Sunday 26 February 2012

#twitjc Feb 26th 2012

Transcript of this evening's Twitter Journal Club (using an experimental Twitter chat curation tool).

Involved ...
@northern_doctor @twitjournalclub @silv24 @PaedsSHO @payamtorabi @GasCast @dsdarbyshire @elinlowri @andrew_dawes @amcunningham @Albajuly @bmdavies89 @Lush_London @tobyhillman @dannymcg @Puffles2010 @dean_jenkins @amitns @benedictwarner @mdthemd @sturob79 @tomayates @dermotor @mgcmitchell @pabakz @JoMacIver @justanotherSHO @wrexhamrob @Chipara @RikThomas @LizzyFerret @JDMoffatt @michealb @pipkelly @discthrower @SavvasN @cheekynurse11 @GPLEDeducation @gasclass @whole_patients @docshannon @MrEpid @rmtyner @Aghoury_ @PAT_Libraries @DrPlumEU @PHTwitJC @CatherinBrunton @EdanStarforth @taggiemonster

Top resources ...
http://www.twitjc.com/2012/02/week-16-low-molecular-weight-heparin-mortality-in-acutely-ill-medical-patients/
http://www.twitjc.com/2012/02/week-16-discussion-points-lmwh-mortality-in-medical-patients/
http://blogs.nejm.org/now/index.php/low-molecular-weight-heparin-in-medical-patients/2011/12/30/
http://www.twitjc.com/2012/02/week-16-low-molecular-weight-heparin-and-mortality-in-acutely-ill-medical-patients/
http://www.nejm.org/doi/full/10.1056/NEJMoa1111288

@twitjournalclubThe paper for this Sunday's #twitjc will be announced tomorrow...watch this space for further details
(Mon, 20 Feb 2012 18:11:37 +0000)
@PAT_LibrariesRT @twitjournalclub : The paper for this Sunday's #twitjc will be announced tomorrow...watch this space for further details
(Tue, 21 Feb 2012 09:35:14 +0000)
@GasCast@silv24 @fidouglas @twitjournalclub - love the idea of #twitjc so much we've featured it on our latest podcast - http://t.co/28bQxNeR
(Wed, 22 Feb 2012 13:56:59 +0000)
@twitjournalclubPaper for this week& #39 ;s #twitjc will be Low-Molecular-Weight Heparin & Mortality in Acutely Ill Medical Patients http://t.co/JOdL2WyZ
(Wed, 22 Feb 2012 17:42:52 +0000)
@twitjournalclubNew post: Week 16 http://t.co/7jcd9kzM #TwitJC
(Wed, 22 Feb 2012 17:49:29 +0000)
@silv24RT @twitjournalclub : Paper for this week& #39 ;s #twitjc will be Low-Molecular-Weight Heparin & Mortality in Acutely Ill Medical Patients http://t.co/JOdL2WyZ
(Wed, 22 Feb 2012 17:51:58 +0000)
@silv24RT @twitjournalclub : New post: Week 16 http://t.co/7jcd9kzM #TwitJC
(Wed, 22 Feb 2012 17:52:05 +0000)
@DrPlumEURT @twitjournalclub : New post: Week 16 http://t.co/7jcd9kzM #TwitJC
(Wed, 22 Feb 2012 17:55:57 +0000)
@PHTwitJCRT @twitjournalclub : Paper for this week& #39 ;s #twitjc will be Low-Molecular-Weight Heparin & Mortality in Acutely Ill Medical Patients http://t.co/JOdL2WyZ
(Wed, 22 Feb 2012 18:04:49 +0000)
@PaedsSHORT @twitjournalclub : New post: Week 16 http://t.co/7jcd9kzM #TwitJC
(Wed, 22 Feb 2012 22:53:42 +0000)
@PaedsSHORT @twitjournalclub : Paper for this week& #39 ;s #twitjc will be Low-Molecular-Weight Heparin & Mortality in Acutely Ill Medical Patients http://t.co/JOdL2WyZ
(Wed, 22 Feb 2012 22:53:48 +0000)
@Aghoury_RT @twitjournalclub : Paper for this week& #39 ;s #twitjc will be Low-Molecular-Weight Heparin & Mortality in Acutely Ill Medical Patients http://t.co/JOdL2WyZ
(Thu, 23 Feb 2012 23:12:15 +0000)
@rmtyner@twitjournalclub Paper for this week& #39 ;s #twitjc will be LMWH & Mortality in Acutely Ill Medical Patients http://t.co/QT3hMegB #meded
(Fri, 24 Feb 2012 02:28:27 +0000)
@silv24The paper for this Sunday's #twitjc - summary of the paper to be posted shortly (delayed slightly by this virus) http://t.co/pZ2wwEtR
(Fri, 24 Feb 2012 16:06:25 +0000)
@twitjournalclubRT @silv24 : The paper for this Sunday's #twitjc - summary of the paper to be posted shortly (delayed slightly by this virus) http://t.co/pZ2wwEtR
(Fri, 24 Feb 2012 16:06:48 +0000)
@gasclassRT @silv24 : The paper for this Sunday's #twitjc - summary of the paper to be posted shortly (delayed slightly by this virus) http://t.co/pZ2wwEtR
(Fri, 24 Feb 2012 16:35:59 +0000)
@silv24@SuzetteWoodward This Sunday's #twitjc might interest you, LMWH and mortality in medical patients http://t.co/pZ2wwEtR
(Fri, 24 Feb 2012 17:15:13 +0000)
@twitjournalclubNew post: Week 16 http://t.co/3pqzUzT5 #TwitJC
(Fri, 24 Feb 2012 22:10:34 +0000)
@whole_patientsRT @silv24 : The paper for this Sunday's #twitjc - summary of the paper to be posted shortly (delayed slightly by this virus) http://t.co/pZ2wwEtR
(Fri, 24 Feb 2012 22:58:39 +0000)
@PaedsSHOWeek 16 – Low Molecular Weight Heparin & Mortality in Acutely Ill Medical Patients http://t.co/JVBRkAjv #twitjc
(Sat, 25 Feb 2012 00:38:09 +0000)
@docshannonRT @PaedsSHO : Week 16 – Low Molecular Weight Heparin & Mortality in Acutely Ill Medical Patients http://t.co/JVBRkAjv #twitjc
(Sat, 25 Feb 2012 09:24:11 +0000)
@silv24Ahead of tomorrow's #twitjc - my summary of LMWH and mortality in acutely unwell medical patients http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 14:43:47 +0000)
@twitjournalclubRT @silv24 : Ahead of tomorrow's #twitjc - my summary of LMWH and mortality in acutely unwell medical patients http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 14:44:17 +0000)
@PaedsSHORT @silv24 : Ahead of tomorrow's #twitjc - my summary of LMWH and mortality in acutely unwell medical patients http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 14:45:03 +0000)
@silv24Tomorrow's #twitjc should be interesting - does low molecular weight heparin as thromboprophlaxis affect mortality? http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 14:45:54 +0000)
@Puffles2010RT @silv24 : Ahead of tomorrow's #twitjc - my summary of LMWH and mortality in acutely unwell medical patients http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 14:46:29 +0000)
@silv24This is a great paper for medical student to join in & critique & an important patient safety issue - hoping for a lively discussion #twitjc
(Sat, 25 Feb 2012 14:47:12 +0000)
@twitjournalclubRT @silv24 : Tomorrow's #twitjc should be interesting - does low molecular weight heparin as thromboprophlaxis affect mortality? http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 14:47:21 +0000)
@MrEpidRT @silv24 : Tomorrow's #twitjc should be interesting - does low molecular weight heparin as thromboprophlaxis affect mortality? http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 14:48:36 +0000)
@ChiparaRT @silv24 : Ahead of tomorrow's #twitjc - my summary of LMWH and mortality in acutely unwell medical patients http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 14:53:33 +0000)
@amcunningham@silv24 another pay walled journal article? :( #twitjc but interesting topic ++
(Sat, 25 Feb 2012 15:04:01 +0000)
@CatherinBruntonRT @silv24 : Ahead of tomorrow's #twitjc - my summary of LMWH and mortality in acutely unwell medical patients http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 15:51:11 +0000)
@silv24@k2_UK tomorrow's journal club may interest, does prophylaxis with LMWH affect mortality in medical patients? #twitjc http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 17:15:09 +0000)
@twitjournalclubIf anyone is having trouble accessing the full paper for tomorrow's #twitjc a link can be found at - http://t.co/Cn2gQL4L
(Sat, 25 Feb 2012 17:49:22 +0000)
@silv24RT @twitjournalclub : If anyone is having trouble accessing the full paper for tomorrow's #twitjc a link can be found at - http://t.co/Cn2gQL4L
(Sat, 25 Feb 2012 17:52:19 +0000)
@EdanStarforthRT @twitjournalclub : If anyone is having trouble accessing the full paper for tomorrow's #twitjc a link can be found at - http://t.co/Cn2gQL4L
(Sat, 25 Feb 2012 17:56:26 +0000)
@PaedsSHORT @twitjournalclub : If anyone is having trouble accessing the full paper for tomorrow's #twitjc a link can be found at - http://t.co/Cn2gQL4L
(Sat, 25 Feb 2012 19:01:54 +0000)
@pabakzhttp://t.co/PVlPOGAe Not the easiest paper to access #twitjc
(Sat, 25 Feb 2012 23:59:53 +0000)
@wrexhamrobRT @twitjournalclub : If anyone is having trouble accessing the full paper for tomorrow's #twitjc a link can be found at - http://t.co/Cn2gQL4L
(Sun, 26 Feb 2012 12:22:06 +0000)
@twitjournalclubDon't miss #twitjc tonight - low-molecular weight heparin and mortality in medical patients - discussion starts at 8pm http://t.co/aCkr4vNq
(Sun, 26 Feb 2012 12:47:38 +0000)
@silv24RT @twitjournalclub : Don't miss #twitjc tonight - low-molecular weight heparin and mortality in medical patients - discussion starts at 8pm http://t.co/aCkr4vNq
(Sun, 26 Feb 2012 12:48:19 +0000)
@silv24If anyone is having trouble accessing the full paper for tonight's #twitjc a link can be found at - http://t.co/TNcmhUEr
(Sun, 26 Feb 2012 12:49:22 +0000)
@twitjournalclubRT @silv24 : If anyone is having trouble accessing the full paper for tonight's #twitjc a link can be found at - http://t.co/TNcmhUEr
(Sun, 26 Feb 2012 12:50:04 +0000)
@jonthehenRT @silv24 : If anyone is having trouble accessing the full paper for tonight's #twitjc a link can be found at - http://t.co/TNcmhUEr
(Sun, 26 Feb 2012 12:51:30 +0000)
@parkerflashRT @twitjournalclub : Don't miss #twitjc tonight - low-molecular weight heparin and mortality in medical patients - discussion starts at 8pm http://t.co/aCkr4vNq
(Sun, 26 Feb 2012 12:53:08 +0000)
@Puffles2010RT @silv24 : If anyone is having trouble accessing the full paper for tonight's #twitjc a link can be found at - http://t.co/TNcmhUEr
(Sun, 26 Feb 2012 12:54:52 +0000)
@EpiSagarRT @twitjournalclub : Don't miss #twitjc tonight - low-molecular weight heparin and mortality in medical patients - discussion starts at 8pm http://t.co/aCkr4vNq
(Sun, 26 Feb 2012 12:54:57 +0000)
@living_as_ifRT @silv24 : If anyone is having trouble accessing the full paper for tonight's #twitjc a link can be found at - http://t.co/TNcmhUEr
(Sun, 26 Feb 2012 12:55:59 +0000)
@twitjournalclubNew post: Week 16 - Discussion Point http://t.co/xkOse1dk #TwitJC
(Sun, 26 Feb 2012 16:32:54 +0000)
@silv24“ @twitjournalclub : New post: Week 16 - Discussion Point http://t.co/21UttdfJ #TwitJC ” - discussion starts at 8pm tonight - please join in
(Sun, 26 Feb 2012 16:34:53 +0000)
@Puffles2010Puffles says if you know any medics, please (*point*) them to @twitjournalclub & http://t.co/u8byW1qK #TwitJC
(Sun, 26 Feb 2012 16:36:14 +0000)
@twitjournalclubRT @silv24 : “ @twitjournalclub : New post: Week 16 - Discussion Point http://t.co/21UttdfJ #TwitJC ” - discussion starts at 8pm tonight - please join in
(Sun, 26 Feb 2012 16:36:15 +0000)
@PaedsSHORT @twitjournalclub : New post: Week 16 - Discussion Point http://t.co/xkOse1dk #TwitJC
(Sun, 26 Feb 2012 16:37:23 +0000)
@immigrant007RT @Puffles2010 : Puffles says if you know any medics, please (*point*) them to @twitjournalclub & http://t.co/u8byW1qK #TwitJC
(Sun, 26 Feb 2012 16:38:13 +0000)
@taggiemonsterRT @silv24 : “ @twitjournalclub : New post: Week 16 - Discussion Point http://t.co/21UttdfJ #TwitJC ” - discussion starts at 8pm tonight - please join in
(Sun, 26 Feb 2012 16:45:28 +0000)
@dannymcgRT @silv24 : “ @twitjournalclub : New post: Week 16 - Discussion Point http://t.co/21UttdfJ #TwitJC ” - discussion starts at 8pm tonight - please join in
(Sun, 26 Feb 2012 16:47:36 +0000)
@silv24“ @PaedsSHO : The paper can be found here: http://t.co/YMqXhKLV” #twitjc
(Sun, 26 Feb 2012 18:08:52 +0000)
@silv24Two hours until #twitjc - please say some of you are going to join in! It is a great paper up for discussion http://t.co/inB34OtI
(Sun, 26 Feb 2012 18:10:32 +0000)
@DrDLittleRT @silv24 : “ @twitjournalclub : New post: Week 16 - Discussion Point http://t.co/21UttdfJ #TwitJC ” - discussion starts at 8pm tonight - please join in
(Sun, 26 Feb 2012 18:10:52 +0000)
@GPLEDeducationRT @Puffles2010 : Puffles says if you know any medics, please (*point*) them to @twitjournalclub & http://t.co/u8byW1qK #TwitJC
(Sun, 26 Feb 2012 18:12:57 +0000)
@pabakz“ @silv24 @PaedsSHO : The paper can be found here: http://t.co/jq2uVkjg #twitjc >> only the abstract, unless I'm doing something wrong
(Sun, 26 Feb 2012 18:20:41 +0000)
@tobyhillmanRT @silv24 : “ @twitjournalclub : New post: Week 16 - Discussion Point http://t.co/21UttdfJ #TwitJC ” - discussion starts at 8pm tonight - please join in
(Sun, 26 Feb 2012 18:25:29 +0000)
@jenrowRT @silv24 : Two hours until #twitjc - please say some of you are going to join in! It is a great paper up for discussion http://t.co/inB34OtI
(Sun, 26 Feb 2012 18:28:40 +0000)
@silv24Half an hour until tonight's #twitjc - low molecular weight heparin and mortality in acutely unwell medical patients - http://t.co/inB34OtI
(Sun, 26 Feb 2012 19:30:20 +0000)
@twitjournalclubRT @silv24 : Half an hour until tonight's #twitjc - low molecular weight heparin and mortality in acutely unwell medical patients - http://t.co/inB34OtI
(Sun, 26 Feb 2012 19:30:38 +0000)
@ChiparaRT @silv24 : Half an hour until tonight's #twitjc - low molecular weight heparin and mortality in acutely unwell medical patients - http://t.co/inB34OtI
(Sun, 26 Feb 2012 19:39:57 +0000)
@silv24Hope everyone is ready for #twitjc ....
(Sun, 26 Feb 2012 19:50:55 +0000)
@bmdavies89@silv24 ready I think. But a #twitjc virgin
(Sun, 26 Feb 2012 19:58:14 +0000)
@PaedsSHO@bmdavies89 We'll be gentle with you ;-) #twitjc
(Sun, 26 Feb 2012 19:59:51 +0000)
@GasCast@silv24 ready and looking forward to my first #twitjc
(Sun, 26 Feb 2012 19:59:54 +0000)
@twitjournalclub@bmdavies89 welcome!! always great to have new people join in! #twitjc
(Sun, 26 Feb 2012 20:00:16 +0000)
@twitjournalclubGood evening and welcome to the 16th week of the journal club which will be run by @silv24 #twitjc
(Sun, 26 Feb 2012 20:00:41 +0000)
@twitjournalclubTonight's paper is a very interesting one - Low molecular weight heparin and mortality in acutely unwell medical patients #twitjc
(Sun, 26 Feb 2012 20:01:14 +0000)
@twitjournalclubA summary of the paper http://t.co/3pqzUzT5 #twitjc
(Sun, 26 Feb 2012 20:01:52 +0000)
@benedictwarnerNot had a chance to properly read the paper, but looking forward to quietly following my first #twitjc over dinner... #twitjc
(Sun, 26 Feb 2012 20:02:17 +0000)
@payamtorabi#twitjc Hello!
(Sun, 26 Feb 2012 20:02:19 +0000)
@twitjournalclubTo start with - introductions.... #twitjc
(Sun, 26 Feb 2012 20:03:01 +0000)
@silv24Hi, Natalie currently a F2 in ITU and soon to be ACCS anaesthetics trainee. Will be running the journal club again tonight #twitjc
(Sun, 26 Feb 2012 20:04:00 +0000)
@dsdarbyshire#twitjc Hi! Dan, anatomy demonstrator, sometime A&E SHO.
(Sun, 26 Feb 2012 20:04:42 +0000)
@PaedsSHODavid, current NICU doc but soon to be adult intensivist. #twitjc
(Sun, 26 Feb 2012 20:04:46 +0000)
@payamtorabi#twitjc I'm Payam an F2 currently on Cardiology at Newham. Only my second #twitjc
(Sun, 26 Feb 2012 20:05:17 +0000)
@sturob79Hi Stuart Gen Surg SpR #twitjc
(Sun, 26 Feb 2012 20:05:32 +0000)
@northern_doctorI'm Mark - medical registrar specialising in elderly care and stroke #twitjc
(Sun, 26 Feb 2012 20:05:33 +0000)
@Microblog_me_ukOk, lets begin #twitjc
(Sun, 26 Feb 2012 20:05:46 +0000)
@bmdavies89Ben. Med Student in Manchester #twitjc
(Sun, 26 Feb 2012 20:06:41 +0000)
@twitjournalclubThank you all and great to see some new faces. And so on with the discussion with the first discussion point... #twitjc
(Sun, 26 Feb 2012 20:07:02 +0000)
@GasCastHi - I'm Rik. Anaesthetics ST5. #twitjc
(Sun, 26 Feb 2012 20:07:02 +0000)
@andrew_dawesOK gonna try to join in #twitjc . Another newie be kind silvey!!
(Sun, 26 Feb 2012 20:07:10 +0000)
@elinlowriElin - respiratory and acute medicine consultant #twitjc but have poorly child so may dip in and out!
(Sun, 26 Feb 2012 20:07:46 +0000)
@amitnsHi, Amit, GP #twitjc
(Sun, 26 Feb 2012 20:07:47 +0000)
@mgcmitchellMark - Med student and Pharmacist #twitjc
(Sun, 26 Feb 2012 20:07:56 +0000)
@twitjournalclubIs the methodology of the study robust enough to support the conclusion that the use of LMWH doesn't alter mortality in medical pts? #twitjc
(Sun, 26 Feb 2012 20:08:22 +0000)
@andrew_dawesFY2 Doctor A&E #twitjc
(Sun, 26 Feb 2012 20:08:49 +0000)
@discthrower@PaedsSHO what's #twitjc ?
(Sun, 26 Feb 2012 20:09:20 +0000)
@silv24@andrew_dawes I am always kind Dawes!! #twitjc
(Sun, 26 Feb 2012 20:09:37 +0000)
@PaedsSHOSo, methodology; double-blind, placebo-controlled, randomised, international, multi-centre... good start! #twitjc
(Sun, 26 Feb 2012 20:09:38 +0000)
@northern_doctorMethodology of study was robust, but caution with extrapolation of results given demographics of study population (ie. not western) #twitjc
(Sun, 26 Feb 2012 20:10:07 +0000)
@RikThomasOnly within the limits of the study i.e. geography (narrow) and patient selection (low numbers with Hx of VTE) #twitjc
(Sun, 26 Feb 2012 20:10:14 +0000)
@northern_doctorSo for population studied, yes, conclusions seem to be based on sound methods #twitjc
(Sun, 26 Feb 2012 20:10:38 +0000)
@payamtorabi#twitjc yeah. I struggled to find much to complain about methodologically!
(Sun, 26 Feb 2012 20:10:47 +0000)
@PaedsSHOThat said, none of the centres used are very close to the UK in terms of demographics. #twitjc
(Sun, 26 Feb 2012 20:11:01 +0000)
@bmdavies89Didn't see their exclusion appendix but does seem population bereft of major RFs for an adverse outcome #twitjc
(Sun, 26 Feb 2012 20:11:08 +0000)
@andrew_dawesAttempt at trying to calculate power of study needed according to effect expected - also good #twitjc
(Sun, 26 Feb 2012 20:11:11 +0000)
@silv24Good points - multicentre, randomised, double blind and international, clear inclusion and exclusion criteria #twitjc
(Sun, 26 Feb 2012 20:11:22 +0000)
@dsdarbyshire#twitjc No. The populations are incredibly diverse and a difference in one may be masked by the lack in others.
(Sun, 26 Feb 2012 20:12:00 +0000)
@payamtorabi#twitjc True, but no similar study (mortality as end-point) done on western caucasian population as far as I could find...
(Sun, 26 Feb 2012 20:12:26 +0000)
@andrew_dawesThought the demographc young compared to UK MAU intake. #twitjc
(Sun, 26 Feb 2012 20:12:30 +0000)
@twitjournalclubAre there any obvious flaws in the study design? #twitjc
(Sun, 26 Feb 2012 20:12:33 +0000)
@SavvasNRT @silv24 : Good points - multicentre, randomised, double blind and international, clear inclusion and exclusion criteria #twitjc
(Sun, 26 Feb 2012 20:12:51 +0000)
@bmdavies89Side point but Could someone clarify the study power, when they mention 77% power to ..... #twitjc
(Sun, 26 Feb 2012 20:13:26 +0000)
@northern_doctor@andrew_dawes Maybe, but a quarter of study population were >75, so that's not too exclusive #twitjc
(Sun, 26 Feb 2012 20:13:46 +0000)
@benedictwarnerInteresting-wld we be asking same question of a study ONLY carried out in western/caucasian pop? (eg does this apply to my 'x' pts?) #twitjc
(Sun, 26 Feb 2012 20:14:22 +0000)
@twitjournalclubRT @bmdavies89 : Side point but Could someone clarify the study power, when they mention 77% power to ..... #twitjc
(Sun, 26 Feb 2012 20:14:37 +0000)
@benedictwarner(where x=any non-caucasian group) #twitjc
(Sun, 26 Feb 2012 20:14:48 +0000)
@payamtorabi#twitjc my personal bias is that I feel for a purely preventative treatment we need exceptionally robust evidence before we start using it
(Sun, 26 Feb 2012 20:15:07 +0000)
@northern_doctorWouldn't call it a *flaw* but I think it's important to point out that the max length of treatment was 14 days #twitjc
(Sun, 26 Feb 2012 20:15:40 +0000)
@GasCastThe study was underpowered because the overall mortality rate was lower than predicted. However, only .1% difference between groups. #twitjc
(Sun, 26 Feb 2012 20:15:55 +0000)
@dsdarbyshire@benedictwarner #twitjc we would if we work outside the western world.
(Sun, 26 Feb 2012 20:16:05 +0000)
@PaedsSHO@benedictwarner I think that if the trial was done purely in the UK, docs in China would rightly ask about applicability to them! #twitjc
(Sun, 26 Feb 2012 20:16:14 +0000)
@cheekynurse11RT @northern_doctor : I'm Mark - medical registrar specialising in elderly care and stroke #twitjc
(Sun, 26 Feb 2012 20:16:15 +0000)
@northern_doctorSuspect they did this to make it comparable with previous trials that have studied prophylactic LMWH and shown reduction in VTE #twitjc
(Sun, 26 Feb 2012 20:16:31 +0000)
@payamtorabi@northern_doctor that's fairly typical length of stay for UK adult inpatients though? #twitjc
(Sun, 26 Feb 2012 20:17:01 +0000)
@silv24Reading throughly the study design it seems very well thought out and clearly set out - I can't see any obvious flaws #twitjc
(Sun, 26 Feb 2012 20:17:05 +0000)
@sturob79the problem is the patient groups most mortality will be from primary disease not VTE therefore grossly underpowered #twitjc
(Sun, 26 Feb 2012 20:17:09 +0000)
@northern_doctorI would be interested to know the mean length of treatment in a real hospital population - suspect many pts given it for much longer #twitjc
(Sun, 26 Feb 2012 20:17:26 +0000)
@dsdarbyshire#twitjc they continue treatment at home. Not standard practice as far as I know.
(Sun, 26 Feb 2012 20:17:39 +0000)
@mdthemd@silv24 power calc difficult given lack of previous and usually a huge number when calculated Hence lower power as compromise #twitjc
(Sun, 26 Feb 2012 20:17:48 +0000)
@RikThomas@benedictwarner see ref 29 - rarity of PE in Asians #twitjc
(Sun, 26 Feb 2012 20:18:11 +0000)
@northern_doctor@payamtorabi Yes, but I'm also interested in the pt population who have long stays and are on LMWH for the duration #twitjc
(Sun, 26 Feb 2012 20:18:20 +0000)
@twitjournalclubLeading on to point 2 - Was all-cause mortality the right primary end point for this study? #twitjc
(Sun, 26 Feb 2012 20:18:56 +0000)
@payamtorabi@northern_doctor Ah, I see! #twitjc
(Sun, 26 Feb 2012 20:19:17 +0000)
@amcunningham@kerryhood very strangely your tweets not showing up when I search #twitjc so others might not be seeing!
(Sun, 26 Feb 2012 20:19:40 +0000)
@northern_doctorGood question...! RT @twitjournalclub : Leading on to point 2 - Was all-cause mortality the right primary end point for this study? #twitjc
(Sun, 26 Feb 2012 20:19:44 +0000)
@GasCast@twitjournalclub I think so but I was surprised at how rare PE was as a cause of mortality. #twitjc
(Sun, 26 Feb 2012 20:19:50 +0000)
@amcunningham“ @kerryhood : I did have one Q (sorry not a clinician) - is bruising likely to unblind? #twitjc ”
(Sun, 26 Feb 2012 20:20:22 +0000)
@Albajuly@twitjournalclub Sorry, sneaking in the back late! Med Cons. Whilst the study is sound, I think the end-point is of little value. #twitjc
(Sun, 26 Feb 2012 20:20:26 +0000)
@northern_doctorAll-cause mortality was an interesting thing to look at. After all, that's what we're hoping to improve by giving the rx #twitjc
(Sun, 26 Feb 2012 20:20:31 +0000)
@amcunningham“ @kerryhood : @bmdavies89 post hoc power calc given low death rate (my pet hate!) #twitjc ”
(Sun, 26 Feb 2012 20:20:35 +0000)
@payamtorabiRT @amcunningham : @kerryhood very strangely your tweets not showing up when I search #twitjc so others might not be seeing!
(Sun, 26 Feb 2012 20:20:54 +0000)
@northern_doctorPrev studies have shown a reduction in VTE with LMWH, but what does that actually mean for the patient? #twitjc
(Sun, 26 Feb 2012 20:21:02 +0000)
@Albajuly@twitjournalclub I have no expectations of enoxaparin reducing mortality from sepsis or cancer. #twitjc
(Sun, 26 Feb 2012 20:21:06 +0000)
@dsdarbyshire#twitjc all cause mortality is the ultimate question. Doesn't answer it so a more precise measure would have greater utility.
(Sun, 26 Feb 2012 20:21:10 +0000)
@twitjournalclub@Albajuly oh, why do you say that? #twitjc
(Sun, 26 Feb 2012 20:21:11 +0000)
@PaedsSHOI thought the primary outcome was a very interesting choice, and probably the right one. #twitjc
(Sun, 26 Feb 2012 20:21:29 +0000)
@northern_doctorControversial? MT @Albajuly : Whilst the study is sound, I think the end-point is of little value. #twitjc
(Sun, 26 Feb 2012 20:22:00 +0000)
@GasCast@Albajuly I always thought the PE was a big source of mortality in cancer? #twitjc
(Sun, 26 Feb 2012 20:22:27 +0000)
@payamtorabiRT @PaedsSHO : I thought the primary outcome was a very interesting choice, and probably the right one. #twitjc
(Sun, 26 Feb 2012 20:22:28 +0000)
@PaedsSHO@Albajuly why not? Both sepsis and malignancy are risk factors for VTE. #twitjc
(Sun, 26 Feb 2012 20:22:37 +0000)
@twitjournalclub@Albajuly you answered my question with your second point about reducing mortality #twitjc
(Sun, 26 Feb 2012 20:22:38 +0000)
@northern_doctorRemember prev studies in support of VTE prophylaxis went looking for VTE that would not have necessarily been clinical suspected! #twitjc
(Sun, 26 Feb 2012 20:22:48 +0000)
@amcunningham“ @kerryhood : does a more precise measure matter if it doesn't have an effect on all cause mortality? #twitjc ”
(Sun, 26 Feb 2012 20:22:51 +0000)
@andrew_dawes@northern_doctor - agree brave - but would have been safer to show reduction in VTE? #twitjc
(Sun, 26 Feb 2012 20:23:16 +0000)
@Albajuly@twitjournalclub The inclusion of the term 'active cancer' I may be missing something but could this mean terminally ill? #twitjc
(Sun, 26 Feb 2012 20:23:47 +0000)
@bmdavies89It should be considered. Does the similarity between placebo and LMWH evidence safety of LMWH prophylaxis? #twitjc
(Sun, 26 Feb 2012 20:24:01 +0000)
@twitjournalclubIf not all cause mortality, what other measures could have been used? #twitjc
(Sun, 26 Feb 2012 20:24:07 +0000)
@payamtorabi@amcunningham @kerryhood Well, exactly #twitjc
(Sun, 26 Feb 2012 20:24:17 +0000)
@northern_doctorThis has already been done, hence a different study question! RT @andrew_dawes : would have been safer to show reduction in VTE? #twitjc
(Sun, 26 Feb 2012 20:24:20 +0000)
@elinlowri@silv24 @andrew_dawes @northern_doctor But a lot of VTE is not diagnosed, which is why mortality is the best endpoint #twitjc
(Sun, 26 Feb 2012 20:24:34 +0000)
@dermotor@northern_doctor @payamtorabi Do think that there are patients on LMWH for too long. Assessed as @ risk & prescribed for whole stay #twitjc
(Sun, 26 Feb 2012 20:24:34 +0000)
@northern_doctorTrials have already shown that we can prevent VTE with LMWH, but does it make a difference in overall outcomes if we do this? #twitjc
(Sun, 26 Feb 2012 20:25:05 +0000)
@northern_doctorYes! RT @dermotor : Do think that there are patients on LMWH for too long. Assessed as @ risk & prescribed for whole stay #twitjc
(Sun, 26 Feb 2012 20:25:21 +0000)
@Albajuly@payamtorabi @northern_doctor Aren't we using enoxaparin to reduce death from VTE? #twitjc
(Sun, 26 Feb 2012 20:25:24 +0000)
@mdthemdAll cause mortality is easy and reliable to record Hence Also previously reported in the literature and used 4 power calc #twitjc
(Sun, 26 Feb 2012 20:25:26 +0000)
@JoMacIverLove it when studies measure the thing we're interested in. Doesn't matter if it stops a few VTEs if it causes more mortality! #twitjc
(Sun, 26 Feb 2012 20:25:31 +0000)
@northern_doctorAgree! RT @elinlowri : But a lot of VTE is not diagnosed, which is why mortality is the best endpoint #twitjc
(Sun, 26 Feb 2012 20:25:37 +0000)
@andrew_dawes@northern_doctor Thank you!! #twitjc
(Sun, 26 Feb 2012 20:25:41 +0000)
@Lush_London@twitjournalclub #twitjc mortality related to VTE? PE etc?
(Sun, 26 Feb 2012 20:25:47 +0000)
@sturob79@northern_doctor it depends on your background mortality rate related to primary disease #twitjc
(Sun, 26 Feb 2012 20:26:02 +0000)
@elinlowri@northern_doctor Exactly. No point faffing about with heparin if people die anyway, despite it seeming the right thing to do #twitjc
(Sun, 26 Feb 2012 20:26:25 +0000)
@GasCast@Albajuly but despite common sense, there doesn't seem to be a huge link between VTE and death. #twitjc
(Sun, 26 Feb 2012 20:26:44 +0000)
@Albajuly@northern_doctor Personally I see LMWH as an attempt to reduce mortality from VTE whilst we attempt to treat their other illness #twitjc
(Sun, 26 Feb 2012 20:26:54 +0000)
@GasCastOnly 1 patient in each group had PE as cause of death #twitjc
(Sun, 26 Feb 2012 20:27:05 +0000)
@PaedsSHOI thought it was interesting that patients were ineligible if predicted hospitalisation was less than 6 days. #twitjc
(Sun, 26 Feb 2012 20:27:37 +0000)
@payamtorabi@Albajuly @northern_doctor but it could increase risk of death from other causes? #twitjc
(Sun, 26 Feb 2012 20:28:07 +0000)
@andrew_dawes@payamtorabi @northern_doctor I meant safer for the drug Co as that is is easier to prove beneficial effect #twitjc
(Sun, 26 Feb 2012 20:28:23 +0000)
@twitjournalclubRT @PaedsSHO : I thought it was interesting that patients were ineligible if predicted hospitalisation was less than 6 days. #twitjc
(Sun, 26 Feb 2012 20:28:36 +0000)
@Lush_London@PaedsSHO #twitjc exactly - so how comparable to UK?
(Sun, 26 Feb 2012 20:28:37 +0000)
@pipkelly#twitjc mortality seems exactly what's important
(Sun, 26 Feb 2012 20:28:41 +0000)
@northern_doctorWould you treat this population in real life? RT @PaedsSHO : Patients were ineligible if predicted hospitalisation was <6 days. #twitjc
(Sun, 26 Feb 2012 20:29:01 +0000)
@dsdarbyshire#twitjc to adequately measure all cause mortality you need a big sample in a homogenous population. This study doesn't do that.
(Sun, 26 Feb 2012 20:29:13 +0000)
@Albajuly@payamtorabi @northern_doctor And that's where the incidence of haemorrhage recorded is useful. #twitjc
(Sun, 26 Feb 2012 20:29:39 +0000)
@justanotherSHOI brought this paper up with our 'VTE specialist nurse'. He said 'well, its what NICE recommends...' #sigh #twitjc
(Sun, 26 Feb 2012 20:30:01 +0000)
@PaedsSHO@northern_doctor If they had plenty of risk factors, probably. You may be asking the wrong specialist though ;-) #twitjc
(Sun, 26 Feb 2012 20:30:05 +0000)
@elinlowriI suspect mortality may have been lower than 'normal' in both groups because underlying conditions better treated #twitjc
(Sun, 26 Feb 2012 20:30:27 +0000)
@northern_doctor@Albajuly Me too? But is it effective and safe? Especially for longer admissions? Don't think we really know. #twitjc
(Sun, 26 Feb 2012 20:30:28 +0000)
@silv24@northern_doctor @paedssho according to our risk assessment tool yes if they had any risk factors for VTE #twitjc
(Sun, 26 Feb 2012 20:30:40 +0000)
@bmdavies89@dsdarbyshire #twitjc how big is big?
(Sun, 26 Feb 2012 20:30:59 +0000)
@Albajuly@twitjournalclub I think the problem is using such a wide range of conditions vaguely defined. Impossible to match the groups #twitjc
(Sun, 26 Feb 2012 20:31:01 +0000)
@twitjournalclubMoving onto the third point - Are the results of this study applicable to a Western population? #twitjc
(Sun, 26 Feb 2012 20:31:12 +0000)
@GasCastI thought it was interesting that the MEDENOX trial that did show a difference in mortality had 10 times higher Hx of VTE. #twitjc
(Sun, 26 Feb 2012 20:31:15 +0000)
@northern_doctor@justanotherSHO And hence why he has a job! NICE has improved the screening and prophylactic treatment, but is there more to it? #twitjc
(Sun, 26 Feb 2012 20:31:45 +0000)
@Albajuly@twitjournalclub I think the end point would have been fine if the condition range had been more specific. #twitjc
(Sun, 26 Feb 2012 20:31:46 +0000)
@amcunningham“ @kerryhood : @GasCast @Albajuly but with ongoing malignancy you would want to continue treating not stop at 14 days #twitjc ”
(Sun, 26 Feb 2012 20:31:51 +0000)
@amcunningham“ @kerryhood : @northern_doctor @sturob79 no randomisation doesn't - need a more targetted population #twitjc ”
(Sun, 26 Feb 2012 20:32:08 +0000)
@northern_doctorMaybe but no way of knowing for sure! RT @twitjournalclub : Are the results of this study applicable to a Western population? #twitjc
(Sun, 26 Feb 2012 20:32:28 +0000)
@Puffles2010Puffles (*invites*) healthcare professionals to follow & join in the debate at #twitjc
(Sun, 26 Feb 2012 20:32:47 +0000)
@GasCast@andrew_dawes I agree. I thought that was weird. #twitjc
(Sun, 26 Feb 2012 20:32:53 +0000)
@elinlowri@amcunningham @kerryhood @GasCast @Albajuly True - trials in lung cancer suggest it improves outcome #twitjc
(Sun, 26 Feb 2012 20:33:18 +0000)
@Lush_London@twitjournalclub as @PaedsSHO said, only its with stay of 6+ days anticipated, so not that applicable to UK for surgical patients? #twitjc
(Sun, 26 Feb 2012 20:33:30 +0000)
@PaedsSHO@GasCast @andrew_dawes No autopsies performed in either group. #twitjc
(Sun, 26 Feb 2012 20:33:53 +0000)
@twitjournalclubAnd could such a study be carried out in a hospital in the UK given the emphasis on prescription of LMWH in NICE guidelines? #twitjc
(Sun, 26 Feb 2012 20:33:57 +0000)
@dsdarbyshire#twitjc all cause and specific conditions not compatible in same study. Need specific studies for specific diseases in specific situations.
(Sun, 26 Feb 2012 20:34:04 +0000)
@elinlowriAre the results of this study applicable to a Western population? #twitjc Errr, probably.
(Sun, 26 Feb 2012 20:34:29 +0000)
@andrew_dawes@GasCast But did they actively investigate for PE? Cause of death was resp failure in this study - not allowed in UK #twitjc
(Sun, 26 Feb 2012 20:34:41 +0000)
@dsdarbyshire#twitjc this study cannot be applied to any population as it encompasses too many different ones.
(Sun, 26 Feb 2012 20:35:11 +0000)
@GasCast@Lush_London Surgical patients already have proven reduction in mortality, although two papers referenced are from 1975 & 1988! #twitjc
(Sun, 26 Feb 2012 20:35:16 +0000)
@northern_doctorNo! Unethical! MT @twitjournalclub : Could study be carried out in UK given emphasis on prescription of LMWH in NICE guidelines? #twitjc
(Sun, 26 Feb 2012 20:35:24 +0000)
@PaedsSHO@Lush_London @twitjournalclub Exclusion criteria (appendix 2) removed all surgical patients. #twitjc
(Sun, 26 Feb 2012 20:35:33 +0000)
@elinlowri@twitjournalclub I think this would be like trying to trial steroids in lung fibrosis - the horse has bolted. #twitjc
(Sun, 26 Feb 2012 20:35:35 +0000)
@Lush_London#twitjc cannot see they analysed by medical or surgical pts, and different rates of VTE in those 2 groups
(Sun, 26 Feb 2012 20:35:56 +0000)
@silv24There are a couple of studies referenced that show little difference in frequency DVTs in Asian and Western populations #twitjc
(Sun, 26 Feb 2012 20:36:08 +0000)
@bmdavies89I think such a trial in the UK would face serious ethical dilemmas over safety of placebo. Would struggle with red tape? #twitjc
(Sun, 26 Feb 2012 20:36:19 +0000)
@Albajuly@twitjournalclub It would be near impossible to gain ethical approval in the UK, esp. since you would be consenting an acute pt #twitjc
(Sun, 26 Feb 2012 20:36:24 +0000)
@GasCast@twitjournalclub Yes - because NICE guidelines are evidence based and this is the latest evidence #twitjc
(Sun, 26 Feb 2012 20:36:29 +0000)
@twitjournalclub@northern_doctor why unethical if as far as we know there is no difference in mortality? #twitjc
(Sun, 26 Feb 2012 20:37:11 +0000)
@dannymcg@twitjournalclub Doubt it, ethics committee would have a little fit #twitjc
(Sun, 26 Feb 2012 20:37:24 +0000)
@northern_doctorBut areas that still lack evidence base include longer duration of stay, and use in CRF or AKI #twitjc
(Sun, 26 Feb 2012 20:37:30 +0000)
@payamtorabi@dsdarbyshire bt at present we dn't have this yet DO prescribe LMWH. Srely til we have evidence of efficacy for specific situations.. #twitjc
(Sun, 26 Feb 2012 20:37:34 +0000)
@twitjournalclubIf there is clinical uncertainty would be be unethical to carry out such a trial in a UK hospital? #twitjc
(Sun, 26 Feb 2012 20:37:49 +0000)
@mdthemd@twitjournalclub a protocol like this would not gain ethical approval in UK Also VTE now enshrined in new outcomes for MONITOR #twitjc
(Sun, 26 Feb 2012 20:37:57 +0000)
@dsdarbyshire#twitjc perhaps retrospective using those patients who ""fail"" to receive VTE prophylaxis.
(Sun, 26 Feb 2012 20:38:01 +0000)
@northern_doctorOther studies have shown increased bleeding risk with eGFR <30 (reduced dose of LMWH doesn't improve this, only lessens efficacy) #twitjc
(Sun, 26 Feb 2012 20:38:08 +0000)
@PaedsSHOTo be done in UK, any consent form would have to be VERY carefully worded! #twitjc
(Sun, 26 Feb 2012 20:38:19 +0000)
@northern_doctor@twitjournalclub Because it's already enshrined within NICE guidelines as 'best practice' #twitjc
(Sun, 26 Feb 2012 20:38:45 +0000)
@bmdavies89RT @dsdarbyshire : #twitjc perhaps retrospective using those patients who ""fail"" to receive VTE prophylaxis.
(Sun, 26 Feb 2012 20:38:50 +0000)
@Lush_London@PaedsSHO #twitjc apologies didn't see appendix, so none of medical pts admitted for surgery
(Sun, 26 Feb 2012 20:38:53 +0000)
@elinlowriBut I d love to see the use of heparin rationalised - it is part of CQUIN and takes up a whole page of admission proforma! #twitjc
(Sun, 26 Feb 2012 20:38:54 +0000)
@Albajuly@twitjournalclub Not unethical on it's face, given there is a potential complication (haemorrhage). But practically? #twitjc
(Sun, 26 Feb 2012 20:39:33 +0000)
@amcunningham“ @kerryhood are the patients likely to have received different treatments to Western ones that affect the risk profile? #twitjc ”
(Sun, 26 Feb 2012 20:39:39 +0000)
@GasCast@Albajuly why does consenting an acute patient create an ethical problem? #twitjc
(Sun, 26 Feb 2012 20:39:43 +0000)
@twitjournalclub@northern_doctor but does best practice with little evidence trump genuine clinical uncertainty when it comes to trial ethics? #twitjc
(Sun, 26 Feb 2012 20:39:44 +0000)
@JoMacIver@silv24 #twitjc Surely more interested in effect of LMWH in the different pops than the freq of events?
(Sun, 26 Feb 2012 20:39:57 +0000)
@northern_doctorIn my trust they're so focused on VTE screening, no tests can be ordered or prescriptions written until it's been done. #crazy #twitjc
(Sun, 26 Feb 2012 20:40:17 +0000)
@dsdarbyshire@payamtorabi #twitjc That is the difference between research design and clinical practice. Agree it's important to consider.
(Sun, 26 Feb 2012 20:40:24 +0000)
@northern_doctorRT @twitjournalclub : Does best practice with little evidence trump genuine clinical uncertainty when it comes to trial ethics? #twitjc
(Sun, 26 Feb 2012 20:40:33 +0000)
@PaedsSHO@northern_doctor I used to have a consultant who wouldn't allow you to present a post-take patient without a VTE assessment! #twitjc
(Sun, 26 Feb 2012 20:41:21 +0000)
@twitjournalclubRT @dannymcg : @twitjournalclub Doubt it, ethics committee would have a little fit #twitjc
(Sun, 26 Feb 2012 20:41:46 +0000)
@GasCast@northern_doctor it certainly shouldn't #twitjc
(Sun, 26 Feb 2012 20:41:47 +0000)
@twitjournalclubRT @Albajuly : @twitjournalclub Not unethical on it's face, given there is a potential complication (haemorrhage). But practically? #twitjc
(Sun, 26 Feb 2012 20:41:53 +0000)
@mdthemd@twitjournalclub actually trusts would not give governance approval so ethics committee would not have to discuss and thats b4 MHRA #twitjc
(Sun, 26 Feb 2012 20:41:56 +0000)
@northern_doctor@twitjournalclub That's a whole different debate! Agree in theory, but practically couldn't do it. Would never get ethical approval. #twitjc
(Sun, 26 Feb 2012 20:42:02 +0000)
@elinlowriWould need to be a massive study to be properly powered, pragmatic to be do-able, funding might be MRC/NIHR - big ask #twitjc
(Sun, 26 Feb 2012 20:42:08 +0000)
@amcunningham“ @kerryhood : @twitjournalclub @northern_doctor it shouldn't and probably is surmountable, but would need to be very convincing! #twitjc ”
(Sun, 26 Feb 2012 20:42:18 +0000)
@payamtorabi@dsdarbyshire yes. but at present clinical practice has lept ahead of the available evidence... #twitjc
(Sun, 26 Feb 2012 20:42:23 +0000)
@northern_doctor@PaedsSHO Post-take a bit different as you've had time to do initial management. Not so good when urgent treatments or tests needed #twitjc
(Sun, 26 Feb 2012 20:42:47 +0000)
@twitjournalclubRT @elinlowri : Would need to be a massive study to be properly powered, pragmatic to be do-able, funding might be MRC/NIHR -big ask #twitjc
(Sun, 26 Feb 2012 20:42:48 +0000)
@justanotherSHO#anecdotalevidence The only deaths from PE I have seen in inpatients have all had disseminated cancer already #twitjc .
(Sun, 26 Feb 2012 20:43:12 +0000)
@GasCastWith this study in mind, I would like to see a comparison of LMWH vs. TEDS #twitjc
(Sun, 26 Feb 2012 20:43:33 +0000)
@dannymcg@northern_doctor now that is utterly mad. No, please stop CPR until someone fills in the form. #WorldGoneMad #twitjc
(Sun, 26 Feb 2012 20:43:53 +0000)
@northern_doctorI'll rephrase - I personally don't consider it unethical (because of arguements re evidence) but an ethics committee would #twitjc
(Sun, 26 Feb 2012 20:44:03 +0000)
@elinlowriWe used to think every acute patient should be on PPI's but now the pharmacists go round crossing them off - things change! #twitjc
(Sun, 26 Feb 2012 20:44:50 +0000)
@northern_doctorAgree! RT @payamtorabi : At present clinical practice has lept ahead of the available evidence... #twitjc
(Sun, 26 Feb 2012 20:45:10 +0000)
@twitjournalclubAnd this brings us perfectly to the last point - Are compression stockings alone enough as thromboprophylaxis in medical patients? #twitjc
(Sun, 26 Feb 2012 20:45:12 +0000)
@GasCast@northern_doctor I disagree and it was a French ethics committee that approved this #twitjc
(Sun, 26 Feb 2012 20:45:15 +0000)
@bmdavies89@northern_doctor #twitjc absolutely- too scared of being sued.
(Sun, 26 Feb 2012 20:45:22 +0000)
@dsdarbyshire#twitjc are we underestimating the benefit of TEDS?
(Sun, 26 Feb 2012 20:45:56 +0000)
@amcunningham“ @kerryhood : @elinlowri agree, but I'm not sure that they would want to fund after this study - maybe NICE will rethink guidance #twitjc ”
(Sun, 26 Feb 2012 20:46:01 +0000)
@payamtorabi@twitjournalclub Probs need another study for that? #twitjc
(Sun, 26 Feb 2012 20:46:28 +0000)
@dannymcg@PaedsSHO @northern_doctor I had Consultant who said proformas were killing clinical acumen. I couldn't agree more. #twitjc
(Sun, 26 Feb 2012 20:46:36 +0000)
@amcunninghamRT @northern_doctor : Agree! RT @payamtorabi : At present clinical practice has lept ahead of the available evidence... #twitjc
(Sun, 26 Feb 2012 20:46:40 +0000)
@GasCastBearing in mind estimated mortality was 7% and measured was 4.7% - TEDS are awesome! #TEDS #twitjc
(Sun, 26 Feb 2012 20:46:53 +0000)
@northern_doctorSorry, mistake on last tweet - we *don't* use TEDS for stroke patients any more. No benefit, but risk of complications! #twitjc
(Sun, 26 Feb 2012 20:46:59 +0000)
@elinlowri'Are compression stockings alone enough thromboprophylaxis in medical patients?' - well, maybe! Wouldn't that be great/cheap/safe #twitjc
(Sun, 26 Feb 2012 20:47:23 +0000)
@twitjournalclubRT @northern_doctor : mistake on last tweet - we *dont* use TEDS for stroke patients any more. No benefit, but risk of complications! #twitjc
(Sun, 26 Feb 2012 20:47:52 +0000)
@Lush_London@twitjournalclub in the population they studied then probably, but no agreement whether applicable in UK #twitjc
(Sun, 26 Feb 2012 20:47:54 +0000)
@payamtorabi@elinlowri as long as we make sure our patients don't have PVD before we prescribe! #twitjc
(Sun, 26 Feb 2012 20:48:29 +0000)
@PaedsSHO@northern_doctor Use of TEDS ineffective in preventing DVT in stroke patients; CLOTS trial #twitjc
(Sun, 26 Feb 2012 20:48:36 +0000)
@twitjournalclubMT @elinlowri : Are compression stockings alone enough thromboprophylaxis in medical pts? - maybe! Wouldnt that be great/cheap/safe #twitjc
(Sun, 26 Feb 2012 20:48:58 +0000)
@northern_doctorEvidence shows LMWH reduces VTE, but no evidence of mortality reduction. Is VTE reduction alone enough to justify rx? NICE says yes #twitjc
(Sun, 26 Feb 2012 20:49:27 +0000)
@northern_doctor@PaedsSHO Yes, I knew that. Mistyped original tweet. *hangs head in shame* #twitjc
(Sun, 26 Feb 2012 20:50:02 +0000)
@dsdarbyshire#twitjc getting out of bed every couple of hours, for those that can, might help.
(Sun, 26 Feb 2012 20:50:13 +0000)
@PaedsSHO@northern_doctor Does NICE say that because anticoagulating them long-term is expensive? #twitjc
(Sun, 26 Feb 2012 20:50:18 +0000)
@andrew_dawes@GasCast @dsdarbyshire - and they used non full length stockings which arent meant to be as good! #twitjc
(Sun, 26 Feb 2012 20:50:28 +0000)
@Lush_London@Lush_London #twitjc could repeat study and this time actually screen for asymptomatic VTE especially as no pm carried out to exclude PE etc
(Sun, 26 Feb 2012 20:50:36 +0000)
@northern_doctor@PaedsSHO There's actually a 3rd CLOTS trial ongoing looking at pneumatic compression stockings. Fancy! #twitjc
(Sun, 26 Feb 2012 20:50:44 +0000)
@northern_doctor@PaedsSHO Suspect because VTE generally regarded as a bad thing #twitjc
(Sun, 26 Feb 2012 20:51:15 +0000)
@elinlowri@northern_doctor But despite this, if someone dies from PE and not on LMWH we get twitched about being sued. EBM can be tricksy! #twitjc
(Sun, 26 Feb 2012 20:51:19 +0000)
@andrew_dawesDoes VTE prophylaxis reduce hospital stay?? That would be the nly other reason for NICE recomending Rx. #twitjc
(Sun, 26 Feb 2012 20:51:49 +0000)
@northern_doctorIt was assumed that insignificant mortality difference in older trials may be because VTE was discovered and treated. Maybe not! #twitjc
(Sun, 26 Feb 2012 20:52:03 +0000)
@northern_doctorVery true! RT @elinlowri : If someone dies from PE and not on LMWH we get twitched about being sued. EBM can be tricksy! #twitjc
(Sun, 26 Feb 2012 20:52:28 +0000)
@PaedsSHO@northern_doctor Plus there are obviously non-fatal complications from VTE, post-thrombotic syndrome etc #twitjc
(Sun, 26 Feb 2012 20:52:54 +0000)
@tobyhillman@dsdarbyshire and fantastic for patients for many other reasons too... #twitjc
(Sun, 26 Feb 2012 20:53:52 +0000)
@northern_doctorValid point! RT @PaedsSHO : Plus there are obviously non-fatal complications from VTE, post-thrombotic syndrome etc #twitjc
(Sun, 26 Feb 2012 20:53:54 +0000)
@GasCast@northern_doctor MEDENOX found 9 - 21% PE on autopsy but only 3 deaths attributed to PE?high numbers of clinically insignificant VTE #twitjc
(Sun, 26 Feb 2012 20:53:58 +0000)
@payamtorabi#twitjc but also non-fatal complications from LMWH...
(Sun, 26 Feb 2012 20:54:07 +0000)
@twitjournalclubOverall - should this paper lead to a review of the NICE guidance and further studies into VTE prophylaxis? #twitjc
(Sun, 26 Feb 2012 20:54:21 +0000)
@PaedsSHO@twitjournalclub Yes. #twitjc
(Sun, 26 Feb 2012 20:55:15 +0000)
@tobyhillman@GasCast finding more and more PEs with better CT scanners nowadays - what to do with them can be a conundrum ( no sx etc) #twitjc
(Sun, 26 Feb 2012 20:55:45 +0000)
@northern_doctorThis is what I suspect too RT @GasCast : ?high numbers of clinically insignificant VTE #twitjc
(Sun, 26 Feb 2012 20:55:59 +0000)
@northern_doctorRT @GasCast : MEDENOX found 9 - 21% PE on autopsy but only 3 deaths attributed to PE?high numbers of clinically insignificant VTE #twitjc
(Sun, 26 Feb 2012 20:56:07 +0000)
@LizzyFerretSomething always conspires against me making #twitjc on a Sunday night :( #RageDotCom
(Sun, 26 Feb 2012 20:56:23 +0000)
@GasCast@twitjournalclub definitely. Work on LMWH in surgery done in 1975/88 when bedrest was an important treatment. #twitjc
(Sun, 26 Feb 2012 20:56:37 +0000)
@elinlowri#twitjc I would love this study to be true as it would justify my apathy towards our VTE proforma
(Sun, 26 Feb 2012 20:56:44 +0000)
@payamtorabi@twitjournalclub yes #twitjc
(Sun, 26 Feb 2012 20:56:45 +0000)
@Albajuly@twitjournalclub I think if study was broken down into comparison of similar conditions eg sepsis only, it may change the impact #twitjc
(Sun, 26 Feb 2012 20:56:57 +0000)
@northern_doctorI think so! RT @twitjournalclub : Should this paper lead to a review of NICE guidance and further studies into VTE prophylaxis? #twitjc
(Sun, 26 Feb 2012 20:57:06 +0000)
@payamtorabiRT @elinlowri : #twitjc I would love this study to be true as it would justify my apathy towards our VTE proforma
(Sun, 26 Feb 2012 20:57:16 +0000)
@dsdarbyshire#twitjc asymptomatic PE. Medicines incidentaloma.
(Sun, 26 Feb 2012 20:57:19 +0000)
@northern_doctorDitto RT @tobyhillman : Finding more and more PEs with better CT scanners - what to do with them can be a conundrum ( no sx etc) #twitjc
(Sun, 26 Feb 2012 20:57:38 +0000)
@northern_doctor@tobyhillman Always feel obliged to treat if found, but never totally sure if that's the right thing #twitjc
(Sun, 26 Feb 2012 20:58:13 +0000)
@northern_doctorRT @dsdarbyshire : #twitjc asymptomatic PE. Medicines incidentaloma. #twitjc
(Sun, 26 Feb 2012 20:58:24 +0000)
@GasCastWould be nice to do a study that quantified the contribution of TEDS alone in high risk patients. #twitjc
(Sun, 26 Feb 2012 20:58:28 +0000)
@dsdarbyshire#twitjc the review will happen but as this study wouldn't change practice in the UK it alone shouldn't expedite it.
(Sun, 26 Feb 2012 20:58:40 +0000)
@andrew_dawesarticle doest do enough to disprove its cont use. But does deserve further evaluation. as said prev other complications #twitjc
(Sun, 26 Feb 2012 20:58:44 +0000)
@elinlowri@dsdarbyshire #twitjc 'asymptomatic PE. Medicines incidentaloma' - get phoned about these a lot. Little known about their natural history
(Sun, 26 Feb 2012 20:59:11 +0000)
@tobyhillman@northern_doctor One starts to wonder if that is something the lungs are nicely placed to do - filter clots... #offtopic #twitjc
(Sun, 26 Feb 2012 20:59:27 +0000)
@twitjournalclubThank you all for such an interesting and lively discussion, I have really enjoyed it #twitjc
(Sun, 26 Feb 2012 20:59:36 +0000)
@dannymcgAnyone else notice the somewhat extensive list of pharmaceuticals at the bottom. Cause for concern? #twitjc
(Sun, 26 Feb 2012 20:59:47 +0000)
@Lush_London@twitjournalclub more UK based studies in medical patients needed for review of NICE #twitjc
(Sun, 26 Feb 2012 21:00:15 +0000)
@tomayates#TwitJC real questions to be answered about the process by which lmwh initially recommended and the role of industry funded pressure groups
(Sun, 26 Feb 2012 21:00:28 +0000)
@northern_doctorInteresting! RT @tobyhillman : One starts to wonder if that is something the lungs are nicely placed to do - filter clots... #twitjc
(Sun, 26 Feb 2012 21:00:33 +0000)
@twitjournalclubPlease continue the discussion using the hashtag or alternatively leave a comment on the website - http://t.co/Luo5ewL4 #twitjc
(Sun, 26 Feb 2012 21:00:44 +0000)
@payamtorabi@twitjournalclub Thanks for arranging :) #twitjc
(Sun, 26 Feb 2012 21:00:51 +0000)
@northern_doctor@dannymcg If anything dodgy was going on, you would have expected a positive result from the study though... #twitjc
(Sun, 26 Feb 2012 21:01:18 +0000)
@payamtorabi@andrew_dawes has the evidence really ever been strong enough for continued use? #twitjc
(Sun, 26 Feb 2012 21:01:25 +0000)
@PaedsSHOGood debate, probably a reflection of the fact that we still don't definitely know the right answer. #twitjc
(Sun, 26 Feb 2012 21:01:40 +0000)
@tobyhillman@twitjournalclub Thanks very much - sorry to join late #twitjc
(Sun, 26 Feb 2012 21:01:41 +0000)
@GasCast@twitjournalclub Thanks very much. Interesting paper and discussion. #twitjc
(Sun, 26 Feb 2012 21:01:41 +0000)
@twitjournalclubOnce again thank you all and I look forward to another interesting discussion in two weeks time - goodbye from @silv24 #twitjc
(Sun, 26 Feb 2012 21:01:56 +0000)
@payamtorabi@tomayates exactly! Posters for ""stop the clot"" have been going up this week with Sanofi Aventis logo emblazoned on them #twitjc
(Sun, 26 Feb 2012 21:02:12 +0000)
@dsdarbyshire@tobyhillman @northern_doctor #twitjc and given emboli don't always infarct...
(Sun, 26 Feb 2012 21:02:14 +0000)
@payamtorabi@tomayates someone making a lot of money from all the clexane we're prescribing #twitjc
(Sun, 26 Feb 2012 21:02:36 +0000)
@andrew_dawesThanks for organising. Must remember to include hashtags!! Doh #twitjc
(Sun, 26 Feb 2012 21:02:53 +0000)
@northern_doctorThank you & goodnight! RT @twitjournalclub : Once again thank you all I look forward to another interesting discussion in 2 wks time #twitjc
(Sun, 26 Feb 2012 21:03:17 +0000)
@tobyhillman@dsdarbyshire @northern_doctor and as resolutions get better on scanners - we will only find more. #twitjc
(Sun, 26 Feb 2012 21:03:47 +0000)
@PaedsSHOAs ever, massive thanks to @silv24 ; I know just how much she puts into each and every week. Well done. #twitjc
(Sun, 26 Feb 2012 21:04:04 +0000)
@andrew_dawes@payamtorabi Evdience for prevention of VTE is better as discussed earlier. #twitjc
(Sun, 26 Feb 2012 21:04:10 +0000)
@benedictwarner@twitjournalclub Thanks! Really enjoyed following along - and impressed at how much was covered in exactly 1hr! Learnt a lot. #twitjc
(Sun, 26 Feb 2012 21:04:23 +0000)
@silv24Thank you all so much for joining in #twitjc this week, fantastic discussion!!!
(Sun, 26 Feb 2012 21:04:39 +0000)
@elinlowriRT @PaedsSHO : As ever, massive thanks to @silv24 ; I know just how much she puts into each and every week. Well done. #twitjc
(Sun, 26 Feb 2012 21:04:47 +0000)
@payamtorabiRT @PaedsSHO : As ever, massive thanks to @silv24 ; I know just how much she puts into each and every week. Well done. #twitjc
(Sun, 26 Feb 2012 21:05:56 +0000)
@dermotor@twitjournalclub So after all this, as medical director, should I seek to change our guidance for medical patients VTE prevention? #twitjc
(Sun, 26 Feb 2012 21:06:00 +0000)
@PaedsSHOThanks to everyone who took part in #twitjc . If you enjoyed it, maybe come back next time? Maybe bring a friend?
(Sun, 26 Feb 2012 21:06:21 +0000)
@mgcmitchell@twitjournalclub @silv24 Thank you for stimulating discussion. Wasn't able to join in but followed.Interesting points for reflection #twitjc
(Sun, 26 Feb 2012 21:06:25 +0000)
@silv24RT @PaedsSHO : Thanks to everyone who took part in #twitjc . If you enjoyed it, maybe come back next time? Maybe bring a friend?
(Sun, 26 Feb 2012 21:06:41 +0000)
@northern_doctor@dermotor I don't think you can yet. Current practice adheres to NICE guidelines. #twitjc
(Sun, 26 Feb 2012 21:07:15 +0000)
@tobyhillmanMT @elinlowri :RT @PaedsSHO : As ever, massive thanks to @silv24 ; I know just how much she puts into each and every week.> Hear Hear! #twitjc
(Sun, 26 Feb 2012 21:07:59 +0000)
@wrexhamrob@twitjournalclub @silv24 #twitjc thanks for good discussion #uncertainty . Rd=Prescribing advisor pharmacist NWales
(Sun, 26 Feb 2012 21:08:04 +0000)
@northern_doctorRT @tobyhillman : @dsdarbyshire @northern_doctor and as resolutions get better on scanners - we will only find more. #twitjc
(Sun, 26 Feb 2012 21:08:20 +0000)
@silv24@mgcmitchell glad you enjoyed!! Keen to get as many people involved from lots of different backgrounds #twitjc
(Sun, 26 Feb 2012 21:08:41 +0000)
@dermotor@northern_doctor Be interesting if the NHS & NICE guidance leads to measurable fall VTE mortality #twitjc #patientsafety
(Sun, 26 Feb 2012 21:09:31 +0000)
@michealb#twitjc When CTPA first became gold standard, tiny PEs in subsegmental branches were not seen/rxed w/o any inc mortal in the CTPA-ve group
(Sun, 26 Feb 2012 21:12:40 +0000)
@amcunninghamRT @northern_doctor : @tobyhillman Always feel obliged to treat if found, but never totally sure if that's the right thing #twitjc
(Sun, 26 Feb 2012 21:15:03 +0000)
@amcunningham@PaedsSHO yes, well done @silv24 :) #twitjc
(Sun, 26 Feb 2012 21:17:22 +0000)
@northern_doctorRT @dermotor : @northern_doctor Be interesting if the NHS & NICE guidance leads to measurable fall VTE mortality #twitjc #patientsafety
(Sun, 26 Feb 2012 21:20:27 +0000)
@silv24Very tired tonight - culmination of four days of tonsillitis and a very engaging #twitjc
(Sun, 26 Feb 2012 21:25:58 +0000)
@amitnsSorry missed the fab discussion. This highlights serious flaw in deciding 'best practices' based on flimsy evidences. Egs abound. #twitjc
(Sun, 26 Feb 2012 21:26:17 +0000)
@JDMoffatt@silv24 A v interesting #twitjc indeed.
(Sun, 26 Feb 2012 21:30:42 +0000)
@dean_jenkins#twitjc Feb 26th 2012: Transcript of this evening's Twitter Journal Club using an experimental Twitter chat cura... http://t.co/qWNbKlNk
(Sun, 26 Feb 2012 22:10:49 +0000)
@dsdarbyshireRT @dean_jenkins : #twitjc Feb 26th 2012: Transcript of this evening's Twitter Journal Club using an experimental Twitter chat cura... http://t.co/qWNbKlNk
(Sun, 26 Feb 2012 22:30:42 +0000)
@tomayates@payamtorabi did you see this in the BMJ - http://t.co/2tjmkf1d? #twitjc
(Sun, 26 Feb 2012 22:35:44 +0000)
@dean_jenkins@amcunningham @dsdarbyshire OK I've modified my curation widgety thingy on the beta site. Shall I redo the blog example for #twitjc ?
(Sun, 26 Feb 2012 22:47:25 +0000)
@dean_jenkins@dsdarbyshire @amcunningham @twitjournalclub @silv24 @fidouglas pleasure to help curate ... been working on a tool to automate it. #twitjc
(Sun, 26 Feb 2012 23:00:09 +0000)
@dean_jenkinsAdded a list of those involved in #twitjc with the most prolific first. http://t.co/HMy2gJJb Will add this to Twitter curation tool.
(Mon, 27 Feb 2012 00:34:24 +0000)
@northern_doctorFollowing on from #twitjc , this is well worth a read! RT @DrGrumble http://t.co/Kcm9bnz6 » v useful and good rules of thumb at end #meded
(Mon, 27 Feb 2012 07:02:54 +0000)
@northern_doctorMost prolific! Good or bad? RT @dean_jenkins : Added a list of those involved in #twitjc with the most prolific first. http://t.co/NigEwv6k
(Mon, 27 Feb 2012 07:12:30 +0000)
@amitnsRT @northern_doctor : Following on from #twitjc , this is well worth a read! RT @DrGrumble http://t.co/Kcm9bnz6 » v useful and good rules of thumb at end #meded
(Mon, 27 Feb 2012 07:17:36 +0000)
@andrew_dawesRT @northern_doctor : Following on from #twitjc , this is well worth a read! RT @DrGrumble http://t.co/Kcm9bnz6 » v useful and good rules of thumb at end #meded
(Mon, 27 Feb 2012 07:47:15 +0000)
@tomayates@parks_tom @drcjar check out yesterday's #twitjc on nejm lmwh paper
(Mon, 27 Feb 2012 08:00:41 +0000)
@silv24RT @dean_jenkins : Added a list of those involved in #twitjc with the most prolific first. http://t.co/HMy2gJJb Will add this to Twitter curation tool.
(Mon, 27 Feb 2012 08:49:08 +0000)
@amitns@silv24 @DrGrumble @northern_doctor The Sixth Sense as a metaphor for Medicine's Heart of Darkness http://t.co/8bsfAQbB last #twitjc
(Mon, 27 Feb 2012 09:47:10 +0000)
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