Lancet retracts article linking vaccines and autism

The journal Lancet has retracted the 1998 article linking mercury in vaccines.

The text from the editors is short:
Following the judgment of the UK General Medical Council's Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al are incorrect, contrary to the findings of an earlier investigation. In particular, the claims in the original paper that children were "consecutively referred" and that investigations were "approved" by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record.

Read news about this retraction at the New York Times

For more on the controversy surrounding vaccines and autism:

• View the original citation in PubMed to connect to various critiques and commentaries, as well as 2004 partial retraction, from the past 12 years.
• Or look for books available at the Duke libraries on vaccines and autism.
  

Want to keep up with the literature? See More from the Literature

Extra Seat Added to MDConsult

It should be easier to get into MDConsult! We've purchased an additional seat to enable more people to get in when they need to.

To facilitate better access for everyone, be sure to click Exit in the upper righthand corner when you're done. That frees up a new spot for somebody else right away!

New AHRQ Study Finds Failure to Order Needed Tests a Leading Cause of Diagnostic Errors

AHRQ researchers found that failure to order tests, report results to patients, or follow up with abnormal test findings are leading types of diagnostic errors. Results were based on a survey issued to nearly 300 primary care and specialist physicians who reported 583 cases of diagnosis error, the largest-ever study of diagnostic errors in medicine. Researchers also found that tests were overlooked because clinicians often failed to consider the diagnosis, leading to delays in ordering the tests or making the correct diagnosis. The most common missed or delayed diagnoses include pulmonary embolism, drug reactions or overdose, lung cancer, colorectal cancer, acute coronary syndrome, including heart attack, breast cancer and stroke.

The study, led by Gordon Schiff, M.D., associate director of Brigham and Women's Hospital Center for Patient Safety Research and Practice, Boston, which is part of the Cook County Hospital/Rush University AHRQ-supported Developmental Center for Research in Patient Safety. According to Dr. Schiff, the survey found that other major categories of errors involved failure to consider a diagnosis or overweighing a competing diagnosis, failures in history taking, physical examination, and referral or consultation delays. Findings from the study, "Diagnostic Error in Medicine: Analysis of 583 Physician-Reported Errors," are published in the November 9 issue of the Archives of Internal Medicine.

New PubMed: Exporting Citations into EndNote

When saving citations in PubMed for importing into EndNote there are two ways to do so:

1. Use the Display Results link and limit your download (using File Save As from your browser) to 200 citations.
2. Use the Send To link > Click Send To > Select File > Click Format dropdown and change to MEDLINE > Click Create File Button and you will be allowed to save more than 200 citations in the MEDLINE format used by EndNote.

Note: The EndNote PubMed filter was changed in November 2009! You need to update your EndNote filter!

• Go to: http://www.endnote.com/support/enfilters.asp
• Click the Filtering Options Tab
• Change "Filter by" to NLM and click the Filter Files Button
• Download & save the PubMed filter to: C:\Program Files\EndNote X?\Filters
  [EndNote X?=whatever version you have]
  (Mac users save in EndNote application folder in the Filters folder.
• If it asks do you want to replace one already in the folder ... YES

Not using X3 yet? Read on about the 2010 Bug
There is a bug when downloading citations from PubMed for EndNote versions prior to X3. The year 2010 will not be imported with the record unless you are using X3. The PubMed record will download but the year field will be blank.

A patch for X2 is available here: http://www.endnote.com/support/ENX201_WinMac_updater.asp A Patch for X1 and earlier is being worked on. To register to receive notification when the patch is available click here: http://www.endnote.com/support/enregister.asp

Here's how to edit imported records where this has occurred:

• You can manually edit individual records
  OR
• You can do a batch edit of selected records. To do this: highlight articles w/o years (which you KNOW to be 2010 then Right Click > Choose Show Selected > Choose Show Selected > Click References > Click Change and Move Fields > Change dropdown to Year > Click Replace Whole Field with > Type in 2010 > Click OK
  

[DO NOT DO THIS UNLESS ONLY BLANK YEAR RECORDS ARE SHOWING!]

Have more EndNote questions? We're happy to help!

JAMA focuses on fallout over Breast Cancer Screen Recommendations

Several commentaries in this week's JAMA (january 13, 2010) focus on the controversial 2009 U.S. Preventive Services Task Force recommendations on breast cancer screening. In one, a former member of the task force reminds readers that the organization does not represent the government. He faults the recommendation's "poor wording" as one cause of the controversy and observes that it was "unwise" for the task force not to plan for the inevitable political fallout. In another brief essay, two experts in health outcomes research examine the real harms of overdiagnosis and decry the politicization of healthcare. "Promoting screening irrespective of the evidence may garner votes," they write, "but will not create healthier voters." There are two other commentaries. One argues for better prescreening assessment and discussion of possible screening harms. The other commentary, by a breast-imaging radiologist, argues for annual screening after age 40 among those "willing to accept the downsides of false positives" -- a willingness, she writes, shared by "the overwhelming majority of women."

The 2009 Breast Cancer Screening Recommendations of the US Preventive Services Task Force

The Benefits and Harms of Mammography Screening: Understanding the Trade-offs

Mammography Screening for Breast Cancer: A View From 2 Worlds

Benefits of Screening Mammography

Asthma Return-on-Investment Calculator

Free tool helps calculate return on investment from better asthma care

Employers are seeking solutions that can help reduce their health care costs without sacrificing the health care services provided to their employees or harming worker productivity. A new online, evidence-based tool, the Asthma Return-on-Investment Calculator developed by the Agency for Healthcare Research and Quality (AHRQ), can help employers decide whether it is cost-effective to establish an asthma care management program for employees and their families. According to AHRQ's 2008 National Healthcare Quality Report, the annual cost of treating asthma is nearly $20 billion, which includes nearly $15 billion in direct medical costs and another $5 billion in costs due to lost productivity.

The Asthma Return-on-Investment Calculator can be used to calculate how a group of employees would fare under an asthma care management program. For example, if 10,000 privately insured New York employees who visited the hospital emergency department for asthma were enrolled in a care management program, ED visits could shrink by about 4,700. This reduction could save close to $1 million in hospital emergency room costs. After factoring in money saved by not admitting patients to hospitals and decreased use of asthma medications, an additional $4.2 million in savings could be realized.

To see how businesses can improve their bottom line by improving asthma care for employees, view AHRQ's free Asthma Return-on-Investment Calculator at statesnapshots.ahrq.gov/asthma.

New EndNote Classes Scheduled

In this introductory class, learn to set up the EndNote program, add citations from databases, and automatically insert citations and build bibliographies while you write. Classes are held in the computer classroom on the library's lower level. No registration required.

• January 28, 12 - 1 pm
• February 9, 12 - 1 pm
• February 25, 12 - 1 pm
• March 16, 12 - 1 pm
• March 25, 12 - 1 pm

For more help with EndNote, see our EndNote support page