Medical Attending and Director of CME @VABostonHC | Critical Appraisal enthusiast @thecurbsiders & @JWatch. Easily fascinated. Views mine, but I'll share.
Massachusetts, USA
Joined August 2011
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Phenobarbital is effective for alcohol withdrawal.
But is it safe?
YES!
At VA Boston, we found that SAEs happened in 1 of 244 hospitalizations (0.4%).
There were ZERO:
- intubations
- ICU transfers for over-sedation
- deaths
sciencedirect.com/science/ar…
Kudos to @mvronan!
Joel, it was such a joy to learn from you all. I am very grateful for the opportunity!
I have never felt more out of my league!!
At least I'll always have flight nannying for bernedoodles to fall back on ...
Hey @thecurbsiders thanks for loaning us @rbganatra for our Journal Club on Mercuri-2 pca.st/episode/2b44ab06-ab8e…
Rahul Ganatra retweeted
1/4
HOW FAST SHOULD HEMOGLOBIN FALL IF THE BONE MARROW JUST STOPS?
Imagine erythropoiesis suddenly shuts down completely.
No new red cells enter the circulation.
How quickly should the hemoglobin fall?
Surprisingly slowly.
Rahul Ganatra retweeted
1/ My fastest paper took one week from draft to done. My slowest is still unpublished 7years on. The difference: a ten minute feasibility check. Trainees I work with earned 6 Merit Awards in 3 years, every project passing it early. Few programs seem to teach this. Let me try
Rahul Ganatra retweeted
Ok, in brief. This story will not die. Why? It is a sexy story. Anaerobes = microbiome = good. Anaerobic therapy -> kills anaerobes -> ... -> metabolic health -> badness. It ties into our fundamental belief of "good bacteria" and well established role of abx issues (e.g. C.diff)+
The price of anaerobic coverage when treating bloodstream infections.
🆕💥🟢Pre-planned BALANCE RCT sub-study (n=2,851) evaluated patients with bloodstream infection without a clinical indication for anaerobic coverage who survived to 7 days after the index blood culture.
After balancing measured confounders using IPTW, receipt of anti-anaerobic antibiotics was associated with:
📈 41% higher adjusted odds of 90-day mortality (OR 1.41; 95% CI 1.03–1.92)
🦠 Greater depletion of beneficial gut anaerobes
⏳ Longer duration of therapy → greater mortality risk and microbiome disruption
#IDXposts academic.oup.com/cid/article…
Rahul Ganatra retweeted
Guess what study was retracted after editorial investigation
Guess which study which never should have been published after editorial & peer review
Guess which study Topol called the "best proof of hte importance of timing of therapy"
Good morning. Just an outstanding little paper trying to answer a question as old as time: how much farting is too much?
jamanetwork.com/journals/jam…
Well, now we know.
In an open-label non-inferiority trial from Italy, among ~600 inpatients undergoing colonoscopy, split-dose administration of 1L and 2L PEG-ascorbate and 4L of PEG-simethicone all resulted in an adequate bowel prep (BPPS >=6) in ~80% of patients.
acpjournals.org/doi/10.7326/…
Question for folks with GI expertise:
1. Why might a lower volume (and I am inferring, higher concentration) prep be more effective? Stronger osmotic gradient pulling out more water -> more effective bowel prep?
For the love of god and all that is holy, can we collectively agree to stop publishing hopelessly confounded retrospective cohort studies using TriNetX data?
Great thread on immortal time bias 👇
A new study in JAMA Network Open suggests GLP-1s like Ozempic cut the risk of death after breast cancer by 91%.
I want to believe it. But this is one of those headlines that falls apart once you read the paper.
buff.ly/Cs2VRJ5
Rahul Ganatra retweeted
A Friday footnote: The New England Journal of Medicine has published the Moderna influenza vaccine data -- the same that led the FDA's CBER division to refuse to review the vaccine under Vinay Prasad. (That decision, called a refuse-to-file or RTF, was later reversed.)
The data had been presented to investors but this was peer-reviewed and there are some wrinkles worth looking at. First, the efficacy slide.
Think you'd be good at identifying AI-generated X-rays?
Try this and prepare to be demoralized:
noneedanick.github.io/DeepFa…?
Rahul Ganatra retweeted
This #journalimage was AI-manipulated and retracted in NEJM.
Can you spot the signs?
ALT DOI: 10.1056/NEJMicm2518379
@DrToddLee - I need your help unpacking the nature of some immortal time.
Here's the paper:
sciencedirect.com/science/ar…
A retrospective cohort study in which the authors conclude that IV iron in patients with anemia & infection was associated with ⬇️ 14d and 90d mortality
...(the exposed group) were considered exposed if they received IV iron within 7 days of the index date.
Crucially, they had to survive up until that date to receive IV iron!
Individual data are not available, so I don't know how much person-time in the exposed group...
Rahul Ganatra retweeted
Key highlights from @rbganatra's fantastic Grand Rounds presentation on Alcohol use disorder today: a thread
1. Use a symptom-triggered approach rather than a schedule. This is shown to reduce both cumulative dose given and time of treatment without increase in DT/complications
"...the broken system explanation [for healthcare] is also a distraction. ...It helps avoid close scrutiny of one’s own practices and enables the status quo."
Really nice piece!
For a few years now, I have been sounding the alarm on the crisis of leadership in US healthcare.
On the occasion of Dr. Martin Luther King Jr.’s birthday, I reflected on the contours of this crisis and the healthcare industry’s silent complicity in the face of massive dysfunction.
This complicity has a name: Ethical erosion.
As patients express more and more frustration with a system that often hurts more than it heals, the need for introspective and authentic leadership has never been greater.
What does this leadership look like? Read my take in Forbes:
lnkd.in/gbMBensm
