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Saturday, July 31, 2010

Blog Updates for July 2010

July 28, 2010. In Holick's July 2007 NEJM Paper on Vitamin D we added: a good overview of the area was written up in the [July 26, 2010 NY Times] which discusses benefits and toxicity. Also Holick has since written a book, The Vitamin D Solution.

July 25, 2010. In Prostate Cancer Calculators we add: Probability of Lymph Node Involvement. The Yale Formula for the probability that prostate cancer has spread to the lymph nodes is [GS - 5] x [PSA/3 + 1.5 x T], where GS is gleason score, PSA is Prostate Specific Antigen level and T = 0, 1, and 2 for cT1c, cT2a, and cT2b/cT2c. For example, a GS of 7 with a PSA of 6 and staging of cT2c (i.e. 2) would give a (7-5) x (6/3 + 1.5 x 2) = 10% chance of lymph node involvement. In [PMID: 20594769], the authors find that if such involvement is predicted when the formula gives a probability of over 15% then its sensitivity is 39% (i.e. among those whose cancer has spread 39% will have a Yale Formula score of over 15%) and its specificity is 94.9% (i.e. among those whose cancer has not spread 94.9% will have a Yale formula score of less than 15%).

July 23, 2010. In Choosing a Surgeon - Part 2. Finding a Surgeon we added: Consumer Reports reports hospital infection rates.

July 23, 2010. In Choosing a Surgeon - Part 2. Finding a Surgeon we updated the US News & World Report link link: here.

July 23, 2010. In Choosing a Surgeon - Part 2. Finding a Surgeon and also in Prostate Cancer Calculators we add: One caveat regarding lists like these are that they are susceptible to reporting random fluctuations as if there were meaningful when, in fact, they are not. For example, this link provides a calculator that initially assumes that 100 surgeons in each of 100 hospitals each have a 5% mortality rate among their patients and that a hospital is deemed unacceptable if its surgery rate is 60% higher than the average. Each time you click on Recalculate below the graphic there it does a new simulation showing how many hospitals will be rated unacceptable even though all hospitals are exactly the same. Paradoxically if the death rate assumption is increased to 12% then the number of hospitals deemed unacceptable decreases (!) because there is lesser variation around larger numbers.

July 4, 2010. We added to: Bradford Hill Criteria of Causation: See [Pubmed: 12693887] [Full Free Text] for a non-technical primer on multivariable adjustment and stratification.

July 1, 2010. In Prostate Cancer Calculators we added a link to the new Blackberry nomograms. See the May 29, 2010 news item on the New Features page.

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