A meta-analytic review of six types of nonpharmacological interventions, including dietary and psychological treatments, for children with ADHD found positive effects on ADHD symptoms for all types when raters were aware of treatment allocation (unblinded conditions). However, when raters were blinded, statistically significant effects on ADHD symptoms were found only for supplementation with omega-3/omega-6 free fatty acids or elimination of artificial food colorings, effects that were small or restricted to food-sensitive individuals.

https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2012.12070991

Nonpharmacological Interventions for ADHD: Systematic Review and Meta-Analyses of Randomized Controlled Trials of Dietary and Psychological Treatments

This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology (JCAAI). The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Food Allergy: A practice parameter update—2014." This is a complete and comprehensive document at the current time. The medical environment is a changing one, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, ACAAI, and JCAAI. These parameters are not designed for use by pharmaceutical companies in drug promotion.

/pdf/food-allergy-a-practice-parameter-update-2014-1rcvmuxqro.pdf

Food allergy: a practice parameter update-2014.

Background: Attention deficit hyperactivity disorder (ADHD) and its possible causes still attract controversy. Genes, pre and perinatal risks, psychosocial factors and environmental toxins have all been considered as potential risk factors.

Method:  This review (focussing on literature published since 1997, selected from a search of PubMed) critically considers putative risk factors with a focus on genetics and selected environmental risks, examines their relationships with ADHD and discusses the likelihood that these risks are causal as well as some of the main implications.

Results:  No single risk factor explains ADHD. Both inherited and noninherited factors contribute and their effects are interdependent. ADHD is familial and heritable. Research into the inherited and molecular genetic contributions to ADHD suggest an important overlap with other neurodevelopmental problems, notably, autism spectrum disorders. Having a biological relative with ADHD, large, rare copy number variants, some small effect size candidate gene variants, extreme early adversity, pre and postnatal exposure to lead and low birth weight/prematurity have been most consistently found as risk factors, but none are yet known to be definitely causal. There is a large literature documenting associations between ADHD and a wide variety of putative environmental risks that can, at present, only be regarded as correlates. Findings from research designs that go beyond simply testing for association are beginning to contest the robustness of some environmental exposures previously thought to be ADHD risk factors.

Conclusions:  The genetic risks implicated in ADHD generally tend to have small effect sizes or be rare and often increase risk of many other types of psychopathology. Thus, they cannot be used for prediction, genetic testing or diagnostic purposes beyond what is predicted by a family history. There is a need to consider the possibility of parents and siblings being similarly affected and how this might impact on engagement with families, influence interventions and require integration with adult services. Genetic contributions to disorder do not necessarily mean that medications are the treatment of choice. We also consider how findings might influence the conceptualisation of ADHD, public health policy implications and why it is unhelpful and incorrect to dichotomise genetic/biological and environmental explanations. It is essential that practitioners can interpret genetic and aetiological research findings and impart informed explanations to families.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1469-7610.2012.02611.x

Practitioner review: what have we learnt about the causes of ADHD?

Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation

The growing amount of data in operational electronic health record systems provides unprecedented opportunity for its reuse for many tasks, including comparative effectiveness research. However, there are many caveats to the use of such data. Electronic health record data from clinical settings may be inaccurate, incomplete, transformed in ways that undermine their meaning, unrecoverable for research, of unknown provenance, of insufficient granularity, and incompatible with research protocols. However, the quantity and real-world nature of these data provide impetus for their use, and we develop a list of caveats to inform would-be users of such data as well as provide an informatics roadmap that aims to insure this opportunity to augment comparative effectiveness research can be best leveraged.

Caveats for the use of operational electronic health record data in comparative effectiveness research.

Objective: The role of diet and of food colors in attention-deficit/hyperactivity disorder (ADHD) or its symptoms warrants updated quantitative meta-analysis, in light of recent divergent policy in Europe and the United States. Method: Studies were identified through a literature search using the PubMed, Cochrane Library, and PsycNET databases through February 2011. Twenty-four publications met inclusion criteria for synthetic food colors; 10 additional studies informed analysis of dietary restriction. A random-effects meta-analytic model generated summary effect sizes. Results: Restriction diets reduced ADHD symptoms at an effect of g 0.29 (95% CI, 0.07‐0.53). For food colors, parent reports yielded an effect size of g 0.18 (95% CI, 0.08‐0.24; p .0007), which decreased to 0.12 (95% CI, 0.01‐0.23; p .05) after adjustment for possible publication bias. The effect was reliable in studies restricted to food color additives (g 0.21, 95% CI 0.06‐0.36) but did not survive correction for possible publication bias and was not reliable in studies confined to Food and Drug Administration‐ approved food colors. Teacher/observer reports yielded a nonsignificant effect of 0.07 (95% CI 0.03 to 0.18; p .14). However, high-quality studies confined to color additives yielded a reliable effect (g 0.22, 95% CI 0.10‐0.41, p .030) that survived correction. In psychometric tests of attention, the summary effect size was 0.27 (95% CI 0.07‐0.47; p .007) and survived correction. An estimated 8% of children with ADHD may have symptoms related to synthetic food colors. Conclusions: A restriction diet benefits some children with ADHD. Effects of food colors were notable were but susceptible to publication bias or were derived from small, nongeneralizable samples. Renewed investigation of diet and ADHD is warranted. J. Am. Acad. Child Adolesc. Psychiatry, 2012;51(1):86‐97. Key words: ADHD, meta-analysis, synthetic food color additives, restriction diet

/pdf/meta-analysis-of-attention-deficit-hyperactivity-disorder-or-4re4448io6.pdf

Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives.

Objective: Secondary use of electronic health record (EHR) data relies on the ability to retrieve accurate and complete information about desired patient populations. The Text Retrieval Conference (TREC) 2011 Medical Records Track was a challenge evaluation allowing comparison of systems and algorithms to retrieve patients eligible for clinical studies from a corpus of de-identified medical records, grouped by patient visit. Participants retrieved cohorts of patients relevant to 35 different clinical topics, and visits were judged for relevance to each topic. This study identified the most common barriers to identifying specific clinic populations in the test collection. Methods: Using the runs from track participants and judged visits, we analyzed the five non-relevant visits most often retrieved and the five relevant visits most often overlooked. Categories were developed iteratively to group the reasons for incorrect retrieval for each of the 35 topics. Results: Reasons fell into nine categories for non-relevant visits and five categories for relevant visits. Non-relevant visits were most often retrieved because they contained a non-relevant reference to the topic terms. Relevant visits were most often infrequently retrieved because they used a synonym for a topic term. Conclusions : This failure analysis provides insight into areas for future improvement in EHR-based retrieval with techniques such as more widespread and complete use of standardized terminology in retrieval and data entry systems.

Barriers to Retrieving Patient Information from Electronic Health Record Data: Failure Analysis from the TREC Medical Records Track

Skin impedance at acupuncture points (APs) has been used as a diagnostic/therapeutic aid for more than 50 years. Currently, researchers are evaluating the electrophysiologic properties of APs as a possible means of understanding acupuncture's mechanism. To comprehensively assess the diagnostic, therapeutic and mechanistic implications of acupuncture point skin impedance, a device capable of reliably recording impedances from 100 kΩ to 50 MΩ at multiple APs over extended time periods is needed. This article describes design considerations, development and testing of a single channel skin impedance system (hardware, control software and customized electrodes). The system was tested for accuracy against known resistors and capacitors. Two electrodes (the AMI and the ORI) were compared for reliability of recording over 30 min. Two APs (LU 9 and PC 6) and a nearby non-AP site were measured simultaneously in four individuals for 60 min. Our measurement system performed accurately (within 5%) against known resistors (580 kΩ–10 MΩ) and capacitors (10 nF–150 nF). Both the AMI electrode and the modified ORI electrode recorded skin impedance reliably on the volar surface of the forearm (r = 0.87 and r = 0.79, respectively). In four of four volunteers tested, skin impedance at LU 9 was less than at the nearby non-AP site. In three of four volunteers skin impedance was less at PC 6 than at the nearby non-AP site. We conclude that our system is a suitable device upon which we can develop a fully automated multi-channel device capable of recording skin impedance at multiple APs simultaneously over 24 h.

/pdf/skin-impedance-measurements-for-acupuncture-research-2x2sbe18sr.pdf

Skin Impedance Measurements for Acupuncture Research: Development of a Continuous Recording System

Objective A literature search to identify relevant studies is one of the first steps in performing a systematic review (SR) in support of evidence-based medicine. To maximize efficiency, the search must find practically all relevant studies and retrieve few that are irrelevant; however, this level of precision is seldom attained. Therefore, many articles must be manually examined for relevance. To better understand the limitations of current search tools as applied to SR, we characterized the most common reasons that papers retrieved by SR searches were excluded from the review. Methods The textual reasons given for retrieved but excluded articles were extracted from 6,743 SRs performed by 54 Cochrane Collaboration review groups. The frequencies of different exclusion reasons were analyzed, and we developed a taxonomy summarizing these reasons. Results Almost 65% of articles were excluded because the means of comparison were inappropriate. Of these, about 72% were due to the randomized controlled trial (RCT) design being required but not employed by the excluded study. Mismatching interventions and outcomes and incorrect population characteristics were also common reasons for exclusion. Conclusions Currently available search methods do not adequately address the most common exclusion reasons for systematic review, even those based primarily on study design.

A Large-Scale Analysis of the Reasons Given for Excluding Articles that are Retrieved by Literature Search During Systematic Review

Objective: Secondary use of electronic health record (EHR) data is enabled by accurate and complete retrieval of the relevant patient cohort, which requires searching both structured and unstructured data. Clinical text poses difficulties to searching, although chart notes incorporate structure that may facilitate accurate retrieval. Methods: We developed rules identifying clinical document sections, which can be indexed in search engines that allow faceted searches, such as Lucene or Essie, an NLM search engine. We developed 22 clinical cohorts and two queries for each cohort, one utilizing section headings and the other searching the whole document. We manually evaluated a subset of retrieved documents to compare query performance. Results: Querying by section had lower recall than whole-document queries (0.83 vs 0.95), higher precision (0.73 vs 0.54), and higher F1 (0.78 vs 0.69). Conclusion: This evaluation suggests that searching specific sections may improve precision under certain conditions and often with loss of recall.

Tracy Edinger

Papers

Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives.

Barriers to Retrieving Patient Information from Electronic Health Record Data: Failure Analysis from the TREC Medical Records Track

Skin Impedance Measurements for Acupuncture Research: Development of a Continuous Recording System

A Large-Scale Analysis of the Reasons Given for Excluding Articles that are Retrieved by Literature Search During Systematic Review

Evaluation of Clinical Text Segmentation to Facilitate Cohort Retrieval