Where are all my charts?

Ah the joys of research!
I have been working a ton lately and have not had much time for traveling. Oh the real world...
As a Fogarty Scholar I am doing cardiovascular disease research in Peru and despite not blogging a lot about it, my fantastic readers, today is your lucky day - I have something to blog about that's related to work! My work usually consists of spending a lot of time on my computer plugging in equations into STATA, making tables, re-making the tables 50 times because we keep changing the the methods and research question, searching PubMed for references, reading PDFs and highlighting them on Skim (a much better PDF program than Adobe or Preview and it's free), writing manuscript drafts, and Skype-ing with my mentors in the states. In the past month, I have spent more time on buses going to a from work than I have spent eating and exercising combined (sad, I know). I often take the bus over an hour each way to Cayetano hospital, tracking down doctors on the medicine wards and shadowing them until the have time to talk with me for 20 minutes and then take the bus an hour back.

I am excited to tell you about my new study: a retrospective chart review study looking at in-mortality after cardiovascular disease events. I am hoping to show a difference in in-hospital mortality between men and women and describe the factors that are strongly associated with mortality after a cardiovascular event in this population. My goal was to review 600 charts based on my sample size calculation and 10% missing charts, which meant we would review all the charts from 2005-2009. Luckily I have a partner-in-crime, the amazing Jennifer Milla.

She is a recent Peruvian medical school grad (so jealous), aka doctora, who is applying for residencies in Spain. We were supposed to start data collection 3 weeks ago but due to IRB delays and people being out of town when we needed their signature, we did not get approval to start until last week.

Soooo excited to have my first project stamp of approval!

That's when the trouble started... first, I did not exclude all the duplicate medical record numbers so in my list of 600 I only have 518 unique entires. Second problem, due to the large number of missing charts I'll be very happy if we get 450 (but realistically we will probably have around 400 - fingers crossed...). Third, our most recent pitfall is that the woman in charge of the charts, Senora Julia, refused to pull our charts last week and now will only give us 10 charts per day as it's "too much extra work" for her staff AND they will only look for them after 4:30pm! The hospital is not in the best neighborhood and leaving after dark is not a great idea for Jennifer or myself. Julia refuses to let us pull our own charts... oh how I wish they have electronic medical records! So at this rate we have officially completed 32 questionnaires and won't be done until July (and I'm leaving at the end of May) and that doesn't include the time it takes to enter the data. Oh well... we'll figure it out and we may just need to bribe someone so we can get it done. Welcome to the wonderful world of research!

Overall, it's a great experience and I find that I really only learn from my mistakes anyway (I hate how that works). I have enjoyed setting up my own project, writing protocols and ethics approvals in English and translating them to Spanish and then back to English again after they changed a dozen times. Thank goodness for Jennifer, who recently completed a thesis to graduate from medical school, who knew all the hoops we needed to jump through, like what little old lady behind the counter in the convenience store across the street from the University who you have to pay $1 to write the "official" cover letter presenting our protocol to the ethics boards and where the chief of medicine's office was and where he has coffee to track him down. Between our meetings and training Jennifer to do the chart abstraction my Spanish has really improved. We talk on the phone but we find text messaging and email to be a little easier as I still have a hard time discussing anything besides, "Where are you?" "What time are we meeting?" and "I'd like that chifa delivered, my address is...".
Learning what hoops to jump through in both the US and Peruvian systems had been very interesting and I find being flexible and having other projects to work on alongside is really the only thing keeping me sane yet a little crazy too because I am swamped with work right now. I enjoy going to rounds at the hospital in the AM and seeing a 39 year old patient who looked like she was in a concentration camp and weighed about 60 lbs. She has severe toxic thyroiditis where her body makes an anti-body to the TSH receptor and her thyroid is SUPER overactive and so her metabolism has increased and she is basically skin and bones. I don't think I will EVER see that again.
Medicine clinic waiting area

Basically, I am working on eight or so projects with four different groups/studies and have three IRB approvals (the bane of all researchers existence - especially in global health) and am waiting on one more for a total of four (the most that any Fogarty in Peru has had before me was two). I had one paper accepted in Diabetes Care and one abstract accepted, which I will be presenting at the World Congress of Cardiology in Beijing in June. The same abstract we are revised and are resubmitting next week to Atherosclerosis on carotid-intima media thickness in this population. I think it has been a very successful year and I'm happy to have accomplished most my goals, namely learning Spanish.
Cayetano
I'm standing in the middle of the street and on one side is the Cayetano University and hospital, on the other, a funeraria with a hearse parked in front. How morbid...



Adios!