Jack Henry

Neurosurgery SpR @Beaumont_Dublin @RCSI_Irl Interests in all things neurosurgery & statistics. #rstats fanatic

[Frank Harrell @f2harrell]

1/2 Nail in the coffin of dichotomania: @ErikVanZwet 's paper with @stephensenn and myself just published: https://t.co/2kPmfbVHWD with extended discussion at https://t.co/EQx3C4Vo5K #Statistics #RCT #ClinicalTrial

[Stephan A Mayer @stephanamayer]

TRAIN randomized over 800 severe acute brain injury patients to a transfusion trigger of <7.0 or <9.0

The liberal transfusion strategy (<9.0) resulted in better outcomes. And fewer cerebral infarcts.

#curingcoma

https://t.co/KpztJKuKG0

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

This is a great point.

We see this in neurosurgery all the time.

An elderly patient comes in on anti coagulation with a speck of blood in their head… what’s the protocol?

There’s no evidence for what people do. We try to use observational data and personal experience. But there’s no rigorous data.

[Elliot Tapper @ebtapper]

Little discussed fact: Choosing to not “treat” high blood pressure makes you look like a wacko to the nurses and CRNAs/anesthesiologists in the real world where I practice

It requires lots of time, explanation, being present, and even documentation of your rationale

[josh wang @joshwangmd]

pheochromocytoma is ridiculed as a zebra dx with an incidence of 0.8/100,000 pt years

withholding ondansetron d/t risk of TdP is considered reasonable care when the incidence of drug-induced TdP is 0.4/100,000 pt years

[Josh Farkas MD 💊 @PulmCrit]

studies of bundled interventions are where EBM goes to die

we did a bunch of stuff and something seemed to work

why? 🤷‍♂️

which intervention helped? 🤷‍♂️

should clinicians implement this heterogenious bundle of stuff? 🤷‍♂️

how should treatment be tailored to specific patients? 🤷‍♂️

[Francis Deng, MD @francisdeng]

A dramatic complication of invasive imaging: aneurysm re-rupture. Some angiographers wouldn't even save these images, much less blast them on the pages of @NEJM.
https://t.co/304YHEFfZg

[Josh Farkas MD 💊 @PulmCrit]

hard cosign.

I explained why this study is incorrect over a *decade* ago! https://t.co/nLWrTeAo53

if you actually believe that giving antibiotics an hour earlier reduces mortality by 8%, please DM me about some oceanside properties in vermont to invest in.

[Josh Farkas MD 💊 @PulmCrit]

the 60 mg/kg levetiracetam dose in status epilepticus is based on a prospective multi-center RCT in NEJM (ESSETT trial)

please don't change your practice based on a single-center retrospective cohort study

IMHO to challenge the 60 mg/kg dose you would need another RCT

[IMCrit @IM_Crit_]

There is a rumour that someone once read a report from an EEG of an ICU patient that had a different conclusion from "moderate to severe generalized slowing"...

#foamed #foamcc #meded #MedTwitter #Medstudent #neurotwitter

[John Crotty @itsjohncrotty]

The greatest sports commentator of all time has passed

Mícheál Ó Muircheartaigh leaves us with lines that will echo

Here are some of his best:

“Anthony Lynch, the Cork corner-back, will be the last person to let you down – his people are undertakers”

#MícheálÓ

[Mujeeb Zubair, MD @MujeebZubair]

A first in man, ischemia-free beating heart transplantation (IFBHT) in humans was described! This involves transplanting a heart without the typical interruption of blood flow (ischemia).

See below the video and article in Lancet !

[Michael T. Lawton, MD @mtlawton]

I say about our patient, "One small step for a man, one giant leap for the mind of mankind." We're pleased to be partnering here @BarrowNeuro w/@Neuralink on this groundbreaking work on brain-computer interface to help pts w/spinal cord injury return to autonomous lives. @ModdedQuad

[Kevin Tsang @drtintin99]

6/ In conclusion, minimally invasive evacuation of moderately-sized lobar #ICH without significant IVH in otherwise healthy individuals <80yrs not on anticoag will lead to better neurological outcome.

For everyone else, the jury is still out...

[Elliot Tapper @ebtapper]

Second, bleeding has little-to-nothing to do with PT/INR

Check out this graph of bleeding time vs PT - no relation.
This is a wild study where Dr. Ewe clocked bleeding time after a laparoscopic liver biopsy. PT does not predict!
Dig Dis Sci. 1981 May;26(5):388-93

[Stephen John Senn @stephensenn]

It can take 100s sometimes 1000s of patients to show a treatment works at all. If you think a single patient can be securely classified as either a responder or non- responder, what are you assuming?

[Stephan A Mayer @stephanamayer]

Patients with minor completed stroke might have a 1% long term absolute reduction in recurrent bleed-free stroke recurrence if started on #DAPT and continued for 3 months.

1%

If you are a neurointensivist, stroke neurologist or neurosurgeon who treats bleeds — think of all your patients with #ICH — many who are on various combinations of antiplatelet agents and anticoagulants.

Those brain bleeds are bigger and badder than recurrent minor ischemic events.

It might make you wonder.

Do you think there is too much over-anticoagulation? Are we in over-love with our therapies?

[Ville Sallinen @villesallinen]

Oh yes, PORSCH trial with 50% reduction in mortality with algorith-based postop care after pancreatic resection @TheLancet

https://t.co/ttPICpq5Rh
@MarcBesselink

[Joel M. Topf, MD FACP @kidney_boy]

It is remarkable that not only was ODS incredibly rare, 0.2% of patients with sodium less than 120, but how good the outcomes of ODS were. 5 of 6 had full neurologic recovery and the one was left with gait imbalance. No deaths. One lost to follow-up.

[Joel M. Topf, MD FACP @kidney_boy]

😳

https://t.co/UlLnf9mk1Z