Taylor Med Info

History of Medicine Prints digital collection

2012-02-06T13:51:00.001-05:00

"The McGill Library is pleased to launch the Osler Library PrintsCollection, a searchable and browsable website of 2,500 visualdocuments related to the history of medicine, spanning severalcenturies, countries, and artistic media. Ranging from theseventeenth to the twentieth century, the collection consistspredominantly of prints, though it also includes some photographs,drawings, posters, and cartoons. Medical professionals throughouthistory are represented largely through portraiture, as well asthrough caricatures and scenes. The images in this collection,acquired from various donors at different times, are fascinatingfor both their historical significance and their artistic merit.Straddling the disciplines of art and science, the collection is avaluable resource on the history of medicine and the history ofportraiture."

Where medical students actually find the answers

2012-01-19T10:20:00.003-05:00

An impressive work done by couple of medical librarains at U of T. Two med studetns finising 2nd year, are asked what resources they found useful in the library's collection for their studies.
You can find the video at http://guides.library.utoronto.ca/content.php?pid=222901&sid=1849893

APA PsycNet Free Trial

2012-01-18T13:46:00.000-05:00

Library is running a free trial for APA PsycNet. You have the opportunity to evaluate this interface, compared to the ProQuest interface, for PsycARTICLES, PsycINFO, PsycBOOKS, and PsycCRITIQUES. The trial runs for 60 days - starting January 16 until February 28.

The APA PsycNet trial is now available via keyword search in the library catalogue or on the Databases by title list, under A http://www.lib.uwo.ca/databases

Please send your comments to ntorabi AT uwo.ca no later than February 28.

Evaluating Sources

2012-01-16T10:17:00.002-05:00

This tutorial describing how to evaluate sources, brought to you by Western Libraries. It is a great video for your undergraduate students.

Medical apps

2012-01-12T14:48:00.004-05:00

Are you following iMedicalApps.com on Facebook? If you are interested in learning more about different medical apps, this is one approach.

DynaMed

2011-12-01T15:32:00.001-05:00

From EBSCO Publishing:

"Skyscape nowsupports the installation of DynaMedon up to up to five devices of the same operating system. For example, if youhave registered DynaMedon your iPhone, you can install it to your iPad using the sameserial number. When you install Skyscape/DynaMed on the iPad, all of theresources that were registered to your iPhone are automaticallyinstalled. This behavior will also apply to the Android and BlackBerryplatforms.

Themaintenance of switching/adding devices is handled through the My Accountpage on http://www.skyscape.com. If you want to have the product installed on a sixth device, you willneed to deactivate the subscription from one of the other five devices. You areable to do this from the My Accountpage."

Recommended Tools for Mobile Devices

2011-11-30T13:56:00.001-05:00

The new mobile apps page on our mobile site is launched. The mobile apps page restricts the list to only the apps that are compatible with your mobile device. This page provides the recommended resources, licensed and free medical applications for mobile devices. Click on the arrow to see the resource description and on the title to see the technical requirements and installation instructions. If you have any questions please contact me at ntorabi at uwo.ca

Summer Research Training Program

2011-11-28T10:59:00.000-05:00

If you need help with the literature search component of your SRTP application, you can contact me, your librarian, to make an appointment for consultation. Contact me at http://www.lib.uwo.ca/contact/nazitorabi.html

Take Action!

2011-11-03T13:15:00.003-04:00

“Remember: Your library card expires at graduation.” Visit the Right to Research Coalition at http://www.righttoresearch.org/

Excellence in Science

2011-11-01T10:49:00.003-04:00

The Royal Society historical journal archive for free. The announcement can be found here.

How Science Should Be!

2011-10-31T16:47:00.001-04:00

Today, I came across this article, How to choose a good scientific problem. It is a bit old but there are some interesting messages in it. It is only three pages long and if you have your own research lab or if you are thinking of doing graduate studies, I recommend you reading this article.

Open Access Week (Oct. 24-30)

2011-10-17T14:58:00.002-04:00

Digital Scholarship @ Western 2011

Date: Tuesday, Oct. 25, 2011
Time: 2:00 pm - 3:30 pm
Location: Social Science Centre, Room 3010

Speakers:
Dr. David Heap, Dept. of French Studies
Dr. Ileana Paul, Dept. of French Studies
Dr. James Voogt, Dept. of Geography

Scholarly Communication Standing Committee at Western libraries presents digital Scholarship @ Western."The speakers will talk about how researchers at Western use technologies to open up communication and facilitate collaboration with scholars around the world. This event is free and open to all. No registration is required."

CyberSafety

2011-10-04T17:00:00.001-04:00

October is CyberSafety month in Canada! Check out Get Cyber Safety page and learn how you can protect yourself.

Required Texts for UME students

2011-08-30T10:26:00.000-04:00

Now you can find some of the required year 1 & 2 medicine textbooks here. It is just one click away.

Pre-Tests

2011-08-18T10:48:00.007-04:00

Have you visited iTunes website lately to check out their most popular medical apps for your iphone. Check out this page to find some useful textbooks and self assessment guides.

UpToDate

2011-07-15T12:01:00.001-04:00

UpToDate is available for iPhone. Link: http://www.uptodate.com/home/about/iphone.html

However this app is not for institutional subscribers.

PDF Books Free to Download

2011-07-04T10:15:00.001-04:00

The National Academies Press, comprised of - National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council now provides access to their e-publications. You do have to register in order to view these books, and a list of available titles can be accessed through the main site: http://www.nap.edu/

The press release and details can be found here.

New DynaMed interface

2011-05-11T15:55:00.002-04:00

DynaMed with have a new look. Please visit the preview site here.

Springer Images TO GO

2011-05-04T11:25:00.000-04:00

In order to download Springer Images App on your mobile device for free please visit http://www.springerimages.com/mobile/

To access Spinger Images, find the link on the Multimedia Tab on any of Taylor's medical program pages: http://www.lib.uwo.ca/programs/generalmedicine/

F1000 Poster

2011-05-02T14:02:00.002-04:00

F1000 Poster includes posters from over 180 international meetings. It also provides an open access poster depository for researchers is the field of Biology and Medicine. For more information please visit http://posters.f1000.com/

Find Journals Impact Factors

2011-05-02T14:01:00.001-04:00

Publish in Open Access Journals

2011-04-01T09:50:00.002-04:00

The Public Library of Science (PLOS) and BioMed Central are two major open access (OA) publishers. They publish a variety of OA journals in Science, Technology, and Medicine as well as in areas related to Geography and Psychology. They charge authors a publication fee to cover the costs incurred by operating and maintaining the journals.

Western Libraries is an institutional member of both publishers. If authors from Western choose to publish with either publisher, they will enjoy a discount of the publication fee.

There are also many OA journals that do not charge a publication fee. Authors who are not sponsored by a research funding agency can choose to publish with them to enhance access to their publications. The Directory of Open Access Journals is a handy tool for authors to identify fee-free OA journals in their disciplines. If you have any questions about publishing in OA journals, please contact Adrian Ho.

HealthMesh

2011-03-23T10:26:00.001-04:00

HealthMash overview on Prezi

Have you found using Google frustrating for your simple clinical queries.? If the answer is yes, you might want to try using HealthMash instead. This search engine used different algorithm to search and sort results. If you would like to learn more about it, watch the Prezi presentation. Simply click on More, Full Screen, and then Auto Play.

LigerCat

2011-03-22T14:22:00.005-04:00

LigerCat was created as part of the Biology of Aging project at the MBLWHOI Library at the Woods Hole Marine Biological Laboratory.

LigerCat is a search tool for PubMed that displays tag clouds of key words (MeSH descriptors) associated with the result set. Also, it facilitates the use of plain language queries or molecular sequences to search the PubMed database for articles or to search for journal titles.

LigerCat also serves a Publication Data Histogram. In the Articles Search a Publication History graph is displayed in addition to the tag cloud. This is an interactive graph. Mousing over the graph will highlight years and display the number of articles from that year that your search retrieved. Clicking on the bar for that year performs the search in PubMed and takes you to that result page. In the Genes Search, the graph will not take you to PubMed but you still can see how many articles related to the query sequence were published in each year.

Please send feedback and suggestions to Holly Miller, Director of MBLWHOI Library at hmiller at mbl.edu

LigerCat: using “MeSH Clouds” from journal, article, or gene citations to facilitate the identification of relevant biomedical literature. Sarkar IN, Schenk R, Miller H, Norton CN. AMIA Annu Symp Proc. 2009 Nov 14;2009:563-7.

Henry Stewart Talks: Biomedical & Life Sciences Collection.

2011-03-11T14:57:00.005-05:00

If you have never heard of Henry Stewart Talks before maybe it is time to check them out. They are online seminars by leading world experts in different fields. The collections are constantly being expanded and updated. The most recent updates to The Biomedical & Life Sciences Collection are realted to ion channles, DNA Methylation, and other Topical Talks.

If you have any problem accessing this resource, please contact me at ntorabi at uwo.ca

Canadian Health Research Collection

2011-03-09T11:21:00.002-05:00

Western Libraries has recently subscribed to the Canadian Health Research Collection.

"CHRC is a collection of monograph publications from Canadian research institutes, government agencies and university centres working in the area of health and medical research. The organizations included in this collection are very active publishers of primary research in the field. The publications included are both general policy documents as well as those of a specialized technical nature. There are over 5,000 titles in the current (2004-2009) collection, and the service provides more than 1600 additional current documents to subscribers each year. Some of well-known publishers include the Canadian Nurses Association, Centre for Addiction and Mental Health (CAMH), Health Canada, National Aboriginal Health Organization, Statistics Canada, and many more."

You can gain access to this database through the Library Catalogue and the Databases by Title list.

Health Data Summit

2011-03-07T12:46:00.000-05:00

The Ontario Council of University Libraries (OCUL) is planning a Health Data Summit on March 28 in Toronto to identify and discuss creative solutions to remove existing barriers and improve accessibility to health data for research. All researchers working with health data or involved in creating health data are welcome to attend. Please see the flyer for further information.

AFMC-Infoway in Canada

2011-02-25T09:48:00.004-05:00

This can be a new start for medical informatics in Canadian medical schools and more collaboration between librarians, clinical faculty, and educators.

Importing Citations from PubMed into RefWorks

2011-02-10T14:31:00.002-05:00

Taylor Library's first web tutorial! Stay tuned for more tutorials on how to conduct a literature review.

New at Western: AccessMedicine

2011-01-03T12:03:00.000-05:00

AccessMedicine

Western Libraries is please to announce a new subscription to the clinical resource, AccessMedicine.

AccessMedicine is a repository of electronic textbooks (Harrison's, Hurst's The Heart, Current Medical Diagnosis & Treatment, Williams Obstetrics, etc.), videos, podcasts, guidelines, diagnostic tools, and much more.

AccessMedicine is a resource designed for students, residents, clinicians, researchers, and health professionals. It can be accessed through Western Libraries' catalogue and from many of the libraries' program pages, such as the Clinical Outreach page. Please select the tab for "Clinical Tools."

Top 10 Articles from 2010

2010-12-29T19:04:00.000-05:00

Daily Aspirin Use for Longer than 4 Years Associated with Reduced Long-Term Risk of Cancer Death

Aspirin has been linked to a reduction in the risk of certain colorectal cancers (N Engl J Med 2007 May 24;356(21):2131), but its effect on other cancers is unknown. A new systematic review assessed the relationship between aspirin use and overall cancer mortality using data from 8 randomized trials originally designed to evaluate aspirin for primary or secondary prevention of cardiovascular disease. A total of 25,570 patients were randomized to receive daily aspirin (≥ 75 mg) vs. placebo for ≥ 4 years. There were 674 total cancer deaths during the trials. Aspirin use was associated with reduced risk of cancer death (odds ratio 0.79, 95% CI 0.68-0.92), with an NNT of 106-429, based on 3% cancer mortality in the control groups (level 2 [mid-level] evidence). In a pooled analysis of individual patient data from 7 trials, there was no significant difference in cancer deaths between aspirin and control groups within the first 5 years of follow-up. However at ≥ 5 years, aspirin use was associated with reduced risk of death from any cancer (hazard ratio [HR] 0.66, 95% CI 0.5-0.87), from any gastrointestinal cancer (HR 0.46, 95% CI 0.27-0.77), and from any solid cancer (HR 0.64, 95% CI 0·49-0·85).

Three trials had 20-year follow-up data. In an analysis of 12,659 patients with 1,378 total cancer deaths, aspirin was associated with reduced 20-year risk of death from any gastrointestinal cancer (HR 0.65, 95% CI 0.54-0.78) and from any solid cancer (HR 0.8, 95% CI 0.72-0.88). Aspirin doses were 75 mg/day in 1 trial and ≥ 300 mg/day in the other 2 trials. The benefits of aspirin were similar for the different dosages. The greatest absolute reduction in risk of cancer death occurred in patients ≥ 65 years old (Lancet 2010 Dec 7 early online).

For more information, see the Aspirin topic in DynaMed. This article was featured in DynaMed Weekly Update 50.
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Compression-Only CPR and Standard CPR Appear to be Similarly Effective for Out-of-Hospital Cardiac Arrest When Performed by Untrained Bystanders

In cases of out-of-hospital cardiac arrest, early cardiopulmonary resuscitation (CPR) initiated before the arrival of trained emergency services may improve a patient's chances of survival. However, untrained bystanders may be reluctant or unable to correctly perform the rescue breathing portion of standard CPR. Improper rescue breathing may reduce the effectiveness of standard CPR. Observational results have suggested that CPR with chest compression alone may be at least as effective as full CPR when performed by untrained people (Lancet 2007 Mar 17;369(9565):920).

Two recent randomized trials compared these two approaches in patients with suspected cardiac arrest. In both trials, bystanders with no previous CPR experience who were calling for emergency assistance were instructed by dispatchers to perform either compression-only CPR or standard CPR (compression and rescue breathing) prior to the arrival of paramedics. In 1 trial with an analysis of 1,941 patients, survival to hospital discharge was 12.5% in the compression-only group and 11% in the standard group (not significant), with 14.4% vs. 11.5% surviving with favorable neurologic status (not significant) (N Engl J Med 2010 Jul 29;363:423). In the second trial, with an analysis of 1,276 patients, 1-day survival was 24% for compression-only vs. 20.9% for standard CPR (not significant) and 30-day survival was 8.7% vs. 7% (not significant) (N Engl J Med 2010 Jul 29;363:434). The analyses in both trials included only about one-third of the randomized patients due to exclusions following randomization (level 2 [mid-level] evidence).

These results do not suggest that chest compression alone is a substitute for standard CPR performed by trained individuals. However, this simplified approach to resuscitation may make untrained people more likely to start CPR. Medical offices receiving emergency calls from families of patients might wish to consider compression-only CPR as an immediate intervention.

For more information, see the Cardiac arrest topic in DynaMed. This article was featured in DynaMed Weekly Update 31.
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Intensive Systolic Blood Pressure Control May Not Reduce Mortality in Patients with Diabetes

Current guidelines from the American Diabetes Association (ADA) and other organizations recommend a blood pressure target < 130/80 mm Hg for patients with diabetes (Diabetes Care 2010 Jan;33 Suppl 1:S11). To date, there has been little experimental data to guide blood pressure target recommendations, but a new trial directly compared 2 different blood pressure goals. The Action to Control Cardiovascular Risk in Diabetes blood pressure trial (ACCORD BP) compared intensive systolic blood pressure control (target < 120 mm Hg) vs. standard control (target < 140 mm Hg) in 4,733 patients. While the trial did not stipulate specific antihypertensive regimens, patients in both groups were required to receive a drug class associated with reduction in cardiovascular events in patients with diabetes (ACE inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, or diuretics). They could also receive other medications as necessary. Mean systolic blood pressure from the end of first year to end of follow-up was 119.3 mm Hg for the intensive group and 133.5 mm Hg for the standard group. Systolic blood pressure target < 120 mm Hg does not reduce mortality or myocardial infarction but does reduce nonfatal stroke compared to target < 140 mm Hg (level 1 [mid-level] evidence). During a mean follow-up of 4.7 years, cardiovascular mortality was 2.5% in each group. There were no significant differences in all-cause mortality (6.3% vs. 6.1%), nonfatal myocardial infarction (5.3% vs. 6.2%), or heart failure (3.5% vs. 3.8%). Stroke occurred in 1.7% of the intensive group compared to 2.6% of the standard group (p = 0.01, NNT 84). However, the risk of serious adverse events from treatment was increased for the intensive group (3.3% vs. 1.3%, p < 0.001, NNH 50). Adverse events reported (not all individually significant) included hypotension, syncope, bradycardia or other arrhythmia, hyperkalemia, angioedema, and renal failure (N Engl J Med. 2010 Apr 29;362(17):1575).

For more information, see the Hypertension treatment in patients with diabetes topic in DynaMed. This article was featured in DynaMed Weekly Update 13.
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Glucosamine and Chondroitin either Separately or in Combination Appear to Lack Efficacy for Improving Pain in Osteoarthritis of Hip or Knee

In an earlier review of 25 randomized trials with significant statistical heterogeneity, there was inconsistent evidence for pain relief with glucosamine, but there was no significant improvement in analysis of 11 trials that had adequate allocation concealment (Cochrane Database Syst Rev 2009 Oct 7;(4):CD002946).

Glucosamine and chondroitin, alone and in combination, have become popular in recent years as both prescription and over-the-counter supplements for joint pain. A recent systematic review of 10 randomized trials evaluated their efficacy in 3,803 patients with hip or knee osteoarthritis. The review excluded trials with fewer than 100 patients in each arm. Neither supplement was found to produce clinically significant reductions in pain in any formulation (level 2 [mid-level] evidence). In all studies, pain was measured on a 10 cm visual analog scale, with a change of > 0.9 cm deemed clinically significant. The mean reductions compared to placebo were 0.4 cm (95% CI -0.7 to -0.1 cm) for glucosamine alone in analysis of 7 trials, 0.3 cm (95% CI -0.7 to 0 cm) for chondroitin alone in analysis of 4 trials, and 0.5 cm (95% CI -0.9 to 0 cm) for the combination in 1 trial. There were no significant differences in adverse events in comparisons of either drug to placebo (BMJ 2010 Sep 16;341:c4675full-text).

For more information, see the Degenerative joint disease of the hip and Degenerative joint disease of the knee topics in DynaMed. This article was featured in DynaMed Weekly Update 41.
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Initial Oral Corticosteroid Treatment Appears as Effective as Initial IV Corticosteroids for Patients Hospitalized with Acute Exacerbation of COPD

High-dose intravenous corticosteroids are widely prescribed for patients admitted to the hospital with acute exacerbation of COPD, despite guidelines recommending oral steroids at lower doses (for a synthesis of 3 guidelines, see National Guideline Clearinghouse 2010 May 24:COPD_ACUTE10). A recent retrospective analysis of 79,985 hospitalized patients who received steroids for COPD exacerbation at 414 centers in the United States found that 92% were initially treated with IV steroids, while only 8% initially received oral steroids. However, outcome measures suggest that oral steroids for initial treatment may be at least as effective as IV steroids (level 2 [mid-level] evidence). Over the first 2 days, median doses (prednisone equivalents) were 60 mg in patients receiving oral steroids and 600 mg in patients receiving IV steroids. A total of 1,356 patients (22%) initially prescribed oral steroids were switched to IV steroids during hospitalization. The primary measure was treatment failure, defined as the composite of 3 outcomes: in-hospital mortality, initiation of mechanical ventilation after the second hospital day, and readmission for acute exacerbation of COPD within 30 days. Treatment failure occurred in 10.3% of the oral group and 10.9% of the IV group (not significant). In-hospital mortality was significantly lower in the oral group (1% vs. 1.4%, p = 0.01).

To control for potential baseline differences, a subgroup analysis compared patients from the 2 groups that were matched by "propensity scores" for initial treatment with oral steroids. Propensity scores were based on patient characteristics (including demographic and insurance factors), comorbidities, all other early treatments and diagnostic tests, and hospital characteristics. In this comparison, initial treatment with oral steroids was associated with reduction in risk of treatment failure (odds ratio 0.84, 95% CI 0.75-0.95), shorter hospital stay (odds ratio 0.9, 95% CI 0 0.88-0.91), and lower hospital costs (odds ratio 0.91, 95% CI 0.89-0.93) (JAMA 2010 Jun 16;303(23):2359).

For more information, see the Acute exacerbation of chronic bronchitis topic in DynaMed. This article was featured in DynaMed Weekly Update 25.
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Lenient Rate Control and Strict Rate Control for Atrial Fibrillation Appear to have Similar Cardiovascular Outcomes

Rate control and rhythm control strategies have been associated with similar rates of stroke and death in patients with chronic atrial fibrillation (Arch Intern Med 2005 Feb 14;165(3):258). A target heart rate of 60-80 beats per minute has been suggested by the American College of Cardiology, but this has not been based on studies with clinical outcomes. To address this issue, a randomized trial compared "lenient" rate control (resting heart rate < 110 beats/minute) vs. "strict" rate control (resting heart rate < 80 beats/minute and heart rate during moderate exercise < 110 beats/minute) in patients with permanent atrial fibrillation. The desired rate control was achieved through the use of beta blockers, calcium channel blockers, and digoxin, alone or in combination. The primary outcome was a composite of death, hospitalization for heart failure, stroke, major bleeding, or significant arrhythmic events. The 3-year estimated cumulative incidence of the primary composite outcome was 12.9% with lenient control vs. 14.9% with strict control (level 2 [mid-level] evidence). There were no significant differences between groups in rates of dyspnea, fatigue, palpitations, or New York Heart Association (NYHA) functional class. The authors concluded that lenient rate control was as effective as strict rate control for the prevention of major cardiovascular events (N Engl J Med. 2010 Apr 15;362(15):1363).

For more information, see the Rate control in atrial fibrillation topic in DynaMed. This article was featured in DynaMed Weekly Update 12.
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Probiotic Lactobacillus reuteri May Reduce Crying Time in Infants with Colic Symptoms

Colic can be stressful for newborns and new parents alike. Previous research has suggested that L. reuteri may reduce symptoms compared to simethicone in colicky infants (Pediatrics 2007 Jan;119(1):e124). A new blinded, placebo-controlled trial with 50 infants provides further support for the efficacy of probiotics. Infants aged 2-16 weeks old with fussy crying episodes lasting at least 3 hours over at least 3 days (modified Wessel's criteria for colic diagnosis) were randomized to L. reuteri vs. placebo for 21 days. L. reuteri was given as 108 colony-forming units in 5 drops of oil suspension, 30 minutes before morning feeding. All infants had been exclusively breastfed, and mothers were asked to avoid cow's milk during the trial. At baseline, the median crying time was 370 minutes per day for the L. reuteri group and 300 minutes per day for controls (not significant). At 21 days' follow-up, the L. reuteri group had significantly reduced crying time (median total crying time 35 minutes per day vs. 90 minutes per day, p = 0.022) (level 2 [mid-level] evidence). The proportion of infants with at least 50% reduction in crying time from baseline was significantly higher in the L. reuteri group at 7, 14, and 21 days (Pediatrics 2010 Sep;126(3):e526).

For more information, see the Infantile colic topic in DynaMed. This article was featured in DynaMed Weekly Update 34.
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Short-Acting Antibiotics for 5 Days Might Be Less Effective than Longer Course Antibiotic Treatments for Children with AOM

Acute otitis media (AOM) is the most common reason children are prescribed antibiotics in the United States. While the optimal treatment duration is unclear, previous studies, including a Cochrane review from 2000, have suggested that short courses of treatment (< 7 days) may be as effective as longer courses. A recent update of that Cochrane review provides evidence that treatment with short-acting antibiotics for 5 days is associated with significantly higher rates of treatment failure than longer course treatments (level 2 [mid-level] evidence). The review examined 49 moderate-quality randomized trials comparing short vs. long course antibiotic regimens in 12,000 children (aged 1 month to 18 years) with a clinical diagnosis of acute otitis media. The primary outcome was treatment failure within 1 month, defined as absence of clinical resolution, relapse, or recurrence of AOM following initiation of therapy. In an analysis of 16 trials of short-acting antibiotics (e.g. amoxicillin), treatment for 5 days was associated with increased risk of treatment failure (OR 1.34, 95% CI 1.15-1.55) compared to 8-10 days of treatment. This corresponds to an NNH of 11-41, assuming treatment failure in 16% of children receiving longer treatment. This result might be due to differences in efficacy for children with and without a history of ear infections. Five-day treatment had a higher failure rate in analysis of 6 trials that included children with a history of recurrent AOM, but not in 4 trials that excluded these patients. For oral azithromycin, treatment for 3-5 days was associated with increased treatment failure at 8-19 days' follow-up compared to longer treatments (OR 1.27, 95% CI 1.04-1.55), but there was no significant difference by 20-30 days' follow-up. The risks of gastrointestinal adverse effects were significantly reduced with short course treatments for both short-acting antibiotics and azithromycin. The authors suggest that clinicians must weigh the relative benefits and harms of longer treatment durations (Cochrane Database Syst Rev 2010 Sep 08;(9):CD001095).

Guidelines from the American Academy of Pediatrics recommend antibiotics for 10 days in children < 6 years old and children with severe disease and for 5-7 days in children ≥ 6 years old with mild to moderate disease (Pediatrics. 2004 May;113(5):1451).

For more information, see the Acute otitis media (AOM) topic in DynaMed.
This article was featured in DynaMed Weekly Update 39.
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Sentinel Lymph Node Resection Alone Is As Effective As Axillary Lymph Node Dissection For Women with Node-Negative Invasive Breast Cancer

Sentinel lymph node (SLN) resection has been advocated as an option to reduce morbidity for women undergoing surgery for breast cancer. When the sentinel node is negative for breast cancer, SLN resection without axillary lymph node dissection (ALND) should minimize the adverse effects, such as arm swelling, numbness, and tingling. New reports from the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32 trial show that SLN resection is as effective for survival as ALND and may reduce post-surgical morbidity and symptoms in node-negative women. A total of 5,611 women with invasive breast cancer and clinically negative nodes were randomized to SLN resection with ALND only if SLN-positive vs. immediate ALND without waiting for biopsy results. The primary analysis was performed on 3,986 women (71%) who were SLN-negative. There were no significant differences between groups in overall survival (90.3% vs. 91.8%) or progression-free survival (81.5% vs. 82.4%) over 8 years (level 1 [likely reliable] evidence). There were also no significant differences in local recurrence (2.4% vs. 2.7%), distant metastases (3.2% vs. 2.8%), cancer in the opposite breast (2.2% vs. 2.8%), or second non-breast cancer (5.4% vs. 4.5%) (Lancet Oncol 2010 Oct;11(10):927).

In a report of 3-year post-surgical follow-up, SLN resection alone was associated with reductions in residual arm tingling (7.5% vs. 13.5%, p < 0.001, NNT 17), numbness (8.1% vs. 31.1%, p < 0.001, NNT 5), lower rates of significant shoulder abduction deficits (5.7% vs. 9%, p < 0.001, NNT 31), and arm volume differences (7.5% vs. 14.3%, p < 0.001, NNT 15) (level 2 [mid-level] evidence) (J Surg Oncol 2010 Aug 1;102(2):111). In a subgroup of 749 women with negative SLNs who completed symptom questionnaires, SLN resection alone was associated with reduced rates of bothersome arm symptoms, restricted work and social activity, and impaired quality of life (level 2 [mid-level] evidence) (J Clin Oncol 2010 Sep 1;28(25):3929).

For more information, see the Breast cancer (female) topic in DynaMed. This article was featured in DynaMed Weekly Update 43.
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Preliminary Data Suggest that Low-Dose Computed Tomography (CT) Screening May Reduce Lung Cancer Mortality and All-Cause Mortality

Guidelines from USPSTF and Canadian Task Force for Preventive Health Care do not recommend lung cancer screening, even in persons who smoke. The National Lung Screening Trial (NLST) evaluated the efficacy of low-dose CT for lung cancer screening in 53,454 current and former smokers aged 55-74 years with a history of > 30 pack-years. Patients were randomized to low-dose CT vs. chest radiography offered at baseline and at 2 annual follow-up visits. Findings were announced in a preliminary, unpublished report from the trial's Data and Safety Monitoring Board. Initial screens were positive for abnormality in 27.3% vs. 9.2%. Lung cancers were detected in 649 patients by screening CT and in 279 patients by chest x-ray. Lung cancer mortality rates were 245.7 per 100,000 patient-years vs. 308.3 per 100,000 patient-years (p < 0.05). The DynaMed Editors estimate the overall lung cancer mortality at 1.345% vs. 1.697% (NNS 284, 95% CI 179-706). All-cause mortality rates were 1,117.2 per 100,000 patient-years with CT screening vs. 1,200 per 100,000 patient-years with radiography (p < 0.05), with estimated all-cause mortality 7.106% vs. 7.662% (NNS 178, 95% CI 100-926) (level 2 [mid-level] evidence). The trial was terminated early at an interim analysis in October 2010 due to a significant difference between groups that met a pre-specified stopping rule (NLST Data and Safety Monitoring Board statement 2010 Oct 28, National Cancer Institute Press Release 2010 Nov 4).

For more information, see the Lung cancer topic in DynaMed. This article was featured in DynaMed Weekly Update 45.

Article Most Likely to Change Clinical Practice - Week Ending Dec 10, 2010

2010-12-16T10:02:00.003-05:00

Daily Aspirin Use for Longer than 4 Years Associated with Reduced Long-Term Risk of Cancer Death

Aspirin has been linked to a reduction in the risk of certain colorectal cancers (N Engl J Med 2007 May 24;356(21):2131), but its effect on other cancers is unknown. A new systematic review assessed the relationship between aspirin use and overall cancer mortality using data from 8 randomized trials originally designed to evaluate aspirin for primary or secondary prevention of cardiovascular disease. A total of 25,570 patients were randomized to receive daily aspirin (≥ 75 mg) vs. placebo for ≥ 4 years. There were 674 total cancer deaths during the trials. Aspirin use was associated with reduced risk of cancer death (odds ratio 0.79, 95% CI 0.68-0.92), with an NNT of 106-429, based on 3% cancer mortality in the control groups (level 2 [mid-level] evidence). In a pooled analysis of individual patient data from 7 trials, there was no significant difference in cancer deaths between aspirin and control groups within the first 5 years of follow-up. However at ≥ 5 years, aspirin use was associated with reduced risk of death from any cancer (hazard ratio [HR] 0.66, 95% CI 0.5-0.87), from any gastrointestinal cancer (HR 0.46, 95% CI 0.27-0.77), and from any solid cancer (HR 0.64, 95% CI 0·49-0·85).

Three trials had 20-year follow-up data. In an analysis of 12,659 patients with 1,378 total cancer deaths, aspirin was associated with reduced 20-year risk of death from any gastrointestinal cancer (HR 0.65, 95% CI 0.54-0.78) and from any solid cancer (HR 0.8, 95% CI 0.72-0.88). Aspirin doses were 75 mg/day in 1 trial and ≥ 300 mg/day in the other 2 trials. The benefits of aspirin were similar for the different dosages. The greatest absolute reduction in risk of cancer death occurred in patients ≥ 65 years old (Lancet 2010 Dec 7 early online).

For more information, see the Aspirin topic in DynaMed.

Micromedex Unavailable

2010-12-10T15:57:00.002-05:00

Micromedex is unavailable through Western Libraries as free access is no longer being provided to educational institutions. We are investigating subscription options for this product. We apologize for the inconvenience and recommend the use of DynaMed, ACP PIER, UpToDate or e-CPS for finding clinical or drug information.

New Open Courseware for Epidemiology and Global Health from University of Pittsburgh

2010-12-10T09:43:00.000-05:00

Supercourse is a global repository of lectures on public health and prevention targeting educators across the world. Supercourse has a network of over 65,000 scientists in 174 countries who are sharing more than 4700 lectures in 31 languages.

Updated List of the Best Medical iPhone Apps

2010-12-09T11:51:00.001-05:00

Check out Software Advice's list of The Best Medical iPhone Apps. With over 10,000 medical apps available from the App Store, this list helps narrow the field down to the best 70, categorized by specialties.

Great Resource: Top 100 Canadian Health Websites

2010-12-09T09:11:00.001-05:00

Looking for Canadian health information? Here's a great start point: HLWiki's Top 100 Canadian Health Websites

Thanks Dean for putting this list together!

Article Most Likely to Change Clinical Practice - Week Ending Dec 3, 2010

2010-12-09T09:05:00.000-05:00

Institute of Medicine Releases New Dietary Reference Intakes for Calcium and Vitamin D

Calcium and vitamin D are essential nutrients for bone health. However, the optimum amounts that should be obtained through diet or supplements have not been definitively established. The Institute of Medicine (IOM) recently conducted a comprehensive literature review to provide dietary and supplementation recommendations. For both calcium and vitamin D, Recommended Dietary Allowances (RDAs) were established for all age groups except infants aged 0-12 months. RDAs are used when there is sufficient evidence to determine estimated average requirements; an RDA is expected to meet the requirement for 97% of the population. When there is insufficient evidence to determine RDAs, values are provided as Adequate Intakes (AIs), which are the amounts considered likely to maintain adequate status.

The new daily RDAs for vitamin D are 600 units for people aged 1-70 years, including pregnant and lactating women, and 800 units for adults > 70 years old. The AI for vitamin D for infants aged 0-12 months is 400 units. The new daily RDAs for calcium for adults are 1,000 mg if ≤ 70 years old, and 1,200 mg if > 70 years old. For children, the calcium RDA ranges from 700 mg/day for ages 1-3 years, up to 1,300 mg/day for ages 9-18 years. For infants, the AI is 200 mg/day for ages 0-6 months and 260 mg/day for ages 6-12 months. Tolerable upper intake levels (ULs) were also revised and vary by age but are generally 4,000 units/day for vitamin D and 2,000 mg/day for calcium.

The committee concluded that the majority of American and Canadian men under age 70 have adequate dietary intakes of calcium, but dietary calcium may be low for most women, especially adolescent girls. Data are less clear regarding the adequacy of vitamin D intake because of the difficulty in accounting for sun exposure. Data about health outcomes other than bone health were unreliable because studies often had mixed or inconclusive results. They also noted that the cut-off for determining vitamin D deficiency had not been scientifically established but that serum 25OHD levels ≥ 50 nmol/L (20 ng/mL) appear adequate for most people. They cautioned that using higher thresholds for starting treatment could result in unnecessary supplementation (Institute of Medicine Report Brief 2010 Nov 30). The full prepublication report can be found at National Academies Press.

For more information, see the Vitamin D intake and supplementation and Calcium intake and supplementation topics in DynaMed.

Article Most Likely to Change Clinical Practice - Week Ending Nov 26, 2010

2010-12-02T13:09:00.000-05:00

Preexposure Chemoprophylaxis Reduces Incidence of HIV Infection in Men who have Sex with Men

Postexposure HIV prophylaxis has been recommended, but the window to start treatment is short (72 hours) and evidence for its efficacy is limited. The Preexposure Prophylaxis Initiative (iPrEx) trial evaluated the safety and efficacy of a 2-drug cocktail for HIV chronic prophylaxis in 2,499 men and transgender women who have sex with men. Participants, who were HIV-negative at baseline, were randomized to a combination of emtricitabine and tenofovir vs. placebo orally once daily and were followed for median 1.2 years. All participants received HIV testing, risk-reduction counseling, condoms, and management of sexually transmitted infections. HIV infection rates were significantly lower in the prophylaxis group (2.9% vs. 5.1%, p = 0.005, NNT 46) (level 1 [likely reliable] evidence). There were no significant differences in overall or serious adverse events or in study drug discontinuation. Of potential concern, chemoprophylaxis was associated with higher rates of unintended weight loss of more than 5% (2.2% vs. 1.1%, p = 0.04, NNH 91). It was also associated with higher rates of nausea (1.6% vs. 0.7%,p = 0.04, NNH 111). In a subgroup analysis of the chemoprophylaxis group, participants with detectable levels of the study drug had decreased risk of HIV infection compared to those without detectable levels (relative risk reduction 92%, 95% CI 70%-99%) (N Engl J Med 2010 Nov 23 early online full-text).

For more information, see the HIV infection topic in DynaMed.

UpToDate Enhancements

2010-12-02T13:06:00.000-05:00

UpToDate has just completed an upgrade. Version 18.3 includes some new features, like "The Basics" which is a new patient information newsletter. For full details of the upgrade, please see UpToDate's news release.

FirstConsult Now Available as a Free iPhone App!

2010-11-26T16:29:00.000-05:00

Follow these instructions to get started. If you don't have a First Consult user account, create one for free. This is a "free trial," but there is no end date for the trial. First Consult is a quality clinical tool from Elsevier, so please check out the app and see if you like it.

24/7 Hours Will be Back at Weldon Library

2010-11-26T12:23:00.002-05:00

From December 10-17 Weldon Library will be open 24 hours a day, 7 days a week. In addition Weldon will be open until 2 a.m. December 8-9 and December 18-20.

Taylor Library will be open until midnight from December 8-20.
http://www.lib.uwo.ca/news/wl/2010/11/24/247libraryhoursareback.html

Pediatrics Study Finds ER Visits Decline After Withdrawal of Cough & Cold Medicine

2010-11-22T15:35:00.000-05:00

The journal Pediatrics just published a study revealing a dramatic decrease in the number of emergency department visits for infants following a voluntary market withdrawal of cough & cold medication. Read the whole article here: http://pediatrics.aappublications.org/cgi/reprint/peds.2010-1839v1

Mobile Tools (including UpToDate) available from WL's Mobile Website

2010-11-17T13:48:00.001-05:00

Western Libraries' mobile website now includes links to databases customized for Smart Phones and other web-enabled handheld devices.

From the library's mobile home page, select Databases:

Then find links to CINAHL Mobile, Medline Plus, Micromedex, PubMed Mobile and UpToDate from the list of mobile-friendly databases:

Unrestricted Access Now Available to AMA's Newspaper

2010-11-12T10:49:00.000-05:00

American Medical News, the award-winning newspaper published by the American Medical Association (AMA), announced today it is offering unrestricted access to its online news archive at amednews.com

The online news archive dates back to January 2000, with selected earlier content. It represents a rich resource on issues confronting physicians and trends in medicine. Content includes in-depth reporting on the business and regulatory sides of health care, practice management and hot issues in public health and patient care.

Article Most Likely to Change Clinical Practice - Week Ending Nov. 5, 2010

2010-11-11T08:59:00.002-05:00

In Selected Women with Breast Cancer and Positive Sentinel Lymph Node Metastases, Axillary Lymph Node Dissection May Not Be Needed

In a recent Weekly Update, the DynaMed Editors reported on a randomized trial with level 1 evidence showing that sentinel lymph node (SLN) resection alone is as effective as SLN resection plus axillary lymph node dissection (ALND) for women with node-negative invasive breast cancer. Another recent trial has compared SLN resection alone to SLN resection plus ALND in 856 women positive for SLN metastases. Women were randomized to have completion ALND or no ALND following a finding of metastatic disease in a SLN resection. Among the reasons for excluding patients from the trial were the presence of matted nodes, ≥ 3 SLNs with metastases, bilateral breast cancer, and gross extranodal disease at time of SLN resection. Comparing SLN resection alone vs. SLN resection plus ALND after median follow-up of 6.3 years, there were no significant differences in either local recurrence (1.8% vs. 3.6%) or regional recurrence (0.9% vs. 0.5%) (level 2 [mid-level] evidence). The trial was stopped early due to slow enrollment after enrolling only about half the calculated number of patients needed for 90% power (Ann Surg 2010 Sep;252(3):426).

For more information see the Breast cancer (female) topic in DynaMed.

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Preliminary Data Suggest that Low-Dose Computed Tomography (CT) Screening May Reduce Lung Cancer Mortality and All-Cause Mortality

Guidelines from USPSTF and Canadian Task Force for Preventive Health Care do not recommend lung cancer screening, even in persons who smoke. The National Lung Screening Trial (NLST) evaluated the efficacy of low-dose CT for lung cancer screening in 53,454 current and former smokers aged 55-74 years with a history of > 30 pack-years. Patients were randomized to low-dose CT vs. chest radiography offered at baseline and at 2 annual follow-up visits. Findings were announced in a preliminary, unpublished report from the trial's Data and Safety Monitoring Board. Initial screens were positive for abnormality in 27.3% vs. 9.2%. Lung cancers were detected in 649 patients by screening CT and in 279 patients by chest x-ray. Lung cancer mortality rates were 245.7 per 100,000 patient-years vs. 308.3 per 100,000 patient-years (p < 0.05). The DynaMed Editors estimate the overall lung cancer mortality at 1.345% vs. 1.697% (NNS 284, 95% CI 179-706). All-cause mortality rates were 1,117.2 per 100,000 patient-years with CT screening vs. 1,200 per 100,000 patient-years with radiography (p < 0.05), with estimated all-cause mortality 7.106% vs. 7.662% (NNS 178, 95% CI 100-926) (level 2 [mid-level] evidence). The trial was terminated early at an interim analysis in October 2010 due to a significant difference between groups that met a pre-specified stopping rule (NLST Data and Safety Monitoring Board statement 2010 Oct 28, National Cancer Institute Press Release 2010 Nov 4).

For more information, see the Lung cancer topic in DynaMed.

New Look for Evidence-Based Alternative Medicine Information

2010-11-09T09:41:00.000-05:00

It would seem I don't have to complain about Natural Standard's web interface anymore - it's been completely overhauled and is much improved!

Check out the new Natural Standard below:

On-campus link: http://www.naturalstandard.com/

Off-campus link: https://www.lib.uwo.ca/cgi-bin/ezpauthn.cgi?url=http://www.naturalstandard.com/

Article Most Likely to Change Clinical Practice - Week Ending October 29, 2010

2010-11-04T13:15:00.003-04:00

Medical Team Training Including Surgical Checklists Associated with Reduced Surgical Mortality

A surgical safety checklist developed by the WHO (PDF) to facilitate communication and safety checks was associated with reduced surgical mortality in a before-and-after study at 8 hospitals (N Engl J Med 2009 Jan 29;360(5):491). Now, a large cohort study with 182,409 surgical procedures conducted at Veterans Health Administration (VHA) facilities from 2006-2008 has assessed the efficacy of a team training program that incorporates a checklist. This team training program is now mandated at all VHA facilities where surgery is performed. The program emphasizes teamwork and communication among clinicians, with training in the use of a checklist to guide pre- and postoperative briefings; strategies for communicating safety risks and red flags; rules for conduct of communication; and effective communication during care transitions.

Surgical outcomes at 74 VHA facilities that implemented the training program during the study period were compared to outcomes from 34 facilities that had not started the training. Because implementation of the program was not randomized, facilities were propensity-matched for the probability of starting the program during the study period. Matching was based on a number of factors including baseline mortality and morbidity rates and hospital size, location, and surgical load. There were no significant differences in mortality between the trained and untrained facilities at baseline. Facilities with training had a decrease in average surgical mortality rates from 17 to 14 per 1,000 procedures. At the end of the study, trained facilities had an 18% reduction in annual mortality compared to baseline (rate ratio 0.82, 95% CI 0.76-0.91), while mortality dropped at untrained facilities by 7% (not significant). In a propensity-matched analysis, training was associated with a significantly greater risk reduction in surgical mortality compared to no training (rate ratio 1.49, 95% CI 1.1-2.07) (level 2 [mid-level] evidence) (JAMA 2010 Oct 20;304(15):1693).

For more information, see the Surgical Safety Checklist topic in DynaMed.

New Images Database from the NIH

2010-11-01T10:08:00.000-04:00

More than 2.5 million images and figures from medical and life sciences journals are now available through Images, a new resource for finding images in biomedical literature. The database was developed and will be maintained by the National Center for Biotechnology Information (NCBI), a division of the National Library of Medicine (NLM) at the National Institutes of Health. Images is available at http://www.ncbi.nlm.nih.gov/images.

Images to be Included in PubMed

2010-10-29T11:51:00.000-04:00

The National Library of Medicine announced this week that they will enhance PubMed's results display with images from their new NCBI Images Database: http://www.nlm.nih.gov/pubs/techbull/so10/so10_pm_display_ncbi_images.html

UpToDate Access Restored

2010-10-28T18:04:00.000-04:00

IP Authenticated access to UpToDate has been restored for the campus at the University of Western Ontario and the London-area hospitals.

Links from Western Libraries' website and the Hospitals are currently functioning and off-site ("remote") access is available through Western Libraries' proxy servers.

On-campus & Hospital link: http://www.uptodate.com/online
Off-site: https://www.lib.uwo.ca/cgi-bin/ezpauthn.cgi?url=http://www.uptodate.com/online

UpToDate Access Unavailable

2010-10-28T09:03:00.000-04:00

We're experiencing technical problems this morning and UpToDate access is currently unavailable. Every effort is being made to restore the service and we appreciate your patience.

PEPID for iPad Users

2010-10-27T15:51:00.000-04:00

PEPID is looking for Beta testers for their iPad application. Sign-up on their website to download the software for free: http://www.pepid.com/iPad-medical-apps/

UpToDate URL Change: Update your bookmarks!

2010-10-26T22:15:00.000-04:00

The URL for Western's institutional subscription to UpToDate has changed. Please change your personal bookmarks to:

https://www.lib.uwo.ca/cgi-bin/uptodate.pl

Library links have been corrected and are functioning, but WebCT pages and other departmental pages may need updating.

The new URL will ask you to enter your Western Identity whenever you access UpToDate, regardless of whether or not you are on or off campus. To link to UpToDate from off-campus it is no longer necessary to log on to Western Libraries' proxy servers.

The exception is when you access UpToDate from one of the London-area hospitals. No authentication is required as access is IP authenticated - just connect to UpToDate's website from a networked computer as per usual.

A - for Western Libraries

2010-10-26T11:28:00.000-04:00

Western Libraries remained in top spot in the Globe & Mail's Canadian University Report 2011 released this week. Western, along with Laval, McGill and the University of Toronto received a grade of A- , according to a survey of students.

The complete 2011 report is available at: http://www.globecampus.ca/in-the-news/globecampusreport/university-report-e-zine-includes-the-latest-survey-results-on-which-schools-made-the-grade/

NY Times: Losing Touch With the Patient

2010-10-22T13:07:00.000-04:00

Thought-provoking article in the NY Times about fear of contagion and the isolating experience of infectious patients: http://www.nytimes.com/2010/10/21/health/views/21chen.html

New Electronic Purchase: ACS Surgery

2010-10-21T09:08:00.000-04:00

The electronic version of the official American College of Surgeons publication, ACS Surgery: Principles & Practice offers authoritative recommendations on current surgical care from over 200 master surgeons. Please see the tab for "Classic Texts" on Western Libraries' Surgery Page to link to this resource: http://www.lib.uwo.ca/programs/surgery/

Something for History of Medicine

2010-10-16T14:29:00.000-04:00

The National Archives, UK, has digitized the contents of the Royal Navy Medical Officers' journals from 1793 to 1880. These meticulous records contain patient histories, symptoms, treatments and "include a variety of colourful tales of 18th and 19th century ship life, from drunken rum-related incidents, venereal disease, scurvy, shark bites and tarantulas, to lightning strikes, gun fights, mutiny, arrests and court martial - not to mention ship wrecks and even murder": http://www.nationalarchives.gov.uk/surgeonsatsea/

Article Most Likely to Change Clinical Practice - Week Ending Oct 8th, 2010

2010-10-13T16:49:00.001-04:00

Glucosamine and Chondroitin either Separately or in Combination Appear to Lack Efficacy for Improving Pain in Osteoarthritis of Hip or Knee

Glucosamine and chondroitin, alone and in combination, have become popular in recent years as both prescription and over-the-counter supplements for joint pain. A recent systematic review of 10 randomized trials evaluated their efficacy in 3,803 patients with hip or knee osteoarthritis. The review excluded trials with fewer than 100 patients in each arm. Neither supplement was found to produce clinically significant reductions in pain in any formulation (level 2 [mid-level] evidence). In all studies, pain was measured on a 10 cm visual analog scale, with a change of > 0.9 cm deemed clinically significant. The mean reductions compared to placebo were 0.4 cm (95% CI -0.7 to -0.1 cm) for glucosamine alone in analysis of 7 trials, 0.3 cm (95% CI -0.7 to 0 cm) for chondroitin alone in analysis of 4 trials, and 0.5 cm (95% CI -0.9 to 0 cm) for the combination in 1 trial. There were no significant differences in adverse events in comparisons of either drug to placebo (BMJ 2010 Sep 16;341:c4675 full-text).

In an earlier review of 25 randomized trials with significant statistical heterogeneity, there was inconsistent evidence for pain relief with glucosamine, but there was no significant improvement in analysis of 11 trials that had adequate allocation concealment (Cochrane Database Syst Rev 2009 Oct 7;(4):CD002946).

For more information, see the Degenerative joint disease of the hip andDegenerative joint disease of the knee topics in DynaMed.

New UpToDate License

2010-10-07T10:59:00.000-04:00

In consultation and with support from Schulich School of Medicine & Dentistry, Western Libraries have signed a four-year license for the information product UpToDate which will go into effect immediately.

The new UpToDate license will include remote access, meaning that Western-affiliated students (including those at Windsor campus), faculty, SWOMEN members, or staff persons may use UpToDate from any location using their Western Identity (user name and password) to log in to Western Libraries’ proxy servers.

The license will also include on-site access at the University of Western Ontario, London Health Sciences Centre, and St. Joseph’s Health Care, including these locations:

Byron Family Medical Centre
Children’s Hospital
Parkwood Hospital
Regional Mental Health Care London
Regional Mental Health Care St. Thomas
South Street Hospital
St. Joseph’s Hospital
Victoria Family Medical Centre
Victoria Hospital
University Hospital.

Any individual at these sites may access UpToDate without having to log in to Western’s proxy servers, provided they are on a networked computer belonging to the institutions’ IP ranges.

Access to this heavily-used information product will continue until 2014, but the long-term sustainability of Western’s arrangement with UpToDate is a cause for concern to both Western Libraries and Schulich. The cost to license UpToDate for our large community has stretched the capacity of current budgets, and over the next four years, in consultation with Schulich, Western Libraries will be evaluating alternative clinical information products.

To access Western-subscribed, point-of-care information tools, please see the “Clinical Tools” tab on Western Libraries’ Clinical Outreach page: http://www.lib.uwo.ca/programs/clinicaloutreach/

Please direct any comments or questions about UpToDate or any other clinical information tools to Robin Featherstone, Clinical Medicine Librarian, at rfeathe@uwo.ca

Article Most Likely to Change Clinical Practice - Week Ending Oct 1, 2010

2010-10-07T09:23:00.000-04:00

Beta Blockers Combined with Behavioral Management May Reduce Migraine Frequency in Adults

The American Academy of Neurology includes beta blockers in its guidelines for migraine prophylaxis (Neurology 2000 Sep 26;55(6):754). A recent randomized trial evaluating treatments for reducing the frequency of migraines evaluated beta blockers, a behavioral management program, and the combination of both interventions in 232 adult patients suffering at least 3 attacks per month. During a 5-week run-in period, all patients received acute migraine treatment that was individually optimized using triptans or selective serotonin receptor agonists, with NSAIDS, antiemetics, and steroids as needed. Patients were then randomized to 1 of 4 preventive groups: beta blockers only, beta blockers plus behavioral migraine management, placebo plus behavioral migraine management, or placebo only. The behavioral program included instruction in relaxation and stress management techniques and exercises for identifying migraine triggers. All patients continued their treatments for acute attacks throughout the 16 month trial.

At 10 months' follow-up, the combination of beta blockers and behavioral management was associated with significantly greater reductions in migraine frequency than the other groups (level 2 [mid level] evidence). In the combination group, 77% of patients had ≥ 50% reduction in migraine frequency per 30-day period compared to 34%-40% for the other groups (p ≤ 0.001, NNT 3). The combination group had a mean reduction of 5.4 migraine days per 30-day period compared to a mean reduction of 3.3-3.9 days for the other groups (p < 0.0083). Results at the end of the trial at 16 months were similar to the 10-month results. Both groups that received behavioral management had significantly improved migraine-specific quality of life scores at 10 and 16 months (BMJ 2010 Sep 29;341:c4871).

Previous research has suggested that beta blockers alone may be effective for migraine prevention (Cochrane Library 2004 Issue 2:CD003225). In this trial, the placebo response rate was 40%, which was higher than the 30% found in the Cochrane review. As in previous trials, the dropout rate was high, with only 65% of the randomized patients evaluated at 10 months. The lack of significant differences between beta blockers alone and placebo in the current trial may be partly due to these factors.

For more information, see the Migraine prophylaxis - prescription medications topic in DynaMed.

Epocrates Study Provides Snapshot of Mobile Use by Medical Students

2010-10-04T11:17:00.000-04:00

Epocrates Study Shows Med Students Like to Use....Epocrates (and that BlackBerry should be worried)

NCBI launches the Database of Genomic Structural Variations

2010-10-01T11:52:00.000-04:00

Yesterday, the National Institutes of Health announced the launch of a new resource, called the Database of Genomic Structural Variation, or dbVar, to help scientists understand how differences in DNA contribute to human health and disease.

See the entire press release

Article Most Likely to Change Clinical Practice - Week Ending Sept 24, 2010

2010-09-30T08:37:00.000-04:00

Short-Acting Antibiotics for 5 Days Might Be Less Effective than Longer Course Antibiotic Treatments for Children with AOM

Acute otitis media (AOM) is the most common reason children are prescribed antibiotics in the United States. While the optimal treatment duration is unclear, previous studies, including a Cochrane review from 2000, have suggested that short courses of treatment (< 7 days) may be as effective as longer courses. A recent update of that Cochrane review provides evidence that treatment with short-acting antibiotics for 5 days is associated with significantly higher rates of treatment failure than longer course treatments (level 2 [mid-level] evidence). The review examined 49 moderate-quality randomized trials comparing short vs. long course antibiotic regimens in 12,000 children (aged 1 month to 18 years) with a clinical diagnosis of acute otitis media. The primary outcome was treatment failure within 1 month, defined as absence of clinical resolution, relapse, or recurrence of AOM following initiation of therapy. In an analysis of 16 trials of short-acting antibiotics (e.g. amoxicillin), treatment for 5 days was associated with increased risk of treatment failure (OR 1.34, 95% CI 1.15-1.55) compared to 8-10 days of treatment. This corresponds to an NNH of 11-41, assuming treatment failure in 16% of children receiving longer treatment. This result might be due to differences in efficacy for children with and without a history of ear infections. Five-day treatment had a higher failure rate in analysis of 6 trials that included children with a history of recurrent AOM, but not in 4 trials that excluded these patients. For oral azithromycin, treatment for 3-5 days was associated with increased treatment failure at 8-19 days' follow-up compared to longer treatments (OR 1.27, 95% CI 1.04-1.55), but there was no significant difference by 20-30 days' follow-up. The risks of gastrointestinal adverse effects were significantly reduced with short course treatments for both short-acting antibiotics and azithromycin. The authors suggest that clinicians must weigh the relative benefits and harms of longer treatment durations (Cochrane Database Syst Rev 2010 Sep 08;(9):CD001095).

Guidelines from the American Academy of Pediatrics recommend antibiotics for 10 days in children < 6 years old and children with severe disease and for 5-7 days in children ≥ 6 years old with mild to moderate disease (Pediatrics. 2004 May;113(5):1451).

For more information, see the Acute otitis media (AOM) topic in DynaMed.

Health Council of Canada Releases Report Calling for Urgent Implementation of Electronic Health Records

2010-09-27T14:59:00.000-04:00

Decisions, decisions

Medical Apps

2010-09-23T14:56:00.000-04:00

I've been asked a lot about medical apps recently. Here's some quick links if you're looking to download some apps to your mobile.

Western Libraries' page of recommended free and Western subscribed medical apps

iMedical Apps, Top 10 Free iPhone Medical Apps for Health Care Professionals

iMedicalApps is a great website for keeping up to date on the latest medical apps for all kinds of devices (from iPad to Android).

Article Most Likely to Change Clinical Practice - Week Ending Sept 17, 2010

2010-09-23T09:07:00.000-04:00

Ivabradine Reduces Heart Failure Mortality and Hospital Admission in Patients with Chronic Heart Failure

Ivabradine is a novel agent that lowers heart rate by inhibiting the I_f current in the sinoatrial node. The SHIFT trial evaluated the drug's efficacy in 6,558 patients with symptomatic chronic heart failure. Patients in sinus rhythm (heart rate ≥ 70 beats per minute) and a left-ventricular ejection fraction ≤ 35% were randomized to ivabradine 2.5-7.5 mg twice daily vs. placebo and followed for a median of 22.9 months. All patients had been admitted to a hospital for heart failure within 1 year and were on stable treatment for at least 4 weeks, including beta blockers if tolerated. About 90% of the patients were on beta blockers at baseline, but only 26% were taking their target beta blocker dose. In the ivabradine group, heart rates were reduced by 11 beats per minute at 28 days and by 9 beats per minute at 1 year compared to placebo (p < 0.05). Ivabradine was associated with reduced heart failure mortality (3% vs. 5%, p = 0.014, NNT 50) and reduced all-cause hospital admission (38% vs. 42%, p = 0.003, NNT 25) (level 1 [likely reliable] evidence). The ivabradine group also had lower hospitalization rates for worsening heart failure (16% vs. 21%, p < 0.0001, NNT 20) and for any cardiovascular cause (30% vs. 34% (p = 0.0002, NNT 25). Differences in all-cause mortality (16% vs. 17%) and total cardiovascular mortality (14% vs. 15%) were not significant. The ivabradine group had higher rates of bradycardia and visual adverse effects (Lancet 2010 Sep 11;376(9744):875).

Ivabradine is approved for the management of stable angina in Europe, India and Australia, but is not available in the United States or Canada.

For more information, see the Heart failure topic in DynaMed.

Opportunity to Comment on WebCT Replacement

2010-09-22T09:09:00.000-04:00

UWO plans to replace WebCT OWL with a new online learning system. Take this opportunity to participate in the process by filling out the online survey for students, faculty and staff: http://webct.uwo.ca/owlflightplan/getinvolved.html

World Alzheimer Report 2010 Available

2010-09-21T15:40:00.000-04:00

Yesterday, an international report on Alzheimer's Disease was published. The study found that the global cost of dementia will likely exceed $604 billion this year. The European researchers also estimate about 35 million people have dementia worldwide. They said that figure is likely to double every 20 years, to nearly 66 million in 2030 and 115 million in 2050.

Link to the report: http://www.alz.co.uk/research/worldreport/

NLM Launches API Web Interface

2010-09-20T15:13:00.000-04:00

The National Library of Medicine, the world’s largest medical library and an arm of the National Institutes of Health, today released a new API Web page. An API is a set of routines that an application uses to request and carry out lower-level services performed by a computer's operating system.

This new resource (http://www.nlm.nih.gov/api/) supports the Administration's interest in promoting computer and mobile applications development using government data resources accessible via APIs.
The NLM API page provides:

a consolidated list and descriptions of NLM systems and databases that currently have API access to data
links to supporting documentation
links to the respective Web application interface, if applicable

The NLM API page is also available from the NLM Databases & Electronic Resources page (http://www.nlm.nih.gov/databases/) which provides links and short descriptions to dozens of health and science related resources maintained by the NLM.

Free classes for Natural Standard

2010-09-16T09:56:00.000-04:00

Natural Standard, an evidence-based alternative medicine database, is hosting free, online searching classes in September.

Thu, Sep 2, 2010 2:00 PM - 2:45 PM EDT

Thu, Sep 9, 2010 2:00 PM - 2:45 PM EDT

Thu, Sep 16, 2010 2:00 PM - 2:45 PM EDT

Thu, Sep 23, 2010 2:00 PM - 2:45 PM EDT

Thu, Sep 30, 2010 2:00 PM - 2:45 PM EDT

Once registered you will receive an email confirming your registration with information you need to join the Webinar.

Article Most Likely to Change Clinical Practice - Week Ending Sept 10, 2010

2010-09-16T09:33:00.000-04:00

Prophylactic Oophorectomy Associated with Reduced Mortality and Ovarian Cancer in Women with BRCA Mutations

The prevalence of BRCA1 or BRCA 2 mutations is estimated at about 0.2%-0.33% of the population, but these mutations account for 5%-10% of breast cancers and 10%-15% of ovarian cancers among white women in the United States. Lifetime risks may be as high as 85% for breast cancer and 26% for ovarian cancer for affected women. Preventive options for these women include prophylactic surgery, chemoprevention, and regular screening.

A recent observational study assessed the efficacy of prophylactic salpingo-oophorectomy to reduce the risks of breast and ovarian cancer. In a cohort of 2,482 women with BRCA mutations identified from 1974-2008 (followed for 6 months to 27 years), 40% had prophylactic salpingo-oophorectomies. In an analysis of the entire cohort, oophorectomy was associated with significant reductions in all-cause mortality (3.1% vs. 9.8%), ovarian cancer-specific mortality (0.4% vs. 2.5%), and breast cancer-specific mortality (2.1% vs. 5.7%) (level 2 [mid-level] evidence). Among women with no previous breast cancer, oophorectomy was associated with significantly reduced incidence of ovarian cancer (1.3% vs. 5.8%) and breast cancer (11.6% vs. 21.6%). In women with previous breast cancer, oophorectomy was associated with reductions in all-cause mortality (4.2% vs. 16%) and incidence of ovarian cancer (1% vs. 6%) (JAMA 2010 Sep 1;304(9):967).

A new statement from the Society of Gynecologic Oncologists Clinical Practice Committee recommends bilateral salpingo-oophorectomy for women at high risk of ovarian cancer based on family history and presence of BRCA 1 or BRCA 2 mutations after childbearing is complete (Obstet Gynecol 2010 Sep;116(3):733).

For more information, see the BRCA mutation testing and management topic in DynaMed.

Canadian Diabetes Association Releases Ontario Diabetes Report

2010-09-08T16:00:00.000-04:00

Estimates from the report include:

1 in 4 Ontarians will be living with diabetes or prediabetes by 2020
Without intervention, the economic burden of diabetes in Ontario will be $7 billion per year by 2020

Read the media release here

Article Most Likely to Change Clinical Practice - Week Ending September 3, 2010

2010-09-08T15:15:00.002-04:00

Individual CBT Associated with Sustained Improvement in ADHD Symptoms in Adults Taking Medication

Medications are often used for treatment for adults with attention deficit hyperactivity disorder (ADHD), but many patients remain symptomatic despite treatment with stimulants or other drugs. A recent randomized trial evaluated the efficacy of cognitive behavioral therapy (CBT) in 86 adult patients with persistent, clinically significant ADHD symptoms who were already being treated with medication. Patients were randomized to 12 weekly sessions of individual CBT vs. progressive muscle relaxation training with educational support. Medications were continued during the trial. In post-treatment assessment at approximately 15 weeks, the CBT group had a higher rate of treatment response on the Clinical Global Impressions scale (53% vs. 23%, p = 0.01, NNT 4) and on the ADHD rating scale (67% vs. 33%, p = 0.002, NNT 3) (level 2 [mid-level] evidence). CBT was also associated with significantly greater improvement in self-reported symptoms (p < 0.001). Responders in the CBT group showed sustained improvement at 6 and 12 month follow-up visits (JAMA 2010 Aug 25;304(8):875).

For more information, see the Attention-deficit hyperactivity disorder (ADHD) in adults topic in DynaMed.

NY Times: Forget What You Know About Good Study Habits

2010-09-08T09:54:00.000-04:00

Psychologists have discovered that some of the most hallowed advice on study habits is flat wrong: http://www.nytimes.com/2010/09/07/health/views/07mind.html

New Search Platform from Elsevier

2010-09-03T11:52:00.000-04:00

Scopus users will find the database looking quite different this week. The search interface has been updated as part of Elsevier's roll-out of their new search platform: SciVerse Hub. SciVerse Hub will search even more content than Scopus, making it the world's largest scientific search platform.

Pediatric Oncology Group of Ontario - Fellowships & Awards

2010-09-02T10:05:00.000-04:00

Fellowship applications will be available on September 7, 2010 on the Pediatric Oncology Group of Ontario’s website at www.pogo.ca under the Research tab.

PhD/Post Doctoral Fellowships (1 or 2 fellowships of 1 or 2 years duration)
The PhD/Post Doctoral Fellowship will be awarded to either an applicant working toward a PhD or to a post doctoral research candidate, with a background in any of the relevant disciplines including medicine and nursing. While applicants may have training and/or experience in areas not directly related to POGO activities, they will be required to demonstrate relevance to pediatric oncology.

The award includes a yearly salary of $45,000 and the ability to apply for $5,000 in project-specific one-time operating support.

Clinician Scholar Award (1 fellowship of 1 or 2 years duration)
The Clinician Scholar Award is open to licensed clinicians and health practitioners of any discipline working in the field of pediatric oncology. Applicants may have limited research experience although they have a strong interest in research.

The award includes a yearly salary of $55,000 and the ability to apply for $5,000 in project-specific one-time operating support.

Criteria for Award
Fellowships will be awarded based on the following criteria:

Scientific merit and methodological rigor of the proposal;
Relevance to the goals and objectives of POGO and the POGO Research Unit;
Potential impact on children with cancer and their families (present and future);
Ability of the applicant to carry out the research project in accordance with POGO’s standards and expectations;
Clinical/academic potential of the applicant; and
Suitability of the proposed research environment, including supervisor.

Deadline for Submission:
Completed applications must be received at the POGO office by December 3, 2010.

* POGO plans and coordinates childhood cancer services for Ontario and advises the Ministry of Health and Long-Term Care on childhood cancer control.

Article Most Likely to Change Clinical Practice - Week Ending Aug 27, 2010

2010-09-02T09:21:00.000-04:00

Low-dose Aspirin Starting Before but Not After 16 Weeks Gestation May Reduce Preeclampsia

Low-dose aspirin has been associated with reduced incidence of hypertensive disorders in pregnant women (Cochrane Library 2007 Issue 2:CD004659) and is recommended for women with increased risk of preeclampsia (J Obstet Gynaecol Can 2008 Mar;30[3 Suppl 1]:S1-48,PDF). A recent systematic review suggests that aspirin should be started at or before 16 weeks gestation to show this benefit. Aspirin (50-150 mg/day with or without dipyridamole) was compared to placebo or no treatment in 27 randomized trials with 11,348 women at risk of preeclampsia. Risk factors included nulliparity, history of preeclampsia or other hypertensive disorders, and abnormal uterine artery Doppler ultrasound. In an analysis of 9 trials with treatment starting at ≤ 16 weeks gestation, aspirin was associated with reduced incidence of preeclampsia (risk ratio 0.47, 95% CI 0.34-0.65) (level 2 [mid-level] evidence). The number needed to treat (NNT) was 9 (95% CI 6-25). Aspirin starting at or before 16 weeks was also associated with decreased incidence of intrauterine growth restriction (IUGR) (risk ratio 0.44, 95% CI 0.3-0.65, NNT 11, 95% CI 8-20) and decreased risk of preterm birth (RR 0.22, 95% CI 0.1-0.5). There were no significant differences in either preeclampsia or IUGR in analysis of trials beginning aspirin after 16 weeks gestational age (Obstet Gynecol 2010 Aug;116(2 Part 1):402).

For more information, see the Hypertensive disorders of pregnancy andIntrauterine growth restriction topics in DynaMed.

Phone App Turns Mobile into Stethoscope

2010-08-31T13:48:00.002-04:00

Open Peer Review

2010-08-30T10:48:00.000-04:00

Thanks to Adrian Ho for sharing:

The openness movement covers more than just open access and open data. It also addresses the peer review process. A recent New York Times article discusses scholars' thoughts about opening the review process:

Scholars Test Web Alternative to Peer Review
http://www.nytimes.com/2010/08/24/arts/24peer.html

The Chronicle of Higher Education has recently run a piece about an open review experiment conducted by a Humanities journal:

Leading Humanities Journal Debuts 'Open' Peer Review, and Likes It
http://chronicle.com/article/Leading-Humanities-Journal/123696/

If you are interested in the future of peer review, take a look at these blog posts:

Assessing the Future of Peer Review
http://blog.historians.org/profession/1065/assessing-the-future-of-peer-review

P ≠ NP and the future of peer review
http://cameronneylon.net/blog/p-%E2%89%A0-np-and-the-future-of-peer-review/

Articles Most Likely to Change Clinical Practice - Week Ending August 20, 2010

2010-08-26T09:09:00.000-04:00

Probiotic Lactobacillus reuteri May Reduce Crying Time in Infants with Colic Symptoms

Colic can be stressful for newborns and new parents alike. Previous research has suggested that L. reuteri may reduce symptoms compared to simethicone in colicky infants (Pediatrics 2007 Jan;119(1):e124). A new blinded, placebo-controlled trial with 50 infants provides further support for the efficacy of probiotics. Infants aged 2-16 weeks old with fussy crying episodes lasting at least 3 hours over at least 3 days (modified Wessel's criteria for colic diagnosis) were randomized to L. reuteri vs. placebo for 21 days. L. reuteri was given as 10⁸ colony-forming units in 5 drops of oil suspension, 30 minutes before morning feeding. All infants had been exclusively breastfed, and mothers were asked to avoid cow's milk during the trial. At baseline, the median crying time was 370 minutes per day for the L. reuteri group and 300 minutes per day for controls (not significant). At 21 days follow-up, the L. reuteri group had significantly reduced crying time (median total crying time 35 minutes per day vs. 90 minutes per day, p = 0.022) (level 2 [mid-level] evidence). The proportion of infants with at least 50% reduction in crying time from baseline was significantly higher in the L. reuteri group at 7, 14, and 21 days (Pediatrics 2010 Aug 16 early online).

For more information, see the Infantile colic topic in DynaMed.

Tai Chi May Improve Symptoms and Sleep in Patients with Fibromyalgia

Fibromyalgia can be hard to treat, and patients may suffer symptoms for years despite treatment. The American Pain Society recommends muscle-strengthening and stretching exercises as well as sleep and anti-anxiety medications as part of a multidisciplinary treatment approach (National Guideline Clearinghouse 2005 Sep 19:7298). A recent randomized trial with 66 patients with fibromyalgia suggests that tai chi might be helpful for both pain and sleep disturbance symptoms. Patients (mean age 50 years) were randomized to classic Yang-style tai chi vs. a control intervention (wellness education and stretching) for 60 minutes twice weekly for 12 weeks. All patients were instructed to practice activity at home for 20 minutes each day, and patients in the tai chi group were encouraged to maintain tai chi practice using an instructional DVD until follow-up at 24 weeks. The primary outcome was clinically-meaningful change in symptom severity defined as an improvement of > 8 points on the 100-point Fibromyalgia Impact Questionnaire. The tai chi group had a significantly higher rate of patients achieving clinically-meaningful improvement (79% vs. 39%, p < 0.001, NNT 3) (level 2 [mid-level] evidence). The mean improvements from baseline were 27.8 points in the tai chi group vs. 9.4 points for controls at 12 weeks and 28.6 vs. 10.2 at 24 weeks (both p < 0.001). Tai chi was also associated with significant improvement in sleep quality, patient-reported global assessments, and both mental and physical SF-36 scores. Improvements in symptom severity were maintained in the tai chi group at 24-week follow-up (N Engl J Med 2010 Aug 19;363(8):743).

For more information, see the Fibromyalgia topic in DynaMed.

Study Compares Google, UpToDate, Ovid & PubMed... With Some Surprising Results

2010-08-23T15:15:00.000-04:00

From the Post Graduate Medical Journal:

From December 2008 to June 2009, medical students, resident physicians, and attending physicians at the authors' institution were asked to answer a set of four anaesthesia and/or critical care based clinical questions, within 5 min, using Google, Ovid, PubMed, or UpToDate (only one search tool per question). At the end of each search, participants rated their results on a four point confidence scale. One to 3 weeks after answering the initial four questions, users were randomised to one of the four search tools, and asked to answer eight questions, four of which were repeated. The primary outcome was defined as a correct answer with the highest level of confidence.

Results Google was the most popular search tool. Users of Google and UpToDate were more likely than users of PubMed to answer questions correctly. Subjects had the most confidence in UpToDate. Searches with Google and UpToDate were faster than searches with PubMed or Ovid.

Conclusion Non-Medline based search tools are not inferior to Medline based search tools for purposes of answering evidence based anaesthesia and critical care questions.

Read the whole article here

New RefWorks Interface Now Available

2010-08-23T13:16:00.000-04:00

RefWorks 2.0 is now available to members of the UWO community. To switch to the new interface, log in to RefWorks and select "RefWorks 2.0" from the upper right hand corner of the page.

RefWorks will remember that you've switched for future sessions. You can switch back to the classic view if you prefer, but at some point the older interface will be deactivated.

If you run into any problems or have any questions, please let me know.

Article Most Likely to Change Clinical Practice - Week Ending August 13, 2010

2010-08-18T15:45:00.002-04:00

CDC Releases 2010 Recommendations on Prevention and Control of Influenza

The Centers for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP) has released recommendations for 2010 on the prevention and control of influenza. In 2009, annual influenza vaccination was recommended for high-risk groups; routine vaccination of healthy nonpregnant adults aged 19-49 years was not recommended. The 2010 recommendations expand routine influenza vaccination to all persons aged 6 months and older, including healthy nonpregnant adults aged 18-49 years, and provide information regarding recently approved vaccines (Fluzone High-Dose, Fluarix and Afluria). CDC now recommends two doses of seasonal influenza vaccine in children aged 6 months to 8 years with no history, or only one dose, of seasonal influenza vaccine or with no or uncertain history influenza A (H1N1) 2009 monovalent vaccine (regardless of previous influenza vaccine history). It is also noted that the seasonal influenza vaccine now includes the A/California/7/2009 (H1N1)-like virus (derived from a 2009 pandemic influenza A (H1N1) virus), eliminating the need for a separate 2009 pandemic influenza A (H1N1) vaccination (MMWR Recomm Rep 2010 Aug 6;59(RR-8):1 full-text). The Food and Drug Administration has approved the vaccines for the 2010-2011 influenza season (FDA Press Release 2010 Jul 30). Vaccination should be given as soon as the 2010-11 seasonal influenza vaccine is available. If the 2010 seasonal vaccine is delayed, monovalent H1N1 2009 vaccine may still be of use (CDC 2010 Jul 6).

For more information, see the Influenza vaccines in adults, Influenza vaccines in children and Pandemic (H1N1) 2009 influenza vaccines topic in DynaMed.

Article Most Likely to Change Clinical Practice - Week Ending Aug 6th, 2010

2010-08-11T15:39:00.000-04:00

Aerobic Training May Reduce Symptom Frequency and Improve Asthma-Related Quality of Life in Adults with Asthma

Asthma symptoms can have effects on both physical and emotional well-being. Since exercise has been associated with improved quality of life in patients with other chronic diseases, a recent randomized trial evaluated the effect of exercise training in 101 patients with moderate or severe persistent asthma. Patients who had received medical asthma treatment for ≥ 6 months and had been clinically stable for ≥ 30 days were randomized to 3 months of aerobic training in twice weekly 30-minute sessions vs. control with no formal exercise. All patients participated in a 4-hour educational program and received yoga breathing training. In an analysis of 88% of the randomized participants, the aerobic training group had a significantly higher rate of symptom-free days (24 vs. 16 per month, p < 0.001) (level 2 [mid-level] evidence). In addition, anxiety and depression scores were significantly improved from baseline in the aerobic group (p < 0.001) but not in the control group. Aerobic training was also associated with improvement in asthma-related quality of life total scores as well as physical limitation, symptom frequency, and psychosocial subscores (p < 0.001). The reduced asthma frequency and the improvements in quality of life scores were not related to improvements in pulmonary function testing, which did not change over the course of the trial, but were only related to improvements in aerobic capacity (Chest 2010 Aug;138(2):331).

For more information, see the Asthma in adults and adolescents topic in DynaMed.

Industry Funding Influences Trial Findings

2010-08-11T10:56:00.000-04:00

An study published in the Annals of Internal Medicine shows that clinical trials funded by pharmaceutical companies are more likely to show positive outcomes than trials sponsored by government or non-profits: Full article

Electronic Thesis and Dissertations Comes to UWO

2010-08-06T08:47:00.000-04:00

The School of Graduate and Postdoctoral Studies at UWO has implemented an optional process for students submitting theses and dissertations to do so electronically. The most significant benefit is the dramatic increase (50 - 250%) in citation impact that results from electronic publishing. This leads to increased rewards from universities, in the form of promotion and increased salary, and from granting agencies.

Other benefits include:

free publicity for your research - authors of electronic theses become more widely known and their reputations are enhanced
easy worldwide access to your theses for colleagues and collaborators
easy worldwide access to your theses for job and grant applications
a raised profile for your research institutions
reduced costs at the point of graduation since there is no need to have multiple copies printed.

For more information about submitting your thesis or dissertation to UWO's institutional repository, Scholarship@Western, please see: http://grad.uwo.ca/current_students/thesis/overview.htm

Article Most Likely to Change Clinical Practice - Week Ending July 30, 2010

2010-08-05T09:08:00.000-04:00

Compression-Only CPR and Standard CPR Appear to be Similarly Effective for Out-of-Hospital Cardiac Arrest When Performed by Untrained Bystanders

In cases of out-of-hospital cardiac arrest, early cardiopulmonary resuscitation (CPR) initiated before the arrival of trained emergency services may improve a patient's chances of survival. However, untrained bystanders may be reluctant or unable to correctly perform the rescue breathing portion of standard CPR. Improper rescue breathing may reduce the effectiveness of standard CPR. Observational results have suggested that CPR with chest compression alone may be at least as effective as full CPR when performed by untrained people (Lancet 2007 Mar 17;369(9565):920). Two recent randomized trials compared these two approaches in patients with suspected cardiac arrest. In both trials, bystanders with no previous CPR experience who were calling for emergency assistance were instructed by dispatchers to perform either compression-only CPR or standard CPR (compression and rescue breathing) prior to the arrival of paramedics. In 1 trial with an analysis of 1,941 patients, survival to hospital discharge was 12.5% in the compression-only group and 11% in the standard group (not significant), with 14.4% vs. 11.5% surviving with favorable neurologic status (not significant) (N Engl J Med 2010 Jul 29;363:434). The analyses in both trials included only about one-third of the randomized patients due to exclusions following randomization (level 2 [mid-level] evidence).

These results do not suggest that chest compression alone is a substitute for standard CPR performed by trained individuals. However, this simplified approach to resuscitation may make untrained people more likely to start CPR. Medical offices receiving emergency calls from families of patients might wish to consider compression-only CPR as an immediate intervention.

For more information, see the Cardiac arrest topic in DynaMed.

Copyright Reform Information Available

2010-08-04T10:31:00.002-04:00

Dr. Sam Trosow gave a public lecture on Bill C-32 and the Access Copyright Tariff at FIMS on July 14th. Thanks to him and his student Michael McNally, the PowerPoint and audio files of the lecture are now available online at: http://ir.lib.uwo.ca/fimspres/4/

The New Yorker: Focus on Care for Terminal Patients

2010-08-01T08:42:00.000-04:00

Hospice medical care for dying patients: newyorker.com