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PubMed2000

Internet resources for spine surgeons.

To classify web sites on common spinal disorders as to their utility for the spine surgeon and patient. Five common spinal disorders were used to generate lists of relevant sites. These sites were categorized as to their relevance for patients and surgeons, their sponsoring organization, and their comprehensiveness. A total of 56,249 web sites were found using the five key words on five search engines. Using the "And" operator, a total of 227 web sites were generated. The majority of sites were patient oriented. Physician- or organization-sponsored sites were the most common. Ten sites were found to have comprehensive information for both patients and spine surgeons. Many web sites exist that discuss disorders of the spine. Currently there is not any one web site that contains comprehensive information for both the spine surgeon and patient.

Education, Medical, Continuing↗

PubMed2001

Surveillance for venous thromboembolic disease after total knee arthroplasty.

The value of deep venous thrombosis screening after total knee arthroplasty is controversial. The purpose of the current study was to examine the value of routine surveillance for venous thrombosis after total knee arthroplasty done with modern operative and perioperative treatment. Computerized search engines were used to identify papers published between 1985 and July 2000 relevant to the purpose of the study. Papers that met the inclusion criteria for review were categorized as follows: the frequency of deep venous thrombosis; the natural history of deep venous thrombosis; the accuracy of screening methods for venous thrombosis; and efficacy of screening in reducing morbidity attributable to venous thromboembolism after total knee arthroplasty. Several studies have shown a low complication rate related to venous thromboembolic disease when compression ultrasound is used for screening as part of a clinical algorithm after knee arthroplasty. However, the only large prospective randomized trial evaluating ultrasound screening failed to show a reduction in morbidity with a surveillance protocol. The benefits of surveillance depend on factors specific to each surgeon's practice including the type and duration of venous prophylaxis, the rate of symptomatic and asymptomatic thromboembolic disease associated with that protocol, and the accuracy of screening tests used for surveillance.

Arthroplasty, Replacement, Knee↗

PubMed2003

Internal fixation versus arthroplasty of comminuted fractures of the distal humerus.

BACKGROUND: A comminuted distal humerus fracture in an older patient is a difficult clinical problem. Open reduction internal fixation (ORIF) carries the risks of nonunion, loss of fixation, infection, and stiffness. Arthroplasty carries the risks of loosening, infection, and periprosthetic fracture. Both procedures are technically challenging, and complications following these procedures are frequent. OBJECTIVE: To evaluate best available evidence to assist in guiding clinical decision making for ORIF versus arthroplasty of intraarticular distal humeral fractures in elderly patients. HIGHEST AVAILABLE EVIDENCE: 1. Case series of internal fixation or arthroplasty of acute interarticular distal humerus fractures in the elderly (level IV). 2. Review of expert opinion without explicit critical appraisal or controlled research (level V). STUDY IDENTIFICATION: 1. Computerized data search 1969-2003, Cochrane Database, OVID Search Engine. 2. Reviews of bibliographies of selected articles.

Aged↗

PubMed1999

Internet resources for neonatal nurses.

The availability of health information over the Internet has exploded in recent years. Nurses can use the Internet to access information to support professional and clinical interests and join in dialogues with colleagues around the world. The Internet can also be used to identify resources for clients and their families. As with any other information resource, Internet sites must be evaluated for accuracy, currency, and objectivity. The article describes examples of Internet resources and discussion forums for neonatal nurses, use of search engines to find and retrieve information about specific topics, and evaluation of World Wide Web sites.

Adult↗

PubMed2003

Duplicate publications in the otolaryngology literature.

OBJECTIVE/HYPOTHESIS: A duplicate publication duplicates other published work by the same author(s). The purpose of the study was to define the extent of this problem within the otolaryngology literature. STUDY DESIGN: Retrospective review of the literature. METHODS: Original articles published in Archives of Otolaryngology-Head and Neck Surgery and Laryngoscope in 1999 were reviewed using the OVID search engine. Titles and abstracts from English articles written by the same first, second, or last author were analyzed, and suspected publications were evaluated. Duplicate publications were classified as dual (identical data set and conclusions) or suspected dual (nearly identical data set and conclusions) publications. RESULTS: Of the 492 articles evaluated, 40 index articles were identified. These led to a total of 42 (8.5%) duplicate articles of which 27 were classified as dual and 15 as suspected dual publications. Approximately half of the duplicate publications were published by authors in the United States (55%). Duplicate articles usually appeared within 12 months of the each other (74%) and failed to cross-reference the earlier publication (83%). CONCLUSIONS: Journal editors have become aware of an increase in the number of duplicate publications in the medical literature. The incidence of duplicate publications in the otolaryngology literature appears to be similar to that in other specialties.

Duplicate Publications as Topic↗

PubMedDate not supplied

Parental perceptions of the lasting effects of infant colic.

PURPOSE: To describe the experience of families with previously colicky infants. STUDY DESIGN: This qualitative, descriptive study explored parents' perspectives of the lasting effects of infant colic on their children's development and on their family relationships. METHODS: Through in-depth interviews, the parents had the opportunity to share what they remembered most about this experience. Participants volunteered by accessing the Infant Colic Study Web site advertised on numerous search engines. Forty-four participants, all of whom had an infant with colic at some time in the past, answered open-ended questions regarding their feelings about the colicky period and how their children developed later. Data were analyzed from a phenomenologic perspective. RESULTS: The majority of participants reported no later problems in their previously colicky children. Some did believe, however, that family relationships had been affected by the colic experience, and that communication and support had been impaired. Most described feelings about the colic experience that were negative. CLINICAL IMPLICATIONS: Continued support needs to be provided to families of colicky infants throughout their growth and development at a primary care level. Nurses need to recognize that the experience of infant colic may have residual effects on the entire family unit. These families need to be provided with the support and resources to enable them to successfully care for their children and to engage in nurturing relationships.

Colic↗

PubMed2001

Surfing for back pain patients: the nature and quality of back pain information on the Internet.

STUDY DESIGN: A prospective, systematic review of web sites related to back pain. OBJECTIVE: To assess the nature and quality of back pain-related information on the World Wide Web during a 2-year period. SUMMARY OF BACKGROUND DATA: The Internet has become a rich source of medical information. Limited knowledge is available, however, about the quality of online resources. Although previous systematic reviews on medical-related web sites found problems in varying degrees with the credibility of information, no such review was conducted to assess the back pain-related sites. METHODS: A search of web sites was conducted in November 1996 using five search engines (AltaVista, Infoseek, Lycos, Yahoo, and Magellan) and two key terms ("back pain" and "back problems"). A sample of sites was evaluated by two independent reviewers. Each site was described by the type and nature of the sponsor, target audience, and content. Overall quality was assessed in terms of evidence-based information available. RESULTS: Seventy-four web sites were reviewed in 1996, and nine of them (12.2%) were identified as high-quality sites. Advertising was the focus of 80.8% of the sites. Eleven sites (14.9%) were found to be discontinued 1 year later, and 20 (27.0%) were not accessible by the reviewers at the 2-year follow-up evaluation. Of the remaining 54 sites, 44.4% were produced by for-profit companies, and most sites targeted people with back pain (63.0%). Only seven out of the nine high-quality sites held their ratings at the 2-year follow-up evaluation. CONCLUSION: Most back pain-related web sites can be classified as advertising. The quality varied considerably, resulting in difficulties for patients to find useful information in this field. The increasing number of people seeking medical information on the Web creates a need for more high quality sites. Further, systematic review of web sites should be encouraged to monitor the accuracy of Internet publication.

Bias↗

PubMed2005

A survey of validated automated home blood pressure monitors available for the Internet shopper.

OBJECTIVE: Self-measurement of blood pressure using an automated home blood pressure monitoring (AHBPM) is increasingly used in hypertension management. Internet commerce increases dramatically each year. This study looked to identify the availability of validity of AHBPM and the correct cuff size to go with the AHBPM. METHODS AND RESULTS: Using the search engine 'Google.com', the author identified 124 consecutive unique sites offering at least one AHBPM. Validated AHBPM were those devices that had published studies showing that they had passed a recognized validation protocol. Each site was evaluated for all forms of sphygmomanometer, number of AHBPM, manual blood pressure devices, all cuff sizes available, additional cost of large adult cuff, number of validated AHBPM offered, and whether the site mentioned device validation. Of the 124 sites, 109 (81%) offered arm AHBPM and 66 (53%) offered one or more (range, 1-11) validated AHBPM. Only six of the 66 (9%) offering a validated AHBPM mentioned that fact; 58 of the 109 (53%) sites offering arm AHBPM offered more than one size of cuff; and 46 of the 58 (80%) charged extra for a large adult cuff (average US dollars 23.75, range, US dollars 4.80-98). CONCLUSIONS: Validated AHBPMs are readily available on the Internet. Currently, these sites do little to aid the consumer in purchasing a validated AHBPM. Large adult cuffs, commonly needed by hypertensive patients, are not always available for purchase. Charging extra for large adult cuffs is a potential hindrance to consumers purchasing the correct cuff size for accurate blood pressure measurement and should be eliminated.

Blood Pressure Determination↗

PubMed2003

Information technology, the internet, and the future of neurology.

BACKGROUND: This review addresses the impact of information technology and the Internet on the current and future practice of neurology. Information technology is influencing medical practice in ways that could be both beneficial and harmful. Scenarios are presented to depict some of the ways in which the practice of neurology is being influenced by the growth of technology. REVIEW SUMMARY: First, the advantages and disadvantages of e-mail as a means of doctor-patient communication are presented. Some of the ethical and legal issues arising in this context are discussed.Second, the Internet is changing neurologists' relationships to other professionals in the health care industry. Geographical isolation is less problematic than in the past. Telemedicine, including remote consulting via the Web, has special implications for neurologists in several areas, including stroke management, movement disorders, and epilepsy.Third, the growing availability of large databases, powerful search engines, and online full-text journals is discussed. Skill in navigating and managing these resources will become increasingly important. New computer-assisted decision support systems will continue to be implemented. Applications exist or are being developed for use by clinicians for many specific neurologic disorders.Finally, some of the problematic issues concerning medical use of the Internet are discussed, including availability, portability, security, quality, and outcomes. CONCLUSIONS: Medical information systems, with their attendant advantages and limitations, will become increasingly significant in the practice of neurology. Despite overall improvement in access to information, major barriers still exist to the proper implementation and utilization of truly integrated information systems.

Access to Information↗

PubMedDate not supplied

An evaluation of internet sites for burn scar management.

Patients rely on the Internet for medical information. It is difficult to discern which resources are accurate or appropriate for patients. The purpose of this study was to develop a quality-assessment tool for health Internet Web sites and to apply this tool to assess the quality of burn scar management information on the Internet. Between September and December 2001, we prospectively evaluated all Web sites on the Internet search engine Yahoo! containing the headings "burn scar management," "burn scar healing," "burn scar treatment," and "burn scar therapy." The quality of each Web site's medical information was evaluated using our scoring system consisting of the following two components: quality and technical characteristics. The total score for each Web site was converted to a percent grade (eg, > or =80% = excellent, 70 to 79% = very good, 60 to 69% = good, 50 to 59% = fair, and <50% = poor). The Web sites were grouped into three categories: commercial (for profit), academic (university, hospital), and organizational (nonprofit). Of 88 Web sites evaluated, the majority 68 (77%) were commercial, 7 (8%) academic, and 13 (15%) organizational. Burn scar management information on the Internet was poor in the majority (79%) of commercial Web sites and was excellent, very good, or good in the majority of academic (86%) and organizational (77%) Web sites. Using our health information evaluation, we found that the majority of burn scar management information on the internet (77%) was of fair or poor quality. Academic and organizational Web sites had the best quality of burn scar management information. Additional testing of the developed tool will be needed to analyze the reproducibility of the results and their applicability in other medical domains.

Burns↗

PubMed2005

Neglected spinal injuries.

Neglected spinal injuries secondary to overlooked diagnosis may result in serious medical and medicolegal problems. These are not uncommon but are reported infrequently in the medical literature. I studied the incidence, causes, and consequences of neglected spinal injuries and recommendations for prevention and treatment by reviewing the literature found in a Medline search. Overlooked spinal injuries are most frequently seen in unconscious or intoxicated patients and in polytrauma patients with distracting remote injuries. These are 4.5 times more frequent in the cervical spine compared with the thoracolumbar spine. The most common cause is failure to obtain radiographs. Other causes include a failure to recognize the injury or the fact that the initial studies may fail to show the injuries. Use of computed tomography and magnetic resonance imaging scans as screening tests may be good ways to diagnose these injuries, but their use is limited by cost and availability. The most serious consequence of overlooked spinal injuries is progressive neural deficit. More frequently they result in progressive deformity and persistent pain requiring surgical intervention that most likely could have been avoidable, often with an unsatisfactory outcome. Untreated or inadequately treated spinal injuries with late presentation are more often seen in the developing world. Unfortunately, reports on these cases are published rarely. Their brief report in the current study is based on search of nonindexed medical journals using in Internet search engine and personal communications.

Cervical Vertebrae↗

PubMed2003

Back pain online: a cross-sectional survey of the quality of web-based information on low back pain.

STUDY DESIGN: A cross section of Web sites accessible to the general public was surveyed. OBJECTIVE: To evaluate the quality of information on low back pain and its treatment that a "typical" patient user might access on the Internet. SUMMARY OF BACKGROUND DATA: Individuals with back pain have a desire to learn about their condition, what to expect, and what they can do about it. Web sites play a potentially useful role in providing information to help people learn about their low back pain and select the most appropriate methods of management. METHODS: A general search using popular search engines located 60 Web sites about back pain for review. A list of criteria for evaluating and scoring back pain Web sites was established using available literature and current clinical guidelines for the management of acute low back pain. The total quality score (maximum score, 38) was composed of two separate scores: one for general quality of the site (maximum score, 14) and one for site content specific to low back pain (maximum score, 24). Statistical tests, as appropriate, were used to investigate the relation between general indicators of Web site quality and total scores obtained. RESULTS: The quality of the Web sites surveyed was poor, most of them (n = 58, 97%) scoring less than half the maximum available score. The mean total score was 7.4 (range, 2-25). The mean score was 4.9 (range, 1-12) for general Web site quality and 2.4 (range, 1-13) for content specific to low back pain. Web sites providing references, sites created more recently, and sites not created for advertising purposes tended to be of better quality. CONCLUSIONS: This study highlighted the poor quality of information, particularly information about low back pain, available to "typical" patient users on the Internet. Health care professionals must have a role in evaluating existing information and in developing good-quality evidence-based Web sites. Patients with back pain should be discouraged from using the Internet as a source of information unless the Web sites they access have been evaluated and found to provide evidence-based messages.

Back Pain↗

PubMed2005

Unusual spondylolisthesis.

STUDY DESIGN: Literature and personal experience review of the topic of unusual spondylolisthesis OBJECTIVE: To provide information to the readership on the association of spondylolisthesis with syndromic and other conditions and implications of, indications for, and details of treatment for the spondylolisthesis. SUMMARY OF BACKGROUND DATA: From personal experience and perusal of the literature, it is known that spondylolysis/spondylolisthesis is frequently associated with various conditions with musculoskeletal abnormalities as part of their overall presentation A formal literature search revealed a number of these conditions. The underlying conditions often have a significant effect or can even be the cause of the spondylolisthesis. In light of this, there needs to be a high index of suspicion when evaluating such patients to identify this spinal deformity, if it is present so that appropriate treatment can be rendered early, before severe deformity and disability occur as indicated. METHODS: A literature search was performed using search engines. RESULTS: The reader has been provided with discussions about a number of conditions with associated spondylolisthesis. CONCLUSION: A number of generalized conditions have as part of their presentation spondylolysis/spondylolisthesis, which should be identified as part of their initial and ongoing evaluations.

Humans↗

PubMed2005

Family-based treatment research: a 10-year update.

OBJECTIVE: To provide an update on the state of the art of family-based treatment research. METHOD: Randomized clinical trials conducted in the past 10 years that included parents as a primary participant in treatment of child and adolescent psychiatric problems were reviewed. Studies were identified from major literature search engines (e.g., PsycINFO, Medline). Current significant pilot work was identified in the National Institute of Mental Health Computer Retrieval of Information on Scientific Projects (CRISP) Web page or from the authors themselves. RESULTS: Family treatments have proven effective with externalizing disorders, particularly conduct and substance abuse disorders, and in reducing the comorbid family and school behavior problems associated with attention-deficit/hyperactivity disorder. Several new studies suggest that family treatments or treatment augmented by family treatments are effective for depression and anxiety. CONCLUSIONS: For many disorders, family treatments can be an effective stand-alone intervention or an augmentation to other treatments. Engaging parents in the treatment process and reducing the toxicity of a negative family environment can contribute to better treatment engagement, retention, compliance, effectiveness, and maintenance of gains. Recommendations for the next decade of research and some implications of family-based treatment for child and adolescent psychiatry are explored.

Adolescent↗

PubMed2005

The University of Michigan Student Health Physics Society's Radiation and Health Physics World Wide Web Site.

The University of Michigan Student Health Physics Society's (UMSHPS) Radiation and Health Physics World Wide Web Site is an informative database of radiation and health physics related topics. With over 1,000 visitors each day, the UMSHPS web site provides professionals and the general public with a valuable resource for information and research. Users of this site can either search for information by topic or submit questions directly to the qualified members the national Health Physics Society. During the past year, progress has been made in replacing the site's older, less versatile framework with new search engines and refined submittal forms, as well as a "Frequently Asked Questions" section. Within the database, references will include brief summaries of the site's available information and target audience. Although these changes have been beneficial for the site, the UMSHPS continuously seeks professional opinions and ideas to further the services that this online resource can provide to the profession and to the general public.

Health Physics↗

PubMed2002

Congenital blepharoptosis: a literature review of the histology of levator palpebrae superioris muscle.

PURPOSE: To identify and summarize the available published literature describing histologic features of congenital blepharoptosis and to consider the evidence for its classification as either a dystrophy or a dysgenesis. A brief overview of etiologic factors is included to highlight the controversy surrounding the cause of the condition. METHODS: Online searches of the current medical literature were performed with the use of search engines provided in British University libraries. Keywords used were ptosis, blepharoptosis, and birth defect, combined with eyelid. Manuscript copies were obtained and translated where necessary. RESULTS: A summary of data found in more than 35 published papers, including theories of etiology (muscular versus neural, genetic versus sporadic, and environmental factors) and evidence for the classification of congenital blepharoptosis as a dysgenesis and as a dystrophy. Study design and data interpretation are commented on where appropriate. CONCLUSIONS: The scarcity of both affected tissue and normal fetal tissue for histologic examination has limited the understanding of the development and classification of congenital blepharoptosis. Each study analyzed had small specimen numbers, highlighting the need for a review of all available data. The available histologic data appear to support the classification of congenital blepharoptosis as a dysgenesis rather than a dystrophy. It is predicted that a greater understanding of the etiology and histology of this condition may distinguish further subtypes. It is also anticipated that a greater understanding of this condition will allow developments in preventive and therapeutic approaches.

Animals↗

PubMed2003

Common complementary and alternative therapies for yeast vaginitis and bacterial vaginosis: a systematic review.

UNLABELLED: This article is a systematic review of the literature regarding the most commonly used complementary and alternative medicine (CAM) therapies for yeast vaginitis and bacterial vaginosis. A search was conducted of all published literature on conventional search engines (PubMed, EMBASE, the Cochrane Registry, CINAHL, LILACS) and alternative medicine databases (Natural Medicines Comprehensive Database, Longwood Herbal Taskforce, and Alternative Medicine Alert), for all studies of the five most commonly used CAM treatments of vaginitis. Inconsistencies in definition of vaginitis, type of intervention, control groups, and outcomes prevented performance of a meta-analysis, and paucity of high-quality studies made ranking by evidence-based scales unsuitable. Lactobacillus recolonization (via yogurt or capsules) shows promise for the treatment of both yeast vaginitis and bacterial vaginosis with little potential for harm. Boric acid can be recommended to women with recurrent vulvovaginal Candidal infections who are resistant to conventional therapies, but can occasionally cause vaginal burning. Because of associated risks in the absence of well-documented clinical benefits, douching remains a practice that should not be recommended for the treatment of vaginitis. Finally, tea tree oil and garlic show some in vitro potential for the treatment of vaginitis, but the lack of in vivo studies preclude their recommendation to patients for the time-being. The available evidence for CAM treatments of vaginitis is of poor quality despite the prevalent use of these therapies. Well-designed randomized, controlled trials investigating the efficacy and safety of these therapies for vaginitis are needed before any reliable clinical recommendations can be made. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to list the most common complementary and alternative medicine therapies for vaginitis, summarize the data surrounding the efficacy of each therapy, describe the adverse affects of each therapy, and outline which therapies are recommended and not recommended for vaginitis.

Anti-Infective Agents, Local↗

PubMed2005

Complete evidence regarding major vascular injuries during laparoscopic access.

Recent reports by the Australian Safety and Efficacy Register for New interventions and Procedures (ASERNIP-S) and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) concluded that insufficient evidence is available to assess the safety of the open versus closed laparoscopy in regard to major vascular and visceral injuries. The aim of this study was to assess the relative safety of open and closed laparoscopy with respect to rates of major vascular and visceral injuries. A combined prospective/retrospective review of a single-surgeon series of 5900 open laparoscopies was performed. A meta-analysis of all reported series of open and closed laparoscopy was conducted using PubMed and MEDLINE search engines to compare major vascular and visceral injury rates. Medicolegal and manufacturer device reports were also reviewed. The case series of 5900 open laparoscopies reported a single visceral injury and no major vascular injuries. The meta-analysis revealed 336 major vascular injuries in 760,890 closed laparoscopies, a mean rate of 0.044%, 1 injury per 2272 cases, compared with 0 injuries in 22,465 open laparoscopies (P = 0.003). Visceral injuries occurred more frequently, 515 injuries in 760,890 closed laparoscopies (mean rate, 0.07) and 11 injuries in 22,465 open laparoscopies (mean rate, 0.05; P = 0.18). Medicolegal and device reports revealed a further 647 major vascular injuries and 500 major visceral injuries. In contrast to the conclusion formed by the RANZCOG and ASERNIP-S, the available evidence shows that open laparoscopy eliminates the risk of major vascular injury and reduces the rate of major visceral injuries. Open laparoscopy using the Hasson cannula should be the preferred method of peritoneal access.

Blood Vessels↗