Giles

“… Quarantine, was derived from the Italian words quaranta giorni which means 40 days.” [During] the Black Death of the 14th century… Venice established the first formal system of quarantine, requiring ships to lay at anchor for 40 days before landing. - Ulster Museum, Belfast

An interesting bit of etymology

My thoughts precisely: it’s not the most clearly explained methodology I’ve ever come across, and surprised no one has answered yet.

Did the PCT guided (and blinded? That’s what protocol seems to imply) group get to see daily CRP?

Were the CRP guided and standard care only able to get a PCT?

These will surely massively alter behaviours. I’m not so sure from the protocol both as a simpleton and someone with a cold.

This is a stupid question but I’m ill and I haven’t been able to answer it.

Are clinicians outside of the “standard care only” blinded to CRP and PCT results? Were they strictly banned from requesting and seeing them?

Standard care in ITU sepsis in the UK seems to include daily CRP.

🆕🔥Multicenter OL RCT
Compared with the GOLD strategy,PCT-guided antibiotic therapy significantly 🔽 rate of antibiotic prescription for patients with AECOPD, without negatively affecting treatment success rate #idsky @bradspellberg.bsky.social
www.clinicalmicrobiologyandinfection.com/article/S119...

How often did standard care cohort have CRP tested?

When interpreting this trial, it is also important to consider the pre-specified adjusted analysis [OR 0.89 (95%CI 0.79 to 0.99)] as adjustment improves statistical efficiency. This article explains the benefits of adjustment quite well. #emimcc jamanetwork.com/journals/jam...

Skytorial: Piptazo vs Cefepime 😁

Recently this JAMA-IM paper correlating piptazo with mortality has gained a weird amount of attention

(It's been out for months so it's not really new)

This one of the most methodologically horrific papers I've ever seen

Lets talk real quick about the paper...

END-OF-LIFE CARE: Hospitals miss opportunities to discuss people's wishes, report finds NHS hospitals are missing opportunities to record people's wishes for care at the end of life, according to the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), which highlighted the importance of "normalising conversations" about death and dying. Its report found too few patients had access to early palliative care, which can improve patients' quality of life and ultimately make a "good death" more likely. NCEPOD reviewed sample data on the quality of care provided to adults with a diagnosis of dementia, heart failure, lung cancer, or liver disease who died in hospital between 1 April 2022 and 30 September 2022 in England, Wales, and Northern Ireland. It found that 72.5% of patients did not have their preferences for care at the end of their life recorded. Suzy Lishman (below), NCEPOD chair, said, "Almost a third of people admitted to hospital as an emergency are in their last year of life, and most have recent hospital contact offering multiple opportunities to discuss wishes, prognosis, symptom control, and end-of-life care.

Like many others, I feel very strongly about this.

@ilovepathology.bsky.social, chair of NCEPOD, expresses appropriate concerns about how we miss far too often the opportunities to discuss end of life care.

Report by Matthew Limb in the @bmj.com.

#EOLC
#PalliativeCare
#ChoosingWisely
#MedSky

UK guidelines for the investigation and management of eosinophilia in returning travellers and migrants Eosinophilia is a common finding in returning travellers, migrants and other travelling groups. In this setting it often indicates an underlying helminth infection. Infections associated with eosinoph...

First paper to share here

Delightful to have been part of the all new UK guidelines on the diagnosis of and management of eosinophilia!

www.journalofinfection.com/article/S016...

You've probably heard that Bicarbonate has to turn into CO2 to raise the pH.

“Don’t give bicarb if you can’t increase ventilation.” But why?!

How much CO2 is there in an amp of sodium bicarbonate? Hos much does it raise pH? And how long does it last?

A 🧵 all about our ICU frenemy NaHCO3

1/

Dexmedetomidine is used quite a lot.
However, it’s not that benign an agent.

Single centre observational study finds 15% of patients on Dexmed have a fever of >38.5.

#emimcc

pubmed.ncbi.nlm.nih.gov/33813941/

Clinical practice guidelines for the care of patients with a chronic subdural haematoma: multidisciplinary recommendations from presentation to recovery A chronic subdural haematoma (cSDH) is an encapsulated collection of fluid and blood degradation products in the subdural space. It is increasingly common, affecting older people and those living w...

A little thread about chronic subdural haematoma - a condition that impacts primary care, non-neurosurgical hospitals, anaesthetists, physicians and some people even need neurosurgery. Some new guidelines are out - led by Dan Stubbs and Ben Davies #Ansky #GeriSky #SDM #EMSky 1/

Exactly my thoughts when I saw this! The kind of thing that made me love med-twitter of yesteryear.

Autologous transplantation of P63+ lung progenitor cells in patients with bronchiectasis: A randomized, single-blind, controlled trial Yan et al. demonstrate that autologous P63+ progenitor cell transplantation enhances lung gas exchange function, quality of life, CT imaging outcomes, and bronchiectasis severity scores in patients wi...

Autologous transplantation of P63+ lung progenitor cells in patients with bronchiectasis: A randomized, single-blind, controlled trial: Cell Reports Medicine www.cell.com/cell-reports...

Correction Rates and Clinical Outcomes in Hospitalized Adults With Severe Hyponatremia This systematic review and meta-analysis evaluates the association of sodium correction rates with mortality among hospitalized adults with severe hyponatremia.

Honey, stop what you're doing, new hyponatremia research just dropped!

What's it say?

It looks like slow correction is associated with worse outcomes, like death and length of stay!

Was it just a small study?

No, it was a meta-analysis of almost 12,000 patients!

jamanetwork.com/journals/jam...

32 minutes to drive 4 miles 😔

Out of curiosity, anyone know why ESC says to wait for more safety data on acetazolamide IV for decompensated heart failure?

AKI and potassium not an issue in ADVOR.

A wall of interesting geopolitics, medical research and teaching, and general non-partisan silliness?

Reminds me of something…

Anti-drug antibodies against adalimumab are called HAHA (human anti-human antibodies). No laughing matter!