I'm asking a possible naive question, regarding coumadin vs. direct inhibitors, as this is outside of my field, but is really more a general question: is there a possibility of introducing a bias in this type of trial design, by randomizing drug switches. I'm thinking that, by definition, you are taking a population who is at least not doing terribly on a specific drug, (so chopping off one end of the bell curve) and possibly even doing well, and potentially exposing them to a different drug where all outcomes are in play. Is this a valid concern?
Another way to ask this: Imagine the opposite scenario, would we expect to see the same results? Is it possible that if you took the same patient population, except they were patients who happened to be on the direct inhibitors, and then randomized to switch to coumadin, that this trial would show that COUMADIN has the increased risks? Is the initial drug given a leg up, regardless of their relative profiles?
Thank you for this podcast! As a CICU nurse and ECMO specialist I found it fascinating. My unit had 3 ECMO patients at the end of July, 2 VV and 1 VA. The VA and 1 VV just went to rehab (walking and talking) this past Thursday. It was a glorious day! The other VV will be decannulated to comfort care tomorrow. The ones that are going home are 20 years younger than our comfort care patient and with way less co-morbidities. Yes, it was a moon shoot. We do way more Impellas than ECMO in my unit.
I test myself for Covid when I have a bad cold to make sure I stay away from work long enough. Only tested my youngest once, last year. He's 9. To his credit, the ER resident did not run an RPP swab after his flu and covid came back negative. He did this for the very reasons you laid out in your discussion, cost and pretty much useless info. I was grateful for his thoughtfulness. Love your podcasts!
I still find a reason for testing for COVID - because everyone wants antibiotics for every sniffle today. "They have green snot, that means an infection" and no matter how much I try to explain that viruses are as much of an infection as bacteria, no one listens. At least if I can tell them they have COVID or flu or RSV they won't turn around and go to the QuickCare for the antibiotic I didn't prescribe. If they are positive, I do tell them not to notify the school and just send their kid back when they feel better.
Thanks for the great discussion. As a critical care physician I especially appreciated the discussion of ECLS-SHOCK. It should be pointed out that as with almost all ECMO trials (except ECPR trials) this was really a trial of early ECMO versus ECMO as rescue therapy, and as with those previous trials was also negative. ECMO as rescue therapy (for uncompensated cardiogenic shock despite best medical therapy) is still a trial to be done (though it won't be - this *might* be an example of a parachute).
Looking forward to more great discussions - especially in the critical care space.
With all due respect, I noticed quite a few F bombs when you discussed TDS - when describing those who have it and seem to debunk science because they hate the guy so much. Could it be that there’s a boomerang effect there? 😬. Love the podcast regardless, just wondered what inflamed you more than the obvious!!
This is just the kind of discussion I would love to read. I will just continue begging. I and many others do not have most of an hour to listen to this as valuable/interesting as I am sure it is. Many are not aural learners. Some have hearing deficits.
Luckily, autotranscribers are cheap/free. You would add significant audience if you autotranscribed these podcasts and posted the transcription when you posted the aural component. Otherwise, many of us will never get the content.
Such a great discussion, as always! On point (European here)
I'm asking a possible naive question, regarding coumadin vs. direct inhibitors, as this is outside of my field, but is really more a general question: is there a possibility of introducing a bias in this type of trial design, by randomizing drug switches. I'm thinking that, by definition, you are taking a population who is at least not doing terribly on a specific drug, (so chopping off one end of the bell curve) and possibly even doing well, and potentially exposing them to a different drug where all outcomes are in play. Is this a valid concern?
Another way to ask this: Imagine the opposite scenario, would we expect to see the same results? Is it possible that if you took the same patient population, except they were patients who happened to be on the direct inhibitors, and then randomized to switch to coumadin, that this trial would show that COUMADIN has the increased risks? Is the initial drug given a leg up, regardless of their relative profiles?
Thank you for this podcast! As a CICU nurse and ECMO specialist I found it fascinating. My unit had 3 ECMO patients at the end of July, 2 VV and 1 VA. The VA and 1 VV just went to rehab (walking and talking) this past Thursday. It was a glorious day! The other VV will be decannulated to comfort care tomorrow. The ones that are going home are 20 years younger than our comfort care patient and with way less co-morbidities. Yes, it was a moon shoot. We do way more Impellas than ECMO in my unit.
I test myself for Covid when I have a bad cold to make sure I stay away from work long enough. Only tested my youngest once, last year. He's 9. To his credit, the ER resident did not run an RPP swab after his flu and covid came back negative. He did this for the very reasons you laid out in your discussion, cost and pretty much useless info. I was grateful for his thoughtfulness. Love your podcasts!
Great job. Entertaining and educational as always plus love the f bombs.
I still find a reason for testing for COVID - because everyone wants antibiotics for every sniffle today. "They have green snot, that means an infection" and no matter how much I try to explain that viruses are as much of an infection as bacteria, no one listens. At least if I can tell them they have COVID or flu or RSV they won't turn around and go to the QuickCare for the antibiotic I didn't prescribe. If they are positive, I do tell them not to notify the school and just send their kid back when they feel better.
Thanks for the great discussion. As a critical care physician I especially appreciated the discussion of ECLS-SHOCK. It should be pointed out that as with almost all ECMO trials (except ECPR trials) this was really a trial of early ECMO versus ECMO as rescue therapy, and as with those previous trials was also negative. ECMO as rescue therapy (for uncompensated cardiogenic shock despite best medical therapy) is still a trial to be done (though it won't be - this *might* be an example of a parachute).
Looking forward to more great discussions - especially in the critical care space.
With all due respect, I noticed quite a few F bombs when you discussed TDS - when describing those who have it and seem to debunk science because they hate the guy so much. Could it be that there’s a boomerang effect there? 😬. Love the podcast regardless, just wondered what inflamed you more than the obvious!!
I am curious about rebound with Paxalovid... seems really common.
Did you say goat? Goes better with red wine IMO
This is just the kind of discussion I would love to read. I will just continue begging. I and many others do not have most of an hour to listen to this as valuable/interesting as I am sure it is. Many are not aural learners. Some have hearing deficits.
Luckily, autotranscribers are cheap/free. You would add significant audience if you autotranscribed these podcasts and posted the transcription when you posted the aural component. Otherwise, many of us will never get the content.
Please...