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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.

Monday, April 30, 2018

Family of late pop singer Prince sues everyone for malpractice

According to the New York Times, “The suit claims that Prince’s death was a “direct and proximate cause” of the hospital failing to appropriately diagnose and treat the overdose, as well as its failure to investigate the cause and provide proper counseling.”

The suit names a hospital and an emergency department physician in Moline, Illinois where Prince’s private jet made an emergency landing when he became unresponsive during a 2016 flight home to Minnesota from a concert in Atlanta.

An employee of his told paramedics who met the plane that he “may have taken a Percocet.” After Prince regained consciousness, he supposedly told the ED doc he had taken two Percocets, but she did not believe him because it had taken two doses of Narcan, an opioid antidote, to revive him.

Friends said he refused all testing including blood and urine toxicology because he was trying to keep his addiction a secret.

Monday, April 23, 2018

2018 Residency Match Update

The National Resident Matching Program Advance Data Tables for the 2018 Main Residency Match again show an increase in the number of first-year positions offered, going from 28,849 in 2017 to 30,232 this year.

Of the 18,818 seniors graduating from US allopathic medical schools, 17,740 (94.3%) matched, 1078 (5.7%) did not match, and 474 withdrew or did not submit a rank list. The 5.7% who went unmatched was identical to last year’s figure.

The 1511 graduates of US allopathic medical schools from previous years did not fare as well with 43.8% matching and 56.2% going unmatched—slightly worse than the 2017 percentages.

Wednesday, April 18, 2018

What is the worst way to combat school shootings?


Please read carefully because there might be a test.

A school district in Pennsylvania placed a 5 gallon bucket of rocks in each classroom two years ago. If locking and barricading the classroom door does not work, the students have been instructed to throw rocks at the would-be shooter instead of hiding under their desks.

According to a Buzzfeed story, the school superintendent for Schuylkill County believes the rocks serve as a powerful deterrent. He said, “If an armed intruder attempts to gain entrance to any of our classrooms, they will face a classroom full of students armed with rocks. And they will be stoned.”

Maybe it’s working. Since the arrival of the rocks, there have been no shooter incidents in any Schuylkill County school.

Wednesday, April 4, 2018

The decline and fall of the rectal exam



For almost 20 years, the value of the digital rectal exam (DRE), a long time staple of the complete examination of the trauma patient, has been questioned. Performing a rectal examination on all trauma patients is no longer advocated except for a few specific indications.

As recently as two months ago, trauma surgeon Michael McGonigal blogging at The Trauma Pro reinforced the message. Because a rectal examination is so uncomfortable for patients already traumatized and its yield is so minimal, he advocates doing it in only patients with spinal cord injury, pelvic fracture, and penetrating abdominal trauma. For a more extensive discussion of the topic, see Life in the Fastlane, an emergency medicine blog.