Human research review committee requirements in medical journals.

PURPOSE: Independent ethical review committees safeguard participants in human research. The purpose of this study was to describe the current ethical guidelines for human research requirements in the Instructions to Authors of the English language medical journals previously studied in 1995. METHODS: The instructions to authors of English language medicine journals from the Abridged Index Medicus were searched for any policies regarding guidance on the ethical treatment of human subjects in research. RESULTS: More medical journals require independent ethics committee approval of human research now [84/101 (83%)] than 10 years ago [48/102 (47%) (P < 0.001)], and most journals continue to require that this disclosure appear in the manuscript [71/84 (85%) vs. then 37/48 (77%) (P=0.29)]. Fewer medical journal instructions to authors provide no ethical guidelines for human research now [8/101 (8%)] than 10 years ago [25/102 (24%) (P < 0.001)]. No journal required submission of the study approval letter or of the approved protocol. CONCLUSIONS: Although medicine journals increasingly require disclosure statements of independent ethics committee approval for human research, they fail to verify such approval beyond taking authors for their word.

Similar deficiencies in procedural dermatology and dermatopathology fellow evaluation despite different periods of ACGME accreditation: results of a national survey.

BACKGROUND: Fellow evaluation is required by the Accreditation Council for Graduate Medical Education (ACGME). Procedural dermatology fellowship accreditation by the ACGME began in 2003 while dermatopathology accreditation began in 1976. OBJECTIVE: The objective was to compare fellow evaluation rigor between ACGME-accredited procedural dermatology and dermatopathology fellowships. METHODS: Questionnaires were mailed to fellowship directors of the ACGME-accredited (2006-2007) procedural dermatology and dermatopathology fellowship programs. Information was collected regarding evaluation form development, delivery, and collection. RESULTS: The response rates were 74% (25/34) and 53% (24/45) for procedural and dermatopathology fellowship programs, respectively. Sixteen percent (4/25) of procedural dermatology and 25% (6/24) of dermatopathology programs do not evaluate fellows. Fifty percent or less of program (4/8 procedural dermatology and 3/7 dermatopathology) evaluation forms address all six core competencies required by the ACGME. CONCLUSION: Procedural fellowships are evaluating fellows as rigorously as the more established dermatopathology fellowships. Both show room for improvement because one in five programs reported not evaluating fellows and roughly half of the evaluation forms provided do not address the six ACGME core competencies.

Inaccessible novel questionnaires in published medical research: hidden methods, hidden costs.

Although critical analysis of survey research is limited when reviewers and readers cannot view a study's questionnaire, access to novel questionnaires used in published research has not been systematically examined. The authors identified publications reporting the results of novel questionnaires in three medical journals (JAMA, The New England Journal of Medicine, and The Lancet) in January 2000-May 2003 and searched portable document format (PDF) versions of the studies for the complete questionnaire or a Uniform Resource Locator (URL) providing access to the questionnaire. When the questionnaire was not provided in the publication or a published URL, the authors requested it from the corresponding author in writing up to three times over a 6-week period. Of 93 publications with novel questionnaires, four printed the questionnaire in the article and three provided online access. Corresponding authors failed to provide questionnaires for 37 of 81 (46%) studies. Novel questionnaires used in published research are frequently not available to readers or researchers. Policies that improve access to novel questionnaires will allow better assessment of study results, reduce duplicated efforts, and improve authorship attribution for questionnaire design.

Dermatology Internet Yellow Page advertising.

BACKGROUND: Patients may use Internet Yellow Pages to help select a physician. OBJECTIVE: We sought to describe dermatology Internet Yellow Page advertising. METHODS: Dermatology advertisements in Colorado, California, New York, and Texas at 3 Yellow Page World Wide Web sites were systematically examined. RESULTS: Most advertisements (76%; 223/292) listed only one provider, 56 listed more than one provider, and 13 listed no practitioner names. Five advertisements listed provider names without any credentialing letters, 265 listed at least one doctor of medicine or osteopathy, and 9 listed only providers with other credentials (6 doctors of podiatric medicine and 3 registered nurses). Most advertisements (61%; 179/292) listed a doctor of medicine or osteopathy claiming board certification, 78% (139/179) in dermatology and 22% (40/179) in other medical specialties. Four (1%; 4/292) claims of board certification could not be verified (one each in dermatology, family practice, dermatologic/cosmetologic surgery, and laser surgery). Board certification could be verified for most doctors of medicine and osteopathy not advertising claims of board certification (68%; 41/60; 32 dermatology, 9 other specialties). A total of 50 advertisements (17%) contained unverifiable or no board certification information, and 47 (16%) listed a physician with verifiable board certification in a field other than dermatology. LIMITATIONS: All Internet Yellow Page World Wide Web sites and all US states were not examined. CONCLUSION: Nonphysicians, physicians board certified in medical specialties other than dermatology, and individuals without verifiable board certification in any medical specialty are advertising in dermatology Internet Yellow Pages. Many board-certified dermatologists are not advertising this certification.

UV tanning advertisements in high school newspapers.

OBJECTIVE: To examine the increasing use of UV tanning parlors by adolescents, despite the World Health Organization recommendation that no one under the age of 18 years use UV tanning devices. DESIGN: We examined tanning advertisements in a sample of public high school newspapers published between 2001 and 2005 in 3 Colorado counties encompassing the Denver metropolitan area. RESULTS: Tanning advertisements appeared in newspapers from 11 (48%) of 23 schools. Newspaper issues (N = 131) contained 40 advertisements placed by 18 tanning parlors. Advertisements commonly offered discounts (19 of 40) including unlimited tanning offers (15 of 40). Thirteen advertisements featured non-UV tanning treatments, and 2 advertisements mentioned parental consent or accompaniment for UV tanning. CONCLUSIONS: UV radiation, a classified carcinogen, is commonly and specifically marketed to adolescents through high school newspaper advertising. Public health skin cancer prevention policies should include the prohibition of UV tanning advertising to minors.

Support of evidence-based guidelines for the annual physical examination: a survey of primary care providers.

BACKGROUND: Current evidence does not support an annual screening physical examination for asymptomatic adults, but little is known about primary care provider (PCP) attitudes and practices regarding an annual physical examination. METHODS: We conducted a postal survey (32 items) of attitudes and practices regarding the annual physical examination (in asymptomatic patients 18 years or older) of a random sample of PCPs (specializing in internal medicine, family practice, and obstetrics/gynecology) from 3 geographic areas (Boston, Mass; Denver, Colo; and San Diego, Calif). RESULTS: Respondents included 783 (47%) of 1679 PCPs. Overall, 430 (65%) of 664 agreed that an annual physical examination is necessary. Three hundred ninety-three (55%) of 712 disagreed with the statement that national organizations do not recommend an annual physical examination, and 641 (88%) of 726 perform such examinations. Most PCPs agreed that an annual physical examination provides time to counsel patients about preventive health services (696/739 [94%]), improves patient-physician relationships (693/737 [94%]), and is desired by most patients (572/737 [78%]). Most also believe that an annual physical examination improves detection of subclinical illness (545/738 [74%]) and is of proven value (461/736 [63%]). Many believed that tests should be part of an annual physical examination, including mammography (44%), a lipid panel (48%), urinalysis (44%), testing of blood glucose level (46%), and complete blood cell count (39%). CONCLUSIONS: Despite contrary evidence, most PCPs believe an annual physical examination detects subclinical illness, and many report performing unproven screening laboratory tests. Primary care providers do not appear to accept recommendations that annual physical examinations be abandoned in favor of a more selective approach to preventing health problems.

Residents' patient-specific clinical questions: opportunities for evidence-based learning.

PURPOSE: Resident physicians generate many patient-related questions in the outpatient setting, but rarely answer them. This study examined how answering a patient-specific clinical question affected residents' patient care decisions. METHOD: From October 2001 to June 2002, 43 internal medicine residents at the University of Colorado Health Sciences Center outpatient clinic formulated and attempted to answer specific clinical questions based on patients seen in the out-patient setting. Residents completed a questionnaire after finishing their clinical question exercise. RESULTS: Residents completed 158 exercises (68%) out of 234 opportunities and found answers to 89% of questions (141/158). Questions most commonly addressed therapy (43%), diagnosis (15%), disease management (13%), and prevention (9%). The most frequently used methods to retrieve clinical information were Medline 73% (115/158) and UpToDate 70% (110/158). UpToDate (45%, 71/158) and journal articles (42%, 66/158) were the most helpful final information sources. Residents rated the impact of the information on a five-point scale (1 = strongly disagree; 5 = strongly agree) for the following: can be used to assist patient's care (mean 4.1), improved care (mean 4.0), improved communication (mean 4.3), improved confidence in care (mean 4.3), improved knowledge (mean 4.6), and will improve care for future patients (mean 4.4). The information affected clinical decision making in 78% (110/141) of cases. CONCLUSION: Internal medicine residents practicing self-directed learning by answering patient-specific clinical questions reported improvement in knowledge and changes in patient care decisions.