A retrospective study shows that negative results on PET-CT within 8 weeks after chemoradiotherapy justify a decision not to operate on patients who presented with advanced squamous cell carcinoma of the head and neck. A separate study by different researchers finds that this is also the most cost-effective strategy.

RESULT: Early Prediction of Response to Chemoradiotherapy for Head and Neck Cancer
Archives of Otolaryngology—Head and Neck Surgery | Nov 1, 2009

RESULT: Cost-effectiveness of CT and PET-CT for determining the need for adjuvant neck dissection in locally advanced head and neck cancer
Annals of Oncology | Oct 14, 2009

Search: PET/CT

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SEARCH TIP: Tabs

The searches above use the All of Medicine tab, rather than Cancer/Hemic. The first article above did not appear in the latter tab.

The journal content in Cancer/Hemic is limited to cancer specialty journals and to the major multispecialty journals such as JAMA. If you’re looking for information about a specialty other than oncology (such as otolaryngology), it’s prudent to try the All of Medicine tab.

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: cord blood stem cells

RESULT: Are 2 cords better than 1?
Blood | Nov 5, 2009

Using cord blood that is only partially HLA-matched for myeloablative transplantation in leukemia? To avoid the risk of relapse it’s better to use two units than one. Graft-versus-host disease was not more common among patients who received two units, according to this study from the University of Minnesota.

Search: neuroendocrine

RESULT: Phase III Data Show Octreotide Reduced Risk of Disease Progression by 66% in Advanced Neuroendocrine Tumor Patients
Oncology | Nov 15, 2009

A feedback message alerted us to this recent news report of a study showing the drug octreotide effective against the diarrhea and flushing associated with advanced carcinoid tumors. Its use has already been incorporated into National Comprehensive Cancer Network guidelines.

RESULT: All – Cancer Network
Oncology | Nov 13, 2009

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SEARCH TIP: Finding the articles directory on Cancer Network

There’s a quicker way to find this same directory of articles, right on the Cancer Network home page. Scroll to the bottom of that page and click on the words “All Content.”

Quebec doctors report the rapid emergence of H1N1 resistance to oseltamivir in a father who was given the drug in a failed attempt to prevent him from catching the pandemic flu from his infected child. They urge that prophylactic doses be raised to therapeutic levels as soon as symptoms develop. Monitoring for the mutation that causes this resistance (in avian and seasonal as well as pandemic H1N1) is also crucial.

RESULT: Emergence of Oseltamivir-Resistant Pandemic H1N1 Virus during Prophylaxis
New England Journal of Medicine | Nov 11, 2009

The CDC quickly posted online ahead of print this report of naturally arising resistance due to a different mutation found in an American teenager who took a flight to Hong Kong, arrived ill with the pandemic flu, and refused treatment with oseltamivir. H1N1 viruses with this mutation appear to replicate rapidly, and there is “great concern” that resistant strains may become dominant.

RESULT: Oseltamivir-Resistant Influenza A Pandemic (H1N1) 2009 Virus, Hong Kong, China
Emerging Infectious Diseases | Oct 20, 2009

Search: tamiflu

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: hypertension

RESULT: Cardiovascular and Metabolic Predictors of Progression of Prehypertension Into Hypertension: The Strong Heart Study
Hypertension | Nov 1, 2009

A prospective study of Native Americans in Arizona, North and South Dakota, and Oklahoma has shown that in addition to diabetes and initial systolic blood pressure, increased left ventricular (LV) mass is a strong predictor of progression from prehypertension to hypertension. There’s a chicken-and-egg question, however: Is the higher LV mass merely an earlier indicator of the underlying problem—as yet undetected by the blood pressure measurement—or an actual risk factor for hypertension?

RESULT: Newly Reported Hypertension After Military Combat Deployment in a Large Population-Based Study
Hypertension | Nov 1, 2009

For military personnel, deployment to Iraq or Afghanistan appears to be a stress-related risk factor for the development of new hypertension.

Search: lower respiratory tract infection

RESULT: Risk Factors for Lower Respiratory Tract Infection Death Among Infants in the United States, 1999-2004
Pediatrics | Oct 1, 2009

Among infants with a normal birth weight, those born to Native American/Alaskan or black mothers are at increased risk for lower respiratory tract infection. The unanswered question is why.

Search: headache

RESULT: Prevalence of Depression Symptoms in Outpatients with a Complaint of Headache
Journal of the American Board of Family Medicine | Nov 1, 2009

About one-third of patients who appear at a primary care office complaining of headache also have depression, according to this study, compared to only 10% of those who come in for another reason. The authors suggest screening all people who have chronic headaches for depression.

RESULT: Health Care Assistants in Primary Care Depression Management: Role Perception, Burdening Factors, and Disease Conception
Annals of Family Medicine Medicine | Nov 1, 2009

Follow-up by health care assistants using structured telephone interviews proved actually better than usual care for depression, according to this study of primary care practices in Germany. The staff found this an additional burden but preferred it to administrative tasks and were willing to undertake it.

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SEARCH TIP: That other option: The entire Web

Someone wrote in to thank us for a useful result about headache found using the option “The entire Web” (rather than “Recommended medical sites,” which is the default).

RESULT: Headache: Hope Through Research
National Institute of Neurological Diseases and Stroke

The gratitude is misplaced. This page for a general audience, including descriptions of research, does not appear among our sites recommended for a physician audience.

This option is useful for searching the general news. But SearchMedica’s Advisory Board has not approved its content and it cannot be recommended as a source of medical information.

Adolescent girls who have borderline personality disorder (BPD) pay more attention to negative facial expressions when they’re in a bad mood, according to this study from Germany. Mood-dependent therapy focusing on attentional issues might well be studied in addition to other interventions for BPD, the authors suggest.

RESULT: Attentional Bias in Later Stages of Emotional Information Processing in Female Adolescents with Borderline Personality Disorder
Psychopathology | Nov 6, 2009

Search: personality disorder

Results of a 134-patient trial showing that mentalization-based treatment (MBT) has superior results for outcomes such as self-harm when compared with the structured therapy for BPD recommended by the UK’s National Institute for Clinical Excellence. MBT requires less training for clinicians, according to the authors of this study, and is easier to implement in an outpatient setting.

RESULT: Randomized Controlled Trial of Outpatient Mentalization-Based Treatment Versus Structured Clinical Management for Borderline Personality Disorder
American Journal of Psychiatry | Oct 15, 2009

Search: borderline personality disorder

This new single-blind trial from the University of Toronto suggests that psychiatrists with expertise in BPD can achieve results just as good as those from therapists trained in dialectical behavior therapy, which has been shown to be effective in previous trials.

RESULT: A Randomized Trial of Dialectical Behavior Therapy Versus General Psychiatric Management for Borderline Personality Disorder
American Journal of Psychiatry | Sep 15, 2009

Search: dialectical behavior therapy

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SEARCH TIP: Related concepts

All three of these related searches, using different terms, occurred on the same day last week.

To be sure you’ve caught everything new on a topic in question, it makes sense to do separate searches using related terms from articles relevant to your topic.

It may also help to look at the list of Related Concepts in the left column.

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: Tourette’s syndrome

RESULT: Thalamic deep brain stimulation for treatment-refractory Tourette syndrome: Two-year outcome
Neurology | Oct 27, 2009

A prospective multicenter study from Italy and the UK shows that deep-brain stimulation significantly reduces obsessive-compulsive, anxiety, and depressive symptoms among patients with intractable Tourette syndrome. Also, there was a marked reduction in the severity of tics and (perhaps not surprisingly) quality of life improved.

Search: bipolar disorder and crime

RESULT: A Psychiatrist’s Worst Nightmare? Psychiatrist Stabbing Raises Concerns
Psychiatric Times | Nov 2, 2009

A stabbing by a patient at Massachusetts General Hospital’s bipolar clinic late last month renews concern about the growing problem of violent attacks on psychiatrists. This article includes resources to help you defend yourself against the risk.

Search: alzheimer dementia

RESULT: JAD Volume 18, Number 2
Journal of Alzheimer’s Disease | Oct 2, 2009

There may be some articles on Alzheimer dementia in the collection of abstracts behind this uninformative link title. Unfortunately, you can’t identify them at a glance.

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SEARCH TIP: Journals that complicate your search

Most major journals (including those below) make it easy for a search engine to locate article abstracts individually. Each abstract appears on a separate Web page, with a convenient link to full text.

But some journals behave differently, complicating searches.

Journal of Alzheimer’s Disease is one of the few journals that includes all abstracts for each new issue on a single Web page. Because all of its abstracts contain several instances of the word “Alzheimer,” new pages from this journal will always rise to the top of the list in any search that includes that word. (Regrettably, the software interprets them as both recent and highly relevant.)

To find relevant articles, you need to click on the link and scroll down looking for articles about dementia, much as you would scan the contents page of a print journal. The only solution to this technical problem would be for SearchMedica to exclude journals with this formatting entirely.

But scroll on, and you’ll see:

RESULT: Association of Muscle Strength With the Risk of Alzheimer Disease and the Rate of Cognitive Decline in Community-Dwelling Older Persons
Archives of Neurology | Nov 1, 2009

RESULT: CSF biomarkers predict rate of cognitive decline in Alzheimer disease
Neurology | Oct 27, 2009

RESULT: Effects of Family History and Apolipoprotein E(varepsilon)4 Status on Cognitive Decline in the Absence of Alzheimer Dementia
Archives of Neurology | Nov 1, 2009

Someone has saved these two search results using SearchMedica’s new saved searches feature. The first confirms that mutations in the glucocerebrosidase gene involved in Gaucher disease are also associated with Parkinson disease. The second reports on a new plant-derived replacement form of the enzyme that is well tolerated and less expensive than a commercial version manufactured in mammalian cell lines.

RESULT: Complete screening for glucocerebrosidase mutations in Parkinson’s disease patients from Portugal
Neurobiology of Aging (PubMed) | Sep 1, 2009

RESULT: A Plant-Derived Recombinant Human Glucocerebrosidase Enzyme—A Preclinical and Phase I Investigation
PLoS One | March 11, 2009

An even more recent multicenter study coordinated by the National Human Genome Research Institute confirms a strong association between this gene and Parkinson disease.

RESULT: Multicenter Analysis of Glucocerebrosidase Mutations in Parkinson’s Disease
New England Journal of Medicine | Oct 22, 2009

Search:  glucocerebrosidase Parkinson’s

Another search, using the name of the manufacturer, reveals that the new drug has already been approved by the FDA to treat Gaucher disease, even though phase 3 trials are still under way. (We see no evidence using the option “The entire Web” of any current efforts to test the drug, velaglucerase, for Parkinson disease.)

RESULT: New Gaucher Drug Goes to Market During Shortage
MedPage Today | Sep 3, 2009

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SEARCH TIP: Searches colleagues have tagged

A box at the top of the left column shows results that other people have been saving on SearchMedica. This allows you for the first time to see for youreself what others have been searching on, without waiting for the next edition of Medical Search Tips.

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: hypertrophic cardiomyopathy

RESULT: Implications of Hypertrophic Cardiomyopathy Transmitted by Sperm Donation
JAMA | Oct 21, 2009

An investigation that identified cardiomyopathy among 9 of 24 children fathered by the same sperm donor has raised new questions about genetic testing that ought to be required among individuals who wish to donate gametes for infertility treatment. It also may have interesting implications for physicians inquiring into the medical histories behind unusual conditions.

Search: alcohol disease

RESULT: Functional genomic and epidemiological studies reveal novel genes regulating cholesterol metabolism
Genome Medicine | Oct 27, 2009

New methods in genetic research are providing a powerful way to explore the heredity of cardiovascular disease as it relates to cholesterol metabolism. (But what on earth does that have to do with this search term?)

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SEARCH TIP: Let’s get one thing perfectly clear

Why do articles about cholesterol turn up with the search term “alcohol disease”? It’s not quite a mystery. Strictly speaking, cholesterol, which possesses a hydroxyl group, is an alcohol. But it certainly should not be turning up as a synonym for “alcohol” in medical searches! We’ve taken steps to correct that.

Setting that aside, this search term is ambiguous in any case.

Does this person want information about alcohol-associated diseases? Using that more specific search term generates a much more relevant list of results.

Perhaps instead, the intent was to find articles about alcoholism as a disease. Putting that phrase inside quotation marks and using it as a query delivers 29 articles pertinent to that topic.

Search: “alcoholism as disease”

A chilling sequence of searches last week inquired into research to prevent deaths during seclusion and restraint. (The first query was actually “deaths during restraint,” but we modified that to “restraint death” for better results.) The newest study, from the University of Miami, reports a “reliable forensic tool for identifying the excited delirium syndrome at autopsy.”

RESULT: Brain biomarkers for identifying excited delirium as a cause of sudden death
Forensic Science International (PubMed) | Sep 10, 2009

The following result, from another forensic journal, reports that psychiatric patients may also die of thromboembolism while physically restrained for long periods. The deceased in this small study had no history of thrombotic risk factors; all had been restrained for several days.

RESULT: Fatal thromboembolic disease: a risk in physically restrained psychiatric patients
Journal of Forensic and Legal Medicine | Jul 1, 2009

Search: restraint death

There were also several searches related to reducing the risk of death during restraint. The query “pulse oximetry during restraint” showed that during the past  two years, despite intense regulatory focus on reducing this risk, there have been no new studies of this simple method that can prevent death. The article below is the most recent result on the subject.

RESULT: Portable Pulse Oximeter Use During Patient Restraint
Psychiatric Times | Oct 1, 2007

Search: pulse oximetry during restraint

There may be brain biomarkers for it, but does “excited delirium” actually exist? A search using that phrase as a search term locates an article that addresses the question, with perspectives from both psychiatrists and police. The lead author of the biomarker study is quoted at length.

RESULT: A knee in the neck of excited delirium
Canadian Medical Association Journal | Mar 11, 2008

Search: excited delirium
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SEARCH TIP: On persistence

Our records show four distinct but related searches in the Mental/Nervous tab this week that include the term “restraint”:

• deaths during restraint
• use of pulse oximetry during restraint
• physical monitoring of a patient during restraint
• reducing risk associated with seclusion and restraint

The results were quite different for each, yielding a rich variety of information on the topic.

Another approach is to use search terms drawn from a phrase in one of the results. Trying the search term “excited delirium,” the topic of the first result above, revealed a diagnostic controversy that adds another perspective to the topic.

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: catatonia

RESULT: The Catatonia Syndrome: Forgotten But Not Gone
Archives of General Psychiatry | Nov 1, 2009

Although it is often masked by other disorders, catatonia is easily recognized and treated, according to the authors of this review. Despite a widespread assumption that it is a form of psychosis, catatonia is not confined to schizophrenia, they write.

Search: verbal and mental abuse

RESULT: Understanding the Dynamics of Abusive Relationships
Psychiatric Times | Sep 1, 1996

Someone sent feedback to commend this 13-year-old review that describes the dynamics of abusive relationships in common language. It draws inferences in part from testimony during the trial of O.J. Simpson.

Search: depression practice parameter adult

RESULT: Practice Parameter for Psychiatric Consultation to Schools
Guidelines.gov | Oct 5, 2009

This 2004 guideline from the American Academy of Child and Adolescent Psychiatry is both misdated and contrary to the search term specification of “adult.” What went wrong, and how can this search be improved?

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SEARCH TIP:  Practice Guidelines

As to the publication date, if you scroll to the bottom of the guideline you’ll see the words “Date Modified 11/9/09” (or perhaps a later date by the time you read this). Unfortunately, that trumps earlier dates on the same page. As a result of this problem, listed publication dates on results from the National Guideline Clearinghouse are often erroneous.

However, it’s easy to eliminate guidelines that mention adults. Use the term “NOT” in the query, which allows you to exclude irrelevant terms.

We found guidelines about depression in adults by restricting the search to the Practice Guidelines article category and using the query depression NOT children NOT adolescents.

It’s imperative to rule out small bowel obstruction before releasing postoperative patients from the hospital. But what are the best actions to take before and during surgery that can prevent ileus afterwards? Besides describing the diagnostic signs of postoperative ileus and gastroparesis, this recent review offers tactics to reduce the likelihood of its occurrence and the time before it resolves—including gum chewing and medications that “coax the gut back to work.”.

RESULT: Current Therapies to Shorten Postoperative Ileus
Cleveland Clinic Journal of Medicine | Oct 19, 2009

A recently completed trial finds a new drug that reduces ileus without interfering with the actions of opioids. Another trial still recruiting will test the effect of chewing gum in decreasing ileus, which has been reported anecdotally but never documented rigorously.

RESULT: Study of Alvimopan for the Management of Opioid-Induced Postoperative Bowel Dysfunction/Postoperative Ileus
ClinicalTrials.gov | Apr 2, 2009

RESULT: Does Chewing Gum After Elective Laparoscopic Colectomy Surgery Decrease Ileus?
ClinicalTrials.gov | Jun 16, 2009

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SEARCH TIP: Clinical Trials article category

This article category (among the links that appear above your list of results) links to the U.S. government’s database of clinical trials.

You can use the Clinical Trials article category (among the links that appear above the first in your list of results) to find studies that are still enrolling patients. But don’t overlook the reports of studies no longer enrolling. They can offer another route to useful clinical information.

In the case of the first of the two studies above, if you scroll down the Internet page you can find a link to the published report of the trial’s outcome.

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: diverticular disease

RESULT: Diarrhea-Predominant Irritable Bowel Syndrome Is Associated With Diverticular Disease: A Population-Based Study
American Journal of Gastroenterology | Oct 27, 2009

People with diverticular disease often have chronic gastrointestinal symptoms, but it’s not clear that the former is causing the latter. A new study involving the population near the Mayo Clinic in Minnesota finds a significant increase in diverticulosis, but not diverticulitis, among patients with irritable bowel syndrome. Next question: What is the physiological link between the two?

Search: colorectal cancer

RESULT: Diagnosis and management of hereditary colorectal cancer syndromes: Lynch syndrome as a model
Canadian Medical Association Journal | Sep 1, 2009

This review (co-authored by Henry T. Lynch himself) offers guidance for primary care physicians on how to recognize, diagnose, and care for patients with hereditary syndromes that increase the risk of colorectal cancers.

RESULT: Human IgG antibody profiles differentiate between symptomatic patients with and without colorectal cancer
Gut | Oct 13, 2009

Among patients with digestive symptoms that warranted colonoscopy, the 18 antigens associated with the presence of cancer showed aberrant results in cellular testing, such as accumulation in cells and levels of cellular expression. What are the implications for diagnosis and treatment?

Search: pseudomembranous enterocolitis

RESULT: Medical Quality: Never Events or Never Never Land?
American Journal of Gastroenterology | Nov 1, 2009

RESULT: Nonantibiotic-associated Pseudomembranous Colitis: A Case Report and Review of the Literature
Advanced Studies in Internal Medicine | Nov 26, 2003

In the first article above (which mentions the condition only in passing but tops the list because it is very recent) Michael Hirsch, MD, wonders what will happen when Medicare decides to stop reimbursing for things that aren’t supposed to happen but sometimes do. Ironically, someone just sent a feedback message to draw your attention to an older article that offers just such an example: pseudomembranous colitis in an elderly woman who had undergone neither surgery nor antibiotic treatment. Her doctors at Drexel University College of Medicine wondered how often this occurs. (Scroll down to see this result.)

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SEARCH TIP: Was this helpful?

Please notice these words in the last line of each result. You can click there (as this person did) to recommend interesting or useful articles.

You can also use this link to report bugs or other problems. We’re grateful to know about errors that need fixing.

Remember that you can also save interesting searches and retrieve them later, using the “Save” link in the same line.

A child psychiatrist from Johns Hopkins argues that the nonspecific term “irritability” should be replaced in DSM-V with a new diagnosis, dysfunctional anger, which will lead to greater precision in understanding mood disorders and other psychiatric conditions. (The PDF of this article appears immediately above the abstract, with the journal name as the clickable result title.)

RESULT: Irritable Mood and the Diagnostic and Statistical Manual of Mental Disorders
Child and Adolescent Psychiatry and Mental Health | Oct 24, 2009

Search: conduct disorder

Call it what you will, irritability in adolescence is a specific predictor of depression and anxiety in early adulthood, according to this prospective study. The authors urge further study to clarify the relationship between the early symptom and the later mood disorder.

RESULT: Adult Outcomes of Youth Irritability: A 20-Year Prospective Community-based Study
American Journal of Psychiatry | Sep1, 2009

Search: irritability

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: schizophreniform disorder

RESULT: A Staging Model Guide to Psychological Interventions in Psychosis
Psychiatric Services | Nov 1, 2009

A paradigm that views the emergence of frank psychosis as part of a continuum should be part of the treatment plan for patients who have early symptoms that probably represent a prodrome, maintain two European psychologists. There’s a place for therapeutic interventions at a stage before the use of medication is justified, they add. (Scroll down to find this result.)

Search:  rape trauma syndrome

RESULT:  Readers React to “Abortion Trauma Syndrome”
Psychiatric Times | Oct 26, 2009

An incidental mention of the search term produces this recent set of letters in response to a controversial report from the APA meeting. Do some women who terminate their pregnancies experience a reaction that is beyond mere regret? Is the suggestion that they do motivated by clinical or political concerns?

Search: in-depth studies

RESULT: Prevalence of genetic muscle disease in northern England: An in-depth analysis of a muscle clinic population
Brain | Nov 1, 2009

This study that has nothing to do with psychiatry and little to do with neurology turns up in a general search because it appears in a neurology journal. It mentions hereditary neuropathy, which apparently accounts for its inclusion there.

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SEARCH TIP: Targeting clinical studies

This search and another this week on the term “double-blind study” are destined to deliver a random mix of topics. Yet again, someone has tried to use the search term to define article categories that are already built into SearchMedica.

The subject of your inquiry should be in the search box, and the choice of tabs and article categories (such as Research/Reviews or Evidence-based Articles) will determine the nature of information you see on that topic.

Although a high body mass index (BMI) seems to predispose to the development of renal carcinoma, obesity apparently prolongs survival as long as the cancer has not metastasized, according to this study from Germany. (To get full text from this PubMed abstract, click on “View MedLine abstract on PubMed.gov” and then on “SpringerLink” in the right column of the next screen. It will cost you $34.)

RESULT: Overweight is associated with improved cancer-specific survival in patients with organ-confined renal cell carcinoma
Journal of Cancer Research and Clinical Oncology (PubMed) | Dec 1, 2009

Looking beyond mere obesity, another study reports that the glycemic index is associated with kidney cancer risk. Clearly insulin is implicated somehow; what’s the connection?

RESULT: Glycemic index, glycemic load and renal cell carcinoma risk
Annals of Oncology | Nov 1, 2009

Search: renal cell carcinoma

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: fallopian tube neoplasms

RESULT: Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: a phase 3, open-label, randomised controlled trial
Lancet | Oct 16, 2009

The Japanese Gynecologic Oncology Group reports a new and better treatment option for women with advanced ovarian cancer. Neutropenia was increased in the dose-dense group, but overall and progression-free survival were both improved compared with those receiving conventional treatment.

Search: TRAM flap reconstruction

RESULT: Abdominal wall following free TRAM or DIEP flap reconstruction: a meta-analysis and critical review
Plastic and Reconstructive Surgery (PubMed) | Sep 1, 2009

There are fewer abdominal skin-area complications after deep inferior epigastric perforator (DIEP) flap surgery for breast reconstruction than after muscle-sparing transverse rectus abdominis myocutaneous (TRAM) flap surgery, according to this systematic review of published studies. But the latter is associated with far less fat necrosis and fewer other complications.

Search: melanoma skin cancer

RESULT: Moderate- to low-risk variant alleles of cutaneous malignancies and nevi: lessons from genome-wide association studies
Genome Medicine | Oct 27, 2009

Look for new genetic tests for melanoma risk that help clarify the relationship between pigment factors (hair color, freckles, moles) and skin cancer risk. A team from Harvard Medical School reviews results from recent genome-wide studies that reveal alleles that confer lower risk levels than the genotypes known to be associated with melanoma risk. These tests may help people with “unfavorable” pigment profiles to understand their individual skin cancer risk—but it will be important not to send the wrong message.

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SEARCH TIP: Synonyms

There was no need for this person to type both “melanoma” and “skin cancer” into the search box.

The lexicon includes a wide range of synonyms and will deliver results for either term.

A review published by the AMA reviews strategies for dealing with the sleep deprivation that is inevitable for many physicians. It gives counsel about strategic napping, light exposure, caffeine, and medication to manage the effects of shift work in health care.

RESULT: Managing the Effects of Shift Work in Medicine
Virtual Mentor | Nov 1, 2009

A trial from Harvard Medical School finds that, like modafinil, the medication armodafinil increases wakefulness for most shift workers, as well as reducing their likelihood of committing errors, having accidents, or falling asleep either intentionally or unintentionally. Side effects are minimal. The authors recommend including it particularly for health care workers in a comprehensive strategy to deal with shift work and sleepiness.

RESULT: Armodafinil for Treatment of Excessive Sleepiness Associated With Shift Work Disorder: A Randomized Controlled Study
Mayo Clinic Proceedings | Nov 1, 2009

Search: sleep deprivation

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SEARCH TIP: The SearchMedica toolbar

Notice that there’s a new black toolbar at the top of your results screen. This is part of the same redesign that has created the ability to save your searches.

The toolbar allows you to take two actions immediately, rather than clicking the “Back” button and returning to the previous list of results. You can save a result while you’re reading it, rather than going back to the list of results and clicking “Save” to the right of the publication date.

In addition, you can enter a different search term and try something else, using the search box on the left side of the black toolbar.

A click box at the upper right allows you to remove the toolbar.

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: soccer

RESULT: Recreational soccer is an effective health-promoting activity for untrained men
British Journal of Sports Medicine | Oct 1, 2009

After 12 weeks of training, men organized into soccer teams showed greater increases in lean body mass and leg bone mass than similar men trained in running, as well as less fat, and greater decreases in low-density lipoprotein cholesterol. One of your colleagues wrote to us to point out this study done in Denmark.

Search: poems syndrome bone

RESULT: Cerebral infarction in POEMS syndrome: Incidence, risk factors, and imaging characteristics
Neurology | Oct 20, 2009

In patients with POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes), the risk of cerebral infarction is 13.4%, and is increased in the presence of plasma cell proliferation in bone marrow and elevated serum platelet count. The Mayo Clinic authors urge aggressive management of stroke risk factors in this scenario.

Search: high or elevated vitamin B12

RESULT: The Prevalence of Vitamin B12 Deficiency in Patients With Type 2 Diabetes: A Cross-Sectional Study
Journal of the American Board of Family Medicine | Oct 8, 2009

You should investigate whether your patients who have type 2 diabetes also have vitamin B12 deficiency. About 22% of type 2 diabetes patients in this study of primary care practices showed metabolically confirmed vitamin B12 deficiency, which was particularly common in those taking metformin.

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SEARCH TIP: Synonyms

There’s no need to type both “high” and “elevated.” SearchMedica’s lexicon automatically includes synonyms.

While we’re discussing this search, notice that one of the top results is about the opposite of the query (vitamin B12 deficiency rather than elevated levels). You can see from the terms in bold that some of the other results mention elevated levels of something else, such as thyroid stimulating hormone.

This is another case where use of quotation marks would confine the search to the intended topic. See what happens with the query “elevated vitamin B12.”

A dense but fascinating report describes a computer-modeling study that analyzed the influence of social learning versus the influence of media coverage of celebrity suicides in creating clusters of suicides. The increase in focus on non-politician celebrities, the spread of reality television, and the globalization of media may be leading to an increase in clusters of copycat suicides, the authors conclude. New media guidelines are in order, they add.

RESULT: The Cultural Dynamics of Copycat Suicide
PLoS One | Sep 30, 2009

Childhood adversity, medical illnesses, impulsivity, aggression, and certain personality disorders are among the factors that increase the risk of completing a suicide attempt, according to this news report of a psychiatric conference in Canada. Among physicians, who are well known to be at high risk of suicide, the most important contributing factors appear to be perfectionism, narcissism, and rugged individualism.

RESULT: More Clues Uncovered in Suicide’s Many Mysteries
Psychiatric News | Oct 2, 2009

Impulsive aggression appears to be the trait that runs in families prone to suicide, according to a new genetic study. But what is the role of environment? And are these two traits that merely coincide or does the former contribute to the latter? This editorial includes, among its citations, a link to full text of the report in question.

RESULT: In Search of Endophenotypes for Suicidal Behavior
American Journal of Psychiatry | Oct 1, 2009

Search: concerns raised about high suicide

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SEARCH TIP: Retrieving a slow-loading document (or one that never loads)

The first result above seemed to take forever to load.

We got around this by clicking the “Cached” adjacent to the publication date, which delivered a version of the text stored previously in SearchMedica’s database. The “cached” option isn’t always available, but this strategy should work for most journal articles.

An article that doesn’t load when you click on the title indicates a problem with the source website. Unfortunately, there’s nothing SearchMedica can do about this.

However, if your list of results loads slowly after you click the Search button (or if you see an error message), that signals a problem on SearchMedica itself.

You can alert us to such a problem by scrolling to the bottom of the screen and clicking “Contact Us.” We’d be very grateful to know about it.

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RECENT SEARCHES ON SEARCHMEDICA

Search: bulimia

RESULT: Increased Mortality in Bulimia Nervosa and Other Eating Disorders
American Journal of Psychiatry | Oct 15, 2009

It has already been established that people with anorexia nervosa have higher mortality rates than the general public. A new study using a large national database establishes a higher mortality risk associated with eating disorder not otherwise specified, and an increased risk of suicide for all eating disorders.

Search: high IQ

RESULT: Executive function impairments in high IQ adults with ADHD
Journal of Attention Disorders (PubMed)| Sep 1, 2009

High-IQ adults with ADHD are significantly likely to show impairments in executive function, according to a special set of measures developed at Yale University School of Medicine. (You can purchase full text of this article for $25 by clicking on “View MedLine abstract on PubMed.gov at the bottom of the screen, and then on the publisher’s link in the right column of the subsequent screen.)

Search: social anxiety Cleveland Clinic

RESULT: Muzina (Recognizing and Treating Social Anxiety Disorder)
Cleveland Clinic Journal of Medicine | June 28, 2001

Unfortunately, the screening questionnaire has been excluded from this 2001 review about diagnosis and treatment of social anxiety disorder. But descriptions of physical symptoms and common fears, a table about differential diagnosis, and medication dosing regimens are present, in addition to the full text. (Find more recent information on the topic by deleting “Cleveland Clinic” from the search term.)

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SEARCH TIP: Multiple versions of the same result

This successful search tactic retrieved a classic article using the topic and the author’s institution as search terms.

The article appears twice, first as the PDF of the full text (identified by the author’s surname) and a few lines farther down as the abstract, which is in HTML.

We human beings know the content is basically the same, but the search engine sees the document name, the format, and the length as different. So both results appear.

Earlier we found a third result that showed just the electronic frame, a bar at the top reading “Cleveland Clinic.” We’ve deleted that one from the results list. If you find such a quirky result, please take a moment to clue us in using the link “Was this helpful?”.