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Brad Spellberg @bradspellberg.bsky.social · 7d

People told me it was too radical at my place too. But then we walked everyone through the policy, which was developed with Counsel and Risk input. It is an actual structured policy that creates a due process mechanism for doing the right thing. It turns out to be rational, rather than radical.

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Brad Spellberg @bradspellberg.bsky.social · 7d

The main take away is to implement a Policy to Override Policies at your institutions too.

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Brad Spellberg @bradspellberg.bsky.social · Sep 5

Yeah but you’re Lawful Good. That’s ok. We need Lawful people too. It’s all about balance, right?

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Brad Spellberg @bradspellberg.bsky.social · Sep 5

Thanks to @abimfoundation.bsky.social ation for posting the video of my recent lecture on the LA General Policy to Override Policies. For those of you who know my lectures, this one is among the most entertaining. And it's only 10 min. Check it out & implement the policy!
youtu.be/RuKAKH8A604?...

Administrator/Clinician Collaboration: Policies to Put Patients First

YouTube video by ABIM Foundation

youtu.be

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Reposted by Brad Spellberg

James Wilson, DO, FACP, FAWM, CTropMed @jameswilsondo.bsky.social · Aug 22

Another plug for #wikiguidelines @bradspellberg.bsky.social
When guidelines don’t keep up with medicine

UNMC Infectious Diseases Division @unmc-id.bsky.social · Aug 22

UNMC ID faculty Dr. Jenn Davis and 🌟 resident Dr. Gigi Green joined up to publish an interesting case in @cidjournal.bsky.social as part of the Clinical Delimmas in ID series:

"A Blurry Line: Navigating Treatment Decisions When the Guidelines Don't Fit"

#IDSky

academic.oup.com/cid/advance-...

A Blurry Line: Navigating Treatment Decisions When the Guidelines Don’t Fit

A 45-year-old female was referred to the infectious diseases (ID) clinic for interpretation of discordant human immunodeficiency virus (HIV) test results.

academic.oup.com

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Brad Spellberg @bradspellberg.bsky.social · Aug 14

I was thinking Samuel Clemens. “…lies, damn lies, and statistics.”

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Reposted by Brad Spellberg

Sébastien Poulin @sebpoule.bsky.social · Aug 13

Me reading DOTS trial #IDsky #DOOR

a man in a black shirt is standing in front of a door

ALT: a man in a black shirt is standing in front of a door

media.tenor.com

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Brad Spellberg @bradspellberg.bsky.social · Aug 14

It’s also an absurd conclusion based on wonky stats. A 48% chance dalba was superior? Seriously? How about, no chance. Based on both pre test prob and the actual clinical endpoint results.

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Reposted by Brad Spellberg

Sébastien Poulin @sebpoule.bsky.social · Aug 13

I love Dalba
I just don’t know why we should do a PhD in statistics to understand a trial now
Or maybe am just getting old and grumpy

a white monkey with a blue face is sitting on a blue blanket .

ALT: a white monkey with a blue face is sitting on a blue blanket .

media.tenor.com

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Brad Spellberg @bradspellberg.bsky.social · Aug 12

#5/5 You have not actually prevented any infections. You simply suppressed colonization growth from non-sterile sites. We are clear in our Discussion that the studies found a statistical reduction in infections that was likely not a true reduction in infections. The trials were poorly designed.

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Brad Spellberg @bradspellberg.bsky.social · Aug 12

#4/5 When you randomized pts to receive abx or not, and then take cultures from non sterile sites, you will OBVIOUSLY grow more bacteria from the patients randomized to NOT receive abx. You are suppressing colonization with abx. This makes it appear that an infection was prevented. But...

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Brad Spellberg @bradspellberg.bsky.social · Aug 12

#3/4 The #2 infection type was "pneumonia". Again, numerous studies over the last 20 years have shown that a high percentage of "pneumonias" diagnosed in hospital are not actually pneumonias.
Which brings us the fundamental error in the design of all of these trials...

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Brad Spellberg @bradspellberg.bsky.social · Aug 12

#2/4 The #1 "infection" type in these RCTs was "UTI" based on positive urine culture, with no description of symptoms being present. Since we know that >50% of "UTIs" in hospitals are not UTIs, but asymptomatic bacteriuria, the majority of infections were not actually infections.

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Brad Spellberg @bradspellberg.bsky.social · Aug 12

#1/5 The problem is even worse than that. It's not simply a trade off of preventing infections vs. worsening resistance & adverse effects. Indeed, it is not at all clear that infections were actually prevented at all in these RCTs. As we discuss, the definition of infection was highly problematic.

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Reposted by Brad Spellberg

𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇 @rmohty.bsky.social · Aug 12

As @bradspellberg.bsky.social would say CRP is missing a letter as a test "A" (CRAP) - www.sciencedirect.com/science/arti...

Revisiting diagnostics: erythrocyte sedimentation rate and C-reactive protein: it is time to stop the zombie tests

www.sciencedirect.com

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Reposted by Brad Spellberg

Antibiotic Steward 🅱️C🆔🅿️🌟 @absteward.bsky.social · Aug 11

International guidelines recommend 5 to 7 days of antibiotic prophylaxis for patients with cirrhosis & upper GI bleeding.
🆕🔥Systematic Review ( 14 RCTs, N=1322) & Bayesian Meta-Analysis challenged this universally held dogma #idsky
jamanetwork.com/journals/jam...

Prophylactic Antibiotics for Upper Gastrointestinal Bleeding in Patients With Cirrhosis

This systematic review and meta-analysis evaluates the evidence supporting the current guidelines antibiotic prophylaxis use in patients with cirrhosis and upper gastrointestinal bleeding.

jamanetwork.com

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Reposted by Brad Spellberg

ID:IOTS Podcast @idiots-pod.bsky.social · Aug 9

#IDsky The Infectious Disease Brad Boy himself, @bradspellberg.bsky.social , has an updated Oral vs IV table, now including the Plague (Y really) and Lyme!

Link here:

www.bradspellberg.com/oral-antibio...

Oral Antibiotic RCTs | mysite

www.bradspellberg.com

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Brad Spellberg @bradspellberg.bsky.social · Aug 9

Oooh i like that! The ID Brad Boy. But it was the OG Gangsta @idiots-pod.bsky.social that came up with this idea. So get on with yo’ bad self!

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Reposted by Brad Spellberg

wiki-guidelines.bsky.social @wiki-guidelines.bsky.social · Aug 3

WikiGuidelines lapel pins are available for purchase on
WikiGuidelines website: www.wikiguidelines.org
Support us to incorporate humility of uncertainty into guidelines!

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Brad Spellberg @bradspellberg.bsky.social · Jul 21

I tend to agree. Especially if a catheter is in place. But if a pt has signs/symptoms of infection, i do it.

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Brad Spellberg @bradspellberg.bsky.social · Jul 21

Might this be it? pubmed.ncbi.nlm.nih.gov/28650745/

Longer-Duration Antimicrobial Therapy Does Not Prevent Treatment Failure in High-Risk Patients with Complicated Intra-Abdominal Infections - PubMed

We were able to identify patients at high risk for treatment failure in the STOP-IT trial. Such patients did not benefit from a longer course of antibiotic administration. Further study is needed to d...

pubmed.ncbi.nlm.nih.gov

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Brad Spellberg @bradspellberg.bsky.social · Jul 10

Q: Is [insert test name] test being over used?

A: Yes!

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Reposted by Brad Spellberg

Rossana Rosa @drrossanarosa.bsky.social · Jul 10

“We’re asking the wrong question. Let’s use fundamental PK. Let’s get the drug to where the bug is, at a high enough concentration to kill the bug, and not worry about whether we label the drug static or cidal”.
As said by @bradspellberg.bsky.social 🤩😇

Fabulous conversation!
#IDSky #MedSky #AMSSky

ASM @asm.org · Jul 9

Bactericidal vs Bacteriostatic Antibiotics. This controversial topic has important conceptual ramifications to treat severe infections. youtu.be/3z4BItBrzbk

Bactericidal vs Bacteriostatic Antibiotics - Editors in Conversation Podcast, Live from ASM Microbe

YouTube video by American Society for Microbiology

youtu.be

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Brad Spellberg @bradspellberg.bsky.social · Jul 9

Imitation is the sincerest form of flattery, my good friends!

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Brad Spellberg @bradspellberg.bsky.social · Jul 4

Even more important for sicker patients!!!!

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