Medical News Blog

Snapdate: Ebola virus diseaseClick on image to enlarge.

case decline, Ebola virus, Guinea, Liberia, Sierra Leone, vaccine

This is one of the data visualizations from my Ebola virus disease (EVD) graphs and tallies page.[1]

A crude extrapolation from current publicly available Ebola virus disease (EVD) confirmed case numbers. To see how I made this please visit here.[2]
The P-value for this linear trend model is <0.0001.
The standard error = 6.13; R-squared = 0.20.
Click on graph to enlarge.

The first time I posted it I wondered if the end was in sight. That was 6th of May. Over three months later I'm wondering that again - but this time things are a bit different. There has been a steady decline in new cases, also in cases that cannot be tracked back to a known source and in cases found only after they have died of EVD. There have also been the first very promising results from one of the vaccine candidates in Guinea [4] - which has always been a difficult locale for the control of EVD case activity.

So it does look much more likely that the end to EVD in West Africa, or at least an end, is nigh.

By "an end" I mean that we may be close to seeing the cessation of new cases popping up in transmission chains each and every week. We may soon be seeing zero new cases for long periods of time. Those blissful stretches however, may be punctuated by a case arising from parts unknown. They may be tracked to a sexual transmission event, or their origin may never be fully understood. We saw this scenario in Liberia.[3] Virus characterisation indicated that the Ebola virus variant from the young Liberian man was most closely resembled other viruses that had been circulating in Liberia weeks before; the exact source of his infection though, remains unknown.

So we're not at all free and clear of this virus yet - but we are getting very close to shifting into another phase. It's still a long haul with many weeks of anxious waiting and heightened vigilance as well as the need to retain the capacity to cope with a new case or cases. But that said, we do seem to have taken one more step back from the precipice we once stared into as we imagined an Africa fending off a rolling EVD epidemic - and a world at risk as well - however unlikely that should have been.

References..

Queensland influenza age shift still shifted...

influenza, Queensland

Figure from State of Queensland (Queensland Health) report found here includes data up to 9th August 2015.
Images excised from PDF and pasted together using Adobe
Photoshop CC 2015.0.0
Click on image to enlarge

Also interesting:

3.3X more influenza type B viruses than influenza type A viruses in week to 9th August
a proportion of the influenza viruses were further genotyped
44% of that proportion were influenza B viruses of the Victoria lineage which is not the lineage in the trivalent vaccine this year (it is in the quadrivalent vaccine though - see full report for detail)

NOTE - the report is not clear on how many genotyped specimens this represents

As you can see in the figure below - the 'flu season is still very much underway in Brisbane
Brisbane is also experiencing its own little 'mass gathering' which started last Friday - the Brisbane Exhibition.

Appendix 1 from the State of
Queensland (Queensland Health) report found here, including data
up to 9th August 2015.
Click on image to enlarge

Queensland influenza sees a shift in age...

Age, flu season, influenza virus, Queensland, Sex

Image adapted from Geoscience Australia,

The Australian Government.[3]

The media Down Under have been doing their thing this influenza season...

...lots of inflammatory (pun intended) headlines to make us all fear just about everything and everyone. Blah.

Nonetheless, it is flu season down here - and hopefully you gave vaccination a try this year, or you got your annual shot. Top marks if so! If you can safely and pretty painlessly dodge a preventable disease, save yourself some misery, avoid making your kids sick - who will require time off to be looked after, not make Aunty Robyn crook as a dog and not put Grandad's ailing ticker under extra stress...why wouldn't you?

VDU Figure 1. Figure 2 from the State of
Queensland (Queensland Health) report
found here.[1]Click on image to enlarge

Thanks to the excellent and publicly available wealth of data presented by the epidemiologists of the State of Queensland (Queensland Health), I talked about influenza in Queensland and the distribution of types (i.e. Flu A or B) and subtypes (e.g. H3N2 or H1N1) last year.[2]

In 2014, influenza A viruses were the big bad, but in 2015, as we can see in VDU Figure 1 (orange), influenza B viruses are ruling the mean streets.

VDU Figure 2. Appendix 1 from the State of
Queensland (Queensland Health) report
found here.[1]Click on image to enlarge

From the look of VDU Figure 2, the influenza season remains in full swing (hint-get that vaccination if you haven't already).

VDU Figure 2 also shows that things are not tracking all that unusually for a Queensland influenza season when you compare this year to curves from the past 5 years. So I'd suggest taking those media headlines with a box of tissues!

However, something stood out to me when looking at the latest report so I went back and cut-and-pasted the age and sex graphs from the past few consecutive weeks to make VDU Figure 3. Sure enough, there was a particular spike in the 5-9 and 10-19 year old age bands (yellow arrows in graph boxed in red). Even allowing for changed y-axis scale in the first 4 graphs (dates are listed in each graph's legend) these 2 bands seem to have risen just in the past reporting week.

Still, the overall pattern of rising case numbers, a dip in the 20-29 year old age band, then a rise before a consistent drop off is retained. Is this the result of school kids returning from school holidays on the 23rd of July, sharing their viruses, incubating an infection and becoming ill? If so - will we see a rise in parent - age age bands in the report after next's? Let's watch and see!

VDU Figure 3. Figure 4s from previous weeks of State of Queensland (Queensland Health) report found here.[4]
Images excised from PDFs and pasted together using
Adobe Photoshop CC 2015.0.0
Click on image to enlarge

References....

U-M reopens medical library without books

Medical News

ANN ARBOR (AP) — The University of Michigan has reopened its Taubman Health Sciences Library after a $55 million overhaul and rethinking of how a library for medical students should function.

Hundreds of thousands of books were moved to an offsite location and are available on demand for delivery, and by becoming “bookless” the school said that frees up space for medical student education. The facility on the school’s Ann Arbor campus officially reopened over the weekend.

“Today’s library can be anywhere, thanks to technology, yet there is still a desire for a physical location that facilitates collaboration, study and learning,” Jane Blumenthal, associate university librarian and Taubman Library director, said in a statement.

The books were moved about two years ago, before construction began. The library includes a realistic simulated clinic and medical students will work with those studying public health, dentistry, pharmacy, social work, nursing and kinesiology — much like they will in their future careers.

The library also features a virtual cadaver, a life-sized display that’s manipulated using a touch screen to view different layers of the body, The Ann Arbor News reported. A scalpel tool can also be used to make incisions and even cut away portions of the body for inspection.

“This new space is truly designed by educators, and it shows in every detail,” said Dr. Rajesh Mangrulkar, associate dean for medical student education. “For example, students can write on erasable walls and tables to help facilitate discussions and teamwork.

“There’s supportive technology infused in every element, not so that it stands out, but so it’s an integral part of the learning environment.”

The 35-year-old, 143,400-square-foot library will serve as the central learning hub for the university’s nearly 780 medical students as well as provide lecture and advising space for the medical school’s more than 1,100 graduate students and postdoctoral fellows in biomedical sciences.

The school has a historical collection of medical books at the Hatcher Graduate Library.

[Original Article]

Medical journal news releases CAN make a difference

Medical News

This week The BMJ sent journalists a news release, “Regular consumption of spicy foods linked to lower risk of death.” The second paragraph – the third sentence overall – of the news release read: “This is an observational study so no definitive conclusions can be drawn about cause and effect, but the authors call for more research that may “lead to updated dietary recommendations and development of functional foods.”

If you go to the journal article on which the news release is based, you see that the seeds of appropriate explanation were planted further upstream.

In the conclusion paragraph of the published study manuscript, the researchers wrote:

“given the observational nature of this study, it is not possible to make a causal inference.”

Did that clarity – that emphasis on the fact that association ≠ causation – make a difference in subsequent news stories based on the study or on the news release? It appears that may be the case in this instance.

TIME.com included this: “More research is needed to make any causal case for the protective effects of chili—this does not prove that the spicy foods were the reason for the health outcomes.”
The New York Times Well blog had a line: “The authors drew no conclusions about cause and effect.”
With even greater emphasis, the Los Angeles Times reported: “Although the study included nearly half a million volunteers who were tracked for a total of 3.5 million person-years, the researchers emphasized that they couldn’t show a causal relationship between eating spicy foods and living longer.”
In The Washington Post: “The researchers said that while it isn’t possible to draw any conclusions about whether eating spicy foods causes you live longer from their work that more studies are needed to look at this link in more depth.”
From HealthDay: “However, the study authors cautioned that their investigation was not able to draw a direct cause-and-effect link between the consumption of spicy foods and lower mortality. They could only find an association between these factors.”
CBSNews.com stated: “The authors emphasize that this is an observational study so no definitive cause and effect relationship can be drawn.”

We’ve had a long-running challenge to news release writers for The BMJ and for news releases for others of the ~50 journals that BMJ publishes, to consistently state the limitations of observational studies that they write about. And we’ve brought this up with other journals as well.

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In this latest chapter, kudos to The BMJ. The words matter. What the researcher-authors submit matters. The journal’s editorial scrutiny matters. The accuracy of the news releases matters as well.

[Original Article]

Music in operating theaters could impair communication

Medical News

The study, published in the Journal of Advanced Nursing, investigates how background music impacted on surgical operations through an analysis of video recordings.

Co-lead author Sharon-Marie Weldon, from the Department of Surgery and Cancer at Imperial College London in the UK, explains that some background music can have a beneficial effect:

"Music can be helpful to staff working in operating theaters where there is often a lot of background noise, as well as other distractions - it can improve concentration."

Recently, Medical News Today reported on a study published in the Aesthetic Surgery Journal that found when surgeons listened to their preferred music, they closed their incisions more effectively.

However, the researchers found that music could disrupt communication between different members of theater teams. In some cases, surgeons had to repeat requests for instruments or supplies made to nurses. The researchers also found evidence of tension in some theater teams recorded on video.

Specifically, in cases where music was played, the researchers noted that repeated requests were five times more likely to occur than during operations without musical accompaniment. They estimate that each repeated request can add up to an extra minute to a procedure's duration and lead to frustration among clinical staff.

Music was first played in operating theaters in 1914 as a way of calming patients. Nowadays, experts estimate that music is played during 53-72% of surgical operations, with many modern theaters equipped with devices specifically for playing music such as MP3 players and portable speakers.

With most surgical patients anesthetized, music is now very much for the benefit of the medical staff.

Music decisions often made by senior medics

The researchers analyzed video recordings made of a total of 20 operations carried out over a period of 6 months in two operating theaters in the UK. Footage was obtained from multiple camera angles, allowing the researchers to examine both verbal and non-verbal communication in the theater teams.

Communication issues were exacerbated when alterations were made to the volume of the music. When digital tracks did not have a standard volume, turning up one popular song could lead to a subsequent song being played far too loudly.

"In the operating theaters we observed, it was usually the senior medics of the team who made the decision about background music," says co-lead author Dr. Terhi Korkiakangas. "Without a standard practice of the team deciding together, it is left up to junior staff and nurses to speak up and challenge the decisions of senior doctors, which can be extremely daunting."

Although the study only examined footage from two operating theaters, it does illustrate the potential problems that could be caused by the playing of music in operating theaters.

The authors state that the possibility that music could interfere with communication is seldom recognized as a potential safety hazard, and that frank discussions between surgical teams should be held - particularly taking into consideration the views of theater nurses.

Weldon concludes:

"We'd like to see a more considered approach, with much more discussion or negotiation over whether music is played, the type of music, and volume, within the operating teams."

At the start of the year, Medical News Today reported on a study suggesting that some emotional responses to music are the same worldwide, regardless of cultural diversities.

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