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PubMed2005

Optimising antiemetic therapy: what are the problems and how can they be overcome?

BACKGROUND: Management of chemotherapy- or radiotherapy-induced emesis has improved significantly following the introduction of the 5-HT3-receptor antagonists. Prophylactic use of these agents is recommended for the prevention of both chemotherapy- and radiotherapy-induced nausea and vomiting, given with a corticosteroid. Despite these advances, nausea and vomiting remain among the most feared and debilitating adverse effects of cytotoxic therapy. The shift towards a more elderly population of patients with cancer presents additional considerations for supportive care, with an emphasis on achieving control of nausea and vomiting, whilst minimising toxicity and avoiding drug-drug interactions. This review presents some of the key issues for consideration in optimising antiemetic therapy. The PubMed search engine was used to search for relevant literature (up to December 2004) and relevant international congress materials collected during 2003 and 2004. SCOPE: While the early stages of nausea and vomiting are 5-HT-mediated, identification of a role for substance P in late emesis has led to the development of the NK1-receptor antagonist, aprepitant. As a new agent, the clinical profile of aprepitant is still being explored, including its interaction with concomitant medications. Patients who achieve good control of acute and late-acute nausea and vomiting have a reduced risk of experiencing delayed onset symptoms, emphasising the importance of prophylactic management with effective agents. Although the 5-HT3-receptor antagonists are widely considered to have equivalent efficacy, they vary in half-life and the nature of antagonism at receptors. Their metabolic profiles also differ, with cytochrome P450 (CYP) metabolism affecting their propensity for drug-drug interactions. Several sets of guidelines are available that outline recommendations for selection and use of antiemetic therapy. However, under-use of 5-HT3 receptor antagonists has been reported in both the radiotherapy and chemotherapy settings, and some commonly used doses may be suboptimal. CONCLUSION: In optimising antiemetic therapy, wider implementation of guidelines is desirable, as is consideration of each patient's individual needs. Safety and tolerability of supportive care medications should be a key consideration, and cardiovascular warnings and the possibility of drug-drug interactions should be given sufficient consideration, particularly in view of the older age of the population with cancer.

Aged↗

PubMed2005

DSD--an integrated, web-accessible database of Dehydrogenase Enzyme Stereospecificities.

BACKGROUND: Dehydrogenase enzymes belong to the oxidoreductase class and utilise the coenzymes NAD and NADP. Stereo-selectivity is focused on the C4 hydrogen atoms of the nicotinamide ring of NAD(P). Depending upon which hydrogen is transferred at the C4 location, the enzyme is designated as A or B stereospecific. DESCRIPTION: The Dehydrogenase Stereospecificity Database v1.0 (DSD) provides a compilation of enzyme stereochemical data, as sourced from the primary literature, in the form of a web-accessible database. There are two search engines, a menu driven search and a BLAST search. The entries are also linked to several external databases, including the NCBI and the Protein Data Bank, providing wide background information. The database is freely available online at: http://www.jenner.ac.uk/DSD/. CONCLUSION: DSD is a unique compilation available on-line for the first time which provides a key resource for the comparative analysis of reductase hydrogen transfer stereospecificity. As databases increasingly form the backbone of science, largely complete databases such as DSD, are a vital addition.

Computational Biology↗

PubMed2006

Increased morbidity and mortality in acute human organophosphate-poisoned patients treated by oximes: a meta-analysis of clinical trials.

Organophosphates are one of the most common causes of poisoning, especially in the Third world, with high morbidity and mortality. The treatment of this type of poisoning involves the use of atropine and oximes. Atropine has been used successfully in large doses to counteract the muscarinic effects of organophosphate poisoning, but the efficacy of oximes in the management of this poisoning remains under question. In this study, we undertook a meta-analysis by reviewing all clinical trials to evaluate the efficacy of oximes in the management of organophosphate poisoning. The databases of PUBMED, EMBASE, Cochrane, SCOPUS, and the search engine of Google were searched for all clinical trials on the use of oximes in organophosphate poisoning. The inclusion criteria were death, development of intermediate syndrome, and need for ventilation. Six clinical trials met the inclusion criteria and were included in the metaanalysis. The chi2 tests for heterogeneity (P = 0.25, 0.16, and 0.33, respectively) indicated that the included studies were not significantly heterogeneous and could be combined. A significant relative risk (P = 0.0017) for death among oxime-exposed was 2.17 (95% CI of 1.34-3.51). The 'need for ventilation' in patients who received oxime was higher (P = 0.03) than those who did not receive oxime with a relative risk of 1.53 (1.16-2.02). The incidence of 'intermediate syndrome' for oxime-exposed patients was significantly higher (P = 0.01) than oxime non-exposed patients with a relative risk of 1.57 (95% CI 1.11-2.11). It can be concluded that oximes are not effective in the management of organophosphate-poisoned patients and, surprisingly, they can be dangerous and worsen the patient's clinical situation.

Antidotes↗

PubMed2006

A systematic review of telephone-based interventions for mental disorders.

To assess the effectiveness of telephone-based interventions for mental illness, a systematic search of the literature was conducted using the databases PsycINFO and PubMed, and the search engine Google Scholar. The search identified 14 studies evaluating telephone-based interventions in the areas of depression (n = 6), anxiety (n = 3), eating disorders (n = 3), substance use (n = 1) and schizophrenia (n = 1). Although these studies provide evidence that telephone interventions can be effective, the few studies conducted, small sample sizes and lack of randomized controlled trial methodology prevent firm conclusions from being drawn. The articles reviewed suggest that an effective telephone intervention includes clearly structured therapy sessions and homework tasks. However, further evidence using large-scale, randomized controlled trials must be obtained in order to inform government and telephone counselling agencies about the efficacy of telephone interventions.

Anxiety Disorders↗

PubMed2007

A systematic review of randomized controlled trials examining the short-term benefit of ambulatory oxygen in COPD.

AIM: To systematically review the short-term efficacy of ambulatory oxygen from single-assessment studies in COPD. METHODS: Searches for relevant randomized controlled trials using predefined search terms were conducted on the Cochrane Airways Group Specialized Register of RCTs, the Cochrane Central Register of Controlled Trials, and other electronically available journals, databases, and search engines. All databases were searched from their inception until December 2004. Two reviewers (J.B., B.O.) independently assessed eligibility and extracted data. All trial data were combined using RevMan analyses 4.2.8 (Cochrane Collaboration; www.cochrane.org). Due to the crossover design of the studies, data were entered using the generic inverse variance method. Fixed-effect or random-effect models were used depending on the level of statistical heterogeneity observed. RESULTS: Thirty-one studies (33 data sets; 534 participants) met the inclusion criteria of the review. Oxygen improved the primary outcomes relating to endurance and maximal exercise capacity. For the secondary outcomes of breathlessness, arterial oxygen saturation (Sao(2)), and minute ventilation (Ve), comparisons were made at isotime. Oxygen improved breathlessness, Sao(2)/Pao(2), and Ve at isotime with endurance exercise testing. For maximal exercise testing, data were not available in a format suitable for metaanalysis for breathlessness, but the improvement in Sao(2)/Pao(2) and Ve at isotime was significant. CONCLUSION: This review provides evidence from single-assessment studies that ambulatory oxygen improves exercise performance in COPD; however, the clinical importance of this size of improvement is unclear. Prior to widespread prescription of ambulatory oxygen, future research is required to establish the net long-term benefit of ambulatory oxygen in patients with different levels of hypoxemia or exercise-induced desaturation.

Ambulatory Care↗

PubMed2003

Efficacy of chemical root surface modifiers in the treatment of periodontal disease. A systematic review.

BACKGROUND: Periodontal regeneration has been a relentless goal of the periodontist. Perhaps the oldest and most frequently attempted type of regeneration has involved chemical modification of the root surface. Varying results from histological and clinical studies have created controversy about the clinical effectiveness of root surface decalcification. RATIONALE: This systematic review assesses the efficacy of root surface biomodification through the use of citric acid, tetracycline, or ethylenediaminetetraacetic acid (EDTA) in patients with chronic periodontitis. FOCUSED QUESTION: Does the use of chemical root declacification result in effective periodontal regeneration and improved clinical outcomes in patients with chronic periodontitis? SEARCH PROTOCOL: The Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effectiveness; Cochrane Central Register of Controlled Trials; American College of Physicians Journal Club, evidence-based MEDLINE journals; and National Center for Biotechnology Information PubMed Journals, as well as Dogpile, Google, and Copernic search engines were screened. Hand searches were performed on the Journal of Clinical Periodontology, Journal of Periodontology, Journal of Periodontal Research, and Periodontology 2000. Searches were performed for relevant clinical trials published through September 25, 2002. SELECTION CRITERIA INCLUSION CRITERIA: Histological and clinical studies evaluating the effects of citric acid, tetracycline, or EDTA on root surfaces of patients with chronic periodontitis were considered for inclusion. EXCLUSION CRITERIA: Studies evaluating extracellular matrix proteins (e.g., fibronectin), enamel matrix proteins (e.g., amelogenins), or other proteins or growth factors applied to the root surface were not included. DATA COLLECTION AND ANALYSIS: Primary outcome measures included changes in connective tissue attachment, cementogenesis, clinical attachment levels, probing depths, and gingival recession. Secondary outcome measures included changes in bone level, gingival inflammation, and plaque levels. Results for continuous outcome measures for primary variables (clinical attachment levels, probing depths, and recession) were expressed as mean differences or standardized mean differences. Clinical attachment levels and reduction in probing depth were evaluated using meta-analysis. All papers were rated according to methodological strength of evidence. MAIN RESULTS: 1. Thirty-four studies incorporating a total patient population of 575 were analyzed: 26 for citric acid, 5 for tetracycline, and 3 for EDTA treatment. 2. Four of 8 human histological studies reported regeneration with the use of citric acid. Only 1 of 18 clinical studies reported attachment gain. 3. Of the 5 studies examined using tetracycline, 1 histological study and 1 clinical study reported attachment gain. 4. No regeneration was reported in the 3 studies evaluating the use of EDTA. 5. Meta-analysis performed on 28 clinical trials did not show any significant effects of acid root treatment on attachment level gains or probing depth. REVIEWER'S CONCLUSIONS: 1. Evidence to date suggests that the use of citric acid, tetracycline, or EDTA to modify the root surface provides no benefit of clinical significance to regeneration in patients with chronic periodontitis. 2. The best method for ascertaining the clinical efficacy of acid-treated root regeneration would be to conduct a randomized clinical trial with sufficient statistical power that is supported by quantitative histological evaluation. 3. The majority of the studies that evaluated the regenerative potential of root surface modifiers were observational in nature; therefore, the value of conclusions reached in this manuscript must be carefully considered.

Citric Acid↗

PubMed1999

Filtering Web pages for quality indicators: an empirical approach to finding high quality consumer health information on the World Wide Web.

The World Wide Web is an increasingly popular source for consumer health information, but many authors have expressed concerns about the quality of health information present on the Internet. We have developed a prototype system that responds to a consumer health query by returning a list of Web pages that are ranked according to the likely quality of the page contents. A computer program identifies some of the criteria that have been suggested for assessing the quality of health information on the Internet. It also identifies characteristics that may serve as proxies for desirable (or undesirable) qualities that are difficult to assess directly using an algorithm. Intervening in the search process and automatically analyzing the contents of each page returned by a general search engine may facilitate the search for high quality consumer health information on the Web.

Health Education↗

PubMed2003

MMR vaccine information on the Internet World Wide Web.

OBJECTIVES: To review world wide web sites that contain information about the MMR vaccine to determine whether the content is accurate compared to recognized standard sources of information. In today's internet age, patients search for information on the internet where there is no regulation of information quality. METHODS: By using an internet search engine, several combinations of search terms including "MMR vaccine" were used to find relevant web sites. Sites were classified as favoring MMR use, not favoring MMR use, no position on favoring MMR use. Adverse reactions described in the web site were classified as consistent with, or inconsistent with the adverse reactions described by the standard sources. RESULTS: 13% to 40% of web sites favor MMR use depending on the search parameters used. 2.5% to 15% do not favor MMR use. 25% to 63% of the sites took no position on favoring MMR use. 45% to 70% of sites provided "consistent" information on adverse reactions, except for a search using "MMR Vaccine Dangers" which resulted in only 18% of the sites describing "consistent" adverse reaction information. 8% to 38% of sites provided information on adverse reactions which was inconsistent with standard sources, most of which involved information on autism. CONCLUSIONS: Most sites do not take a stand on favoring MMR use. Most sites provide adverse reaction information consistent with the standard sources; however, it is likely that parents and patients will encounter sites that provide adverse reaction information, not consistent with standard sources.

Health Education↗

PubMed2003

Accurate searching using XML and topic maps.

Most clinical data is narrative text and often not accessible and searchable at the clinical workstation. We have therefore developed a search engine that allows indexing, searching and linking different kinds of data using web technologies. Text matching methods fail to represent implicit relationships between data, e.g. the relationship between HIV and AIDS. The ISO topic maps standard provides a data model that allows representing arbitrary relationships between resources. Such relationships form the basis for context sensitive searching and accurate search results. XML standards are used for the interchange of data relationships. Our approach has been applied to medical classification systems and clinical practice guidelines with promising results.

Germany↗

PubMed1997

Creatine and phosphocreatine: a review of their use in exercise and sport.

OBJECTIVE: Creatine and phosphocreatine (PCr) are important compounds in the normal energy metabolism of muscle. Recently, it has been shown that dietary creatine (5 to 20 g/day) can increase muscle creatine and PCr, with enhancement in anaerobic exercise performance after two weeks of administration caused by an increase in anaerobic capacity. DATA SOURCES: MEDLINE was searched from 1983 to 1996 using key word "creatine" along with "humans," "muscle," "exercise," and "transport." Also, APStracts, the American Physiology Society search engine for abstracts, was searched from 1994 to 1996. DATA SYNTHESIS: Creatine is transported into the muscle cell by a specific transporter, resulting in increased intracellular creatine and PCr. The PCr is capable of acting as an energy buffer, protecting the adenosine triphosphate (ATP) concentration. Maintaining muscle nucleotides therefore enhances exercise performance and recovery. There have been reports that PCr protects the cells from ischemic damage and decreases the loss of nucleotides by stabilizing cell membranes. Indeed, intravenous PCr (2-4 g/day) has been administered to cyclists, resulting in a faster recovery time between training sessions. CONCLUSIONS/RECOMMENDATIONS: It is becoming evident that oral creatine supplementation may yield certain benefits to enhance the athlete's performance during maximal anaerobic exercise and interval training.

Journal Article↗

PubMed1996

Ten basic World-Wide Web sites for Florida physicians.

The Internet is a rapidly growing information resource for rapid publication and access to information. While it has attracted a certain mystique and is undoubtedly attractive as an information source, its rapid and chaotic growth mitigates against ease of use for novices. The authors-all associated with health-care providers in the Dade/Broward market-offer the novice user their best assessment for initial Web sites to explore for health care information, and general guidance on using Internet search engines to direct effective searches.

Computer Communication Networks↗

PubMed2000

Benchmarking the clinical orthodontic evidence on Medline.

The purpose of this study was to identify and quantify the availability of orthodontic literature for evidence-based clinical decision-making (ie, sound clinical studies of etiology, diagnosis, treatment, or prognosis meeting basic methodologic criteria for direct clinical use). This is a first step toward developing online decision analysis systems. A search strategy based on Medical Subject Headings (MeSH) for orthodontics was developed to examine MEDLINE using the Ovid Web Gateway search engine. Sensitive and specific methodologic search filters were then employed to identify the 4 categories of information. The results were then subdivided by year to identify trends and sorted to identify source of publications. In the period 1990 to 1998, the MEDLINE searches identified 6938 English-language articles about orthodontics. The mean number of articles (+/-SD) per year ranged from 42+/-25 for specific searches to 314+/-214 for sensitive searches. The number of articles identified by the specific or sensitive searches increased 14% to 21% annually. When subdivided by clinical category, the mean numbers of articles per year for specific and sensitive searches were respectively: etiology 19+/-15 and 91+/-37, diagnosis 11+/-5 and 80+/-35, therapy 3+/-1 and 50+/-23, and prognosis 10+/-7 and 93+/-33. Five dental journals accounted for nearly half of these publications. These results provide several key findings: (1) there is a substantial literature of clinically relevant information in orthodontics upon which to base clinical decisions; (2) the information appears to be balanced between etiology, diagnosis, treatment, and prognosis; (3) approximately 45% of the articles reside in 5 journals, whereas the remainder reside in approximately 66 other journals, making it difficult to stay current; (4) the number of articles is increasing significantly each year; (5) to stay current, one would need to read between 1 and 6 articles per week, 52 weeks per year; (6) these trends suggest the need for computer-based clinical knowledge systems; and (7) the methods used here can be immediately employed to identify the best and most current clinical orthodontic evidence.

Analysis of Variance↗

PubMed2003

Meta-analysis of periodontal disease and risk of coronary heart disease and stroke.

OBJECTIVE: The purpose of this study was to analyze published studies and abstracts in order to provide a quantitative summary of periodontal disease as a risk factor for cardiovascular disease and to explore the possible causes for conflicting results in the literature. STUDY DESIGN: We searched all published literature on the Medline literature search engine since 1980. An additional search was performed with bibliographic citations from each article. Nine cohort studies (8 prospective and 1 retrospective), in which relative risks (RRs), CIs, and P values were reported or could be calculated were included. Four researchers independently extracted RRs, CIs, and P values from each study and evaluated the degree of confounding adjustment. The combined result was calculated with weighted average, and sources of disparity were tested with regression analyses. RESULTS: The summary RR was 1.19 (95% CI, 1.08 1.32), indicating a higher risk of future cardiovascular events in individuals with periodontal disease compared with those without. In an analysis stratified to individuals of </=65 years of age, the RR was 1.44 (95% CI, 1.20 to 1.73). When the outcome was restricted to stroke only, the RR was 2.85 (95% CI, 1.78 to 4.56). In the metaregression analysis, the effects of residual confounding caused an overestimate of the results by 12.9% and, with a proxy for periodontal disease, caused an underestimate of 29.7%. CONCLUSIONS: Periodontal disease appears to be associated with a 19% increase in risk of future cardiovascular disease. This increase in RR is more prominent (44%) in persons aged </=65 years. Although the increment of risk between subjects with or without periodontal disease in the general population is modest, at around 20% because nearly 40% of population has periodontal disease, this modest increase may have a profound public health impact.

Adult↗

PubMed2003

PGAGENE: integrating quantitative gene-specific results from the NHLBI programs for genomic applications.

SUMMARY: PGAGENE is a web-based gene-specific genomic data search engine, which allows users to search over 5.9 million pieces of collective genetic and genomic data from the NHLBI supported Programs for Genomic Applications. This data includes microarray measurements, SNPs, and mutations, and data may be found using symbols, parts of gene names or products, Affymetrix probe IDs, GenBank accession numbers, UniGene IDs, dbSNP IDs, and others. The PGAGENE indexing agent periodically maps all publicly available gene-specific PGA data onto LocusLink using dynamically generated cross-referencing tables.

Base Sequence↗

PubMed2006

Antibiotic use in pregnancy and lactation: what is and is not known about teratogenic and toxic risks.

OBJECTIVE: Over ten million women are either pregnant or lactating in the United States at any time. The risks of medication use for these women are unique. In addition to normal physiologic changes that alter the pharmacokinetics of drugs, there is the concern of possible teratogenic and toxic effects on the developing fetus and newborn. This article reviews the risks and pharmacokinetic considerations for 11 broad-spectrum antibiotics that can be used to treat routine and life-threatening infections during pregnancy and lactation. DATA SOURCES: Information from the U.S. Food and Drug Administration (FDA) product labels, the Teratogen Information Service, REPROTOX, Shepard's Catalog of Teratogenic Agents, Clinical Pharmacology, and the peer-reviewed medical literature was reviewed concerning the use of 11 antibiotics in pregnant and lactating women. The PubMed search engine was used with the search terms "[antibiotic name] and pregnancy," "[antibiotic name] and lactation," and "[antibiotic name] and breastfeeding" from January 1940 to November 2005, as well as standard reference tracing. METHODS OF STUDY SELECTION: One hundred twenty-four references had sufficient information concerning numbers of subjects, methods, and findings to be included. TABULATION, INTEGRATION, AND RESULTS: The teratogenic potential in humans ranged from "none" (penicillin G and VK) to "unlikely" (amoxicillin, chloramphenicol, ciprofloxacin, doxycycline, levofloxacin, and rifampin) to "undetermined" (clindamycin, gentamicin, and vancomycin). Assessments were based on "good data" (penicillin G and VK), "fair data" (amoxicillin, chloramphenicol, ciprofloxacin, doxycycline, levofloxacin, and rifampin), "limited data" (clindamycin and gentamicin), and "very limited data" (vancomycin). Significant pharmacokinetic changes occurred during pregnancy for the penicillins, fluoroquinolones and gentamicin, indicating that dosage adjustments for these drugs may be necessary. With the exception of chloramphenicol, all of these antibiotics are considered compatible with breastfeeding. CONCLUSION: Health care professionals should consider the teratogenic and toxic risk profiles of antibiotics to assist in making prescribing decisions for pregnant and lactating women. These may become especially important if anti-infective countermeasures are required to protect the health, safety, and survival of individuals exposed to pathogenic bacteriologic agents that may occur from bioterrorist acts.

Anti-Bacterial Agents↗

PubMed2006

Criteria and methods used for the assessment of fitness for work: a systematic review.

The main findings from reports published in scientific journals on the criteria and methods used to assess fitness for work were reviewed. Systematic searches were made using internet engine searches (1966-2005) with related keywords. 39 reports were identified, mostly from the US and western Europe. Assessment of fitness for work is defined by most as the evaluation of a worker's capacity to work without risk to their own or others' health and safety. It is mainly assessed at recruitment (pre-offer or post-offer), and when changes of work or health conditions occur. Five main criteria used by occupational doctors to evaluate fitness for work were identified: the determination of worker's capacity and worker's risk in relation to his or her workplace, as well as ethical, economic and legal criteria. Most authors agreed that assessment tools used need to be specific and cost-effective, and probably none gives unequivocal answers. Outcomes from fitness for work assessments range from "fit" to "unfit", with other possible intermediate categories such as "fit subject to work modifications", "fit with restrictions" or "conditionally fit (temporarily, permanently)". Workplace modifications to improve or adjust working conditions must always be considered. There is confusion about the decision-making process to be used to judge about fitness for work. There is very scarce scientific evidence based on empirical data, probably because there are no standard or valid methodologies for all professions and circumstances.

Health Status↗

PubMed2000

[Intranet-based integrated information system of radiotherapy-related images and diagnostic reports].

PURPOSE: To use an intranet technique to develop an information system that simultaneously supports both diagnostic reports and radiotherapy planning images. METHODS: Using a file server as the gateway a radiation oncology LAN was connected to an already operative RIS LAN. Dose-distribution images were saved in tagged-image-file format by way of a screen dump to the file server. X-ray simulator images and portal images were saved in encapsulated postscript format in the file server and automatically converted to portable document format. The files on the file server were automatically registered to the Web server by the search engine and were available for searching and browsing using the Web browser. RESULTS: It took less than a minute to register planning images. For clients, searching and browsing the file took less than 3 seconds. Over 150,000 reports and 4,000 images from a six-month period were accessible. Because the intranet technique was used, construction and maintenance was completed without specialty. CONCLUSION: Prompt access to essential information about radiotherapy has been made possible by this system. It promotes public access to radiotherapy planning that may improve the quality of treatment.

Computer Communication Networks↗

PubMedDate not supplied

Benchmarking the dental implant evidence on MEDLINE.

The purpose of this study was to estimate the quantity of dental implant literature available on MEDLINE for evidence-based clinical decision-making and to identify its location. A search strategy based on Medical Subject Headings for dental implants was developed to examine MEDLINE using the Ovid Web Gateway search engine. Sensitive and specific methodologic search filters identified 4 categories of information: etiology, diagnosis, therapy, and prognosis. The results were then subdivided by year to identify trends and sorted to identify the sources of publications. The searches identified 4,655 articles published in English between 1989 and 1999 on human dental implants on MEDLINE. The mean number of articles (+/- SD) per year ranged from 15 +/- 11 for specific searches to 107 +/- 50 for sensitive searches. The number of articles increased by 14% to 43% each year for the sensitive search. When subdivided by clinical category, the mean numbers of articles per year for sensitive and specific searches were, respectively: diagnosis 12 +/- 7.5 and 1.5 +/- 1.6, etiology 58 +/- 33 and 1.9 +/- 2.5, therapy 23 +/- 15 and 0.3 +/- 0.5, and prognosis 67 +/- 33 and 12 +/- 8.3. Four dental journals account for approximately half of these publications. These results provide 6 key central findings: (1) there appears to be a substantial literature of clinically relevant information on implants upon which to base clinical decisions; (2) the implant literature is significantly biased toward articles addressing prognosis; (3) to stay current, one would need to read between 1 and 2 articles per week 52 weeks per year, and this number increases significantly each year; (4) approximately 50% of the articles were published in 4 journals, whereas the remainder reside in approximately 97 other journals, making it difficult to stay current; (5) these trends reaffirm the need for lifelong learning; (6) these trends also suggest the need for computer-based clinical knowledge systems.

Analysis of Variance↗