Category: Uncategorized

Blog posts will be … intermittent … for the next couple weeks.

Hello, New York City!  You win – with a commanding lead, 4.4% of all visitors to the site, over the past year.  But, after NYC, you have to go down to #5 to get to another U.S. city, and only 4 of the top 10 are ‘merican:

• New York
• Sydney
• Melbourne
• London
• Chicago
• Houston
• Brisbane
• Philadelphia
• Perth
• Toronto

Australia, I love you too.

What were some of the top posts of the past year?

Pre-Hospital Furosemide – No, No, Also No
It’s almost certainly net harmful for paramedics to give furosemide in the pre-hospital setting.

TMJ Dislocations: A Better Mousetrap?
The syringe technique for relocating mandible dislocations.  Cool.

The Scandal of Dabigatran – A Summary
Unless you’ve been living under a rock, you know we’ve been lied to about Pradaxa.

Azithromycin, the World’s Most Effective Antiviral
What’s more insane than one mostly useless treatment for influenza?  Trying to prove the value in adding an antimicrobial to the mix.

Go Ahead, Age-Adjust the D-Dimer
If you’re going to use D-Dimer to rule-out PE, you probably won’t miss much if you use higher cut-offs in the elderly.

The tPA Cochrane Review Takes Us For Fools
The updated tPA Cochrane Review is just another biased document failing to acknowledge the limitations of the underlying data.

My ACEP tPA Policy Critique
The ACEP Clinical Policy regarding use of tPA was controversial, to put it mildly.

Bayesian Statistics: We’re Dumb as Rocks
How many patients have a disease with prevalence 1/1000, given a test with 5% false positives?  Banana.

Of course, a few great posts from the past couple months simply haven’t had enough of an internet lifetime to accumulate pageviews, including Jerry Hoffman Debates Greg Albers on tPA, the ARISE study, and MR-CLEAN.

Also, a special thanks to Anand Swaminathan, Rory Spiegel, and William Paolo for their guest posts this year.

Thanks for visiting!  I hope you enjoy keeping up and poking holes in the newly published literature as much as I do in 2015!

It’s been three years since I started this blog, during PGY-3 of residency.  If you can imagine, I started out by posting every weekday.

That lasted – looking back – a surprisingly long time.

I’d like to say nowadays is “quality” over of “quantity”, but I’ll let the astute reader judge for themselves.

What have I learned?

• This is a viable form of academic scholarship that bypasses the bureaucracy and limited format of print journals.  Just a quick look around at the folks who have substantially augmented their careers with an online presence validates this opinion.
• tPA – we love to hate this drug.  Many of my most-viewed posts concern new trials and publications regarding tPA use in acute stroke.  Other popular topics seem to be cardiovascular & resuscitation topics, along with highly-controversial articles from prominent journals.
• Blogger and Google Analytics traffic stats still don’t match up, but revisions to Analytics have brought the numbers closer together.
• As any writer will tell you – the best way to improve your writing is to write.  The best way to improve your critical appraisal is to read other experts – and then throw your own hat in the ring.  Many projects now – including this one – offer the opportunity for intermittent, mentored posts with higher visibility for someone just starting out.
• Knowledge translation is more important now than ever before.  Creating new knowledge through research is the foundation of advancing the practice of medicine, but the conflicts-of-interest and distortions (sometimes inadvertent) pervading even peer-reviewed publications demand an ever-more-vital skeptical layer of peer review.
• This current state of online discourse is not the end.  Twitter, blogs, podcasts, Google Hangouts, Global Journal Clubs – don’t forget how “new” these elements are, and watch for (or go create) the next innovation.

Thanks for reading; the pleasure is all mine.

Continuing our mini-Christmas sabbatical from serious business, yet again Science has asked an important question.  And, yet again Science has the answer – chocolates don’t survive very long on medical wards.

In the BMJ’s annual Christmas collection, this “covert” observational study evaluated the median time Cadbury Roses and Nestle Quality Street chocolates survived from their arrival on the wards.  The boxes were opened within an average of 12 minutes, and were half-consumed within 2 hours.  Roses appeared to be preferred to Quality Street, based on median survival time.

Important science; previously known as Sweet Consumption of Famished Faculty – a Limited Observational Trial; SCOFF-A LOT.

“The survival time of chocolates on hospital wards: covert observational study”
http://www.bmj.com/content/347/bmj.f7198

A few of you might have noticed this week we had a couple guest posts from Dr. Spiegel, affiliated with Newark Beth Israel Emergency Medicine.  He’s been doing great work on his own blog site, emnerd.com, taking a deeper dive into some of the newly published medical literature.  You can also follow him on Twitter:  @CaptainBasilEM

If you’re interested in guest posting on a new or fascinating piece of the Emergency Medicine or general medical literature, send along an e-mail and we’ll chat!

Just as relevant a year later, a quick re-post to the Cochrane Collaboration’s Tamiflu exposé:

“Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children.”www.ncbi.nlm.nih.gov/pubmed/22258996

See what I wrote about it last year:
https://www.emlitofnote.com/2012/01/lies-damned-lies-and-tamiflu.html

(spoiler alert:  hardly worth the cost, at best; next to useless, more likely)

No post today!

(Ceci n’est pas une pipe)

With Rob Ormon[sic] of ERcast, discussing how (hopefully) coronary CT angiograms don’t become as popular as July’s discussants propose.

Sorry, I don’t have my own readily distributable copy of the clip – but I do have an article coming in a few weeks in EMJ BMJ summarizing my views.

“CT Angio Again!”
http://www.emrap.org/episode/2012/october/ctangioagain?link=episode-segment

Hosted by the mellifluous Rob Orman, we discuss a couple recent articles regarding the outpatient management of low-morbidity pulmonary emboli.  Short summary:  overdiagnosis of pulmonary emboli of uncertain clinical significance notwithstanding, the key to managing physiologically intact patients with pulmonary emboli is close follow-up to minimize the length of time patients are subject to dual anticoagulation.

Listen at:  ERCast – Pulmonary Embolus Outpatient Treatment

Happy Birthday to my blog – one year old.  No longer neonatal, but still an infant.

Blogging has been interesting – it is, indeed, time-consuming to read all these articles.  However, I’d be reading them regardless – so the time commitment is mostly the part with the typing.  Luckily, in academics, your clinical time is scaled down specifically to encourage these sorts of activities (although, blogging has so far only been parlayed into an endowed chair by Michele Lin).  And operating a blog is nothing like the amazing podcasts other folks put together – I have no idea how they do it.

At the moment, we’re on a schedule of a post every other day or so – and up to about 11,000 views per month.  In contrast, my article in JAMA from last summer has been downloaded 2,250 times.  Which has more value?  So far, the blog seems to be leading to more opportunities.  The traditional model of knowledge and opinion dissemination in medicine is certainly shifting.

Firefox and Safari are literally tied at 30% of my site traffic, as well as Macintosh vs. Windows at 30%.  Australia is in second place behind the U.S., and counts for about 10% of my traffic.

The top five most frequently viewed articles:
#1. Yet Another Highly Sensitive Troponin – In JAMA
#2. Too Many Traumatic Arrests Are Transported
#3. Cardiology Corner – More Brugada Tidbits
#4. C-Collars Cannot Stabilize Unstable Injuries
#5. Must We Use Paracetamol/Acetaminophen?

Thank for reading!