Tag Archives: journal article

“A Game-Changer…”

Every so often a piece of research comes out that significantly affects our practice. It is refreshing to see that such research is still occasionally published, amidst the plethora of commerce sponsored papers that can be useful, but more often than not, are simply adverts.

Diverse Sources of C. difficile Infection Identified on Whole-Genome Sequencing. David W. Eyre et al.N Engl J Med 2013; 369:1195-1205.

This paper involves sequencing Clostridium difficile isolates from symptomatic patients over a 4 year period between 2007 and 2011 in Oxford Hospitals. 45% of the isolates were genetically distinct enough to suggest that their source was not from other patients symptomatic from Clostridium difficile infection.

The bottom line of this research is that it suggests that the epidemiology of Clostridium difficile is multi-factorial and that Infection Control measures will only go so far in controlling Clostridium difficile rates in hospitals. We also need to take such research into account when setting realistic targets for Infection Control teams to attain when addressing organisms such as Clostridium difficile.

These findings should not really surprise us that much… We know from previous carriage studies that approximately 10% of the population carry Clostridium difficile, so there are bound to be significant reservoirs in the hospital, peri-hospital and community settings. It may even be that some patients become infected with their own endemic Clostridium difficile strains, which are allowed to proliferate and produce significant amounts of toxin when the patient is challenged with broad spectrum antibiotics, thus creating an ecological niche for the Clostridium difficile bacteria. 

This study and another recent one on the laboratory diagnosis of Clostridium difficile have real implications from both a clinical and laboratory point of view on how we think about Clostridium difficile. As both these papers challenge established thought, they may not be readily accepted. From a lab point of view there may be a few grumbles because we may have to change and possibly increase our testing in light of these findings.

Both these papers need to be discussed in detail at departmental journal clubs, and not the interesting but highly isoteric environmental bacterium isolated on the blood culture bench for the first time in 10 years…

Michael

“Reading a Journal Article…,in my own chaotic way.”

It would make sense that when you sit down to read a journal article, you would start at the start and finish at the end. Not being a particularly sensible person, I will summarise the order in which I usually read journal articles:

1) Abstract: I probably read 5-10 abstracts for every full article I read. I find it a good filter.

2) Author Affiliations and Conflicts of Interest, Research Sponsorships: Possibly the most important text in the whole paperIt is essential that these points are noted so that you can make your own assessment of the integrity and independence of the article. It is also worthwhile noting that just because an author has declared a conflict of interest, that there isn’t a conflict of interest…

3) Conclusions: I read this next as it’s usually the most interesting part to read, rather like reading the end of a book without reading the middle.

4) Introduction: Should always answer the question “Why is the research being done in the first place?” If it doesn’t answer this question then I start to wonder if the authors know what they are doing.

5) Results: Sometimes interesting, sometimes tedious. However if I have got this far then I am genuinely interested in the article.

6) Methods: The most tedious part of all, so I leave it to last. However if I am going to use the article to change practice or for teaching purposes then I know I need to read this part, and carefully.

 

I hope you can see there is method to my madness. I suspect I may not be the only person who reads journal articles in a topsy-turvy way…..

Michael