#5: Redefining compassion: "A spiritual technology"#4: CMS never events: Evidence of smoke in mirrors?#3: The rose-colored glasses of early trial terminatio...#2: Guidelines: What really constitutes level I eviden...Drum roll for #1 post of the week: New treatments: What benefits at what costsThanks for stopping by and readi...
Sunday, 27 February 2011
Friday, 25 February 2011
Guidelines: What really constitutes level I evidence?
There has been some interesting buzz in the blogosphere about where evidence-based guideline recommendations come from, and I wanted to add a little fuel to that fire today.As you know, I think a lot about the nature of evidence, about the "science" in clinical science, and about pneumonia, specifically ventilator-associated pneumonia or VAP. Last...
Thursday, 24 February 2011
New treatments: What benefits at what costs
Yesterday brought quite a bit of press coverage to a small biotechnology company in Cambridge called Vertex. All this attention was spurned by their gene therapy trial results in cystic fibrosis. The treatment, aimed at a genetic mutation present in about 4% of all CF sufferers, was able to improve the volume that a patient can force out of his lungs in 1 second by over 10%, from about 65% to 75%. Matthew Herper of Forbes on his blog, while being...
Tuesday, 15 February 2011
The rose-colored glasses of early trial termination
The other day I did a post on semi-recumbent positioning to prevent VAP. The point I wanted to make was that an already existing quality measure for a condition that is well on its way to becoming a CMS "never event" is based on one unreplicated single-center small unblinded randomized controlled trial that was terminated early for efficacy. In my post I cited several issues with the study that question its validity. Today I want to touch upon the...
Monday, 14 February 2011
Redefining compassion: "A spiritual technology"
This is a TEDxUN talk by Krista Tippett. It is fantastic!If you are in a rush, just go to around minute 10:00 or so. But really the whole talk is well worh consideri...
Sunday, 13 February 2011
Top 5 this week
#5: Reviewing medical literature, part 5: Inter-group ...#4: Intervention in ICU reduces hospital mortality, bu...#3: CMS never events: Evidence of smoke in mirrors?#2: Medical decision making: More signal less noise, p...And #1 post of the week is: Evidence and profit: An unhealthy allia...
Friday, 11 February 2011
CMS never events: Evidence of smoke in mirrors?
Let me tell you a fascinating story. In 1999, I was still fresh out of my Pulmonary and Critical Care Fellowship, struggling for breath in the vortex of private practice, when a cute little paper appeared in the Lancet from a great group of researchers in Spain, describing a study performed in one large academic urban medical center's two ICUs: one...
Wednesday, 9 February 2011
Evidence and profit: An unhealthy alliance
My JAMA Commentary came out this week, and I am getting e-mail about it. It seems to have resonated with many docs who feel that the research enterprise is broken and its output fails them at the office. But what I want to do is tie a few ideas together, ideas that I have been exploring on this blog and elsewhere, ideas that may hold the key to our devastating healthcare safety problem.The last four decades can be viewed as a nexus between the growth...
Tuesday, 8 February 2011
Medical decision making: More signal less noise, please!
It's official, I'm a country bumpkin! Driving in Boston last week I was distracted, annoyed, made anxious and confused by the constant traffic, billboards and signs. Even highway markings confused me, particularly one indicating a detour to Storrow Drive East, which never materialized. Despite the fact that I know the geography of Boston like the back of my hand, I nearly went down the wrong streets multiple times, including driving the wrong way...
Wednesday, 2 February 2011
Intervention in ICU reduces hospital mortality, but by how much?
Addendum #2, 12:09 PM EST, 2/2/11:So, here is the whole story. Stephanie Desmon, the author of the JH press release, e-mailed me back and pointed me to Peter Pronovost as the source for the 10% reduction information. I e-mailed Peter, and he got back to me, confirming that "The 10 percent is the rounded differences in differences in odds ratios"Moral...
Tuesday, 1 February 2011
The beautiful uncertainty of science
I am so tired of this all-or-nothing discussion about science! On the one hand there is a chorus singing praises to science and calling people who are skeptical of certain ideas unscientific idiots. On the other, with equal penchant for eminence-based thinking, are the masses convinced of conspiracies and nefarious motives of science and its perpetrators. And neither will stop and listen to the other side's objections, and neither will stop the name-calling....
