NHJ direct online in January 2011!

In one of our previous Editor’s pages, we announced that our Netherlands Heart Journal (NHJ) received a 2009 impact factor of 1.4, which is a crucial step for our journal. This achievement was a consequence of another important step for our journal, being the recognition by PubMed as of January 2007. From that moment on, the Chief Editorial Board and our Publisher observed a considerable increase in submitted articles. In 2007 we received a total of 62 submissions.     

Study on the effects of sulfur fumigation on chemical constituents and antioxidant activity of Chrysanthemum morifolium cv. Hang-ju

The traditional after-harvesting drying method of C. morifolium cv. Hang-ju (HJ) is sun drying, but recently sulfur fumigation is increasingly used as a cheap and convenient method. However, the effects of sulfur fumigation on chemical constituents and potential activities of HJ were unknown. A comprehensively comparison of the chemical profiles between non-fumigated HJ (NHJ) and sulfur-fumigated HJ (SHJ) was conducted by HPLC fingerprints analysis and the discrepant peaks were identified or tentatively assigned by HPLC–ESI/MSⁿ. Dramatic chemical changes were found that the contents of 4 flavonoid aglycones remarkably increased while those of 7 glycosides significantly reduced which suggested that sulfur-fumigation induced flavonoid glycosides transformed into aglycons by hydrolysis reaction. A significant loss of hydroxycinnamoylquinic acids showed the sulfur fumigation was a destructive effect on HJ. Principal component analysis (PCA) was employed to rapidly discriminate NHJ and SHJ samples. By ICP-OES analysis, it was found that the residue of sulfur of SHJ were three times higher than NHJ (p < 0.05). The antioxidant activity of NHJ and SHJ were evaluated by DPPH and FRAP assay, and the results showed that NHJ had much stronger antioxidant activities than SCF (p < 0.05). Combining the results of chemical analysis, residue of sulfur and pharmacological evaluation, it showed that the sulfur fumigation was a destructive effect on HJ.     

Examining the Impact of the National Institutes of Health Public Access Policy on the Citation Rates of Journal Articles

PurposeTo examine whether National Institutes of Health (NIH) funded articles that were archived in PubMed Central (PMC) after the release of the 2008 NIH Public Access Policy show greater scholarly impact than comparable articles not archived in PMC.MethodsA list of journals across several subject areas was developed from which to collect article citation data. Citation information and cited reference counts of the articles published in 2006 and 2009 from 122 journals were obtained from the Scopus database. The articles were separated into categories of NIH funded, non-NIH funded and whether they were deposited in PubMed Central. An analysis of citation data across a five-year timespan was performed on this set of articles.ResultsA total of 45,716 articles were examined, including 7,960 with NIH-funding. An analysis of the number of times these articles were cited found that NIH-funded 2006 articles in PMC were not cited significantly more than NIH-funded non-PMC articles. However, 2009 NIH funded articles in PMC were cited 26% more than 2009 NIH funded articles not in PMC, 5 years after publication. This result is highly significant even after controlling for journal (as a proxy of article quality and topic).ConclusionOur analysis suggests that factors occurring between 2006 and 2009 produced a subsequent boost in scholarly impact of PubMed Central. The 2008 Public Access Policy is likely to be one such factor, but others may have contributed as well (e.g., growing size and visibility of PMC, increasing availability of full-text linkouts from PubMed, and indexing of PMC articles by Google Scholar).     

Biomarkers for detection of prenatal alcohol exposure: a critical review of fatty acid ethyl esters in meconium

BACKGROUND: The objective of this study was a review of published studies utilizing measurement of fatty acid ethyl esters (FAEE) in meconium as biomarkers for prenatal alcohol exposure. METHODS: We completed a literature search of PubMed using the terms meconium, fatty acid ethyl esters, biomarkers, and prenatal alcohol exposure. We included only peer reviewed studies utilizing analysis of meconium for the presence of FAEE in humans through the year 2007. RESULTS: We found 10 articles reporting on original research examining the relationship of FAEE from meconium and prenatal alcohol exposure (PAE). The 10 articles used six different PAE assessment strategies and four different analytical techniques for determining FAEE endpoints. The articles included 2,221 subjects (range 4 to 725) with 455 (20.5%) subjects identified as exposed using the methods stated in the articles. FAEE levels above the studies' respective cutoffs were reported for 502 (22.6%) subjects. CONCLUSIONS: The accurate identification of alcohol‐exposed pregnancies represents a significant challenge in the development of FAEE detection cutoffs to maximize the sensitivity and specificity of the test. We present several options for the improvement of exposure assessment in future studies of FAEE as biomarkers for PAE. Birth Defects Research (Part A), 2008. © 2008 Wiley‐Liss, Inc.     

Scientific publications in nephrology and urology journals from Chinese authors in East Asia: a 10-year survey of the literature

Background

Diseases of the kidneys and genitourinary tract are common health problems that affect people of all ages and demographic backgrounds. In this study, we compared the quantity and quality of nephrological and urological articles published in international journals from the three major regions of China: the mainland (ML), Hong Kong (HK), and Taiwan (TW).

Methods

Nephrological and urological articles originating from ML, TW, and HK that were published in 61 journals from 1999–2008 were retrieved from the PubMed database. We recorded the numbers of total articles, clinical trials, randomized controlled trials, case reports, impact factors (IF), citations, and articles published in the leading general-medicine journals. We used these data to compare the quantity and quality of publication output from the three regions.

Results

The total number of articles increased significantly from 1999 to 2008 in the three regions. The number of articles from ML has exceeded that from HK since 2004, and surpassed that from TW in 2008. Publications from TW had the highest accumulated IF, total citations of articles, and the most articles published in leading general-medicine journals. However, HK publications had the highest average IF. Although ML produced the largest quantity of articles, it exhibited the lowest quality among the three regions.

Conclusion

The number of nephrological and urological publications originating from the three major regions of China increased significantly from 1999 to 2008. The annual number of publications by ML researchers exceeded those from TW and HK. However, the quality of articles from TW and HK was higher than that from ML.     

Molecular analysis of green-tide-forming macroalgae in the Yellow Sea

In the summer of 2008, free-floating green algae bloomed in the Yellow Sea. Samples were collected in a wide area (119°32′-122°00′E, 32°25′-36°49′N). We calculated the sequence divergences of nuclear ITS, chloroplast rbcL, and psbA data of free-floating samples collected from the Yellow Sea and Ulvaceae from Europe and Japan. In the ITS sequence, 19 out of the 21 Yellow Sea samples of 2008 were identical to those of a sample taken at Qingdao in 2007. A low divergence (0.2%) was found in remaining two samples. Similar evidence was shown by pairwise distances of rbcL and psbA gene sequence data, implying the uniformity of the Yellow Sea blooms in 2007 and 2008. The ITS sequence of the Yellow Sea samples differed 8.1-10.8% from free-floating Enteromorpha or Ulva reported worldwide. ITS-based molecular phylogenetic results and rbcL sequence data grouped the free-floating alga in the Yellow Sea into one clade with Enteromorpha procera, Enteromorpha linza and Enteromorpha prolifera. Furthermore, both morphological characteristics and ribotype network of the ITS sequences imply that the blooming algae in 2007 and 2008 were E. prolifera. The haplotypes of the Yellow Sea free-floating E. prolifera are closely related to those from the Japanese coast but less to European and American algae.     

Impact of Article Language in Multi-Language Medical Journals - a Bibliometric Analysis of Self-Citations and Impact Factor

Background

In times of globalization there is an increasing use of English in the medical literature. The aim of this study was to analyze the influence of English-language articles in multi-language medical journals on their international recognition – as measured by a lower rate of self-citations and higher impact factor (IF).

Methods and Findings

We analyzed publications in multi-language journals in 2008 and 2009 using the Web of Science (WoS) of Thomson Reuters (former Institute of Scientific Information) and PubMed as sources of information. The proportion of English-language articles during the period was compared with both the share of self-citations in the year 2010 and the IF with and without self-citations. Multivariable linear regression analysis was performed to analyze these factors as well as the influence of the journals‘ countries of origin and of the other language(s) used in publications besides English.We identified 168 multi-language journals that were listed in WoS as well as in PubMed and met our criteria. We found a significant positive correlation of the share of English articles in 2008 and 2009 with the IF calculated without self-citations (Pearson r=0.56, p = <0.0001), a correlation with the overall IF (Pearson r = 0.47, p = <0.0001) and with the cites to years of IF calculation (Pearson r = 0.34, p = <0.0001), and a weak negative correlation with the share of self-citations (Pearson r = -0.2, p = 0.009). The IF without self-citations also correlated with the journal‘s country of origin – North American journals had a higher IF compared to Middle and South American or European journals.

Conclusion

Our findings suggest that a larger share of English articles in multi-language medical journals is associated with greater international recognition. Fewer self-citations were found in multi-language journals with a greater share of original articles in English.     

Impact of PubMed search filters on the retrieval of evidence by physicians

Background:

Physicians face challenges when searching PubMed for research evidence, and they may miss relevant articles while retrieving too many nonrelevant articles. We investigated whether the use of search filters in PubMed improves searching by physicians.

Methods:

We asked a random sample of Canadian nephrologists to answer unique clinical questions derived from 100 systematic reviews of renal therapy. Physicians provided the search terms that they would type into PubMed to locate articles to answer these questions. We entered the physician-provided search terms into PubMed and applied two types of search filters alone or in combination: a methods-based filter designed to identify high-quality studies about treatment (clinical queries “therapy”) and a topic-based filter designed to identify studies with renal content. We evaluated the comprehensiveness (proportion of relevant articles found) and efficiency (ratio of relevant to nonrelevant articles) of the filtered and nonfiltered searches. Primary studies included in the systematic reviews served as the reference standard for relevant articles.

Results:

The average physician-provided search terms retrieved 46% of the relevant articles, while 6% of the retrieved articles were nonrelevant (the ratio of relevant to nonrelevant articles was 1:16). The use of both filters together produced a marked improvement in efficiency, resulting in a ratio of relevant to nonrelevant articles of 1:5 (16 percentage point improvement; 99% confidence interval 9% to 22%; p < 0.003) with no substantive change in comprehensiveness (44% of relevant articles found; p = 0.55).

Interpretation:

The use of PubMed search filters improves the efficiency of physician searches. Improved search performance may enhance the transfer of research into practice and improve patient care.Retrieving health literature is a cornerstone of evidence-based practice. With the rapid increase in available evidence, physicians can no longer rely on one or two key journals to stay current. Increasingly, physicians search bibliographic databases, such as PubMed, for research evidence, which is dispersed across hundreds of journals. Each year, physicians perform over 200 million searches in PubMed.^1,2 Physicians face challenges while searching PubMed and often miss relevant articles while retrieving too many nonrelevant articles.^3–6 Clinical decision-making based on evidence from a search may be impaired if relevant articles are missed. Retrieving many nonrelevant articles impedes the efficiency of searching. Improved search strategies are therefore necessary to retrieve a manageable amount of information. The use of PubMed search filters may help solve this problem. Filters are objectively derived, pretested strategies optimized to help users efficiently retrieve articles for a specific purpose.^7,8PubMed provides two types of clinical search filters: methods-based and topic-based. Methods-based filters (known as clinical queries) were designed to retrieve articles on therapy, diagnosis, prognosis and etiology.^9–13 For example, the clinical queries “therapy” filter is optimized to retrieve publications of randomized controlled trials. Methods-based filters can be used for any clinical discipline and are available for general use in PubMed (www.ncbi.nlm.nih.gov/pubmed/clinical). Topic-based filters, in contrast, are designed to retrieve articles within a specific discipline or topic. For example, the recently developed nephrology filters were optimized to retrieve articles with renal content.¹Physicians can use methods- and topic-based filters alone or in combination. For example, Figure 1A shows a search without search filters for studies about the effectiveness of hepatitis B vaccination in patients with chronic kidney disease. Alternatively, this search could be performed with search filters (Figure 1B). Using filters removes the task of generating and including method-specific or topic-specific terms in a search strategy because the filters act as optimized substitutes. For example, applying the nephrology filter eliminates the need to enter renal terms and synonyms in a search query (e.g., chronic kidney disease, end-stage renal disease, chronic renal failure). The nephrology filter, instead, maximizes the retrieval of all renal content (see the nephrology filter strategy in Figure 1B).Open in a separate windowFigure 1:PubMed searches without (A) and with (B) filters. This figure was created from the PubMed clinical queries Web interface; this page currently does not feature a “clinical category” section. When we performed searches with the nephrology filter (B), we removed the term “chronic kidney disease” because the filter acts as an optimized substitute for clinical content terms.In theory, filters should make searching more efficient; however, empiric evidence of this among physicians is lacking. We conducted this study to determine whether the use of methods-based filters and topic-based filters (alone and in combination) improve the efficiency of physician searches in PubMed. The area of renal medicine is an excellent test model because the literature in this field is dispersed across 400 multidisciplinary journals, and many nephrologists search PubMed for information to guide patient care.^14,15     

Relationship between prostate-specific antigen levels and ambient temperature

We examined the association between prostate-specific antigen (PSA) and daily mean ambient temperature on the day of the test in healthy men who had three annual checkups. We investigated 9,694 men who visited a hospital for routine health checkups in 2007, 2008, and 2009. Although the means and medians of ambient temperature for the three years were similar, the mode in 2008 (15.8 °C) was very different from those in 2007 and 2009 (22.4 °C and 23.2 °C). After controlling for age, body mass index, and hematocrit, a multiple regression analysis revealed a U-shaped relationship between ambient temperature and PSA in 2007 and 2009 (P?<?0.001 and P?=?0.004, respectively), but not in 2008 (P?=?0.779). In 2007, PSA was 13.5 % higher at 5 °C and 10.0 % higher at 30 °C than that at 18.4 °C (nadir). In 2009, PSA was 7.3 % higher at 5 °C and 6.8 % at 30 °C compared with the level at 17.7 °C (nadir). In logistic regression analysis, a U-shaped relationship was found for the prevalence of a higher PSA (> 2.5 ng/mL) by ambient temperature, with the lowest likelihood of having a high PSA at 17.8 °C in 2007 (P?=?0.038) and 15.5 °C in 2009 (P?=?0.033). When tested at 30 °C, there was a 57 % excess risk of having a high PSA in 2007 and a 61 % higher risk in 2009 compared with those at each nadir temperature. We found a U-shaped relationship between PSA and ambient temperature with the lowest level of PSA at 15–20 °C.     

Impact of STROBE Statement Publication on Quality of Observational Study Reporting: Interrupted Time Series versus Before-After Analysis

Background

In uncontrolled before-after studies, CONSORT was shown to improve the reporting of randomised trials. Before-after studies ignore underlying secular trends and may overestimate the impact of interventions. Our aim was to assess the impact of the 2007 STROBE statement publication on the quality of observational study reporting, using both uncontrolled before-after analyses and interrupted time series.

Methods

For this quasi-experimental study, original articles reporting cohort, case-control, and cross-sectional studies published between 2004 and 2010 in the four dermatological journals having the highest 5-year impact factors (≥4) were selected. We compared the proportions of STROBE items (STROBE score) adequately reported in each article during three periods, two pre STROBE period (2004–2005 and 2006–2007) and one post STROBE period (2008–2010). Segmented regression analysis of interrupted time series was also performed.

Results

Of the 456 included articles, 187 (41%) reported cohort studies, 166 (36.4%) cross-sectional studies, and 103 (22.6%) case-control studies. The median STROBE score was 57% (range, 18%–98%). Before-after analysis evidenced significant STROBE score increases between the two pre-STROBE periods and between the earliest pre-STROBE period and the post-STROBE period (median score_2004–05 48% versus median score_2008–10 58%, p<0.001) but not between the immediate pre-STROBE period and the post-STROBE period (median score_2006–07 58% versus median score_2008–10 58%, p = 0.42). In the pre STROBE period, the six-monthly mean STROBE score increased significantly, by 1.19% per six-month period (absolute increase 95%CI, 0.26% to 2.11%, p = 0.016). By segmented analysis, no significant changes in STROBE score trends occurred (−0.40%; 95%CI, −2.20 to 1.41; p = 0.64) in the post STROBE statement publication.

Interpretation

The quality of reports increased over time but was not affected by STROBE. Our findings raise concerns about the relevance of uncontrolled before-after analysis for estimating the impact of guidelines.     

Phenological Patterns and Preferences for Aromatic Compounds by Male Euglossine Bees (Hymenoptera,Apidae) in Two Coastal Ecosystems of the Brazilian Atlantic Forest

In order to investigate phenological patterns and seasonal and geographic variations in the preference for fragrances of Euglossini males, monthly sampling was carried out from August 2007 to July 2009 in two coastal areas of Atlantic Forest in Ubatuba, northern coast of the state of São Paulo. Fourteen aromatic baits were used, 3 of them in the first year (August 2007 to July 2008) and the other 11 in the second year (August 2008 to July 2009). A total of 1,475 individuals from 22 species were collected. The highest frequency of the individuals of the majority of the sampled species occurred in the hot/super-humid season. However, Eulaema cingulata (Fabricius) showed peaks of abundance in the cold/less-humid season on Anchieta Island. Seasonal variation in fragrance choice by males was not registered. Males of El. cingulata showed preference for β-ionone on Anchieta Island and for benzyl acetate in the Picinguaba region, characterizing the single example of geographic variation in preference for scent baits we recorded.     

The Resistance Analysis of Ureaplasma urealyticum and Mycoplasma hominis in Female Reproductive Tract Specimens

The aim of this study was to analyze the drug resistance of Ureaplasma urealyticum (Uu) and Mycoplasma hominis (Mh) in female reproductive track from 2007 to 2011 in Hangzhou. Antibiotics sensitivity test in Mycoplasma, which was isolated in clinics from 2007 to 2011 were analyzed retrospectively. The detection of Mycoplasma during 2007–2011 was 20,146 (54.37 %), of which the single infection rate of Uu was 42.08 %, of Mh 1.26 %, and of Uu+Mh was 11.02 %. The drug resistance rate of Uu was increased significantly in ofloxacin in 2007 (41.80 %), 2008 (45.94 %), 2009 (46.07 %), 2010 (50.36 %), and 2011 (53.22 %) (P < 0.05). The resistance rate to ciprofloxacin was significantly increased in 2007 (67.15 %), 2008 (67.44 %), 2009 (73.00 %), 2010 (75.28 %), and 2011 (75.28 %) (P < 0.05). Exceptionally, the resistance rates of the other antibiotics were low. The drug resistance rate of Uu was significantly increased with quinolones at increasing tendency. It is necessary to monitor the local drug resistance rate of Uu regularly to provide reasonable guidelines in clinics.     

Intra- and interannual variation in the diet of the Magellanic penguin (Spheniscus magellanicus) at Martillo Island,Beagle Channel

Knowledge of seabirds’ diet at each breeding site and its temporal variation is key to understanding and evaluating how changes in marine resources affect each seabird population. In this study, we determined the diet of Magellanic penguins (MP, Spheniscus magellanicus) at Martillo Island, accounting for sex, breeding stage and year. We analyzed a total of 144 stomach contents during three consecutive breeding seasons (2006–2007, 2007–2008 and 2008–2009) and stages (incubation, early and late chick-rearing). MP fed mainly on fuegian sprat (Sprattus fuegensis), which represented 75 % of the biomass consumed by birds during the entire study. The next important prey was squat lobster (Munida gregaria), followed by Patagonian squid (Loligo gahi). Both sexes consumed similar prey items. We observed variation in diet relative composition among breeding years and stages. Fuegian sprat consumption decreased throughout the years whereas squat lobster increased. Penguins consumed a higher proportion of squat lobster and Patagonian squid during the incubation stage than in the chick-rearing stages, whereas fuegian sprat was almost the only prey item consumed during the late chick-rearing stage. MPs show certain flexibility in the use of resources probably as a response to changes in prey populations. Variability in the diet among different reproductive stages could be related to changes in the distribution and abundance of their main prey near the colony during the breeding season together with changes in the energy requirements of seabirds.     

Carbon, nitrogen, and hydrogen isotope ratios in creekside trees in western Kansas

Three species of creekside trees were monitored weekly during the 2007 and 2008 growing seasons. The 2007 growing season was wet early, but became drier as the season progressed. In contrast, the 2008 growing season was dry early, but became wetter as the season progressed. Creekside trees were measured to determine effects of changing water regimes on leaf-level processes. Lonicera tatarica plants were compared to Morus alba and Celtis occidentalis trees. Leaves were monitored for changes in stomatal conductance, transpiration, δ¹³C, δ¹⁵N, δD, leaf temperature, and heat losses via latent, sensible, and radiative pathways. δD of creek water was more similar to ground water than to rain water, but the creek was partially influenced by summer rains. δD of bulk leaf material was significantly higher in individuals of C. occidentalis compared to the other species, consistent with source water coming from shallower soil layers. Despite decreasing water levels, none of these tree species showed signs of water stress. There were no significant differences between species in stomatal conductance or transpiration. Leaf δ¹³C was significantly lower in individuals of L. tatarica compared to the other species. Differences in δ¹³C were attributed to a lower carboxylation capacity, consistent with lower leaf nitrogen content in L. tatarica plants. Leaf δ¹⁵N was significantly lower in individuals of L. tatarica compared to the other species, consistent with uptake of a different N source. Two of the three sites appeared to be affected by inorganic N from fertilizer run-off. Evidence is presented that these species acquired water and nitrogen from different sources, resulting from differences in root uptake patterns.     

Prevalence of primary aldosteronism in patient's cohorts and in population-based studies--a review of the current literature

There is an ongoing controversy on the prevalence of primary aldosteronism (PA). We aimed to update a meta-analysis published in 2008, that compiled studies reporting the prevalence of positive ARR screening tests and PA. We therefore reviewed original studies published in 2008 or later to examine whether current reports provide similar, higher or lower prevalences of elevated ARRs or PA than reports included in the original meta-analysis. A systematic review of English articles using PubMed was conducted. Search and extraction of articles were performed by one review author; the second review author checked all extracted data. We identified 11 eligible studies. The updated, weighted mean prevalences of elevated ARRs and PA in primary care (prevalence of high ARRs 16.5%; prevalence of PA 4.3%) and referred patients (prevalence of high ARRs 19.6%; prevalence of PA 9.5%) were only marginally different from the mean values obtained in the original meta-analysis. Among the current studies the maximum values for the prevalence of elevated ARRs and PA were substantially lower than among the older studies. Our results confirm the main conclusions from the original meta-analysis. The prevalence of PA increases with the severity of hypertension and the inclusion of current study results did not alter the mean prevalences of elevated ARRs and PA in primary care and referred patients. Additionally, we found that current studies focus increasingly on patients in referral centers or special subgroups, while the prevalence of PA in the general hypertensive population is yet unknown.     

1998-2007年主要国家（地区）H5N1禽流感相关SCI文献统计分析

H5N1流感病毒引起的禽流感造成了大量禽类的死亡,并且有越来越多人感染病例的发生。在本文中,我们利用PubMed数据库检索H5N1禽流感相关文献,并筛选出SCI文献进行文献数量的年度变化、国家（地区）分布、主要研究机构等方面的统计分析,以此探讨禽流感文献的分布规律和禽流感研究现状与趋势,为我国的H5N1禽流感研究提供参考。     

HIV and syphilis co-infection increasing among men who have sex with men in China: a systematic review and meta-analysis

Background

This study aims to estimate the magnitude and changing trends of HIV, syphilis and HIV-syphilis co-infections among men who have sex with men (MSM) in China during 2003–2008 through a systematic review of published literature.

Methodology/Principal Findings

Chinese and English literatures were searched for studies reporting HIV and syphilis prevalence among MSM from 2003 to 2008. The prevalence estimates were summarized and analysed by meta-analyses. Meta-regression was used to identify the potential factors that are associated with high heterogeneities in meta-analysis. Seventy-one eligible articles were selected in this review (17 in English and 54 in Chinese). Nationally, HIV prevalence among MSM increased from 1.3% during 2003–2004 to 2.4% during 2005–2006 and to 4.7% during 2007–2008. Syphilis prevalence increased from 6.8% during 2003–2004 to 10.4% during 2005–2006 and to 13.5% during 2007–2008. HIV-syphilis co-infection increased from 1.4% during 2005–2006 to 2.7% during 2007–2008. Study locations and study period are the two major contributors of heterogeneities of both HIV and syphilis prevalence among Chinese MSM.

Conclusions/Significance

There have been significant increases in HIV and syphilis prevalence among MSM in China. Scale-up of HIV and syphilis screening and implementation of effective public health intervention programs should target MSM to prevent further spread of HIV and syphilis infection.     

Diagnosis and treatment of dementia: 5. Nonpharmacologic and pharmacologic therapy for mild to moderate dementia

Background

Practising physicians frequently seek advice on the most effective interventions for dementia. In this article, we provide practical guidance on nonpharmacologic and pharmacologic interventions for the management of mild to moderate dementia based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia.

Methods

We developed evidence-based guidelines using systematic literature searches, with specific criteria for the selection and quality assessment of articles, and a clear and transparent decision-making process. We selected articles published from January 1996 to December 2005 that dealt with the management of mild to moderate stages of Alzheimer disease and other forms of dementia. Recommendations based on the literature review were drafted and voted on. Consensus required 80% or more agreement by participants. Subsequent to the conference, we searched for additional articles published from January 2006 to April 2008 using the same major keywords and secondary search terms. We graded the strength of the evidence using the criteria of the Canadian Task Force on Preventive Health Care.

Results

We identified 1615 articles, of which 954 were selected for further study. From a synthesis of the evidence in these studies, we made 48 recommendations for the management of mild to moderate dementia (28) and dementia with a cerebrovascular component (8) as well as recommendations for addressing ethical issues (e.g., disclosure of the diagnosis) (12). The updated literature review did not change these recommendations. An exercise program is recommended for patients with mild to moderate dementia. Physicians should decide whether to prescribe a cholinesterase inhibitor on an individual basis, balancing anticipated benefits with the potential for harm. For mild mood and behavioural concerns, nonpharmacologic approaches should be considered first.

Interpretation

Although the available therapies for dementia can help with the management of symptoms, there is a need to develop more effective interventions.

Articles to date in this series

• Chertkow H. Diagnosis and treatment of dementia: Introduction. Introducing a series based on the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. CMAJ 2008;178:316-21.
• Patterson C, Feightner JW, Garcia A, et al. Diagnosis and treatment of dementia: 1. Risk assessment and primary prevention of Alzheimer disease. CMAJ 2008;178:548-56.
• Feldman HH, Jacova C, Robillard A, et al. Diagnosis and treatment of dementia: 2. Diagnosis. CMAJ 2008;178:825-36.
• Chertkow H, Massoud F, Nasreddine Z, et al. Diagnosis and treatment of dementia: 3. Mild cognitive impairment and cognitive impairment without dementia. CMAJ 2008;178:1273-85.
• Hogan DB, Bailey P, Black S, et al. Diagnosis and treatment of dementia: 4. Approach to management of mild to moderate dementia. CMAJ 2008;179:787-93.