Jumat, 28 Mei 2010

Going negative

Those of you that have had to sit through one of my "Business Case" talks know that one of my favorite books to recommend is William Ury's, "The Power of the Positive No." I probably should post more on the subject at some later point, but the take home message of the book is that you should say "no" to unreasonable demands by saying "yes" to yourself and your infection control team.

While flying back from San Diego I had a chance to read through two articles with a negative theme. The first was a negative study by Kyle Popovich and collegues at Stroger Hospital in Chicago published in the May Intensive Care Medicine. The group studied the benefit of daily chlorhexidine baths in a surgical ICU in preventing CLABSI. The results: negative, meaning that there was no benefit of CHG baths with a CLABSI rate between soap-and-water and CHG bathing periods (3.81/1,000 central line days vs. 4.6/1,000 central line days; p = 0.57). What I really liked about this study was that a group so highly linked to the benefits of CHG put the effort into reporting this negative study; this effort should not be underestimated. Both the journal and the authors should be applauded.

A related and I think very important article by Isabelle Boutron was published in JAMA this week. The group looked at how authors report and discuss results of randomized clinical trials with statistically non-significant results. It was interesting to see how they quantified the "spin" and how the Discussion sections didn't often match the results. As a side note, the senior author on the paper, Douglas Altman, has been an author on many great epi and stats papers, just search his name and BMJ in PubMed; he has made and continues to make wonderful contributions to clinical research.

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