要開學了…
white water rafting
今日菜單…
開始學習CCM…
蒙古大夫續集…
I. Anticipate the Results before Doing the First Study
想想看，如果你的結果是你所預期的，有沒有什麼臨床價值？Journal會不會登？如果連結果是理想的都沒什麼價值了，這個問題顯然沒什麼意思…
II. Pick an Area on the Basis of the Interest of the Outcome
如果你有興趣的題目是大家都沒興趣的，不要說journal不會登，申請grant不會下來，解決了也沒什麼用…
III. Look for an Underoccupied Niche That Has Potential
我們在做post-doc的研究時還是做老闆的題目，但要如何想一個自己的題目？其實每個領域裡都還有不少topic是沒人做完整的，還是可以繼續之前的題目而發現更細的問題。
IV. Go to Talks and Read Papers outside Your Area of Interest
一直看自己專門領域的東西容易有bias，覺得那問題重要且可以做。多參加不同的meeting或看些不同的journal，比較可能會有creativity…
V. Build on a Theme
一篇很棒的paper比不上兩篇soso的paper。建立自己的主題，做一系列的研究。NIH或任何單位都希望支持的學者是可以做三年五年而有所成就的…
VI. Find a Balance between Low-Risk and High-Risk Projects, but Always Include a High-Risk, High-Interest Project in Your Portfolio
當然要選這樣的主題會難做許多…但如果真的做出來了，才有機會把我們的位子往前挪一點…
VII. Be Prepared to Pursue a Project to Any Depth Necessary
深度，深度!(急診人的毛病之一)我們要繼續往下挖時會遇到什麼問題？新的Molecular biology技術不會怎麼辦？either找合作伙伴或再去學習！！Research, Re-search!! 為什麼要研究的目的就是要繼續學習!!!
VIII. Differentiate Yourself from Your Mentor
在研究生涯的初期有個很強的老闆是很重要的，但和老闆有所區別也是更重要的，尤其在你還待在同樣的機構時會很難做到。Peer review, Faculty promotion committee這些地方都會讓你跟很強的老闆難以區分，但還是儘量要去做…
IX. Do not Assume That Outstanding, or Even Good, Clinical Research Is Easier Than Outstanding Basic Research
一開始做basic science的MD可能覺得難做，因此容易轉到他熟悉的Clincial research而覺得較可能成功，事實上大概不會是如此，臨床研究不像基礎研究容易repeat，而且要花更多時間完成。(好像說到我的苦處了…)
X. Focus, Focus, Focus
來亂的蒙古大夫…
蒙古人的脾氣…
祝我明天生日快樂…
三十一是滿沈重的數字…(雖然還有老爸的兩倍當後盾…)
人生到這時候，該有些不同了不是？
同學結婚的結婚，開診所的開診所…
雖然我也是個小小的主治醫師了，
但在現在想追求的領域裡，還是個不折不扣的新生…
即將要入學的壓迫感，和有那麼點仍然高不成低不就的感覺…
從踏進美國的第一天就叫自己要耐住性子，
做實驗，念課本何嘗不是如此？
雖然選擇了不用耐性子的急診醫學，
但人生有太多事要耐著性子，沈得住氣去思考…
每年生日都有新目標，但似乎過完也就忘了？
只希望下一個年度的生日，回頭看看在這裡的另一個整年是不是所成長？
美國樣樣好？
The Waiting Room
看了兩三次第二季裡的這一集，the Waiting Room，
講Dr. Green連值三天後還得出來幫whiplash受傷的Doug上他第四天夜班…
原本上的很不爽，neuro因為HMO把他覺得該住院的TIA病人放出院，
Peter忙樓上的刀沒下來幫trauma的病人，
只有一個intern可以幫忙，
病人多到waiting room堆了41個人還沒看…
一個手上有laceration的病人媽媽一直來找Mark叫他縫，
到後來因為時間拖太久要等24小時後再縫…
還記得我第一次看是R4下夜班，那也是很累的一年…
看到一半覺得很沮喪，
想著"為什麼我下班了還要看人家病人很多看不 完的慘況…
但到最後Mark率眾nurse和intern到waiting room看病人，
那裡的病人都沒有chart，不能charge的…
他看了nursemaid elbow，沒照x光reduce回去…
幫periodontal abscess的病人打麻葯然後明天看牙科…
還叫intern用警察的金屬探測器掃一個吞下foreign body的小朋友，
當然又是不用照x光就讓他回去…
這就是急診醫師的精神啊…
我們是為了幫助人們存在的…
我們是用最基本的方式就可以看病人的…
我…還是很愛臨床不能不做的…
零啊…
常有人會問這個問題：
滔滔不絕的美國人
奈及利亞黑人在小組會議上被電得很慘…
study design很糟…而且講半天他還聽不懂…
不過我知道美國人都期待你在meeting裡能講些什麼…
除了之前lab meeting糟糕的presentation經驗，
我的發言只能少的可憐…
加油啊…
再當回學生…
金光閃閃…
| Comparing Quantitative Real-time Polymerase Chain Reaction with Conventional Culture Method in Sepsis Diagnosis
Background: Sepsis is a potential lethal and critical disease lacking of efficient and accurate diagnostic markers. Without knowing the presence of organism clinical treatment could be ineffective or inducing more antibiotics resistance. Polymerase chain reaction (PCR) is known a more rapid and accurate tool in molecular biological diagnosis. The use of PCR in microbiologic pathogen recognition is already in progress but still need to be validated in sepsis.
Hypothesis: Quantitative PCR will be a better diagnosis tool than the current gold standard, culture method for sepsis. And the bacteria load quantified by PCR will be a better indicator to clinical care.
Study population: All the adult patients with discharge diagnosis of sepsis admitted through Emergency Department in a tertiary medical center.
Methods: We design a two steps trial to test our hypothesis. The validation test of the quantitative real-time PCR will be the first step. We will compare the PCR with blood culture, the current gold standard, in laboratory proved septic patients and healthy volunteers. The sensitivity, specificity and likelihood ratio of PCR will be analyzed by Paired T test. The bacterial load quantified by PCR will be analyzed by Simple linear regression to see the correlation with severity, course and mortality rate of this disease. The ROC curve will be used to check the cut-off value of bacterial load for sepsis. The second step is a cohort study. We will create the trial group with quantitative real-time PCR to be done simultaneously with conventional blood culture for patients diagnosed clinically in Emergency Department. Physicians will be notified the result of PCR to aid their clinical management. The control group will be selected in similar disease severity, age, gender, race and period of visit our Emergency Department. The patient will be followed up to see the 30-days mortality, length of stay in hospital and length of stay in intensive care unit if they have. This part will be analyzed by Paired T test for mortality, Simple linear regression for the length comparison.
Significance: None of the trials had used the quantitative real-time PCR to test the general population for validation so far. Rapid and accurate diagnosis of sepsis will be a novel progress of clinical decision making aid. Knowing pathogen earlier will be a huge impact to care quality, mortality reduce and clinical decision making. |
Party party
Incoming fellow party:
結果找半天在一個很幽靜的地方…
像愛麗斯夢遊仙般的出現一間木屋，
進去後才發現真是另有洞天，和度假村一樣的感覺…
原本在lab待久的socialphobia應該沒有了…
自己唬爛還是沒問題，
不過聽他們交談還是有點困難…
不過…
總算是開始進入狀況了，
果然是Hopkins，隨便聊聊就發現一個發表Early Goal Directed Therapy (EGDT) Dr. River的學生 …
聊著聊著開始討論我們在台灣可以合作的study了…
嗯，來對的。
新的挑戰…
要開課了…
愚笨的弄傷自己…
永遠看不膩的ER…
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