The quality improvement movement hasn't improved healthcare quality, especially when taking into account the massive amount of money and manpower we spent collecting and analyzing quality metrics. A new paradigm is necessary.

In the ENRICH trial of minimally invasive cerebral hematoma removal within 24 hours after onset of hemorrhage, functional outcomes were better with surgery than with medical treatment, particularly among patients with lobar hemorrhages. Full trial results: nej.md/3VPYggf

A new use for paroxetine (Paxil): Erythema of rosacea. The SSRI #antidepressant improved multiple outcomes in this well designed, 12 week randomized controlled trial of 97:
pubmed.ncbi.nlm.nih.gov/36806645

#psychiatry #clinicaltrials #dermatology

I like this recommendation to report confidence intervals not as 3.5 [-2.0, 8.7] but as subscripts ₋₂.₀ 3.5 ₈.₇
academic.oup.com/biostatistics/…
Not the biggest thing, jut but seems a tiny bit easier to process.

Interesting example for the 'is there ever heterogeneity of treatment effect?' debate. Congrats to my colleagues Berry Consultants Ben Saville Roger Lewis, Giorgio Paulon, Mark Fitzgerald, and Anna McGlothlin! Also an example for the 'how to analyze an enrichment trial' debate.

New for #alcohol use d/o: Cyproheptadine+Prazosin. The combo reduced drinking in RCT of 154 (3 mth, medium effect)
pubmed.ncbi.nlm.nih.gov/38597214

Cyproheptadine is similar to mirtazapine and has small trials various psych disorders. Prazosin a blood pressure medicine used in #PTSD .

I knew UNOS and OPTN and certain OPOs were bad from Sumit Mohan and others work

But this….is still wild reading

statecraft.pub/p/how-to-stop-…

From Santi Ruiz h/t Raj Mehta

28000 organs are tragically wasted every year - including 17,500 kidneys

One quarter of all kidneys from organ donors get thrown in the trash.

At Statecraft, we uncovered why a corrupt monopolist has managed organ procurement for 40 years, and how it’s getting fixed.
statecraft.pub/p/how-to-stop-…

We did an internal experiment using LLMs to parse and visualise ORRs from AACR clinical trial abstracts. Worked pretty well; check out the results in the link (click the bubbles to open the relevant abstract)

aacr.convoke.bio

1/12 - Mystery #1

You are seeing a patient recently diagnosed with heart failure and started on GDMT. You notice that their hemoglobin (HGB) has increased (12 → 13 g/dL) in the intervening weeks.

🤔Which medication is the likely cause of this increase in HGB?

Anil Makam Manni Mohyuddin Just make sure that mgus patients have had FLC checked/tracked. About 10-15% of myeloma is light chain only, so someone can go from “it’s just mgus with a small m spike” to “full blown myeloma” if you check flc.
But also the reference ranges are wider now, which is good 😎

Anil Makam The values of what a normal light chain is were revised. Many people previously considered to have abnormal light chains (or light chain only MGUS) now have normal labs. Saves many a hematology referral!

ashpublications.org/blood/article/…

A long-waited PREVENT trial is now presented at LBCT-V #ACC2024
🇰🇷From the inception of trial to completion of trial took a decade.
✅1,606 pts with intracoronary imaging-detected “Vulnerable Plaque” randomized 1:1 to (1) Preventive PCI vs (2) OMT alone.
✅Prevent PCI…

Students sometimes ask 'should I do a regression or calculate a correlation?'

This is a useful explanation about why it's the same thing: lindeloev.github.io/tests-as-linea…

(originally via Sam Abbott (@[email protected]))

Astonishing results from the DanGer Shock Trial presented at #ACC24 and out in NEJM today.

In patients with ST-elevation MI with cardiogenic shock, Impella reduced all-cause mortality (45.8% Impella vs. 58.5% control) at 180 days.

Some thoughts on this ground breaking trial:

New on our site: The best augmentation strategy varies by patient. Learn which features help personalize the plan. #mentalhealth thecarlatreport.com/articles/4662-…

#Statistics throught of the day: If sponsors knew how much money was wasted with fixed sample size designs, and how much earlier Bayesian sequential designs would have bailed out on ineffective treatments, they'd be shocked. hbiostat.org/bayes/bet/desi…

Bupropion is no more likely to cause anxiety than an SSRI. I argued that earlier:
psychiatrictimes.com/view/3-myths-a…

And this study backs that up with rating scales from a large EMR databank:
ncbi.nlm.nih.gov/pmc/articles/P…

Our new study in JAMA Internal Medicine looking at the reasoning abilities of GPT-4 compared with human physicians just came out.

Big picture: AI displays (much) better reasoning than humans, makes diagnoses similarly, but hallucinates considerably more.

A 🧵to put in context ⬇️

John Mandrola, MD I think the most important steps are to separate 4 things:
1) priors based on theory
2) methodological stgth/amt of evidence
3) bounding uncertainty
4) attaching values LAST

I find even smart/knowledgeable/confident ppl are often unable to even understand such distinctions /1