C-Reactive Protein and Charcot

[whiskers]

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This month's JAPMA featured an article, from what I gather after reading it, about using C-reactive protein as a screen for charcot foot. (It was the 1st article that was in the journal so I read it first.)

A few, of about a hundred, questions/comments relating to this "little gem"

1. Charcot has multiple origins and the title accomodates this fact... but the article is clearly about diabetic pts w/ charcot. Uhhh mmm OK I had to figure that out by reading the first couple of paragraphs. Editors?

2. The article mentions C-reactive proteins being measured, but fails to mention what assay they were measured with and at what interval, both of which, from my limited knowledge of medicine (as a D- student) seem quite important when assessing these markers... and were measures taken to adjust normal values to the pt population being considered or is this just read it and weep nite at the hospital??? This is not to mention that CRPs should be assessed, from what I understand, (as a D- student) as a trend and not as a single event. Ie is the trend going up or down over this period of time...

3. What about false positives or even F. negatives??? Are not diabetics are notorious for manifold conditions ranging from atherosclerosis to increased adipose that all increase c-reactive proteins? Was this accounted for and are they really ideal candidates for this type of screening test without substantial room for error. What is the room for error?

4. Patient selection and background information were not given. Smokers?? Obese?? Male/female?? etc

5. 7 patients??????? It's a good start I guess.

My conclusion, will remain mute but I will ask these questions:

If we D- (GPA) docs, and future docs alike, like myself are to use CRPs as a screening test, how is it that we are to reproduce this gem of a study as a guide?

Do we simply take 1 sample, use a divination rod to assess the CRP level and say yup, the CRPs are high, ya got there an N-fection in you foot. And if the CRPs are low on another day and patient using a souped up electric nail grinder to asses the CRPs are we suppose to say, Yup, ya gotchaself chared-coal foot?

Honestly, what is the METHOD and how exactly do we interpret these results from this study?

And I don't want to hear ya got ta look at the other clinical evidence that occupied a nice size of the article... because that is kinda what we do in the first place, isn't it and if someone is proposing another method, shouldn;t they clue us in to the methodology, practicality and what the negatives and positives of the whole thing are?

In my D- opinion I that CRPs are poor choices for use in SCREENING diabetics period. Although I feel that they are useful clinically, I feel that more serious investigation needs to be done before I would think it was a good idea to clarify perameters and assessin interpretation in subset populations such as diabetics. Step right up and get screened for evil CRPs. Yikes.

I am all for big sophisticated sounding studies and mixing key words and trends in medicne together, but....

Anyway, I am now reading something else (Cat in the Hat) and wishing I were a D+ student so I could actually understand what it meant

plus as a D+ student I could finally count as a person; a real human be-an.

 

[Feli]

I agree that JAPMA is pretty hit or miss and most articles have fairly small patient populations, but there certainly are still some good articles that you can learn from. I haven't read that CRP-Charcot article yet. I'm usually a lot more impressed with the articles in JFAS and FAI. I tend to prefer those in my limited reading time, and you probably would too.

In the end, the best way to improve podiatry's reasearch is to contribute to it. Criticizing it really doesn't accomplish a whole lot. A lot of the mediocre articles keep making the journal since they are the best submissions that they are getting. There's only one way to fix that...

 

[whiskers]

In my opinion, I've seen mediocre high school science fair projects that were better than some journal articles...

My opinion on journals: I.e. more than one way to increase the IQ of a journal.

1. Don't publish gibberish just to have a journal. IMO if hideous articles are being published in any publication, it may just be that the publication is being published way too frequently and there is just not enough going on in terms of original ideas in the field. Cut the publication back to every other month or even once a year if it is that bad.

Crap articles should not be published period. It embarasses the profession in my opinion. When something hideous is published, there should be a natural uproar within the community, especially at the academic level. Letters should be fired off to the editor lamenting the waste of paper.

Personally, I'd rather receive one well-authored article in a journal for an entire year than be swamped with month after month of useless gibberish/garbage that gets tossed in the trash in order to find that one article that was well authored."

2. Academic criticism, in the primary form of strict PEER REVIEW, does indeed increase the 'IQ' of any journal as well as the entire profession. Some of the most well respected medical and professional journals are also the most critical and it is high time, in my opinion, that Podiatry demands higher standards from it's "academic" journals. It sends a clear message to poor authors when their half arsed work is not even considered for publication or sent back with a note that states, "shame on you, don't waste our time again."

3. The authors of garbage should not get any credibility based on their published balderdash. There is a subset of the academic population in any field that uses 3rd rate journals seemingly to promote their own self-esteem and advance in rank among simpletons. I think that the question is, which journals want to be considered 3rd rate (we'll publish anything) and which authors want to submit their decent works to those same places.

 

[OSUDDS]

i don't know what school you go to, but if youre at mine D's don't get degrees

 

[whiskers]

And just what did you get your school for Valentines Day?

I'm thinking of getting my sweety, Moon Boot P.U., a bag of cat's litter.

lol

 

[OSUDDS]

ill go halfsies

 

[densmore22]

I haven't received the most recent JAPMA yet, but just out of curiosity on this. Did the article state whether to obtain a CRP to determine WHEN a "flare up" might occur or did they say to use it to diagnose Charcot? Because why would you order a test if you already knew it was going to be positive? Yes, you can use it temporally to measure if someone is getting better or not, but still, that's USUALLY (not always) how a CRP is utilized in clinical practice, in my understanding (I got a C-, HA! Whiskers).

 

[whiskers]

The substance of any good article never comes down to a single word such as when, if, but etc. If I happened to miss one if or but or when at the end of the article I appologize, I never made it that far... for obvious reasons.

Regardless of initial premise which seemed interesting enough (that I clearly will never go back and reinvestigate via this article) the entire substance of particularly the design, execution and authorship of the article struck me as somthing I once read at an 8th grade science fair that received a d-.

I just can't imagine how some things get published and the standards should be at least 13 academic grades higher esp in an academic journal; in my opinion.

If somoene doesn't know how to conduct a study or how to do even mediocre research, they should at least consult a high school science teacher for help long before the submission deadline.

 

[OSUDDS]

FORESIGHT: It Never Hurts to be Prepared

 

[whiskers]

All that guy needs now is a journal article in his hand with the caption

"Publishing Poor Research has Never Been Easier."

Awesome pic and very fitting! A+

 

[OSUDDS]

lol thanks

if i didnt have exams next week i might photoshop that...

maybe the week after