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Slow Information Update

October-November 2018

This issue’s contents :

• Irish Research

• Dietetics & Biochemistry

• Adverse events

• Older people

• Infection control

• Health issues in the news

• Medical Physics

• Stroke

• Research Roundup

This Update looks at recent papers designated practice-changing by your peers and gives a more com-

prehensive overview of findings on these and various other topics of interest.

Where comments or opinions from health professionals and other sources are featured, it is for in-

formative/discussion purposes only and not an endorsement of these opinions.

Should you wish to comment or discuss any aspect of this publication, please contact: Anne Madden anne.madden@ucd.ie. Phone: (01) 221 4921

Recent Irish research & guidelines

Office of the Ombudsman (2018): Learning to Get

Better: Progress Report: A report on the pro-

gress made following the Ombudsman’s investi-

gation into how public hospitals handle com-

plaints.

Communicable Disease Update; Vol. 17(4), No-

vember 2018

NCCP (2018): National Prostate Cancer GP Refer-

ral Guideline

Donnelly S, Prizeman G, Coimín DÓ, Korn B,

Hynes G. Voices that matter: end-of-life care in

two acute hospitals from the perspective of be-

reaved relatives. BMC palliative care. 2018

Dec;17(1):117.

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Dietetics & Biochemistry “Trial concludes vitamin D and fish oil don't lower incidences of heart disease or cancer” from Rich Haridy (New Atlas, 13/11/18). The conclusion of the omega-3 study was, "Supplementation with n−3 fatty acids did not result in a lower incidence of major cardiovascular events or cancer than placebo." Manson JE, Cook NR, Lee IM, Christen W, Bassuk SS, Mora S, Gibson H, Albert CM, Gordon D, Copeland T, D’Agostino D. Marine n− 3 fatty acids and pre-vention of cardiovascular disease and cancer. New England Journal of Medicine. 2018 Nov 10. Secondary positive results were being highlighted but “Jane Armitage, from University of Oxford, also questions the veracity of some of these secondary conclusions, suggesting while "they did see fewer heart attacks among those taking the fish oils," there was also no overall effect seen on all other cardiovascular events, so this needs to be interpreted cautiously.“

A substantial paper which supports what we have always been told—breakfast is, possibly, the most important meal of the day. Aurélie Ballon, Manuela Neuenschwander, Sabrina Schlesinger; Breakfast Skipping Is Associated with Increased Risk of Type 2 Diabetes among Adults: A Systematic Review and Meta-Analysis of Prospective Cohort Studies, The Journal of Nutrition, , nxy194,

“Two Studies May Change View of Probiotics: One Size May Not Fit All” states Tara Haelle for Medscape (15/10/18). “The medical community has much to learn about probiotics and their effects on individual patients before the supplements can be broadly prescribed to achieve uniform effects, results of two new studies show. The randomized, controlled studies, which relied on serial biopsies rather than stool samples, show that whereas some patients appear to benefit of probiotics, others may have little response or potentially adverse reactions to the sup-plements.“ The studies, both in Cell, are: available here and here. It may not be everybody’s first choice of beverage after abdominal surgery, but for coffee addicts the good news is: “None of the included studies reported adverse events associated with coffee consumption. Postoperative coffee consumption is effective and safe for enhancing the recovery of gastrointestinal function after abdominal sur-gery.” (Note however that all included papers were judged to have a high risk of performance bias.) Eamudomkarn N, Kietpeerakool C, Kaewrudee S, Jampathong N, Ngamjarus C & Lumbiganon P: “Effect of postop-erative coffee consumption on gastrointestinal function after abdominal surgery: A systematic review and meta-analysis of randomized controlled trials” Scientific Reportsvolume 8, Article number: 17349 (2018).

Updated standards of practice from America: Ukleja A, Gilbert K, Mogensen KM, Walker R, Ward CT, Ybarra J, Hol-combe B, Task Force on Standards for Nutrition Support: Adult Hospitalized Patients, the American Society for Parenteral and Enteral Nutrition. Standards for Nutrition Support: Adult Hospitalized Patients. Nutrition in Clini-cal Practice. 2018 Oct.

How effective are Public Enforcement Notices? Cohen PA, Wen A, Gerona R. Prohibited stimulants in dietary sup-plements after enforcement action by the US Food and Drug Administration. JAMA internal medicine. 2018 Oct 22. Given the reported consumption of supplements, the potential harms (watch Dr. Kenny Lin commenting on unapproved contents), add in the fact that, in our own HEAL survey (summary of results available on request from the Library), over 50% of 1350 respondents claimed to have bought supplements or prescription medicine/natural remedies online; it soon becomes apparent that patients need guidance and information on this topic.

“People who consume at least one orange per day have a 60% lower risk of developing age-related macular de-generation (AMD) 15 years later compared with those who do not eat oranges, a study has found.” This is from Troy Brown (Medscape) based on outcomes of the Blue Mountains Eye Study: Gopinath B, Liew G, Kifley A, Flood VM, Joachim N, Lewis JR, Hodgson JM, Mitchell P. Dietary flavonoids and the prevalence and 15-y incidence of age-related macular degeneration. The American journal of clinical nutrition. 2018 Jul 6;108(2):381-7.

More on curcumin/turmeric: Mousavi SM, Milajerdi A, Varkaneh HK, Gorjipour MM, Esmaillzadeh A. The effects of curcumin supplementation on body weight, body mass index and waist circumference: a systematic review and dose-response meta-analysis of randomized controlled trials. Critical reviews in food science and nutrition. 2018 Oct 20:1-0.

Finally, a UK population-based cohort study reported by the Lancet Diabetes & Endocrinology which found “Important associations exist between BMI and almost every category of mortality outcome.“ They also found an “effect modification by age” which suggests that more targeted recommendations are required. See the full study at: Bhaskaran K, dos-Santos-Silva I, Leon DA, Douglas IJ, Smeeth L. Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3· 6 million adults in the UK. The Lancet Diabetes & Endo-crinology. 2018 Oct 30.

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Adverse events

“The .. ASHP guidelines on preventing medication errors in hospitals lays a framework in which pharmacists are pro-vided guidance and best practices in order to proactively, rather than reactively, prevent and mitigate harm due to medication errors in health-system settings.” American Society of Health-System Pharmacists. ASHP guidelines on preventing medication errors in hospitals. Am J Health-Syst Pharm. 2018; 75:1493–1517.

“For patients with hypothyroidism, being treated with too much medication could lead to an increased risk of atrial fibrillation, a new study of more than 174,000 patients indicates.” American Heart Association (AHA) 2018 Scientific Sessions: Abstract 450. Presented November 11, 2018. By Nancy Melville for Medscape.

Hohl CM, Badke K, Zhao A, Wickham ME, Woo SA, Sivilotti ML, Perry JJ. Prospective validation of clinical criteria to identify emergency department patients at high risk for adverse drug events. Academic Emergency Medicine. 2018 Mar 8.

Supplemental oxygen is not always indicated for acutely ill patients and may contribute to mortality, according to new recommendations published online October 24 in the BMJ. (Medscape). Siemieniuk RA, Chu DK, Kim LH, Güell-Rous MR, Alhazzani W, Soccal PM, Karanicolas PJ, Farhoumand PD, Siemieniuk JL, Satia I, Irusen EM. Oxygen thera-py for acutely ill medical patients: a clinical practice guideline. BMJ. 2018 Oct 24;363:k4169.

“Ignoring Patient Input Tied to Diagnostic Error” Giardina TD, Haskell H, Menon S, Hallisy J, Southwick FS, Sarkar U, Royse KE, Singh H. Learning From Patients’ Experiences Related To Diagnostic Errors Is Essential For Progress In Patient Safety. Health Affairs. 2018 Nov 1;37(11):1821-7. “Amid the almost 200 examples of diagnostic error ana-lyzed, problems in patient-physician interactions emerged as a major contributing factor.“ Preparing patients to return to a normal independent life before the end of their treatment can avoid stress-related symptoms and anxiety. Lee YH, Lai GM, Lee DC, Tsai Lai LJ, Chang YP. Promoting physical and psychological reha-bilitation activities and evaluating potential links among cancer-related fatigue, fear of recurrence, quality of life, and physiological indicators in cancer survivors. Integrative Cancer Therapies. 2018 Oct 25:

A similar pattern was noted in a large UK study on PTSD occurrence following a hospital intensive care stay: Hatch RA, Young JD, Barber V, Griffiths J, Harrison D, Watkinson P. Anxiety, depression and post traumatic stress disor-der after critical illness: A UK wide prospective cohort study. Critical Care. 2018 22:310 https://doi.org/10.1186/s13054-018-2223-6

"In some surveys up to 70 percent of patients [in the ICU] get these antipsychotics," says Dr. E. Wesley "Wes" Ely, an intensive care specialist at Vanderbilt University Medical Center. They're prescribed by "very good doctors at ex-tremely good medical centers," he says. "Millions of people worldwide are getting these drugs to treat their deliri-um." But the drugs can have serious side effects. And Ely says there is no solid research showing that they are effec-tive at treating delirium. From NPR.org This recent randomised controlled double-blind trial by Girard et al on behalf of the MIND-USA Investigators in the NEJM supports the view that antipsychotics do not help manage delir-ium in the ICU.

Rheumatology & Drugs: Woodell T, Avasare RS. Nephrotoxicity of Select Rheumatologic Drugs. Rheumatic diseases clinics of North America. 2018 Nov;44(4):605-17 and Chronic Opioid Use in Rheumatoid Arthritis: Prevalence and Pre-dictors

“Mortality after liver resection has not de-creased over the past decade.” Khaoudy I, Farg-es O, Boleslawski E, Vibert E, Soubrane O, Ad-ham M, Mabrut JY, Christophe L, Bachellier P, Scatton O, Le Treut YP. Half of Postoperative Deaths After Hepatectomy may be Preventa-ble: A Root-cause Analysis of a Prospective Multicenter Cohort Study. Annals of surgery. 2018 Nov 1;268(5):792-8.

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“Noise levels are negatively associated and restorative periods and female gender are positively associated with subjective sleep quality in ICU patients.” Simons KS, Verweij E, Lemmens PM, Jelfs S, Park M, Spronk PE, Sonneveld JP, Feijen HM, Van Der Steen MS, Kohlrausch AG, Van Den Boogaard M. Noise in the intensive care unit and its in-fluence on sleep quality: a multicenter observational study in Dutch intensive care units. Critical Care. 2018 Dec;22(1):250.

Finally: Malpas PJ, Bagg W, Yielder J, Merry AF. Medical students, sensitive examinations and patient consent: a qualitative review. The New Zealand medical journal. 2018 Sep 21;131(1482):29-37.

Older people

The 4th wave TILDA report from TCD is now available to download (“full report “and “key findings”) at: https://

tilda.tcd.ie/publications/reports/. A person’s social network is critical to quality of life and older people in rural

areas felt they had better social interaction. However, older people were more likely to have poor living conditions

including damp, poor heating etc.

This is the first study in Ireland to investigate the link between the communication styles used by health care provid-

ers and to what extent older patients felt encouraged to talk about physical, emotional, social, or sensitive health

problems. When providers took a more patient-centered approach, these patients felt more encouraged to disclose

physical, social, and emotional health problems.” Gibney S, Moore T. Older Patients' Views of Health Care Interac-

tions in Ireland. HLRP: Health Literacy Research and Practice. 2018 Oct 15;2(4):e180-91.

Trevisan C, Di Gregorio P, Debiasi E, Pedrotti M, La Guardia M, Manzato E, Sergi G, March A. Decision tree for ward

admissions of older patients at the emergency department after a fall. Geriatrics & gerontology international.

2018 Sep;18(9):1388-92. Worth looking again at “Mrs. Andrews’ story—her failed care pathway” from the NHS.

Reeve E, Wolff JL, Skehan M, Bayliss EA, Hilmer SN, Boyd CM. Assessment of Attitudes Toward Deprescribing in

Older Medicare Beneficiaries in the United States. JAMA Intern Med. Published online October 15, 2018.

doi:10.1001/jamainternmed.2018.4720 “A full 92% said they would be willing to stop taking one or more of their

regular medicines. And about 67% agreed that they would like to reduce the number of medicines they are taking”

O’Hare F, Flanagan Z, Nelson M, Curtis A, Heritier S, Spark S, Zoungas S. Comparing two methods for delivering

clinical trial informed consent information to older adults: singular versus stepped approach. Clinical Trials. 2018

Dec;15(6):610-5.

The latest Physical Activity Guidelines from the US Government Health Dept focus on “move more and sit less”.

This can be challenging for older people in particular, especially if they are in hospital.

Aunger JA, Doody P, Greig CA. Interventions targeting sedentary behavior in non-working older adults: a system-

atic review. Maturitas. 2018 Oct 1;116:89-99.

“An individualised, multicomponent exercise program proved safe and effective to reverse the functional decline

associated with acute hospitalisation in very elderly patients, according to a study published in JAMA Internal Medi-

cine.” (DG News, 19th November) This new study is: Martínez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F, de

Asteasu ML, Lucia A, Galbete A, García-Baztán A, Alonso-Renedo J, González-Glaría B, Gonzalo-Lázaro M, Iráizoz IA.

Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: a ran-

domized clinical trial. JAMA internal medicine. 2018 Nov 12.

How "Flipped" Discharge Can Help Your Largest Patient Population. By IHI Multimedia Team, Tuesday, October

23, 2018. “What if we could shorten hospital length of stay and, potentially, reduce the number of older adults who

experience post-hospital syndrome? “

Dumuid D, Lewis LK, Olds TS, Maher C, Bondarenko C, Norton L. Relationships between older adults’ use of time

and cardio-respiratory fitness, obesity and cardio-metabolic risk: a compositional isotemporal substitution analy-

sis. Maturitas. 2018 Apr 1;110:104-10.

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Infection control

“The study by Wittekamp and colleagues in this issue of JAMA evaluating strategies for decontamination of me-

chanically ventilated patients in the intensive care unit (ICU) fills an important gap in the evidence regarding these

practices.” (Editorial, JAMA 22nd October) Wittekamp BH, Plantinga NL, Cooper BS, Lopez-Contreras J, Coll P,

Mancebo J, Wise MP, Morgan MP, Depuydt P, Boelens J, Dugernier T. Decontamination strategies and blood-

stream infections with antibiotic-resistant microorganisms in ventilated patients: a randomized clinical trial.

Jama. 2018 Oct 22.

Rudd KE, Kissoon N, Limmathurotsakul D, Bory S, Mutahunga B, Seymour CW, Angus DC, West TE. The global bur-

den of sepsis: barriers and potential solutions. Critical Care. 2018 Dec;22(1):232.

Health issues in the news New uses for old drugs? Common antibiotic may help prevent Alzheimer's and boost lifespan.

From the Irish Times, 21st November: “The ‘Harley Davidson’ man dispensing more than just drugs in Galway.

Galway pharmacist Frank McAnena’s doorstep calls to patients saves lives and money. So why won’t health offi-

cials listen to him?” Costs to the health service in the UK due to mismanagement of medication by patients costs

an est. £500 million per year both in waste and in subsequent patient illness. “Eight years ago, when McAnena

came up with the idea of making home calls, he knew of one diabetic patient who had 14 unopened boxes of insu-

lin worth €700 in his fridge, and a psychiatric patient with €900 worth of medication in a drawer.“

“The upside of providing cancer patients with easy access to their physicians' notes far outweighs any downside,

according to a new exploratory study from a major US cancer center that has embraced the "OpenNotes" move-

ment in medicine.” The vast majority—over 90% - claimed a greater understanding of their illness and more faith

in their treatment.

“How fake medical news is SERIOUSLY damaging our health: From vaccines and heart pills to cancer drugs and di-

ets, as experts report a rise in misinformation online, a special investigation tackles the dangerous myths threaten-

ing our health” From the Daily Mail, 24th November.

A further reason for alarm is the trend towards crowdfunding: Vox F, Folkers KM, Turi A, Caplan AL. Medical

Crowdfunding for Scientifically Unsupported or Potentially Dangerous Treatments. JAMA. 2018;320(16):1705–

1706. doi:10.1001/jama.2018.10264

Will anyone believe this? “Claim that hot

baths can substitute for exercise lacks evi-

dence” This headline was based on a very

small study: Hoekstra SP, Bishop NC, Faulk-

ner SH, Bailey SJ, Leicht CA. The acute and

chronic effects of hot water immersion on

inflammation and metabolism in seden-

tary, overweight adults. Journal of Applied

Physiology. 2018 Oct 18.

Photo attribution “How genetics work”:

https://kottke.org/10/02/how-genetics-

works

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Medical Physics

Schaub SK, Hartvigson PE, Lock MI, Høyer M, Brunner TB, Cardenes HR, Dawson LA, Kim EY, Mayr NA, Lo SS,

Apisarnthanarax S. Stereotactic body radiation therapy for hepatocellular carcinoma: Current trends and contro-

versies. Technology in cancer research & treatment. 2018 Aug 1;17:1533033818790217.

Olsson CE, Jackson A, Deasy JO, Thor M. A Systematic Post-QUANTEC Review of Tolerance Doses for Late Toxicity

After Prostate Cancer Radiation Therapy. International Journal of Radiation Oncology* Biology* Physics. 2018 Dec

1;102(5):1514-32. “Summary: From a total of 33 studies (N = 10,149) this post-QUANTEC systematic review has

identified novel dose/volume tolerances for 17 distinct gastrointestinal (GI), genitourinary, and sexual dysfunction

symptoms following radiation therapy(RT) for prostate cancer. Synthesized dose/volume tolerances were assessed

across studies for Defecation urgency, Diarrhea, Fecal incontinence, Proctitis,and Rectal bleeding post external-

beam RT (EBRT) and also across these symptoms leading to a curve for overall GI toxicity (R2 = 0.98). Restricting

treatments for EBRT using the lower boundaries of this curve are likely to limit overall GI toxicity. Further investiga-

tive initiatives are encouraged to untangle similar effects for symptoms of the remaining domains.”

The following papers have been highlighted by Medical Physicists as of interest:

McDonald AM, Colvin T, Boggs DH, Spencer SA, Popple RA, Clayton R, Minnich D, Dobelbower MC. Longitudinal

assessment of anchored transponder migration following lung stereotactic body radiation therapy. Journal of

applied clinical medical physics. 2018 Nov 1.

Mizuno H, Fukumura A, Kanematsu N, Yonai S, Shirai T, Yusa K, Yanou T, Suga M, Mizota M, Minohara S, Kanai T.

External dosimetry audit for quality assurance of carbon‐ion radiation therapy clinical trials. Journal of applied

clinical medical physics. 2018 Nov 1.

Han S, Woo S, Suh CH, Kim YJ, Oh JS, Lee JJ. A systematic review of the prognostic value of texture analysis in 18 F

-FDG PET in lung cancer. Annals of nuclear medicine. 2018 Nov 1;32(9):602-10.

Ma C, Chen M, Long T, Parsons D, Gu X, Jiang S, Hou Q, Lu W. Flattening filter free in intensity modulated radio-

therapy (IMRT)–theoretical modeling with delivery efficiency analysis. Medical physics. 2018 Oct 29.

Niu C, Li M, Yan H, Guo C, Dai J. Selecting noncoplanar beam directions in a patient coordinate system for radio-

therapy planning. Medical Dosimetry. 2018 Nov 23.

Janssen TM, Kusters M, Wang Y, Wortel G, Monshouwer R, Damen E, Petit SF. Independent knowledge-based

treatment planning QA to audit Pinnacle autoplanning. Radiotherapy and Oncology. 2018 Nov 15. “Suboptimal

plans did occur. Once identified, these plans could indeed be improved.”

Su TS, Luo R, Liang P, Cheng T, Zhou Y, Huang Y. A prospective cohort study of hepatic toxicity after stereotactic

body radiation therapy for hepatocellular carcinoma. Radiotherapy and Oncology. Volume 129, Issue 1, October

2018, Pages 136-142

Reuzé S, Schernberg A, Orlhac F, Sun R, Chargari C, Dercle L, Deutsch E, Buvat I, Robert C. Radiomics in Nuclear

Medicine Applied to Radiation Therapy: Methods, Pitfalls, and Challenges. International Journal of Radiation On-

cology* Biology* Physics. 2018 Nov 15;102(4):1117-42.

Versteijne E, Suker M, Punt CJ, Groothuis KB, Beukema JC, Bruynzeel A, Buijsen J, Hendriksen EM, Intven MP, Neelis

K, Nuyttens J. Preoperative Chemoradiotherapy Potentially Improves Outcome for (Borderline) Resectable Pan-

creatic Cancer: Preliminary Results of the Dutch Randomized Phase III PREOPANC Trial. International Journal of

Radiation Oncology• Biology• Physics. 2018 Dec 1;102(5):1606-7.

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Stroke

Updated standards of practice: Pierot L, Jayaraman MV, Szikora I, Hirsch JA, Baxter B, Miyachi S, Mahadevan J,

Chong W, Mitchell PJ, Coulthard A, Rowley HA. Standards of practice in acute ischemic stroke intervention: inter-

national recommendations. Journal of neurointerventional surgery. 2018 Nov 1;10(11):1121-6.

Do very elderly stroke patients (over 80s) benefit from a stay in the Stroke Unit? Cocho D, Yarleque S, Boltes A,

Espinosa J, Ciurans J, Pont-Sunyer C, Pons J. Clinical Outcome of Ischemic Stroke in Old Patients Versus Oldest-

Old. Journal of Stroke and Cerebrovascular Diseases. 2018 Sep 29. “Our results support the hypothesis that oldest-

old patients have good recovery potential, and should not be excluded from the stroke unit.”

A shorter hospital stay is beneficial to both patient and hospitals. Manwani B, Rath S, Lee NS, Staff I, Stretz C,

Modak J, Finelli PF. Early Magnetic Resonance Imaging Decreases Hospital Length of Stay in Patients with Ischem-

ic Stroke. Journal of Stroke and Cerebrovascular Diseases. 2018 Nov 3.

Stroke Prevention in Patients With Atrial Fibrillation: A Systematic Review Update Of interest, comparison of

oral anti-coagulants and best evidence on tools to predict stroke and bleeding risks.

Two recent studies on timing of anti-coagulation following stroke: Seiffge DJ, Werring DJ, Paciaroni M, Dawson J,

Warach S, Milling TJ, Engelter ST, Fischer U, Norrving B. Timing of anticoagulation after recent ischaemic stroke in

patients with atrial fibrillation. The Lancet Neurology. 2018 Nov 8, and Wilson D, Ambler G, Banerjee G,

Shakeshaft C, Cohen H, Yousry TA, Salman RA, Lip GY, Houlden H, Brown MM, Muir KW. Early versus late anticoag-

ulation for ischaemic stroke associated with atrial fibrillation: multicentre cohort study. J Neurol Neurosurg Psy-

chiatry. 2018 Nov 17:jnnp-2018.

An interesting paper and a strong contender in the “most co-authors/collaborators” stakes: Campbell BC, Majoie

CB, Albers GW, Menon BK, Yassi N, Sharma G, van Zwam WH, van Oostenbrugge RJ, Demchuk AM, Guillemin F,

White P. ……. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke

treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level

data. The Lancet Neurology. 2018 Nov 6.

“In (adults who present to the ED with acute ischaemic stroke), what is the (rate and clinical characteristics) of

(missed diagnosis)?” Shake A, Oostema A, Jones J. BET 2: Missed diagnosis of ischaemic stroke in the emergency

department. Emerg Med J. 2018 Dec 1;35(12):768-9. Part of the “Best Evidence Topics” collection.

Early diagnosis as the cornerstone of current stroke care: Zerna C, Thomalla G, Campbell BC, Rha JH, Hill MD. Cur-

rent practice and future directions in the diagnosis and acute treatment of ischaemic stroke. The Lancet. 2018

Oct 6;392(10154):1247-56.

Lyden P, Pryor K, Coffey C, Cudkowicz M, Conwit R, Jadhav A, Sawyer R Jr. Final Results of the RHAPSODY trial: A

multi‐center, Phase 2 trial using a continual reassessment method to determine the safety and tolerability of

3K3A‐APC, a Recombinant Variant of Human Activated Protein C, in combination with tissue plasminogen activa-

tor, mechanical thrombectomy or both in moderate to severe acute ischemic stroke Annals of Neurology 2018.

Nov2018 https://doi.org/10.1002/ana.25383 “RHAPSODY is the first trial of a neuroprotectant for acute ischemic

stroke in a trial design allowing thrombectomy, thrombolysis, or both. The MTD was 540μg/kg for the PAR1 active

cytoprotectant 3K3A‐APC. A trend toward lower hemorrhage rate in an exploratory analysis requires confirmation.”

“Swallowing therapy did not result in less death or disability among stroke survivors, nor did it lead to a safer swal-

low after treatment. However, some individual swallowing therapies seemed to reduce hospital length of stay, less-

en the chance of getting a chest infection or pneumonia, or improve swallowing ability and recovery from swallow-

ing problems.” (article heterogeneity, low to medium level evidence) Bath PM, Lee HS, Everton LF. Swallowing

therapy for dysphagia in acute and subacute stroke. Cochrane Database of Systematic Reviews 2018, Issue 10. Art.

No.: CD000323. DOI: 10.1002/14651858.CD000323.pub3.

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Research oundup

Brainard J. What a massive database of retracted papers reveals about science publishing’s ‘death penalty’. Sci-ence. 25th October 2018. Fraud accounts for 60% of retractions, from “photo-shopping” images to fabricating da-ta. Check all your referenced papers in the database before you publish, just to be sure. Some short videos from “The Scholarly Kitchen” by David Glass “These short videos offer quick lessons in positive and negative controls, as well as how to validate your experimental system.”

“Inappropriateness” in Research: Localio AR, Stack CB, Meibohm AR, Ross EA, Guallar E, Wong JB, Cornell JE, Gris-

wold ME, Goodman SN. Inappropriate Statistical Analysis and Reporting in Medical Research: Perverse Incentives

and Institutional Solutions. Annals of internal medicine. 2018 Oct 16;169(8):577-8. This is a follow-up to: Wang

MQ, Yan AF, Katz RV. Researcher Requests for Inappropriate Analysis and Reporting: A US Survey of Consulting

Biostatisticians. Annals of internal medicine. 2018 Oct 16;169(8):554-8. As highlighted by Will Boggs MD

October 11, 2018 for Reuters Health Information: “Researchers Often Ask Statisticians for Inappropriate Analyses”

The annual Global Burden of Disease (GBD) study is a giant peer-reviewed assessment of global health trends. It is reported in seven articles in the Lancet . From the Editorial “GBD 2017 should be an electric shock, galvanising na-tional governments and international agencies not only to redouble their efforts to avoid the imminent loss of hard-won gains but also to adopt a fresh approach to growing threats.” The other 7 papers are available here.

The Year’s Most Important Study Adds to Uncertainty in Science (John M Mandrola, for Medscape)

Bloom D, Beetsch J, Harker M, Hesterlee S, Moreira P, Patrick-Lake B, Selig W, Sherman J, Smith SK, Valentine JE, Roberts JN. The rules of engagement: CTTI recommendations for successful collaborations between sponsors and patient groups around clinical trials. Therapeutic innovation & regulatory science. 2018 Mar;52(2):206-13.

Ma Y, Yang W, Song M, Smith-Warner SA, Yang J, Li Y, Ma W, Hu Y, Ogino S, Hu FB, Wen D. Type 2 diabetes and risk of colorectal cancer in two large US prospective cohorts. British journal of cancer. 2018 Nov 7:1.

“ACP Releases Guiding Principles, Toolkit for Patient Partnership.” Marcia Frellick for Medscape. Novem-ber 27, 2018 : Principles for Patient and Family Partnership in Care: An American College of Physicians Position Paper. That’s all—time to say goodbye…..