5/12/00
JOURNAL CLUB, AMIR ARTICLE, CONTINUATION …
Both Lisa Amir's and Carol L'Esperance's postings have
succeeded in appropriately categorizing and describing the Amir
article.
As Carol points out, "Studies like this are very necessary to
add to our beginning body of knowledge (of mastitis)." In other
words, the Amir article with its retrospective design helps to
document and describe how 'mastitis' is assessed, diagnosed and
treated in a particular community by a particular group of healthcare
providers. Because all retrospective studies are, by definition,
conducted upon subjects in order to collect historical data, the
veracity of the findings and the strength of the conclusions are
largely limited by the strength and completeness of the data. If
certain data was not collected the importance of findings may be
limited. Quotations are used with the word mastitis because, as Lisa
stated in her posting, "it (the study) can't really be used to work
out the signs and symptoms of mastitis - b/c we are limited to relying
on what the doctor wrote." As can be evidenced from the study, the
documentation found in these ED (emergency dept.) charts often failed
to include some of the classic signs and symptoms of the disorder. In
other words, we will never really know which patients truly had
mastitis. However, thanks to Lisa and her colleagues, we have a much
better description of the approach to and probably the knowledge of
(by the healthcare providers) mastitis. Lisa correctly states, "A
review of records obviously raises more questions than it answers, but
it does give some idea of what is happening in the real world."
As the first author of the paper, Lisa's description of the
genesis and evolution of this study are certainly an invaluable
contribution to the analysis and discussion of this article. As she
mentions, this retrospective study was conducted partly to help in the
design of a future prospective study of this disorder. One can only
optimally conduct a prospective study if one has an understanding of
how the problem is currently approached and treated. The data
collected via chart review also may hint at ways in which the
diagnosis and/or treatment may need to be modified. For example, if
one learns (via reviewing 200 ED cases of pneumonia) that pneumonia
(as detected on a chest x-ray) is rarely treated with antibiotics, one
can then design a prospective study in which patients are randomized
to antibiotics or placebo. Comparing the morbidity and mortality of
the 2 groups will then hopefully enable one to conclude whether the
current practice (no antibiotics for a positive chest x-ray) needs to
modified or improved upon.
Danny Hirsch, MD
Director, Lactation Institute of Westchester
Assistant Professor of Pediatrics
New York Medical College
Valhalla, NY, USA
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