gathered since the 1996 recommendations (1). Significant changes in the newer guidelines included a recommendation for universal prenatal screening for GBS; detailed instructions on specimen collection, processing and testing; updated prophylaxis regimens for penicillin-allergic women; recommendations against routine antipartum antibiotic prophylaxis for GBS-colonized women undergoing planned cesarean deliveries prior to the onset of labor or the rupture of membranes; a suggested algorithm for management of threatened preterm delivery; and an updated algorithm for the management of newborns exposed to intrapartum antibiotics.

Diagnosis and Treatment of Migraine Headaches

Migraine headache is a common disorder affecting nearly 18% of women and 6% of men in the United States. The American Academy of Neurology, in conjunction with the seven participating specialty societies of the US Headache Consortium, performed an evidence-based review of available treatments for migraine headache in both acute and preventive settings, as well as assessing the role of diagnostic imaging in evaluation and treatment of headache (1,2).

Diagnosis and Management of Otitis Media

Acute otitis media (AOM) is one of the most common reasons for sick child visits in the United States. Controversy over its diagnosis and appropriate management has led the American Academy of Pediatrics and American Academy of Family Physicians to author evidence-based clinical practice guidelines. These guidelines are used for the healthy children aged 2 mo to 12 yr. The guidelines do not apply to children with underlying conditions that alter the nature of middle ear disease. Underlying conditions include anatomic abnormalities such as cleft palate and genetic conditions such as Down syndrome, immunodeficiencies, and the presence of cochlear implants.

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