@ToshiAkima @LadyScorcher RCTs certainly have their disadvantages. How do physico-engineers account for non-measurable confounders and selection bias if they’re going to make causal inferences?
Bendale, Toronto 🇨🇦 English
Martin Betts
237 posts
Martin Betts
@bettsme
Physician. Early adopter. Aesthete.
TO Beigetreten Nisan 2009
174 Folgt259 Follower
RCTs have never been a standard of proof in physico-engineering safety systems in any industry. Feigning such a precedent exists flies in the face of reason, given the track record of non-pharmacological engineering-based physical safety system development twitter.com/toshiakima/sta…
Dr Satoshi Akima FRACP 『秋間聰』@ToshiAkima
I am sorry to say that clinicians don't know what evidence is. And YES, you ARE an idiot if you reply that RCTs are the pinnacle of scientific methodology. Nobody in aerospace safety or automobile safety uses RCTs. Einstein's theory of relativity has never been subjected to RCTs
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The use of RCTs to test non-pharmacological physico-engineering-based preventative physical devices like respirators is virtually unheard of and sets an outrageous and dangerous precedent. 🧵 acpjournals.org/doi/10.7326/M2…
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@BogochIsaac Read manuscript in detail and comments. Conclusions:
1. An important question when posed in spring 2020. The concept if not the methods (cluster RCT, continuous masking) has some validity. Should have stopped enrolment
2. Poorly done research is worse than useless, it’s harmful.
L'Amoreux, Toronto 🇨🇦 English
A hospital-based randomized trial of N95 VS medical masks was recently published.
No study is perfect & there is some valid criticism.
As Twitter skews unidirectionally, it is worth reading critiques & also the authors' responses (scroll to the bottom). bit.ly/3G3INRK
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@DrKateJMiller Congratulations, superstar doctor.
OCFP@OntarioCollege
Congratulations to our Regional Family Physicians of the Year! The OCFP recognizes physicians from each region of Ontario who provide exemplary care to their patients and are involved in activities that contribute to excellence in family medicine. #OCFPAwards
Parkwoods-Donalda, Toronto 🇨🇦 Română
Bendale, Toronto 🇨🇦 English
“The health care system as a whole is relying too heavily on emergency departments. We can try our best to prepare for surges, but we can’t do everything.”
TY @torontolife for covering ED overcrowding @SickKidsNews
#cdnhealth #pediatrics torontolife.com/city/its-a-per…
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Martin Betts retweetet
The old party is dead. Time to bury it. Build something new
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@DrJacobsRad @deonandan 20 of the 25 vented patients Thursday at Sick Kids were viral pneumonia and no comorbidities. Only last couple weeks included RSV.
Solidaridad, Quintana Roo 🇲🇽 English
@deonandan Same concept. Mask the pediatric population at highest risk for RSV.
Masking the entire population in a non acute pandemic setting is not a viable solution.
Masking vulnerable populations makes sense, just like we vaccinate for HPV and Herpes Zoster in vulnerable age groups.
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@ADetsky @BogochIsaac @UofT_dlsph @OntarioHealthOH An important question and agree there’s equipoise between a respirator and nose-kerchief
Solidaridad, Quintana Roo 🇲🇽 English
Once again we have a real opportunity to perform a randomized trial of masking policies in schools. We should have done this 2 years ago. Why not now? @BogochIsaac @UofT_dlsph @OntarioHealthOH
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Martin Betts retweetet
@ADetsky @DavidJuurlink @davidcarr333 @katplenk @BogochIsaac @DrToddLee I must have missed this seminar. More familiar with an international variant called “sibling in [name of country from which a visa will never be granted] syndrome” with similar consequences
Parkwoods-Donalda, Toronto 🇨🇦 English
@DavidJuurlink @davidcarr333 @katplenk @BogochIsaac @DrToddLee I definitely taught this to @DavidJuurlink and many others. And it was the guilt ridden daughter who never saw the mum from California.. and Vancouver.., and Winnipeg… and Calgary….
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Daughter(Son)from California syndrome.Has anyone seen this before? Seen more commonly by Internists but occasionally seen in the ED. A name has been given to the entity. @katplenk @BogochIsaac @DrToddLee @DavidJuurlink en.wikipedia.org/wiki/Daughter_…
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Historic gift that will transform healthcare in Scarborough for decades… many thanks to @orlando_corp for setting the bar so high.
Scarborough Health Network Foundation@SHNFoundation
The largest donation in Scarborough history… a $75 million gift from @Orlando_Corp! 🙌 From the bottom of our hearts, thank you for this incredible investment in Scarborough. Your gift will open many doors & will forever be a monumental part of our history. #LoveScarborough
Parkwoods-Donalda, Toronto 🇨🇦 English
@HawryluckLaura @DFisman @scott_wakelin @TorontoStar Actually on rereview I believe this is a poorly written statement referring to patients admitted to hospital/ICU that are COVID positive but not with pneumonia (the whole “with/for”) and the writers use of “subsequently” is misleading
Downtown, Vancouver 🇨🇦 English
@HawryluckLaura @DFisman @scott_wakelin @TorontoStar I have a hard time recalling any true nosocomial cases (sample >1000). The phenomenon Laura refers to was real but small in waves 1-3 but not since. Probably many patients who had ICU orders but test returned afterwards ie. the ~24hr wait for pcr
Downtown, Vancouver 🇨🇦 English
@DavidJuurlink I had my answer for “Sue” when our local MPP told me I was spending too much time caring for COVID patients. “It’s a simple condition”. This was at the end of 6 weeks of 1:2 in-house call and while there was an outbreak at a LTC facility in his riding that killed 80 people.
Parkwoods-Donalda, Toronto 🇨🇦 English
Martin Betts retweetet
Dr. Betts has been working at SHN for over 8 years. As Chief of Critical Care, he was instrumental in our care for #COVID19 patients as Scarborough tackled among the highest number of #COVID19 cases in Ontario.
Submit your letter or watch the full video: LoveScarborough.ca
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Martin Betts retweetet
Our Birchmount Hospital ICU with @TrilliumGift became the 3rd hospital in Ontario to perform a NPOD. An extended window of 27 hrs makes this the longest time from withdrawal of invasive support to organ retrieval on record #BeADonor #NOTDAW
Read more: ow.ly/7FSN50IW6tS
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@MPaiMD @RosovskyRachel But giving bleedy drugs to patients with blood in their brain is just so nerve racking. With UHF I feel like Im making a 2hr commitment (if I’m wrong) vs. 24hours for LMWH
Bendale, Toronto 🇨🇦 English
Reupping this great 2020 work from @RosovskyRachel! I still encounter the misconception that “scary clots” need UFH. In fact, using LMWH in sick patients w CSVT, splanchnic clots, PE etc more likely to give stable anticoag without dangerous peaks & valleys = better outcomes.
Rachel Rosovsky@RosovskyRachel
We know early anticoagulation SAVES lives; we need to move away from UFH. Nearly 60% of our patients failed to achieve ANY therapeutic PTT within 24 hours. We need to do better for our patients & we can. #PERC @PERTConsortium @StopTheClot @AnticoagForum @CMichaelGibson
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@cdavidnaylor @BrooksFallis And yet Brampton Civic is the 3rd newest hospital in the GTA (“Cortellucci”, Humber)? Outgrown before moving in. Come to Scarborough and I can show you what medicine and surgery in the 1950s look like!
Bendale, Toronto 🇨🇦 English
Noteworthy again from @BrooksFallis who knows this situation inside out. The shortfall in Brampton is longstanding. Can't build equitable healthcare capacity via politicking (whether by politicos or providers).
Brooks Fallis@BrooksFallis
The people of Brampton deserve better. Brampton has one of the lowest hospital beds per capita in 🇨🇦 Brampton needs a 600-800 bed acute care hospital. Instead they are getting 250 mostly non acute beds & an urgent care centre rebranded as an Emergency department.
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Martin Betts retweetet
You can't just ignore mass spread forever and pretend it isn't happening. Scotland last week saw 9% of its population infected, England 6.5%. UK hospital admissions are higher than ever, deaths rising. You can't just ignore covid because it's annoying.
theguardian.com/australia-news…
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Hospitalizations are a lagging indicator and it'll likely take a bit to see the expected rise in the topline numbers, but we're plausibly already seeing the start of it in Toronto and the Central health region (Halton, Peel, York, Simcoe-Muskoka and, I think, the D part of W-D-G)
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