Questioning Things We Routinely Do: A Lines and PPI drips


Great Post — Could Patient Centred Outcomes Research — based on real time analytics on data harnessed from the patients within the system — help stop such practices ?

JAMA Internal Medicine Blog


A medicine trainee’s daily life is filled not just with rounds, the calling of consults, and care coordination, but also with smaller tasks, never formally taught in the medical school curriculum, that take on a rote, almost liturgical quality. Potassium repletion, ordering daily labs, making patients NPO–all are faithfully transmitted from one trainee generation to the next. Annoying as these can be to everyone–the patient most of all, but also the trainee and the nurse–most survive because they “make sense” and seem harmless. (Not always true, of course, at least not as often as believed.) In last week’s online issue of JAMA IM, then, there may be some relief for all from these daily errands: arterial catheters (“A lines”) in the ICU and proton pump inhibitor (PPI) drips for the patient with a GI bleed.

In the first article, Gershengorn and colleagues retrospectively examined patients in 139 ICUs in the US and compared mortality among those who received an A line and propensity matched controls who…

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Surrogate outcomes: That’s not why we play the game


JAMA Internal Medicine Blog


Sports fans are familiar with the adage, “that’s why they play the game.” Statistically any one team may seem to be better on paper, but upsets are possible and do happen with some regularity. For baseball, for example, batting averageon-base percentage, and RBIs all matter, but at the end of any game they only matter to the extent that one team scores more runs than the other when the last player is out.

So, too, it is in medical research. We can’t test every intervention to a defining conclusion for fear of wasting money or causing harm, so we aim initially for what are called surrogate outcomes: HDL and cardiac arryhthmia among others. These outcomes can help us gauge the likelihood of success, and see if we are on track to ultimately help patients. But it’s the outcomes of interest to patients–subsequent heart attacks and of course 

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How to teach a young introvert


Great thoughts on Education

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What should we do with the quiet kids? A conversation with Susan Cain on the future of classroom education.

Susan Cain sticks up for the introverts of the world. In the U.S., where one third to one half the population identifies as introverts, that means sticking up for a lot of people. Some of them might be data engineers overwhelmed by the noise of an open-floor-plan office. Others might be lawyers turning 30, whose friends shame them for not wanting a big birthday bash. But Cain particularly feels for one group of introverts: the quiet kids in a classroom.

Cain remembers a childhood full of moments when she was urged by teachers and peers to be more outgoing and social — when that simply wasn’t in her nature. Our most important institutions, like schools and workplaces, are designed for extroverts, says Cain in her TED Talk. [Watch: The power of…

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