Monday, January 23, 2006

CHIPS, Archives, and Research Methods

The current Archives of Internal Medicine has an evaluation of the California CHIPS program. This is a California "version" of the nationwide CAPC program to help establish hospital-based palliative care services. The article is essentially a survey of CHIPS graduates; the results support the idea that CHIPS has been helpful in establishing palliative programs at California hospitals. Hospitals were more likely to succeed in establishing a palliative service if they had a preexisting hospitalist service. This isn't terribly surprising, and one wonders if the future of hospital-based palliative care consultation, at least for non-academic institutions, depends on the good work of our hospitalist colleagues.

What's somewhat surprising about this article is that it was published in one of the more prominent general internal medicine journals & not, for instance, the Journal of Palliative Medicine . The actual 'findings' of the survey are probably of very little interest to the average Archives reader. One has to conclude-- the accompanying hurray for palliative care editorial bolsters this conclusion--that the editors of Archives made a decision to promote palliative care by highlighting a program to help expand palliative care services. And that is good news.

The entire issue is somewhat interesting, especially from a research methods standpoint. There's quite a provocative article asking why, given the dozen or so randomized controlled trials (and half as many meta-analyses) on using N-acetylcysteine to prevent contrast nephropathy, do we still not know if NAC actually does prevent contrast nephropathy! One of the answers, interestingly enough, is that this may be such an easily studiable phenomenon (NAC is cheap and safe and practically everyone who walks into a hospital gets iodinated contrast) that it invited a flurry of small, heterogeneous, and under-powered studies.

Finally, there's an analysis of "placebo-induced" side effects in clinical trials which questions how reliable these are to determine baseline adverse events in drug trials.

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