Background: Nausea and vomiting in early pregnancy (NVEP) is commonly encountered in family medicine. Ginger (Zingiber officinale) is a popular nonpharmacological treatment but consensus of its use is lacking.Methods: We conducted a meta-analysis of clinical trials using ginger for NVEP as published in PubMed and EMBASE, CINAHL, Cochrane Library, and all EBM reviews. Studies satisfying 3 criteria were selected: (1) randomized placebo-controlled design; (2) use of ginger or Z. officinale; and (3) extractable data on improvement in NVEP. Data were synthesized into pooled odd ratios based on the random effects model, and results were tabulated with the aid of Forest plots.Results: We identified 135 potentially relevant records; only 6 studies met the final criteria. Of the total 508 subjects, 256 and 252 subjects were randomly assigned to receive ginger and placebo, respectively. The use of ginger (ϳ1 g daily) for at least 4 days is associated with a 5-fold likelihood of improvement in NVEP. Heterogeneity among the clinical studies were acknowledged in the final interpretation of results.Conclusions: Despite the widespread use of ginger in the diet, its clinic value and safety profile in treating NVEP is still unknown. Our meta-analysis suggests that ginger is an effective nonpharmacological treatment for NVEP. (J Am Board Fam Med 2014;27:115-122.)

Rationale, aims and objectives Given the increasing emphasis being placed on managing patients with chronic diseases within primary care, there is a need to better understand which primary care organizational attributes affect the quality of care that patients with chronic diseases receive. This study aimed to identify, summarize and compare data collection tools that describe and measure organizational attributes used within the primary care setting worldwide. Methods Systematic search and review methodology consisting of a comprehensive and exhaustive search that is based on a broad question to identify the best available evidence was employed. Results A total of 30 organizational attribute data collection tools that have been used within the primary care setting were identified. The tools varied with respect to overall focus and level of organizational detail captured, theoretical foundations, administration and completion methods, types of questions asked, and the extent to which psychometric property testing had been performed. The tools utilized within the Quality and Costs of Primary Care in Europe study and the Canadian Primary Health Care Practice-Based Surveys were the most recently developed tools. Furthermore, of the 30 tools reviewed, the Canadian Primary Health Care Practice-Based Surveys collected the most information on organizational attributes. Conclusions There is a need to collect primary care organizational attribute information at a national level to better understand factors affecting the quality of chronic disease prevention and management across a given country.

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Introduction Cardiovascular disease (CVD) is currently the leading cause of death worldwide, contributing to 30% of all deaths. CVD etiology is complex, with many modifiable and nonmodifiable risk factors. Epidemiological evidence generally supports an association between shiftwork and an increased risk for CVD. However, the underlying physiological mechanisms remain poorly understood. Limited research suggests that the production of cortisol may differ between shift workers and non-shift workers, resulting in physiological changes that potentially increase the risk of CVD among shift workers. This study will focus on females who comprise the largest proportion of workers in healthcare settings. Objectives 1) To describe and compare total cortisol levels and its diurnal pattern in relation to current shiftwork status, and cumulative duration of exposure to shiftwork. 2) To determine if current shiftwork status and/or cumulative duration are associated with total cortisol levels, and diurnal pattern.