Labyrinth of Terror

Many of the readers of this blog may be interested to know that Dick Wenzel has just published his first novel, Labyrinth of Terror. I just finished reading it and recommend it highly. It's not everyday that those of us who work in infection prevention can read a novel that deals with our world, but here's your chance. The story is set in London and the protagonist is an American hospital epidemiologist who helps a British colleague with an outbreak of healthcare associated infections in a London hospital. The book is fast paced, immediately drew me in, and was a very fun read. You can order it here.

The impact factor & the almighty dollar

Since the inception of this blog, we have written frequently about conflict of interest, and it seems as though new types of conflicts continue to be uncovered. There's an interesting new paper and editorial in PLoS Medicine on how industry supported clinical trials affect a journal's impact factor. The authors reviewed randomized trials in 6 major journals, including JAMA and the New England Journal of Medicine. They found that industry supported trials had more citations than those not funded by industry. What I didn't know was that "non-citable" papers (editorials, news pieces, and letters to the editor) are included in the numerator but not the denominator of the impact factor calculation. For the New England Journal, removing the non-citable pieces would lower its impact factor by 24%. So there is a conflict of interest at play here: the publication of industry-funded trials not only increases the journals' impact factors, but the journals also make money by publishing reprints. For example, nearly half of Lancet's income is derived by selling reprints. As the editorial points out, the journals have greatly increased their scrutiny of authors' conflicts of interest, but the journals and their parent organizations may not be holding themselves to the same standards.

In the Atlantic Monthly

In the November Atlantic Monthly the cover story is on 19 brave thinkers for 2010. The first of these is Dr. John Ioannidis, a Harvard-trained physician epidemiologist, who chairs the Department of Hygiene and Epidemiology at the University of Ioannina, Greece. He is probably most famous for a paper he published in 2005, Why Most Published Research Findings are False. The paper has been downloaded nearly 300,000 times. He believes that 80% of non-randomized studies have incorrect conclusions, as do up to 25% of randomized trials. The Atlantic's profile of Ioannidis can be viewed here.

In the same issue, there's also a piece on the demise of the wristwatch. I haven't worn a wristwatch since I embraced bare below the elbows 2 years ago. Losing the watch was a sacrifice for the sake of infection prevention, but I have to admit I don't miss it at all. According to the article, watchmakers are developing apps for mechanical watches (called complications) to try to maintain consumer's interest in them, but the author predicts that watches will go the way of the sundial.

Holy Superlatives, Batman! Hospital-acquired infections have significant economic costs!

1935 Dollar

There is a well done study out in Medical Care by Rebecca Roberts et al. from Stroger/Cook County that assesses the attributable costs of HAIs in a cohort of patients from 2000.  What sets this paper apart is the careful attention they paid to design and analysis methodology.  Just to paste from the abstract, they used "ordinary least squares linear regression and median quantile regression, Winsorizing, propensity score case matching, attributable LOS multiplied by mean daily cost, semi-log transformation, and generalized linear modeling. Three-state proportional hazards modeling was also used for LOS estimation. Attributable mortality was estimated using logistic regression." 

Quality, safety, and value

There is an interesting commentary in JAMA this week. The money quote:

“So more than 40 years after the birth of the quality improvement movement, there is still not much known about what has been accomplished.”

The author, Robert Brook, argues for embracing the business case for quality, and for developing a new “epidemiology of value”,

“…which contains both measurement of cost and quality, and is applicable to both the developed and developing world. The results of this work would help to distinguish between a level of quality that is a good value and the best available quality that may produce small improvements in health at enormous cost.”

Eli, as our house economist, has a better grasp of what it takes to build a business case for quality…I should let him take it from here…

Ctrl+F

…will bring up the “Find and Replace” tool in Microsoft Word. Illinois legislators, you may want to use this tool today, so you can get yourselves a shiny new law to deal with the latest emerging antimicrobial resistance threat.

Hint: you’ll want to find “MRSA”, and replace with “KPC”. Make sure to go to “search options” and click on “Match Case”, or you’ll mess it all up.

That should do it.

Links:
Illinois screening legislation
IDSA abstract on emergence of KPC-producers in Illinois
Chicago Tribune story

Cholera in Haiti

A horrendous development, poised to get much worse if the epidemic begins spreading in Port-au-Prince. The preconditions for a massive outbreak are present, namely limited access to safe potable water and proper sanitation, both of which require an intact infrastructure. Over a million people are still living in tent camps around Port-au-Prince, with minimal or no sanitation.
While media attention is appropriately focused on Haiti, this should also serve as a reminder that cholera outbreaks occur regularly throughout the world, most commonly in sub-Saharan Africa, where Nigeria is now in the midst of a huge outbreak. These outbreaks typically receive very little media attention.