This week we discussed a National Geographic article, “She gave her body to science. Her corpse became immortal,” about a person who became a virtual anatomy cadaver.
Zero-order kinetics came up in our discussion, and just to be thorough, here are a few details we left out. Kaplan says it most succinctly: “Drugs with zero-order elimination include ethanol (except low blood levels), phenytoin (high therapeutic doses), and salicylates (toxic doses).” So it’s important to note that although a lot of resources will list these three examples as having zero-order kinetics, each has a caveat related to its dose concentration. It’s highly unlikely you would encounter a board exam question about kinetics of one of these drugs with dosing outside of the zero-order range, but, well, caveat emptor. Here’s a link to a wiki resource on dose-dependent clearances from Tulane.
Addie’s inductive logic about the functional state of transketolase being a cause of Wernicke-Korsakoff seems supported by this 1977 NEJM article.
Among other things, we talked about the benefits of connecting with patients ‘on their level’ by doing something as simple as sitting when you talk to them. Addie mentioned we can look to research that uses patient estimation of encounter length as a surrogate marker for whether this helps us more meaningfully connect with patients. (And, spoiler alert, the research shows that when you sit, patients may dramatically overestimate the time you spent in the room. Here’s a 2012 study that found patients estimated a surgeon spent an average of 5:14 in the room, despite the fact that he sat with them for only 1:04 on average.)
Cystic fibrosis & trial acronyms
From when we talked about cystic fibrosis, here’s the 2004 article from Atul Gawande that Addie mentioned. Many thanks to Dave for sharing it on Slack last year.
Regarding trial acronyms, here are the papers related to the EVOLVE clinical trial, and EXPAND clinical trial. If you want to search out your own ideas for ridiculous acronyms, you can try the ClinicalTrials-dot-gov search page; look for the “acronym” field about 2/3 of the way down. We didn’t manage to mention it, but there’s a 2002 paper in Chest entitled, “The potentially coercive nature of some clinical research trial acronyms,” that does a good job of pointing out that naming trials in a way that implies they are examining an intervention likely to confer great benefit has the possibility of misleading trial participants:
A distraught or frightened patient with a life-threatening illness who is offered a research study with an acronym of CURE, HOPE, HELP, IMPROVED, LIFE, RESCUE, MIRACL (sic), SAVED, or ALIVE is possibly being coerced by the acronym. Institutional review boards (IRBs) and the medical research community would not tolerate a CRT entitled, “A Surefire Cure for Cancer.” They should be no more tolerant of a CRT with an acronym listed above. It is time for researchers, sponsors, and IRBs to take a more responsible approach to potentially coercive CRT acronyms and discourage or prohibit their use.
There is a really great tongue-in-cheek 2014 paper in the BMJ that involved a systematic search and rating of trial acronyms on a scale. It has tables with their 25 best and worst as well as some honorable mentions. (These are the authors who define the “Tolstoy manoeuvre” that was mentioned in our episode.)
Consider the completely wonderful RATIONAL acronym, derived from “aspiRin stAtins or boTh for the reductIon of thrOmbin geNeration in diAbetic peopLe.” Orthographically, a worse acronym than this is literally impossible to construct.
There is also something from Nature in 2010, Medscape in 2016, and the Boston Globe in 2006. A cardiologist at GWU, Dr Cheng, has published so regularly on this topic that he really deserves his own bullet-pointed list. Here are several articles from Cheng that contain interesting trial acronym things…
- A 2015 article has a list of 40+ “HEART” trials
- A 1999 article contains the list of hundreds of acronym trials, including Addie’s favorite: CABG PATCH [NEJM] [ClinicalTrials.gov]
- A 2009 article has 11 references, 9 of which are other papers Cheng has written about medical acronym naughtiness
— Episode credits —
Hosted by Addie, Kim, and Alex. Audio production and editing by Addie. Theme music compositions (Too Cool, and Laserpack) by Kevin MacLeod of incompetech.com, licensed under Creative Commons: By Attribution 3.0 License.