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Give yourself a break

That’s right. Don’t be so hard on yourself. Not only will you feel better emotionally, you might also be physically healthier. A recent RCT published in Diabetes Care showed that an 8-week intervention using something called “Mindful Self-Compassion” resulted in a decrease in measures of depression, diabetes-specific distress and HbA1c. (1) What is mindful...
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Narrative Medicine

We have all heard that evidence-based clinical practice includes three essential components: best available research evidence; clinical experience; and patient values. Most programs in EBCP, including this blog, focus on the interpretation and application of research evidence. Lip service is given to clinician experience and patient values. I believe the reason for this is...
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Therapeutic Illusion

There was an interesting commentary in the March 31st issue of the New England journal of Medicine called “The Science of Choosing Wisely-Overcoming Therapeutic Illusion.” The article pointed out the propensity of human beings to overestimate the effects of their actions. This is an offshoot of a well-defined reasoning fallacy referred to as “faulty...
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Even more about more on diagnostic testing

It’s like a sore spot I can’t stop poking! If you’ve been following this blog you will have read a number of submissions by my colleague Dana Lawrence and myself on the shortcomings of Sensitivity and Specificity in clinical decision making. From a clinician’s point of view you really need to use likelihood ratios....
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High Blood Pressure

When doing vitals during a patient evaluation would it be a surprise to anyone to find a patient has hypertension? Of course not. Hypertension is extremely common. In fact it is estimated that worldwide 41% of those between 35 and 70 are hypertensive. Additionally, less than half of them aware they have the diagnosis....
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Cautions on SpIn and SnOut

Many of us have heard about SpIn and SnOut. The mnemonic helps to remind us that very Specific tests help to rule in a disorder (Sp = specific, In = rule in) and very Sensitive tests help to rule out a disorder (Sn = sensitive, Out = rule out). I usually don’t teach this...
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Surrogates are everywhere

Last month the British Medical Journal published a systematic review and meta-analysis on calcium intake and bone mineral density. It has long been hypothesized that adequate calcium in the diet is important for “healthy bones.” There has been quite a bit of research on the subject. In fact the authors identified 59 randomized controlled...
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How clinicians think

Last September and October my friend and colleague, Dr. Dana Lawrence, wrote a series of blogs in this column on diagnostic testing. He gave readers clear explanations on a variety of related topics including pre-test probability, sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, nomograms and post-test probability. He gave...
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Hot peppers

Finally, the peppers are starting to come in. Fresh chile peppers from the garden can add such a delightful kick to a meal. Grill up some onions, green peppers and chilies with a little coriander and cumin, add some black beans, fresh tomato, lime and cilantro to a tortilla and you have a fantastic...
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Slice of PIE

Something rather historic happened just recently on the Palmer, Davenport campus. A 3 day training program took place in evidence-based clinical practice (EBCP) for educators who teach at institutions traditionally designated as CAM (Complementary and Alternative Medicine). Educators in Acupuncture, Ayurvedic Medicine, Chiropractic, , Massage Therapy, Midwifery, Naturopathy, Rolf Structural Integration and Traditional Chinese...
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