Medical News Blog Information

Queensland influenza age shift still shifted...

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...

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

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

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.”
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The BMJ logoWe’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

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.

[Original Article]

Best Medical Schools Linked to Top-Notch Hospitals

At almost any medical school, soon-to-be doctors will get years of hands-on and classroom training in preparation for their careers. But there are perks that come with going to a school that's affiliated with a prestigious hospital.
"You get to see the medical cases that are really complex," says Sahil Mehta, a graduate of thePritzker School of Medicine at the University of Chicago, which is affiliated with NorthShore University HealthSystem. "You get to see a wide variety of disease." 
A school that is affiliated with a top-ranked hospital may give students the chance not only to see patients with routine needs, but also those who need advanced care, says Mehta, who's also the founder of MedSchoolCoach, a company that helps prospective medical students get into school. Plus, students can see leaders in various areas of medicine — such as oncology, radiology or surgery – who may work at such hospitals.
U.S. News recently released its 2015-2016 Best Hospitals rankings, and many of the hospitals on the Honor Roll, a list of hospitals that rank highly in at least half a dozen specialties, are also affiliated with schools that rank highly for research or primary care in the 2016 Best Medical Schools rankings.
Below are the 15 hospitals on the Honor Roll, and the medical schools that are affiliated with each.
Hospital (state)U.S. News Best Hospitals Honor Roll rankAffiliated medical school (name) (state)U.S. News research rankU.S. News primary care rank
Massachusetts General Hospital1Harvard University (MA)112 (tie)
Mayo Clinic (MN)2Mayo Medical School (MN)2742 (tie)
Johns Hopkins Hospital (MD)3 (tie)Johns Hopkins University (MD) 3 (tie)29 (tie)
UCLA Medical Center​3 (tie)University of California—Los Angeles (Geffen)137
Cleveland Clinic5Case Western Reserve University (OH)2462 (tie)
Brigham and Women's Hospital (MA)​6Harvard University (MA)112 (tie)
New York-Presbyterian University Hospital of Columbia and Cornell7Columbia University (NY)8 (tie)52 (tie)
New York-Presbyterian University Hospital of Columbia and Cornell7Cornell University (Weill) (NY)1849 (tie)
UCSF Medical Center8University of California—San Francisco3 (tie)3
Hospitals of the University of Pennsylvania-Penn Presbyterian9University of Pennsylvania (Perelman)512 (tie)
Barnes-Jewish Hospital/Washington University (MO)10Washington University in St. Louis619 (tie)
Northwestern Memorial Hospital (IL)​11Northwestern University (Feinberg) (IL)1929 (tie)
NYU Langone Medical Center12New York University14 (tie)42 (tie)
UPMC-University of Pittsburgh Medical Center13University of Pittsburgh1619 (tie)
Duke University Hospital (NC)14Duke University (NC)8 (tie)29 (tie)
Stanford Health Care-Stanford Hospital (CA)15Stanford University (CA)​225 (tie)
Medical schools often have relationships with several hospitals, where students get experience working in different specialties and with different kinds of patients.
Harvard University, for example, has a partnership with Massachusetts General Hospital, ranked No. 1 on the Honor Roll; Brigham and Women's Hospital, which is ranked No. 6; and other medical facilities.
Hospitals can also have partnerships with more than one school. Both Cornell University and Columbia University are affiliates of New York-Presbyterian University Hospital of Columbia and Cornell, ranked at No. 7.
[Follow a timeline to learn when to apply to medical school.]
​If students attend a medical school that's not associated with a big, highly ranked​ hospital and is instead partnered with a more community-based hospital​, they shouldn't think it's the end of the world, says Mehta, who is completing a fellowship at Massachusetts General Hospital. At a community hospital, students can get a solid understanding of how to practice medicine​.
"Sometimes for a med student it's actually nice to see basic cases to really get a good, solid foundation, and then build upon that in residency and then in fellowship after that," Mehta says. Students may also be able to "get their hands dirtier" while training in community hospitals, which may have fewer​ residents and fellows, he says.
[Think carefully about the pros and cons of hiring a medical school admissions consultant.]
At many schools, students also have the option of spending time at several different kinds of medical centers, and they can get experience at hospitals that are not partnered with their schools by doing what's called an away rotation.
Prospective students should consider a range of factors beyond a school's hospital affiliation, experts say, when deciding where to go, such as what they might want to practice and if they want a dual-degree program.
"They should never choose a school just based on rankings, whether it's based on the rankings of the school itself or based on the hospital that they're affiliated with," says Mehta. "Choosing a school just based on rankings is a recipe for disaster."

[Original Article]

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