Financial incentives in health-care – a podcast recommendation

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Water ducks on land. Image is CC by GrooverFW.

Water-ducks on land. Image is CC by GrooverFW.

I recently e-mailed Freakonomics asking them to look into the economic incentives that govern health-care. Guess if I was thrilled when I found these two recent gems (although I can’t take any credit):

Freakonomics delivers as always with a fresh, interesting scientific perspective. As a supporter since a few years I want to recommend these to anyone interested in the topic. As I have written earlier, I find it perplexing that so many arthroscopies are being performed while so much evidence is pointing against this. There is probably a vast combination of incentives that result in this, these podcasts provide some nice insights.

Introducing the htmlTable-package

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How should we convey complex data? The image is is CC by Sacha Fernandez.

How should we convey complex data? The image is is CC by Sacha Fernandez.

My htmlTable-function has perhaps been one of my most successful projects. I developed it in order to get tables matching those available in top medical journals. As the function has grown I’ve decided to separate it from my Gmisc-package into a separate package, and at the time of writing this I’ve just released the 1.3 version. While htmlTable allows for creating plain tables without any fancy formatting (see usage vignette) it is primarily aimed at complex tables. In this post I’ll try to show you what you can do and how to tame some of the more advanced features. Continue reading →

Are the fancy locking plates for distal radius fractures nothing more than orthopaedic bling?

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Shinier is not always better. The image is CC by Dennis Skley.

Shinier is not always better. The image is CC by Dennis Skley.

Costa et. al. performed recently a multi-center study including 18 trauma centers throughout the United Kingdom. They randomized patients with distal radius fractures to volar locking plates or Kirschner wires. They managed to randomize 461 patients and follow-up 90% after 1 year using self-reported scores. They could not find any difference after 1 year regarding their primary outcome, PRWE-score (−1.3 points, 95% CI -4.5 to 1.8). This was well below their stipulated minimally clinically important difference of 6 points. Could this be the end of the volar locking plate era? Continue reading →

How-to go parallel in R – basics + tips

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Don’t waist another second, start parallelizing your computations today! The image is CC by Smudge 9000

Don’t waist another second, start parallelizing your computations today! The image is CC by Smudge 9000

Today is a good day to start parallelizing your code. I’ve been using the parallel package since its integration with R (v. 2.14.0) and its much easier than it at first seems. In this post I’ll go through the basics for implementing parallel computations in R, cover a few common pitfalls, and give tips on how to avoid them. Continue reading →

Confused on a higher level – the haunted degenerative meniscus

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Where is the evidence actually pointing? The image has been kindly provided by Rinna-Ranna.

Where is the evidence actually pointing? The image has been kindly provided by Rinna-Ranna.

One, never-ending thread on this blog seems to be the degenerative meniscus. Gauffin et al. recently published a randomized controlled trial comparing surgery vs physiotherapy with favorable results for surgery regarding pain. Could this be the turnaround for one of the most controversial, but common orthopaedic procedures? Continue reading →

We all have our trigger

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Every surgeon likes surgery, it is therefore nice to see a study examining what happens if we refrain from cutting. The image is CC by Andrew E. Russell

Every surgeon likes to cut. It is therefore nice to see what happens if we refrain from cutting. The image is CC by Andrew E. Russell

Surgical treatment for trigger finger consists of cleaving the A1 pulley, a simple procedure, considered to be low risk. Even so, there can still be scar tenderness, nerve injury, tendon bowing, and infection. It is therefore nice to see Wojahn et al.’s paper on long-term follow-up after cortisone injections.  Injection is a simple alternative that consists of an injection angling 45° distally at the A1 pulley with 1 mL 40 mg/mL Depo-Medrol. Continue reading →

ACL-reconstruction in vain?

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How does the knee age after ACL-surgery? The image is CC by Thomas Mues.

How does the knee age after ACL-surgery? The image is CC by Thomas Mues.

Nordenvall et al. [1] recently report in PLOS ONE an interesting study on cruciate ligament (CL) injuries where they could not find any protective effect on knee osteoarthritis (OA) from reconstructive surgery. It is a nation-wide study based on > 60,000 patients where they used the National Swedish Patient Register in order to find ICD-codes and surgical procedures code to identify patients with CL injury and those with a subsequent procedure. While the early results showed slightly less OA, there was an increased risk of 1.4 (95% confidence interval, 1.2 to 1.7) after > 10 years for those with surgery. Continue reading →

Keeping the cast dry

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The image is CC by Mattieu Guionnet.

The image is CC by Mattieu Guionnet.

I love the study from McDowell et al. where they tested different methods for keeping casts dry. It is simple but takes up a both common and important issue that we doctors frequently forget about. They compare six different methods and it seems that double plastic bags secured with duct tape provide the best protection for the money. Continue reading →

An exercise in non-linear modeling

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Finding the right curve can be tricky. The image is CC by Martin Gommel.

Finding the right curve can be tricky. The image is CC by Martin Gommel.

In my previous post I wrote about the importance of age and why it is a good idea to try avoiding modeling it as a linear variable. In this post I will go through multiple options for (1) modeling non-linear effects in a linear regression setting, (2) benchmark the methods on a real dataset, and (3) look at how the non-linearities actually look. The post is based on the supplement in my article on age and health-related quality of life (HRQoL). Continue reading →

Does age matter for THR-outcomes?

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Age is perhaps one of the most important confounder that none of us can escape. The image is CC by Sara.

Age is perhaps one of the most important confounder that none of us can escape. The image is CC by Sara.

Age is an important confounder in studying most health related outcomes [1, s 5], and perhaps the most commonly adjusted variable. In this and next post I will go into (1) what we know about the age effect in relation to total hip replacements (THR) re-operations and mortality, (2) what I found in my study on age and health-related quality of life (HRQoL) using splines, and (3) how I implemented and evaluated different splines using R for this study. Continue reading →