High Blood Pressure is a common medical condition. If it is not checked or treated, it can damage body organs such as the brain, heart, and kidneys. A number of problems such as heart disease and stroke are caused by high blood pressure. Blood pressure is measured by taking the systolic pressure (the upper number) followed by the diastolic pressure (the lower number). High blood pressure occurs when either of these numbers is too high which can happen with no symptoms. Signs and symptoms in instances of severe High Blood Pressure may include headache, feeling weak and tired, dizzy or light headed, chest pain or tightness, fast heart rate, visual or hearing problems, and shortness of breath.

The Patient-Centered Medical Home (PCMH) is a model of care based on the patient, their doctor and the healthcare team working together. The team tries new ways to work for the patient to have good health. One focus is on the patient doctor bond and to help the patient be more active in their health care plan. The patient may be sent to class or to watch a video. The family of the patient is added to the team with the permission of the patient sometimes. Computers are used to record the care and to measure the quality of care. The computers send and receive data to and from patients, labs, x-rays, pharmacy and other doctors. The payment plan for doctors adjusts for the added value to those who have a patient-centered medical home.

OBJECTIVEDescribe the characteristics of the Tennessee (TN) Emergency Medicine (EM) workforce.METHODSA cross-sectional mail survey of all non-government emergency departments (EDs) in TN was performed between January and April 2009. Data collected included: number and residency training of physicians, ED volume, employment and type of mid-level providers. Survey datawere compared to recent national EM workforce data. Subgroup analysis of rural EDs using Rural-Urban Commuting Area Code (RUCA) criteria was conducted.RESULTSWe received responses from 50 of the 100 emergency departments surveyed. Roughly half (53 percent) were rural, based on RUCA criteria. Mid-level providers worked with physicians in 31 departments, with physician assistants(PAs) being employed more commonly than nurse practitioners(NPs). Paramedics and emergency medical technicians (EMTs) were employed less frequently. Most EM residency trained physicians in Tennessee are working in EDs with approximately 39,000 annual visits per year or greater. Subspecialty physicians such as neurosurgeons, gastroenterologists and otorhinolaryngologists are generally not available to rural EDs, except by patient transfer, illustrating the marked differences in the work environments.CONCLUSIONWhile there is clearly a need for more emergency medicine residency training programs in Tennessee, the need to continue to provide advanced training for family medicine residency trained physicians is also clear. Family medicine doctors provide most of the rural emergency medicine in Tennessee.

Background: Because generic medications are less expensive than brand-name medications, government and private insurers have encouraged and/or mandated the use of generics.Objective: This study aimed at evaluating perceptions about generic medications among English-speaking women of childbearing age currently enrolled in U.S. TennCare (Medicaid).Methods: We recruited a convenience sample of patients from the waiting room of a primary care/gynecology health clinic, with 80% recruitment rate among those approached. We orally administered a 25-item questionnaire to gather sociodemographic information and to assess beliefs regarding the efficacy, safety, cost, and preferences for personal use of generic medications.Results: The average age of the women (n = 172) was 28.8 +/- 6.4 years, and most were white (82.0%) and currently married (58.1%). Nearly one-fifth (19.2%) had not completed high school. Most women believed that generic medications were less expensive (97.6%) and better value (60.5%) than brand-name medications, but only 45.3% preferred to take generics themselves. About a quarter (23.3%) believed that brand-name medications were more effective than generics, whereas 13.4% believed that generics caused more side effects. Few women reported that their doctor (29.7%) and/or pharmacist (35.5%) had ever talked to them about taking generics.Conclusion: Awareness of the benefits of generics did not equal preferences for personal use of generics among this sample of women enrolled in U.S. TennCare. Furthermore, women reported that providers both physicians and pharmacists-infrequently discussed generic substitution with them. (C) 2012 Elsevier Inc. All rights reserved.

Introduction: Dosing errors by caregivers are common and often are directly attributed to poorly designed instructions. The purpose of this study was to assess whether instruction wording-that is, implicit versus explicit dosage intervals-was associated with participants' ability to describe and correctly measure a dose of a commonly prescribed liquid pediatric prescription medication.Methods: English-speaking women (N = 193) of child-bearing age were recruited to participate in this study from an outpatient residency clinic in the southeastern United States. Based on a priori randomization, each participant was presented with one of two medication bottles that were identical except for the instructions: (1) "SHAKE LIQUID WELL AND GIVE (CHILD'S NAME) 6 ML BY MOUTH EVERY 12 HOURS" ("implicit" dosage interval)," or (2), "SHAKE LIQUID WELL AND GIVE (CHILD'S NAME) 6 ML BY MOUTH AT 7 AM AND 7 PM" ("explicit" dosage interval). Participants completed a structured interview to assess sociodemographic characteristics, health literacy skills, ability to describe and demonstrate the dosage of the liquid medication, and preferences for label format.Results: Seventy-two participants (37.3%) were able to correctly describe how they would give the medicine to a child during a 24-hour period, while 145 women (75.1%) were able to correctly demonstrate how they would give one dose of the medication. Approximately one third of participants (32.1%) were able to correctly describe and measure a dose of the medication. Slightly more than half of participants (n = 103, 53.4%) indicated that they would prefer instructions with "explicit" dosage intervals.Discussion: This study suggests that few people can accurately describe how liquid medications are to be administered, while more people can demonstrate the correct dose to be administered. J Pediatr Health Care. (2012) 26, 443-450.

This article describes the process of peer review from receipt of an article by a journal to publication. The need for timely response is explained. The importance and method of completing a helpful peer review is detailed. Specifically the areas of originality, structure, language, and ethical concerns are discussed. Communication between the peer reviewer and both the authors and the editors is highlighted.

Background: The terms opioid and narcotic are often used interchangeably by healthcare providers. The purpose of this study was to compare understanding narcotics vs. opioids. Methods: A convenience sample of English-speaking women (n=188), aged 2145years, seeking care at a primary care clinic were asked (1) What is an opioid/narcotic? (2) Give an example of an opioid/narcotic? (3) Why does someone take an opioid/narcotic? and (4) What happens when someone takes an opioid/narcotic for a long time? Responses were recorded verbatim by a research assistant and then coded independently by two investigators. Results: More than half of respondents (55.9%) responded don't know to all 4 opioid questions, while just 3.2% responded don't know to all 4 narcotic questions (P<0.01). Most women were unfamiliar with the term opioid (76.3%) and did not know why someone would take an opioid (68.8%). About two-thirds of respondents were able to give an example of a narcotic (64.2%) and knew the consequences of long-term narcotic use (63.2%). Conclusions: While more women were more familiar with narcotic, many identified negative connotations with this term. Future research should explore how to improve patient understanding and attitudes regarding both the terms opioids and narcotics.

context Few emergency medicine residency trained physicians practice in rural areas upon graduation. Family physicians are known to practice in rural locations at a higher rate. The distribution of emergency medicine fellowship trained family physicians from 2000-2008 of one program was examined. The continuing medical education (CME) pursued by these individuals is presently unknown and was explored.

Background: Time constraints often limit the amount of instruction pharmacists can provide to patients regarding accurate prescription medication use.Objectives: To assess the content, text point size, and reading difficulty of medication container labels and auxiliary warning labels (stickers) of 2 commonly prescribed children's medications (prednisolone and amoxicillin) dispensed by 20 US pharmacies. Secondly, to examine variability of pharmacy interpretations of electronically generated physician instructions (signatures [sigs]).Methods: All medication container labels were evaluated on the following: presence and rank order of 7 Food and Drug Administration (FDA)-required label items, presence of additional label content (eg, fill date), and whether each label content item was emphasized in some way (eg, highlighting). Presence, placement, content, and color of auxiliary warning labels (stickers) were also assessed. Text point size of pharmacy name, instructions, medication name, and instructional/warning stickers was measured to the nearest centimeter. Reading grade level (RGL) of medication label instructions and auxiliary warning labels was estimated using the Lexile Analyzer (available via the Internet [http://www.lexile.corn]). Amount and timing of medication administration of pharmacy interpretations of sigs were examined.Results: All containers included the 7 FDA-required label items. Text point sizes varied widely (pharmacy name [mean standard deviation [SD] = 12.0 +/- 3.9] versus auxiliary warning labels [mean SD = 6.8 +/- 1.1]). Four (10%) containers did not include any additional type of warnings related to the medication, beyond the dosage amount and administration frequency. Mean Lexile score of warning stickers was 488.3 +/- 316.3 (approximately third to fourth RGL), whereas that of pharmacy-generated instructions was 648.3 +/- 215.9 (approximately fifth to sixth RGL). Prednisolone sig instructions were presented in 14 distinct ways by the pharmacies, whereas amoxicillin sig instructions were interpreted in 16 different ways.Conclusions: Although all prescriptions reviewed met the minimum FDA-required labeling standards, pharmacy characteristics were more likely to be prominently emphasized on the labels than were

BACKGROUND AND OBJECTIVES Smoking cessation interventions should be individualized based on patient history and readiness for change. The objective of this study was to assess stages of change and key components of smoking and cessation history among a sample of primary care patients. METHODS A telephone survey of current or recent smokers identified smoking status, stage of change, motivation, concerns, relapse history, pharmacotherapy, and social support. RESULTS Of 150 participants, most were within precontemplation (22.7 percent) or contemplation (44.0 percent) stages of change; 14.0 percent were in preparation, 4.7 percent in action, and 14.7 percent in maintenance. The primary motivation for quitting was to improve general health (42.3 percent). The most common cessation-related concerns were: breaking the habit, stress, and weight gain. Pharmacotherapy was discontinued due to adverse events in 31.5 percent of users. Intratreatment social support was reported by 17.5 percent. The most common reasons for relapse were falling back into the habit (36 percent), stressful situations (27 percent), and being around other smokers (25 percent). CONCLUSIONS Targeted interventions are needed for patients in either precontemplation or contemplation stages. Counseling should focus on helping patients resolve barriers to cessation and reasons for relapse, particularly stress and weight management. Pharmacotherapy should be utilized when patients are ready to quit. Increased intratreatment social support and counseling appear warranted to support behavior change and appropriate medication use.

OBJECTIVES:The aim of this study was to assess supplementary materials accompanying 2 commonly prescribed pediatric medications, including the following: 1) readability and layout characteristics of pharmacy-generated consumer medical information(CMI); and 2) types and features of oral liquid measuring devices(OLMDs) provided.METHODS:We filled the same two prescriptions (prednisolone and amoxicillin) at 20 pharmacies (national grocery store chain [n = 1], regional grocery store chains [n = 4], national pharmacy chains [n = 3], national superstore chains [n = 3], and independently owned [n = 9]) across three states (Colorado,Georgia, and Tennessee). We evaluated readability, using both the Flesch-Kincaid (FK) formula and McLaughlin's Simplified Measure of Gobbledygook (SMOG), and text point size of pharmacy-generated CMI. We also assessed whether an OLMD(oral syringe, dropper, or cylindrical spoon) was included with each prescription and recorded the largest marked dose (in mL).RESULTS:Three pharmacies did not provide any type of CMI for either medication. Therefore, CMI was reviewed for 34 prescriptions. Reading grade levels of CMI averaged 9.6 1.9 (range, 5.3-11.7) using the FK and 11.2 2.6 (range, 6-14) based on the SMOG. Average text font size of CMI was 9.8 1.9 (range, 6-12). Although 32 (80%) prescriptions included an OLMD (oral syringe [n = 20], cylindrical spoon [n = 7], and dropper [n = 5]), close to one third (31.3%) would require multiple measurements to attain prescribed dosages.CONCLUSIONS:Many of the supplemental materials accompanying the prescriptions filled in this study were suboptimal;CMI was written at reading levels exceeding that of many parents,and the largest marked dose on each OLMD varied substantially. Physicians should be cognizant of the shortcomings of supplemental materials included with many medications, whereas pharmacies should strive to provide understandable CMI (ie, written at or below sixth-grade reading level) and suitable OLMDs (ie,requiring only one measurement of medication) to promote proper medication use.

Objective: To examine readability and formatting characteristics of consumer medication information (CMI) accompanying prescription medication samples.Methods: We collected the most commonly used prescription medication samples (n = 100) from four out-patient clinics at a large teaching hospital in the Southeastern US. Seventeen percent of samples were not pills/tablets and of such diverse nature (e.g., injections, drops, and creams) that there were not enough in any category to draw conclusions. Therefore, our analyses were limited to 83 pill/tablet samples, belonging to I I drug classes (e.g., cardiovascular, and psychiatric). We noted if CMI was present, and if so we assessed it for how instructions were presented, reading level, text size, format/layout, and comprehensibility.Results: No CMI was present in 39 (46.9%) samples. In 19 (22.9%), CMI was contained in a package insert and in 25 (30.2%) it was printed on the medication package. Average reading difficulty of CMI was at the 10th grade level (range = 6-15) using the Fry formula, and text point size was small (mean 9.9 +/- 2.2 on package inserts and 9.4 +/- 2.6 when printed on packages).Conclusions: Almost half of samples did not include any type of CMI. For those that had CMI, it was often written at a reading difficulty level higher than the average reading skills of American adults, and the format of most CMI was not optimal for comprehensibility. It is likely that many patients do not understand the instructions accompanying medication samples they receive from clinicians.Practice implications: Clinicians should be cognizant of the shortcomings of CMI accompanying medication samples and thereby, distribute them to patients with caution. Manufacturers too should consider revising CMI to comply with low-literacy guidelines.(c) 2007 Elsevier Ireland Ltd. All rights reserved.