Wednesday, November 27, 2013
Don't BUGG me! (some more)
Recently I blogged about the BUGG study. This paper has generated a fair amount of media coverage, and as I looked through the headlines this morning, I was struck by the variability of the messages they seem to contain. Take a look at the headlines below all describing the BUGG study:
• Gloves, Gowns in ICUs Cut Down on MRSA
• Cheaper Way to Stop MRSA Adds No Patient Risk
• Widespread Glove, Gown Use In ICUs Could Reduce Spread Of MRSA
• Gloves and gowns use in ICU not completely effective against infection, says study
• ICU gloves and gowns may reduce infection
• Use of gloves, gowns by health care workers for ICU patient contact does not reduce MRSA infection
• Gloves, Gowns In ICU Reduces MRSA 40 Percent
• Gloves and Gowns Don’t Cut Hospital Care Infections, A Study Finds
• Universal gloves, gowns in ICU reduced MRSA acquisition
• Universal glove use not associated with reduction in acquiring antibiotic-resistant bacteria
• Widespread gown and glove use by health-care workers in ICU reduces MRSA 40 percent
• Gown And Glove Use In ICU Cuts MRSA by 40 Pct
• Gloves and Gowns Don’t Stop Spread of All Infections in Hospitals
• ICU Gloves and Gowns Might Reduce MRSA Infection, Study Says
• Universal Gown And Glove Use By Health-Care Workers In ICU Reduces MRSA 40 Percent
• Gloves and gowns do not protect against MRSA or VRE, study shows
• Study Examines Effect of Use of Gloves and Gowns For All Patient Contact in ICUs on MRSA or VRE
• Universal gown and glove use by health-care workers in ICU reduces MRSA 40 percent
• Wearing gown and gloves for all ICU patient contact reduces MRSA infections by 40%
• Study-Hospital Precautions Do Nothing to Stop Infections
Interestingly, if you examine each headline carefully you find that almost every one of them is technically correct, though if you had never read the paper you would likely be very confused. It’s a great example of how technical papers get translated for the general public. In this case it’s related to understanding the difference between colonization and infection, the differences between types of outcomes (are we talking about device-associated infections or pathogen-specific infections?), and combined vs. single outcomes (MRSA and VRE combined vs. MRSA and VRE evaluated separately).
Lastly, even if you read the paper and have a good understanding of its findings, the implications of the study will be different based on the value judgments of the reader. Despite all of the confusion, I think that you’ll seldom find a better designed or better executed study in health care epidemiology. In Facebook parlance, “It’s complicated.”
Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. This post originally appeared at the blog Controversies in Hospital Infection Prevention.
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Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
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Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
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Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
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Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.
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Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.
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Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.
The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.