New website on reporting guidelines

The Equator website serves as a resource for consistent, accurate reporting in the literature of new research in a variety of health disciplines (e.g., systematic reviews, clinical trials, observational studies). Several of these disciplines have their own guidelines (e.g., the CONSORT guidelines for clinical trials), which are enforced by some of the leading journals. The site provides resources for authors, editors, and guideline developers.

reporting guidelines

Another online evidence-based medicine course

This one is from the University of North Carolina Health Sciences Library (my favorite library in the whole world, as it happens...) and the Duke University Medical Center Library.

(The photo is of UNC's Old Well, which is more photogenic than the library...)

New quality/safety blog

Robert Wachter, professor at UC San Francisco, author of Internal Bleeding, and patient-safety leader and innovator, has a new blog. This post nicely illustrates the health care quality learning curve as experienced by interns.

Be skeptical; be very skeptical

The Kaiser Daily Health Policy Report has a piece today about an effort to survey Wellpoint's many (35 million) about their physicians in order to provide consumer-based rankings, also to include comments. All together now: "The plural of anecdote is not data." Indeed, as one consumer group interviewed by Kaiser said, these rankings are likely to be skewed to the negative by patients who have had bad experiences. There are better ways to collect consumer-centered data - for example, AHRQ's CAHPS measures - than mass rants of the type Wellpoint proposes.

I don't have much use for Zagat's restaurant reviews, either, for the same reason.

Gross, but thought-provoking

Kent Sepkowitz, writing for Slate, asks whether we might not be better off in terms of immunity by living under less sterile conditions. His recommendation to scientists: figure out if there's a level of excrement we can eat that would boost our immune systems without killing us. I imagine susceptibility varies by age, and I do know that we live longer as a population than we used to before sanitation. Other than that, I'm not a microbiologist, and I can't decide whether this idea is completely wacky or not.

Any discussion?

Good news on hospital death rates

The Agency for Healthcare Research and Quality has released new data showing that mortality rates for six conditions and six procedures have declined steeply over a 10-year period from 1994 to 2004. In brief,

AHRQ compared the death rates for 1994 and 2004 for patients who were hospitalized for heart attack, congestive heart failure, stroke, pneumonia, gastrointestinal hemorrhage, or hip fracture.

For every 1,000 patients admitted for their condition:

o Heart attack deaths fell by 43; deaths from congestive heart failure, pneumonia, and stroke each dropped roughly 30; deaths from gastrointestinal hemorrhage declined by 21; and 16 fewer died from hip fracture.

For every 1,000 patients who underwent six surgical procedures examined:

o Abdominal aortic aneurysm repair deaths plunged from 103 to 74;
o Deaths from craniotomy – an operation for brain lesions and other conditions – declined from 83 to 68;
o Deaths from heart bypass surgery fell from 48 to 28, angioplasty deaths diminished from 16 to 12, those from carotid endarterectomy – an operation to avert stroke – fell from 12 to 7, and
o Deaths from hip replacement surgery declined by half – from 4 to 2 per every 1,000 operations.

The death rates for the six conditions and six surgical procedures are risk-adjusted, meaning that AHRQ’s researchers took into account differences in how ill patients were over time when calculating the results.

Isn't getting old hard enough as it is?

The New York Times today reports on various forms of mistreatment and bias against elderly gay people, especially in assisted-living and long-term care facilities. There are not a lot of data here, just a few anecdotes and examples of efforts to address the problem, but that's ok - the fact that it ever occurs is unacceptable. And you can sort of see what's going on - elderly people slowly lose their ability to control the environment they live in, and the world at large is still quite homophobic. So if you've grown up in the closet and eventually gotten past all the barriers to coming out, you now find yourself in a position of going back in, or struggling mightily to surround yourself with people who will accept you.

The problem simply had never occurred to me, and I have few words to express how sad it makes me.

Why universal coverage is not socialized medicine

Ezekiel J. Emanuel, bioethicist at the National Institutes of Health, lays it out in this Washington Post op-ed piece.

The Antidote in translation

Scanning links to this blog in Technorati, I found that one of my recent posts (mostly consisting of data from AHRQ) has been fully translated into German! Thanks to Healthy Index for taking the time to include the content. Based on my very limited German, it does appear that this was done by a human, not by a machine like Babelfish, which is helpful in a pinch but not particularly reliable, and sometimes downright hilarious, at least for language geeks like me.

Edit: thanks to my friend Z, with whom I probably should have checked before posting, for pointing out that it is an automatic translation after all. (Just goes to show how nonexistent my German really is these days...) So my new German readership are probably scratching their heads a bit.

One of my readers pointed out the following amusing choice of a bullet, however:

O arme Amerikaner really just means "Poor Americans," (meaning Americans without resources) not "Oh, you poor Americans." At least I think it does... Europeans don't feel that sorry for us, do they?

AHRQ e-updates available

The Agency for Healthcare Research and Quality has a new email notification service, where users can sign up for new Agency information (research, guidelines, etc.) in categories of their choosing. Sign up here.

health care quality

More on health coverage: a case study

From the macro-level previous post, to the micro...

Ryan Healy, at The Brazen Careerist blog, a 20-something writer, muses on the implications of taking a job without health insurance and buying individual coverage. (He also touches on issues of screening and prevention.) Whether or not Ryan intended to make a political statement with this piece, it's a good illustration of just why universal health care is a good idea.

Update on health-insurance coverage in the US

The Agency for Health Care Research and Quality (AHRQ) has just released data on the extent of lack of health coverage, and in particular the lack of continuity of coverage. This is of course a central issue for presidential candidates and others who are debating what to do about the problem. From AHRQ's News and Numbers:

More than 17 million Americans under age 65 – almost a third of whom are middle income, could be considered continuously uninsured. This means that they have not had health insurance to help cover their medical bills for at least four years, according to the latest News and Numbers from the Agency for Healthcare Research and Quality. Middle income Americans are defined as living in families earning between 200 percent and 400 percent of the federal poverty thresholds, which vary according to family size and composition. In 2004, the base year for these data, poverty level income for a family of four averaged $19,307. From AHRQ's News and Numbers: The AHRQ data examined Americans who were continuously uninsured for at least four years between 2002 and 2005 as well as those who were uninsured for shorter periods over those years. The AHRQ data also show that:
o Poor Americans, those in families with incomes at or below the Federal poverty line, comprised about a quarter of the continuously uninsured. In contrast, less than 10 percent of the continuously uninsured were people who lived in families with incomes over 400 percent of the Federal poverty line.
o Fully 17 percent of Hispanics were continuously uninsured, compared with 7 percent of blacks, and 4 percent of whites.
o Some 12 percent of people age 25 to 29 years of age were continuously uninsured, followed by Americans age 18 to 24 (11 percent), 30 to 34 (10 percent), 35 to 54 (8 percent), and 55 to 64 (5 percent). However, only 2 percent of children and adolescents under 18 years of age were continuously uninsured.