Graph Quality in Top Medical Journals.

STUDY OBJECTIVE: Well-designed graphs can portray complex data and relationships in ways that are easier to interpret and understand than text and tables. Previous investigations of reports of clinical research showed that graphs are underused and, when used, often depict summary statistics instead of the data distribution. This descriptive study aims to evaluate the quantity and quality of graphs in the current medical literature across a broad range of better journals. METHODS: We performed a cross-sectional survey of 10 randomly selected original research articles per journal from the 2012 issues of 20 highly cited journals. We identified which figures were data graphs and limited analysis to a maximum of 5 randomly selected data graphs per article. We then described the graph type, data density, completeness, visual clarity, special features, and dimensionality of each graph in the sample. RESULTS: We analyzed 342 data graphs published in 20 journals. Our sample had a geometric mean data density index across all graphs of 1.18 data elements/cm2. More than half (54%) of the data graphs were simple univariate displays such as line or bar graphs. When analyzed by journal, excellence in one domain (completeness, visual clarity, or special features) was not strongly predictive of excellence in the other domains. CONCLUSION: Despite that graphs can efficiently and effectively convey complex study findings, we found their infrequent use and low data density to be the norm. The majority of graphs were univariate ones that failed to display the overall distribution of data.

Assessing severity, immediacy, and ideal setting in ED patients: a pilot study on interrater reliability.

OBJECTIVES: We conducted a pilot study to test the interrater reliability of emergency department (ED) physician assessments of 3 ED visit attributes-severity, immediacy, and ideal setting, with the long-term goal of developing a novel ED categorization system. METHODS: Using 2010 National Hospital Ambulatory Care Survey data, we randomly selected 300 ED patient records for review by 6 emergency medicine physicians. Each record was assessed by 2 physicians for severity and immediacy using a 7-point scale; "ideal" setting was chosen among 6 possible settings. κ-Weighted and unweighted-and interclass correlation coefficients were used to test interrater agreement. RESULTS: For severity, immediacy, and ideal setting, there was "fair" agreement in assessments with a weighted κ of 0.33 (95% confidence interval [CI], 0.27-0.40), 0.30 (95% CI, 0.23-0.36), and nonweighted κ of 0.28 (95% CI, 0.21-0.34), respectively. When both raters were "very certain" about their assessments, weighted κ increased to 0.42 (95% CI, 0.34-0.51) for severity and 0.35 (95% CI, 0.27-0.44) for immediacy. Interclass correlation coefficients showed similar results. There was agreement on ideal setting for 162 (54%) of 300 scenarios. Scenarios with poor agreement on ideal setting in general involved care for nonspecific symptoms rather than specific diagnoses. CONCLUSIONS: Rater agreement among ED physicians when assessing clinical data on specific ED visits was fair for severity and immediacy ratings. Raters agreed on ideal treatment settings half the time. In general, there was greater agreement when a specific diagnosis was found rather than negative workups for symptoms. This demonstrates a validity issue when it comes to developing and using categorization systems for ED visits and assessing setting appropriateness.

Mouse model of OPRM1 (A118G) polymorphism has altered hippocampal function.

A single nucleotide polymorphism (SNP) in the human µ-opioid receptor gene (OPRM1 A118G) has been widely studied for its association in a variety of drug addiction and pain sensitivity phenotypes; however, the extent of these adaptations and the mechanisms underlying these associations remain elusive. To clarify the functional mechanisms linking the OPRM1 A118G SNP to altered phenotypes, we used a mouse model possessing the equivalent nucleotide/amino acid substitution in the Oprm1 gene. In order to investigate the impact of this SNP on circuit function, we used voltage-sensitive dye imaging in hippocampal slices and in vivo electroencephalogram recordings of the hippocampus following MOPR activation. As the hippocampus contains excitatory pyramidal cells whose activity is highly regulated by a dense network of inhibitory neurons, it serves as an ideal structure to evaluate how putative receptor function abnormalities may influence circuit activity. We found that MOPR activation increased excitatory responses in wild-type animals, an effect that was significantly reduced in animals possessing the Oprm1 SNP. Furthermore, in order to assess the in vivo effects of this SNP during MOPR activation, EEG recordings of hippocampal activity following morphine administration corroborated a loss-of-function phenotype. In conclusion, as these mice have been shown to have similar MOPR expression in the hippocampus between genotypes, these data suggest that the MOPR A118G SNP results in a loss of receptor function.