Tuesday, February 14, 2017

Stimulant Meds for ADHD: What are the Risks for Bone Disease?

This well-done retrospective cross-sectional study delivers just what we want from such a study design: a clear path forward to develop a prospective trial to answer a specific question.

Source: Feuer AJ, Rhai A, Demmer RT, et al. Association of stimulant medication use
with bone mass in children and adolescents with attention-deficit/hyperactivity disorder. JAMA Pediatr. 2016;170(12):e162804; doi:10.1001/jamapediatrics.2016.2804. See AAP Grand Rounds commentary by Dr. Daniel Doherty (subscription required).

Tuesday, February 7, 2017

Cardiac Disease Screening in Down Syndrome: Is the Fox Guarding the Henhouse?

Guidelines can be biased, particularly if the guideline developers stand to gain from some of the recommendations. In most cases this isn't an intentional bias, but rather implicit bias hovering beneath the clinician's consciousness. Is implicit bias influencing screening for heart disease in Down Syndrome children?

Source: Bogarapu S, Pinto NM, Etheridge SP, et al. Screening for congenital heart disease in infants with Down Syndrome: is universal echocardiography necessary? Pediatr Cardiol. 2016;37(7):1222-1227; doi:10.1007/s00246-016-1419-2. See AAP Grand Rounds commentary by Dr. David Spar (subscription required).

Wednesday, February 1, 2017

Welcome to February at Evidence eMended

After a tumultuous January, I'm ready to settle back into a more ordinary routine, and February's list of articles in AAP Grand Rounds is a welcome sight. For those of you prudent enough to have subscriptions, you can see reviews of articles on late-onset group B streptococcal disease, maternal flu vaccination, scoliosis surgery in adolescents, and other topics.

This month for my weekly Tuesday postings I'll be expanding commentary on screening for cardiac disease in Down syndrome infants, bone mass measurement in children receiving stimulants, Kawasaki Disease treatment (a great excuse for me to revisit one of the classic "bad" study designs in medicine!), and more information on the burden of respiratory infections in young children.

Tuesday, January 31, 2017

The Strange Case of the Missing Whistle-Blower: Predatory Publishing Strikes Back?

It's a Fifth Tuesday of the month, my chance to break free from the shackles of AAP Grand Rounds and rant about anything I want! [NB: This posting has a lot of external links, but I'll think you'll enjoy exploring them and may find some useful sites you didn't know about.]

Sometime in the first half of January 2017, a valuable Internet resource for monitoring quality in scientific publications, Scholarly Open Access, disappeared.

If you took the time to click on the link in the previous sentence, you can see what's left of it. Another important publishing watchdog, Retraction Watch, gave us a glimpse of the official disappearance reason from Jeffrey Beall, a librarian at Colorado University and blogger at Scholarly Open Access. This relatively bland official statement sure sounds like threat of lawsuits by publishers drove Mr. Beall off the Internet, but that's just my speculation.

What's going on here is something I started noticing a few years ago, when I began receiving unsolicited emails from editors of journals I never heard of, asking me to submit articles on any subject at all. They went straight into my junk email list, but the steady stream of these solicitations hasn't stopped. Investigating all this led me to Beall's List of Predatory Publishers.*

What's a predatory publisher? To put it simply, these are publishers that try to induce authors to pay for getting their articles published, but in a situation that subverts the normal peer review process. The pay-for-publication model itself isn't necessarily predatory behavior; journals need to pay their costs somehow, most do it by selling advertising space, by subscription fees, and/or by having a publication fee for authors. One legitimate publisher of open-access journals with a publication fee is the Public Library of Science (PLOS) group of journals. What the predatory journals do, however, is make a mockery of the peer review process, either by having no peer review at all, by having the manuscript authors review their own submissions, or simply by utilizing unqualified reviewers. In many instances, articles end up being retracted when such practices are exposed; that's what Retraction Watch, mentioned above, keeps an eye on. Fake reviews occasionally happen to mostly legitimate publishers, so it seems nothing is entirely safe.

In this era of facts and "alternative facts," how does the earnest clinician know what to believe? Well, if a researcher reports fake results, there's not much we as consumers of the medical literature can do, other than hope the crime is exposed when other researchers are unable to replicate the results. However, if it's a matter of predatory publishing/fake reviews, that's what I'm hoping Evidence eMended helps you with. If by reading this blog you feel a little bit more comfortable knowing how to critically read an article (not just the abstract), you'll be better positioned to see some gaps in the authors' logic. Unfortunately, we won't have Beall's List to help us anymore, but it's good to see Retraction Watch is still going strong.

*Did you wonder how I led you to this posting of the 2017 Beall's List, when the entire site has been taken down? Well, if someone had the foresight to archive important pages, they are still out there somewhere. A really handy resource is Wayback Machine, you just enter the web address of the site that's been taken down and voila, you can see some views that have been saved in cyberspace. (I suspect the name of that site was a twist on the WABAC Machine from my favorite cartoon series of all time.)

Tuesday, January 24, 2017

The Gray Zone of Periodic Fevers

Last week I wrote about a retrospective case series study that could change clinical practice, but for this week's study of a similar design I would argue the reverse. Both studies are well-done, so why the difference in applying the results?

Source: Lantto U, Koivunen P, Tapiainen T, et al. Long-term outcome of classic and incomplete PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis) syndrome after tonsillectomy. J Pediatr. 2016; 179:172-7. doi:10.1016/j.jpeds.2016.08.097. See AAP Grand Rounds commentary by Dr. Rebecca Brady (subscription required). 

Tuesday, January 17, 2017

Time to Tweak our Lead-Screening Questionnaire?

In the hierarchy of evidence, aka the "evidence pyramid," retrospective case series don't rank very highly. However, this one is worth consideration for changing your practice in screening children for lead poisoning risk.

Source: Keller B, Faciano A, Tsega A, et al. Epidemiologic characteristics of children with blood lead levels ≥45μg/dL. J Pediatr 2017; 180:229-234. doi:10.1016/j.jpeds.2016.09.017. See AAP Grand Rounds commentary by Dr. Jeffrey Winer (subscription required). 

Tuesday, January 10, 2017

Certainty in Medicine: Dream On, Especially for Appendicitis Diagnosis

Uncertainty is inherent in medical practice, but that doesn't mean we shouldn't strive for accuracy in our medical decision-making. This study on sonographic diagnosis of appendicitis points to the difficulties involved in decision making based on relatively subjective criteria.

Source: Telesmanich ME, Orth RC, Zhang W, et al. Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams. Pediatr Radiol. 2016;46(11):1539-1545; doi: 10.1007/s00247-016-3645-4. See AAP Grand Rounds commentary by Dr. Michelle Stevenson (subscription required).

Tuesday, January 3, 2017

Why Can't We Refer SCFE in a Timely Manner?

This article really surprised me. How can we be so tardy in diagnosing slipped capital femoral epiphysis?

Source: Schur MD, Andras LM, Broom AM, et al. Continuing delay in the diagnosis of slipped capital femoral epiphysis. J Pediatr. 2016;177:250-254; doi:10.1016/j.jpeds.2016.06.029. See AAP Grand Rounds commentary by Dr. William Hennrikus (subscription required). 

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