Science-Based Medicine

It all seemed so easy

In 2010 an article was published in the New England Journal of Medicine, Preventing Surgical-Site Infections in Nasal Carriers of Staphylococcus aureus .  Patients were screened for Staphylcoccus aureus ( including MRSA, methicillin resistant Staphylococcus aureus) and those that were positive underwent a 5 day perioperative decontamination procedure with chlorhexidine baths and an antibiotic, mupirocin, in the nose.  The results were impressive.  Before the intervention the infection rates were 7.7 % and after the intervention it was 3.4 %.  That is an impressive drop in surgical infections.

One of the orthopedic groups approached us (us being the hospital administration, pharmacy, nursing  and infection control, of which I am Chair) to implement the protocol in their patients, citing a similar study on an orthopedic population.  Great.  It should be an easy enough intervention.  I should have known better, of course, long experience has continually demonstrated that what appears to be simple never is.

First was the question as to whether the study was applicable to our patients.  Resources were going to be devoted to an intervention, so going forward we had to demonstrate that the bang would be worth the buck.  These are financially lean times, with cutbacks and declining reimbursement, so every expenditure of time and money needs to be justified.  In the bizarro accounting of health care, not every hospital administration will include money saved in the evaluation of interventions, only the money spent.   I work in a hospital system with a remarkably strong commitment to patient safety and quality, so there was little  worry on that point. Continue Reading »

Earlier this week, a reader of ours wrote to Steve and me with a request:

First off, I just want to say thank you for everything you gentlemen do. I find that your sites are extremely helpful when trying to figure out what level of information is BS, and what is real.

In short, I was wondering if either of you two would be able to refer me to a scientific or psuedo-scientific article where the abstract completely misrepresents the article or the conclusion doesn’t fit the analysis/data. The reason is that I’m writing is that I’m currently in my third year at [REDACTED], and currently I’m working on my seminar paper so I can graduate. I decided to look at whether there is a reasonable fair use argument in the reproduction of an entire scientific article and at what instances prior precedent would allow it. Inherent in the argument is that a scientific paper can’t be properly excerpted without losing vital information (or that an abstract does not adequately describe the entire paper), so complete reproduction of the article is necessary to properly convey the point.

Sincerely,

A Reader

So…at the risk of being too blatant, I’ll just say that our readers are very informed and scientifically knowledgeable (excepting the odd troll, of course). Can you help another reader out and provide references that fit this reader’s request? I can think of one, but I don’t think it’s as blatant as what he has in mind. Please list your references below. Heck, we might even be able to get a post for SBM out of this if there are some interesting papers that fit the description above.