Nurturing a Research Mindset

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Raja Selvaraj, JIPMER

What this talk is about

The Clinician - Researcher dichotomy

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  • I am a clinician, not a researcher
  • Busy practice with little additional time
  • Not necessary outside academic practice

Why

Good Clinical practice is a form of research

  • Find best way to treat a patient (systematic review / metaanalysis)
  • Find reasons for gap between evidence and practice (implementation research)
  • Fill evidence gaps (Retrospective review of data / prospective study)
  • Help others learn from your experience (publish)

"Hidden" outcomes revealed by registries

  • Hidden outcomes can blur clinical judgement
  • Sudden deaths in patients post myocardial infarction
  • Mortality in RHD patients on anticoagulation

100 patients post MI

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At 1 year, Angina -> PCI

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Angina -> CABG

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Worsen -> Death

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Remaining on medical management

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Sudden death. "Hidden" from clinician

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How

Evidence based medicine

"Integrating individual clinical expertise with the best external evidence" - David Sackett

Stay Curious, Stay Disinterested, Stay Sceptical

Maintain records

  • Handwritten records
  • Spreadsheets
  • Full fledged EMR

Quantify what can be measured

  • Qualitative information may be useful in situations
  • But quantitative information lends itself better to analysis
  • Key performance indicators

Promote research in medical curriculum

  • Undergraduates should learn research
  • Changing trend

Examples

Records at JIPMER

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KPI for JIPMER EP

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Sedation for EP procedures

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Reuse of CIED

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Computerized Heart Failure Clinic

  • Multi-disciplinary clinic for patients with heart failure
  • Computerised algorithm driven suggestions to promote evidence based rules
  • Limited clinic capacity
  • Options - First come, first serve / Historical controls / RCT

Paul Wood 1907-1962

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Paul Wood

  • Learn from meticulous and scientific evaluation of each case
    • Described ihss without surgical / pathologic correlation
    • Described acyanotic fallot
  • Measure everything
    • Grading for effort tolerance
  • Maintain and collate data
    • Graph of effort tolerance in ASD
  • Filter / sort
    • Index cards with punch holes

Clinician - researcher ahead of his time

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Rheumatic heart disease - AF and embolism

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Paul Wood's system

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