careers in research - mcgill
TRANSCRIPT
My Careery
• The ImageThe Image– Controlled, organized, coordinated, planned
• The reality• The reality– Calculated chaos
– M13 globular cluster
– 25,100 light years
– 100,000 stars
CareerCareer
• Grew up in Oxford – went to London –vascular surgery & medicine and then became a GP
• As a resident (1983) I had 3 months to do an audit or a research project
• I read about Geoffrey Rose and started to ybecome interested in epidemiology
• “the priority should always be the discoverythe priority should always be the discovery and control of the causes of incidence.”
Doing FirstDoing FirstObesity causes problems
Questionnaire and weighing
GP registrar
Hand delivered the envelopes
Examined all patients myself
E h i h h k l dEnthusiasm much greater than knowledge
Many missed opportunities
B t d t i i f thBut good training for marathons
Obese people are sickerObese people are sicker
• The prevalence of obesity was 21 per cent forThe prevalence of obesity was 21 per cent for males and 22 per cent for females.
17% difference17% difference
CareerCareer
• 1983‐1992 full time GP 1700 patientsp
• A full time family physician makes 2,500 diagnoses per year.
• Covering 450 separate conditions.• Prescribing 833 different drugs as
part of a total of 20 000 prescriptionspart of a total of 20,000 prescriptions per year.
• So I put in an electronic record
Weight GainWeight Gain
• Why do women I refer with low weight gainWhy do women I refer with low weight gain have normal weight babies?
• Career: Mentor Geddes Grudzinskas guided• Career: Mentor ‐ Geddes Grudzinskas guided me through my PhD
H l d l i h l l• Helped me learn to write at another level
• Helped me design questions
• Helped me get my first grant
Ambulatory BP MonitoringAmbulatory BP Monitoring
A&D TM2420 (version 7)A&D TM2420 (version 7) ambulatory blood pressure monitors
Do they predict mortality better than office BP
Career – Lecturer in Department
10OXAM Study Results 2006 Summary
Career 1992‐Career 1992
• Start a research networkStart a research network
• Start a research course for GP’s
h h G ff• Meet the teachers Geoffrey Rose, Ian Chalmers, Jonathan Mant.
• Start a masters with David Sackett
Hazard ratios (95%ci) by systolic blood pressure adjusted for age and gender, and stratified by
cohort (I)
This steeper gradient This steeper gradient of hazard ratios of hazard ratios through the rangethrough the rangecohort. (I) through the rangethrough the rangeindicates that ABP is indicates that ABP is a stronger predictor a stronger predictor of mortalityof mortality
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White Coat Compared to Uncontrolled Hypertension
• Item HR p 95% CI
• WCH 0.62 0.02 0.41 to 0.93
• Adjusted for the following:
G d 1 79• Gender 1.79
• Age 5y 1.62
• Smoke 1.50
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CareerCareer
Wrote a textbook on EBHC
Run Centre for Evidence Based Medicine
Move to Canada (more research dollars) and become Chair of the
departmentdepartment
Involved in 10 research projects but PI on only two.
Night time BP dip – not so i t t i i ?important in primary care?
• Hazard Ratio P 95% CI
• Gender 1.57 0.005 1.14 to 2.15Ge de 5 0 005 to 5• Age (5yrs) 1.63 0.000 1.49 to 1.78 • Smoking 1 45 0 022 1 05 to 1 98• Smoking 1.45 0.022 1.05 to 1.98• Day ASBP
(5 H ) 1 06 0 001 1 02 t 1 10• (5mmHg) 1.06 0.001 1.02 to 1.10• BP Rx 0.95 . 0.748 0.70 to 1.28
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• Non Dip 1.00 0.998 0.71 to 1.39
The most common question asked by a h lth f i l i h t i thhealth professional is what is the cause
of this symptom
• 410 patients questionnaires over 3 months.
( )• 202 patients (52.9%) reported 790 symptoms.
• Patients had 3.9 symptoms/patient (sd 3.5)
• 52.8% of patients coming for a chronic disease check had symptomsy p
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Taking BP over a shirt sleeveSmall difference
• Bare arm bare arm Bare arm Sleeved
• SBP1 138 5 137 9SBP1 138.5 137.9
• SBP2 134.3 134.5
• Diff 4.1 3.4 0.76mmHg
Forest plot of the results of all studiesForest plot of the results of all studies examining effect of sleeves on BP
Holleman et al 1993 n=36 1.70 (-5.30, 8.70)
Kahan et al 2003 n=201 0.54 (-0.49, 1.57)
Leibl et al 2004 n=201 1.00 (-0.20, 2.10)
SHIRT study 2007 n=376 0.76 (-1.13, 2.65)
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Some On Going ResearchSome On Going Research
• We need one guideline per patient not perWe need one guideline per patient not per disease
• Pharmacogenetic based prescribing in primary• Pharmacogenetic based prescribing in primary care
D l i li i ll l h i f• Developing a clinically clever search engine for NLM
CareerCareer• Teacher, Researcher, Administrator –
l l h l l k f• Run a Clinical Unit – I help look after 377 patients 44 of whom have diabetes.
• MUHC: Team of >200 admin staff, doctors, nurses
• Univ: Team of >400 researchers, teachers & ,admin staff
• Home life: we sail scuba dive ski play music & IHome life: we sail, scuba dive, ski, play music & I still run but only 15 to 20 miles per week and watch starswatch stars