Friday, July 13, 2018

Everything you ever wanted to know about operating room head coverings

In case you might want to challenge your hospital’s policy on the subject, I have gathered all of the recent research I could find on surgical head wear.

In response to a 2013 question from a reader, I blogged about the complete lack of evidence that OR staff hair caused wound infections or any other problem. After a similar question from another reader three years later, I pointed out nothing had changed.

Finally a 2017 paper in the journal Neurosurgery appeared online comparing the incidence of wound infections in clean cases for the 13 months before and the 13 months after the institution of a ban on the wearing of the traditional surgeons’ ca`p. Over 15,000 patients were included in the study which found no statistically significant difference in the rate of wound infections.

Monday, July 9, 2018

Are neckties dangerous to your health?

Wearing a necktie significantly decreases cerebral blood flow says a new study in the journal Neuroradiology. This finding caused a minor flurry of activity on Twitter, and as usual, the press sensationalized and misinterpreted the study’s results.

Here’s a headline from the Deccan Chronicle: “Wearing ties hamper [sic] productivity in office; here’s why.” The sub- heading is “Study suggests men who wear T-shirts in the office may produce better work.” T-shirts were not mentioned in the paper. The name of the journal that published it was incorrect in the article too.

Forbes didn’t do much better. It’s lede is “Neckties are stupid. Could they also make you stupid?” The paper said nothing of the kind.

Friday, June 29, 2018

Papers about robotic surgery outcomes may be swayed by payments from the manufacturer

In 2015 alone, the top 20 surgeons receiving payments from Intuitive Surgical Inc., makers of the da Vinci robot, collected a median of almost $142,000. Of those surgeons, 12 have published 37 papers about the robot with 27 (73%) reaching strongly favorable conclusions about the robot’s effect on clinical outcomes, feasibility, or safety. Nine (24%) were equivocal, and one (2%) study was negative.

These results appeared in a paper published online in the American Journal of Surgery by investigators from the University of Michigan.

The 37 papers consisted of 36 observational studies and 1 randomized controlled trial. Robotic surgery patient outcomes were compared to patients operated on in the same institution or by the same surgeon in 11 papers, patients operated on in a different institution or by a different surgeon in 4 studies, to a database in 4, and to previously published papers in 2 instances. No controls or comparisons were used in 16 (43%) papers.

Intuitive Surgical sponsored six of the studies, all of which had positive outcomes.

According to the CMS Open Payments website, compensation received by the top 20 surgeons ranged from $106,176 to $325,164. Among the top 20 earners were 11 general surgeons, 4 colorectal surgeons, 3 thoracic surgeons, and 2 gynecologists.

Three of the 37 papers contained no conflict of interest disclosure statements.

Several limitations of the study were listed. Most journals favor publishing papers with positive results. It may be that surgeons not receiving any industry payments might have published similar numbers of positive studies. The accuracy of the Open Payments site has been questioned but it is the best resource we have currently.

The authors described their paper as a pilot study and called for more research on not only Intuitive’s effect on the medical literature but also the influence of industry in general.

The paper also illustrates the woeful state of research on robotic surgery—a device that has been used on patients for almost 20 years.

Tuesday, June 26, 2018

We need less research

“We need less research, better research, and research done for the right reasons. Abandoning using the number of publications as a measure of ability would be a start.” Although I have expressed similar sentiments in blog posts [here and here], I didn’t say it. It was written by Douglas Altman, a well-known statistician and researcher who died in June.

Altman made that statement in a 1994 BMJ article entitled “The scandal of poor medical research.” Here we are, 24 years later, and nothing has changed. In fact, thanks to the rise of predatory journals, things are much worse.

Altman lamented research containing flaws such as “the use of inappropriate designs, unrepresentative samples, small samples, incorrect methods of analysis, and faulty interpretation” and felt many poor studies were the result of pressure on researchers to publish.

Monday, June 18, 2018

Some data is better than no data at all

Do you believe that?

I heard it frequently when the infamous Propublica Surgeon Scorecard first appeared three years ago. Back then I blogged about it saying “To me, bad data is worse than no data at all.”

A recent study in BJU International confirmed my thoughts about this type of publicly posted data and identified a previously unreported issue. The paper attempted to determine whether the public was able to accurately interpret statistics used in the Surgeon Scorecard. It turns out they were not very good at it.

Investigators from the Department of Urology at the University of Minnesota surveyed 343 people who attended the Minnesota State Fair in 2016. Those who took the survey had a median age of 48, were 60% female, 80% white, and 60% college educated. Their median annual income was $26,550 with an interquartile range of $22,882-$32,587.

Sunday, June 3, 2018

The dark side of academic research

A new study found several senior academic surgeons had published papers in what used to be termed “predatory journals.” The newer, gentler term is “solicited publishing,” but it defines the same pay-to-play, low quality publications.

Surgeons from the University of California, San Diego examined 110 emails sent to the senior author from 29 publishers during a six-week period and early 2017. Nearly all were requesting manuscript submissions. The 29 publishers represented 113 different surgery journals most of which had existed for two years or less. Only 12 were indexed in PubMed, and of the 9 that mentioned a self-reported impact factor, the median was 0.24 which means they had less than one citation per article in the last two years. The median publication fee for the 88 journals posting the information was $755.

Emails from the publishers contained a mean of 9.6 grammatical errors, possibly because more than half had addresses in foreign countries, and of those with US addresses, 30% were residential.

Monday, May 21, 2018

The requirement that residents must be involved in research should be abolished

In a 2012 blog post called “Things that puzzle me about surgical education,” I wrote the following:

“There was the emphasis that still exists today on making sure every resident did research. At last, some are questioning the value of this for the average clinical surgeon. Contrary to the prevailing wisdom, there is no evidence that a resident who is dragged kicking and screaming through a clinical research project or who spent a year in someone’s lab really learns anything about research or how to read and understand a research paper.”

Nothing has changed.

According to the ACGME Program Requirements for Graduate Medical Education in General Surgery Section II.B.5.e: Clinical and/or basic science research must be ongoing in the residency program; based at the institution where residents spend the majority of their clinical time; and performed by faculty with frequent, direct resident involvement.