To ascertain the perceived skills of students at U.K. medical schools in palliative medicine. Design: A validated questionnaire survey. Participants: Newly qualified U.K. pre-registration house officers (PRHOs). Measures: A Likert scale from 0 to 5 for respondents to rate their perceived skills in four clinical scenarios, and their anxiety in caring for the dying. Results: Mean confidence rating in breaking bad news was 2.9, in ability to empathize was 3.2, in discussing prognosis was 3.3, and in providing symptom control was 2.8. Mean anxiety rating in caring for a dying patient was 2.9. Of the comments, 24% wished for more "hands on" experience and 23% suggested further curriculum recommendations. Conclusion: Teaching of palliative medicine is still inadequate for the needs of recently qualified doctors. Although PRHOs have identified a need for further instruction there is also acknowledgment that it is a difficult subject to teach. Recommendations are made for coordination of current interdepartmental teaching programs. medecins nouvellement recus, Meme s'ils ont identifie la necessite d'avoir plus de cours sur Ie sujet, ils ont d'autre part reconnu que c'est un sujet difficile a enseigner. On recommande done, entre autre, de COordonner au niveau lnterdeparternental les programmes d'enseignement couramment dispenses.

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It is commonly held that a normal electrocardiography (ECG) rules out heart failure (HF). In older populations with HF, 98% of patients have been reported to have major ECG abnormalities. Anecdotally, young patients with HF have been noted to have ECGs without major abnormalities. The aim of this study was to determine the proportion of patients aged under 65 years with HF lacking major ECG abnormalities. Data were collected for 100 consecutive admissions with HF (aged ,65 years) with echocardiogram and ECG available. ECGs were independently assessed by two cardiologists; disagreements were resolved by a third. Ejection fraction was quantified using the biplane Simpson's. Majorly abnormal ECGs contained !1 of Q waves, left ventricular hypertrophy, bundle branch block or atrial fibrillation. Minor abnormalities of ECG also recorded; these included atrial enlargement, bradycardia, tachycardia, broadening of QRS complex, poor R wave progression, left/right axis deviation, first-degree atrioventricular block and non-specific ST-T wave changes. The mean age was 50.0 years. Seventy-six had major abnormalities on ECG, 22 had minor abnormalities and two showed no abnormalities. Ejection fractions were similar across all groups (28.6 + 2.8%, 28.4 + 3.4% and 25.5 + 6.9%, respectively). Twenty-four percent of patients with HF (aged ,65 years) do not have major ECG abnormalities. Patients aged ,65 years with a clinical suspicion of HF but without major ECG abnormalities should undergo further investigation.

Coincidental correlations are useless for making predictions. In order to predict something, it has to be predictable; there must be an underlying causal structure—a real reason for the correlation. Correlation without causation mean predictions without hope. Causation can be demonstrated by a randomized controlled trial (RCT) in which there is both a treatment group and a control group, and in which the subjects are randomly assigned to the two groups. There should also be enough data to draw meaningful conclusions. A/B tests are essentially RCTs for the Internet. Unfortunately, we often cannot do RCTs. We have to make do with observational data. A valid study specifies the theory to be tested before looking at the data. Finding a pattern after looking at the data is treacherous, and likely to end badly—with a worthless, temporary coincidental correlation.