Discover and read the best of Twitter Threads about #EBM

Most recents (19)

This response by @mlipsitch to my @BostonReview #COVID19 piece (bostonreview.net/science-nature…) provides a fascinating (and philosophical) look inside epidemiological thinking at a time when understanding the science is crucial. Some thoughts... 1/
I still argue there are different ‘philosophies of science’, one represented by orthodox evidence-based medicine (#EBM), other by the pragmatic, pluralist epidemiological epistemology explored in @mlipsitch's piece. This is a description, not an endorsement of the dichotomy. 2/
Again, this an exception-ridden generalization, not a hard division. It describes different ways of thinking one may adopt. It’s not like there is a two-party system in epidemiology and epidemiologists register with one of these two parties. 3/
Read 11 tweets
1/34 Okay #medtwitter #epitwitter , read on for an #EBM #Tweetorial on p-values, with specific attention to the implications of the recent remdesivir trial with p=0.059 for mortality (full report still not published, which is not ideal …).
2/ This is a follow-up to my prior #EBM #Tweetorial on diagnostic test performance study design
3/ Again, who am I to do this? My PhD is in #biostatistics, I direct the @MayoClinicSOM #EBM curriculum, and I teach Bayesian Diagnostic Testing Strategies @MayoGradSchool @MayoClinic @MayoMedEd @MayoFacDev.
Read 34 tweets
#CHEST bronchoscopy guidelines fir #COVID19 patients. The 6 statements in a thread .. #MedEd #FOAMed #MedTwitter #StaySafeForScience #EBM #CriticalCare journal.chestnet.org/article/S0012-…
1-Use full #PPE and #n95Masks with confirmed and suspected #COVID19 cases undergoing #bronch.
2-Check nasopharyngeal swab test for #COVID19 first, if more deep samples are indicated, bronch + BAL can be performed.
3-Use #n95Masks during #bronchoscopy procedures to asymptomatic patients in areas with #COVID19 community spread.
4-Test patients for #COVID19 prior to #bronchoscopy in areas with community spread.
Read 5 tweets
1/
Welcome to a new @MayoMN_IMRES #EBM #Tweetorial Series!

Content is brought to you by @CourtHarrisMD @Jaegermeister58 & @ColinWestMDPhD. Our purpose: educate on confusing #EBM topics! Engage with us & RT if you find this helpful!

Topic: Clinical vs statistical significance
2/
Let’s get our definitions straight first!

➡️Clinical significance: the importance of the observed effect in practice (i.e., is the magnitude of the effect large enough to affect clinical care)
3/
➡️Statistical significance: p < 0.05 (commonly). This does NOT mean the probability the conclusion is false is <5%!

See this article from @Amstatnews on guiding principles for p-value use (this is a game changer article people): amstat.tandfonline.com/doi/full/10.10…
Read 19 tweets
The past few days have included a lot of thoughtful debate/discussion about #COVID19 and #ARDS, some snark (of which I too am guilty), and a hefty dose of HOW DARE YOU CHALLENGE A MASTER, YOUR RIGIDITY IS KILLING PEOPLE. I have a few things to say. Bear with me as I ramble a bit.
The idea that #EvidenceBasedMedicine does not allow for individualization for specific patients and changes in their clinical courses is a fallacy. Certain concepts that are known to save lives can & should be adhered to in a manner that is appropriate for the individual patient.
I thought this was obvious but that clearly is not everyone’s interpretation of #EBM. Also lung-protective ventilation does not = set it and forget it. Settings needed to maintain LPV will obviously change during a patient's course, something that experienced clinicians know.
Read 13 tweets
1/Many of my colleagues and I have not been redeployed to the hospital during the #COVID pandemic. We have been doing the ambulatory care of pre/non hospitalized patients, helped w admitted pts and starting to see post discharge pts.

Many thoughts/advice points:

A 🧵THREAD
2/ First our #primarycare triage function in this process is crucial.

Workflows/teamwork/infrastructure have to be worked out and optimized.

An updated list of daily follow up #telehealth covid pts must be kept. Day of illness, daily update notes and tracking has to happen
3/ Key points:

Age, comorbidities matter. And yet, there are those healthier patients that get sicker, hypoxemic/stormy as well

Don’t completely know (like so much in this illness) the grouped likelihood ratios for the following but these are things to ask to be complete ..
Read 20 tweets
1/32 Okay #medtwitter #epitwitter , as promised here’s a #Tweetorial on diagnostic test performance study design. Who am I to do this? My PhD is in #biostatistics, I direct the @MayoClinicSOM #EBM curriculum, and I teach Bayesian Diagnostic Testing Strategies @MayoGradSchool.
2/ Yep, this is a little wonkish but really not so complicated. And anyway, when I hear “wonkish” I hear:
3/ BLUF: To date, how many studies of #COVID19 diagnostic tests have been conducted ideally, with fully appropriate measures to minimize risk of bias?
Read 32 tweets
Thread sur le fameux essai clinique dirigé par le Dr D. Raoult où des patients COVID-19 étaient traités par hydroxychloroquine (HCQ)

@qffwffq @MedicusFR @DrGroquik @ContactPrimum @Damkyan_Omega @TroncheBiais @dr_l_alexandre @idrissaberkane @PotardDechaine
#Chloroquine #Raoult
1/ Le protocole et les résultats sont dispo ici : mediterranee-infection.com/wp-content/upl…
2/
Pour résumer rapidement, le but de l’essai était d’évaluer si les prélèvements nasaux de patients traités par HCQ devenaient plus rapidement négatifs au test de détection du SARS-COV2 par RT-PCR que ceux de patients contrôles.
Read 31 tweets
@tavrkapadia delivering @CleClinicMD Grand Rounds. On #TAVR. Starts by showing how morbid and complex the open surgery is. Many elderly patients are not candidate. Hence #TAVR was developed. #meded
The team that ensures ZERO percent mortality in #TAVR for any patient coming to @ClevelandClinic with Aortic stenosis. #meded
Heart is NOT stopped! After #tavr can see immediate hemodynamics improvement!
Read 10 tweets
#medtwitter

I love to provide structure for my learners. A couple years ago I adopted a set of rules for rounds and ward teams. These continue to evolve.

I share them on day 1, and refer back to them frequently while on service.
👇

#TeamRules #MedEd
What are your #teamrules?
Rule 1: We treat patients, not diseases or numbers.

Always always put the disease and number into context for that specific patient. And get to know the patient.

It’s good medicine, and makes the job so much more interesting.

#SDOH #IllnessInContext #EBM
Rule 2: Rounds are done by noon.

Come prepared and we will get the work done together

Stick with the 4 Ds - decompensated, discharges, diagnostic dilemmas, the C Diff patients last. Stop wherever we are at 11:30 and finish running the list.

HT @thecurbsiders ep157

#efficient
Read 7 tweets
1/n #EBM revenons aux fondamentaux. Et en particulier à l'article, au manifeste initial du groupe de travail sur l'EBM de Mc Master publié dans le JAMA en 1992 . Il était intitulé: "EBM, une nouvelle approche pour enseigner la pratique de la médecine" cebma.org/wp-content/upl…
2/n On pourra constater avec quelle prudence les auteurs s'avancent en terrain miné, conscients que leurs propositions d'une approche systématisée et autonome des apprentissages en médecine remet en cause des positions bien établies.
3/n Le principal changement de paradigme prôné par l'approche EBM est de ne plus fonder sa pratique sur l'avis du plus gradé mais sur une revue critique de la littérature avec, comme référence, les essais randomisés pour évaluer l'efficacité des traitements.
Read 10 tweets
1/ Quelques réflexions @RecheckHealth sur la critique de l’#EBM que j’avais présentées à @MartinFierro769 @BoussageonR @cucherat @FranoisGueyffi2 @boylandry et qui montrent que si ses ennemis font ce genre de propositions #BigPharma n’aura bientôt plus besoin d’amis
2/ Le constat de récupération des instruments #EBM par #BigPharma et de leur détournement à des fins commerciales est partagé par de nombreux observateurs p.ex. Jack E James en 2017 tinyurl.com/yygrvgwa
3/ Les critiques portent notamment sur les #RCT
#BigPharma ayant (encore) besoin de #RCT avec des résultats favorables pour obtenir l'#AMM de nouveaux produits ou des extensions d’indication
Read 13 tweets
1/ Dear #medtwitter:

Please help. Let’s discuss #EBM.

- a thread. #crazypills
2/ I was commuting to work the other day when I read the results of the EXTEND trial nejm.org/doi/full/10.10…

EXTEND was stopped early after WAKE-UP was published due to “lack of clinical equipoise.”

Interesting. Let’s read WAKE-UP then, I thought.
3/ Here’s the link to WAKE-UP: nejm.org/doi/full/10.10…

Traditionally, systemic tPA has been reserved for patients with ischemic stroke who can be confirmed to have had onset of symptoms within the last 4.5 hours.
Read 19 tweets
Day 15/15 #PCPOnTheWards Two more admissions and I’m done! Going through my head:
❓1 week or 2 week stints next year?
❗️I’ve set the wheels in motion to go up for promotion!
📖Resident brought up desire for specific #EBM “rounds.” Brainstorming if after lunch best time?
(1/ )
📖Morning rounds/identify question/research #evidence/present to team ~130pm. Would #housestaff buy in?
🙌🏾Daughters coming home for weekend
💪🏽Workouts need to be kickstarted
🍩Food w holes (bagels, donuts) do help team morale.
Hope you all are having a great Friday!
(2/ )
Thoughts on the post lunch brief team rounds to run evidence for our decision making, #MedTwitter? #Twitternist @COREIMpodcast @ShreyaTrivediMD @medicalaxioms @cacace_frank @LaurenKuwikMD @ORourkeJr @meggerber @SusanHingle
Read 3 tweets
Tweetorial 1 / Eficacia de la vacuna #HPV de @RecheckHealth

¿Te importaría empezar el año nuevo con un TWEETORIAL? Nuestro humilde homenaje a-@VPrasadMDMPH te guiará a través de la evidencia sobre las vacunas #HPV y lo que @Cochranecollab hizo de ella.
2/n Primero acordemos una cosa: los ensayos controlados aleatorios (ECA) son superiores a los estudios observacionales @JuanGrvas @RedeSciELO
3/n En las vacunas contra el VPH, muchos estudios observacionales publicados y los ensayos controlados aleatorios promocionados de #Gardasil #Cervarix no pudieron demostrar la eficacia esperada sin embargo. Es triste, verdadero y poco discutido. Echemos un vistazo más de cerca
Read 26 tweets
Care to kick off the New Year with a TWEETORIAL? Our humble homage to @VPrasadMDMPH will walk you through the evidence on #HPV vaccines and what @Cochranecollab made of it. Let’s first agree on one thing: RCTs are superior to observational studies
On HPV vaccines many observational studies published and hyped Randomized Controlled Trials on #Gardasil #Cervarix failed to demonstrate the expected efficacy though. It is sad, true and rarely discussed. Let’s have a closer look. @garyschwitzer @HealthNewsRevu @senseaboutsci
In 2006 @US_FDA VRBPAC Committee required @Merck to provide data and analyses on Gardasil RCTs FUTURE I and II.
Which outcome would you consider as the most relevant to assess Gardasil efficacy?
Read 22 tweets
So @getadrip deleted their tweet about IV and IM medicines for £50, after I asked about regulatory issues.
Emails from "Richard" @getadrip are bizarre.
"We are not currently CQC registered as we do not fall within their scope and have not been informed otherwise by the CQC."
Again from @getadrip :

"All our products are MHRA approved and are prescribed by GMC Registered Doctors or Advanced Nurse Practitioners, all of whom have 10 - 25 years experience in the NHS individually.
"
And:
"There are many Vitamin Drip providers within the UK, some of which have been operating for up to 10 years, they are also not regulated by the CQC ..., please see an example below:
cqc.org.uk/location/1-353…
"
#bonkersMedicine
This is the strangest @CareQualityComm report ever.
Read 28 tweets
@TheBMA @BMANews "FRONTLINE" 4th August displays worrying prejudice. Please refer your pseudonymous ED consultant Charles Lamb to the following:

en.m.wikipedia.org/wiki/Out-group…

We no longer call people "schizophrenics", "diabetics", or "cyclists". To do so risks lazy prejudice.

1/
@TheBMA @BMANews From Lamb's article:

"Where there are cycle lanes some choose not to use them" - correct; may I refer you to the UK's unfit for purpose cycling "infrastructure" or "farcilities":

colyer.plus.com/danny/cycling/…

2/
@TheBMA @BMANews And (referring to someone riding a bike):

"After all they all look the same"

This is never an acceptable way to describe any group of human beings.

Particularly when you use dehumanising language to "other" them - this is prejudice and out-group homogeneity bias again.

3/
Read 8 tweets
In commemoration of 3 years of emailing hundreds of papers/ resources to my @OHSUIMRes ward teams & thanks to the amazing educators here and on #medtwitter #meded

My 10 greatest hits based on learner feedback:
10/ AGC “Approach to abnormal LFT” guidelines - for all those times when it’s not acute liver failure, but those LFT’s look like they need some investigating - ht Dr Jou gi.org/guideline/eval…
9/ “Normotensive ischemic acute renal failure” - can’t tell you how many times this has come in handy where I’ve slipped this to my resident, antihypertensives were backed down and a mysterious AKI disappeared; ht Dr Chiovaro nejm.org/doi/full/10.10…
Read 11 tweets

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