B. McPeek's research while affiliated with Massachusetts General Hospital and other places
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Publications (51)
When spinal and epidural anesthesia were introduced into clinical practice, their primary use was as an alternative to general anesthesia. Later, largely as a result of the realization that opioids could be safely and effectively used to produce selective spinal analgesia, spinal and epidural (neuraxial) analgesia began to be used specifically for...
A modified critical-incident analysis technique was used in a retrospective examination of the characteristics of human error and equipment failure in anesthetic practice. The objective was to uncover patterns of frequently occurring incidents that are in need of careful prospective investigation. Forty seven interviews were conducted with staff an...
Turning a question or a problem into a research question is a special skill that allows investigators to “link facts to reason, and create the opportunity to advance knowledge,” as Bernard explains in his fascinating book An Introduction to the Study of Experimental Medicine. 1 The design of a research study depends on clear formulation of a resear...
The art and practice of academic surgery are mastered by defining and learning the pertinent basic principles and skills, and by practicing them under an experienced mentor. This requires a delineation of the personal qualities and professional skills needed to integrate surgical practice and investigation, and their attainment through an appropria...
Surgery is constantly changing, and some of the changes are dramatic advances instantly recognizable for their benefit to patients. William T.G.Morton’s administration of ether anesthesia to John Collins Warren’s patient on October 14,1846, required no confirmation. Warren’s immediate and definitive conclusion—“Gentlemen,this is no humbug!”—was soo...
Just as they communicate ideas by writing and lecturing, surgeons conceptualize, plan, and organize scientific meetings throughout their careers. Planning and organizing a meeting, especially a new one without an established format, is a major challenge that requires a systematic approach as well as scientific creativity.
Much thought occurs before you are ready to formulate an initial research proposal. At the broadest level, a fertile mind must be receptive to fresh ideas, ready to nurture and support a nascent plan and, after a period of intellectual germination, able to formulate the idea into a written research proposal. The process, and this chapter, operates...
Surgical Research: Basic Principles and Clinical Practice, Third Edition is an excellent source book for the young surgical investigator as well as the senior investigator in surgery. It is divided into nine sections: The Surgeon as Investigator, Reading and Writing, Speaking and Listening, Design and Methods, Funding, Implementation, Analyzing Out...
Research ethics is as integral a part of scientific judgment as clinical ethics is of clinical judgment? Many ethical issues in research arise from a failure to think as rigorously about the conditions for ethical consistency as about those for scientific validity. The ethical principles governing all surgical, clinical, and biomedical research wit...
What is the best way to plan surgical research? What problems are most often encountered in clinical research? How should a research report be presented at a scientific meeting? These questions and more are all answered in Principles and Practice of Research.The second edition has added new sections on animal research models, the molecular and cell...
Much thought occurs before you are ready to formulate an initial research proposal. At the broadest level, a fertile mind must be receptive to fresh ideas, ready to nurture and support a nascent plan and, after a period of intellectual germination, able to formulate the idea into a written research proposal. The process, and this chapter, operates...
The final part of research is the publication of results, and good research deserves good writing. Methods, results, conclusions, ideas, and thoughts must be published if they are to last; unless they are put into the literature they can be committed only to a small circle of colleagues or students and will lie beyond recall once verbal communicati...
The art and practice of academic surgery are mastered by defining and learning the pertinent basic principles and skills, and by practicing them under an experienced mentor. This requires a delineation of the personal qualities and professional skills needed to integrate surgical practice and investigation, and their attainment through an appropria...
We frequently do not know which is the best of several possible treatments. Worse yet, we may not know if any of them are better than what we are now doing, or better than providing only encouragement and sympathy.
While there is general agreement that surgical research can make a substantial contribution to the education of surgeons, the care of patients, and the advancement of knowledge, there is considerable diversity in the approaches used to teach, conduct, and fund research in different countries throughout the world.
Just as they communicate ideas by writing and lecturing, academicians conceptualize, plan, and organize scientific meetings throughout their careers. Planning and organizing a meeting, especially a new one without an established format, is a major challenge that requires a systematic approach as well as scientific creativity.
Reviewing a journal manuscript makes a vital contribution to the peer review system and gives the reviewer an opportunity to develop a perspective that will improve his or her skill in writing manuscripts for the scientific and medical literature. Unless your other commitments preclude it, always accept an invitation to review a manuscript on a top...
Sir William Osler, the legendary clinician-scholar-teacher, identified patient care, teaching, and research as the three traditional functions of an academic clinical unit. He noted that scientific investigation, the most recent of the three, was often the first to suffer when resources were strained.1 Academicians everywhere find that their demand...
When it is well conducted, a randomized clinical provides the strongest evidence available for evaluating the comparative effectiveness of the interventions tested. Over the last two generations, we have learned much about various devices for strengthening them and about methods of avoiding between in their design, execution, analysis, and reportin...
Clinical trials are commonly performed in surgery to assess the efficacy of one or more treatments. Many therapies result in only partial or temporary improvement, rather than cure. Others sharply affect the quality of patients' lives or of their deaths. For most interventions, it is important to document effects on quality of life as well as morbi...
Many of us tend to regard reviewing previous literature as an unexciting chore, perhaps because well-read laboratory chiefs appear to consider the research review as a low-priority activity to be delegated to a research assistant or the most junior member of the team. For many, the excitement lies in carrying out a new experiment to add more inform...
Research ethics is as integral a part of scientific judgment as clinical ethics is of clinical judgment (2). Many ethical issues in research arise from a failure to think as rigorously about the conditions for ethical consistency as about those for scientific validity. The ethical principles governing all surgical, clinical, and biomedical research...
Scholars are frequently called upon to chair panel discussions, to moderate or conduct seminars involving large numbers of peers, or guide the deliberations of consensus conferences. The success and productivity of any of these meetings depend on the expertise, tact, and wisdom of the chairperson, the specialized knowledge and communications skills...
emerging on the surgical scene to challenge or For some readers, the title of this book will im thodoxy. Although these innovations are often mediately raise the question, what exactly is greeted with great optimism, a factual basis for meant by surgical research? In the very broadest that enthusiasm is sometimes far from secure sense the term ca...
While there is general agreement that surgical research can make a substantial contribution to the education of surgeons, the care of patients and the advancement of knowledge, there is considerable diversity in the approaches used to teach, conduct and fund research in different countries throughout the world.
We need outcome measures to monitor and improve patient care. Mortality, by itself, fails to measure the wide range of outcomes experienced by patients discharged alive. We present a new measure of outcome from operation based on mortality, need for intensive care and length of postoperative hospital stay. The operation performed, physical status,...
Sir William Osler, the legendary clinician-scholar-teacher, has identified patient care, teaching, and research as the three traditional functions of an academic clinical unit. He noted that scientific investigation, the most recent of the three, was often the first to suffer when resources were strained (1).
The final part of research is the publication of results, and good research deserves good writing. Methods, results, conclusions, ideas, and thoughts must be published if they are to last; unless they are put into the literature they can be committed only to a small circle of colleagues or students and will lie beyond recall once verbal communciati...
Readers need information about the design and analysis of a clinical trial to evaluate and interpret its findings. We reviewed 84 therapeutic trials appearing in six general surgical journals from July 1981 through June 1982 and assessed the reporting of 11 important aspects of design and analysis. Overall, 59% of the 11 items were clearly reported...
A clinical trial cannot be adequately interpreted without information about the methods used in the design of the study and the analysis of the results. To determine the frequency of reporting what we consider 11 important aspects of design and analysis, we surveyed all 67 clinical trials published in the New England Journal of Medicine, the Lancet...
From a study in Part I of many papers using controlled clinical trials in cancer research, we summarize quantitatively the frequency of reporting important statistical and procedural matters: randomization, statistical method, blindness, power, sample size, survival, and informed consent. We recommend that editors set standards for such reporting t...
In addition to using his or her knowledge and skills for treating today’s patient, the clinician has a responsibility to strengthen medical knowledge and upgrade the quality of care that will be available in the future. The ways in which clinicians can make such a contribution include devising clinically relevant descriptive scales, avoiding pitfal...
A modified critical-incident analysis technique was used in a retrospective examination of the characteristics of human error and equipment failure in anesthetic practice. The objective was to uncover patterns of frequently occurring incidents that are in need of careful prospective investigation. Forty-seven interviews were conducted with staff an...
Right stellate ganglion block performed 24 times in 17 patients decreased heart rate from a mean resting control value of 86±5 (SD) to 72±4 beats/min. This difference was statistically significant (P<0.01). It is noteworthy, however, that the stress to the patient involved in the performance of the procedure transiently increased heart rate prior t...
Two indices of postoperative morbidity, Nursing Assessment Index and Observed Treatment Index, are described and evaluated in this study of 4,182 consecutive anesthetics. The use of these indices in studies of the quality and effectiveness of surgical and anesthetic care should increase the economy and precision with which the causes of unsatisfact...
A review of 182 cases from the U.S. National Halothane Study showed the interval to the onset of jaundice after one exposure to halothane (91 cases) to be slightly shorter than the interval for those having had multiple exposures to the agent. These findings are in sharp contrast to other recently published results. Thirty-three cases of jaundice a...
Citations
... [182][183][184][210][211][212] Results from RCTs remain a reference standard for many clinical care and research questions. However, RCTs are costly, time-and resource-consuming, cannot address all pertinent clinical areas of uncertainty because of resource limitations, 174,194,[213][214][215][216][217][218] and impact clinical care slowly and incompletely. 5 As a complement and addition to needed RCTs, many clinical questions and challenges could be effectively addressed with valid study designs in a learning healthcare system with data generated through routine clinical care. ...
... However, these systems have been shown to be poor predictors of clinical events and outcome. 21,[29][30][31] Quality of life is used as an outcome measure when studying chronic disease states, such as CAD, and when evaluating treatments that may prolong life while concurrently increasing morbidity. [32][33][34] CABG may increase the life span of selected patients with CAD; however, patients remain ill with progressive chronic atherosclerosis. ...
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... Bone mineral density remains an indirect indicator of osteoporosis and fracture risk. 23 The addition of a validated risk factor tool such as the FRAX calculator improves assessment accuracy of a person's risk for a fracture over the BMD alone. 24 FRAX has been validated as a predictive tool for bone fracture in the general population but does have limitations. ...
... Thus, the study was underpowered. It is likely that the statistically significantly higher assignment marks achieved by embedded workshop attendees compared to non-attendees is partially due to volunteer bias, whereby study participants tend to be more motivated ( Troidl et al. 1991). Despite this, attendees also achieved statistically significantly higher assignment marks in comparison to the control group, indicating the effectiveness of the embedded workshop intervention in improving academic writing, over and above the potential effects of higher motivation levels of embedded workshop attendees. ...
... We established mixed-effects models, controlling for potential confounders to estimate each child's growth trajectory at monthly intervals. The mixed-effects model is the extension of typical linear regression analysis, which includes random effects in the structure of the mean rather than only fixed effects, and can effectively handle repeated measurements data 23 The response variable y ij was either the weight or length measurement. The following variables were included as independent variables: Age (polynomial age/month), Group (children's exposure condition; 1 = syphilis-exposed, uninfected, 2 = unexposed, uninfected), Sex (children's sex; 1 = boy, 2 = girl), (Group × Age) and (Sex × Age) interaction terms, and other covariates X (maternal education, family income, and underweight at birth), with the random effects on intercept and Age. ...
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... For outcome assessment as second primary endpoint in a hierarchic order, the McPeek recovery score was used. 16 Patients were assigned a total McPeek score of 1 to 9 points based on mortality (1 point for mortality in the operating room or 2 points during hospital stay), amount of critical care (4 or 5 points), and duration of hospitalization (7 to 9 points). Hospitalization was defined as short duration (less than 8 days ϭ 9 points), average (8 to 12 days ϭ 8 points, and long (exceeding 12 days ϭ 7 points). ...
Reference: Ref45-RCT-GCSF-Surgery
... The ethical responsibilities could be limited into two main aspects; (1) knowledge of collecting data methods, (2) values and behaviors during collecting data (Pupovac et al,. 2008;Smith, 2003;Stern & Elliott, 1997). Having knowledge about the various methods according to research methodology and recognize the use of each is essential, the choice of the appropriate method vary according to the methodology and questions of the research. ...
... Thus, this information may be considered in preparing a new research article. 18 This meta-analysis included 10 articles on the prevalence of drug-induced GE. The articles were evaluated for the risk of bias. ...
... It has also been argued that case studies tend to reflect the bias of the researcher, who is the primary instrument of data collection and analysis. Hoaglin et al. (1982) maintain that the value system of the author tends to influence the presentation of the facts as well as analysis, and the usefulness of a case study can be influenced by the value system of the reader, who tends to remember results that support his/her values , rejecting the others that do not fit as neatly. Bias can also enter into th ...
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... These CP children were randomly assigned to either receive or not receive stretching treatment according to an odd-even principle from each age group according to the previous studies. [20][21][22][23] For CP children in the same age group, an odd visiting sequence was used for the AFO + stretching group and an even visiting sequence as assigned to the static AFO group. Usual physical therapy was required. ...
