Roland Brian Büchter

@TDekkersPhysio Sound guidelines, but I suppose it can be a preference sensitive option for some patients. For some of the recommendations there is also residual uncertainty —radiofrequency ablation to name one example, which is why the RADICAL trial is running in the UK: bmjopen.bmj.com/content/14/7/e…

@cormac_mullins would love your take on this

Spinal injections 💉 strongly NOT recommended for chronic back, neck and sacroliliac pain ⛔️ Here's a 🧵 on the recent (and controversial) BMJ study and why I think some caution is needed here.

@KCKlatt @methodsnerd Interesting. Based on the abstract I‘m surprised the analysis ends up with low to moderate QoE in favor of an effect, given the reasonably large statistical uncertainty/wide CIs. Seems like an uncommon approach. Reasoning? Low risk?

Had fun working with @methodsnerd And colleagues on this update Systematic Review and Meta Analysis of trials reducing or modifying saturated fat published in @AnnalsofIM - while there are many reviews on the topic, ours adds some important methodological approaches & considerations, including utilizing patient-important, individual cardiovascular outcomes (heart attack, stroke, etc) as opposed to composite outcomes; stratifying results by baseline cardiovascular risk; assessing certainty of evidence in the context of the minimally important difference (MID) thresholds, the smallest change in the outcome that patients might perceive as important; and a comprehensive consideration of all relevant subgroups.

Promiscuous dichotomisation. 😅 The 8 flags are worth reading even for non-statisticians. bmcmedresmethodol.biomedcentral.com/articles/10.11…

Thema braucht Dialog. Ist wichtig, nicht neu (s. z.B. SVR Gutachten zu Unter-, Über-, und Fehlversorgung aus 2002) und natürlich stellt sich auch generell die Frage, was Dinge kosten dürfen - erst recht, wenn Reformen nicht gelingen, die das GS effektiver/effizienter manchen.

@dnunan79 I find it hard to drop my exercise bias as someone who loves to exercise, too. Maybe this rare occasion of a sham-physiotherapy controlled trial will make your day: nejm.org/do/10.1056/NEJ…

Actually, most medical treatments are not supported by high quality evidence: pubmed.ncbi.nlm.nih.gov/35447356/ And non-drug interventions, including exercise, are also not supported by high quality evidence: x.com/dnunan79/statu… High quality evidence is rare

@drjohnm IMO with better studies and carefully designed, they could become useful. Do they need detailed appraisal skills?I’d love mine to have them, but I’d settle with more consultation time and being taken seriously.IMO docs should be able to rely on guidelines. These need improvement.

I could not agree more. Central illustrations, infographics, are dumb. As are minutes long video summaries, no matter the quality. Manuscripts are nuanced and meant to be read carefully. 👆How can you practice EBM if you can’t appraise the evidence?

Gebt Gas, liebe Journalisten! Regelmäßig lese ich fragwürdige Schlagzeilen von seriösen wissenschaftsjournalistischen Medien. Heute: Putzen sei so schädlich für die Lunge wie 20 Jahre Rauchen. Ein Blick in die zitiert Studie warf mehr Fragen auf als Antworten. Wer kann es besser?

@adamcifu It’s perfect. Up the dose on the sugar, add some sodium and you can go on a proper bike ride with @drjohnm. But the artificial colors will just stain your bidons.

Breakfast of champions.Coffee, sugar, citric acid, artificial colors. Convince me I’m wrong.

@Dan_Nash94 Yup. I do too. Still, I think most athletes would prefer mixing things up. 30/15, 4x4, 16x1, a pyramid,…And would it mean 102% of FTP or 108%? I have seen both suggestions, but of course it depends on the individual physiology and whether your ftp estimate is accurate.

@rob130285 Hate to break it to you but endurance training is pretty repetitive and athletes training for performance typically push themselves pretty hard 2-3x week

A thread on designing intervals to improve VO2max 🧵 (TL;DR, most people go too short and too hard)

@VPrasadMDMPH FYI, would be interesting to see whether there are other analyses like this one: pmc.ncbi.nlm.nih.gov/articles/PMC72…

Doing a deep dive into alcohol research Coming soon Check out this GEM from a paper Alcohol causes colon cancer, but just in women. 1 -2 drinks increase prostate cancer 70%! but 3 only 55%! What explains this? Shitty science is what. Not real biology.

@VPrasadMDMPH @AaronGoodman33 No strings attached.

This is the best version @AaronGoodman33

@drjohnm Maybe too uncommon, but could familial HC play a role in such an analysis? It has a decent overlap in LDL-values with non-familial HC and yet might be an independent risk factor. And it seems to be underdiagnosed.

Serious question to the #prevention crowd -- How do you deal with this observational study?#xref-ref-10-1" target="_blank" rel="nofollow noopener">bmjopen.bmj.com/content/14/3/e… Best survival in patients with LDL-C levels moderately elevated. I have some ideas. But I am truly asking. Perhaps the PREVENT score which labels fewer patients "statin-eligible" is on to something. Hoping @PeterAttiaMD engages 1/n

@carole_lunny @tanjarombey @PieperDawid @Daniellep89 @Hanan2000Khalil @liviapuljak @ATricco In Germany we eat fries in a bun and call it a hippie roll, so I should probably tread lightly 😅 Thank you, Carole! 🙏

@rob130285 @tanjarombey @PieperDawid @Daniellep89 @Hanan2000Khalil @liviapuljak @ATricco I think there's an insult to Canadians in there somewhere 🤔 Also it's fries and curd cheese. The beer is the appetizer 😂 Also congrats, it's a huge accomplishment without the hardships! 🎉💐🎊

🎓👨🏻‍💻📝 Personal note and thanks.

German Medical Association (BÄK) and Statutory Health Insurance Physicians (KBV) are closing the German Agency for Quality in Medicine (ÄZQ), coordinator of ind. quality guidelines. Many guidelines here are poor. This will worsen the situation. Very sad for EBM. 🤞for a solution.

@VPrasadMDMPH To be fair, whatever you make of EBM+, the authors don't argue against RCTs for drugs and vaccines: "While acknowledging the primacy of randomised controlled trials (RCTs) and meta-analyses of RCTs for estimating the efficacy of drugs and vaccines,...". At least I hope not.

EBM+

German soulfood. Cabbage. Best.

@ARatOfRat @VPrasadMDMPH @TracyBethHoeg I‘m impressed. Would be happy with a sub-20 5k. Maybe I need whatever was in that bottle.

@VPrasadMDMPH @TracyBethHoeg It’s nice to see a pair of highly intelligent people team up for the betterment of others. But competition is a valuable fuel as well, so since I know you both are runners I gotta ask — who’s got the best 10K PB? 😊

We have written a dozen papers together but this might be first photo @TracyBethHoeg

@TomPMarshall There were statements from several societies - family doctors etc. We don’t have a strong public health approach here. Seems too difficult politically. And I am afraid, ironically, at least some decision makers are quite aware of the evidence.

@rob130285 Equally wrong. Tell them to read the evidence.

We have known for many years from multiple randomised controlled trials: general health checks are of no medical value. Yet the NHS Health Checks programme spends £130 million a year on the programme. What should we do with NHS Health Checks?