There are too many studies in the medical literature comparing AI models
It doesnât add anything meaningful and these models are often obsolete or replaced by the time of publication
SSC has done more harm than good
Yet, they learn nothing over time
We need guidelines based in evidence, led with hubris, and written by folks with appraisal skills
@phil_c89@MoarSahitoPTI Unfortunately that urban legend still persists despite years of trying to combat it. Lou Rice first pointed out it was bunk as far back as '08. But I still regularly hear people recite it reflexively. We need to keep messaging about this. The correct mantra is: Shorter Is Better.
as a general rule, IGRA (interferon gamma release assay) should NOT be used as a test for active pulmonary TB
if you're worried about active pulmonary TB --> isolate & get induced sputa
yes, this is effort-intensive, but it's the correct way to do it
again for the people in the back:
urinary tract infection is an EXCEEDINGLY rare cause of nosocomial fever or sepsis.
most such âcasesâ are probably misdiagnoses.
cystitis happens, for sure, but isolated cystitis doesnât cause fever or sepsis.
@emedfocus@ABsteward I think youâve missed the point. Iâve been doing inpatient medicine for 27 years. Iâve never seen a hospital onset pyelonephritis. No one else i know has either. What youâre talking doesnât happen. You are being fooled by urine and missing the actual source.
@ABsteward@DrToddLee You know them allâŠ
1) Shorter Is Better
2) Oral Is the New IV
3) Static/Cidal: Not a Thing
4) Antibiotics are the most potent anxiolytics in the pharmacopeia
5) Resistance is inevitable
6) ESR/CRP: Stop the Zombie Tests
7) Toddâs quote: The urine is innocent until proven guilty
"If youâre going to give antibiotics to patients who donât need them, at least do the courtesy of giving them for a brief period of time." @BradSpellberg#IDQuotes đ #IDXposts#shorterisbetter
in ICU, the white coat is just a big walking fomite
ideally, every piece of external clothing should be industrially laundered daily by the hospital (e.g. scrubs, green hospital-issued warm-up jackets)
part of primum non nocere is not walking around covered in Cdiff spores
âAtheists will never get to Heaven!â
Most of us know this. We also know we wonât get to Oz, Middle-earth, Narnia, or Valhalla. But we can still choose to be decent people anyway, right?
Imagine every pixel on your screen, streamed live directly from a model. No HTML, no layout engine, no code. Just exactly what you want to see.
@eddiejiao_obj, @drewocarr and I built a prototype to see how this could actually work, and set out to make it real. We're calling it Flipbook. (1/5)
@ABsteward@DrToddLee Hereâs the thing. This is a burden of proof paradox issue. Cefazolin is easier (3x per day not 6), cheaper, safer (fewer AEs). It actually doesnât have to be more effective to be preferred. Itâs the other way around
@ABsteward@DrToddLee But at the end of the day, this isnât about data. Weâve lived through this with short vs long abx. Static vs cidal. Oral vs iv. ESR/crp vs not. This is how đ people are. You just have to wear them out with persistence.
âJustâŠkeepâŠswimming!â
new, larger RCT on selective decontamination of the digestive tract in NEJM shows that its ineffective
SDD would eventually lead to drug-resistant organisms (beyond the timeframe of RCTs)
SDD is an intellectual wasteland that ignores the whole field of antimicrobial stewardship
Antibiotics in patients with CAP and a positive respiratory viral test:
Our "hypothetical" WikiGuidelines recommendation:
A Procalcitonin negative: Clear Recommendation
Multiple concordant randomized controlled trials in patients with lower
respiratory tract infections demonstrate that antibiotics can be safely discontinued based on procalcitonin results. Therefore, in patients with
CAP with a positive respiratory viral test, we recommend stopping antibiotics if the procalcitonin result supports cessation using a published algorithm.
@sarubactam
Our @wikiguidelines letter to the editor regarding the controversy between IDSA and ATS on CAP guidelines is now published. Time for societies to modernize their approach to guidelines to STOP creating care standards based on opinions. @ABsteward@DrToddLee@AnilMakam@medrants
Words matter!
Itâs very frustrating that Iâm still encountering the term âoral step-downâ in major ID journals.
Letâs replace it with stewardship-aligned terms:
IV to oral switch
Oral transition
Streamlining
âStep-downâ implies inferiority of oral antibiotics.
Time to stop using this term in ID journalsâauthors, editors, reviewers. #IDXposts