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David L Schriger

Publications and source records attributed to David L Schriger.

At least 19 recordsLinked to original sources
PubMed2007

The use of the World Wide Web by medical journals in 2003 and 2005: an observational study.

OBJECTIVES: The 2- to 6-page print journal article has been the standard for 200 years, yet this format severely limits the amount of detailed information that can be conveyed. The World Wide Web provides a low-cost option for posting extended text and supplementary information. It also can enhance the experience of journal editors, reviewers, readers, and authors through added functionality (eg, online submission and peer review, postpublication critique, and e-mail notification of table of contents.) Our aim was to characterize ways that journals were using the World Wide Web in 2005 and note changes since 2003. METHODS: We analyzed the Web sites of 138 high-impact print journals in 3 ways. First, we compared the print and Web versions of March 2003 and 2005 issues of 28 journals (20 of which were randomly selected from the 138) to determine how often articles were published Web only and how often print articles were augmented by Web-only supplements. Second, we examined what functions were offered by each journal Web site. Third, for journals that offered Web pages for reader commentary about each article, we analyzed the number of comments and characterized these comments. RESULTS: Fifty-six articles (7%) in 5 journals were Web only. Thirteen of the 28 journals had no supplementary online content. By 2005, several journals were including Web-only supplements in >20% of their papers. Supplementary methods, tables, and figures predominated. The use of supplementary material increased by 5% from 2% to 7% in the 20-journal random sample from 2003 to 2005. Web sites had similar functionality with an emphasis on linking each article to related material and e-mailing readers about activity related to each article. There was little evidence of journals using the Web to provide readers an interactive experience with the data or with each other. Seventeen of the 138 journals offered rapid-response pages. Only 18% of eligible articles had any comments after 5 months. CONCLUSIONS: Journal Web sites offer similar functionality. The use of online-only articles and online-only supplements is increasing.

Internet↗
PubMed2006

From submission to publication: a retrospective review of the tables and figures in a cohort of randomized controlled trials submitted to the British Medical Journal.

STUDY OBJECTIVE: We characterize the quantity and quality of data tables and figures in reports of randomized controlled trials (RCTs) submitted to the British Medical Journal (BMJ) and published in peer-reviewed journals. We investigate how the peer review process affected table and figure quality. METHODS: We reviewed 62 consecutive reports of RCTs submitted to the BMJ in 2001 that were later published in the BMJ (n=12) or elsewhere. We counted and categorized the tables and figures in both the initial submissions and published articles. Using standardized instruments and procedures, we analyzed the quality of these tables and figures and checked BMJ editorial documents to see whether changes were triggered by their review process. RESULTS: The numbers of tables and figures did not change markedly between submission and publication. Five percent of publications had no data tables; 56% had no data figures. Data density was low for published tables and figures. Tables seldom showed data stratified on important covariates; 88% of published tables were simple lists or were stratified on only 1 variable. Less than half the figures met their data presentation potential, with most failing to portray by-subject data and few displaying advanced features such as pairing, symbolic dimensionality, or small multiples. BMJ external peer reviewers seldom commented on tables or figures. CONCLUSION: Tables and figures can convey details and complex relationships not easily described in text. Although tables are included in most submitted and published articles, they are not presented optimally; figures are used sparingly and are also of suboptimal quality. Journals should consider improving their table and figure quality in the hope that improved graphics will empower readers to scrutinize the data, thereby dissuading authors from presenting biased analyses and misrepresented conclusions.

Documentation↗
PubMed2006

The content of medical journal Instructions for authors.

STUDY OBJECTIVE: We describe the general and statistical content of the Instructions for Authors of major medical journals. METHODS: This article reports on 2 observational studies. In study 1, we investigated the online versions of Instructions for Authors of 166 journals from 33 specialties for the presence of content about 15 methodologic and statistical topics. In study 2, we categorized the general content of the online versions of the Instructions for Authors of 35 medical journals. Two abstractors independently assigned the content into 18 categories and counted the total number of words devoted to each category. Interrater reliability of the classification was assessed. RESULTS: Less than half of the 166 Instructions for Authors in study 1 provided any guidance on statistical methods, and the majority failed to cite accepted publication standards such as the International Committee of Medical Journal Editors Uniform Guidelines or CONSORT. Only 13% of journals commented on the content and style of data tables and figures. The 35 Instructions for Authors in study 2 varied greatly in length (mean 3,308; median 2,283; range 885 to 18,927) and, with few exceptions, focused on formatting issues. Forty-three percent of Instructions offered no advice on scientific content, and only 5 journals devoted more than 10% of their words to scientific content. CONCLUSION: There is great heterogeneity among medical journal Instructions for Authors. Instructions provide little guidance about methodologic and statistical issues, and the advice provided is often contradictory among journals.

Guidelines as Topic↗
PubMed2006

Imaging in trauma.

Explore the source record for details and available documents.

Emergency Medicine↗
PubMed2005

Failure of a patient-centered intervention to substantially increase the identification and referral for-treatment of ambulatory emergency department patients with occult psychiatric conditions: a randomized trial [ISRCTN61514736].

BACKGROUND: We previously demonstrated that a computerized psychiatric screening interview (the PRIME-MD) can be used in the Emergency Department (ED) waiting room to identify patients with mental illness. In that trial, however, informing the ED physician of the PRIME-MD results did not increase the frequency of psychiatric diagnosis, consultation or referral. We conducted this study to determine whether telling the patient and physician the PRIME-MD result would result in the majority of PRIME-MD-diagnosed patients being directed toward treatment for their mental illness. METHODS: In this single-site RCT, consenting patients with non-specific somatic chief complaints (e.g., fatigue, back pain, etc.) completed the computerized PRIME-MD in the waiting room and were randomly assigned to one of three groups: patient and physician told PRIME-MD results, patient told PRIME-MD results, and neither told PRIME-MD results.The main outcome measure was the percentage of patients with a PRIME-MD diagnosis who received a psychiatric consultation or referral from the ED. RESULTS: 183 (5% of all ED patients) were approached. 123 eligible patients consented to participate, completed the PRIME-MD and were randomized. 95 patients had outcomes recorded. 51 (54%) had a PRIME-MD diagnosis and 8 (16%) of them were given a psychiatric consultation or referral in the ED. While the frequency of consultation or referral increased as the intervention's intensity increased (tell neither = 11% (1/9), tell patient 15% (3/20), tell patient and physician 18% (4/22)), no group came close to the 50% threshold we sought. For this reason, we stopped the trial after an interim analysis. CONCLUSION: Patients willingly completed the PRIME-MD and 54% had a PRIME-MD diagnosis. Unfortunately, at our institution, informing the patient (and physician) of the PRIME-MD results infrequently led to the patient being directed toward care for their psychiatric condition.

Journal Article↗
PubMed2005

The availability of references and the sponsorship of original research cited in pharmaceutical advertisements.

BACKGROUND: The primary goal of pharmaceutical advertisements is to convince physicians to prescribe the manufacturer's product. We sought to determine what materials are cited in support of claims in pharmaceutical ads and medical research articles, and whether health care professionals seeking to verify the claims could obtain these references. METHODS: We reviewed 438 unique ads from the 1999 issues of 10 American medical journals, and a random sample of 400 references in medical research articles selected from the same journals. We classified references as journal article, data on file, meeting abstract or presentation, book or monograph, marketing report, prescribing information, government document or Internet site. We attempted to confirm or obtain each reference through library and Internet searches or by direct request from the manufacturer. The main outcome we sought to determine was the availability of the reference to a clinician. We also ascertained the source of funding for original research cited in the ads and the research articles. RESULTS: In the 438 ads with medical claims, 126 contained no references and 312 contained 721 unique references. Of these ad references, 55% (396/721) cited journal articles and 19% (135/721) cited data on file. In contrast, in the sample of research article references, 88% (351/400) cited journal articles and 8% (33/400) cited books. Overall, 84% of the citations from the ads were available: 98% of journal articles, 86% of books, 71% of meeting abstracts or presentations and 20% of data-on-file references. In all, 99% of the sample of research article references were available. We determined that 58% of the original research cited in the pharmaceutical ads was sponsored by or had an author affiliated with the product's manufacturer, as compared with 8% of the articles cited in the research articles. INTERPRETATION: Many pharmaceutical ads contain no references for medical claims. Although references to journal articles were usually obtainable, other published sources were not as easily acquired. The majority of unpublished data-on-file references were not available, and the majority of original research cited to substantiate claims in the pharmaceutical ads was funded by or had authors affiliated with the product's manufacturer.

Advertising↗
PubMed2005

Suggestions for improving the reporting of clinical research: the role of narrative.

This article discusses the importance of narrative in reports of medical research. Stripped of all jargon and analytic technique, a scientific investigation is a story, and it is the nuances and details of the story that make it interpretable. While guidelines such as CONSORT have greatly improved the reporting of research, such guidelines are insufficient to ensure a meaningful reporting. The provision of explanatory narrative is essential. In this article, I propose that authors and journals exploit opportunities created by the worldwide Web to post supplementary material regarding their conception of the investigation, their execution of the study, their assumptions and limitations, and their rationale for any modeling efforts. I provide examples of how such narrative could be included in reports of randomized trials, observational studies, and studies of diagnostic tests.

Information Dissemination↗
PubMed2004

Automated linking of free-text complaints to reason-for-visit categories and International Classification of Diseases diagnoses in emergency department patient record databases.

STUDY OBJECTIVE: The use of the International Classification of Diseases system to describe emergency department (ED) case mix has disadvantages. We therefore developed computer algorithms that recognize a combination of words, word fragments, and word patterns to link free-text complaint fields to 20 reason-for-visit categories. We examine the feasibility and reliability of applying these reason-for-visit categories to ED patient-visit databases. METHODS: We analyzed a database (containing complaints and International Classification of Diseases diagnoses for 1 year's visits to a single ED) using a 3-step process (create initial terms, maximize sensitivity, maximize specificity) to define inclusion and exclusion terms for 20 reason-for-visit categories. To assess the reliability of the reason-for-visit assignment algorithm, we repeated the final 2 steps on a second database, composed of visits sampled from 21 EDs. For each database, we determined the prevalence of complaints that link to each reason-for-visit category and the distributions of International Classification of Diseases, Ninth Revision diagnoses that resulted for all patients and patients stratified by age. RESULTS: The 20 reason-for-visit categories capture 77% of all patients in database 1 (mean age 33.5 years) and 67% of all patients in database 2 (mean age 38.9 years). The percentage of visits captured by the 20 reason-for-visit categories, by age range, for databases 1 and 2 are (respectively) 0 to 2 years (84% and 76%), 3 to 10 years (82% and 74%), 11 to 65 years (76% and 68%), and 66 years or older (69% and 60%). The proportions of all complaints that link to each reason-for-visit category are largely similar between databases. Every complaint field that is linked to each reason-for-visit category includes at least 1 term that relates it to the category title, and the most frequently assigned diagnoses in each reason-for-visit category are those that one would expect to be associated with the reason-for-visit category complaints. CONCLUSION: The method by which free-text complaint fields are parsed into reason-for-visit categories is feasible and reasonably reliable; the finalized database 1 reason-for-visit category inclusion/exclusion terms lists required only modest changes to work well in database 2. The reason-for-visit categories used here are broadly defined to maximize the proportion of visits that they capture; more narrowly defined reason-for-visit categories will require more extensive revision of their inclusion/exclusion terms lists when used in different databases. A prospective, reason-for-visit-based ED classification system could have several useful applications (including syndromic surveillance), although content validity analysis will be necessary to investigate this hypothesis.

Adolescent↗
PubMed2003

The quantity and quality of scientific graphs in pharmaceutical advertisements.

We characterized the quantity and quality of graphs in all pharmaceutical advertisements, in the 10 U.S. medical journals. Four hundred eighty-four unique advertisements (of 3,185 total advertisements) contained 836 glossy and 455 small-print pages. Forty-nine percent of glossy page area was nonscientific figures/images, 0.4% tables, and 1.6% scientific graphs (74 graphs in 64 advertisements). All 74 graphs were univariate displays, 4% were distributions, and 4% contained confidence intervals for summary measures. Extraneous decoration (66%) and redundancy (46%) were common. Fifty-eight percent of graphs presented an outcome relevant to the drug's indication. Numeric distortion, specifically prohibited by FDA regulations, occurred in 36% of graphs.

Advertising↗
PubMed2003

Heterogeneous effect of an Emergency Department Expert Charting System.

STUDY OBJECTIVE: We compare results from different modules (occupational exposure to blood and body fluids, low back pain, and fever in children) of the Emergency Department Expert Charting System. Each module of this electronic medical record provides real-time advice based on clinical guidelines embedded in the software. METHODS: We used a staggered off-on-off interrupted time-series design with an intent-to-treat analysis to implement the Emergency Department Expert Charting System in a university hospital emergency department for the treatment of fever in children, low back pain, and occupational exposure to blood and body fluids. We measured the quality of documentation as the percentage of essential items contained in the medical record and discharge instructions, the percentage of appropriate testing and treatment decisions, median charges per patient visit, physician satisfaction by pre-experiment and postexperiment questionnaires, and patient satisfaction by telephone questionnaire. RESULTS: The Emergency Department Expert Charting System improved documentation rates for all modules. The Emergency Department Expert Charting System consistently improved the appropriateness of diagnostic testing and treatment decisions for patients with occupational exposure to blood and body fluids while decreasing median charges. For the low back pain and fever in children modules, improvements in appropriateness of testing and treatment were less consistent and did not result in a decrease in charges. Although physicians were generally supportive of the intervention, the physicians' use of the Emergency Department Expert Charting System and satisfaction with the modules were greatest with occupational exposure to blood and body fluids and least with fever in children. For each presenting complaint, mean patient satisfaction was highest during the Emergency Department Expert Charting System phase. CONCLUSION: The delivery of guidelines through an electronic medical record with background decision support improved documentation, patient care, and patient satisfaction, although effects were heterogeneous across presenting complaints. The optimal guideline implementation strategy likely varies with the nature of the clinical problem and the type of health care delivery setting. For selected problems, delivering guidelines in this format through the Internet holds great promise for modifying physician behavior and improving care (see http://www.needlestick.mednet.ucla.edu ).

Adult↗
PubMed2003

Interobserver agreement in emergency department triage.

STUDY OBJECTIVES: We measure the interobserver reliability of the triage process, examine the effect of vital signs on the triage process, and provide a context for the prior observation of poor interobserver agreement between in-person and telephonic interviews. METHODS: We performed a prospective observational study using a randomized crossover design at a university teaching hospital emergency department. Patients were eligible if they spoke English, were not presenting for a reevaluation, and were unlikely to be harmed by the delay created by a second triage interview. Every eligible patient underwent 2 independent, sequential, in-person ED intake interviews conducted by experienced ED triage nurses. After taking a history, each nurse chose 1 of 5 hypothetic triage designations (ED by 911, ED within 2 hours, see a physician within 8 hours, see a physician within 24 hours, or home care-see a physician in >24 hours) and, after being told the patient's vital signs, again selected a designation. RESULTS: Three hundred sixty-three patients presented during the study period: 113 were ineligible, 34 were missed by the investigators, and 15 refused to participate. Nineteen nurses participated in the triage of the 201 study patients. Agreement between 2 in-person designations made without knowledge of vital signs was poor (percent agreement 53%; kappa=0.30; tau(b)=0.50). Knowledge of vital signs did not improve agreement (percent agreement 49%; kappa=0.25; tau(b)=0.45). CONCLUSION: There was poor interobserver agreement between certified triage nurses using a 5-item triage scale designed for telephonic triage. These findings suggest that only a small portion of the poor interobserver agreement observed in a prior study of telephonic versus in-person triage can be attributed to the use of the telephone.

Cross-Over Studies↗
PubMed2003

Cost effectiveness of statin therapy for the primary prevention of major coronary events in individuals with type 2 diabetes.

OBJECTIVE: To assess the cost and cost effectiveness of hydroxymethylglutaryl (HMG)-CoA reductase inhibitor (statin) therapy for the primary prevention of major coronary events in the U.S. population with diabetes and LDL cholesterol levels > or =100 mg/dl, especially in the population with LDL cholesterol levels 100-129 mg/dl. RESEARCH DESIGN AND METHODS: Analyses were performed using population estimates from National Health and Nutrition Examination Survey (NHANES)-III, cost estimates from a health system perspective, statin LDL-lowering effectiveness from pivotal clinical trials, and treatment effectiveness from the diabetic subgroup analysis of the Heart Protection Study. RESULTS: -There are approximately 8.2 million Americans with diabetes, LDL cholesterol levels > or =100 mg/dl, and no clinical evidence of cardiovascular disease. Each year, statin therapy could prevent approximately 71,000 major coronary events in this population. In the subgroup with LDL cholesterol levels 100-129 mg/dl, the annual cost of statin treatment ranges from 600 to 1,000 US dollars per subject. In the population with LDL cholesterol levels > or =130 mg/dl, the annual cost ranges from 700 to 2,100 US dollars. Annual incremental cost per subject, defined as the cost of statin treatment plus the cost of major coronary events with statin treatment minus the cost of major coronary events without statin treatment, ranges from 480 to 950 US dollars in the subgroup with LDL cholesterol levels 100-129 mg/dl and from 590 to 1,920 US dollars in the population with LDL cholesterol levels > or =130 mg/dl. CONCLUSIONS: Statin therapy for the primary prevention of major coronary events in subjects with type 2 diabetes and LDL cholesterol levels 100-129 mg/dl is affordable and cost effective relative to statin therapy in subjects with higher LDL cholesterol levels.

Atorvastatin↗