@OHDSI@suchard_group I was fortunate to work with an incredibly talented group, committed to answering important questions w/exemplary methods - and pre-specifying our approach and sharing code. Fantastic example of open science team. Sure, we want trial evidence, but in the meantime...
@OHDSI@suchard_group And data from high quality observational studies have a place, but quality of data and methods matter. Trials cannot address every question in every population. These data can complement trial data. And in the absence of trial data, are the best we have. But has to be done well.
@OHDSI@suchard_group And this study has relevance to everyday practice, we should not assume all drugs in a class act the same. We need more head to head comparisons. Not true they are similar till proven so. @PCORI: a nice avenue for funding...
@OHDSI@suchard_group@PCORI We concluded: 'chlorthalidone use was not associated with significant cardiovascular benefits when compared with hydrochlorothiazide, while its use was associated with greater risk of renal and electrolyte abnormalities.’ @JAMAInternalMed
Our study was based on 14 104 individuals receiving chlorthalidone and 287 390 individuals receiving hydrochlorothiazide. Just because it is big doesn’t mean it is a good study… but size helps when accompanied by high quality methods.
What are good methods? 'Balancing of large numbers of baseline patient covariates to make comparison groups more equivalent, using many negative controls to detect and correct residual bias and testing of the consistency among heterogeneous data sources.’ @OHDSI
@OHDSI So until better evidence says otherwise (and we always hope for better evidence), I will be recommending hydrochlorothiazide for those using a thiazide diuretic for hypertension. This is a change for me.
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1/🧵 @SubodhVermaMD @MkosiborodMD and colleagues have published important findings @JACCJournals on inflammation in obesity-related HFpEF from the STEP-HFpEF Program. Let's break it down! #CardioTwitter #HFpEF #ESCCongress jacc.org/doi/10.1016/j.…
2/ The study analyzed data from 1,145 patients with obesity-related HFpEF, looking at the prevalence of inflammation (measured by CRP levels) and its relationship with patient characteristics and outcomes. #ESCCongress @JACCJournals
@JACCJournals 3/ Key finding #1: Inflammation is highly prevalent in obesity-related HFpEF. 71% of patients had CRP levels ≥2 mg/L, with 19% having very high levels (≥10 mg/L). #Inflammation #ObesityHF #ESCCongress @JACCJournals
What we do now is write a paper...& then preprint @medrxivpreprint ...then we take reviews from the journal & the world & work to make the research better. So, Internal tremors & vibrations in long COVID: a cross-sectional study is open for public comment. https://t.co/xh7dXqPcSGmedrxiv.org/content/10.110…
@medrxivpreprint Our objective: 'We compared demographics, socioeconomic characteristics, pre-pandemic comorbidities, & new-onset conditions between people with internal tremors and vibrations as part of their #LongCovid symptoms & people with long COVID but without these symptoms.' #LISTENstudy
@medrxivpreprint Our finding: Among people with long COVID, those with internal tremors and vibrations have more associated symptoms and worse health status, suggesting it may be associated with a severe phenotype of the condition. @YaleCII @YaleMed @YaleCardiology
We have been doing a series of studies, led by @jeb1426, on sex differences in symptom complexity & phenotypes in acute myocardial infarction (AMI) and their impact on diagnosis & treatment. Some imp findings. #Cardiology#MedTwitter@YaleMed@YaleCardiology@yuan_lu1
One of most important articles I’ve done… showing the noise in clinic BP measurement is large & makes it impossible to track Rx effects; almost useless in evaluating change from 2 clinic visits. Let me explain… ahajournals.org/doi/abs/10.116…@YaleMed@YaleCardiology@CircOutcomes
@yuan_lu1@CircOutcomes@SpatzErica@YaleMed@YaleCardiology@AHAScience@amjmed We wrote that persistent hypertension was a condition of repetitive measures of above-goal elevated blood pressure over a period of time (eg, 6 mos), and drug resistance was just one of many causes. And many causes were related to missed opportunities in the care pathways.
Sleep as medicine... On behalf of hospitalized patients, what is we simply stopped ordering routine lab draws before 7am. What is we wrote an order, do not disturb before 7am except for an urgent need. Or an order for 7 hrs of peace and quiet. @FutureDocsnam12.safelinks.protection.outlook.com/?url=https%3A%…
@FutureDocs I strongly believe that rest and sleep are essential to recovery from acute illness...and yet everything we do in the hospital seems to ignore the role of sleep in treatment. We need to put people in a position to help their bodies heal and recovery... not make it more difficult.
@FutureDocs In our study we found it was normal operating procedures to draw bloods from 4-6am on hospitalized patients...the unintended effect, in my view, is to slow recovery and add stress... and impede healing. Shouldn't the hospital be where people can be treated, healed and recover?