What you don't know about open access... will hurt you

I often get emails from journals asking me to submit articles, or to become an editor. These are usually open access journals, and the temptation is always to say yes why not. An editorial stint will look good on the CV. But I have always cited limited time as the reason not to take up these positions.

Now, there is another reason, an even more important one. Ryan Radecki's post Ocorrafoo Cobange & Grace Groovy in his blog highlighted a recent publication in Science. This is one of those articles that will give an OMG moment once you read it, and I urge everyone to take a look.

Who's Afraid of Peer Review? by John Bohannon

The authors and his collaborators conducted a 'sting' operation, in which they sent bogus scientific research papers to a number of suspect open access journals. The papers looks 'credible' but are littered with grave errors that any competent reviewer should pick out to render the papers unpublishable.

Bottomline:
  • "Of the 255 papers that underwent the entire editing process to acceptance or rejection, about 60% of the final decisions occurred with no sign of peer review. For rejections, that's good news: It means that the journal's quality control was high enough that the editor examined the paper and declined it rather than send it out for review. But for acceptances, it likely means that the paper was rubber-stamped without being read by anyone."
  • "Of the 106 journals that discernibly performed any review, 70% ultimately accepted the paper. Most reviews focused exclusively on the paper's layout, formatting, and language. This sting did not waste the time of many legitimate peer reviewers. Only 36 of the 304 submissions generated review comments recognizing any of the paper's scientific problems. And 16 of those papers were accepted by the editors despite the damning reviews."  
  • About a third of the targeted journals were based in India, though the US was the next largest base. Though the front company reaping the benefits may be in the US or Europe, many of the editors, bank accounts or publishing houses are in the developing world. 
  • Some of these journals are even published by powerhouses like Elsevier, Wolters Kluwer, and Sage. 
  • It is a big problem, with year on year growth of deceptive open access journals out to capitalize on the research community, by using the open access publication model and charging authors a publication fee. 
I think I will stick to traditional journals for now, and save my dollars for those high quality open access journals I know. 

Webucation 23/10/13

Web wisdom this time encompasses the fields of paeds, surgery, orthopaedics and a whole lot of radiology. As always, support the original content providers.


We here echo this last link as a great reminder to all trainees and professionals of the high morbidity and mortality of abdo pain in the elderly. Our guide can be found under "Useful guides" above and here is the direct link for your reference. Have a high threshold of suspicion always.

I am EM Doc by Ken Milne.

This is just more evidence that we are brothers even though continents may separate us.


Choose wisely... reader discretion advised - some of you may say DUH

The ACEP board of directors approved the following 5 Choosing Wisely recommendations for patients seen in the emergency department:
  1. For patients with minor head injury who are deemed to be at low risk for skull fractures or hemorrhage, based on validated decision rules, clinicians should avoid head computed tomography scans. The majority of minor head injuries do not result in brain hemorrhage.
  2. For stable patients who can urinate on their own, clinicians should avoid placing indwelling urinary catheters for either urine output monitoring or patient or staff convenience.
  3. For patients likely to benefit from palliative and hospice care services, clinicians should not delay in engaging such services when available. Early referral from the emergency department can improve quality, as well as quantity, of life.
  4. For patients with uncomplicated skin and soft tissue abscesses successfully treated with incision and drainage, clinicians should provide adequate medical follow-up but avoid antibiotics and wound cultures.
  5. For children with mild to moderate, uncomplicated dehydration, clinicians should avoid giving intravenous fluids before a trial of oral rehydration therapy.

Probiotics fail the evidence triangle

I have heard seniors tell me about the use of probiotics in preventing antibiotic related complications like C.diff infection and diarrhoea. Sounds simple enough, theoretically sound, and supported by good evidence.

Several meta-analyses purported the benefits of probiotics:
Now, meta-analyses sit right at the top of the evidence triangle; the pinnacle of evidence based medicine. Or is it?

The authors of the JAMA article noted that while probiotics are associated with a reduction in antibiotic related diarrhoea, there exists significant heterogeneity in pooled results. Similarly, the Annals of Internal Medicine article also suffers from significant clinical heterogeneity as a limitation, a caveat rightly pointed out by the folks at NNT.com.

We all know that if you take a bunch of lousy studies and pool all the results together in a meta-analysis does not make the end result any better. Listen to the folk from SmartEM talk about thrombolytics in stroke and you'll get a fair idea.

A well conducted study, randomised controlled and properly blinded, will mostly provide a better answer. Thankfully, there is just that study done, the PLACIDE trial, recently published in Lancet 2013 Aug 8 (e-pub ahead of print).
In this UK study, 2941 older patients (age >65) who were about to start or recently were exposed to systemic antibiotics in five hospitals, were randomized to receive single capsules that contained either a multistrain preparation of Lactobacilli and Bifidobacteria, or placebo once daily for 21 days.

According to the accompanying editorial, the study was rigorous, there was central randomisation, with placebo control, good allocation concealment, and thorough follow-up was performed to identify antibiotic-related or C.diff diarrhoea. It was the largest trial to date to examine this topic in detail, the only fault of the trial being a lower than predicted event rate marring the confidence intervals.

It is then no wonder that the result of this RCT is actually negative for probiotics: the rate of antibiotic-related diarrhoea as well as C.diff diarrhoea were similar in the probiotic group versus the placebo group. So we can all say, at least in older patients > 65 years of age, probiotics given alongside antibiotic therapy, do not reduce the risk of antibiotic-related diarrhoea or C.diff diarrhoea.

For now, at least according to the Journal Watch reviewers, hand washing and antibiotic stewardship remains key.



Trochar to chest!

Interesting new device demonstrated here by a video by Prof Larry Mellick.
Lots of different ways around the world to treat this type of pathology eh?



Early inferiority complex

Dr Amal Mattu reminds us of the importance of early detection in inferior MIs.
Inferior wall and right ventricular infarcts are challenging and require vigilance to say the least.
Do also remember:

  • Early recognition in leads which and NOT just in II, III and aVF 
  • ST elevation in III > II means right ventricular infarct 
  • Refrain from GTN due to the drop in preload (use opioids instead)
  • Watch for posteriors as well (ST depression in V2, V3 and tall R wave in V1)




For more of his vids or older cases, go to www.ekg.umem.org