Doody’s Core Titles 2012 is Published!

Doody Enterprises published the 9th annual edition of its industry-leading collection development tool for health sciences librarians, Doody’s Core Titles in the Health Sciences, earlier this month.

More than 2,100 core titles have been selected for Doody’s Core Titles 2012 by 87 academically affiliated healthcare professionals and 104 medical librarians. The list is available to licensees at the Doody’s Core Titles website and to Doody’s Review Service subscribers. It is also licensed and republished by numerous book distributors and eBook aggregators like Rittenhouse, Ovid, EBSCO, ebrary, and many others.

Coincidentally, the May issue of the Rittenhouse Update eNewsletter features an interview with Anne Hennessy, DCT Editor in Chief, and me. The interview included a number of provocative questions, and we’d welcome your views on two in particular:

1. What do you see as the three biggest changes in the medical publishing industry over the last 30 years?

2. What is the need for specialization within the medical library, and how is that evolving?

Not so fast! The case for letting nature take its course

Each week, we select an article from an influential journal that has broad implications for healthcare and has just become available for free online.

In pregnant women, premature rupture of the membranes (the chorion and the amniotic sac) is a problem that can lead to infections in both mother and baby by permitting hostile bacteria to colonize the birth canal. Often, but not always, this premature rupture quickly causes the woman to go into labor, greatly reducing risks to the baby.

But what if the woman does not go into labor? Standard practice in the U.S. and many other advanced nations is to induce labor. If the pregnancy already has run to full term, this is intuitively appealing. However, even in the U.S., cautious clinicians take a wait-and-see approach, particularly if the baby is premature. Is this prudent?

In this week’s paper, Dutch researchers looked at women whose pregnancies were not yet at term when their membranes ruptured. There was little difference in pregnancy outcome for mothers, or for babies, between inducing labor and a careful wait-and-see approach called “expectant management.”

Obviously, expectant management took more work — monitoring, lab tests, and simple patient management. And it goes against the tendency of both doctors and patients to “do something quick” when a medical problem arises. More tellingly, if the goal is to save money and/or fit neatly into an obstetrician’s schedule, expectant management probably won’t catch on.
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Two Doctors Battle Online Defamation

The Internet is very fickle when it comes to rating healthcare providers. It can be a source of praise for excellent patient care, but it also can be used to slam a doctor’s reputation. Unfortunately, it is very hard for the doctor on the receiving end to counter bad reviews without violating HIPAA. Even more unfortunately, it only takes one patient to destroy a doctor’s practice.

A recent article from American Medical News highlighted two situations where a patient made a significant negative impact on the practice of a doctor. Both doctors were forced to file defamation suits.

Dr. Albert Carlotti III, MD, DDS, spent 3 years fighting the online attacks of a former patient. During the course of this battle, the cosmetic surgeon lost hundreds of patients, dropped 35 pounds, and was forced to sell his home.

“I was dealing with somebody who had the intent of destroying us professionally, personally and on every level. I went from a very successful surgeon to pretty much out of business,” said Dr. Carlotti

The patient had created her own website posting claims that Dr. Carlotti was being investigated by the state medical board and was not board certified. The Arizona Board of Medical Examiners showed no record of any disciplinary action against Dr. Carlotti and his practice. In the end, the suit went to a three-week trial in which the jury found in favor of Dr. Carlotti, awarding him $12 million.

Neurologist David McKee, MD, was in a similar situation and an appeals court ruled that he may sue a former patient’s son for defamation. The lower court had originally ruled that online comments made by the patient’s son were not defamation. However, the Minnesota Court of Appeals decided that the comments carried weight in terms of their defamatory nature.

Dr. McKee’s reputation suffered as a result of the online comments.

“I think people feel they are unrestrained on the Internet and they think they can get away with anything. I think this decision shows there are limits to what you can say,” said Marshall Tanick, the doctor’s attorney.

The moral of the story? Online review sites and comments can be a double-edged sword. While some comments may be accurate and reliable, others can emanate from a frustrated individual venting and lying.

Angioplasty in community hospitals: sure, why not?

Each week, we select an article from an influential journal that has broad implications for healthcare and has just become available for free online.

In the generation or so since cardiac angioplasty has become a widely used alternative to bypass surgery, standards of care required that a cardiac surgeon be on call at the hospital in case of major problems with the procedure. In such cases, the surgeon would take over, open the patient’s chest, and complete a surgical bypass. Because smaller hospitals can’t afford the financial and logistical commitments of on-call cardiac surgeons, this has meant that angioplasties are typically done in large referral hospitals.

This week’s paper confirms a longstanding hunch: With the right contingency plans in place, doing angioplasties in hospitals without cardiac surgeons on call is no riskier than doing them in larger hospitals. The contingency plans are not trivial, and it’s worth reading the full article to appreciate how much planning and staff education is needed to get them in place. However, for a lot of patients, this could mean having this important procedure closer to home, or in a hospital that’s in their insurance plan’s network — less hassle and maybe less expense as a result.

Because this article appeared in the august New England Journal of Medicine, it could be the last word. Until the next last word, of course.
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Discovering Hidden Gems at MedInfoNow

A few weeks ago I met a relatively new MedInfoNow subscriber at his blog (social media at its finest!). Jerry Fahrni is a licensed pharmacist who now works as a product manager for a company that specializes in pharmacy automation and technology. On his “Pharmacy Informatics and Technology” blog, he talked about using MedInfoNow to stay up to date with the literature, but expressed his frustration that the Medline® updates at MedInfoNow did not deliver the full text of the articles.

This gave me the opportunity to post a comment on his blog and point out that about 17% of the articles indexed in Medline are available for free on the Internet. But that still means access to 83% of the articles is controlled by the publishers and aggregators, and most of them charge for access to the full text. However, MedInfoNow does give some subscribers the ability to link to the full text of an article in their institution’s library. Read More

Type 2 diabetes: the first-line pill that might or might not work

Each week, we select an article from an influential journal that has broad implications for healthcare and has just become available for free online.

Glucophage and its generic equivalent metformin have been mainstays for treating type 2 diabetes, the most common form, for well over a decade. The drug reliably reduces blood sugar, which is the most obvious finding in diabetes, and it’s relatively safe. So it works, right?

Well, not so fast. This week’s paper studies the evidence that metformin actually keeps people healthier — for instance, by lowering the incidence of vascular disease or by lowering the death rate, particularly from cardiovascular disease. Unfortunately, according to the authors, there’s not enough evidence after all this time to support these expectations.

The strongest endorsement the authors can give is: “Compared with other antidiabetic treatments, metformin may be the one with the least disadvantages.”
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Men, genes, and heart disease

Each week, we select an article from an influential journal that has broad implications for healthcare and has just become available for free online.

For a long time, we have known that men have a higher incidence of coronary artery disease than women of the same age. This is serious stuff, of course, since coronary artery disease can lead to heart attacks and strokes. Is it something in our genes? This study says yes.

The authors focused on the Y chromosome, the one that determines male sex. On the Y chromosome, they found a specific grouping of genes that is associated strongly with the development of coronary artery disease. Moreover, in working through the function of this group of genes, they learned that the genes affect immunity and inflammation. The latter observation ties in with current thinking that inflammation of blood vessel walls is often the key culprit in triggering heart attacks, which is scientifically satisfying.

Like all genetic studies, this one won’t influence clinical care in the near future. Eventually, if it’s possible to develop a reasonably-priced diagnostic test for this gene grouping, it could help to identify men at higher risk for coronary artery disease and influence how aggressively patients take preventive measures.
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Googling Symptoms: 3 Tips for Doctors on Dealing with Cyberchondria

We’ve written a few times about Cyberchondria, the “disease” where patients come into the office with a self-diagnosis pulled from the Internet. Sometimes the patients are shockingly accurate, but oftentimes they misdiagnose and overdiagnose.

A recent interesting article in Time suggested that “Googling Symptoms Helps Patients and Doctors.” The article, written by Dr. Zachary F. Meisel, points out that sometimes when patients are correct, the diagnosis can be determined more quickly than if the doctor were to work it out alone.

Most interesting, though, were the author’s 3 tips for doctors when patients do make their way into your office with a Google stack:

1. Embrace patient self-education. Patients are more empowered when they have taken the time to understand what is happening to them and what their various choices are. As a doctor you can help promote this by steering them to good, reliable sources, including tools, videos, and decision-making surveys.
2. Point them in the right direction. There are a lot of poor sources for health information on the Internet. You’d rather have your patients on reliable, peer-reviewed, and evidence-based sites that offer good information than on Yahoo Answers, where anyone can give their opinion about what might be wrong. Provide your patients, particularly the ones who come in citing bad sources, with a list of better sites to check when they have questions about their health.
3. Get over the idea that the Internet is a nuisance when it comes to patient care. Patients will go online. Many patients will self-diagnose. Doctors can’t continue to roll their eyes at this behavior. Instead, their attitude should shift to, “What can I do to help patients do this in a more productive way?” Finally, doctors shouldn’t be surprised when their patients are sometimes correct.

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MedInfoNow’s Enhanced Search Makes Staying on Top of the Literature Even Easier

MedInfoNow is known for delivering personalized weekly updates of the new journal literature to busy healthcare professionals who are pressed for time yet need to keep abreast of developments in their fields. Our subscribers simply let us know what topics they want to track, by completing a profile, and MedInfoNow does all the work, saving them precious time while ensuring they are always prepared.

But, MedInfoNow is much more than that. It also offers our readers the fastest and most intuitive search of Medline® for those times they need to quickly locate information on topics outside of their profile.

Now, furthering our mission to find ways to save our subscribers time while keeping them informed, we are adding a powerful new enhancement to the search experience at MedInfoNow.  The technical name for this new feature is faceted searching, but what it means is that when readers do a quick search or advanced search, in addition to presenting a list of articles that match the search terms, MedInfoNow will display right alongside them a list of topics represented by the search results.

The juxtaposition of the search results with the topics gives our users the ability to instantly drill down to the topic that best matches their interests, narrowing their results from dozens or hundreds of articles to just the few that are most relevant for them.

With this enhancement, busy healthcare professionals can find useful, timely articles on a topic in just two steps and a matter of seconds:

1. They type search terms in the Quick Search box at the top of the page. A list of articles matching those terms instantly appears, but now alongside the search results is a listing of all the topics represented by those articles. Each topic will display the number of articles in parentheses.
2. They click on a topic to immediately narrow their search results to articles related to that specific topic – and they can quickly move through the topics to see different, targeted subsets of their results.

Take a look at the step by step video to see just how quick and easy it is to use MedInfoNow’s Enhanced Search.

MedInfoNow is committed to providing our users the tools they need to save time … stay informed … be prepared. Take a free trial and check it out for yourself.

Opioids for back pain patients: primary care prescribing patterns and use of services

Each week, we select an article from an influential journal that has broad implications for healthcare and has just become available for free online.

Pain management is a well-known clinical challenge. Pain is hard to define, there’s no laboratory test to clarify how much someone actually hurts, and individuals seem to vary in the amount of pain they can live with. Looming over the clinical challenge is the specter of drug abuse, real or suspected, with prescribing regulations and a veritable law enforcement industry.

This study examines the use of the most potent pain killers in managing back pain, perhaps the poster child for difficult challenges in pain management. The setting is Kaiser Permanente Northwest, an enormous multispecialty practice that prides itself on evidence-based treatment. Even here, though, patients taking opioid pain killers are problematical. The more opioids they take, they more they visit both clinic offices and emergency departments. The authors note that these patients have a higher incidence of psychological distress, and their lifestyles tend to be less healthy than people who are not taking opioids. What’s the cause, and what’s the effect? This retrospective review of patient records can’t say.

Another concern is that even in this salary-based system replete with clinical guidelines, physicians do a sloppy job of monitoring opioid use among their patients. They seem to give prescription refills more or less on autopilot, for instance.

This paper doesn’t try to offer solutions, only to identify the nature and extent of the problem. I hope this health system is now working prospectively to understand how to keep patients with back pain healthier in all respects. If it were easy, someone would have done it by now.
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