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Pitfalls of retrospective database studies

30 Mar

As you know a part of my work consists to participate in studies based on the extraction from retrospective databases and the analysis of the informations thus retrieved. The eligibility of the beneficiaries to the provision that represents the study’s outcome is always a major concern. There is two explanations for a beneficiary not having access to a care according to the data retrieved from the reimbursement base: either a real lack of access or a non eligibility of the care for a record in the reimbursement data base (for example if the insured is covered by another insurance or has lost his coverage and has exited from the health plan)*. I have always to keep in mind that I work on secondary data which are only a reflection of the primary data the reality of which I try to apprehend.
The dilemma is pretty well addressed in this article:

http://onlinelibrary.wiley.com/doi/10.1046/j.1524-4733.2003.00242.x/full

*as always there is a third possibility: the data concerning the care has been erased from or not yet recorded in the base. The timeline of the refreshment of the base (ie the loading and the purifying of the data) must be precisely described in the methodology of the study.

Article cited:
1)- Motheral, B., Brooks, J., Clark, M. A., Crown, W. H., Davey, P., Hutchins, D., Martin, B. C. and Stang, P. (2003),

A Checklist for Retrospective Database Studies—Report of the ISPOR Task Force on Retrospective Databases.

Value in Health, 6: 90–97. doi: 10.1046/j.1524-4733.2003.00242.x

Two other articles address the pitfalls of inferring from secondary data extracted from a retrospective data base:

2)- Berger M, Mamdani M, Atkins D, Johnson M.

Good Research Practices for Comparative Effectiveness Research: Defining, Reporting and Interpreting Nonrandomized Studies of Treatment Effects Using Secondary Data Sources: The ISPOR Good Research Practices for Retrospective Database Analysis Task Force Report—Part I.

Value in Health 2009 ; 12(8) :1044-52
3)-

The use of claims databases for outcomes research : Rationale, challenges, and strategies. Annual international meeting of the Association for Pharmacoeconomics and Outcome Research.

Philadelphia, Pennsylvania (USA), 1996/05/12. CLINICAL THERAPEUTICS, vol. 19, n° 2, 1997, pages 346-366, 74 réf., ISSN 0149-2918, USA. MOTHERAL (B.R.) *, FAIRMAN (K.A.). Outcomes Research. Express Scripts. Inc. Maryland Heights. USA

Full text of the article here:

http://ehealthecon.hsinetwork.com/Motheral_ClinTher_1997.pdf

 

The French national medical Board incites physicians to produce content on the internet

16 Mar

The French national Medical Board declares in its last Newsletters that Physicians, as a reliable source of information, should be encouraged to produce contents on the Internet. The ethic is the same as in a patient-physician relationship but the advantage is that the patient can takes his time to apprehend and deepen the information given to him by the physician by consulting his website. The National Board incites physicians to be present on the Web as professionals. But Doctors can also have their blogs like every citizen, provided that they do not discredit the profession and its digital reputation. And provided also that they do not use their blog for advertising and for falsely flattering their skill! The Board recommends also the Doctors to stay sober in their presentation and not to request fees in their websites, but I think that that went without saying.

http://www.conseil-national.medecin.fr/sites/default/files/livre_blancdeontoweb2012.pdf

http://www.conseil-national.medecin.fr/sites/default/files/charte_internet_cnom2014.pdf

http://www.conseil-national.medecin.fr/newsletter/2014/3

How to write a good (bad) title ( abstract)

20 Feb

Here below is a link toward an interesting post on the qualities that a title should have (in fact half of the post gives the recipe of an empty uninformative, useless title, in an ironic way, with the intend to be more pedagogic).

http://blogs.lse.ac.uk/impactofsocialsciences/2014/02/05/academics-choose-useless-titles/

And the same author in another post, with the same sharp irony shows us how to write a bad abstract :

View story at Medium.com

By the way the title of my post is not informative enough according to the standards here above. At least a cue of what the response to the question is should have been inserted.

Flawed evidence based medicine

26 Jan

James Coynes is a professor of psychology who has dedicated an important part of his research field in denouncing the flawed evidence based medicine applied to the psychology practice. His writings in PLOs blog are an example of the critical appraisal we all should exercercise when we read such advertisements as “evidence supported”.
Here bellows is a link toward his posts in PLOs blogs:

http://blogs.plos.org/mindthebrain/author/jcyone/

The unexpected reader

18 Jan

When writing a medical article the author has in mind that it will be read by his (her) colleagues or supervisors or more widely by other health professionals. But more and more the patients, with internet, have access to the scientific medical writing. Thus authors have to be careful about how they describes the subjects of their study. A respectful description of the study participants and of the people to which the authors aim to apply the results of their study is the less that is required for an ethical writing.

Professor Patt Thomson warns the authors about this sensitive topic in his blog here:

http://patthomson.wordpress.com/2014/01/13/anticipate-the-unexpected-reader/

And Tessa Richards, a BMJ editor, plans to include representatives of patients in the team of BMJ reviewers here:

http://blogs.bmj.com/bmj/2014/01/17/tessa-richards-the-rise-and-reach-of-expert-patients/#more-30858

Have a good Week End.

conclusion mise-en-place. christmas present six

2 Jan

Ha-Vinh:

For an author the conclusion is a tricky section to write, be it in a thesis or an article. The two pitfalls that one has to avoid are to repeat what has already been said in the preceding sections and not to respond to the questions “so what ?” and “now what?”. The conclusion section is the place where one must describe what our findings imply for policy and practices at an operational level. At this stage one must not forget either to situate our article in the extant literatures. In conclusion the pillars of the conclusion section should be:
practice and policy implications,
place in the literature ,
weakness and further research to be done.
The two consecutive posts in the blog “patter” on the subject are worth to be read.

Originally posted on patter:

Any of you who watch cooking programmes will know the cheffy talk about mise-en-place. It’s a term used to describe all the various kinds of preparation that need to be done in order to whip up something that can be described as “freshly cooked to order”. In reality many restaurant meals have components that are precooked and cut into the right portion sizes – they need only to be added, heated, stirred and assembled, with a minimum of actual cooking time between order and service. That you don’t have to wait too long for your food is down to lots of mise-en-place.

The notion of mise-en-place is also helpful in thesis writing. There is a lot of preparation than can be done before a draft text is begun. And just as in cooking, the more preparation you do, the quicker and less painful the actual writing time involved.

It…

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Ten years after

19 Dec

Even ten years after, sound data are worth to be published. Below is an example. Actually a great Christmas story.

http://blogs.bmj.com/bmj/2013/12/12/simon-wessely-the-lost-trial-a-christmas-story/

Author

26 Oct

To be considered as an author one has to fulfill 3 criteria:

1) to give a critical appraisal of the intellectual content of the paper

2) to endorse the responsibility of the paper

3) to contribute at least partly to the analysis or the gathering of the data or to the research design or the method of the study

Below are enlisted the criteria in French:

recommandations_signatures_article 2011

Role_auteur

Medical writing

28 Jan

Medical writer is a job that can sometimes be very poorly paid. The blog below displays many cases in support of this statement.

http://ridiculads.blogspot.ca/2012/07/ridiculad-writer-needed-for-10-articles.html?m=1

23 Dec

Ha-Vinh:

Designing a questionnaire is a step in health services research whose importance is too often under estimated and that is implemented more rapidly than it would deserve. The importance of how the questions are featured by the searcher is highlighted in the blog written by Keith Meadows, a Health Psychologist.

 

Originally posted on DHP Research thepatientoutcomesblog:

Designing a patient survey questionnaire whether it’s to measure patient satisfaction or patient experience is more than simply writing some questions expecting patients to understand them and give reliable and valid answers. Designing a patient satisfaction or experience questionnaire involves  initiating  a relationship with respondents  that stimulates their interest and encourages them to provide the best answers possible.

  • UNDERSTAND THE BIG PICTURE  It is essential that the overall objectives of the patient survey are defined at the outset  i.e. the research question. This will include  establishing the purpose of the survey e.g. measuring patient satisfaction, experience and outcomes, clarifying the target population the questionnaire will be administered to e.g. patient group, disease type, how the information will be collected e.g. paper/pencil, interview, web and how that information will be used e.g. improve patient experience.
  • START AT THE END The aims of the patient survey questionnaire will  provide the…

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