New reasons for confusion about when brain death is real death

February 9, 2010

FEATURED SEARCH: brain death

For several years, the definition of death has been in turmoil as evidence accumulates that a legally brain-dead human body can continue to carry out many metabolic processes independently. The implications for the field of organ transplantation, obviously, are tremendous.

The article below, by an NIH bioethicist, turns for insights to an ethical analysis from the late 1960s, the era when criteria for brain death were first being drafted.

RESULT: Death and Organ Donation: Back to the Future
 Journal of Medical Ethics | Oct 1, 2009

The following results are among several recent studies that point to vulnerabilities in the assumption that someone who is brain-dead is also biologically dead.

RESULT: Controversies About Brain Death
JAMA | Jul 22, 2009

RESULT: A 10-month-old infant with reversible findings of brain death
Pediatric Neurology (PubMed) | Nov 1, 2009

The process of assessing brain death may also lead to biological responses that mislead those making the assessment, according to the following report.

RESULT: Cardiogenic oscillation and ventilator autotriggering in brain-dead patients: a case series
American Journal of Critical Care | Sep 1, 2009

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SEARCH TIP: Double-blind placebo-controlled

We noticed another person trying to achieve what SearchMedica has already accomplished. The search term was simply “double-blind placebo-controlled” (not even a symptom or condition name).

Just use the Evidence-based Articles category (above Result #1 in any search) to find only double-blind trials, meta-analyses, and systematic reviews.

Perhaps a better way to include only double-blind trials would be to specify “NOT meta-analysis NOT systematic” in results within that category, which would deliver only the trials and not the reviews.

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Search: neonatal discharge

Allowing parents to help care for their premature infant and letting them stay in the neonatal ICU reduced the time to discharge, according to a study from Sweden.

RESULT: The Stockholm Neonatal Family Centered Care Study: Effects on Length of Stay and Infant Morbidity
Pediatrics | Feb 1, 2010

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SEARCH TIP: Free review articles

Someone searched on “free review Hereditary Spherocytosis.”

Here’s a better strategy for finding only PDFs of review articles on a specific topic. Type m:text/pdf and then the search term. For example, the request above would be m:text/pdf hereditary spherocytosis.

This limits your search to PDFs. Finding reviews only is more difficult, because sometimes the word “review” doesn’t even appear in a review. (The journal may use a designation such as “Clinical Perspectives.” You may be better off just scanning the titles for what appears to be a relevant review.)

Also, this strategy will not offer articles that are not put online in PDF format. You can tell whether a non-PDF result is full text by looking at the blue URL immediately above the journal name and date. (It’s clickable, by the way.) Usually you’ll see the word “full” somewhere inside the URL garble if the result includes the complete text.

Leave a Comment » | Medical ethics, Pediatrics, Uncategorized | Tagged: , , , , , | Permalink
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Minimizing surgery risks for liver cancer patients

February 4, 2010

FEATURED SEARCH: HCC

Abstracts just in from the 2010 American Society for Clinical Oncology meeting on gastrointestinal cancers include several new reports about hepatocellular carcinoma (HCC). Among them, oncological surgeons from Japan discuss their experience using a hybrid ablation strategy for patients with multiple HCC, including a mix of percutaneous and endoscopic approaches to minimize the risk of dissemination and puncture. Scroll down to find many other interesting studies on the topic. (You can target abstracts from ASCO meetings by using the Meeting Abstracts articles category.)

RESULT: Hybrid ablation therapy for multiple hepatocellular carcinomas
ASCO 2010 Gastrointestinal Cancers Symposium | Jan 19, 2010

In another report, a multicenter team from Europe compared modified WHO and modified RECIST guidelines for assessment of HCC responses to therapy, using data on patients from a clinical trial. They found that the RECIST guidelines may be preferable, and may explain a disconnect between time to progression and overall survival that arises when using the WHO criteria.

RESULT: Comparison of tumor responses by modified WHO and new RECIST criteria from a phase II study of first-line brivanib in hepatocellular carcinoma (HCC)
ASCO 2010 Gastrointestinal Cancers Symposium | Jan 19, 2010

Also in this search is a recent review about assessing and addressing the risk of recurrence among HCC patients given liver transplantation. (The article below is an editorial about the review; the link to the review itself is at the bottom of the screen, beneath the comments box.)

RESULT: Getting a Handle on Post-transplant Recurrence of HCC
Cancer Network | Dec 17, 2009

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Search: lymphangitis

After observing 116 patients for a year after breast cancer surgery involving axillary node dissection, researchers from Spain found that physiotherapy including manual lymph drainage, massage, and shoulder exercises can significantly reduce the risk of postoperative lymphedema when begun shortly after surgery. (The British Medical Journal offers full text of this article for free.)

RESULT: Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial
British Medical Journal | Jan 10, 2010

Search: CINV

By adding the 5HT3-receptor antagonist palonosetron to dexamethasone on day one of treatment, researchers found that on the following two days placebo was as good as dexamethasone in preventing chemotherapy-induced adverse effects. This obviously offers a way to reduce the risk of corticosteroid-induced adverse effects of the drug given to ease the chemotherapy-induced nausea and vomiting (CINV).

RESULT: Double-blind, randomised, controlled study of the efficacy and tolerability of palonosetron plus dexamethasone for 1 day with or without dexamethasone on days 2 and 3 in the prevention of nausea and vomiting induced by moderately emetogenic chemotherapy
Annals of Oncology | Jan 15, 2010

Leave a Comment » | Breast, Cancer | Tagged: , , , , | Permalink
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Delirium in the elderly: Risky, underdiagnosed, an effect of sedation?

February 3, 2010

FEATURED SEARCH: delirium

A diagnosis of delirium is missed in up to 95% of cases, according to the first result below, although it is common among people in hospitals and nursing homes, and is a significant risk factor for dementia and death. The review provides keys to diagnosis, prevention, and treatment. The second article questions whether sedation is an important contributor to the risk of delirium in nursing home patients, and whether this risk is justifiable under the circumstances. It links to a study that assessed the correlation between sedation during hip fracture repair and the onset of dementia.

RESULT: Update on Delirium: Diagnosis, Management, and Pathophysiology
 Psychiatric Annals | Jan 8, 2010

RESULT: Delirium: A Cognitive Cost of the Comfort of Procedural Sedation in Elderly Patients?
Mayo Clinic Proceedings | Jan 1, 2010

Doctors in Japan report success in treating delirium in two individuals with Alzheimer disease using the antidepressant fluvoxamine rather than antipsychotics. This may be an option with significantly fewer adverse effects, they point out. (After clicking on the title below, choose the first result on the list (the journal name) rather than the second (with the article title) in order to read full text.)

RESULT: Sigma-1 receptor agonist fluvoxamine for delirium in patients with Alzheimer’s disease
Annals of General Psychiatry | Jan 20, 2010

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Search: hypomanic manic

Analysis of results from the STEP-BD trial for bipolar disorder shows that previous or concurrent substance abuse does not affect the time to recovery from a depressive episode. But it appears to influence the risk of a direct switch from depression to mania or hypomania.

RESULT: Impact of Substance Use Disorders on Recovery From Episodes of Depression in Bipolar Disorder Patients: Prospective Data From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)
American Journal of Psychiatry | Dec 15, 2009

Search: medical marijuana

The US Justice Department has authorized the use of medical marijuana in states that allow it, while saying that it remains illegal. (Say again?) The following article by a Connecticut legal scholar attempts to clarify the issue. The comments at the end of the article are also interesting.

RESULT: The Past, Present, and Future of Medical Marijuana in the United States
 Psychiatric Times | Jan 6, 2010

Leave a Comment » | Dementia, Geriatrics, Medical ethics, Psychiatry | Tagged: , , , | Permalink
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H1N1: Lessons from the first wave that can inform us in the second

February 2, 2010

FEATURED SEARCH:  H1N1

A timely literature review from the Mayo Vaccine Research Group offers a comprehensive overview of what we’ve learned about symptoms, diagnosis, treatment, and prevention from the first influenza pandemic in four decades, whose first wave is now waning. It compares this pandemic with the one that began in 1918, and offers insights for the future. The second result, including information from patients admitted to the Hospital for Sick Children in Toronto, found that H1N1 was not noticeably more severe than seasonal influenza A, although children with pandemic influenza were more likely to have asthma.

RESULT: 2009 H1N1 influenza
Mayo Clinic Proceedings | Jan 1, 2010

RESULT: Risk factors and outcomes among children admitted to hospital with pandemic H1N1 influenza
Canadian Medical Association Journal | Jan 12, 2010

Researchers have also been monitoring the molecular progress of the pandemic virus itself, of course. The H1N1 virus was “nested within a well-established swine influenza lineage” for at least 10 years before it began to infect humans, although birds were its original reservoir, according to an international team of scientists who have studied cross-species patterns of its hemagglutinin receptor molecules. However, it has mutated so that it can no longer replicate in chicken or ducks.

RESULT: Extensive Mammalian Ancestry of Pandemic (H1N1) 2009 Virus
 Emerging Infectious Diseases | Jan 11, 2010

Search: H1N1

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SEARCH TIP: NEW! Medical Search of the Day

You can now have a daily glance at useful results from others’ searches with SearchMedica’s “Medical Search of the Day.” (Recent examples: foreign body in gastrointestinal tract, benign positional vertigo, polymyalgia rheumatica.)

Follow the RSS link in the right column to have it sent to your email account.

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: postural hypotension

Results from an observational study of nearly 4000 women between the ages of 60 and 80 who visit general practitioners in the United Kingdom reveal factors that predispose to orthostatic hypotension.

RESULT: The association between orthostatic hypotension and medication use in the British Women’s Heart and Health Study
 Age and Ageing | Jan 1, 2010

Leave a Comment » | Family Medicine, Geriatrics, Infectious diseases, Influenza, Internal Medicine, Women | Tagged: , , , , , , | Permalink
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How to reduce your risk of being sued

January 28, 2010

FEATURED SEARCH: lawsuit

Sadly, the most common search term using the Musculoskeletal tab last week was “lawsuit.” According to the article below, surgeons are sued on average every 4 to 5 years. Based on a seminar about malpractice litigation, it describes the most common types of lawsuits, reviews three real-life malpractice cases, and suggests how doctors can protect themselves.

RESULT: Medicolegal issues in perioperative medicine: Lessons from real cases
Cleveland Clinic Journal of Medicine | Oct 21, 2009

One of the “four C’s” mentioned in the article above as key to avoiding malpractice litigation, competence, correlates poorly with the likelihood of being sued, according to the commentary below.  Also, in the current system patients who might deserve compensation even though no negligence was involved do not receive any. The author suggests that a general insurance fund for medical injuries would be a better option for all.

RESULT: It Is Patients Who Most Need Tort Reform
 New England Journal of Medicine | Dec 2, 2009

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SEARCH TIP: How to make this search better

A simple search on the word “lawsuit” (see above) delivers results including the irrelevant synonyms “sue” and “cause.” Results would be better if you enclosed the search term in quotation marks, which forces the search engine to look for that specific word.

Also, the specialist Musculoskeletal tab includes journals relevant to musculoskeletal medicine, as well as the major general journals such as New England Journal of Medicine. But content about other topics is excluded.

Much more information about malpractice litigation appears using the term “lawsuit” in the Practice Management tab.

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: triangular fibrocartilage complex

Does injury to the triangular fibrocartilage complex cause tendon friction that threatens the function of the extensor carpi ulnaris muscle, perhaps risking later repetitive motion injury? A study of cadaver wrists at the Mayo Clinic answers the question. (Reach full text, which costs $31.50 without a subscription, by clicking on “View MedLine abstract on PubMed.gov” at the bottom of the page, then on the Elsevier link in the right column and after that on the link to ScienceDirect.)

RESULT: The effect of triangular fibrocartilage complex injury on extensor carpi ulnaris function and friction
Clinical Biomechanics (PubMed)| Dec 1, 2009

Search: low-energy fracture

A small case series from the NYU Hospital for Joint Diseases raises the possibility that taking alendronate for years places women at special risk for bilateral fractures of the femur. The authors suggest checking the other femur when such a woman breaks one, and discontinuing the drug in consultation with an endocrinologist.

RESULT: Bilateral Low-Energy Simultaneous or Sequential Femoral Fractures in Patients on Long-Term Alendronate Therapy
The Journal of Bone and Joint Surgery (American) | Nov 1, 2009

Search: comminuted fracture

A cadaver study carried out at Wayne State University in Detroit determined the kind of impact that will cause a comminuted fracture in the temporoparietal region of the skull from a “less lethal” 38-mm blunt ballistic projectile used by police to incapacitate suspects. (Presumably this information will be used to avoid that kind of fracture.) This may not be the kind of information about comminuted fractures that your colleague was seeking. But as SearchMedica includes everything in the authoritative medical literature, it turned up.

RESULT: Tolerance of the skull to blunt ballistic temporo-parietal impact
 Journal of Biomechanics (PubMed) | Jan 1, 2010

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SEARCH TIP: Type a few more keys, save a few minutes

This search turned up nearly 1000 results, including information about comminuted fractures of the femur, the mandible, the ribs, and many other bones.

Adding an anatomical term to the query would target the search.

Leave a Comment » | Musculoskeletal | Tagged: , , , , | Permalink
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What odds after mitral valve repair?

January 27, 2010

FEATURED SEARCH: mitral regurgitation

Chronic mitral regurgitation affects about one patient in four after myocardial infarction and is often clinically silent. The choice between surgery and conservative treatment remains controversial. A new systematic review addresses the question head-on.

RESULT: Should patients with asymptomatic severe mitral regurgitation with good left ventricular function undergo surgical repair?
Interactive Thoracic and Cardiovascular Surgery | Feb 1, 2010

In the full-text article that follows, cardiologists from Italy describe the use of exercise echocardiography to assess the cause and functional nature of mitral valve regurgitation. They offer suggestions for clinical situations in which it should be used routinely, along with a diagnostic algorithm.

RESULT: Assessing functional mitral regurgitation with exercise echocardiography: rationale and clinical applications
Cardiovascular Ultrasound | Dec 14, 2009

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SEARCH TIP: Research/Reviews: A Reminder

If your main list of results is crowded with guidelines and clinical trials and you just want to see the research, click on the Research/Reviews article category above the first article title on your list.

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: constipation

Behavioral screening should be incorporated in the assessment of children who have chronic constipation, according to a study from Belgium, which found that internalizing and externalizing behavior problems were three to four times more common among children with constipation than in the general population. In the second article, doctors in the Netherlands compare two treatment approaches to childhood fecal impaction. Enemas were as successful as polyethylene glycol, they found. But repeated enemas do not improve the constipation problem, they reported in another journal at the same time.

RESULT: Prevalence and Associated Clinical Characteristics of Behavior Problems in Constipated Children
 Pediatrics | Jan 18, 2010

RESULT: Rectal Fecal Impaction Treatment in Childhood Constipation: Enemas Versus High Doses Oral PEG
Pediatrics | Dec 1, 2009

RESULT: No role for increased rectal compliance in pediatric functional constipation
Gastroenterology (PubMed) | Dec 1, 2009

Search: postpartum hemorrhage

If oxytocin isn’t available, misoprostol is nearly as effective as a first-line treatment for postpartum hemorrhage. The study was carried out in Ecuador, Egypt, and Vietnam and funded by the Bill and Melinda Gates Foundation. The medicine can be stored for years without refrigeration.

RESULT: Medical News: Misoprostol Can Work for Postpartum Hemorrhage
MedPage Today | Jan 7, 2010

RESULT: Post-partum haemorrhage: beyond the confrontation between misoprostol and oxytocin
The Lancet | Jan 15, 2010

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SEARCH TIP: The news and SearchMedica

The news item from MedPage Today, above, describes two studies, only one of which was available on SearchMedica at the time of writing.

Because new medical articles appear every day by the hundreds, it may take SearchMedica’s Web crawler longer to retrieve a particular article than it takes a news source to publish a news article with a hand-crafted link to that article. If the publication is very recent, it may appear at the bottom of a news article before you see it on SearchMedica.

Leave a Comment » | Cardiovascular, Family Medicine, Gastrointestinal, Pediatrics, Women | Tagged: , , | Permalink
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Patients denied euthanasia view suffering differently from MDs who deny it

January 26, 2010

FEATURED SEARCH: euthanasia

In defining “unbearable” pain, many physicians focus on bodily pain and regard forms of suffering related to the mind as “subjective and not really ‘real’.”  This information comes from interviews of patients who requested physician-assisted suicide in the Netherlands (where it is legal) and their doctors who refused. Most patients were older than 80 years, and most said what was unbearable, leading to the request, was not the physical pain but the fear of dependence or mental suffering because of deterioration. These insights are useful not only in the context of legal euthanasia, the authors suggest, but in end-of-life care in general. (Full text is available via the link below.)

RESULT: Concept of unbearable suffering in context of ungranted requests for euthanasia: qualitative interviews with patients and physicians
British Medical Journal | Nov 16, 2009

Analysis of responses to case descriptions showed that general practitioners, specialists, and euthanasia review committees also have strong differences of opinion about the nature of non-physical suffering. All three groups tended to feel that the suffering involved in early dementia was not sufficient to justify physician-assisted suicide.

RESULT: Judgement of suffering in the case of a euthanasia request in The Netherlands
Journal of Medical Ethics | Aug 1, 2009

On a related note, a letter to the latest American Journal of Psychiatry urges finding new ways to relieve suffering that might otherwise lead to suicide in the elderly. This will be especially important as the baby boom in the US population continues to age, the correspondents assert.

RESULT: Reducing Suicidal Ideation and Depression in Older Primary Care Patients: The Oldest Old and Pain
American Journal of Psychiatry | Jan 1, 2010

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: psychodynamic psychotherapy

Someone has used SearchMedica to find the continuing debate about a recent trial of psychodynamic psychotherapy for generalized anxiety disorder. The critics contend that using the HAM-A scale renders the study results “equivocal.” The authors, after defending their methods, conclude that perhaps pharmacotherapy studies are equally vulnerable. (The original study, published in August, also appears in this search.)

RESULT: Limitations of the Hamilton Anxiety Rating Scale as a Primary Outcome Measure in Randomized, Controlled Trials of Treatments for Generalized Anxiety Disorder
American Journal of Psychiatry | Jan 1, 2010

RESULT: Drs Leichsenring, Salzer, and Leibing Reply
American Journal of Psychiatry | Jan 1, 2010

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SEARCH TIP: Quotation marks

Note the effective use of quotation marks in the search above to define a phrase as a search term.

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Search: strategic family therapy

A Miami-based team has completed a trial of brief strategic family therapy as a method of reducing drug abuse and other equally risky behaviors among adolescents. Have Jose Szapocznik and his team yet published the results? What is this therapy anyway? Read on to learn how to find the answers.

RESULT: Brief Strategic Family Therapy for Adolescent Drug Abusers
 ClinicalTrials.gov | Nov 16, 2009

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SEARCH TIP: Strategic Searching Tactics

As usual, the 100 or more results in the main search list for the query strategic family therapy are a mix of clinical trials, guidelines, and other kinds of publications. It’s a good example of how to hone a search to find exactly what you’re looking for, once you face that jumble of options.

•   As you already know, to clear away articles that use words from the search term in different contexts, you can put quotation marks around the phrase: “strategic family therapy” (41 results)

•   To read only research journal articles on the topic, click on the option Research/Reviews (18 results)

•    What solid evidence exists about this kind of therapy? Try the option Evidence-based Articles to see only randomized trials, meta-analyses, and systematic reviews (4 results)

•    Want to see how  this kind of therapy is conducted? A result from the National Institute of Drug Abuse contains an online version of a manual for administering Brief Strategic Family Therapy. (This appears in the main search, but also in Practical Articles/News, the location for practical information rather than research results or other kinds of content.)

•    Find information about forms of strategic family therapy other than the “brief strategic family therapy” championed by Szapocznik’s team by excluding the term “brief”:  “strategic family therapy” NOT brief

•    Having found the name of the lead investigator of the study above, what else has he been studying? Use the name Szapocznik as the query

Leave a Comment » | Anxiety, Depression, Medical ethics, Mood Disorder, Psychiatry | Tagged: , , , , | Permalink
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Radiofrequency ablation for lung metastases: Good medicine, or desperate move?

January 21, 2010

FEATURED SEARCH: radiofrequency ablation of lung metastases

In yet another small series report, this one from Australia, radiofrequency ablation (RFA) proved safe and effective against pulmonary metastases. The primary tumor in all four cases was leiomyosarcoma, and the patients were not eligible for surgery. The authors report low morbidity from the procedure, and a relatively long (nearly a year) disease-free period afterward.

RESULT: Feasibility of ablation as an alternative to surgical metastasectomy in patients with unresectable sarcoma pulmonary metastases
Interactive Cardiovascular and Thoracic Surgery | Dec 1, 2009

Among other trials under way on the subject, the National Cancer Institute is sponsoring a multicenter study in France to determine which of two imaging technologies is best for determining response to this treatment.

RESULT: PET Scan and CT Scan in Evaluating Response in Patients Undergoing Radiofrequency Ablation for Lung Metastases
 ClinicalTrials.gov | Jul 7, 2009

A recent review questions whether “potentially toxic” local measures against metastasis, such as radiofrequency ablation, are justified given their short-term effectiveness, or whether they are moves of “desperation.” Scroll down to follow the vigorous debate in letters of response to this article.

RESULT: Local Surgical, Ablative, and Radiation Treatment of Metastases
CA: A Cancer Journal for Clinicians | May 1, 2009

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SEARCH TIP: When time may not be of the essence

By default, SearchMedica includes publication date as an important factor in ranking search results. But in some cases, it makes sense to un-check the option “Prioritize results by publication date” immediately below the yellow Search button.

No “Evidence-based Articles” option appears among the article categories listed for the search “radiofrequency ablation of lung metastases” above. Thus we know that no randomized trials or systematic reviews have yet been published to document the evidence.

The latest report on the subject (the one above) may not be the largest or the best. To see the full range of the research to date, un-check the publication date option and then try the query radiofrequency ablation of lung metastases in the Research/Reviews category.

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: pericardial effusion

Another small series reports the success of a “new, shorter and easier approach for pericardial exposure” in cancer patients threatened by the common sequela of pericardial effusion. In most cases, according to the authors, the procedure can fully drain the pericardium using only local anesthesia.

RESULT: Left paraxiphoidian approach for drainage of pericardial effusions
Interactive Cardiovascular and Thoracic Surgery | Jan 1, 2010

Search: oral cancer

“Excellent and well vetted information,” wrote your colleague, recommending this patient education page on oral cancer. 

RESULT: Oral Cancer Facts
Oral Cancer Foundation | Mar 2, 2009

The next feedback message, using the same search term, most likely came from the same author. He or she was not so impressed by the second result below (see below).

RESULT: Screening programmes for the early detection and prevention of oral cancer
Cochrane Database (PubMed) | Jan 1, 2006

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SEARCH TIP: Deletions and debate

“As a SEER database researcher I know that it is clear that finding early-stage oral cancer through visual and tactile screenings yields more stage one patients with higher long-term survivals,” wrote the correspondent about the guideline above. “These guys overlook the most basic source of information to come up with wrong, or better stated, a conclusion that they can’t make a conclusion. This link should be deleted.”

This comment may not be correct, strictly speaking. The June 2009 Health Professional PDQ from the National Cancer Institute on oral cancer screening states that although routine examination “can lead to detection of earlier stage cancers and premalignant lesions . . . there is no definitive evidence . . . to show that this screening can reduce mortality.”

There are nuggets of an interesting debate here. (Is simple early-stage oral cancer screening worth the effort? Should guidelines that cannot offer any recommendation be suppressed?) If you’d like to express an opinion, please write and tell us.

However, SearchMedica will not suppress out-of-date or controversial results. Nor would PubMed, where this report appears. Like them, our objective is to be comprehensive.

We have the ability to delete links, but do so only for results that are technically flawed or not appropriate to SearchMedica’s content designations. Otherwise, all content from authoritative sources will be indexed.

Leave a Comment » | Cancer | Tagged: , , , , | Permalink
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Use the placebo effect—or disavow it?

January 20, 2010

FEATURED SEARCH: placebo effect

In the essay below, an orthopedic surgeon candidly dissects his own cognitive dissonance after two placebo-controlled trials call into question an established procedure—vertebroplasty, the injection of cement to stabilize a spine after vertebral fracture in order to relieve pain and disability. Both studies showed a sham procedure to be as effective as the actual injection. Is the analgesic effect caused by the anesthetic, he asks, and not the stabilization? Are both studies invalid? Should he stop offering the procedure even though he has witnessed its transforming effects? (Any mental health professional might confront similar questions tomorrow, next week, or next month. Would you reach the same conclusion he does?)

RESULT: Vertebroplasty, cognitive dissonance, and evidence-based medicine: What do we do when the “evidence” says we are wrong?
Cleveland Clinic Journal of Medicine | Jan 1, 2010

Is the spine especially susceptible to the placebo effect—maybe even the physiological center of its effects? The following article describes a study that used functional MRI to study the neural response to pain in a placebo study involving healthy volunteers. Both groups received a painful heat stimulus. Those who thought they were receiving a painkiller showed no response in an area of the spine that lit up in subjects told they were receiving placebo.

RESULT: Placebos:  Is it all in your spine?
 Psychiatric Times | Nov 9, 2009

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: behavioral dementia ftd

A few weeks ago Medical Search Tips included a recent article about frontotemporal dementia. Someone sent feedback pointing out this other interesting result. A study from Mayo Clinic medical centers in Minnesota and Florida finds that two forms of right temporal variant frontotemporal dementia can be distinguished by their symptoms. One appears to have more to do with cognition and the other has more effect on behavior.

RESULT: Two distinct subtypes of right temporal variant frontotemporal dementia
Neurology | Nov 3, 2009

Search: borderline dsm-iv-tr

Bipolar disorder and borderline personality disorder have similar symptoms and may sometimes coexist, creating exquisite challenges in diagnosis. A feedback message draws our attention to this CME-accredited review that provides guidance on how to distinguish the two conditions. (The first result in the link below reaches page 3 of the article. Scroll to the bottom and click on “1″ in the list of numbers to find page 1.)

RESULT: Borderline Personality Disorder and Bipolar Disorder—Distinguishing Features of Clinical Diagnosis and Treatment
 Psychiatric Times | Jul 13, 2009

Search: Tourette’s and treatment

Someone clicked “No” after responding to the prompt “Was this helpful?” beneath this result, which is a page from the FDA website. As usual, the message left no comment about why the result was not useful. We wonder whether this person saw “dementia” in the black box warning at the top of the screen, read no further, and assumed the result was irrelevant. The warning has to do with risks to elderly patients with dementia, something indeed irrelevant to the query.  But a few lines later, Tourette’s is listed among the first indications for haloperidol.

RESULT: Haloperidol solution (DailyMed: About DailyMed)
 DailyMed | Jan 4, 2010

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SEARCH TIP: Cached

Clicking on this word, which often appears in the same line as the journal name and date, takes you to a version of the article with your search terms highlighted. It’s a quick way to find why an article that appears irrelevant has been included in the results list.

Leave a Comment » | Bipolar, Dementia, Medical ethics, Psychiatry, Uncategorized | Tagged: , , , , , , , | Permalink
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Despite evidence to contrary, kids born with diaphragmatic hernia think they’re infirm

January 19, 2010

FEATURED SEARCH: congenital diaphragmatic hernia

A sad pair of studies from the Netherlands turned up with this search last week—a problem that primary doctors can address if they’re aware of it. According to the report below, children and adolescents who survived high-risk congenital diaphragmatic hernia show somewhat reduced lung function, but not enough to cause any physical impairment. Their measures for gas exchange and exercise capacity are normal.

RESULT: Pulmonary function and exercise capacity in survivors of congenital diaphragmatic hernia
European Respiratory Journal | Nov 1, 2009

However, although these children are essentially healthy, they and their parents believe their health is poor and likely to decline, according to another study by the same group. (The researchers did find an increase in attentional and behavioral problems compared with controls.)

RESULT: Psychological outcome and quality of life in children born with congenital diaphragmatic hernia
Archives of Disease in Childhood | Nov 1, 2009

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SEARCH TIP: Query challenge: ADHD famous people

We wondered how the person fared after entering the query ADHD famous people. Answer: not so well: The highlighted words in the blurbs beneath those results include no references to famous people. (Click on the link to see for yourself.)

How would a power SearchMedica user find this information?

•  Un-click “Prioritize results by publication date,” just beneath the yellow Search button. (Because the query has to do with history, it’s a waste of your time to see the results ranked by publication date. Relevance to the search term is all that matters.)

•   Eliminate the word “people” from the query. It’s a red herring, a general term likely to prompt the search engine to include irrelevant results. Using quotation marks (ADHD “famous people”) might help, but that could eliminate articles that use words like “athletes,” “performers,” or even “celebrities.”

The search term ADHD famous includes among the top 10 results one article that mentioned famous individuals thought to have had ADHD: Albert Einstein, Thomas Jefferson, and Thomas Edison.

RESULT: Adults With ADD Getting Long-Overdue Attention
Psychiatric News | May 17, 2002

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: hereditary hemorrhagic telangiectasia

Your colleague wrote in to draw our attention to a classic tale of medical hypothesis and trial. In the first article below, Oklahoma City cardiologists present the solid biochemical case for treating hereditary hemorrhagic telangiectasia (HHT), which they call “a disorder of unbalanced angiogenesis,” with the vascular endothelial growth factor (VEGF) inhibitor bevacizumab. The results were impressive and sustained. A few months later, in the second article, several other groups report similar success using the same strategy to treat HHT in individual patients. The treatment is expensive, of course. Are clinical trials next? (Our search shows none yet in planning.)

RESULT: Bevacizumab in Hereditary Hemorrhagic Telangiectasia
New England Journal of Medicine | May 14, 2009

RESULT: More on Bevacizumab in Hereditary Hemorrhagic Telangiectasia
New England Journal of Medicine | Aug 27, 2009

Search: therapeutic diet

This search turned up, among many other interesting results, an article about a consensus report that weighs against trying special diets to treat autism spectrum disorders. But further down the same search page, you’ll find studies on diet and cardiovascular disease, diet and prostate cancer, and diet and kidney disease.

RESULT: Evidence Lacking for Special Diets in Treating ASDs
MedPage Today | Jan 4, 2010

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SEARCH TIP: Get one thing perfectly clear

If the person who typed the query above is doing a research paper about everything known about using diet to treat disease, this was probably a good search.

Otherwise, it’s a good example of a nonspecific search. Adding the condition of interest to the search term would render a much more targeted list of results.

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