What’s happening to Medical Search Tips?

It’s great to see how many people have enjoyed reading Medical Search Tips. I’m sorry that I’ve missed a few days of posting here on WordPress. The blog has been busy growing and moving.

Medical Search Tips is expanding to become SearchMedica Insights — now updated daily, with a new look and a more in-depth search into the featured search term.

Meanwhile, the blog has relocated to SearchMedica Direct, where we are building customized searches on a growing list of chronic disease topics.

Reader comments will be posted automatically there, and you’ll also find an archive of earlier articles based on SearchMedica searches.

Your RSS feed will be redirected automatically to SearchMedica Insights. Meanwhile, please follow the link and come on over to see what you’ve missed so far this week.

As ever, we’re very grateful for your interest in what’s happening at SearchMedica.

Yours truly,

Lois Wingerson
Content Manager, SearchMedica

PTSD is different for women: Why and when?

FEATURED SEARCH: ptsd

In general women are more likely to develop PTSD than men after major trauma; this has been known for a long time. The reasons why involve a more nuanced set of questions, which a team of researchers in Denmark have been pursuing for several years.

In a careful analysis of numerous studies, taking life stages and age into account, they include midlife crisis for men and menopause for women as some of the factors that may aggravate response to trauma. (They also find an up-tick in PTSD risk among very aged women. Unlike the last major study on the question, their analysis extends the age range into the 70s and 80s.) A quick look at Figure 1 in this document tells the story at a glance.

In a separate study, they found that among people who developed PTSD after an explosion in their neighborhood, women were more likely to experience anxiety and a sense of isolation, but less likely to be troubled by a sense of danger, than were men.

RESULT: The combined effect of gender and age on post traumatic stress disorder: do men and women show differences in the lifespan distribution of the disorder?
Archives of General Psychiatry | Aug 3, 2010

RESULT: Risk factors for posttraumatic stress disorder following an industrial disaster in a residential area: A note on the origin of observed gender differences
Gender Medicine (PubMed) | Apr 1, 2010

What makes some women more vulnerable to PTSD than others? Investigators with the large-scale Nurses Health Study have begun looking to the genes for an explanation.

RESULT: Protocol for investigating genetic determinants of posttraumatic stress disorder in women from the Nurses Health Study II
BMC Psychiatry | May 29, 2009

Can women who have borderline personality disorder (BPD) in response to early trauma also have PTSD? If so, how do the two interact? A pioneer of BPD research, psychologist Marsha Linehan, contends that the two conditions are distinct; PTSD further roils the emotional dysregulation that is characteristic of BPD, increasing the frequency of nonsuicidal self-injury that such women use to blunt their emotional state.

RESULT: Impact of Co-Occurring Posttraumatic Stress Disorder on Suicidal Women With Borderline Personality Disorder
American Journal of Psychiatry | Sep 1, 2010

Childhood cancer and pain: Answers to questions not asked

FEATURED SEARCH: pain end of life pediatric oncology

This search finds nothing new or definitive about end-stage pain relief in pediatric oncology, sad to say. There have been no new guidelines about pediatric cancer pain for the past five years. During that period the only research reports on the topic are case studies of using ketamine or fentanyl when opioids fail. But what of the other kinds of pediatric cancer pain: The deeper pain of a future that is death, and that of the professionals responsible for seeing it through?

An essay in AMA’s Virtual Mentor provides concrete guidance for these larger issues, in the story of a medical student caught between a rock (the parents who fear telling the truth to their teenage son) and a hard place (the son who wants no more treatment). The writer is pediatric palliative care specialist Sarah Fiebert, MD, coauthor of a study on palliative care in pediatric oncology published two years ago. It found that barely half of Children’s Oncology Group centers had palliative care facilities. Several studies since then have examined the barriers to and educational needs for pediatric palliative care (some of which appear in the special issue of Virtual Mentor that includes Fiebert’s essay.)

RESULT: Nondisclosure and Emerging Autonomy in a Terminally Ill Teenager
Virtual Mentor | Jul 11, 2010

RESULT: Availability and Use of Palliative Care and End-of-Life Services for Pediatric Oncology Patients
Journal of Clinical Oncology | Oct 1, 2008

This month, researchers in Ottawa report on their experience with a new program for children with terminal illness. One-fifth had cancer. Referrals have increased over time, and a substantial proportion of children left the program alive—to die at home or in a hospice.

RESULT: A paediatric palliative care program in development: trends in referral and location of death
Archives of Disease in Childhood | Jul 15, 2010

Perhaps the hardest part in pediatric brain cancer is not the pain, observe the unflinching authors of a survey that approached parents whose children had died of brain cancer and interviewed them in detail. It’s the gradual loss of capacities, which makes the child sad. Many parents wanted their child to die at home in a familiar room, but often the support network was not available. (Who should have the duty to provide that? Is it even feasible, in this environment?)

RESULT: Palliative care of children with brain tumors: A parental perspective
Archives of Pediatrics and Adolescent Medicine | Mar 1, 2010

Often the children themselves help parents and professionals with the psychic pain, says the report of their survey. But caregivers can also help each other. Full text of this study in Supportive Oncology is available, showing that a program of writing and sharing can help pediatric oncologists to endure that pain for which they have volunteered.

RESULT: Interprofessional Training to Promote Empathy, Build Teams, and Prevent Burnout
Supportive Oncology | Sep 10, 2008

Why CA-MRSA turns out not to be so scary after all

FEATURED SEARCH: cellulitis

Another public health scare succumbs to reasoned medical investigation.

Reports within the past few months confirm that, although it may be classed as an epidemic, community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is coming under control. Observing that antibiotic treatment for diffuse, non-culturable cellulitis had become “broad-spectrum and haphazard,” doctors at a UCLA-affiliated county hospital began a prospective investigation in late 2004 using serology to determine the cause of these infections.

Three of four traced to beta-hemolytic streptococci as usual, they found, and 96% succumbed to beta-lactam antibiotics. Their report offers a cost-effective algorithm for the management of uncomplicated soft-tissue infections. (There are no guidelines for cellulitis treatment, and a recent review by the Cochrane Collaboration says most recommendations so far are based on single trials like this one.)

RESULT:  The role of beta-hemolytic streptococci in causing diffuse, nonculturable cellulitis: a prospective investigation
Medicine (PubMed) | Jul 1, 2010

RESULT: Interventions for cellulitis and erysipelas
Cochrane Reviews (PubMed) | May 4, 2010

The NIH is testing various antibiotic regimens for MRSA in two trials, one of which focuses on skin and soft tissue infections (SSTIs) and CA-MRSA. Recruiting in Los Angeles and Chicago, it is testing clindamycin or trimethoprim-sulfamethoxazole against placebo. Results aren’t due until 2012.

RESULT: Strategies Using Off-Patent Antibiotics for Methicillin Resistant S. Aureus “STOP MRSA”
ClinicalTrials.gov | Jun 24, 2010

RESULT: Uncomplicated Skin and Soft Tissue Infections Caused by Community-Associated Methicillin-Resistant Staphylococcus Aureus
ClinicalTrials.gov | Jul 22, 2010

In a clinical review, a Boston University Medical Center pediatrician reports that do far the choice of antibiotic doesn’t seem to have much effect on the outcome of CA-MRSA cellulitis, and recommends looking to the profile of antibiotic susceptibility in your own community. In the case of abscesses, she finds, the choice of antibiotic therapy is irrelevant. What matters is the adequacy of drainage.

RESULT: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections
Current Opinion in Pediatrics (PubMed) | Jun 1, 2010

As for halting CA-MRSA at the point of entry, a different set of UCLA researchers offers some puzzling information. Their prospective survey of body sites involved in SSTIs shows that the resistant organism is less likely than susceptible S. aureus to enter by the nose. When the CA-MRSA infection does lead to pneumonia, Northwestern University doctors report in a prospective study, it does not necessarily begin with influenza. Their findings are less ominous than some previous studies: The only patients in their series who died from the infection were immunocompromised, and most patients did not need to enter the ICU.

RESULT: Body-site colonization in patients with community-associated methicillin-resistant Staphylococcus aureus and other types of S. aureus skin infections
Clinical Microbiology and Infection (PubMed) | May 1, 2010

RESULT: Expanded clinical presentation of community-acquired methicillin-resistant Staphylococcus aureus pneumonia

Chest (PubMed) | Jul 1, 2010

Central pressure: Important new risk factor. No consensus on how to assess it.

FEATURED SEARCH: central pressure

A proposal that central pressure can be deduced rather than measured directly has provoked an intense response in the Journal of the American College of Cardiology. This bespeak the new focus in cardiology on the importance of central hemodynamics in assessment of cardiovascular risk, and debate about the best way to assess it noninvasively. The pair of articles that follow are a two-part tutorial that gives the basics about noninvasive measurement of central blood pressure, with a focus on concepts, not on calculations. Tonometry appears to be the preferred method for now, according to a review from the Mayo Clinic, but a newer method is claimed to be preferable.

RESULT: Pulse Pressure Amplification as a Predictor of Cardiovascular Risk
Journal of the American College of Cardiology | Aug 24, 2010

RESULT: Noninvasive Evaluation of Left Ventricular Afterload. Part 1: Pressure and Flow Measurements and Basic Principles of Wave Conduction and Reflection
Hypertension | Aug 23, 2010

RESULT: Noninvasive Evaluation of Left Ventricular Afterload. Part 2: Arterial Pressure Flow and Pressure-Volume Relations in Humans
Hypertension | Aug 23, 2010

RESULT: Noninvasive Measurement of Central Vascular Pressures With Arterial Tonometry: Clinical Revival of the Pulse Pressure Waveform?
Mayo Clinic Proceedings |  May 11, 2010

RESULT: A new oscillometric method for pulse wave analysis: comparison with a common tonometric method
Journal of Human Hypertension | Jun 21, 2010

RESULT: Central blood pressure estimation for the masses moves a step closer
Journal of Human Hypertension | Jun 17, 2010

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: malpractice

The University of Michigan Medical Center has tried apologizing quickly for its mistakes rather than waiting to be sued, with interesting results.

RESULT: Patient Compensation Without Litigation: A Promising Development
Annals of Internal Medicine | Aug 17, 2010

Search: healthy ageing

You probably won’t be surprised to learn that studies including direct measures of exercise capacity find wide variations among people of similar age. All studies in which ageing is a factor should include objective measures of physical function as well as lifespan at the time of the study, say the authors of this meta-analysis.

RESULT: Exercise, physiological function, and the selection of participants for aging research
The Journals of Gerontology, Series A | Aug 1, 2010

FDA risk-reporting program for drugs: Time for a rethink?

FEATURED SEARCH: REMS

The day will not be long in coming when pharmaceutical manufacturers no longer retain complete control of the FDA-mandated Risk Evaluation and Mitigation Strategy (REMS), predicts an article in Cancer Network, based on an FDA hearing that involved other stakeholders. The REMS program for erythropoiesis-stimulating agents, in place since March, is the subject of many complaints from oncologists, who say their concerns have not been taken into account.

RESULT: Outside stakeholders seek more input on REMS
Cancer Network | Aug 3, 2010

RESULT: REMS for ESAs: The FDA-mandated program is under scrutiny
HemOnc Today | Jul 10, 2010

An FDA advisory panel roundly rejected a plan to use REMS to try to stem abuse of opiate painkillers. For one thing, they said, pharmas should not be advising you on how to prescribe these drugs. For another, it said, the proposal wasn’t tough enough for the problem.

RESULT: FDA Panel Wants Tougher Restrictions on Opioids
MedPage Today | Jul 23, 2010

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SEARCH TIP: NCI Drug Dictionary

Whoever searched for cancer drug information using the query “NCI drug dictionary” didn’t find any results last week, unfortunately.

We had not noticed the dictionary. It’s on the SearchMedica database now, and results should be complete shortly.

However, much of the same information is already available by simply searching on the drug name.

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: recurrent prostate cancer quality of life

Whoever entered this search term might have concluded that there aren’t many recent studies of prostate cancer that directly assess quality of life. In the top result at the time of writing, the term “quality of life” appeared only in a citation to a 2001 study. However, there has actually been fairly intensive attention to the after-effects of brachytherapy. A Harvard study published last year contained guidance on optimizing the use of brachytherapy with regard to its impact on quality of life. Substituting “patient-reported outcomes” for “quality of life” produced the second study below.

RESULT: Patient-reported quality of life after salvage brachytherapy for radio-recurrent prostate cancer: A prospective Phase II study
Brachytherapy (PubMed) | Oct 1, 2009

RESULT: Long-term patient-reported outcomes of alternative prostate brachytherapy techniques: Five-year outcomes of a prospective multi-institutional study
ASCO 2010 Genitourinary Cancers Symposium Abstracts | Mar 3, 2010

Search: immunoconjugate review

This review describes new opportunities in nuclear medicine, particularly focusing on multidisciplinary collaboration, using breast cancer imaging as an example.

RESULT:  A Bridge Not Too Far: Linking Disciplines Through Molecular Imaging Probes
Journal of Nuclear Medicine | Aug 1, 2010

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SEARCH TIP: Radiology channel

The search above appeared not in Hematology/Oncology but in the All of Medicine channel. The Radiology channel is targeted to resources about imaging. It’s best to look there as well as in Hematology/Oncology if your query is relevant to radiation oncology.

Why some kids with ADHD grow defiant

FEATURED SEARCH: ADHD

Children with ADHD may become oppositional in response to parents whose behavior is cold and hostile. This might not be news to you, except that researchers have now linked it to cortisol levels in a controlled study involving ADHD and non-ADHD children and their parents. They found that cortisol responses matched the oppositional behavior in every subject who had ADHD. (Why that parental style doesn’t trigger the cortisol response in non-ADHD kids is a question for another study.)

RESULT: Does the cortisol response to stress mediate the link between expressed emotion and oppositional behavior in Attention-Deficit/Hyperactivity-Disorder (ADHD)?
Behavioral and Brain Function | Aug 6, 2010

Yet another score for cognitive behavior therapy (CBT): A randomized study shows that adults with ADHD who are already on medication benefit further if CBT is added to the regimen.

RESULT: Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms
JAMA | August 25, 2010

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: consciousness

“I can never be much nearer parting company with my readers forever than I was then,” wrote Charles Dickens about a railway accident that left his carriage dangling over a viaduct. Afterwards, he experienced symptoms that would be recognized today as PTSD. In this essay, a humanities scholar examines trauma in the history of literature and muses about the effects of culture on changing attitudes in society and psychiatry toward personal responses to traumatic experience.

RESULT: Psychological trauma Victorian style: from perpetrators to victims
Lancet | Aug 6, 2010

Search: sensory integration disorders

Children with autism disorders are confused by shadows, apparently, which would interfere considerably with their ability to understand what they’re seeing.

RESULT: Perception of shadows in children with autism spectrum disorders
PLoS One | May 11, 2010

Ambulatory surgical centers under scrutiny for high volume, infection risk

FEATURED SEARCH: ambulatory surgery comorbidities death

Recent studies based on claims from Idaho and Florida find that the likelihood of having surgery is considerably increased if your surgeon has a financial interest in the ambulatory center offering the surgery. The third article, from an orthopedics society website, heralds the growth of ambulatory joint replacement.

RESULT: Effect of Physician Ownership of Specialty Hospitals and Ambulatory Surgery Centers on Frequency of Use of Outpatient Orthopedic Surgery
Archives of Surgery | Aug 1, 2010

RESULT: Physician-Ownership Of Ambulatory Surgery Centers Linked To Higher Volume Of Surgeries
Health Affairs | Apr 1, 2010

RESULT: The 23-hour total joint
AAOS Now | Aug 11, 2010

That doesn’t directly answer the question in the search term, because neither study addressed adverse events. But a government survey of ambulatory surgical centers found that two-thirds of ambulatory surgical centers had lapses in standard infection control procedures.

RESULT: Infection Control Assessment of Ambulatory Surgical Centers
JAMA | Jun 9, 2010

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SEARCH TIP: Now on SearchMedica Direct: Reflux Disorders

A new chronic disease category has been added to SearchMedica Direct.

Now, you can find the latest information on reflux disorders in one location, updated regularly and sorted by article category: research studies, evidence-based medicine, patient information, and more.

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: CRPS

People who have complex regional pain syndrome process pain signals (and therefore painkillers) differently than others, according to a brain imaging study. This insight could lead to better treatment for this baffling chronic pain problem.

RESULT:  Central opioidergic neurotransmission in complex regional pain syndrome
Neurology | Jul 13, 2010

Search: postpartum anxiety

Is an over-anxious young mother more likely to raise an overweight child? Analyzing more than 21,000 mother-child pairs in a Danish database, researchers assessed whether alterations in the hypothalamic-pituitary-adrenal axis caused by maternal stress can affect a child’s later weight through breastfeeding or other means.

RESULT: Maternal Postpartum Distress and Childhood Overweight
PlosOne | Jun 30, 2010

Engage brain when treating bowel disorders

FEATURED SEARCH: inflammatory bowel disease

Why do some patients continue to suffer symptoms when by all objective indications their inflammatory bowel disease is resolved? Gastroenterologist Douglas Drossman responds to evidence that a fecal biomarker is increased in these baffling patients by explaining how a vicious cycle of defective signaling between the gut and the brain can lead to longstanding digestive distress. At the same time he challenges the accepted diagnostic distinctions between two disorders of the bowel.

RESULT: Inflammatory Bowel Disease, Irritable Bowel Syndrome, or What?: A Challenge to the Functional–Organic Dichotomy
American Journal of Gastroenterology | Aug 1, 2010

A meta-analysis finds the fecal biomarker mentioned above, calprotectin, proves promising as a way to identify symptomatic patients most likely to need endoscopy, particularly those who are adults. In the second article, French gastroenterologists report a way to detect inflammation in ulcerative colitis or Crohn’s disease using a form of MRI that does not require bowel preparation.

RESULT: Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis
British Medical Journal | Jul 16, 2010

RESULT: Diffusion-weighted magnetic resonance without bowel preparation for detecting colonic inflammation in inflammatory bowel disease
Gut | Aug 1, 2010

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: intestinal fistula

Debate rages about whether prosthetic plugs are an appropriate intervention for a patient with an anal fistula. Case series reports from three unrelated medical centers express satisfaction with outcomes. But a review from the Cleveland Clinic finds that they have a lower success rate than often reported, with a risk of failure due to infection.

RESULT: Anal fistula plug is a valid alternative option for the treatment of complex anal fistula in the long term
International Journal of Colorectal Disease | Jun 17, 2010

RESULT: Long-term outcomes with the use of bioprosthetic plugs for the management of complex anal fistulas
Diseases of the Colon and Rectum (PubMed) | May 1, 2010

RESULT: Outcomes of anal fistula surgery in patients with inflammatory bowel disease
American Journal of Surgery (PubMed) | May 1, 2010

RESULT: A retrospective review of chronic anal fistulae treated by anal fistulae plug
Colorectal Disease (PubMed) | May 1, 2010

Search: elastography

Combined with sonography, a new imaging method that responds to the stiffness (or elasticity) of body structures improves the detection and assesses the severity of appendicitis.

RESULT:  Real-time Elastography in Acute Appendicitis
Journal of Ultrasound Medicine | Jun 1, 2010

Merging pathology with genetics creates new view of lung cancer subtype

FEATURED SEARCH: lung cancer

Just looking at lung adenocarcinoma cells is no longer good enough to define them, say the authors of the article below; it’s time to integrate the pathology with knowledge from molecular biology about how they work. In a tour de force of clinical analysis, collaborating researchers from top cancer centers in the US, France, and Japan achieve statistical power by re-assessing over 400 lung adenocarcinoma tissue samples according to gene expression, pathological subtype, and clinical information including survival. The result is a proposed new set of subtypes corresponding to known molecular pathways in the oncogenic process, providing new insights for treatment. (The journal PLoS One, from the open-access Public Library of Science, specializes in publishing this kind of cross-disciplinary research.)

RESULT: Clinically Relevant Characterization of Lung Adenocarcinoma Subtypes Based on Cellular Pathways: An International Validation Study
PLoS One | Jul 22, 2010

This search also turns up a dispute between researchers from Mayo Clinic, MD Anderson, and Harvard School of Public Health and from the deCODE Icelandic gene repository about whether a certain single nucleotide polymorphism (SNP) predicts lung cancer risk in people who never smoked. A UK team has observed a relationship of the same SNP with multiple sclerosis, in which lung cancer risk is reduced, and hint at future studies.

RESULT: GPC5 rs2352028 variant and risk of lung cancer in never smokers
Lancet Oncology | 2 Aug 2010

RESULT: GPC5 and lung cancer in multiple sclerosis
Lancet Oncology | 2 Aug 2010

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OTHER RECENT SEARCHES ON SEARCHMEDICA

Search: ovarian cancer

This report defines the gene expression patterns among BRCA-positive ovarian cancer patients that predict their response to platinum- and PARP-based chemotherapy. (Other results in a search on the term “BRCAness” find studies that link this genetic type with the risk of metastasis in ovarian cancer.)

RESULT:  Gene Expression Profile of BRCAness That Correlates With Responsiveness to Chemotherapy and With Outcome in Patients With Epithelial Ovarian Cancer
Journal of Clinical Oncology | Aug 1, 2010

Search: opioid constipation pain

A study from the UK reckons the disproportionate number of staff hours and pounds (or dollars) spent on dealing with the bowel-related adverse effects of opioid painkillers among a very small fraction of palliative care patients. Respond quickly and effectively to constipation, the authors suggest, and save yourself a great deal of trouble.

RESULT: How much does it cost a specialist palliative care unit to manage constipation in patients receiving opioid therapy?
Journal of Pain and Symptom Management (PubMed) | Apr 1, 2010