Physician Knowledge e-Newsletter - V 4(3) September 2006

Physician Knowledge e-Newsletter - V 4(3) September 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)

These live online training sessions will help you make the most of your InfoPOEMs® and InfoRetriever® subscription!

Mark H. Ebell MD, MS, is Associate Professor in the Department of Family Practice at Michigan State University, former editor of the Journal of Family Practice, and now Deputy Editor for Evidence-Based Medicine of the American Family Physician. Dr. Ebell initially developed InfoRetriever® as a tool for his practice, and has been the primary software architect for InfoPOEMs®.

In these live "ask the expert" training sessions, Dr. Ebell will discuss the benefits of InfoPOEMs® and InfoRetriever®. All you need is a computer and a phone to participate!

To view the full schedule of upcoming Wiley training events, visit the Wiley Interscience Training Page. Upcoming "Ask the Expert" sessions:
"Ask the Expert": InfoPOEMs® & InfoRetriever® featuring Dr. Ebell

Announcing an Update to InfoRetriever

An InfoRetriever update was posted on Wednesday, June 21. This release includes both program improvements and content updates, including new Practice Guideline summaries, Clinical Rules and Calculators, and InfoPOEM Synopses. We are sending all of our administrators this notice now and will send a notice to your users about this new release the last week of June.

What's new

This InfoRetriever update includes:
2,977 InfoPOEMs
2,595 Abstracts of Cochrane Systematic Reviews
The complete 5-Minute Clinical Consult (2006 edition)
253 Decision Support Calculators
1,220 Evidence-Based Practice Guideline Summaries
1,373 Diagnostic Test Calculators
1,345 History and Physical Test Calculators

Coming Soon

Check for updates to InfoRetriever each time you sync your PDA! This summer, InfoRetriever will be available with automatic updates for users with Microsoft Windows desktop PCs. Want a sneak peek of Automatic Updates? Join the InfoRetriever Beta program and check it out.

Installation Instructions

Instructions for downloading the InfoRetriever update, as well as detailed installation instructions, can be found on our Getting Started Page. In addition, please note the following information:

There is no need for your users to re-register InfoRetriever after upgrading to the Spring Release. However, in some cases InfoRetriever on Pocket PC may forget the license code during the upgrade. Pocket PC users may wish to record their license code before performing the upgrade, in order to avoid having to repeat the registration process after the upgrade. To locate your current license code, select File -> Register from within InfoRetriever.
Please don't hesitate to contact us with any questions you may have.

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

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.

• Vitamin K is getting more attention as a potential treatment for osteoporosis. Early research suggested that low vitamin K status is associated with low bone mass and an increased risk of fracture in elderly patients. Clinical research then began to develop showing that taking certain vitamin K supplements might also improve bone mineral density in some patients. Now a new analysis of studies suggests that taking vitamin K supplements can improve bone mineral density and possibly decrease fracture risk in at-risk patients...postmenopausal women, patients with osteoporosis, people taking steroids, etc. Keep in mind that there are several forms of vitamin K. Researchers have mainly used vitamin K2 (menaquinone) 45 mg daily. But most vitamin K supplements don't contain anywhere close to this amount.

• SunPill and Heliocare are two new supplements promoted as ORAL "sunscreens." SunPill is a basic combination of vitamins, minerals, and herbals such as vitamin C, vitamin E, vitamin A, selenium, green tea extract and others. Heliocare contains an extract of the fern Polypodium leucotomos. Some evidence suggests that some of the antioxidants contained in these products MIGHT help reduce skin damage from sun exposure. But there is no reliable evidence that these products are more effective than a topically applied sunscreen. Explain to patients that these should not be considered a substitute for a topical sunscreen. Continue to recommend sunscreens with a SPF of at least 15.

• Beer is now getting lots of press as a "healthy" alcoholic drink. Researchers are focusing on flavonoid constituents such as xanthohumol that come from the hops used to produce beer. Preliminary research suggests that these flavonoids activate proteins that decrease the viability of prostate cancer cells. Other research shows that they block the enzyme aromatase, suggesting potential benefits against breast cancer. This is interesting research, but very preliminary. Explain to patients that there's only a tiny amount of these compounds in a bottle of beer. But don't be surprised to see new beer or hops extracts coming out promoted for prostate health and other uses.

• Sinol Headache nasal spray is a new capsaicin 0.01% nasal spray promoted for migraine and other headaches. So far, there is no reliable evidence specifically for this formulation. But some evidence suggests that other intranasal capsaicin applications, in higher concentrations, might be beneficial for aborting and preventing cluster headache and migraines. The downside is the side effects. Imagine putting chili peppers in your nose...it really burns. Explain to patients that intranasal capsaicin might help migraines and cluster headaches, but other treatments are likely to be much more tolerable.

For more information about natural products used for headaches, get our latest course, Natural Medicines in the Clinical Management of Headache. You'll get the latest information on feverfew, butterbur, melatonin, and many other products used for migraines and cluster headaches.

Have you noticed the new look at naturaldatabase.com? It's more than a cosmetic makeover. You also get a new supercharged search feature. This means you get MORE answers...and you get them faster and easier.

Type in a natural product name - you get matching products PLUS quick links to conditions that the product is used for and potential interactions with drugs.

Type in a conventional drug name - you get quick links to natural products that might interact with the drug.

Type in a condition or disease name - you get products that are used for that condition PLUS our Effectiveness ratings.

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

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.

• Chamomile tea has now been identified as a potential concern for patients who take the anticoagulant warfarin (Coumadin). A case report suggests that drinking the most common form of chamomile tea (Matricaria recutita) might INCREASE the anticoagulant effects of warfarin...and potentially result in bleeding. It's too soon to say for sure that chamomile can consistently cause this interaction. In the meantime, advise patients who take warfarin to talk with you before drinking chamomile.

• Green tea and coffee drinkers have some good news. People who drink these beverages seem to have a lower risk of developing type 2 diabetes compared to those who don't. Several studies now suggest that drinking 3-6 cups of coffee daily decreases type 2 diabetes risk anywhere from 30% to 60%. Research in Japanese adults also suggests that drinking 6 or more cups of green tea daily reduces risk by about 30%. Interestingly, the more you drink, the lower your risk seems to be. But the same benefits aren't seen in people who drink black tea or oolong tea. Tell diabetes patients that there is no reliable evidence that coffee or green tea is helpful for TREATING diabetes.

• Chromium might not be as effective for helping to treat type 2 diabetes as we previously thought. New research in an obese, Western population suggests that chromium is NOT effective for improving diabetes control. Previous research has suggested significant benefit. But the largest previous trial included patients from China, where chromium deficiency is more likely. Tell patients who want to try chromium that it might only help if they are chromium deficient. Chromium deficiency can occur in some diabetes patients, but not all. Explain that if they don't have any improvement within a few weeks of using chromium, then it probably won't help at all.

• Digestinol is a new brand product containing "aloe mucilaginous polysaccharide" and glutamine. As the name implies, it's used for a wide variety of gastrointestinal conditions...irritable bowel syndrome, diverticulitis, ulcerative colitis, ulcers, GERD, and a long list of other conditions. The manufacturer claims that there are over 500 published studies on the healing agent of aloe. There is no dispute over this, but, so far, there are no published studies proving the effectiveness of Digestinol. Advise patients not to rely on it.

Our latest course in the series is now available...Natural Medicines in the Clinical Management of Osteoarthritis. Get the latest info on glucosamine, chondroitin, MSM, and many other products.

Have you noticed the new look at naturaldatabase.com? It's more than a cosmetic makeover. You also get a new supercharged search feature. This means you get MORE answers...and you get them faster and easier.

Type in a natural product name - you get matching products PLUS quick links to conditions that the product is used for and potential interactions with drugs.

Type in a conventional drug name - you get quick links to natural products that might interact with the drug.

Type in a condition or disease name - you get products that are used for that condition PLUS our Effectiveness ratings.

You'll also get relevant links from any of the disease management series.

*CE is at NO CHARGE for individual subscribers and all members of group subscriptions.
Copyright 1995-2006, Therapeutic Research Faculty. All rights reserved.

To ensure that all technology improvements to the platform are implemented smoothly, the Books@Ovid navigation and usability enhancements that were scheduled for completion by Tuesday, May 30 will instead be completed by Wednesday, June 7.

With these enhancements, users can:

Get higher ranked results when search terms appear in chapter titles and headers
Use the Quick Search feature to get results fast from the browse books page
Instantly return to browse books from search results
Limit searches to a single book on the main search page
View terms searched using the natural language lexicon and view highlighted search terms on the results page (requires additional setup; please contact your Technical Support representative)
Precisely identify your location within the full text-the closest heading in the Table of Contents is now highlighted and the "crumb-trail" is always refreshed (Table of Contents now syncs with index selections, too!)
Easily print sections and subsections within chapters using PrintPreview to output text along with the book and chapter identifying information
Regards,
Ovid Technologies

Title
A Nurse's Guide to Cancer Care - 1st Ed. (2000)
ACP Medicine (2006)
ACS Surgery: Principles & Practice (2006)
Adams and Victor's Principles of Neurology - 8th Ed. (2005)
AHFS Drug Information® (2006)
AJCC Cancer Staging Handbook - 6th Ed. (2002)
Ambulatory Care Procedures for the Nurse Practitioner - 2nd Ed. (2004)
Ambulatory Care Procedures for the Nurse Practitioner - 2nd Ed. (2004)
Basic and Clinical Pharmacology - 9th Ed. (2004)
Brunner & Suddarth's Textbook of Medical-Surgical Nursing - 10th Ed. (2004)
Brunner & Suddarth's Textbook of Medical-Surgical Nursing - 10th Ed. (2004)
Control of Communicable Diseases Manual - 18th Ed. (2004)
Current Critical Care Diagnosis & Treatment - 2nd Ed. (2003)
Current Diagnosis & Treatment in Cardiology - 2nd Ed. (2003)
Current Diagnosis & Treatment in Gastroenterology - 2nd Ed. (2003)
Current Diagnosis & Treatment in Infectious Diseases (2001)
Current Diagnosis & Treatment in Orthopedics - 4th Ed. (2006)
Current Diagnosis & Treatment in Orthopedics - 4th Ed. (2006)
Current Emergency Diagnosis & Treatment - 5th Ed. (2004)
Current Medical Diagnosis & Treatment - 45th Ed. (2006)
Current Obstetric & Gynecologic Diagnosis & Treatment - 9th Ed. (2003)
Current Pediatric Diagnosis & Treatment - 17th Ed. (2005)
Current Surgical Diagnosis & Treatment - 12th Ed. (2006)
Davis's Drug Guide for Nurses - 10th Ed. (2007)
DeGowin's Diagnostic Examination - 8th Ed. (2004)
Delmar's Fundamental & Advanced Nursing Skills - 2nd Ed. (2004)
Delmar's Geriatric Nursing Care Plans - 3rd Ed. (2005)
Delmar's Guide to Laboratory and Diagnostic Tests (2002)
Diagnostic and Statistical Manual - Text Revision (DSM-IV-TR™, 2000)
Dictionary of Medical Acronyms & Abbreviations - 5th Ed. (2005)
Diseases and Disorders: A Nursing Therapeutics Manual - 2nd Ed. (2002)
Emergency Medicine: A Comprehensive Study Guide - 6th Ed. (2004)
Family Medicine: Principles and Practice - 6th Ed. (2003)
Family Nursing: Research, Theory and Practice - 5th Ed. (2003)
Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology - 5th Ed. (2005)
Foundations of Nursing Research - 4th Ed. (2002)
Geriatric Medicine: An Evidence Based Approach - 4th Ed. (2003)
Goldfrank's Toxicologic Emergencies - 8th Ed. (2006)
Goldfrank's Toxicologic Emergencies - 8th Ed. (2006)
Goldfrank's Toxicologic Emergencies - 8th Ed. (2006)
Goodman & Gilman's The Pharmacological Basis of Therapeutics - 11th Ed. (2006)
Griffith's 5-Minute Clinical Consult - 14th Ed. (2006)
Guide to Culturally Competent Health Care (2005)
Harrison's Principles of Internal Medicine - 16th Ed. (2005)
Harrison's Principles of Internal Medicine - 16th Ed. (2005)
Harrison's Principles of Internal Medicine - 16th Ed. (2005)
Harrison's Principles of Internal Medicine - 16th Ed. (2005)
Holland-Frei Cancer Medicine - 6th Ed. (2003)
Hurst's The Heart - 11th Ed. (2004)
INFECTIOUS DISEASES: The Clinician's Guide to Diagnosis, Treatment, and Prevention (2006)
Internal Medicine, Stein - 5th Ed. (1998)
Maternal-Newborn Nursing & Women's Health Care - 7th Ed. (2004)
Medical Immunology - 10th Ed. (2001)
Mosby's Drug Consult™ - 16th Ed. (2006)
Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs - 5th Ed. (2004)
Nurse's Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales - 10th Ed. (2006)
Nurse's Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales - 10th Ed. (2006)
Nursing Diagnosis Reference Manual - 6th Ed. (2005)
Orthopaedic Examination, Evaluation, & Intervention (2004)
Oxford Textbook of Palliative Medicine - 3rd Ed. (2004)
Pediatric Nursing: Caring for Children and Their Families (2002)
Pharmacotherapeutics: A Primary Care Clinical Guide - 2nd Ed. (2005)
Primary Care for Physician Assistants: Clin Prac Guidelines, 2nd Ed. (2001)
Red Book®: 2006 Report of the Committee on Infectious Diseases - 27th Ed
Review of General Psychiatry - 5th Ed. (2000)
Review of Medical Physiology - 22nd Ed. (2005)
Review of Natural Products (2006)
Rudolph's Pediatrics - 21st Ed. (2003)
Schwartz's Principles of Surgery - 8th Ed. (2005)
Sherris Medical Microbiology - 4th Ed. (2004)
Smith's General Urology - 16th Ed. (2004)
Taber's® Cyclopedic Medical Dictionary - 20th Ed. (2005)
Trauma - 5th Ed. (2004)
USP DI® Drug Info. for the Health Care Pro. - 26th Ed. (2006)
Williams Obstetrics - 22nd Ed. (2005)
Women's Health: A Primary Care Clinical Guide - 3rd Ed. (2004)

UpToDate 14.2 is now available on our web site at www.uptodateonline.com or by clicking on the UpToDate icon on your computer.

Since our previous release, more than 180 new topic reviews were added to the program and approximately 45% of existing topics were updated based on new information. A visit to the "What's New" section of the Table of Contents gives you a summary of updates thought to be of particular interest by our editors.

You may also read up on the latest developments at UpToDate by going to http://www.uptodate.com/img/newsletter.pdf for a copy of our 14.2 newsletter. Among the articles you may find of interest is one about a unique pay-for-performance program featuring use of UpToDate.

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