Robert Goulden
@emrobg.bsky.social
Emergency physician | Epidemiology PhD student | Medical Flashnotes app creator
Epidemiologic methods are increasingly difficult for clinicians and policy makers (and epidemiologists?) to understand. Are they at least getting us closer to uncovering causal relationships? My argument in this new piece: we don't know, because we haven't checked: academic.oup.com/ije/article-...
Time for evidence-based methodology in epidemiology
A formalized counterfactual approach to causal inference has come to dominate epidemiology in recent decades. This was, in part, a response to widely recog
academic.oup.com
May 13, 2025 at 2:15 PM
Epidemiologic methods are increasingly difficult for clinicians and policy makers (and epidemiologists?) to understand. Are they at least getting us closer to uncovering causal relationships? My argument in this new piece: we don't know, because we haven't checked: academic.oup.com/ije/article-...
Less is more wins again. RCT of high MAP target in older adults with sepsis (50% w/underlying HTN), stopped early for harm, 39% mortality MAP 80-85 vs. 29% mortality MAP 65-70 link.springer.com/article/10.1.... Recall also that the 65 Trial hinted that MAP60 may be better than 65. How low can we go?
Efficacy of targeting high mean arterial pressure for older patients with septic shock (OPTPRESS): a multicentre, pragmatic, open-label, randomised controlled trial - Intensive Care Medicine
Purpose We examined the effect of a high-target mean arterial pressure (MAP) on septic shock in a previously underrepresented region. Methods A multicentre, pragmatic, open-label, randomised controlle...
link.springer.com
May 13, 2025 at 1:58 PM
Less is more wins again. RCT of high MAP target in older adults with sepsis (50% w/underlying HTN), stopped early for harm, 39% mortality MAP 80-85 vs. 29% mortality MAP 65-70 link.springer.com/article/10.1.... Recall also that the 65 Trial hinted that MAP60 may be better than 65. How low can we go?
New WTA resus thoracotomy (RT) algorithm. 2 new/key points:
-Now incorporates POCUS: if no organised cardiac rhythm and no tamponade on POCUS, no RT (regardless of time since arrest / mechanism).
-RT if pulse but refractory SBP <60 plus {blunt/penetrating thoracic injury OR tamponade on POCUS}
-Now incorporates POCUS: if no organised cardiac rhythm and no tamponade on POCUS, no RT (regardless of time since arrest / mechanism).
-RT if pulse but refractory SBP <60 plus {blunt/penetrating thoracic injury OR tamponade on POCUS}
November 20, 2024 at 8:27 PM
New WTA resus thoracotomy (RT) algorithm. 2 new/key points:
-Now incorporates POCUS: if no organised cardiac rhythm and no tamponade on POCUS, no RT (regardless of time since arrest / mechanism).
-RT if pulse but refractory SBP <60 plus {blunt/penetrating thoracic injury OR tamponade on POCUS}
-Now incorporates POCUS: if no organised cardiac rhythm and no tamponade on POCUS, no RT (regardless of time since arrest / mechanism).
-RT if pulse but refractory SBP <60 plus {blunt/penetrating thoracic injury OR tamponade on POCUS}
Do diuretics ⬇️mortality in heart failure? UpToDate, quoting Cochrane, says yes OR 0.24 (0.07-0.83). Looking at the 3 small RCTs this is based on suggests an important error in the meta-analysis, and an implausible mechanism of the diuretic benefit (1/4)
November 18, 2024 at 4:48 PM
Do diuretics ⬇️mortality in heart failure? UpToDate, quoting Cochrane, says yes OR 0.24 (0.07-0.83). Looking at the 3 small RCTs this is based on suggests an important error in the meta-analysis, and an implausible mechanism of the diuretic benefit (1/4)
Dr Adnan al-Bursh was an orthopedic surgeon who heroically served his patients in the most impossible circumstances; this new report suggests he was beaten to death by Israeli prison guards. He is 1 of around 1000 healthcare workers killed in Israel's war on Gaza www.youtube.com/shorts/iM6pa...
Doctor’s final moments revealed
YouTube video by Sky News
www.youtube.com
November 14, 2024 at 4:49 PM
Dr Adnan al-Bursh was an orthopedic surgeon who heroically served his patients in the most impossible circumstances; this new report suggests he was beaten to death by Israeli prison guards. He is 1 of around 1000 healthcare workers killed in Israel's war on Gaza www.youtube.com/shorts/iM6pa...
2 big new RCTs on IO vs IV access in cardiac arrest -> another chance to check on the utility of conventional observational studies. Relative risk/odds of IO vs IV for survival in the RCTs: 1.16 (0.87-1.56), 0.93 (0.72-1.21). What about the most recent observational studies? 1/
November 12, 2024 at 3:21 AM
2 big new RCTs on IO vs IV access in cardiac arrest -> another chance to check on the utility of conventional observational studies. Relative risk/odds of IO vs IV for survival in the RCTs: 1.16 (0.87-1.56), 0.93 (0.72-1.21). What about the most recent observational studies? 1/