What’s happening to Medical Search of the Day?

September 15, 2010

It’s great to see how many people have enjoyed reading Medical Search of the Day. 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 of the Day is expanding to become SearchMedica Insights — also updated daily, but with a new look and a more in-depth search into the featured topic of the day.

Meanwhile, the search of the day 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

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EHR

September 10, 2010

Only about 2% of US hospitals have been able to meet the rules set by the US government for adoption of electronic health records (EHRs), according to a survey of EHR adoption published in Health Affairs. These are predominantly large academic medical centers.

Rural, public, and smaller hospitals are behind and appear likely to fall even farther behind. Because electronic health records improve the quality of care, the authors say, this gap is likely to aggravate inequities in health care in the United States unless something is done about it.

As for individual medical practices that are having difficulty making the switch to EHRs, an article in Physicians Practice suggests starting with an intermediate step: high-volume scanning. (If you’re into acronyms, it calls this EDMS, for electronic document management system.)

Bereavement

September 9, 2010

How is grief different from depression, and when does it become abnormal? A current debate about grief in Psychiatric Times appears against the backdrop of efforts to revise the Diagnostic and Statistical Manual that defines psychiatric disorders.

Perhaps complicating matters, a comparative study of grief and first-episode depression from Denmark finds that depression after the death of a loved one can’t be distinguished from new-onset depression of other kinds.

Studies of people who have lost loved ones during major disasters or political conflicts are helping to refine the diagnosis of prolonged or complicated grief. Three different studies in recent months have analyzed the difference between prolonged grief and post-traumatic stress disorder, in survivors of conflicts in Croatia, Kosovo, and Rwanda.

Pertussis

September 8, 2010

Whooping cough is back. If the prevalence of pertussis reported in California between January and June continues throughout the year, California will have had the largest annual number of cases since 1958.

An infection that was once deadly to American infants , pertussis is often overlooked these days because it is all but eradicated by a vaccine.

However, the P in the standard DTP childhood vaccine does not wipe out pertussis completely. A study of pertussis  in Europe shows that the vaccine has shifted the prevalence of the disease from infants to adolescents and adults.

Pertussis tends to re-emerge every 3 to 5 years in the United States. Besides a deep, wet cough, the symptoms of pertussis include vomiting after a cough and a characteristic “whoop”. These latter symptoms do not always occur, making the infection sometimes difficult to diagnose.

Fever treatment (ibuprofen OR acetaminophen)

September 7, 2010

Whether it’s better to use medicine to reduce a fever or to let nature take its course remains controversial — especially for children. Some parents are wary of medication side effects while others can’t bear to stand by and do nothing.

A new guidance document on pediatric fever from the Alberta College of Family Physicians, summarized in Canadian Family Physicians, advises doctors to discuss the controversy about treating fever with parents, but to prefer ibuprofen over acetaminophen if they decide to opt for treatment.

To judge from a recent study in Denmark, parents often give their children acetaminophen (which is called paracetamol in Europe) for symptoms that are “vague”. Overdoses are not uncommon.

Randomized trials comparing ibuprofen and acetaminophen have shown that ibuprofen reduces fever more quickly and with no more adverse effects.

Otherwise healthy adults with a fever can make the decision for themselves and buy the medications over the counter. But whether  to reduce fever in critically ill adults is  not yet clear either.  It’s the subject of an ongoing study in Alberta, due for completion next summer.

A recent retrospective study of critically ill adults with fever from the University of Maryland found that acetaminophen (the drug used in the Canadian study) has some effect, but not much.

Complex partial seizures

September 3, 2010

Your patient with epilepsy isn’t sleeping well. Is it nocturnal seizures, or something else? Sleep specialists urge that you investigate the possibility of obstructive sleep apnea, which can do more than ruin sleep when it is triggered by a seizure.

A recent report in Practical Neurology entitled “A Fitful Night’s Sleep” chronicles the history of a 61-year-old woman with lifelong epilepsy whose symptoms suddenly began to worsen in tandem with sleep problems.

Continuous positive airway pressure (CPAP), the night-time appliance used for people with sleep apnea, may improve the situation, according to a review of breathing and seizures in Sleep Review.

It’s important to address the problem, because the sleep apnea can worsen the epilepsy.

Polycythemia

September 2, 2010

Researchers from the United States and Italy report new evidence that the regulatory protein erythropoetin (EPO) may be involved in the maturation of cells that line the walls of blood vessels, not just the maturation of circulating blood cells. This may help to explain why EPO, which has been used as a drug, is associated with an increased risk of blood clots.

The researchers found that an autosomal dominant inherited form of the blood disorder polycythemia is due to a mutation that causes the cell surface receptor for EPO to accumulate on certain immature  immature endothelial cells (those that line the surface of blood vessels and some organs). This apparently causes these precursor cells to accumulate.

The role of EPO in regulating non-blood cells has been a subject of intense debate, because it is  used to treat anemia in cancer patients. The FDA issued a black-box warning for this indication after reports of an increase in potentially fatal blood clots among patients taking EPO for anemia.

Shoulder impingement syndrome

September 1, 2010

Nothing improves on exercise to speed healing of this common cause of shoulder pain — at least as far as we know for now.

A randomized trial of arthroscopic surgery for shoulder impingement syndrome showed that it is more costly than exercise but no more effective.

Corticosteroid injections added to exercise relieve shoulder pain more quickly than exercise alone, but after six months there’s no difference in shoulder function.

A clinical trial comparing personalized physiotherapy with a standard exercise program is now underway. We don’t know yet whether custom treatment will be better than just going by the book.

Behavior change telemedicine

August 31, 2010

Is “distance learning” effective in promoting healthy behaviors? Few answers are in yet, but plenty of people are asking the question in a systematic fashion.

A recent systematic review of telemedicine studies found a small but significant effect of Internet-based efforts on “patient empowerment.” (The report appears in the Journal of Medical Internet Research.)

And a telemedicine program in rural South Carolina brought about lasting improvement in self-management among diabetes patients.

A survey about telehealth by Intel found that most health professionals use remote care in some fashion. But there are issues with reimbursement, according to Medical Economics.

Watch for more to come. According to searches on “behavior change telemedicine” in the Clinical Trials article category on SearchMedica, studies are under way testing telemedicine for smoking cessation, post traumatic stress disorder, chronic pain, hypertension, ADHD, and much more.

Anaphylaxis

August 30, 2010

People who have an allergy to wheat with symptoms induced by exercise may go for 3 to 5 years without a correct diagnosis, according to a retrospective study from England.

Because of the variable time lag between wheat consumption and exercise, it can be difficult to figure out the source of the allergic symptoms.

A definitive diagnosis is based on a food-exercise test, which is difficult to carry out, or a blood test that detects an immune reaction to gliadin, a component of wheat.

The problem is quite rare. In a recent study involving children with food allergies, only 1 of 1255 had an allergy to wheat.

Many patients are told they have “idiopathic anaphylaxis” (meaning a potentially life-threatening allergy to who-knows-what).

Because the “anaphylaxis” is rarely life-threatening in these cases, according to the report in Journal of Clinical Pathology, the term “wheat induced exercise dependent anaphylaxis” may be a misnomer.