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By: Priscilla Yu,
on 9/6/2016
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In 2011, the US Supreme Court unanimously ruled in Matrixx Initiatives Inc. v. Siracusano that investors could sue a drug company for failing to report adverse drug effects—even though they were not statistically significant. Describing the case in the Wall Street Journal, Carl Bialik wrote, “A group of mathematicians has been trying for years to have a core statistical concept debunked.
The post Misinterpretation and misuse of P values appeared first on OUPblog.
By: Chloe Miller,
on 4/24/2016
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Over the past few years, the momentum of research and efforts on malaria has tremendously decreased malaria transmission and the number of deaths from this disease. However, in many poor tropical and subtropical countries of the world, malaria continues to be one of the leading causes of illness and death.
The post World Malaria Day 2016 appeared first on OUPblog.
By: JulieF,
on 4/15/2016
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Most randomized controlled trials (RCTs) can appear deceptively simple. Study subjects are randomized to experimental therapy or placebo—simple as that. However, this apparent simplicity can mask how important subtle aspects of study design—from patient selection to selected outcomes to trial execution—can sometimes dramatically affect conclusions.
The post Randomized controlled trials: Read the “fine print”! appeared first on OUPblog.
By: Helena Palmer,
on 3/21/2016
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The scientific method has long reigned as the trusted way to test hypotheses so as to produce new knowledge. Shaped by the likes of Francis Bacon, Galileo Galilei, and Ronald A. Fisher, the idea of replicable controlled experiments with at least two treatments has dominated scientific research as a way of producing accepted truths about the world around us. However, there is growing interest in design thinking, a research method which encourages practitioners to reformulate goals, question requirements, empathize with users, consider divergent solutions.
The post Can design thinking challenge the scientific method? appeared first on OUPblog.
By: Priscilla Yu,
on 2/2/2016
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Cancer treatment’s biggest failings occur in the metastatic setting, when metastatic cells escaping from the primary tumor colonize and attack critical organs. Much about how cells colonize distant tissues as opposed to remaining in the primary tumor or in circulation without settling in one place remains unknown. But a new bioengineered device could offer insights.
The post Metastatic cells colonize implantable scaffold in mice appeared first on OUPblog.
By: Carolyn Napolitano,
on 11/10/2015
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Following the Episcopal Church's 1976 decision to ordain women, Catholic leaders in America and Rome were approached by Episcopal clergy who opposed the decision and sought conversion as a result.
The post How conservative are married priests? appeared first on OUPblog.
By: Rebekah Daniels,
on 10/25/2015
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For years, my cholesterol level remained high, regardless of what I ate. I gave up all butter, cheese, red meat, and fried food. But every time I visited my doctor, he still shook his head sadly, as he looked at my lab results. Then, anti-cholesterol medications became available, and I started one.
The post Are drug companies experimenting on us too much? appeared first on OUPblog.
By: Amelia Carruthers,
on 10/19/2015
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When I started my career as a medical statistician in September 1972, medical research was very different from now. In that month, the Lancet and the British Medical Journal published 61 research reports which used individual participant data, excluding case reports and animal studies. The median sample size was 36 people. In July 2010, I had another look.
The post Better medical research for longer, healthier lives appeared first on OUPblog.
By: Julia Callaway,
on 6/20/2014
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By Richard D. Griffiths
Over the last half century, critical care has made great advances towards preventing the premature deaths of many severely ill patients. The urgency, immediacy, and involved intimacy of the critical care team striving to correct acutely disturbed organ dysfunction meant that, for many years, physiological correction and ultimate patient survival alone was considered the unique measure of success. However, over the last quarter century, our survivor patients and their relatives have told us much more about what it means to have a critical illness. We work in an area of medicine where survival is a battle determined by tissue resilience, frailty, and the ability to recover, but this comes at a price. As our focus has moved beyond the immediate, we have learned about the ‘legacy of critical care’ and how having a critical illness impacts life after ICU through its consequential effects on physical and psychological function and the social landscape.
This fundamental cultural change in how we perceive critical care as a specialty and where our measure of a successful outcome includes the quality of life restored has come about through the sound medical approach of listening to our patients and families, defining the problems, and carefully testing through research hypotheses as to causation and possible therapeutic benefit. It not only has changed how patients are considered and cared for after intensive care, but, through the detailed knowledge of how patients are affected by the consequences of the critical illness, it has fostered fundamental research to improve the care and therapies we use during their stay. As with all sound clinical advances, it has helped shed light and ill-informed dogma and helped re-focus the research agenda to ensure that the long-term legacies of a critical illness are equally considered. Immobility, oft considered of little consequence, is now recognized to be a significant pathological participant and contributor to disability. Amnesia, in short-term anaesthesia considered a benefit, now has defined pathological significance, along with previously poorly recognized cognitive deficits and delusional experiences, all consequences of acute brain dysfunction. The family, often in the past merely a repository of information, is now recognized to play a much greater role in how patients recover and are themselves traumatized by the experience, so meriting help and support if they are to assist in rehabilitation.
Perhaps the purest achievement has been the bringing together of contributions not just from patients and their families, but form the wide breadth of professionals deeply involved in the care of the critically ill from across many continents. Not only have the doors of the intensive care unit been thrown open, but so too have the minds of those working for the best care of our patients. The reward of a visit some months later of a patient brought back from the brink of death is cherished by a critical care team. Added to this, the knowledge that our patients are now understanding what happened to them and they and their families are being given the help to recover their lives following the legacy of critical care is something of which our specialty should be justly proud. We cannot ignore the lessons we have learned.
Richard D. Griffiths is Emeritus Professor of Medicine (Intensive Care) and Honorary Consultant at the Institute of Aging and Chronic Disease, University of Liverpool. He is a contributor to Textbook of Post-ICU Medicine: The Legacy of Critical Care.
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Image: Doctor consults with patient by National Cancer Institute. Public domain via Wikimedia Commons.
The post The legacy of critical care appeared first on OUPblog.
By: Nicola,
on 3/28/2012
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by Caroline Relton
Epidemiology, a well established cornerstone of medical research, is a group level discipline that aims to decipher the distribution and causes of diseases in populations. Epigenetics, perceived by many as the most fashionable research arena in which to be involved, is a mechanism of gene regulation. What brings these perhaps unlikely partners together?
Epigenetic processes are key features in gene regulation. Epigenetic patterns are laid down in early development and are moulded through in utero and early postnatal life and continue to show some degree of plasticity across the lifecourse. Many environmental, behavioural, nutritional and lifestyle factors are believed to influence epigenetic patterns and in some case the evidence base is substantial. What is less clear is the role of this environmentally modifiable ‘epigenome’ on disease risk in populations. This is where epidemiology can help. A good starting point for an epidemiological engagement with epigenetics is clearly identified by Nessa Carey, in her recent popular science book The Epigenetics Revolution:
“The majority of non-infectious diseases that afflict most people take a long time to develop, and then remain as a problem for many years if there is no cure available. The stimuli from the environment could theoretically be acting on the genes all the time in the cells that are acting abnormally, leading to disease. But this seems unlikely, especially because most of the chronic diseases probably involve the interaction of multiple stimuli with multiple genes. It’s hard to imagine that all these stimuli would be present for decades at a time. The alternative is that there is a mechanism that keeps the disease-associated cells in an abnormal state, i.e. expressing genes inappropriately. In the absence of any substantial evidence for a role for somatic mutation, epigenetics seems like a strong candidate for this mechanism”.
Recent literature points to a role for epigenetic variation in a range of diseases including neurological disease, cardiovascular disease, osteoarthritis and obesity but in most instances these are correlations without robust evidence of causality. Indeed, epigenetics is often proffered as the answer to many unresolved causes of disease. The enthusiasm for establishing whether epigenetic mechanisms link the environment with disease development must be tempered by the knowledge that the epigenome is dynamic and has as much potential to respond to disease as respond to the environment. Therefore it is very difficult to disentangle cause from consequence when studying epigenetic variation and disease.
This is just one of the many challenges that face researchers interested in understanding the role of epigenetics in common complex disease. Other challenges include the differences in interpretation of the term ‘epigenetics’ itself – in a field that attracts cell, developmental and evolutionary biologists, epidemiologists and bioinformaticians, amongst others, it is unsurprising that epigenetics means different things to different people and discussions of its relevance to disease can sometimes suffer misinterpretation.
The methods at our disposal to accurately measure epigenetic variation and in turn assess the impact this has upon disease risk are still being developed and there is much to do in this arena with respect to when, where and how to look at the epigenome. The complexity and interplay of multiple factors in determining d