Happy almost February to everyone. It is time to resume our series. First I am grateful for the vigorous response to my survey about interest in a webinar to cover some of this stuff. Over the next few months one of my projects will be to develop and execute one. I will keep you posted. In the meantime, if anyone has thoughts or suggestions on the logistics, etc., please, reach out to me.OK, let's talk about group comparisons and hypothesis testing....
Monday, 31 January 2011
Friday, 28 January 2011
Soliciting contributions: "Healthcare professional as e-patient" series
I am contemplating a series of posts arising from my own recent experience as an e-patient to help the broader e-patient community navigate the stormy medical waters with a bit more comfort. I am looking for other healthcare professionals who have had their own experiences as an e-patient that may be instructive for non-healthcare professionals as patients to contribute to the series. Namely, I am most interested in helping people establish...
Thursday, 27 January 2011
The price of marginal thinking in healthcare policy
I find it fascinating how our brains have this propensity to latch on to what is at the margins at the expense of seeing the bulk of what sits in the center. This peripheral only vision is in part responsible for our obscene healthcare expenditures and underwhelming results.I have blogged ad nauseam about the drivers of early mortality in the US. In one post I reproduced a pie chart from the Rand Corporation, wherein they show explicitly that a mere...
SoMe in medicine: It's about communication, stupid!
My generation of doctors was almost proud of its paternalistic overbearing know-it-all archetype, with the my-way-or-the-highway attitude to patient care. Even today there are inter-specialty fights in medicine that demonstrate these entrenched and seemingly fundamental, albeit willfully exaggerated, differences of opinion and clinical approach. It used to be, and still is to an extent, a badge of honor for an internist to disagree with a surgeon,...
Wednesday, 26 January 2011
Webinar survey results
Last week I posted a survey link to gauge interest in and potential content for a webinar on how to review medical literature critically. I had a great response, and wanted to share the data with you.The web page got 302 hits, resulting in 82 survey responses. This is a 27% rate of response, which certainly sets the results up to be biased and non-generalizable. But what the heck? I was looking to hear from people with some interest in this, not...
Tuesday, 25 January 2011
Mirror neurons and the need for slow medicine
How long does it take for a silence to become uncomfortable? 5 seconds? 20 seconds? A minute? Students of education are taught to give a child roughly 20 seconds to answer a question posed to him. How long do teachers actually give? About 5 seconds, if that. Now sit there and count out 20 Mississippis and see what an astonishingly long time it seems. Why, what if a web page takes that long to load on your browser? This becomes a major technological...
Sunday, 23 January 2011
Top 5 this week
#5: Do private ICU rooms really reduce HAIs?#4: Data mining: It's about research efficiency.#3: To guideline or not to guideline, that is the ques...#2: Reviewing medical literature, part 1: The study qu...#1: A webinar survey -- Please, take this brief survey to help me gaugeinterest in and content for a possible webinar on how to read and reviewmedical literature.Thanks for visiting and readi...
Friday, 21 January 2011
A webinar survey
Hi, folks,I am conducting a survey to see how much interest there may be in a webinar on reviewing medical literature. This should take no more than 10 minutes of your time and would be enormously helpful to me to a). gauge interest and b). create appropriate content.Thank you so much for doing this!To get to the survey, click on this url: http://qtrial.qualtrics.com/SE/?SID=SV_bKEvpW0cEjYW...
Thursday, 20 January 2011
To guideline or not to guideline, that is the question in... pneumonia?
Addendum 1/20/11, 1:27 PMI want to add something to this, since I have been reflecting on the data more. It turns out that about 3/4 of all patients had an organism isolated felt to be causative of their pneumonia. Among these patients, over 80% in each group received empiric treatment that covered the pathogen. This means that 4 out of 5 patients in both groups received appropriate antibiotic coverage. What the authors skimmed over briefly is to...
HOW TO SURVIVE A HEART ATTACK WHEN ALONE
Since many people are alone when they suffer a heart attack, without help,the person whose heart is beating improperly and who begins to feel faint, has only about 10 seconds left before losing consciousness. However, these victims can help themselves by coughing repeatedly and very vigorously. A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest. A breath and...
Wednesday, 19 January 2011
Data mining: It's about research efficiency.
I have taken a little break from my reviewing literature series -- work has superseded all other pursuits for a little while. But I did want to do a brief post today, since this JAMA Commentary really intrigued me.First thing that interested me was the authors. Now, I know who Benjamin Djulbegovic is -- you have to live under a rock as an outcomes researcher not to have heard of him. But who is Mia Djulbegovic? It is an unusual enough surname to...
Sunday, 16 January 2011
Top 5 this week
#5: Reviewing medical literature, part 1: The study qu...#4: Reviewing medical literature part 3 continued: thr...#3: Reviewing medical literature, part 3: Threats to v...#2: Reviewing medical literature, part 2b: Study desig...And #1 post of the week is: Do private ICU rooms really reduce HA...
Friday, 14 January 2011
Reviewing medical literature, part 4: Statistical analyses -- measures of central tendency
Well, we have come to the part of the series you have all been waiting for: discussion of statistics. What, you are not as excited about it as I am? Statistics are not your favorite part of the study? I am frankly shocked! But seriously, I think this is the part that most people, both lay public and professionals, find off-putting. But fear not,...
Thursday, 13 January 2011
Reviewing medical literature part 3 continued: threats to validity
As promised, today we talk about confounding and interaction.A confounder is a factor related to both, the exposure and the outcome. Take for example the relationship between alcohol and head and neck cancer. While we know that heavy alcohol consumption is associated with a heightened risk of head and neck cancer, we also know that people who consume a lot of alcohol are also more likely to be smokers, and smoking in turn raises the risk of H&N...
Wednesday, 12 January 2011
Reviewing medical literature, part 3: Threats to validity
You have heard this a thousand times: no study is perfect. But what does this mean? In order to be explicit about why a certain study is not perfect, we need to be able to name the flaws. And let's face it: some studies are so flawed that there is no reason to bother with them, either as a reviewer or as an end-user of the information. But again, we need to identify these nails before we can hammer them into a study's coffin. It is the authors' responsibility...
Tuesday, 11 January 2011
Do private ICU rooms really reduce HAIs?
We have known for quite some time now that the patient's environment in a hospital matters to his/her outcomes. The concept of biophilia was applied by Roger Ulrich back in the 1980s to surgical patients in a series of experiments. Famously, this work showed that looking out your hospital room's window on a bunch trees is associated with better and...
Monday, 10 January 2011
Reviewing medical literature, part 2b: Study design continued
To synthesize what we have addressed so far with regard to reading medical literature critically:1. Always identify the question addressed by the study first. The question will inform the study design.2. Two broad categories of studies are observational and interventional.3. Some observational designs, such as cross-sectional and ecological, are adequate...
Sunday, 9 January 2011
Top 5 this week
#5: Guest post: How our brains are wired to advance sc...#4: National Healthcare Expenditures, 2009 (In picture...#3: Reviewing medical literature, part 1: The study qu...#2: Radium, dopamine and innovation: Name your poisonDrum roll...#1: Gaol fever and intercessory prayer: Redefining the...
Friday, 7 January 2011
Reviewing medical literature, part 2a: Study design
It is true that the study question should inform the study design. I am sure you are aware of the broadest categorization of study design -- observational vs. interventional. When I read a study, after identifying the research question I go through a simple 4-step exercise:1. I look for what the authors say their study design is. This should be...
Reviewing medical literature, part 1: The study question
Let's start at the beginning. Why do we do research and write papers? No, not just to get famous, tenured or funded. The fundamental task of science is to answer questions. The big questions of all time get broken down into infinitesimally small chunks that can be answered with experimental or observational scientific methods. These answers integrated together provide the model for life as we understand it.Clearly, the question is the most important...
Series launch: Critical review of medical literature
Today I am launching a series of posts on how to read medical literature critically. The series should provide a solid foundation for this task and dove-tail nicely with some of the more dense methods themes that occur on this blog. Who should read the series? Everyone. Although the current model of dissemination of medical information relies on a layer of translators (journalists and clinicians), it is my belief that every educated patient must...
