PRACTICE EXERCISE SOLUTIONS
1. What is the current state of smallpox.
STEPS TAKEN
Smallpox from MeSH;
Selected “statistics and numerical data” subheading;
“Smallpox/statistics and numerical data"[Mesh];”
MeSH Returns:
Of 986 Papers, returned by publication date, the third paper looked promising:
Smallpox in the post- eradication era
Source: Wkly Epidemiol Rec. 2016 May 20; 91(20):257-64. English, French. No abstract available.
WHO Weekly Epidemiological Record
5/20/16
“World Health Assembly (WHA) declared smallpox eradicated – the only infectious disease to achieve this distinction.”
It’s not necessary for this solution, but I went to the CDC because I’m always skeptical and like to have a second option. The CDC reported what I read in the WHO paper. The CDC sited the National Institute of Allergy and Infectious Disease(NIAID) as their source so I went to the original source. Often your supervisor or the client will ask for a second source and its best to find the original source of anything.
“The last naturally occurring case of smallpox was reported in 1977. In 1980, the World Health Organization declared that smallpox had been eradicated. Currently, there is no evidence of naturally occurring smallpox transmission anywhere in the world. Although a worldwide immunization program eradicated smallpox disease decades ago, small quantities of smallpox virus officially still exist in two research laboratories in Atlanta, Georgia, and in Russia.”
National Institute of Allergy and Infectious Disease
2. In the most current year for which statistics are available, how many office visits were made at private physician practices?
Inserted “physician office visits” and then just “physician” along with other combinations.
MeSH failed to provide a more streamlined way to find information on this subject. It returned: “No items found.”
Left MeSH and inserted “physician office visits” into the PubMed search box.
3,458 papers were returned. Sorted by publication date, I scanned the titles to see if there were any possibilities.
OfficeVisits for Women Aged 45-64 Years According to Physician Specialties.
Raffoul MC, Petterson SM, Rayburn WF, Wingrove P, Bazemore AW.
J Womens Health (Larchmt). 2016 Dec;25(12):1231-1236.
I was hoping to see the article’s references – there would have been a government resource for the statistics, however, this article is published by Journal of Women’s Health. This journal typically never supplies full-text without payment. You would have learned this when you followed the link to the journal and the pricing would be displayed. Let’s assume that my budget doesn’t allow for this; I’m reasonably sure there is a free source for this information.
So I continue to scan titles.
I notice the use of “ambulatory care” and NOT “physician office visit.”
In addition, I noticethe use of “ambulatory settings.” I change my search query.
(This is all “good to know” information that will help to build your knowledge of general research.)
I then selected a couple of articles that I knew were not available in full text but hoped would provide abstracts with access to the paper’s reference list.
I found what I needed based on the title.
The article, “Clinical productivity of primary care nurse practitioners in ambulatory settings” published by Elsevier allows access to the article’s reference list.
Looking for a free resource other than a medical journal, I see one of the references included is NCHS Data Brief. The other articles listed in references probably got their statistics from the same place.
Insert the phrase NCHS Data Briefinto your browser and search.
BINGO - First Google return:
“NCHS Data Briefs - CDC (National Center for Health Statistics, you will refer to this site often)
nchs/products/databriefs.htm
“Data Briefs are statistical publications that provide information about current public health topics in a straightforward format. Each report takes a complex data...”
“Data Briefs are statistical publications that provide information about current public health topics in a straightforward format. Each report takes a complex data subject and summarizes it in text and graphics that provide readers with easily comprehensible information in a compact publication.Full text (.PDF) files are linked to each item appearing in these lists. If for any reason a .PDF file does not exist, a note will indicate that fact. Paper copies of Data Brief reports may be available for review in a Federal Depository or health sciences library near you.”
Scanning the list of reports available, I see the following titles that may provide the data we need:
No. 248. Physician Office Visits by Children for Well and Problem-focused Care: United States, 2012. 8 pp. (PHS) 2016-1209. May 2016.
No. 263. Age Differences in Visits to Office-based Physicians by Adults With Hypertension: United States, 2013. 8 pp. (PHS) 2017-1209. November 2016. [PDF - 344 KB]
No. 237. Characteristics of Physician Office Visits for Obesity by Adults Aged 20 and Over: United States, 2012. 8 pp. (PHS) 2016-1209. March 2016
No. 212. Variation in Physician Office Visit Rates by Patient Characteristics and State, 2012. 8 pp. (PHS) 2015-1209. September 2015.
No. 195. Acceptance of New Patients With Public and Private Insurance by Office-based Physicians: United States, 2013. 8 pp. (PHS) 2015-1209. March 2015
There are others. It is clear that each of the reports named above took their data from another report. Look for that report.Just by checking the data source for the above reports you will find the original data source.
National Ambulatory Medical Care Survey: 2012 State and National Summary Tables. A summary of this summary can be found here:
Along with many other interesting statistics we find that Table providing the data we need.
“Web table estimates include physician visits to office-based practices. Visit estimates are based on sample data weighted to produce annual national estimates and include standard errors. Because of the complex multistage design of NAMCS, a sample weight is computed for each sample visit that takes all stages of design into account. The survey data are inflated or weighted to produce unbiased national annual estimates. The visit weight includes four basic components: inflation by reciprocals of selection probabilities, adjustment for nonresponse, population ratio adjustments, and weight smoothing. Estimates of the sampling variability were calculated using Taylor approximations in SUDAAN, which take into account the complex sample design of NAMCS. Detailed information on the design, conduct, and estimation procedures of 2012 NAMCS are discussed in the NAMCS Public Use Data File Documentation at the website: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2012.pdf.”
This exercise provides a good example of using PubMed/MeSH for CLUES to another source,beyond a paper.
3. A policyholder is being sued for wrongful death due to a “failure to diagnose.” The patient died of lung cancer.
This is a case where the radiologist responsible for the imaging did not tell the physician there were lesions on the lung due to cancer. Lesions were not the reason for the imaging and the radiologist assumed the physician would look at the image. The physician read the report without looking at the image and didn’t know about the lesions. The patient wasn’t diagnosed with lung cancer and by the time he arrived at the hospital a year later, the cancer was at stage 4 in the right lung.
I went to MeSH and entered “failure to diagnose” as the search term. MeSH did not return a result but did recommend 642 papers found in PubMed. Click on the highlighted No results found in MeSH. Search PubMed for 642 items. The papers returned look relevant for misdiagnosis, however at first glance you can see there aren’t relevant to lung cancer.
NOTE:
An analysis of malpractice litigation related to the management of brain aneurysms.
Gupta R, Griessenauer CJ, Moore JM, Adeeb N, Patel AS, Ogilvy CS, Thomas AJ.
J Neurosurg. 2016 Dec 23:1-7. doi: 10.3171/2016.9.JNS161124. [Epub ahead of print]
In reading the abstract this paper does a thorough job of researching the litigation process related to poor diagnosis. This is a paper you want to take note of for future reference.
After noting this valuable citation, I went back to the PubMed search box and
Entered “lung cancer” (note the italics to include both words as a phrase)in the box next to “failure to diagnose.”
The returns included the articles cited below.Note that the first article is marked “FREE,” indicating it is available in PubMed Central. Note the article is also available in Spanish. This is reminder of the filtering process-an option on the left side bar that allows filtering for English only. In this case the article would have still appear in the results because it is also in English.
Diagnostic errors in examinations of the spine.
Mota Martínez J, Facal de Castro F, Mirón Mombiela R.
Radiologia. 2016 Apr;58 Suppl 1:2-12. doi: 10.1016/j.rx.2015.11.003. English, Spanish.
PMID: 26775011 Free Article
Similar articles
Select item 24149862
2.
Malpractice suits in chest radiology: an evaluation of the histories of 8265 radiologists.
Baker SR, Patel RH, Yang L, Lelkes VM, Castro A 3rd.
J Thorac Imaging. 2013 Nov;28(6):388-91. doi: 10.1097/RTI.0b013e3182a21be2.
PMID: 24149862
Similar articles
Select item 20465054
3.
Concierge medicine: failure to diagnoselung cancer.
Samaritan G.
J Med Assoc Ga. 2010;99(1):30-1. No abstract available.
PMID: 20465054
Similar articles
Select item 12490474
4.
Failure to diagnoselung cancer: anatomy of a malpractice trial.
Berlin L.
AJR Am J Roentgenol. 2003 Jan;180(1):37-45. No abstract available.
PMID: 12490474
Similar articles
Select item 8633131
5.
Primary carcinoma of the lung overlooked at CT: analysis of findings in 14 patients.
White CS, Romney BM, Mason AC, Austin JH, Miller BH, Protopapas Z.
Radiology. 1996 Apr;199(1):109-15
This solution is an example of how often the researcher will locate something obviously useful but not for this exercise. Never overlook these jewels, take note in a special file you’ve establish for this purpose and continue with the current search. This also demonstrates how the researcher needs to be multitasking, on the look-out for material relevant to your job.
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