Discover and read the best of Twitter Threads about #ebm
Most recents (24)
1/In this RCT, continuous IV hydrocortisone significantly lowered the risk of death in patients with severe CAP compared to placebo. Welcome to our weekly #OMTweetorial. #MedTwitter #MedEd #EBM #JournalClub 
2/In this pre-COVID government-funded trial in @NEJM, Pierre-François Dequin et al assessed whether a continuous hydrocortisone infusion reduced mortality in patients with severe CAP.
3/Design: RCT of 800 adults admitted to ICUs in France with severe CAP. Randomized 1:1 to placebo or a 4-d continuous infusion of hydrocortisone 200 mg IV daily followed by an 8–14 d taper. All pts received abx and standard supportive care. Primary outcome: death by day 28.
Kennst Du den Satz "ich kann gar nicht so viel essen, wie ich kotzen könnte".
Sehr schräg, wenn Du wegen eines Arztbesuchs nach seriösen Seiten googelst und dadurch nach 34 Jahren den Namen der #EBM Gottväter raus findest...
#VomitoNegro = Schwarze Galle
Sehr schräg, wenn Du wegen eines Arztbesuchs nach seriösen Seiten googelst und dadurch nach 34 Jahren den Namen der #EBM Gottväter raus findest...
#VomitoNegro = Schwarze Galle
Die Original #MusicFromBelgium EP kursierte im Spätsommer 1988 durch unsere Region #EBM
Es existiert kein Knüppel: Irrlicht ( ∃!Truncheon: Irradio)
BTW: Der Text ist etwas anspruchsvoller als das meiste von #Front242 ...
Es existiert kein Knüppel: Irrlicht ( ∃!Truncheon: Irradio)
BTW: Der Text ist etwas anspruchsvoller als das meiste von #Front242 ...
für #Medziner:
Absolute #Körperkontrolle: #Totenschein
(Absolute Body Control: Final Report)
to the doctors Amazement the Patient recovered consciousness: he was clinicly dead
there are no responses from an ideologic standpoint
#EBM #MusicFromBelgium
Absolute #Körperkontrolle: #Totenschein
(Absolute Body Control: Final Report)
to the doctors Amazement the Patient recovered consciousness: he was clinicly dead
there are no responses from an ideologic standpoint
#EBM #MusicFromBelgium
This is an excellent podcast on evidence-based medicine and randomised controlled trials, in the context of Covid-19. W/ @EricTopol & @cuttingforstone hosting @trishgreenhalgh as guest. Implications that I think extend beyond #EBM. A few thoughts. 1/16
medscape.com/viewarticle/98…
medscape.com/viewarticle/98…
@trishgreenhalgh tells about sitting in on a WHO committee discussing the transmission of SARS-CoV2 early on in the pandemic. Scientists who had made their careers on droplet transmission would dismiss the possibility of airborne transmission. 2/n
An evidence-based medicine #EBM approach would require RCT evidence on mode of transmission; or on the effectiveness of interventions such as masking. As @trishgreenhalgh points out, in an emergency with a rapidly spreading pandemic we must be more open-minded -- but to what? 3/n
Landmark trial thread🧵
This series of tweets will be about key trials studying SGLT-2 inhibitors in heart failure. While initially studied for DM, these meds were shown to improve CV outcomes in CHF patients, regardless of DM status.
#MedEd #EBM #CardioTwitter #clinicaltrials
This series of tweets will be about key trials studying SGLT-2 inhibitors in heart failure. While initially studied for DM, these meds were shown to improve CV outcomes in CHF patients, regardless of DM status.
#MedEd #EBM #CardioTwitter #clinicaltrials
1) DAPA-HF trial:
Among patients with a reduced EF, the risk of worsening heart failure or death from CV causes was lower among those who received dapagliflozin vs placebo.
Link: nejm.org/doi/full/10.10…
Among patients with a reduced EF, the risk of worsening heart failure or death from CV causes was lower among those who received dapagliflozin vs placebo.
Link: nejm.org/doi/full/10.10…
2) DELIVER trial:
Dapagliflozin reduced the combined risk of worsening heart failure or CV death in patients with heart failure and a mildly reduced or preserved EF.
Link:
nejm.org/doi/10.1056/NE…
Dapagliflozin reduced the combined risk of worsening heart failure or CV death in patients with heart failure and a mildly reduced or preserved EF.
Link:
nejm.org/doi/10.1056/NE…
1/ The colonoscopy trial reported in @NEJM is being widely reported as suggesting that colonoscopy is not effective for colon cancer screening. This is not the correct interpretation of these results. #EBM #evidencebasedmedicine #epitwitter
nejm.org/doi/full/10.10…
nejm.org/doi/full/10.10…
2/ This study’s results do not demonstrate that colonoscopy is effective, but also do not demonstrate that it is ineffective. Why? Because only 42% of those in the screening arm actually had a colonoscopy!
3/ What *does* this study show? Only that a screening program involving an invitation to get a one-time colonoscopy modestly reduced colon cancer cases but did not reduce colon cancer deaths or overall mortality at a median of 10 years of follow-up.
Epic editorial just published in @jrheum re:@ACRheum 2019 osteoarthritis recommendations
In short, ACR took the (correct!) stance that we should recommend AGAINST hyaluronic acid
This somewhat understandably upset companies that produce this voodoo. So they wrote an editorial!
In short, ACR took the (correct!) stance that we should recommend AGAINST hyaluronic acid
This somewhat understandably upset companies that produce this voodoo. So they wrote an editorial!
Right up front, we get the "I'm not biased, you're biased!" accusation
It's pretty rich for authors who literally worked for and actively own stock in OrthogenRx (a purveyor of fine hyaluronic acid) accuse others of "bias"
Oh, also, OrthogenRx "funded" this editorial
It's pretty rich for authors who literally worked for and actively own stock in OrthogenRx (a purveyor of fine hyaluronic acid) accuse others of "bias"
Oh, also, OrthogenRx "funded" this editorial
Really - who needs funding to write an editorial? It's like 1200 words and a figure. I've written tweetorials that long while driving
I suppose it was nice to have AOIC LLC, which OrthogenRx funded, make your figure, edit your paper, add refs, and submit the article
I suppose it was nice to have AOIC LLC, which OrthogenRx funded, make your figure, edit your paper, add refs, and submit the article
1/ Thread on Analyzing Physician Thought Processes with Conditional Probability
One important aspect of #EBM is to help physicians calibrate their probabilistic reasoning and improve their clinical judgement.
We will walk through one example from study highlighted below.
One important aspect of #EBM is to help physicians calibrate their probabilistic reasoning and improve their clinical judgement.
We will walk through one example from study highlighted below.
2/ The Study:
The basis of this thread is this interesting paper on physician probability estimates of medical outcomes:
jamanetwork.com/journals/jaman…
The basis of this thread is this interesting paper on physician probability estimates of medical outcomes:
jamanetwork.com/journals/jaman…
3/ Key concepts:
Difference between Independent vs dependent events
en.wikipedia.org/wiki/Independe…
Conditional Probability
en.wikipedia.org/wiki/Condition…
Summary of Probabilities (picture)
Difference between Independent vs dependent events
en.wikipedia.org/wiki/Independe…
Conditional Probability
en.wikipedia.org/wiki/Condition…
Summary of Probabilities (picture)
1) Welcome to a new #accredited #tweetorial, Prevention and Management of Heart Failure in T2 Diabetes: The Cardiologist’s Perspective! Our expert author is Giuseppe Galati MD, MMSc in Heart Failure, @GiuseppeGalati_ , Consultant #Cardiologist #HeartFailure & #Cardiomyopathies
2) @GiuseppeGalati_ is at San Raffaele Research Hospital, Milan 🇮🇹 @SanRaffaeleMI. This program is intended for #healthcare professionals & is accredited for 0.75h CE/#CME credit for #physicians #physicianassistants #nurses #nursepractitioners #pharmacists 🇺🇸🇨🇦🇬🇧🇪🇺.
3) @cardiomet_CE is supported by educational grants from AstraZeneca, Bayer, Boehringer Ingelheim Pharmaceuticals Inc. and Eli Lilly Company, & Chiesi. Earn credit from archived programs at cardiometabolic-ce.com. Disclosures at cardiometabolic-ce.com/disclosures/.🙏 FOLLOW US !
On #IND2022 we reflect on JBI’s origins as the ‘Joanna Briggs Institute for Evidence Based Nursing’ and the continuing importance, 25 years on, of evidence-based nursing research and clinical practice
#JBIEBHC 🧵 1/7
#JBIEBHC 🧵 1/7
Quality healthcare services require that clinical decision-making in #nursing is based on evidence, particularly in standardising and aligning healthcare practices with evidence at the point of care. JBI was founded by Emeritus Professor Alan Pearson to address this very need 2/7
🇮🇳#Inde
1. Le travail de sape de l'OMS a fini par payer…
Jusqu'au 23 déc, on trouvait uniquement cela sur le site @MoHFW_INDIA, section "Hospitals"
web.archive.org/web/2021122318…
1. Le travail de sape de l'OMS a fini par payer…
Jusqu'au 23 déc, on trouvait uniquement cela sur le site @MoHFW_INDIA, section "Hospitals"
web.archive.org/web/2021122318…
3. Mais le 24 déc. @ICMRDELHI & @aiims_nd, organes de conseil et de recherche, beaucoup plus sensibles aux arguments de l'OMS, ont enfin réussi à faire référencer leurs recommandations, sans toutefois réussir à faire disparaître le protocole complet.
THREAD : Du vécu des #soignants durant la crise sanitaire : aspects émotionnels et #biaiscognitifs face au #covid. Reflexions issues de mon experience de terrain, n'a pas la prétention d'être une enquête qualitative. Echo au post de @linternedegarde et aux derniers Spaces. 1/20
Le système n'était deja pas frais. Manifs, manque de moyen. Au début de la crise et à chaque 1ere vague (puisquelles sont arrivée en décalé ds les Dom-Tom):Le déni initial a rapidement laissé place au choc de la confrontation au réel du covid. La roulette russe.L'incertitude 2/20
Toutes les régions ont connu la saturation de leurs moyens au fur et à mesure des vagues successives, et avec elle la disparition progressive des manifestations de soutien, renforcement narcissisant, bien que pas tjr bien reçu, face a l'épreuve de l'inconnu. 3/20
1/ Happy #TweetorialTuesday from @ChrisDJacksonMD!
Hi #MedTwitter, I’m Chris Jackson. Honored and pumped to join @JenniferSpicer4, @GStetsonMD, and @YihanYangMD to share my love of #MedEd with you all through the @MedEdTwagTeam
A brief intro…
Hi #MedTwitter, I’m Chris Jackson. Honored and pumped to join @JenniferSpicer4, @GStetsonMD, and @YihanYangMD to share my love of #MedEd with you all through the @MedEdTwagTeam
A brief intro…
2/ I’m a current @UTHSC_Medicine senior APD of curriculum, assistant clerkship director @UTHSCMedicine, academic general internist @RegOneHlthFDN @CCHSmemphis
You may have seen me on #MedTwitter with my threads on #EBM or interactions via @primarycarechat
You may have seen me on #MedTwitter with my threads on #EBM or interactions via @primarycarechat
3/ I became interested in #MedEd after meeting inspiring role models & mentors @AU-UGA Medical Partnership: @3owllearning, Dr. Howard Cohen and @UTHSC_Medicine: Dr. Jim Lewis
After residency, I joined @UTHSC_Medicine faculty with a specific interest in ambulatory education
After residency, I joined @UTHSC_Medicine faculty with a specific interest in ambulatory education
38yr old male who is case of stable CKD since 2008 with creatinine of 3 & small size kidneys... his kidneys worsened due to covid in March and creatinine went upto 6...told him to be in close follow up ..he didn't listen and started taking ayurvedic medicine
Now creatinine went upto more than 14 & urea 350, not just that his hemoglobin which was in good range during all these years drop down to 4gm and his platelets also very low ..less than 50thousands .. probably due to his bone marrow is also damaged due to these medicines
He was taking these four bottles since last 6 months....they r not cheap Even though..the cost of these 4 bottles is equal to chemotherapy drugs. This is not the story of this patient alone...this is the story of thousands of patients who were lured by these alternative medicine
A Sunday reflection and rant about the way prostate cancer treatment is evolving and its implications on my practice.
I am a clinical oncologist in India, and I've been treating PRCA patients with radiation and systemic therapy for 11 years.
1/n 🧵
I am a clinical oncologist in India, and I've been treating PRCA patients with radiation and systemic therapy for 11 years.
1/n 🧵
Considering that I also treat HN and GI, prostate treatment has been very different, in terms of philosophy and intensity.
I love treating prostate cancer precisely because of this difference in approach.
2/n
I love treating prostate cancer precisely because of this difference in approach.
2/n
More than 80% of the patients I see are high-risk, node-positive, or metastatic.
And they are middle-class retired Indian men, who value their independence and free time.
They are also predominantly asymptomatic or mildly symptomatic.
3/n
And they are middle-class retired Indian men, who value their independence and free time.
They are also predominantly asymptomatic or mildly symptomatic.
3/n
It's worrying for a new NICE guidance to be delayed and undermined on the grounds it doesn't match 'clinical experience'.
If the scientific evidence always matched 'clinical experience', there'd be no point to research or evidence based medicine... 🤔
#EBM #EpiTwitter
If the scientific evidence always matched 'clinical experience', there'd be no point to research or evidence based medicine... 🤔
#EBM #EpiTwitter
If 'evidence based medicine' is working there should be REGULAR occasions when the 'evidence' not only disagrees with 'clinical experience' but actively contradicts it.
Wherever 'clinical experience' is allowed to overrule 'scientific evidence', we return to quackery.
Wherever 'clinical experience' is allowed to overrule 'scientific evidence', we return to quackery.
'Clinical experience' can be extremely misleading, and history is littered with examples. That's why we take a wider dispassionate view and aim to update practice based on science. This principle is the main distinction between contemporary medicine and 'medicine' of old.
@emresidents family! Let’s have a little #journalclub 🧵from the EMRA Research Comm. Agitation is super common problem(~2mil presentations per year) so what’s in your 🧰 to care for these patients? Let’s talk about it!📢
📄: IM Droperidol vs IM Olanzapine for Agitation in the ED
📄: IM Droperidol vs IM Olanzapine for Agitation in the ED
Before we dive in 🤿 what do you reach for when you need an IM medication for acute agitation? 🚑💉
Hypothermia not superior to normothermia in OHCA for patients sill comatose. #paperinapic by the talented @KirstyChallen #FOAMed #EBM
thesgem.com/2021/07/sgem33…
@NEJM @RCEMLearning @stemlyns
thesgem.com/2021/07/sgem33…
@NEJM @RCEMLearning @stemlyns
Therapeutic? thesgem.com/2021/07/sgem33…
Why seaweed? It can mitigate pollution, provide habitat for marine life, support fish popns and reduce climate impacts #loveseaweed
There is hype behind seaweed: It is being sold as a silver bullet to the worlds problems. We don’t want to overdeliver so how can we achieve a seaweed sector? The answer is #EcosystemBasedManagement or #EBM
Patient has ROSC after OHCA but is comatose. What's your target temperature in the ED? #EBM #FOAMed thesgem.com/2021/07/sgem33… @First10EM @emcrit @NEJM @ACEPNow @srrezaie @stemlyns
The 5 Step Process:
1-Vote on the twitter poll
2-Retweet the twitter poll
3-Read the primary pub (TTM2 trial) nejm.org/doi/full/10.10…
4-Check out the TheSGEM.com appraisal
5-Earn your CME credits sgem.ccme.org
1-Vote on the twitter poll
2-Retweet the twitter poll
3-Read the primary pub (TTM2 trial) nejm.org/doi/full/10.10…
4-Check out the TheSGEM.com appraisal
5-Earn your CME credits sgem.ccme.org
Proud 🤩 to present our preprint on the use of #CO2 monitors in hospital: background, pilot data and protocol for an RCT.
A #COVID19 🧵 @trishgreenhalgh @mjb302
A #COVID19 🧵 @trishgreenhalgh @mjb302
While Belgium is about to become one of the first countries to mandate #CO2monitors in bars, no evidence supports their use, which is particularly problematic in clinical medicine #EBM. How are CO2 levels in hospitals? What does the literature say? @HuffmanLabDU @j_g_allen
Widely varying results have been reported, with values >1000 p.p.m. up to 3000 p.p.m. in low-income setttings vs. excellent values in high-resource settings
@DRTomlinsonEP @ColdProofUK @vanranstmarc @mdc_martinus @PedroFacon
sciencedirect.com/science/articl…
mdpi.com/1660-4601/17/4…
@DRTomlinsonEP @ColdProofUK @vanranstmarc @mdc_martinus @PedroFacon
sciencedirect.com/science/articl…
mdpi.com/1660-4601/17/4…
(1/4) This @CochraneLibrary review is based on modelling and observational studies. In other words, LOW level of evidence. The #Covid era has trashed well-established standards and practices. What does this mean? cc @RecheckHealth @CatherineRiva
(2/4) Throughout this crisis, public health authorities put the world in stand-by without knowing if that would make sense. Instead of quality studies to assess the effectiveness of non-pharmaceutical interventions, we are left with low level of evidence. #evidencefreepandemic
(3/4) In less than two years, clinical medicine and a robust evidence-based approach indeed seem to not count anymore. But there is a good reason why #publichealth policies need solid evidence. It's because all interventions come with downsides. #GIJNHealthGuide
Decía Pennac en #comounanovela que "No es un libro de reflexión sobre la lectura, sino una tentativa de reconciliación con el libro”
A veces no sabemos trasmitir que la #EBM no es necesidad, sino disfrute personal
Con sus derechos
@drmiguelmarcos @rafabravo @vbaosv @jdelpinomont
A veces no sabemos trasmitir que la #EBM no es necesidad, sino disfrute personal
Con sus derechos
@drmiguelmarcos @rafabravo @vbaosv @jdelpinomont
Pues el primer derecho en la EBM es a no usarla, y centrarse en otro tipo de transmisión de conocimiento, las guías, los manuales... pero ojo, que la MBE siempre le está esperando
El segundo derecho es a comenzar a leer el artículo por la conclusión. Años insistiendo en el material y métodos, que es genial, pero al final, si no te llama, no te llama...
Otra de las herramientas que ha popularizado la #EBM es la interpretación de los test diagnósticos.
Y para darle una vuelta a su explicación voy a volver a mis orígenes. Las ovejitas.
"Test de antígeno y COVID desde la EBM"
@drmiguelmarcos @boticariors @mpericacho
1/20
Y para darle una vuelta a su explicación voy a volver a mis orígenes. Las ovejitas.
"Test de antígeno y COVID desde la EBM"
@drmiguelmarcos @boticariors @mpericacho
1/20
De forma simplista se tiende a pensar que un test que da POSITIVO es que uno tiene la enfermedad o condición a estudio.
Y si da NEGATIVO, pues que uno está “sano”.
Nada más lejos de la realidad
2/
Y si da NEGATIVO, pues que uno está “sano”.
Nada más lejos de la realidad
2/
La interpretación de un test diagnóstico depende de 2 cosas:
1) la probabilidad de padecer la enfermedad de la que partimos
Es decir, necesitamos valorar a nuestro paciente, sospechar una condición y entonces pedir una prueba para confirmarla
3/
1) la probabilidad de padecer la enfermedad de la que partimos
Es decir, necesitamos valorar a nuestro paciente, sospechar una condición y entonces pedir una prueba para confirmarla
3/
Word “racism” silenced, actively, by #MedEd #MedTwitter #healthcare “#professionalism” & “communication” labels
Saying “racism” offends or “hurts feelings” > actual #BLM deaths
If #professionalism itself is racist -makes sense that word suppressed
@FutureDocs
Saying “racism” offends or “hurts feelings” > actual #BLM deaths
If #professionalism itself is racist -makes sense that word suppressed
@FutureDocs
What @ayshakhoury experienced pushes out & silences many
If the editors of @JAMA_current resist hearing word “structural racism” then they certainly are not publishing papers using that word
@DrAlethaMaybank @RheaBoydMD @FutureDocs @TIME #BlackintheIvory #MedTwitter @bmj_latest
If the editors of @JAMA_current resist hearing word “structural racism” then they certainly are not publishing papers using that word
@DrAlethaMaybank @RheaBoydMD @FutureDocs @TIME #BlackintheIvory #MedTwitter @bmj_latest
Journal gatekeeping: men
Behavior gatekeeping: women/HR
#accountability only for white men
-> we miss “Amy Cooper” in #academia, #HR, #professionalism #compliance
insidehighered.com/advice/2020/06…
@DrAlethaMaybank @RheaBoydMD @FutureDocs @TIME #BlackintheIvory #MedTwitter @bmj_latest
Behavior gatekeeping: women/HR
#accountability only for white men
-> we miss “Amy Cooper” in #academia, #HR, #professionalism #compliance
insidehighered.com/advice/2020/06…
@DrAlethaMaybank @RheaBoydMD @FutureDocs @TIME #BlackintheIvory #MedTwitter @bmj_latest
