KB eNewsletter V 3(1) March 2006 - Physician Knowledge Newsletters

Physician Knowledge e-Newsletter - V 3(1) March 2006

Below you will find information related to the Knowledge Based Systems at MGHS
(Please note you must be connected to the MGHS Network to gain access to these systems)

"InfoPOEMs is an outstanding resource for clinicians seeking evidence-based recommendations at the point-of-care."
--Paul Gianutsos, Faculty Physician, Swedish Medical Center

New InfoRetriever Updates

We have recently posted new InfoRetriever files with updated content to our website. To download new Practice Guideline Summaries, InfoPOEMs and more, direct your clinicians to our downloads page.

"Thank you"...what administrators all over the world who have chosen InfoPOEMs/InfoRetriever as their institution's EBM resource are hearing from their clinicians...

InfoRetriever was featured in the December 2005 issue of Medical Economics, "10 great programs for your PDA."

"A patient with a migraine headache asks for an MRI. Is that an appropriate diagnostic test? You can look up the latest and best research on that subject with InfoRetriever, one of the premier search engines for evidence-based medicine," says author Robert Lowes.

The evidence-based resources available to clinicians continue to grow in number and complexity. What can you respond to your clinicians who ask, "why should I take advantage of InfoPOEMs/InfoRetriever above other evidence-based resources that are available to me?"

Here's just a sample of what sets us a part from the many other evidence-based solutions you have to choose from for your clinicians:

We provide clinicians with insurance that they're using the gold standard in quality evidence-based medicine.

Each piece of information searched within InfoRetriever and each InfoPOEM is labeled with a Level of Evidence, from the Centre for Evidence-Based Medicine in Oxford.

No other evidence-based resource provides an integrated search system, a "one-stop shop."
InfoRetriever searches 7 different databases all at once (among them Griffith’s 5-Minute Clinical Consult, Abstracts of Cochrane Systematic Reviews, Decision Support and Calculators, and more!) so your clinicians don’t need to spend time moving in and out of different databases.
We provide clinicians with interactive decision support tools to help them work efficiently, reduce errors and provide the best medical care.

InfoRetriever translates evidence-based information into action with it’s 229 Decision Support Calculators, 1,373 Diagnostic Test Calculators, and 1,345 H&PE Calculators.

You can now get the newest Natural Medicines CE course Natural Medicines in the Clinical Management of Irritable Bowel Syndrome.*

You can also use any of the many prior courses on many other conditions. All are accredited for physicians, pharmacists, NPs, PAs, CNMs, RDs.

We make updates to Natural Medicines Comprehensive Database every business day. Here are a few of special interest to you:

• Cold-Fx is getting attention as a treatment for the common cold. It contains a specific extract of American ginseng known as CVT-E002. The extract does seem to increase markers of immune function. New clinical evidence also suggests that people who take the extract 400 mg DAILY FOR FOUR MONTHS during flu season seem to have a SLIGHTLY decreased risk of developing cold symptoms. Some analysis suggests that it doesn't help prevent a FIRST cold, but may decrease the risk of developing repeat colds in the same season. It might reduce the severity and duration of colds that do develop. Cold-Fx is currently only sold in Canada, Hong Kong, and the Internet for about $23/month.

• Glucosamine and chondroitin are under scrutiny again now that preliminary data from the big NIH-sponsored GAIT study have been presented at a scientific meeting. The study shows that taking either glucosamine HCl 500 mg OR chondroitin sulfate 400 mg three times daily does NOT reduce knee pain in patients with osteoarthritis. But taking the combination of these products does seem to help patients with moderate to severe knee pain. Unfortunately the study doesn't evaluate glucosamine SULFATE and that is the most widely studied form of glucosamine, and the form that seems to show benefits in other studies. The big new study also does not show that taking the combo product is any better than glucosamine sulfate or glucosamine hydrochloride alone. For now, suggest that patients try ONE of the glucosamines alone...and if it doesn't help in a couple months to try adding the chondroitin. If there's still no perceived benefit, give it up.

• Selenium is also in the news as a potential preventive agent against osteoarthritis. University of North Carolina researchers say that people who consume a lower than average amount of selenium seem to have an increased risk of osteoarthritis. It is an interesting association. But most people in North America are not selenium deficient. Most adults need about 55 mcg/day of selenium. Tell patients that selenium supplements are not usually necessary. Explain that many common foods can provide adequate amounts of selenium...canned tuna, 63 mcg...beef, 35 mcg/3.5 ounces...spaghetti with meat sauce, 34 mcg...an egg, 14 mcg...whole wheat bread, 10 mcg.

• Melatonin is now being studied in some patients with irritable bowel syndrome (IBS). In addition to being produced in the pineal gland, melatonin is also produced in the gut. It's thought to be involved in regulating gut motility. Researchers are trying melatonin 3 mg at bedtime for IBS patients who have trouble sleeping. Preliminary findings suggest that it might decrease abdominal pain in these patients. Don't recommend it yet for this purpose. But if people hear about this and want to try it, explain that if it's used in doses consistent with the label, there is no significant downside.

For more info on natural products used for irritable bowel syndrome, get our latest eCE...Natural Medicines in the Clinical Management of Irritable Bowel Syndrome.

You can now get the newest Natural Medicines CE course Natural Medicines in the Clinical Management of HIV/AIDS.*

You can also use any of the many prior courses on many other conditions. All are accredited for physicians, pharmacists, NPs, PAs, CNMs, RDs.We continue to make updates to Natural Medicines Comprehensive Database every business day. Here are a few of special interest to you.

• L-arginine (ArginMax, Herc, InnerPower, and the recently discontinued HeartBar) is often used by people with heart disease...angina, heart failure, hypertension. But new research now suggests that some heart disease patients might be better off avoiding L-arginine. A study of L-arginine in patients who have recently had a heart attack suggests that the supplement is NOT beneficial...and it might be harmful. The study was stopped early after six patients in the L-arginine group died, compared to none in the placebo group. Most of the deaths occurred in people over age 60, which suggests that L-arginine might be a problem just in these older patients. For now, advise patients who have had a recent heart attack to avoid taking L-arginine.

• Schisandra is in 179 brand name products listed in Natural Medicines Comprehensive Database, and gets used a lot. We now see that it needs to be added to the list of natural products that might be involved in drug interactions. Evidence suggests that schisandra can inhibit cytochrome P450 3A4 (CYP3A4) enzymes in vitro. In fact, some schisandra constituents seem to irreversibly inactivate CYP3A4. They appear to be more potent inhibitors of CYP3A4 than the conventional drug ketoconazole. But this is very preliminary evidence. So far there are no clinical studies or case reports showing this interaction in humans. For now, just be watchful if patients taking medications metabolized by CYP3A4 begin using schisandra. Some medications metabolized by CYP3A4 include lovastatin (Mevacor), clarithromycin (Biaxin), cyclosporine (Neoral, Sandimmune), diltiazem (Cardizem), estrogens, indinavir (Crixivan), triazolam (Halcion), and many others.

• Immunity Plus, Vira 38, Nature's Biotics, Immunitril, and Immunocil are just a few of the supplement products now being promoted to prevent or treat avian flu. Bird flu scares have people flocking to buy supplements that claim to be helpful in preventing and treating the avian flu. Many of these products contain the usual laundry list of supposed "immunity boosters"...vitamin C, echinacea, selenium, zinc, etc. Others contain less familiar ingredients purported to increase the immune response...goji, red reishi, humic acid. There is also a buzz about star anise. It's the primary source of shikimic acid, which is used to produce the antiviral drug Tamiflu. But HUGE amounts shikimic acid are needed and it needs to be chemically modified to make Tamiflu. In other words, taking star anise will not have the same beneficial effect as taking the drug Tamiflu. Explain to patients that NO supplement is proven to prevent or treat avian flu. The FDA is now cracking down on these false claims.

The newest Natural Medicines CE program in the series is now posted online...Natural Medicines in the Clinical Management of HIV/AIDS.

New Editions:
Nursing Diagnosis Reference Manual - 6th Ed. (2005)
For student nurses as well as expert clinicians, Nursing Diagnosis Reference Manual, Sixth Edition, offers clearly written, authoritative care plans to help meet patients' healthcare needs throughout the life span.

Current Medical Diagnosis & Treatment - 46th Ed. (2006)
Now celebrating 45 years, Current Medical Diagnosis & Treatment (CMDT) delivers authoritative, timely coverage of more than 1,000 common diseases and disorders along with a clear synopsis of treatment and diagnosis. Coming soon! Check your subscription.

» New Edition:
Griffith's 5-Minute Clinical Consult - 14th Ed. (2006)
The 14th annual edition of this quick medical reference for current diagnosis and treatment includes over 1000 topics arranged alphabetically and cross-indexed to synonyms: 615 expanded topics in a format that contains enough detail to confirm the diagnosis and treat the problem; 432 short topics in a brief format. ICD-9-CM entries make coding easier.

» Supplemental Updates:
Monthly Updates:
- ACP Medicine
- ACS Surgery: Principles & Practice
- USP DI® Drug Information for the Health Care Professional
- USP DI® Advice for the Patient®
- Infectious Diseases: The Clinician's Guide to Diagnosis, Treatment, and Prevention

Yearly Updates:
- AHFS Drug Information (2006)
- Mosby's Drug Consult™ - 16th Ed. (2006)
- Ingenix® CPT with RVUs Data File (2006)

» News You Can Use:
STAT!Ref New Name Contest
Help us rename the STAT!Ref Online application by entering our contest with NEW name suggestions. The best name will be chosen by July 1st and the winner will receive a $1000 (U.S.) American Express Travel Cheque Card.
Why are we changing the STAT!Ref product name?
- To prevent the misperception that STAT!Ref is a statistics product.
- To improve immediate recognition and understanding of the product.
- To support diversification of our products and customers.

UpToDate 14.1 is now available by clicking on the UpToDate icon on your computer.

With this release, we have an important enhancement to announce - evidence grading is now being added to recommendations for treatment and screening. These grades will help users better understand the strength of the recommendations being made, both in terms of importance and quality of evidence. There are over one hundred graded topics in UpToDate 14.1 and more will be added with each new release.

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