Evidence-based Medical Information Research Articles

RETRACTED: A novel DNA sensor based on C60NPs-PAMAM-PtPNPs to detect VKORC1 gene for guiding rational clinical therapy with warfarin

Reports have indicated that warfarin is the most widely prescribed anticoagulant. However, traditionally prescribed doses for each patient may be too low or too high. The therapeutic effect is often hindered by a lack of evidence-based medical information. Herein, our aim is to provide this information. To accomplish this challenge, we report the development of a novel assay based on biotinylated tetrahedral DNA as a capture probe and fullerene (C60)-based nanomaterial as a redox probe using an ultrasensitivity assay with the Vitamin K epoxide reductase complex, subunit 1 (VKORC1). Platinum porous nanoparticles (PtPNPs) were modified on amino-terminated polyamidoamine (PAMAM)-functionalized C60 nanoparticles (C60NPs). The resultant C60NPs-PAMAM-PtPNPs were used as a redox probe. In this design, C60 exhibited excellent redox activity that was triggered by tetraoctylammonium bromide (TOAB). To improve the immobilization of the tetrahedral DNA capture probe, avidin was introduced during the fabrication of the biosensor because it can provide more active sites for the immobilization capture probe. The free-standing probe on top of the tetrahedral DNA served as a receptor to hybridize with target DNA directly. Different pulse voltammetry (DPV) was applied to record the electrochemical signals, which increased linearly with the target DNA. Under optimal conditions, the prepared biosensor showed a wide linear relationship, from 1 pM to 10 nM, with detection limits of 0.33 pM. This strategy demonstrates a new avenue for the determination of tumour-related mutated nucleotides in biosamples.

Reflection on the present study of anastomotic leakage after colorectal surgery

Anastomotic leakage is one of the most serious complications of colorectal surgery. Despite progress in available surgical techniques, the morbidity associated with anastomotic leakage remains high. In this review, we summarize the current clinical status of this complication, the problems it causes, and relevant research achievements. To date, a lack of consensus regarding the diagnosis of anastomotic leakage has resulted in varying rates of diagnosis across countries and regions worldwide. Accurately predicting the occurrence of anastomotic leakage using the established risk factors and preoperative scoring systems remains difficult. Many of the described preventive measures, including defunctioning stoma creation, positive air leak testing, and use of effective tissue adhesives, remain controversial; more evidence-based medical information is urgently needed. Delayed diagnoses of anastomotic leakage also remain common in clinical practice. To prevent catastrophic outcomes, such as reoperations or deaths, early diagnosis is critically important. Parameters local to the area of the anastomosis may facilitate early detection of leakage, but their effectiveness is subject to clinical validation. Lastly, the pathological etiology of anastomotic leakage remains to be determined, and its elucidation may inspire innovative interventions that solve this critical surgical complication.

From Bench to Bedside: Converting Placebo Research into Belief Activation.

Research on the placebo effect contains important elements that can be harnessed to improve clinical care. This paper proposes a new term, "Belief Activation," to describe the deliberate use of placebo effect tools by both patients and clinicians to catalyze healing. Belief Activation includes, but is not limited to, maximizing patient and practitioner expectations, classical and social conditioning, spirituality and prayer/intention, therapeutic relationship, healing environments, and minimizing the nocebo effect. This paper demonstrates ways in which Belief Activation is a form of evidence-based medicine and seeks to translate knowledge from placebo research into medical practice.

Voltammetric hybridization assay for the β1-adrenergic receptor gene (ADRB1), a marker for hypertension, by using a metal organic framework (Fe-MIL-88NH2) with immobilized copper(II) ions

The β1 receptor blocker metoprolol targets the hypertension-carrying adrenergic receptor gene (ADRB1), but therapy is often hindered by a lack of evidence-based medical information. The authors describe an assay for the ADRB1 gene. It is based on the electrocatalytic oxidation of H2O2 by a nanocomposite consisting of hemin and platinum nanoparticles in an amino-modified metal-organic framework of the type Fe-MIL-88-NH2 and heavily loaded with Cu(II) ions. The nanocomposite was placed on a glassy carbon electrode (GCE), and the resulting sensor displays increased electrocatalytic activity with the addition of H2O2 because of the synergistic effects of hemin and the platinum nanoparticles (Pt NPs). Next, a capture DNA probe for the target ADRB1 gene was immobilized on the modified GCE. Binding of the target gene results in a distinct change in the electrocatalytic activity of H2O2. The amperometric i–t curves were recorded at −0.4 V in 5 mL of phosphate buffered saline at room temperature. The electrode responds to ADRB1 in the 1 f. to 10 nM concentration range and has a 0.21 f. detection limit (at a S/N ratio of 3). In our perception, this detection scheme can simplify and accelerate the identification of drug response and therapeutic efficacy. Conceivably, it may be applied to other mutations, and it may enable a more precise clinical prognosis and thus facilitate personalized medical diagnostics.

149: TRAINING EFFECTIVE SEARCH SKILLS IN EVIDENCE-BASED MEDICINE IN THE CLINIC IN BUSHEHR`S PERSIAN GULF MARTYRS HOSPITAL IN 2016: A DESCRIPTIVE STUDY

Background and aims:Effective information search and access to the right information at the right time, has become one of the ideals medical purposes for physicians. If for any reason physicians...

A new sight for detecting the ADRB1 gene mutation to guide a therapeutic regimen for hypertension based on a CeO2-doped nanoprobe

The β1-adrenergic receptor gene (Entrez Gene:ADRB1), as the target of beta-blockers for hypertension, can directly influence the antihypertensive effect of metoprolol in the Chinese population. This therapeutic effect is often hindered by a lack of evidence-based medical information. To address this challenge, we report a novel assay based on graphene oxide and a CeO2 nanocomposite functionalized by 3-aminopropyltriethoxysilane supported Pt nanoparticles (GO/CeO2/PtNPs) as a signal probe. Due to the large specific surface area and good adsorption properties of the GO/CeO2 nanocomposite, large amounts of PtNPs were immobilized, which amplified the electrochemical signal and improved the sensitivity of the biosensor. To further improvement the sensitivity of the biosensor, Streptavidin (SA) was introduced because it can provide more active sites for the immobilization of the biotinylated capture probe (bio-CP). The electrochemical signal was primarily derived from the catalysis of H2O2 by GO/CeO2/PtNPs. Chronoamperometry was applied to record electrochemical signals, which linearly increased with target DNA. Under optimal conditions, the prepared biosensor had a wide linear range from 1fM to 10nM and a low detection limit of 0.33fM in the detecting of ADRB1 gene. Moreover, the proposed method had good stability and recovery, suggesting its potential for use in clinical research.

Challenges of evaluating a computer-based educational programme for women diagnosed with early-stage breast cancer: a randomised controlled trial.

In a two-group, multi-centre, randomised controlled 9months trial, we (1) evaluated the impact of a computer-based educational programme compared to standard care and (2) examined whether different patterns of programme usage could be explained by demographic, medical and psychosocial factors. We involved 226 Swedish-speaking women diagnosed with early-stage breast cancer and scheduled for surgery. Primary outcomes were health self-efficacy and health care participation measured by the Comprehensive Health Enhancement Supportive System instrument. Secondary outcomes were anxiety and depression levels measured by the Hospital Anxiety and Depression scale. The Functional Assessment of Cancer Therapy-Breast and Sense of Coherence scales measured psychosocial factors for the study's secondary aim. Multi-level modelling revealed no statistically significant impact of the computer-based educational programme over time on the outcomes. Subsequent exploratory regression analysis revealed that older women with axillary dissection and increased physical well-being were more likely to use the programme. Furthermore, receiving post-operative chemotherapy and increased meaningfulness decreased the likelihood of use. Providing reliable and evidence-based medical and rehabilitation information via a computer-based programme might not be enough to influence multi-dimensional outcomes in women diagnosed with breast cancer. The use of these programmes should be further explored to promote adherence to e-Health supportive interventions.

Effects of fertility education on knowledge, desires and anxiety among the reproductive-aged population: findings from a randomized controlled trial.

STUDY QUESTIONWhat are the effects of fertility education on knowledge, childbearing desires and anxiety?SUMMARY ANSWERProviding fertility information contributed to greater knowledge, but increased anxiety.WHAT IS KNOWN ALREADYPast studies have found that exposure to educational material improved fertility awareness and changed desires toward childbearing and its timing. Existing educational websites with evidence-based medical information provided in a non-judgmental manner have received favorable responses from reproductive-aged men and women.STUDY DESIGN, SIZE, DURATIONThis three-armed (one intervention and two control groups), randomized controlled trial was conducted using online social research panels (SRPs) in Japan in January 2015.PARTICIPANTS/MATERIALS, SETTING, METHODSA total of 1455 participants (726 men and 729 women) between 20 and 39 years of age who hoped to have (more) children in the future were block-randomized and exposed to one of three information brochures: fertility education (intervention group), intake of folic acid during pregnancy (control group 1) or governmental financial support for pregnancy and childbirth (control group 2). Fertility knowledge was measured with the Japanese version of the Cardiff Fertility Knowledge Scale (CFKS-J). Knowledge, child-number and child-timing desires, subjective anxiety (i.e. whether participants felt anxiety [primary outcome]), and scores on the State-Trait Anxiety Inventory were assessed immediately after exposure. Non-inferiority comparisons were performed on subjective anxiety with non-inferiority declared if the upper limit of the two-sided 95% confidence interval (CI) for risk difference did not exceed a margin of 0.15. This test for non-inferiority was only performed for subjective anxiety; all the other variables were tests of superiority.MAIN RESULTS AND THE ROLE OF CHANCEPosttest scores on the CFKS-J (mean, SD) were higher in the intervention group than that of the control groups: intervention versus Control 1 and versus Control 2: 52.8 (28.8) versus 40.9 (26.2) (P< 0.001) versus 45.1 (27.1) (P = 0.003) among men and 64.6 (26.0) versus 50.8 (26.9) (P< 0.001) versus 53.0 (26.4) (P< 0.001) among women.The percentage of participants who felt subjective anxiety after exposure to the intervention brochure was significantly higher than that of the control groups: intervention versus Control 1 and versus Control 2: 32.6 versus 17.8% (risk difference [RD] = 0.149, 95% CI: 0.073–0.225) versus 14.5% (RD = 0.182, 95% CI: 0.108–0.256) among men, and 50.2 versus 26.3% (RD = 0.239, 95% CI: 0.155–0.322) versus 14.0% (RD = 0.362, 95% CI: 0.286–0.439) among women. Non-inferiority of the intervention was inconclusive (i.e. the CI included 0.15) among men whereas inferiority was declared among women. The incidence of anxiety was higher in the intervention group than that of the control groups especially among men aged 30 and older and among women aged 25 and older. No difference existed in childbearing desires between groups after exposure.LIMITATIONS, REASONS FOR CAUTIONThe possibility of selection bias associated with the use of SRPs (higher socioeconomic status and education) and volunteer bias toward those more interested in fertility may limit the generalizability of these findings.WIDER IMPLICATIONS OF THE FINDINGSIn addition to education targeting a younger generation, psychological approaches are needed to alleviate possible anxiety caused by fertility information.STUDY FUNDING/COMPETING INTEREST(S)This study was funded by National Center for Child Health and Development, Seiiku Medical Study Grant (24-6), the Daiwa Foundation Small Grants and Grant-in-Aid for JSPS Fellows (26-1591). No competing interest declared.TRIAL REGISTRATION NUMBERUMIN Clinical Trials Registry. Trial registration number, 000016168.TRIAL REGISTRATION DATE13 January 2015.DATE OF FIRST PATIENT'S ENROLMENT15 January 2015.

Get Vaccinated! and Get Tested! Developing Primary and Secondary Cervical Cancer Prevention Videos for a Haitian Kreyòl-Speaking Audience

Although routine screening reduces cervical cancer rates between 60% and 90%, thousands of women worldwide are diagnosed with the disease on an annual basis because of inadequate screening. Haitian women in South Florida experience a disproportionate burden of cervical cancer, with disease rates 4 times higher than the average for women in Miami. An ongoing community-based participatory research initiative to assess and reduce this burden has revealed that a complex interplay of factors contributes to a lack of access to screening in this community, including socioeconomics, language barriers, and traditional understandings of health and disease. In an effort to address some of these barriers and encourage uptake of primary and secondary cervical cancer prevention strategies, 2 videos on cervical cancer prevention were created using a community-based participatory research framework. The video screenplays were created by a Haitian screenwriter using evidence-based medical information provided by academic researchers. The films feature Haitian actors speaking a Haitian Kreyòl dialogue with a storyline portraying friends and family discussing human papillomavirus disease and vaccination, Papanicolaou testing, and cervical cancer. Focus groups held with Haitian women in South Florida suggested that the films are engaging; feature relatable characters; and impact knowledge about human papillomavirus, cervical cancer development, and current prevention recommendations.

Analyzing Information Seeking and Drug-Safety Alert Response by Health Care Professionals as New Methods for Surveillance.

BackgroundPatterns in general consumer online search logs have been used to monitor health conditions and to predict health-related activities, but the multiple contexts within which consumers perform online searches make significant associations difficult to interpret. Physician information-seeking behavior has typically been analyzed through survey-based approaches and literature reviews. Activity logs from health care professionals using online medical information resources are thus a valuable yet relatively untapped resource for large-scale medical surveillance.ObjectiveTo analyze health care professionals’ information-seeking behavior and assess the feasibility of measuring drug-safety alert response from the usage logs of an online medical information resource.MethodsUsing two years (2011-2012) of usage logs from UpToDate, we measured the volume of searches related to medical conditions with significant burden in the United States, as well as the seasonal distribution of those searches. We quantified the relationship between searches and resulting page views. Using a large collection of online mainstream media articles and Web log posts we also characterized the uptake of a Food and Drug Administration (FDA) alert via changes in UpToDate search activity compared with general online media activity related to the subject of the alert.ResultsDiseases and symptoms dominate UpToDate searches. Some searches result in page views of only short duration, while others consistently result in longer-than-average page views. The response to an FDA alert for Celexa, characterized by a change in UpToDate search activity, differed considerably from general online media activity. Changes in search activity appeared later and persisted longer in UpToDate logs. The volume of searches and page view durations related to Celexa before the alert also differed from those after the alert.ConclusionsUnderstanding the information-seeking behavior associated with online evidence sources can offer insight into the information needs of health professionals and enable large-scale medical surveillance. Our Web log mining approach has the potential to monitor responses to FDA alerts at a national level. Our findings can also inform the design and content of evidence-based medical information resources such as UpToDate.

New Hypertension Guidelines: Progression or a Step Backwards in Hypertension?

In the last years, many hypertension guidelines have been published as new or revised versions. They follow the general trend that only clinical evidence is relevant for guidelines. Expert opinion is downplayed. At present, guidelines from three major organizations have been produced: by the European Society of Hypertension, the International Society/American Society of Hypertension, and the US Joint National Committee. We discuss eight versions of these guidelines in this review. All of these include statements on blood pressure goals or treatment algorithms for patients with high blood pressure. The variability of practical tips is great, and the recommendations, which mainly rely on evidence-based medical information, show slight differences that have resulted in some confusion with specialists and also practitioners. In the current review, the changes in the guidelines in comparison to previous guidelines are discussed, and reasons for different recommendations are explained. The hope is to reduce confusion.

The Impact of Search Engine Selection and Sorting Criteria on Vaccination Beliefs and Attitudes: Two Experiments Manipulating Google Output

BackgroundDuring the past 2 decades, the Internet has evolved to become a necessity in our daily lives. The selection and sorting algorithms of search engines exert tremendous influence over the global spread of information and other communication processes.ObjectiveThis study is concerned with demonstrating the influence of selection and sorting/ranking criteria operating in search engines on users’ knowledge, beliefs, and attitudes of websites about vaccination. In particular, it is to compare the effects of search engines that deliver websites emphasizing on the pro side of vaccination with those focusing on the con side and with normal Google as a control group.MethodWe conducted 2 online experiments using manipulated search engines. A pilot study was to verify the existence of dangerous health literacy in connection with searching and using health information on the Internet by exploring the effect of 2 manipulated search engines that yielded either pro or con vaccination sites only, with a group receiving normal Google as control. A pre-post test design was used; participants were American marketing students enrolled in a study-abroad program in Lugano, Switzerland. The second experiment manipulated the search engine by applying different ratios of con versus pro vaccination webpages displayed in the search results. Participants were recruited from Amazon’s Mechanical Turk platform where it was published as a human intelligence task (HIT).ResultsBoth experiments showed knowledge highest in the group offered only pro vaccination sites (Z=–2.088, P=.03; Kruskal-Wallis H test [H5]=11.30, P=.04). They acknowledged the importance/benefits (Z=–2.326, P=.02; H5=11.34, P=.04) and effectiveness (Z=–2.230, P=.03) of vaccination more, whereas groups offered antivaccination sites only showed increased concern about effects (Z=–2.582, P=.01; H5=16.88, P=.005) and harmful health outcomes (Z=–2.200, P=.02) of vaccination. Normal Google users perceived information quality to be positive despite a small effect on knowledge and a negative effect on their beliefs and attitudes toward vaccination and willingness to recommend the information (χ2 5=14.1, P=.01). More exposure to antivaccination websites lowered participants’ knowledge (J=4783.5, z=−2.142, P=.03) increased their fear of side effects (J=6496, z=2.724, P=.006), and lowered their acknowledgment of benefits (J=4805, z=–2.067, P=.03).ConclusionThe selection and sorting/ranking criteria of search engines play a vital role in online health information seeking. Search engines delivering websites containing credible and evidence-based medical information impact positively Internet users seeking health information. Whereas sites retrieved by biased search engines create some opinion change in users. These effects are apparently independent of users’ site credibility and evaluation judgments. Users are affected beneficially or detrimentally but are unaware, suggesting they are not consciously perceptive of indicators that steer them toward the credible sources or away from the dangerous ones. In this sense, the online health information seeker is flying blind.

Infection and Chemotherapy: We Are Ready to Fly

On behalf of the editorial board, I am pleased to announce that Infection and Chemotherapy is being published as an open-access English journal beginning in March, 2013 with volume 45, issue 1 to facilitate its international competitiveness. We believe that this change represents a significant step toward the globalization of the Korean Society of Infectious Disease and the Korean Society for Chemotherapy, providing you with the opportunity to communicate with a wide range of scientists around the world. Infection and Chemotherapy is a journal born in 2003 that extensively integrates two journals: Kamyeom, published by the Korean Society of Infectious Diseases since 1969 [1], and Hwahakyobeophwakhaeji, published by the Korean Society for Chemotherapy since 1983 [2]. Over the past 44 years, more than 1,870 valuable original articles and case reports have been published in these historical journals. Infection and Chemotherapy is a member of the Korean Association of Medical Journal Editors [3] and KoreaMed [4], and we have endeavored to maintain the high quality of the journal. We are obliged to accelerate the speed of taking, discussing, and distributing new and evidence-based international academic medical information in order to keep up with rapid updates of clinical and laboratory research in the field of infectious diseases. This is why Infection and Chemotherapy just converted to English, closing its character as a Korean journal even though it was published in a Korean and English mixed format, with the last edition, volume 44, issue 6, published in December 2012. Articles published in Infection and Chemotherapy can be obtained for free from an English website (www.icjourmal.org), where their abstracts and full-text PDF files can be located. Furthermore, all articles can also be viewed on the website of KoreaMed (www.koreamed.org) and found on the KoreaMed Synapse (http://synapse.koreamed.org) search system. Infection and Chemotherapy will continue striving to accomplish its goal of serving as one of the major international journals focusing on infectious diseases. It will include valuable editorials, several review articles by renowned scholars, novel original articles, practice guidelines, and informative case reports. Infection and Chemotherapy welcomes articles on a wide range of clinical descriptions of clinical infectious diseases as well as public health issues, microbiology, parasitology and infection immunity, evaluations of current and novel treatments, and the promotion of optimal practices for diagnoses and treatments. Finally, I would like to express my sincere appreciation for the ongoing effort of the many editors in chief who have worked to keep Infection and Chemotherapy worthy of its name as a professional journal.

Health care workers in Africa access a broad range of topics using evidence-based online medical information

Health care workers (HCW) rely on Internet-based medical resources to obtain current evidence-based clinical guidelines. While such resources are being used with increasing frequency in developed countries, they have not been broadly employed in resource-limited settings (RLS). To investigate the feasibility and the types of medical content used by HCW in RLS, we studied one Internet-based medical resource used in the United States, (UpToDate©) in four hospitals in Africa. Health care workers were trained on how to use this resource and surveyed over a six month study period. Automated topic tracking found that HCW searched a variety of medical topics. About 78% of HCW reported daily or weekly use of the Internet-based medical resource and 70% felt the tool was very useful for teaching. All users report the tool increased their clinical knowledge. This descriptive study suggests that Internet-based medical information resources are feasible in RLS and are accessed for a broad variety of medical topics. Supplemental content providing guidance when minimal diagnostic and therapeutic options exist could increase its relevance in RLS. With increased availability, Internet-based medical information could enhance current global health care initiatives to improve providers' knowledge, clinical practice and potentially patient outcomes.

Information Literacy for Users at the National Medical Library of Cuba: Cochrane Library Course for the Search of Best Evidence for Clinical Decisions

The National Medical Library of Cuba is currently developing an information literacy program to train users in the use of biomedical databases. This paper describes the experience with the course “Cochrane Library: Evidence-Based Medicine,” which aims to teach users how to make the best use of this database, as well as the evidence-based medicine concept for making better decisions about medical care. During the course, the Big 6TM Model is also introduced for finding and organizing the evidence-based medical information; it also enables students to create information products (electronic bulletins) that will allow the presentation of search results as well as promoting information for healthcare in the future.

Using Web 2.0 Technologies to Enhance Evidence-Based Medical Information

This article invokes research on information seeking and evaluation to address how providers of evidence-based medical information can use Web 2.0 technologies to increase access to, enliven users’ experiences with, and enrich the quality of the information available. In an ideal scenario, evidence-based medical information can take appropriate advantage of community intelligence spawned by Web 2.0 technologies, resulting in the ideal combination of scientifically sound, high-quality information that is imbued with experiential insights from a multitude of individuals. To achieve this goal, the authors argue that people will engage with information that they can access easily, and that they perceive as (a) relevant to their information-seeking goals and (b) credible. The authors suggest the utility of Web 2.0 technologies for engaging stakeholders with evidence-based medical information through these mechanisms, and the degree to which the information provided can and should be trusted. Last, the authors discuss potential problems with Web 2.0 information in relation to decision making in health contexts, and they conclude with specific and practical recommendations for the dissemination of evidence-based health information via Web 2.0 technologies.

How can we meet the information needs of patients with early stage papillary thyroid cancer considering radioactive iodine remnant ablation?

In patients with early stage papillary thyroid carcinoma (PTC) who have had a thyroidectomy, the decision must be made to accept or reject radioactive iodine remnant ablation (RRA). Counselling patients about this decision can be challenging, given the medical evidence uncertainties and the complexity of related information. Although physicians are the primary source of medical information for patients considering RRA, some patients have a desire for supplemental information from sources such as the internet. Yet, thyroid cancer resources on the internet are of variable quality, and some may not be applicable to the individual case. We have developed a computerized educational tool [called a decision aid (DA)], directed to patients with early stage papillary thyroid cancer, and intended as an adjunct to physician counselling, to relay evidence-based medical information on disease prognosis and the choice to accept or reject RRA. DAs are tools used to inform patients about available treatment options and have been utilized in oncologic decision-making. We tested our web-based DA in fifty patients with early stage PTC and found that it improved medical knowledge. Furthermore, participants found the technical usability of the tool acceptable. We are currently conducting a randomized controlled trial comparing the use of the DA plus usual care to usual care alone to confirm the educational benefit of the website and examine its impact on the decision-making process. In the future, DAs may play an expanded role as an adjunct to physician counselling in the care of patients with thyroid cancer.

Banking cord blood stem cells: attitude and knowledge of pregnant women in five European countries

This study explores pregnant women's awareness of cord blood stem cells and their attitude regarding banking options in France, Germany, Italy, Spain, and the UK. Questionnaires were distributed in six maternities. This anonymous and self-completed questionnaire included 29 multiple-choice questions based on: 1) sociodemographic factors, 2) awareness and access to information about cord blood banking, 3) banking option preferences, and 4) donating cord blood units (CBUs) to research. A total of 79% of pregnant women had little awareness of cord blood banking (n = 1620). A total of 58% of women had heard of the therapeutic benefits of cord blood, of which 21% received information from midwives and obstetricians. A total of 89% of respondents would opt to store CBUs. Among them, 76% would choose to donate CBUs to a public bank to benefit any patient in need of a cord blood transplant. Twelve percent would choose a mixed bank, and 12%, a private bank. A total of 92% would donate their child's CBU to research when it is not suitable for transplantation. The study reveals a strong preference for public banking in all five countries, based on converging values such as solidarity. Attitudes of pregnant women are not an obstacle to the rapid expansion of allogeneic banking in these EU countries. Banking choices do not appear to be correlated with household income. The extent of commercial marketing of cord blood banks in mass media highlights the importance for obstetric providers to play a central role in raising women's awareness early during their pregnancy with evidence-based medical information about banking options.

‘Case reporting of rare adverse events in otolaryngology’: can we defend the case report?

The study of errors in medicine has proliferated since the publication of The Institute of Medicine Report 'TO ERR IS HUMAN' in 2000. Case nuances and process of care issues are valuable areas to explore if the goal is to provide the health care worker with the knowledge to avoid future errors. Meta-analysis and randomized controlled trials provide a large data base of evidence towards improvement and opportunities, but it is suggested that case reports can still provide valuable clinical information. The aim is to use the published literature to produce a series of rare harm case reports in E.N.T. The methods include systematic literature review. Journals searched in PUBMED were 60. Rare harm case obtained from the search were 5,322. Rare harm case reports not reported in any other form of evidence-based medicine were 40. Yes, the case report can be defended as it is an important pillar of evidence-based medicine.

Patient UK

Seeking information on the Internet is easy. Finding free, fact-based, authoritative medical and health data written for the consumer is a challenge. Patient UK is a free resource primarily aimed at enabling nonmedical persons to quickly locate reliable evidence-based health and medical information. However, health professionals also can, and do, use it as a tool to address clinical questions and to provide answers to patient queries. The Web site is owned by a company that provides medical software to more than half of the general practitioners (GPs) throughout the United Kingdom (UK), but the information located there is freely available to all.