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PubMedDate not supplied

How available is positron emission tomography in the United States?

PURPOSE: Positron emission tomography (PET) has become a major clinical diagnostic and prognostic tool for oncology and multiple other arenas. To some, however, the perception exists that PET is not available as a resource in their community. Our goal with this project was to determine how available clinical PET was in the United States. PROCEDURES: We used existing lists of PET centers, websites from PET scanner manufacturers, as well as a common Internet search engine to find clinical PET facilities. A mapping program was then used to determine area coverage with a 75-mile radius for each PET scanner found, and the United States Census website was utilized as a source of population data for covered and not covered areas. RESULTS: We found that 97% of the US population lives within 75 miles of a clinical PET facility. CONCLUSION: Thus, it appears that the idea of clinical PET being unavailable to many is a misconception, which may be limiting its use by some physicians who are unaware of how common it has become.

Equipment and Supplies, Hospital↗

PubMed2005

New intraocular lens technology.

PURPOSE: To review the current status of phakic intraocular lenses (IOLs), intraocular treatment of presbyopia, and IOLs that filter some blue light. DESIGN: Review of current information on the subject from numerous sources. METHODS: Medline search and Internet search engines on the topics of phakic IOLs, presbyopia or multifocal IOLs, and blue light and macular degeneration. RESULTS: An iris fixated phakic IOLs is now approved in the United States (US). There are concerns for corneal endothelial stability and late dislocation. Other approaches include anterior chamber fixation with concerns of corneal endothelial stability and pupil elongation, and posterior chamber fixation with concerns of cataract formation, IOL dislocation, and pigment dispersion. Intraocular treatment of presbyopia includes monovision, multifocal, and accommodative IOLs. Which approach is superior today is still not clear. There are IOLs designed to block some blue light to potentially lessen the risk of age-related macular degeneration (ARMD). While there is presumptive evidence of this, no definitive study shows such a correlation. Color perception issues are unlikely to be a problem. While decreased scotopic vision has been proposed, there is no study that proves this is an issue of clinical significance. CONCLUSIONS: The IOL field is dynamic with many new choices. Phakic IOLs and treatment of presbyopia will be an increasingly important part of ophthalmology; however, there are important unresolved issues. With better evidence that blue light is an important variable in ARMD, such an approach could rapidly become the standard.

Biomedical Technology↗

PubMed2004

The risks of underwater birth.

OBJECTIVE: We performed a retrospective review of the literature on the complications that could be associated potentially with water birth. STUDY DESIGN: We performed an extensive review of the medical literature using the Pub Med search engine, which is available through the National Library of Medicine. We also examined the Cochrane review on immersion in pregnancy, labor and birth. RESULTS: Our review revealed 74 articles regarding water births. We found 16 citations that described complications that were associated with underwater birth. Possible complications that were associated with water birth included fresh water drowning, neonatal hyponatremia, neonatal waterborne infectious disease, cord rupture with neonatal hemorrhage, hypoxic ischemic encephalopathy, and death. Our systematic review did not identify an adequately controlled trial of delivery underwater (second stage of labor underwater) compared with delivery in air. CONCLUSION: Water birth may be associated with potential complications that are not seen with land-based birth. The rates of these complications are likely to be low but are not well defined.

Adult↗

PubMed2005

Consumer health information on the Internet about carpal tunnel syndrome: indicators of accuracy.

PURPOSE: To identify indicators of accuracy for consumer health information on the Internet. METHODS: Several popular search engines were used to find websites on carpal tunnel syndrome. The accuracy and completeness of these sites were determined by orthopedic surgeons. It also was noted whether proposed indicators of accuracy were present. The correlation between proposed indicators of accuracy and the actual accuracy of the sites was calculated. RESULTS: A total of 116 websites and 29 candidate indicators were examined. A high Google toolbar rating of the main page of a site, many inlinks to the main page of a site, and an unbiased presentation of information on carpal tunnel syndrome were considered genuine indicators of accuracy. Many proposed indicators taken from published guidelines did not indicate accuracy (e.g., the author or sponsor having medical credentials). CONCLUSION: There are genuine indicators of the accuracy of health information on the Internet. Determining these indicators, and informing providers and consumers of health information about them, would be useful for public health care. Published guidelines have proposed many indicators that are obvious to unaided observation by the consumer. However, indicators that make use of the invisible link structure of the Internet are more reliable guides to accurate information on carpal tunnel syndrome.

Carpal Tunnel Syndrome↗

PubMed2004

Minimally invasive total hip arthroplasty: in opposition.

At the Knee Society Winter Meeting in 2003, Seth Greenwald and I debated about whether there should be new standards (ie, regulations) applied to the release of information to the public on "new developments." I argued for the public's "right to know" prior to the publication of peer-reviewed literature. He argued for regulatory constraint or "proving by peer-reviewed publication" before alerting the public. It is not a contradiction for me to currently argue against the public advertising of minimally invasive (MIS) total hip arthroplasty as not yet being in the best interest of the public. It is hard to remember a concept that has so captured both the public's and the surgical community's fancy as MIS. Patients are "demanding" MIS without knowing why. Surgeons are offering it as the next best, greatest thing without having developed the skill and experience to avoid the surgery's risks. If you put "minimally invasive hip replacement" into the Google search engine (http://www.google.com), you get 5,170 matches. If you put the same words in PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi), referencing the National Library of Medicine database, you get SEVENTEEN; none is really a peer-reviewed article. Most are 1 page papers in orthopedics from medical education meetings. On the other hand, there are over 6,000 peer-reviewed articles on total hip arthroplasty. Dr. Thomas Sculco, my couterpart in this debate, wrote an insightful editorial in the American Journal of Orthopedic Surgery in which he stated: "Although these procedures have generated incredible interest and enthusiasm, I am concerned that they may be performed to the detriment of our patients." I couldn't agree with him more. Smaller is not necessarily better and, when it is worse, it will be the "smaller" that is held accountable.

Advertising↗

PubMed2006

An evaluation of information available on the internet regarding minimally invasive hip arthroplasty.

The Internet is a popular source of information regarding health care especially when seeking advice on new and less invasive surgical techniques. We evaluated 150 Web sites (3 search engines) for authorship and quality of information regarding minimally invasive hip arthroplasty. The results revealed that 45% were authored by a hospital/university, 26% were news stories, 25% were private medical groups, and 6% were orthopedic industry Web sites. Forty-five percent offered the opportunity to make an appointment, 41% described the surgical technique, and only 15% explained eligibility. Thirteen percent described the risks, whereas 9% made reference to peer-reviewed publications. More than 91% made specific claims regarding the advantages of minimally invasive surgery. Our study suggests the information on the Internet regarding minimally invasive total hip arthroplasty is misleading and of poor quality.

Arthroplasty, Replacement, Hip↗

PubMed2006

Mémoire: A framework for semantic interoperability of case-based reasoning systems in biology and medicine.

OBJECTIVE: Mémoire is a framework for sharing and distributing case bases and case-based reasoning (CBR) systems in biology and medicine. METHODS AND MATERIAL: This paper first introduces the semantic Web approach to build a better Web where search engines, knowledge sources and servers, applications and services can live, work, and learn in cooperation. This semantic approach is particularly well suited for biomedical domains because significant ontologies have been developed there and constitute a sound basis for the standardization effort required for the semantic Web. Case-based reasoning systems in biomedicine have also benefited from these biomedical ontologies and models. RESULTS: This article demonstrates for three such systems how a semantics infused approach in CBR gives better, more accurate results in CBR. From this previous work on a semantic approach in CBR in biomedicine, the Mémoire framework has evolved. CONCLUSION: Mémoire proposes a unified OWL-based representation language for cases and case-based ontologies in biomedicine, where a Web Ontology Language (OWL) is a language to represent ontologies on the Web. Mémoire provides a set of tools for building case-based reasoning systems compliant with its language. Mémoire is extensible and can be adapted to different types of biomedical application domains, tasks, and environments. Mémoire will permit bridging the gap within the multiple case-based reasoning systems dedicated to a single domain, and make available to agents and Web services the case-based competency of the CBR systems adopting its interchange language. The approach could be extended to other application domains of CBR.

Artificial Intelligence↗

PubMed2004

Acetoxy drug: protein transacetylase of buffalo liver-characterization and mass spectrometry of the acetylated protein product.

The purification and characterization of the buffalo liver microsomal transacetylase (TAase) catalyzing the transfer of acetyl groups from a model acetoxy drug: 7,8-diacetoxy-4-methylcoumarin (DAMC) to GST3-3 has been described here. The enzyme was routinely assayed using DAMC and cytosolic GST as the substrates and was partially purified from microsomes of the buffalo liver. The enzyme was found to have approximate molecular of weight 65 kDa. The action of TAase and DAMC on liver cytosolic GST resulted in the formation of monoacetoxymonohydroxy-4-methylcoumarin (MAMHC) and 7,8-dihydroxy-4-methylcoumarin (DHMC), although the former was the major metabolite. The buffalo liver microsomal TAase exhibited hyperbolic kinetics and yielded K(m) (1667 microM) and V(max) (192 units) when the concentration of DAMC was varied keeping the concentration of GST constant. After having characterized the nature of the substrates and a product of the TAase-catalyzed reaction, we set out to identify the acetylated protein which is another product of the reaction. GST3-3 was used as a model protein substrate for the action of TAase using DAMC as the acetyl donor. The subunit of control and modified GST3-3 were separated by SDS-polyacrylamide gel electrophoresis (PAGE) and digested with trypsin. The tryptic peptides were extracted from the gel pieces and analyzed by matrix assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOFMS). The data search for calibrated and labeled mass peaks of peptides was performed on the Matrix Science Server using the search engine Mascot. The peptide maps so obtained covered 97% of the GST3-3 sequence. On comparison of MALDI peptide maps of modified and control GST, seven new peaks were recognized corresponding to the potentially acetylated peptides in peptide map. The mass value of each of them was 42 Da higher than the theoretical mass of a non-modified GST3-3 tryptic peptide, strongly suggesting acetylation. By examining the fragmentation patterns and by comparing experimental and predicted values for MS/MS daughter ions, the identity of the seven acetylated GST tryptic peptides could be confirmed by the application of LC/MS/MS. In the modified GST, N-terminal proline and six lysines (Lys(51), Lys(82), Lys(123), Lsy(181), Lys(191) and Lys(210)) were found to be acetylated. The structure of acetylated GST revealed that the lysines that underwent acetylation were peripheral in positions.

Acetylation↗

PubMed2004

Many commonly used siRNAs risk off-target activity.

Using small interfering RNA (siRNA) to induce sequence specific gene silencing is fast becoming a standard tool in functional genomics. As siRNAs in some cases tolerate mismatches with the mRNA target, knockdown of genes other than the intended target could make results difficult to interpret. In an investigation of 359 published siRNA sequences, we have found that about 75% of them have a risk of eliciting non-specific effects. A possible cause for this is the popular BLAST search engine, which is inappropriate for such short oligos as siRNAs. Furthermore, we used new special purpose hardware to do a transcriptome-wide screening of all possible siRNAs, and show that many unique siRNAs exist per target even if several mismatches are allowed. Hence, we argue that the risk of off-target effects is unnecessary and should be avoided in future siRNA design.

Base Sequence↗

PubMed2004

Breast cancer on the Internet: the quality of Swedish breast cancer websites.

The aim of this study was to investigate the quality of Swedish-language breast cancer information available on the Internet. The questions explored were the extent and type of breast cancer information available, the coverage and correctness of that information, and whether the websites fulfilled the European Commission quality criteria for health-related websites. Three search engines were used to find websites containing medical information on breast cancer. An oncologist then evaluated the 29 relevant sites. Only seven of these were judged suitable for breast cancer patients. The coverage and correctness of the medical information varied considerably. None of the websites fulfilled the European Commission quality criteria. Therefore, considerable effort will be required before the Internet can serve as a valuable and up-to-date source of information on breast cancer for both professionals and laypersons. Our findings broadly match the results of earlier studies of English-language websites.

Breast Neoplasms↗

PubMed2006

Burns first aid information on the Internet.

The Internet is an increasingly important source of health-related information. However, the growth of the Internet and its use as a medical delivery tool should be viewed with caution. One of the key concerns is that although the volume of information is huge, the quality, accuracy and completeness of the information is questionable. The aim of this study was to evaluate burns first aid information on the Internet. The search term used was "first aid for burns" and the first 25 hits from each search engine were analysed by one of the observers. We gathered basic information on the web sites--such as the country of origin, language in which the information was offered, accessibility, relevance and whether the site was commercial, organisational or academic. Quality and technicality of the web sites were assessed and scored. The mean quality score was 4.7/15 (31.5%) The mean technical score was 6.1 of 12 (51.1%). When the total score was categorised by percentage, none of the web sites ranked in the excellent category, 1 was very good, 4 were good, 6 were fair and the majority, 36, were poor. Based on the quality score only, two web sites were in the excellent category and two were very good. For technicality one web site was excellent and three were very good. This study has shown first aid information on the Internet is largely of poor quality, that the technical information provided is inadequate and that the sites include a significant amount of grossly inaccurate information. The few sites that contain excellent technical information make up a very small proportion of what is available. Therefore, the average Internet user may not encounter these resources, instead gaining knowledge from sites of questionable value.

Burns↗

PubMed2006

Learning from tragedy: a survey of child and adolescent restraint fatalities.

OBJECTIVE: This descriptive study examines 45 child and adolescent fatalities related to restraints in residential (institutional) placements in the United States from 1993 to 2003. METHOD: The study team used common Internet search engines as its primary case discovery strategy to determine the frequency and the nature of the fatalities, as well as the characteristics of the children and the adolescents involved. RESULTS: Male children and adolescents were over-represented in the study sample. Thirty-eight of the fatalities occurred during or after a physical restraint, and 7 fatalities occurred during the use of mechanical restraints. Twenty-eight of the deaths occurred in a prone restraint. In 25 of the fatalities, asphyxia was the cause of death. CONCLUSION: In the 23 cases in this study where information is available, none of the child behaviors or conditions that prompted the restraint would meet the standard of danger to self or others: the commonly accepted criteria for the use of a restraint. The study points to deficiencies in fatality reporting, recommends reporting fatalities to established state child fatality review boards, and reinforces that restraints be governed by strict protocol and monitoring. The study also urges caution to policymakers in substituting or changing restraint procedures based on the incomplete data reported in this study.

Accidents↗

PubMed2005

Evidence for the association of synaptotagmin with glutathione S-transferases: implications for a novel function in human breast cancer.

OBJECTIVE: To analyze the pattern of changes in GSTs in cancerous and adjacent non-cancerous tissues obtained from breast cancer patients undergoing surgery. DESIGN AND METHODS: Cytosolic GST purification, assay of GST, protein expression levels, and GST-synaptotagmin association were analyzed using standard biochemical techniques like GSH-affinity purification, spectrophotometry, SDS-PAGE, Western blots, and matrix-assisted laser desorption and ionization-time of flight (MALDI-TOF). RESULTS: GST activity in cancerous tissues (0.26 U/mg protein) was significantly higher (P < 0.05) as compared to those from adjacent non-cancerous tissues (0.14 U/mg protein) of breast cancer patients. Further analysis of GST subunits on SDS-PAGE and Western blots using class-specific GST antibodies revealed significant elevation in GST-pi levels in cancer tissues with no appreciable changes in GST-alpha and GST-mu. Along with the elevation of GST-pi levels, high molecular weight proteins (approximately 70 kDa) cross reacting with GST antibodies were detected only in surgically resected tumor biopsies but not in the non-cancerous tissues adjacent to the tumor. Based on MALDI-TOF analysis, the high molecular weight band was identified as synaptotagmin V bound to GST-M1 with 47% sequence coverage after processing on an MS-FIT search engine. CONCLUSIONS: Our results suggest a novel putative functional role for the GST-synaptotagmin complex in human breast cancers. As this association of GST M1-synaptotagmin was not seen in adjacent non-cancerous tissues, this can be used as a marker for breast cancers.

Adult↗

PubMed2004

OptiRNAi, an RNAi design tool.

RNA interference (RNAi), a recently developed reverse genetics tool, has many advantages compared to traditional gene knockout methods. Appropriate selection of double stranded RNAs identical to a specific region(s) of the target gene is critical for the successful implementation of this technology. Recently, Elbashir et al. [Methods 26 (2002) 199] has established empirical criteria for siRNA sequence selection that significantly improved the success rate for RNAi attempts. We have developed OptiRNAi, a computational tool, which uses the Elbashir et al. criteria to predict appropriate target sequences for siRNA production. Specificity of these siRNAs for the target of interest can then be assessed by the investigator using the embedded Blast search engine optimized for RNAi design. Thus, OptiRNAi is an efficient and user friendly tool for RNAi design based on criteria that are more stringent than other available tools.

Animals↗

PubMed2005

Over-the-internet availability of hormonal contraceptives regardless of risk factors.

OBJECTIVE: The purpose of this study is to measure the accessibility to purchase oral and transdermal contraceptives over the Internet for low- and high-risk individuals. METHODS: The Internet was used to search for and order both oral and transdermal contraceptives. Using the "Google" search engine to locate online pharmacies by entering the term "purchase contraception," we proceeded to purchase either oral contraceptives or contraceptive patches without a prescription. We first posed as a healthy 25-year-old woman, then as a 35-year-old woman who was obese and a heavy tobacco user, and finally, as a 35-year-old smoker on an antihypertensive medication. RESULTS: Our attempts to order both combination oral contraceptives, as well as contraceptive patches, over the Internet without a prescription were successful for all three risk profiles. We ordered from three different Web sites, two within the United States and one international site. The two U.S. Web sites required us to complete a medical questionnaire to obtain a prescription from the site provider, but the foreign site had no questionnaire or risk information posted on the Web site. Despite entering known risk factors for estrogen use, we received all the medications. There was no medical follow-up to these sales except for offers to sell more products. CONCLUSIONS: Both oral and transdermal contraceptives are easy to obtain over the Internet without a physical appointment with a health care provider to obtain a prescription.

Administration, Cutaneous↗

PubMed2006

Treatment of specific phobia in adults.

This is a comprehensive review of treatment studies in specific phobia. Acute and long-term efficacy studies of in vivo exposure, virtual reality, cognitive therapy and other treatments from 1960 to 2005 were retrieved from computer search engines. Although specific phobia is a chronic illness and animal extinction studies suggest that relapse is a common phenomenon, little is known about long-term outcome. Treatment gains are generally maintained for one year, but longer follow-up studies are needed to better understand and prevent relapse. Acutely, the treatments are not equally effective among the phobia subtypes. Most phobias respond robustly to in vivo exposure, but it is associated with high dropout rates and low treatment acceptance. Response to systematic desensitization is more moderate. A few studies suggest that virtual reality may be effective in flying and height phobia, but this needs to be substantiated by more controlled trials. Cognitive therapy is most helpful in claustrophobia, and blood-injury phobia is uniquely responsive to applied tension. The limited data on medication have not been promising with the exception of adjunctive D-clycoserine. Despite the acute benefits of in vivo exposure, greater attention should be paid to improve treatment acceptance and retention, and additional controlled studies of more acceptable treatments are needed.

Adult↗

PubMed2004

Quality and safety issues of web-based information about herbal medicines in the treatment of cancer.

A number of studies have been carried out to assess health information on the internet and they all have demonstrated that, whereas the internet can be the third opinion for many patients, often contains inaccurate and misleading information. Furthermore, as herbal medicines are increasingly used by patients, it is imperative to assess the quality of information presented on the internet. Hence, the aim of this study was to assess the quality and safety of the information presented on the internet about medicinal herbs specifically in the field of cancer. Two hundred relevant websites were initially selected from a process using 10 search engines and the keywords 'herbs' and 'cancer', and 43 sites actually met all inclusion criteria. Assessment of both quality and safety indicators was carried out using the DISCERN instrument, which has been developed to enable consumers and information providers to judge the quality of health information. Readability scores of the sites were also obtained (Flesch formula). It was shown that most sites had low quality in a number of indicators, including accuracy of information, revealing sources of information, biased presentation of information or regularity of updates. The mean score for quality was 22.12 (S.D.=4.18) out of a maximum score of 50. The mean safety score was 13.26 (S.D.=2.14) out of a maximum score of 30. Commercial sites had the most inaccurate or misleading information, emphasizing only the positive aspects of the use of herbs, with little or no evidence. The only biomedical sites assessed achieved the highest score in both quality and safety. Readability of the information was equal to the school level of college (mean=44.63). Seven percent of the sites discouraged the use of conventional medicine. Results suggest that health professionals should talk about use of alternative therapies with their patients and help them find the best available information when using the internet.

Cross-Sectional Studies↗

PubMedDate not supplied

Anterior mediastinal nonseminomatous germ cell tumor with malignant transformation: a case report.

OBJECTIVE: We report a case of a 21-year-old man who presented with the unusual symptoms of heart failure and was found to have an anterior mediastinal yolk sac tumor. METHODS: A review of the literature using the Ovid search engine was performed. RESULTS: The patient was treated with the current standard of neoadjuvant chemotherapy: bleomycin, etoposide, and cisplatin (BEP) with marked reduction in tumor size, followed by en bloc surgical resection. The final pathology revealed teratoma with malignant change: chondrosarcoma, adenocarcinoma, and poorly differentiated sarcoma. CONCLUSIONS: This is a rare initial presentation of an anterior mediastinal germ-cell tumor with treatment consisting of neoadjuvant therapy and surgical resection. In addition, we present the adverse and extremely rare malignant degeneration of this tumor.

Adult↗