Christmas 2008 Research from the BMJ

headbanger     The British Medical Journal continues in 2008 its annual tradition of publishing important research related to Christmas.   See also:  BMJ Christmas Issues and read articles going back to 1995.

Below are this year’s offerings, available free online (because they are research, after all).     2008 Seasonal Fayre2008 Christmas Podcasts

Head and neck injury risks in heavy metal: head bangers stuck between rock and a hard bass
Head banging to heavy metal is a popular dance form, but it increases the risk of head and neck injury. The effects may be lessened with reduced head and neck motion, head banging to lower tempo songs or to every second beat, and using protective equipment such as neck braces, say Australian researchers Declan Patton and Andrew McIntosh. The study helps to explain why metal concert goers often seem dazed, confused, and incoherent.

Rugby (the religion of Wales) and its influence on the Catholic church: should Pope Benedict XVI be worried?
Researcher Gareth Payne and his two colleagues from Cardiff investigate whether there is any substance to the intriguing urban legend that has arisen in Wales in recent times: “Every time Wales win the rugby grand slam, a Pope dies, except for 1978 when Wales were really good, and two Popes died.” Wales won the Grand Slam in 2008 – so should Pope Benedict XVI be worried?

Appointments timed in proximity to annual milestones and compliance with screening: randomised controlled trial
In this randomised controlled trial, attendance rates for colorectal cancer screening were higher in December and around attendees’ birthdays. Compliance with screening programmes may therefore be improved by timing invitations in proximity to annual milestones, conclude researchers Geir Hoff and Michael Bretthauer.

Frankincense: systematic review
Edzard Ernst, the UK’s only professor of complementary medicine, systematically reviews the evidence on frankincense – a tree resin that was one of the first ever Christmas presents and is now a popular complementary remedy. He concludes that, although frankincense does not bestow supernatural instant youth or eternal life as many claims would have it, it has encouraging anti-inflammatory properties. (Picture credit: Jerry Mason/Science Photo Library)

Mortality on Mount Everest, 1921-2006: descriptive study
Thousands of mountaineers have attempted to scale Mount Everest, the highest point on earth, at 8850 metres above sea level. The death rate above base camp is 1.3%. Paul Firth and colleagues examined the circumstances of such deaths, to establish patterns of mortality among climbers over 86 years. In an accompanying article, Jeremy S Windsor wonders how to explain the benign presence he met while climbing Mount Everest.

Right-left discrimination among medical students: questionnaire and psychometric study
Male students were better than female students at distinguishing right from left, and aspiring surgeons were better than aspiring GPs or medical doctors, according to this questionnaire and psychometric study. Are left handed people the last great neglected minority, asks an accompanying editorial.

Festive Medical Myths


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Evidence-informed Health Policy: a series from Implementation Science

Here is a new series from Implementation Science, a BioMed Central journal (Open Access):

John N Lavis, Andrew D Oxman, Ray Moynihan, Elizabeth J Paulsen. Evidence-informed health policy 1 – Synthesis of findings from a multi-method study of organizations that support the use of research evidence. Implementation Science 2008, 3:53 (17 December 2008)
Conclusions: This synthesis of findings from a multi-method study, along with the more detailed findings from each of the three phases of the study (which are reported in the three following articles in the series), provide a strong basis on which researchers, policymakers, international organizations (and networks) like WHO can respond to the growing chorus of voices calling for efforts to support the use of research evidence in developing health policy.

John N Lavis, Elizabeth J Paulsen, Andrew D Oxman, Ray Moynihan. Evidence-informed health policy 2 – Survey of organizations that support the use of research evidence. Implementation Science 2008, 3:54 (17 December 2008)
Conclusions: The findings from our survey, the most broadly based of its kind, both extend or clarify the applicability of the messages arising from previous surveys and related documentary analyses, such as how the ‘principles of evidence-based medicine dominate current guideline programs’ and the importance of collaborating with other organizations. The survey also provides a description of the history, structure, processes, outputs, and perceived strengths and weaknesses of existing organizations from which those establishing or leading similar organizations can draw.

John N Lavis, Andrew D Oxman, Ray Moynihan, Elizabeth J Paulsen. Evidence-informed health policy 3 – Interviews with the directors of organizations that support the use of research evidence. Implementation Science 2008, 3:55 (17 December 2008)
Conclusions: The findings from our interview study, the most broadly based of its kind, extend to both CPG-producing organizations and GSUs the applicability of the messages arising from previous interview studies of HTA agencies, such as to collaborate with other organizations and to be attentive to implementation considerations. Our interview study also provides a rich description of organizations supporting the use of research evidence, which can be drawn upon by those establishing or leading similar organizations in LMICs.

John N Lavis, Ray Moynihan, Andrew D Oxman, Elizabeth J Paulsen. Evidence-informed health policy 4 – Case descriptions of organizations that support the use of research evidence. Implementation Science 2008, 3:56 (17 December 2008)
Conclusions: The findings from our case descriptions, the first of their kind, intersect in interesting ways with the messages arising from two systematic reviews of the factors that increase the prospects for research use in policymaking. Strong relationships between researchers and policymakers bodes well given such interactions appear to increase the prospects for research use. The time-consuming nature of an evidence-based approach, on the other hand, suggests the need for more efficient production processes that are ‘quick and clean enough.’ Our case descriptions and accompanying video documentaries provide a rich description of organizations supporting the use of research evidence, which can be drawn upon by those establishing or leading similar organizations, particularly in low- and middle-income countries.

See also:
Jane L Hutton, Martin P Eccles, Jeremy M Grimshaw. Ethical issues in implementation research: a discussion of the problems in achieving informed consent. Implementation Science 2008, 3:52 (17 December 2008).


A controlled trial of the effectiveness of Internet continuing medical education

Just published online in BMC Medicine [Open Access]:

Casebeer L, Engler S, Bennett N, Irvine M, Sulkes D, Deslauriers M, Zhang S. A controlled trial of the effectiveness of Internet continuing medical education. BMC Med 2008 Dec 4;6(1):37. [Epub ahead of print] PDF Version

BACKGROUND: The internet has had a strong impact on how physicians access information and on the development of continuing medical education activities.  Evaluation of the effectiveness of these activities has lagged behind their development.
METHODS: To determine the effectiveness of a group of 48 internet CME activities, case vignette surveys were administered to U.S. physicians immediately following participation, and to a representative control group of non-participant physicians. Responses to case vignettes were analyzed based on evidence presented in the content of CME activities. An effect size for each activity was calculated using Cohen’s d to determine the amount of difference between the two groups in the likelihood of making evidence-based clinical decisions, expressed as the percentage of non-overlap, between the two groups. Two formats were compared.
RESULTS: In a sample of 5,621 U.S. physicians, of the more than 100,000 physicians who participated in 48 internet CME activities, the average effect size was .75, an increased likelihood of 45% that participants were making choices based on clinical evidence. This likelihood was higher in interactive case-based activities 51% (effect size.89) than for text-based clinical updates, 40% (effect size .63). Effectiveness was also higher among primary care physicians than specialists. CME physician participation was associated with making diagnostic and therapeutic choices based on clinical evidence.
CONCLUSIONS: Physicians who participated in selected internet CME activities were more likely to make evidence-based clinical choices than non-participants. Internet CME activities show promise in offering a searchable, credible, available on-demand, high-impact source of CME for physicians.
PubMed Record       Related Articles

Perspectives on Continuing Education in the Health Professions: Improving Health Care through Lifelong Learning [Macy Foundation]

A new article just published in the December 2008 issue of Chest provides yet another perspective on the Macy Foundation report:

Leach DC, Fletcher SW. Perspectives on Continuing Education in the Health Professions: Improving Health Care through Lifelong Learning [Macy Foundation]. Chest 2008 Dec;134(6):1299-303. [subscription required]

In November 2007, the Josiah Macy, Jr. Foundation convened a conference to address a number of complex issues concerning continuing education (CE) in the health professions. Participants concluded that CE, as currently practiced, does not focus adequately on improving clinician performance and patient care, is too dependent on lectures and too removed from the daily practice of clinicians, does not encourage or emphasize newer technologies and point-of-care learning, is poorly integrated across disciplines, and is inappropriately financed. Recommendations concerning educational methods, metrics, responsibilities, research in CE, financing, and oversight are reviewed. The relationship between the goals of improving clinician performance and patient care, while maintaining high standards of accountability and transparency, are reviewed.  Journal Link

Editorial: How many unjustifiable lectures are worth $2.4 billion? (Dunn WF)

See more reactions to this report here:

Continuing Education in the Health Professions: Improving Healthcare Through Lifelong Learning (Macy Foundation)


2008 CME Congress: presentations, abstracts from JCEHP 2008;28(S1)

   The 2008 CME Congress was held in Vancouver from May 29 – 31. The conference organizers have kindly made available the PowerPoint presentations of some of the plenary speakers. (The documents are in PDF format. And be patient, they download rather slowly.) The slides are not as compelling as are the words of excellent speakers such as Glenn Regehr, unfortunately.

Now you can read the words of these speakers  in a new supplement of the Journal of Continuing Education in the Health Professions that was just published; JCEHP 2008; 28(S1) . This supplements contains articles resulting from the Congress. View all the PubMed records for this supplement.

Here are the conference brochure and the list of conference abstracts.