Malcolm Maclure

I'm the BC Academic Chair in Patient Safety and Professor in the Dept of Anesthesiology, Pharmacology and Therapeutics at UBC. All views expressed are my own.

[Malcolm Maclure @MalcolmMaclure]

@WynesSeth Please direct message me about Climate Action and Awareness Fund proposal

[Malcolm Maclure @MalcolmMaclure]

@Deprescribing A3: In med & nursing school, create a non-shame supportive culture of small-group performance review, not secrecy #derxchat

[Malcolm Maclure @MalcolmMaclure]

@Deprescribing A2 "Prescribing" educational websites and tools for patients and families. Write a URL on a Rx pad. #derxchat

[Malcolm Maclure @MalcolmMaclure]

@Deprescribing A1 Ministries of Health who sit (too passively) on dispensing data needed for QI feedback on deprescribing #derxchat

[Malcolm Maclure @MalcolmMaclure]

@Deprescribing Health prof associations have responsibility to embrace deprescribing as a key to QI in residential care #derxchat

[Malcolm Maclure @MalcolmMaclure]

@Pharma_Emma @rojasfec @Deprescribing To teach UBC med students deRx, we use Barb's 1st CMAJ case as reading; but too few students read it

[Malcolm Maclure @MalcolmMaclure]

@Deprescribing #DeRxchat Most deRx is in seniors; do family members want to hear anecdotes of success, testimony of others, from Internet?

[Malcolm Maclure @MalcolmMaclure]

@Deprescribing #DeRxchat As a patient/spouse stopping a med: I notice change of symptoms: n-of-1 trial but low power (too few crossovers)

[Malcolm Maclure @MalcolmMaclure]

@MalcolmMaclure Chair Patient Safety UBC. Good morning/afternoon!

[Malcolm Maclure @MalcolmMaclure]

@Deprescribing #deRxchat A4: a) Descriptive Epi = small area variations; b) 'Analytic' Epi = compare diff cohorts' outcomes; c) Trials

[Malcolm Maclure @MalcolmMaclure]

@Deprescribing #deRxchat A2: Organizations like Cochrane and NIHCE are needed to judge evidence quality. Beyond ability of clinicians.

[Malcolm Maclure @MalcolmMaclure]

@Deprescribing #derxchat A1: Ministry data routinely collected on massive numbers of patients. Ministries' drug plans should pay for trials.

[Malcolm Maclure @MalcolmMaclure]

@Deprescribing #deRxchat A1 To demonstrate statistically fewer falls, sample size > 2500. Significantly fewer fractures, sample > 10,000.

[Malcolm Maclure @MalcolmMaclure]

@Deprescribing #deRxchat A1: Deprescribing often involves a 'non-inferiority' hypothesis (you are no worse). Requires bigger samples.

[Malcolm Maclure @MalcolmMaclure]

#deRxchat A1 Generalizability is puzzling when the patients are so mixed in their other meds and co-morbidities. @Deprescribing

[Malcolm Maclure @MalcolmMaclure]

@Deprescribing A1: If solid evidence is needed to add meds (default is don't add), maybe deprescribe is default if evid to continue is low

[Malcolm Maclure @MalcolmMaclure]

@DAGoldmann #ph556x What’s a paper on SPC v RCT/epidem analysis? why longer “before period” boosts signif diff of means, but not in SPC?

[Malcolm Maclure @MalcolmMaclure]

@patricialane17

[Malcolm Maclure @MalcolmMaclure]

@masalapuri

[Malcolm Maclure @MalcolmMaclure]

I DIG THE SHAPE OF YOUR FORMULARY! #PharmacareValentines @CadaretteSM