To assess the experienced or perceived barriers and facilitators to health research participation for major US racial/ethnic minority populations, we conducted a systematic review of qualitative and quantitative studies from a search on PubMed and Web of Science from January 2000 to December 2011. With 44 articles included in the review, we found distinct and shared barriers and facilitators. Despite different expressions of mistrust, all groups represented in these studies were willing to participate for altruistic reasons embedded in cultural and community priorities. Greater comparative understanding of barriers and facilitators to racial/ethnic minorities' research participation can improve population-specific recruitment and retention strategies and could better inform future large-scale prospective quantitative and in-depth ethnographic studies.

Objective: To evaluate the impact of exam‐room computers on communication between clinicians and patients. Design and Methods: Longitudinal, qualitative study using videotapes of regularly scheduled visits from 3 points in time: 1 month before, 1 month after, and 7 months after introduction of computers into the exam room. Setting: Primary care medical clinic in a large integrated delivery system. Participants: Nine clinicians (6 physicians, 2 physician assistants, and 1 nurse practitioner) and 54 patients. Results: The introduction of computers into the exam room affected the visual, verbal, and postural connection between clinicians and patients. There were variations across the visits in the magnitude and direction of the computer's effect. We identified 4 domains in which exam‐room computing affected clinician–patient communication: visit organization, verbal and nonverbal behavior, computer navigation and mastery, and spatial organization of the exam room. We observed a range of facilitating and inhibiting effects on clinician–patient communication in all 4 domains. For 2 domains, visit organization and verbal and nonverbal behavior, facilitating and inhibiting behaviors observed prior to the introduction of the computer appeared to be amplified when exam‐room computing occurred. Likewise, exam‐room computing involving navigation and mastery skills and spatial organization of the exam‐room created communication challenges and opportunities. In all 4 domains, there was little change observed in exam‐room computing behaviors from the point of introduction to 7‐month follow‐up. Conclusions: Effective use of computers in the outpatient exam room may be dependent upon clinicians' baseline skills that are carried forward and are amplified, positively or negatively, in their effects on clinician–patient communication. Computer use behaviors do not appear to change much over the first 7 months. Administrators and educators interested in improving exam‐room computer use by clinicians need to better understand clinician skills and previous work habits associated with electronic medical records. More study of the effects of new technologies on the clinical relationship is also needed.

Background: Markers of protein-energy wasting (PEW) and inflammation are common in chronic kidney disease (CKD) and are among the strongest predictors of mortality in dialysis patients. Objective: We hypothesized that markers of PEW and inflammation show similar associations in patients with non-dialysis-dependent CKD (NDD-CKD). Design: We examined the associations of serum albumin, white blood cell (WBC) count, percentage of lymphocytes in WBCs (%LYM), and a combination of all 3 with all-cause mortality and with the composite of predialysis mortality or end-stage renal disease (ESRD) by using fixed-covariate and time-dependent Cox models in 1220 men with NDD-CKD. Results: Lower albumin and %LYM and a higher WBC count were significantly associated with outcomes. In time-dependent Cox models, compared with patients in whom none of these markers indicated PEW, those in whom 1, 2, or all 3 markers indicated the presence of PEW had multivariable-adjusted hazard ratios (95% CI) for all-cause mortality of 1.7 (1.2, 2.4), 2.4 (1.7, 3.4), and 3.6 (2.5, 5.1); the P for trend was ,0.001. Similar associations were present in fixed-covariate models for all-cause mortality and in fixed-covariate and time-dependent models for the composite outcome. Conclusions: Traditional and nontraditional markers of PEW display robust, strong, and independent associations with mortality in patients with NDD-CKD. Clinical trials are warranted to examine whether PEW-improving interventions can lead to better outcomes in these patients.