Statistics 101

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Fowl_Language

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Bobby,

Have you even thought about what you suggested? No, the Le article is not prospective, randomized, double-blind, and the response rate/quality is certainly questionable. You try to insult me for suggesting some background reading (which based on the way you were talking, seemed well-justified) instead of taking a step back, having a little breather, and reminding yourself of the original issues at the root of this debate. To summarize, OMFS is an emerging specialty; there are many, many driven individuals who are willing to sacrafice the entirety of their adult lives to surgical training. Over time, boredom sets in and the need for professional progression and expansion ensues: what you call "arrogance" and desire to "prove something" is what, I would argue, is how the enthusiasm and excitement of an emerging specialty manifests itself. These guys are driven to do trachs. So what. Fifteen years ago, when resedencies were two-three years, their predecessors didn't even have those opportunities. They've got a right to be excited, and as I see it, they've got a right to show that they can manage those cases to the previously established standard of care (set forth by many generations of territorial knife-jockeys like yourself). Seriously. Take a step back and look at what we do: we're surgeons. We're the monkeys of the medical community; all of us - whether it's ENT, plastics, or OMFS. You say cut, we think for a bit and weigh the options, and then we cut. It would be at least halfway comprehensible if some endocrinology fellow got on here and started calling us a bunch of flint-stone wielding cavemen, but to hear it from someone who's allegedly within that circle of surgery just doesn't make sense.
No matter what kind of surgeon you are, or aspire to be, you're still a surgeon and for the most part, that's still a very, very primitive way to cure disease. Don't get me wrong, I love what I'm getting into, but I also like to believe that I'm a little more grounded than you. The next time you swing a scalp flap, pec flap, and RFFF to close up some gnarly ablative cancer defect, take a step back and look at that final product and tell me there's not a thousand people around the country doing the same thing. That little pearl of medical knowledge you guard so dear is really common knowledge; anyone can be trained to do it, even a "dentist." ENT and plastics are more established specialties; no question. The history, tradition, and literature is much deeper than OMFS. To carry out a RCT on the subject you suggest is pointless, unless your point indeed is to "prove" who handles procedure X better. As a whole, a greater percentage of ENTs are "better" with the acute airway; as a whole, a greater percentage of plastics are "better" managing the SMAS, and yes, as a whole, it's reasonable to assume that a greater percentage of OMFS is probably "better" with orthognathics and mandibular trauma. Those are all reasonable hypotheses. The thing this multi-center RCT (aka. professional jihad) of yours won't tell you about are the outliers, the "trend-setters" who are paving the way for progression within their field. As an example, the chairman where I'm going is probably as (or more) competent in thyroid surgery than many ENTs (mainly the one's who've been rendered to the mundanes of otology). Somewhere out there, I imagine there's a plastic surgeon, a good one, who's learned to incorporate orthognathics into his rhinoplasty cases. Likewise, there's probably a handful of ENTs who manage cleft lip/palate as well, or better than any OMFS, despite not having the word "oral" anywhere in their professional title. The Le study is not perfect and most literature is garbage, but it's a good starting point. You, of all people, should appreciate how difficult it is to conduct a multicenter RCT. Any review board is going to laugh at you for trying to start a study like that de novo; and for what reason... to satiate your fragile professional ego. Bottom line, we're all doing the same procedures and we all have the same access to the literature. Nothing within the realm of surgery is that difficult; it just takes some experience, and we're all more than capable of performing each other's jobs. Just focus on what you do; enjoy your time doing it, and more importantly, enjoy you're time when you're not doing it. Getting all caught up in this garbage is a waste of everyone's time. If feel bad for all you white-coats who walk big and talk big like your some sort of gift to the common-man. Truth is, the moment one of us surgeons retires (or expires), there's a line of residents waiting to fill the void and nobody will miss us when we're gone.
What makes you so special (as an individual or a discipline)?
Keep it real! Booyakasha!

And PS... you seem quick to jump on reseach biases, but you've continued to evade informing us of your own personal biases: again, what specialty do you belong to and where do you train? It is a fair and reasonable quesiton.

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Bitters said:
Somebody needs to get laid :laugh:
Yeah, I really should. Oh, wait.....you weren't referring to me, were you?!?
 
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Bobby6 said:
Now if theere were a prospective study that randomized each facial trauma patient to either ENT, OMS, or Plastics, blinded the patient to which service performed the repair, and then assess the degree and number of complications along with patient statisfication, all this while blinding both the investigator and the patients, then that study would have a high degree of evidence and power.

On another note - maybe you should review what power actually means statistically. Strictly speaking, power has very little to do with the study design (cohort, case-control, RCT) - and more to do with standard parameters like alpha, the sample size, the magnitude of the difference you are trying to observe, and the type of statistical test used to analyze the data (i.e. parametric versus non-parametric, multiple comparisons procedures, etc.). There are plenty of crappy RCTs that are much less powerful than properly analyzed retrospective cohort studies. Don't get me wrong - RCTs are the gold standard, but only if they are done properly and analyzed correctly.
 
Bitters said:
Somebody needs to get laid :laugh:

Reads more like someone who is on meth and "twinking out" on medical/dental issues
 
Come on guys. I never insulted Oral surgery. Reread all the things I wrote. I have much respect for them and I work along side them and Plastics every day alternating facial trauma call. We consult oral surgery all the time with our head and neck cancer patients for teeth extractions before they undergo radiation therapy. Per our trauma contract, all isolated mandible fractures (meaning there are no other facial fractures) go to them and all isolated nasal fractures come to us no matter who is on facial trauma call. If it is a fac lac or Leforte fx with either nasal or mandibular fx then it goes to whowever is on face call. I never said they weren't competent in what they do and I have no problem with them doing whatever they are qualified to do. The oral surgery guys at my hospital are cool as hell and we get along fine. Its when you start insulting other specialties and stating that oral surgeons are superior to ENTs or Plastics is when you get into these battles.

And to the previous poster, I know well what statistical power means, I rather not turn the post into some kind of thesis to explain every minute detail.

Can't all get along like the guys in the picture below? Seriously.

gayasthis7yl.jpg
 
toofache32, you're funny as hell. It would be awesome to work along side you. Keep the pictures coming! :)
What other pictures you got?
 
bobby6 said:
toofache32, you're funny as hell. It would be awesome to work along side you. Keep the pictures coming! :)
What other pictures you got?
Ummm...just OMFSCardsFan's mom in the bathtub, stuff like that... :eek:
 
OMFSCardsFan & TXOMS after a hard day of whiffle-ball

 
toofache32 said:
Ummm...just OMFSCardsFan's mom in the bathtub, stuff like that... :eek:
Only you rich guys can afford the wide angle lens...bastards...
 
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