Stuff that occurs to me

All of my 'how to' posts are tagged here. The most popular posts are about blocking and private accounts on Twitter, also the science communication jobs list. None of the science or medical information I might post to this blog should be taken as medical advice (I'm not medically trained).

Think of this blog as a sort of nursery for my half-baked ideas hence 'stuff that occurs to me'.

Contact: @JoBrodie Email: jo DOT brodie AT gmail DOT com

Science in London: The 2016 scientific society talks in London blog post

Sunday, 26 February 2012

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@dean_jenkins@dsdarbyshire @amcunningham @twitjournalclub @silv24 @fidouglas pleasure to help curate ... been working on a tool to automate it. #twitjc
(Sun, 26 Feb 2012 23:00:09 +0000)
@dean_jenkins@amcunningham @dsdarbyshire OK I've modified my curation widgety thingy on the beta site. Shall I redo the blog example for #twitjc ?
(Sun, 26 Feb 2012 22:47:25 +0000)
@tomayates@payamtorabi did you see this in the BMJ - http://t.co/2tjmkf1d? #twitjc
(Sun, 26 Feb 2012 22:35:44 +0000)
@dsdarbyshireRT @dean_jenkins : #twitjc Feb 26th 2012: Transcript of this evening's Twitter Journal Club using an experimental Twitter chat cura... http://t.co/qWNbKlNk
(Sun, 26 Feb 2012 22:30:42 +0000)
@dean_jenkins#twitjc Feb 26th 2012: Transcript of this evening's Twitter Journal Club using an experimental Twitter chat cura... http://t.co/qWNbKlNk
(Sun, 26 Feb 2012 22:10:49 +0000)
@JDMoffatt@silv24 A v interesting #twitjc indeed.
(Sun, 26 Feb 2012 21:30:42 +0000)
@amitnsSorry missed the fab discussion. This highlights serious flaw in deciding 'best practices' based on flimsy evidences. Egs abound. #twitjc
(Sun, 26 Feb 2012 21:26:17 +0000)
@silv24Very tired tonight - culmination of four days of tonsillitis and a very engaging #twitjc
(Sun, 26 Feb 2012 21:25:58 +0000)
@northern_doctorRT @dermotor : @northern_doctor Be interesting if the NHS & NICE guidance leads to measurable fall VTE mortality #twitjc #patientsafety
(Sun, 26 Feb 2012 21:20:27 +0000)
@amcunningham@PaedsSHO yes, well done @silv24 :) #twitjc
(Sun, 26 Feb 2012 21:17:22 +0000)
@amcunninghamRT @northern_doctor : @tobyhillman Always feel obliged to treat if found, but never totally sure if that's the right thing #twitjc
(Sun, 26 Feb 2012 21:15:03 +0000)
@dermotor@northern_doctor Be interesting if the NHS & NICE guidance leads to measurable fall VTE mortality #twitjc #patientsafety
(Sun, 26 Feb 2012 21:09:31 +0000)
@silv24@mgcmitchell glad you enjoyed!! Keen to get as many people involved from lots of different backgrounds #twitjc
(Sun, 26 Feb 2012 21:08:41 +0000)
@northern_doctorRT @tobyhillman : @dsdarbyshire @northern_doctor and as resolutions get better on scanners - we will only find more. #twitjc
(Sun, 26 Feb 2012 21:08:20 +0000)
@wrexhamrob@twitjournalclub @silv24 #twitjc thanks for good discussion #uncertainty . Rd=Prescribing advisor pharmacist NWales
(Sun, 26 Feb 2012 21:08:04 +0000)
@tobyhillmanMT @elinlowri :RT @PaedsSHO : As ever, massive thanks to @silv24 ; I know just how much she puts into each and every week.> Hear Hear! #twitjc
(Sun, 26 Feb 2012 21:07:59 +0000)
@northern_doctor@dermotor I don't think you can yet. Current practice adheres to NICE guidelines. #twitjc
(Sun, 26 Feb 2012 21:07:15 +0000)
@silv24RT @PaedsSHO : Thanks to everyone who took part in #twitjc . If you enjoyed it, maybe come back next time? Maybe bring a friend?
(Sun, 26 Feb 2012 21:06:41 +0000)
@mgcmitchell@twitjournalclub @silv24 Thank you for stimulating discussion. Wasn't able to join in but followed.Interesting points for reflection #twitjc
(Sun, 26 Feb 2012 21:06:25 +0000)
@PaedsSHOThanks to everyone who took part in #twitjc . If you enjoyed it, maybe come back next time? Maybe bring a friend?
(Sun, 26 Feb 2012 21:06:21 +0000)
@dermotor@twitjournalclub So after all this, as medical director, should I seek to change our guidance for medical patients VTE prevention? #twitjc
(Sun, 26 Feb 2012 21:06:00 +0000)
@payamtorabiRT @PaedsSHO : As ever, massive thanks to @silv24 ; I know just how much she puts into each and every week. Well done. #twitjc
(Sun, 26 Feb 2012 21:05:56 +0000)
@elinlowriRT @PaedsSHO : As ever, massive thanks to @silv24 ; I know just how much she puts into each and every week. Well done. #twitjc
(Sun, 26 Feb 2012 21:04:47 +0000)
@silv24Thank you all so much for joining in #twitjc this week, fantastic discussion!!!
(Sun, 26 Feb 2012 21:04:39 +0000)
@benedictwarner@twitjournalclub Thanks! Really enjoyed following along - and impressed at how much was covered in exactly 1hr! Learnt a lot. #twitjc
(Sun, 26 Feb 2012 21:04:23 +0000)
@andrew_dawes@payamtorabi Evdience for prevention of VTE is better as discussed earlier. #twitjc
(Sun, 26 Feb 2012 21:04:10 +0000)
@PaedsSHOAs ever, massive thanks to @silv24 ; I know just how much she puts into each and every week. Well done. #twitjc
(Sun, 26 Feb 2012 21:04:04 +0000)
@tobyhillman@dsdarbyshire @northern_doctor and as resolutions get better on scanners - we will only find more. #twitjc
(Sun, 26 Feb 2012 21:03:47 +0000)
@northern_doctorThank you & goodnight! RT @twitjournalclub : Once again thank you all I look forward to another interesting discussion in 2 wks time #twitjc
(Sun, 26 Feb 2012 21:03:17 +0000)
@andrew_dawesThanks for organising. Must remember to include hashtags!! Doh #twitjc
(Sun, 26 Feb 2012 21:02:53 +0000)
@dsdarbyshire@tobyhillman @northern_doctor #twitjc and given emboli don't always infarct...
(Sun, 26 Feb 2012 21:02:14 +0000)
@payamtorabi@tomayates exactly! Posters for ""stop the clot"" have been going up this week with Sanofi Aventis logo emblazoned on them #twitjc
(Sun, 26 Feb 2012 21:02:12 +0000)
@twitjournalclubOnce again thank you all and I look forward to another interesting discussion in two weeks time - goodbye from @silv24 #twitjc
(Sun, 26 Feb 2012 21:01:56 +0000)
@GasCast@twitjournalclub Thanks very much. Interesting paper and discussion. #twitjc
(Sun, 26 Feb 2012 21:01:41 +0000)
@tobyhillman@twitjournalclub Thanks very much - sorry to join late #twitjc
(Sun, 26 Feb 2012 21:01:41 +0000)
@PaedsSHOGood debate, probably a reflection of the fact that we still don't definitely know the right answer. #twitjc
(Sun, 26 Feb 2012 21:01:40 +0000)
@payamtorabi@andrew_dawes has the evidence really ever been strong enough for continued use? #twitjc
(Sun, 26 Feb 2012 21:01:25 +0000)
@northern_doctor@dannymcg If anything dodgy was going on, you would have expected a positive result from the study though... #twitjc
(Sun, 26 Feb 2012 21:01:18 +0000)
@payamtorabi@twitjournalclub Thanks for arranging :) #twitjc
(Sun, 26 Feb 2012 21:00:51 +0000)
@twitjournalclubPlease continue the discussion using the hashtag or alternatively leave a comment on the website - http://t.co/Luo5ewL4 #twitjc
(Sun, 26 Feb 2012 21:00:44 +0000)
@northern_doctorInteresting! RT @tobyhillman : One starts to wonder if that is something the lungs are nicely placed to do - filter clots... #twitjc
(Sun, 26 Feb 2012 21:00:33 +0000)
@tomayates#TwitJC real questions to be answered about the process by which lmwh initially recommended and the role of industry funded pressure groups
(Sun, 26 Feb 2012 21:00:28 +0000)
@Lush_London@twitjournalclub more UK based studies in medical patients needed for review of NICE #twitjc
(Sun, 26 Feb 2012 21:00:15 +0000)
@twitjournalclubThank you all for such an interesting and lively discussion, I have really enjoyed it #twitjc
(Sun, 26 Feb 2012 20:59:36 +0000)
@tobyhillman@northern_doctor One starts to wonder if that is something the lungs are nicely placed to do - filter clots... #offtopic #twitjc
(Sun, 26 Feb 2012 20:59:27 +0000)
@elinlowri@dsdarbyshire #twitjc 'asymptomatic PE. Medicines incidentaloma' - get phoned about these a lot. Little known about their natural history
(Sun, 26 Feb 2012 20:59:11 +0000)
@andrew_dawesarticle doest do enough to disprove its cont use. But does deserve further evaluation. as said prev other complications #twitjc
(Sun, 26 Feb 2012 20:58:44 +0000)
@dsdarbyshire#twitjc the review will happen but as this study wouldn't change practice in the UK it alone shouldn't expedite it.
(Sun, 26 Feb 2012 20:58:40 +0000)
@GasCastWould be nice to do a study that quantified the contribution of TEDS alone in high risk patients. #twitjc
(Sun, 26 Feb 2012 20:58:28 +0000)
@northern_doctorRT @dsdarbyshire : #twitjc asymptomatic PE. Medicines incidentaloma. #twitjc
(Sun, 26 Feb 2012 20:58:24 +0000)
@northern_doctor@tobyhillman Always feel obliged to treat if found, but never totally sure if that's the right thing #twitjc
(Sun, 26 Feb 2012 20:58:13 +0000)
@northern_doctorDitto RT @tobyhillman : Finding more and more PEs with better CT scanners - what to do with them can be a conundrum ( no sx etc) #twitjc
(Sun, 26 Feb 2012 20:57:38 +0000)
@dsdarbyshire#twitjc asymptomatic PE. Medicines incidentaloma.
(Sun, 26 Feb 2012 20:57:19 +0000)
@payamtorabiRT @elinlowri : #twitjc I would love this study to be true as it would justify my apathy towards our VTE proforma
(Sun, 26 Feb 2012 20:57:16 +0000)
@northern_doctorI think so! RT @twitjournalclub : Should this paper lead to a review of NICE guidance and further studies into VTE prophylaxis? #twitjc
(Sun, 26 Feb 2012 20:57:06 +0000)
@Albajuly@twitjournalclub I think if study was broken down into comparison of similar conditions eg sepsis only, it may change the impact #twitjc
(Sun, 26 Feb 2012 20:56:57 +0000)
@payamtorabi@twitjournalclub yes #twitjc
(Sun, 26 Feb 2012 20:56:45 +0000)
@elinlowri#twitjc I would love this study to be true as it would justify my apathy towards our VTE proforma
(Sun, 26 Feb 2012 20:56:44 +0000)
@GasCast@twitjournalclub definitely. Work on LMWH in surgery done in 1975/88 when bedrest was an important treatment. #twitjc
(Sun, 26 Feb 2012 20:56:37 +0000)
@LizzyFerretSomething always conspires against me making #twitjc on a Sunday night :( #RageDotCom
(Sun, 26 Feb 2012 20:56:23 +0000)
@northern_doctorRT @GasCast : MEDENOX found 9 - 21% PE on autopsy but only 3 deaths attributed to PE?high numbers of clinically insignificant VTE #twitjc
(Sun, 26 Feb 2012 20:56:07 +0000)
@northern_doctorThis is what I suspect too RT @GasCast : ?high numbers of clinically insignificant VTE #twitjc
(Sun, 26 Feb 2012 20:55:59 +0000)
@tobyhillman@GasCast finding more and more PEs with better CT scanners nowadays - what to do with them can be a conundrum ( no sx etc) #twitjc
(Sun, 26 Feb 2012 20:55:45 +0000)
@PaedsSHO@twitjournalclub Yes. #twitjc
(Sun, 26 Feb 2012 20:55:15 +0000)
@twitjournalclubOverall - should this paper lead to a review of the NICE guidance and further studies into VTE prophylaxis? #twitjc
(Sun, 26 Feb 2012 20:54:21 +0000)
@payamtorabi#twitjc but also non-fatal complications from LMWH...
(Sun, 26 Feb 2012 20:54:07 +0000)
@GasCast@northern_doctor MEDENOX found 9 - 21% PE on autopsy but only 3 deaths attributed to PE?high numbers of clinically insignificant VTE #twitjc
(Sun, 26 Feb 2012 20:53:58 +0000)
@northern_doctorValid point! RT @PaedsSHO : Plus there are obviously non-fatal complications from VTE, post-thrombotic syndrome etc #twitjc
(Sun, 26 Feb 2012 20:53:54 +0000)
@tobyhillman@dsdarbyshire and fantastic for patients for many other reasons too... #twitjc
(Sun, 26 Feb 2012 20:53:52 +0000)
@PaedsSHO@northern_doctor Plus there are obviously non-fatal complications from VTE, post-thrombotic syndrome etc #twitjc
(Sun, 26 Feb 2012 20:52:54 +0000)
@northern_doctorVery true! RT @elinlowri : If someone dies from PE and not on LMWH we get twitched about being sued. EBM can be tricksy! #twitjc
(Sun, 26 Feb 2012 20:52:28 +0000)
@northern_doctorIt was assumed that insignificant mortality difference in older trials may be because VTE was discovered and treated. Maybe not! #twitjc
(Sun, 26 Feb 2012 20:52:03 +0000)
@andrew_dawesDoes VTE prophylaxis reduce hospital stay?? That would be the nly other reason for NICE recomending Rx. #twitjc
(Sun, 26 Feb 2012 20:51:49 +0000)
@elinlowri@northern_doctor But despite this, if someone dies from PE and not on LMWH we get twitched about being sued. EBM can be tricksy! #twitjc
(Sun, 26 Feb 2012 20:51:19 +0000)
@northern_doctor@PaedsSHO Suspect because VTE generally regarded as a bad thing #twitjc
(Sun, 26 Feb 2012 20:51:15 +0000)
@northern_doctor@PaedsSHO There's actually a 3rd CLOTS trial ongoing looking at pneumatic compression stockings. Fancy! #twitjc
(Sun, 26 Feb 2012 20:50:44 +0000)
@Lush_London@Lush_London #twitjc could repeat study and this time actually screen for asymptomatic VTE especially as no pm carried out to exclude PE etc
(Sun, 26 Feb 2012 20:50:36 +0000)
@andrew_dawes@GasCast @dsdarbyshire - and they used non full length stockings which arent meant to be as good! #twitjc
(Sun, 26 Feb 2012 20:50:28 +0000)
@PaedsSHO@northern_doctor Does NICE say that because anticoagulating them long-term is expensive? #twitjc
(Sun, 26 Feb 2012 20:50:18 +0000)
@dsdarbyshire#twitjc getting out of bed every couple of hours, for those that can, might help.
(Sun, 26 Feb 2012 20:50:13 +0000)
@northern_doctor@PaedsSHO Yes, I knew that. Mistyped original tweet. *hangs head in shame* #twitjc
(Sun, 26 Feb 2012 20:50:02 +0000)
@northern_doctorEvidence shows LMWH reduces VTE, but no evidence of mortality reduction. Is VTE reduction alone enough to justify rx? NICE says yes #twitjc
(Sun, 26 Feb 2012 20:49:27 +0000)
@twitjournalclubMT @elinlowri : Are compression stockings alone enough thromboprophylaxis in medical pts? - maybe! Wouldnt that be great/cheap/safe #twitjc
(Sun, 26 Feb 2012 20:48:58 +0000)
@PaedsSHO@northern_doctor Use of TEDS ineffective in preventing DVT in stroke patients; CLOTS trial #twitjc
(Sun, 26 Feb 2012 20:48:36 +0000)
@payamtorabi@elinlowri as long as we make sure our patients don't have PVD before we prescribe! #twitjc
(Sun, 26 Feb 2012 20:48:29 +0000)
@Lush_London@twitjournalclub in the population they studied then probably, but no agreement whether applicable in UK #twitjc
(Sun, 26 Feb 2012 20:47:54 +0000)
@twitjournalclubRT @northern_doctor : mistake on last tweet - we *dont* use TEDS for stroke patients any more. No benefit, but risk of complications! #twitjc
(Sun, 26 Feb 2012 20:47:52 +0000)
@elinlowri'Are compression stockings alone enough thromboprophylaxis in medical patients?' - well, maybe! Wouldn't that be great/cheap/safe #twitjc
(Sun, 26 Feb 2012 20:47:23 +0000)
@northern_doctorSorry, mistake on last tweet - we *don't* use TEDS for stroke patients any more. No benefit, but risk of complications! #twitjc
(Sun, 26 Feb 2012 20:46:59 +0000)
@GasCastBearing in mind estimated mortality was 7% and measured was 4.7% - TEDS are awesome! #TEDS #twitjc
(Sun, 26 Feb 2012 20:46:53 +0000)
@amcunninghamRT @northern_doctor : Agree! RT @payamtorabi : At present clinical practice has lept ahead of the available evidence... #twitjc
(Sun, 26 Feb 2012 20:46:40 +0000)
@dannymcg@PaedsSHO @northern_doctor I had Consultant who said proformas were killing clinical acumen. I couldn't agree more. #twitjc
(Sun, 26 Feb 2012 20:46:36 +0000)
@payamtorabi@twitjournalclub Probs need another study for that? #twitjc
(Sun, 26 Feb 2012 20:46:28 +0000)
@amcunningham@kerryhood : @elinlowri agree, but I'm not sure that they would want to fund after this study - maybe NICE will rethink guidance #twitjc
(Sun, 26 Feb 2012 20:46:01 +0000)
@dsdarbyshire#twitjc are we underestimating the benefit of TEDS?
(Sun, 26 Feb 2012 20:45:56 +0000)
@bmdavies89@northern_doctor #twitjc absolutely- too scared of being sued.
(Sun, 26 Feb 2012 20:45:22 +0000)
@GasCast@northern_doctor I disagree and it was a French ethics committee that approved this #twitjc
(Sun, 26 Feb 2012 20:45:15 +0000)
@twitjournalclubAnd this brings us perfectly to the last point - Are compression stockings alone enough as thromboprophylaxis in medical patients? #twitjc
(Sun, 26 Feb 2012 20:45:12 +0000)
@northern_doctorAgree! RT @payamtorabi : At present clinical practice has lept ahead of the available evidence... #twitjc
(Sun, 26 Feb 2012 20:45:10 +0000)
@elinlowriWe used to think every acute patient should be on PPI's but now the pharmacists go round crossing them off - things change! #twitjc
(Sun, 26 Feb 2012 20:44:50 +0000)
@twitjournalclubAnd this brings us perfectly to the last point - Are compression stockings alone enough as thromboprophylaxis in medical patients? #twitjc
(Sun, 26 Feb 2012 20:45:12 +0000)
@northern_doctorAgree! RT @payamtorabi : At present clinical practice has lept ahead of the available evidence... #twitjc
(Sun, 26 Feb 2012 20:45:10 +0000)
@elinlowriWe used to think every acute patient should be on PPI's but now the pharmacists go round crossing them off - things change! #twitjc
(Sun, 26 Feb 2012 20:44:50 +0000)
@northern_doctorI'll rephrase - I personally don't consider it unethical (because of arguements re evidence) but an ethics committee would #twitjc
(Sun, 26 Feb 2012 20:44:03 +0000)
@dannymcg@northern_doctor now that is utterly mad. No, please stop CPR until someone fills in the form. #WorldGoneMad #twitjc
(Sun, 26 Feb 2012 20:43:53 +0000)
@GasCastWith this study in mind, I would like to see a comparison of LMWH vs. TEDS #twitjc
(Sun, 26 Feb 2012 20:43:33 +0000)
@justanotherSHO#anecdotalevidence The only deaths from PE I have seen in inpatients have all had disseminated cancer already #twitjc .
(Sun, 26 Feb 2012 20:43:12 +0000)
@twitjournalclubRT @elinlowri : Would need to be a massive study to be properly powered, pragmatic to be do-able, funding might be MRC/NIHR -big ask #twitjc
(Sun, 26 Feb 2012 20:42:48 +0000)
@northern_doctor@PaedsSHO Post-take a bit different as you've had time to do initial management. Not so good when urgent treatments or tests needed #twitjc
(Sun, 26 Feb 2012 20:42:47 +0000)
@payamtorabi@dsdarbyshire yes. but at present clinical practice has lept ahead of the available evidence... #twitjc
(Sun, 26 Feb 2012 20:42:23 +0000)
@amcunningham@kerryhood : @twitjournalclub @northern_doctor it shouldn't and probably is surmountable, but would need to be very convincing! #twitjc
(Sun, 26 Feb 2012 20:42:18 +0000)
@elinlowriWould need to be a massive study to be properly powered, pragmatic to be do-able, funding might be MRC/NIHR - big ask #twitjc
(Sun, 26 Feb 2012 20:42:08 +0000)
@northern_doctor@twitjournalclub That's a whole different debate! Agree in theory, but practically couldn't do it. Would never get ethical approval. #twitjc
(Sun, 26 Feb 2012 20:42:02 +0000)
@mdthemd@twitjournalclub actually trusts would not give governance approval so ethics committee would not have to discuss and thats b4 MHRA #twitjc
(Sun, 26 Feb 2012 20:41:56 +0000)
@twitjournalclubRT @Albajuly : @twitjournalclub Not unethical on it's face, given there is a potential complication (haemorrhage). But practically? #twitjc
(Sun, 26 Feb 2012 20:41:53 +0000)
@GasCast@northern_doctor it certainly shouldn't #twitjc
(Sun, 26 Feb 2012 20:41:47 +0000)
@twitjournalclubRT @dannymcg : @twitjournalclub Doubt it, ethics committee would have a little fit #twitjc
(Sun, 26 Feb 2012 20:41:46 +0000)
@PaedsSHO@northern_doctor I used to have a consultant who wouldn't allow you to present a post-take patient without a VTE assessment! #twitjc
(Sun, 26 Feb 2012 20:41:21 +0000)
@northern_doctorRT @twitjournalclub : Does best practice with little evidence trump genuine clinical uncertainty when it comes to trial ethics? #twitjc
(Sun, 26 Feb 2012 20:40:33 +0000)
@dsdarbyshire@payamtorabi #twitjc That is the difference between research design and clinical practice. Agree it's important to consider.
(Sun, 26 Feb 2012 20:40:24 +0000)
@northern_doctorIn my trust they're so focused on VTE screening, no tests can be ordered or prescriptions written until it's been done. #crazy #twitjc
(Sun, 26 Feb 2012 20:40:17 +0000)
@JoMacIver@silv24 #twitjc Surely more interested in effect of LMWH in the different pops than the freq of events?
(Sun, 26 Feb 2012 20:39:57 +0000)
@twitjournalclub@northern_doctor but does best practice with little evidence trump genuine clinical uncertainty when it comes to trial ethics? #twitjc
(Sun, 26 Feb 2012 20:39:44 +0000)
@GasCast@Albajuly why does consenting an acute patient create an ethical problem? #twitjc
(Sun, 26 Feb 2012 20:39:43 +0000)
@amcunningham@kerryhood are the patients likely to have received different treatments to Western ones that affect the risk profile? #twitjc
(Sun, 26 Feb 2012 20:39:39 +0000)
@Albajuly@twitjournalclub Not unethical on it's face, given there is a potential complication (haemorrhage). But practically? #twitjc
(Sun, 26 Feb 2012 20:39:33 +0000)
@elinlowriBut I d love to see the use of heparin rationalised - it is part of CQUIN and takes up a whole page of admission proforma! #twitjc
(Sun, 26 Feb 2012 20:38:54 +0000)
@Lush_London@PaedsSHO #twitjc apologies didn't see appendix, so none of medical pts admitted for surgery
(Sun, 26 Feb 2012 20:38:53 +0000)
@bmdavies89RT @dsdarbyshire : #twitjc perhaps retrospective using those patients who ""fail"" to receive VTE prophylaxis.
(Sun, 26 Feb 2012 20:38:50 +0000)
@northern_doctor@twitjournalclub Because it's already enshrined within NICE guidelines as 'best practice' #twitjc
(Sun, 26 Feb 2012 20:38:45 +0000)
@PaedsSHOTo be done in UK, any consent form would have to be VERY carefully worded! #twitjc
(Sun, 26 Feb 2012 20:38:19 +0000)
@northern_doctorOther studies have shown increased bleeding risk with eGFR <30 (reduced dose of LMWH doesn't improve this, only lessens efficacy) #twitjc
(Sun, 26 Feb 2012 20:38:08 +0000)
@payamtorabiRT @twitjournalclub : @northern_doctor why unethical if as far as we know there is no difference in mortality? #twitjc
(Sun, 26 Feb 2012 20:38:08 +0000)
@dsdarbyshire#twitjc perhaps retrospective using those patients who ""fail"" to receive VTE prophylaxis.
(Sun, 26 Feb 2012 20:38:01 +0000)
@mdthemd@twitjournalclub a protocol like this would not gain ethical approval in UK Also VTE now enshrined in new outcomes for MONITOR #twitjc
(Sun, 26 Feb 2012 20:37:57 +0000)
@twitjournalclubIf there is clinical uncertainty would be be unethical to carry out such a trial in a UK hospital? #twitjc
(Sun, 26 Feb 2012 20:37:49 +0000)
@payamtorabi@dsdarbyshire bt at present we dn't have this yet DO prescribe LMWH. Srely til we have evidence of efficacy for specific situations.. #twitjc
(Sun, 26 Feb 2012 20:37:34 +0000)
@northern_doctorBut areas that still lack evidence base include longer duration of stay, and use in CRF or AKI #twitjc
(Sun, 26 Feb 2012 20:37:30 +0000)
@dannymcg@twitjournalclub Doubt it, ethics committee would have a little fit #twitjc
(Sun, 26 Feb 2012 20:37:24 +0000)
@twitjournalclub@northern_doctor why unethical if as far as we know there is no difference in mortality? #twitjc
(Sun, 26 Feb 2012 20:37:11 +0000)
@GasCast@twitjournalclub Yes - because NICE guidelines are evidence based and this is the latest evidence #twitjc
(Sun, 26 Feb 2012 20:36:29 +0000)
@Albajuly@twitjournalclub It would be near impossible to gain ethical approval in the UK, esp. since you would be consenting an acute pt #twitjc
(Sun, 26 Feb 2012 20:36:24 +0000)
@bmdavies89I think such a trial in the UK would face serious ethical dilemmas over safety of placebo. Would struggle with red tape? #twitjc
(Sun, 26 Feb 2012 20:36:19 +0000)
@silv24There are a couple of studies referenced that show little difference in frequency DVTs in Asian and Western populations #twitjc
(Sun, 26 Feb 2012 20:36:08 +0000)
@Lush_London#twitjc cannot see they analysed by medical or surgical pts, and different rates of VTE in those 2 groups
(Sun, 26 Feb 2012 20:35:56 +0000)
@elinlowri@twitjournalclub I think this would be like trying to trial steroids in lung fibrosis - the horse has bolted. #twitjc
(Sun, 26 Feb 2012 20:35:35 +0000)
@PaedsSHO@Lush_London @twitjournalclub Exclusion criteria (appendix 2) removed all surgical patients. #twitjc
(Sun, 26 Feb 2012 20:35:33 +0000)
@northern_doctorNo! Unethical! MT @twitjournalclub : Could study be carried out in UK given emphasis on prescription of LMWH in NICE guidelines? #twitjc
(Sun, 26 Feb 2012 20:35:24 +0000)
@GasCast@Lush_London Surgical patients already have proven reduction in mortality, although two papers referenced are from 1975 & 1988! #twitjc
(Sun, 26 Feb 2012 20:35:16 +0000)
@dsdarbyshire#twitjc this study cannot be applied to any population as it encompasses too many different ones.
(Sun, 26 Feb 2012 20:35:11 +0000)
@andrew_dawes@GasCast But did they actively investigate for PE? Cause of death was resp failure in this study - not allowed in UK #twitjc
(Sun, 26 Feb 2012 20:34:41 +0000)
@elinlowriAre the results of this study applicable to a Western population? #twitjc Errr, probably.
(Sun, 26 Feb 2012 20:34:29 +0000)
@dsdarbyshire#twitjc all cause and specific conditions not compatible in same study. Need specific studies for specific diseases in specific situations.
(Sun, 26 Feb 2012 20:34:04 +0000)
@twitjournalclubAnd could such a study be carried out in a hospital in the UK given the emphasis on prescription of LMWH in NICE guidelines? #twitjc
(Sun, 26 Feb 2012 20:33:57 +0000)
@PaedsSHO@GasCast @andrew_dawes No autopsies performed in either group. #twitjc
(Sun, 26 Feb 2012 20:33:53 +0000)
@Lush_London@twitjournalclub as @PaedsSHO said, only its with stay of 6+ days anticipated, so not that applicable to UK for surgical patients? #twitjc
(Sun, 26 Feb 2012 20:33:30 +0000)
@GasCast@andrew_dawes I agree. I thought that was weird. #twitjc
(Sun, 26 Feb 2012 20:32:53 +0000)
@Puffles2010Puffles (*invites*) healthcare professionals to follow & join in the debate at #twitjc
(Sun, 26 Feb 2012 20:32:47 +0000)
@northern_doctorMaybe but no way of knowing for sure! RT @twitjournalclub : Are the results of this study applicable to a Western population? #twitjc
(Sun, 26 Feb 2012 20:32:28 +0000)
@amcunningham@kerryhood : @northern_doctor @sturob79 no randomisation doesn't - need a more targetted population #twitjc
(Sun, 26 Feb 2012 20:32:08 +0000)
@amcunningham@kerryhood : @GasCast @Albajuly but with ongoing malignancy you would want to continue treating not stop at 14 days #twitjc
(Sun, 26 Feb 2012 20:31:51 +0000)
@Albajuly@twitjournalclub I think the end point would have been fine if the condition range had been more specific. #twitjc
(Sun, 26 Feb 2012 20:31:46 +0000)
@northern_doctor@justanotherSHO And hence why he has a job! NICE has improved the screening and prophylactic treatment, but is there more to it? #twitjc
(Sun, 26 Feb 2012 20:31:45 +0000)
@GasCastI thought it was interesting that the MEDENOX trial that did show a difference in mortality had 10 times higher Hx of VTE. #twitjc
(Sun, 26 Feb 2012 20:31:15 +0000)
@twitjournalclubMoving onto the third point - Are the results of this study applicable to a Western population? #twitjc
(Sun, 26 Feb 2012 20:31:12 +0000)
@Albajuly@twitjournalclub I think the problem is using such a wide range of conditions vaguely defined. Impossible to match the groups #twitjc
(Sun, 26 Feb 2012 20:31:01 +0000)
@bmdavies89@dsdarbyshire #twitjc how big is big?
(Sun, 26 Feb 2012 20:30:59 +0000)
@silv24@northern_doctor @paedssho according to our risk assessment tool yes if they had any risk factors for VTE #twitjc
(Sun, 26 Feb 2012 20:30:40 +0000)
@northern_doctor@Albajuly Me too? But is it effective and safe? Especially for longer admissions? Don't think we really know. #twitjc
(Sun, 26 Feb 2012 20:30:28 +0000)
@elinlowriI suspect mortality may have been lower than 'normal' in both groups because underlying conditions better treated #twitjc
(Sun, 26 Feb 2012 20:30:27 +0000)
@PaedsSHO@northern_doctor If they had plenty of risk factors, probably. You may be asking the wrong specialist though ;-) #twitjc
(Sun, 26 Feb 2012 20:30:05 +0000)
@justanotherSHOI brought this paper up with our 'VTE specialist nurse'. He said 'well, its what NICE recommends...' #sigh #twitjc
(Sun, 26 Feb 2012 20:30:01 +0000)
@Albajuly@payamtorabi @northern_doctor And that's where the incidence of haemorrhage recorded is useful. #twitjc
(Sun, 26 Feb 2012 20:29:39 +0000)
@dsdarbyshire#twitjc to adequately measure all cause mortality you need a big sample in a homogenous population. This study doesn't do that.
(Sun, 26 Feb 2012 20:29:13 +0000)
@northern_doctorWould you treat this population in real life? RT @PaedsSHO : Patients were ineligible if predicted hospitalisation was <6 days. #twitjc
(Sun, 26 Feb 2012 20:29:01 +0000)
@pipkelly#twitjc mortality seems exactly what's important
(Sun, 26 Feb 2012 20:28:41 +0000)
@Lush_London@PaedsSHO #twitjc exactly - so how comparable to UK?
(Sun, 26 Feb 2012 20:28:37 +0000)
@twitjournalclubRT @PaedsSHO : I thought it was interesting that patients were ineligible if predicted hospitalisation was less than 6 days. #twitjc
(Sun, 26 Feb 2012 20:28:36 +0000)
@andrew_dawes@payamtorabi @northern_doctor I meant safer for the drug Co as that is is easier to prove beneficial effect #twitjc
(Sun, 26 Feb 2012 20:28:23 +0000)
@payamtorabi@Albajuly @northern_doctor but it could increase risk of death from other causes? #twitjc
(Sun, 26 Feb 2012 20:28:07 +0000)
@PaedsSHOI thought it was interesting that patients were ineligible if predicted hospitalisation was less than 6 days. #twitjc
(Sun, 26 Feb 2012 20:27:37 +0000)
@northern_doctor@sturob79 Exactly. Does randomisation account for this? Or should 'at risk' treatment population be better defined? #twitjc
(Sun, 26 Feb 2012 20:27:08 +0000)
@GasCastOnly 1 patient in each group had PE as cause of death #twitjc
(Sun, 26 Feb 2012 20:27:05 +0000)
@Albajuly@northern_doctor Personally I see LMWH as an attempt to reduce mortality from VTE whilst we attempt to treat their other illness #twitjc
(Sun, 26 Feb 2012 20:26:54 +0000)
@GasCast@Albajuly but despite common sense, there doesn't seem to be a huge link between VTE and death. #twitjc
(Sun, 26 Feb 2012 20:26:44 +0000)
@elinlowri@northern_doctor Exactly. No point faffing about with heparin if people die anyway, despite it seeming the right thing to do #twitjc
(Sun, 26 Feb 2012 20:26:25 +0000)
@payamtorabi@andrew_dawes @northern_doctor safer in what sense? #twitjc
(Sun, 26 Feb 2012 20:26:15 +0000)
@sturob79@northern_doctor it depends on your background mortality rate related to primary disease #twitjc
(Sun, 26 Feb 2012 20:26:02 +0000)
@Lush_London@twitjournalclub #twitjc mortality related to VTE? PE etc?
(Sun, 26 Feb 2012 20:25:47 +0000)
@andrew_dawes@northern_doctor Thank you!! #twitjc
(Sun, 26 Feb 2012 20:25:41 +0000)
@northern_doctorAgree! RT @elinlowri : But a lot of VTE is not diagnosed, which is why mortality is the best endpoint #twitjc
(Sun, 26 Feb 2012 20:25:37 +0000)
@JoMacIverLove it when studies measure the thing we're interested in. Doesn't matter if it stops a few VTEs if it causes more mortality! #twitjc
(Sun, 26 Feb 2012 20:25:31 +0000)
@mdthemdAll cause mortality is easy and reliable to record Hence Also previously reported in the literature and used 4 power calc #twitjc
(Sun, 26 Feb 2012 20:25:26 +0000)
@Albajuly@payamtorabi @northern_doctor Aren't we using enoxaparin to reduce death from VTE? #twitjc
(Sun, 26 Feb 2012 20:25:24 +0000)
@northern_doctorYes! RT @dermotor : Do think that there are patients on LMWH for too long. Assessed as @ risk & prescribed for whole stay #twitjc
(Sun, 26 Feb 2012 20:25:21 +0000)
@northern_doctorTrials have already shown that we can prevent VTE with LMWH, but does it make a difference in overall outcomes if we do this? #twitjc
(Sun, 26 Feb 2012 20:25:05 +0000)
@dermotor@northern_doctor @payamtorabi Do think that there are patients on LMWH for too long. Assessed as @ risk & prescribed for whole stay #twitjc
(Sun, 26 Feb 2012 20:24:34 +0000)
@elinlowri@silv24 @andrew_dawes @northern_doctor But a lot of VTE is not diagnosed, which is why mortality is the best endpoint #twitjc
(Sun, 26 Feb 2012 20:24:34 +0000)
@payamtorabi@amcunningham @kerryhood Well, exactly #twitjc
(Sun, 26 Feb 2012 20:24:17 +0000)
@twitjournalclubIf not all cause mortality, what other measures could have been used? #twitjc
(Sun, 26 Feb 2012 20:24:07 +0000)
@twitjournalclubIf not all cause mortality, what other measures could have been used? #twitjc
(Sun, 26 Feb 2012 20:24:07 +0000)
@bmdavies89It should be considered. Does the similarity between placebo and LMWH evidence safety of LMWH prophylaxis? #twitjc
(Sun, 26 Feb 2012 20:24:01 +0000)
@Albajuly@twitjournalclub The inclusion of the term 'active cancer' I may be missing something but could this mean terminally ill? #twitjc
(Sun, 26 Feb 2012 20:23:47 +0000)
@silv24@andrew_dawes : @northern_doctor - agree brave - but would have been safer to show reduction in VTE?” #twitjc
(Sun, 26 Feb 2012 20:23:27 +0000)
@andrew_dawes@northern_doctor - agree brave - but would have been safer to show reduction in VTE? #twitjc
(Sun, 26 Feb 2012 20:23:16 +0000)
@amcunningham@kerryhood : does a more precise measure matter if it doesn't have an effect on all cause mortality? #twitjc
(Sun, 26 Feb 2012 20:22:51 +0000)
@northern_doctorRemember prev studies in support of VTE prophylaxis went looking for VTE that would not have necessarily been clinical suspected! #twitjc
(Sun, 26 Feb 2012 20:22:48 +0000)
@twitjournalclub@Albajuly you answered my question with your second point about reducing mortality #twitjc
(Sun, 26 Feb 2012 20:22:38 +0000)
@PaedsSHO@Albajuly why not? Both sepsis and malignancy are risk factors for VTE. #twitjc
(Sun, 26 Feb 2012 20:22:37 +0000)
@payamtorabiRT @PaedsSHO : I thought the primary outcome was a very interesting choice, and probably the right one. #twitjc
(Sun, 26 Feb 2012 20:22:28 +0000)
@GasCast@Albajuly I always thought the PE was a big source of mortality in cancer? #twitjc
(Sun, 26 Feb 2012 20:22:27 +0000)
@northern_doctorControversial? MT @Albajuly : Whilst the study is sound, I think the end-point is of little value. #twitjc
(Sun, 26 Feb 2012 20:22:00 +0000)
@Albajuly@twitjournalclub Say what? #twitjc
(Sun, 26 Feb 2012 20:21:41 +0000)
@PaedsSHOI thought the primary outcome was a very interesting choice, and probably the right one. #twitjc
(Sun, 26 Feb 2012 20:21:29 +0000)
@twitjournalclub@Albajuly oh, why do you say that? #twitjc
(Sun, 26 Feb 2012 20:21:11 +0000)
@dsdarbyshire#twitjc all cause mortality is the ultimate question. Doesn't answer it so a more precise measure would have greater utility.
(Sun, 26 Feb 2012 20:21:10 +0000)
@Albajuly@twitjournalclub I have no expectations of enoxaparin reducing mortality from sepsis or cancer. #twitjc
(Sun, 26 Feb 2012 20:21:06 +0000)
@northern_doctorPrev studies have shown a reduction in VTE with LMWH, but what does that actually mean for the patient? #twitjc
(Sun, 26 Feb 2012 20:21:02 +0000)
@payamtorabiRT @amcunningham : @kerryhood very strangely your tweets not showing up when I search #twitjc so others might not be seeing!
(Sun, 26 Feb 2012 20:20:54 +0000)
@amcunningham@kerryhood : @bmdavies89 post hoc power calc given low death rate (my pet hate!) #twitjc
(Sun, 26 Feb 2012 20:20:35 +0000)
@northern_doctorAll-cause mortality was an interesting thing to look at. After all, that's what we're hoping to improve by giving the rx #twitjc
(Sun, 26 Feb 2012 20:20:31 +0000)
@Albajuly@twitjournalclub Sorry, sneaking in the back late! Med Cons. Whilst the study is sound, I think the end-point is of little value. #twitjc
(Sun, 26 Feb 2012 20:20:26 +0000)
@amcunningham@kerryhood : I did have one Q (sorry not a clinician) - is bruising likely to unblind? #twitjc
(Sun, 26 Feb 2012 20:20:22 +0000)
@GasCast@twitjournalclub I think so but I was surprised at how rare PE was as a cause of mortality. #twitjc
(Sun, 26 Feb 2012 20:19:50 +0000)
@northern_doctorGood question...! RT @twitjournalclub : Leading on to point 2 - Was all-cause mortality the right primary end point for this study? #twitjc
(Sun, 26 Feb 2012 20:19:44 +0000)
@amcunningham@kerryhood very strangely your tweets not showing up when I search #twitjc so others might not be seeing!
(Sun, 26 Feb 2012 20:19:40 +0000)
@payamtorabi@northern_doctor Ah, I see! #twitjc
(Sun, 26 Feb 2012 20:19:17 +0000)
@twitjournalclubLeading on to point 2 - Was all-cause mortality the right primary end point for this study? #twitjc
(Sun, 26 Feb 2012 20:18:56 +0000)
@northern_doctor@payamtorabi Yes, but I'm also interested in the pt population who have long stays and are on LMWH for the duration #twitjc
(Sun, 26 Feb 2012 20:18:20 +0000)
@RikThomas@benedictwarner see ref 29 - rarity of PE in Asians #twitjc
(Sun, 26 Feb 2012 20:18:11 +0000)
@mdthemd@silv24 power calc difficult given lack of previous and usually a huge number when calculated Hence lower power as compromise #twitjc
(Sun, 26 Feb 2012 20:17:48 +0000)
@dsdarbyshire#twitjc they continue treatment at home. Not standard practice as far as I know.
(Sun, 26 Feb 2012 20:17:39 +0000)
@northern_doctorI would be interested to know the mean length of treatment in a real hospital population - suspect many pts given it for much longer #twitjc
(Sun, 26 Feb 2012 20:17:26 +0000)
@sturob79the problem is the patient groups most mortality will be from primary disease not VTE therefore grossly underpowered #twitjc
(Sun, 26 Feb 2012 20:17:09 +0000)
@silv24Reading throughly the study design it seems very well thought out and clearly set out - I can't see any obvious flaws #twitjc
(Sun, 26 Feb 2012 20:17:05 +0000)
@payamtorabi@northern_doctor that's fairly typical length of stay for UK adult inpatients though? #twitjc
(Sun, 26 Feb 2012 20:17:01 +0000)
@northern_doctorSuspect they did this to make it comparable with previous trials that have studied prophylactic LMWH and shown reduction in VTE #twitjc
(Sun, 26 Feb 2012 20:16:31 +0000)
@cheekynurse11RT @northern_doctor : I'm Mark - medical registrar specialising in elderly care and stroke #twitjc
(Sun, 26 Feb 2012 20:16:15 +0000)
@PaedsSHO@benedictwarner I think that if the trial was done purely in the UK, docs in China would rightly ask about applicability to them! #twitjc
(Sun, 26 Feb 2012 20:16:14 +0000)
@dsdarbyshire@benedictwarner #twitjc we would if we work outside the western world.
(Sun, 26 Feb 2012 20:16:05 +0000)
@GasCastThe study was underpowered because the overall mortality rate was lower than predicted. However, only .1% difference between groups. #twitjc
(Sun, 26 Feb 2012 20:15:55 +0000)
@northern_doctorWouldn't call it a *flaw* but I think it's important to point out that the max length of treatment was 14 days #twitjc
(Sun, 26 Feb 2012 20:15:40 +0000)
@payamtorabi#twitjc my personal bias is that I feel for a purely preventative treatment we need exceptionally robust evidence before we start using it
(Sun, 26 Feb 2012 20:15:07 +0000)
@benedictwarner(where x=any non-caucasian group) #twitjc
(Sun, 26 Feb 2012 20:14:48 +0000)
@twitjournalclubRT @bmdavies89 : Side point but Could someone clarify the study power, when they mention 77% power to ..... #twitjc
(Sun, 26 Feb 2012 20:14:37 +0000)
@benedictwarnerInteresting-wld we be asking same question of a study ONLY carried out in western/caucasian pop? (eg does this apply to my 'x' pts?) #twitjc
(Sun, 26 Feb 2012 20:14:22 +0000)
@northern_doctor@andrew_dawes Maybe, but a quarter of study population were >75, so that's not too exclusive #twitjc
(Sun, 26 Feb 2012 20:13:46 +0000)
@bmdavies89Side point but Could someone clarify the study power, when they mention 77% power to ..... #twitjc
(Sun, 26 Feb 2012 20:13:26 +0000)
@SavvasNRT @silv24 : Good points - multicentre, randomised, double blind and international, clear inclusion and exclusion criteria #twitjc
(Sun, 26 Feb 2012 20:12:51 +0000)
@twitjournalclubAre there any obvious flaws in the study design? #twitjc
(Sun, 26 Feb 2012 20:12:33 +0000)
@andrew_dawesThought the demographc young compared to UK MAU intake. #twitjc
(Sun, 26 Feb 2012 20:12:30 +0000)
@payamtorabi#twitjc True, but no similar study (mortality as end-point) done on western caucasian population as far as I could find...
(Sun, 26 Feb 2012 20:12:26 +0000)
@dsdarbyshire#twitjc No. The populations are incredibly diverse and a difference in one may be masked by the lack in others.
(Sun, 26 Feb 2012 20:12:00 +0000)
@silv24Good points - multicentre, randomised, double blind and international, clear inclusion and exclusion criteria #twitjc
(Sun, 26 Feb 2012 20:11:22 +0000)
@andrew_dawesAttempt at trying to calculate power of study needed according to effect expected - also good #twitjc
(Sun, 26 Feb 2012 20:11:11 +0000)
@bmdavies89Didn't see their exclusion appendix but does seem population bereft of major RFs for an adverse outcome #twitjc
(Sun, 26 Feb 2012 20:11:08 +0000)
@PaedsSHOThat said, none of the centres used are very close to the UK in terms of demographics. #twitjc
(Sun, 26 Feb 2012 20:11:01 +0000)
@payamtorabi#twitjc yeah. I struggled to find much to complain about methodologically!
(Sun, 26 Feb 2012 20:10:47 +0000)
@northern_doctorSo for population studied, yes, conclusions seem to be based on sound methods #twitjc
(Sun, 26 Feb 2012 20:10:38 +0000)
@RikThomasOnly within the limits of the study i.e. geography (narrow) and patient selection (low numbers with Hx of VTE) #twitjc
(Sun, 26 Feb 2012 20:10:14 +0000)
@northern_doctorMethodology of study was robust, but caution with extrapolation of results given demographics of study population (ie. not western) #twitjc
(Sun, 26 Feb 2012 20:10:07 +0000)
@PaedsSHOSo, methodology; double-blind, placebo-controlled, randomised, international, multi-centre... good start! #twitjc
(Sun, 26 Feb 2012 20:09:38 +0000)
@silv24@andrew_dawes I am always kind Dawes!! #twitjc
(Sun, 26 Feb 2012 20:09:37 +0000)
@discthrower@PaedsSHO what's #twitjc ?
(Sun, 26 Feb 2012 20:09:20 +0000)
@andrew_dawesFY2 Doctor A&E #twitjc
(Sun, 26 Feb 2012 20:08:49 +0000)
@twitjournalclubIs the methodology of the study robust enough to support the conclusion that the use of LMWH doesn't alter mortality in medical pts? #twitjc
(Sun, 26 Feb 2012 20:08:22 +0000)
@mgcmitchellMark - Med student and Pharmacist #twitjc
(Sun, 26 Feb 2012 20:07:56 +0000)
@amitnsHi, Amit, GP #twitjc
(Sun, 26 Feb 2012 20:07:47 +0000)
@elinlowriElin - respiratory and acute medicine consultant #twitjc but have poorly child so may dip in and out!
(Sun, 26 Feb 2012 20:07:46 +0000)
@andrew_dawesOK gonna try to join in #twitjc . Another newie be kind silvey!!
(Sun, 26 Feb 2012 20:07:10 +0000)
@thefourthcraw@twitjournalclub #twitjc Mike, paediatrician, fellow in sleep medicine.
(Sun, 26 Feb 2012 20:07:03 +0000)
@GasCastHi - I'm Rik. Anaesthetics ST5. #twitjc
(Sun, 26 Feb 2012 20:07:02 +0000)
@twitjournalclubThank you all and great to see some new faces. And so on with the discussion with the first discussion point... #twitjc
(Sun, 26 Feb 2012 20:07:02 +0000)
@bmdavies89Ben. Med Student in Manchester #twitjc
(Sun, 26 Feb 2012 20:06:41 +0000)
@Microblog_me_ukOk, lets begin #twitjc
(Sun, 26 Feb 2012 20:05:46 +0000)
@northern_doctorI'm Mark - medical registrar specialising in elderly care and stroke #twitjc
(Sun, 26 Feb 2012 20:05:33 +0000)
@sturob79Hi Stuart Gen Surg SpR #twitjc
(Sun, 26 Feb 2012 20:05:32 +0000)
@payamtorabi#twitjc I'm Payam an F2 currently on Cardiology at Newham. Only my second #twitjc
(Sun, 26 Feb 2012 20:05:17 +0000)
@PaedsSHODavid, current NICU doc but soon to be adult intensivist. #twitjc
(Sun, 26 Feb 2012 20:04:46 +0000)
@dsdarbyshire#twitjc Hi! Dan, anatomy demonstrator, sometime A&E SHO.
(Sun, 26 Feb 2012 20:04:42 +0000)
@silv24Hi, Natalie currently a F2 in ITU and soon to be ACCS anaesthetics trainee. Will be running the journal club again tonight #twitjc
(Sun, 26 Feb 2012 20:04:00 +0000)
@twitjournalclubTo start with - introductions.... #twitjc
(Sun, 26 Feb 2012 20:03:01 +0000)
@payamtorabi#twitjc Hello!
(Sun, 26 Feb 2012 20:02:19 +0000)
@benedictwarnerNot had a chance to properly read the paper, but looking forward to quietly following my first #twitjc over dinner... #twitjc
(Sun, 26 Feb 2012 20:02:17 +0000)
@twitjournalclubA summary of the paper http://t.co/3pqzUzT5 #twitjc
(Sun, 26 Feb 2012 20:01:52 +0000)
@twitjournalclubTonight's paper is a very interesting one - Low molecular weight heparin and mortality in acutely unwell medical patients #twitjc
(Sun, 26 Feb 2012 20:01:14 +0000)
@twitjournalclubGood evening and welcome to the 16th week of the journal club which will be run by @silv24 #twitjc
(Sun, 26 Feb 2012 20:00:41 +0000)
@twitjournalclub@bmdavies89 welcome!! always great to have new people join in! #twitjc
(Sun, 26 Feb 2012 20:00:16 +0000)
@GasCast@silv24 ready and looking forward to my first #twitjc
(Sun, 26 Feb 2012 19:59:54 +0000)
@PaedsSHO@bmdavies89 We'll be gentle with you ;-) #twitjc
(Sun, 26 Feb 2012 19:59:51 +0000)
@bmdavies89@silv24 ready I think. But a #twitjc virgin
(Sun, 26 Feb 2012 19:58:14 +0000)
@silv24Hope everyone is ready for #twitjc ....
(Sun, 26 Feb 2012 19:50:55 +0000)
@ChiparaRT @silv24 : Half an hour until tonight's #twitjc - low molecular weight heparin and mortality in acutely unwell medical patients - http://t.co/inB34OtI
(Sun, 26 Feb 2012 19:39:57 +0000)
@twitjournalclubRT @silv24 : Half an hour until tonight's #twitjc - low molecular weight heparin and mortality in acutely unwell medical patients - http://t.co/inB34OtI
(Sun, 26 Feb 2012 19:30:38 +0000)
@silv24Half an hour until tonight's #twitjc - low molecular weight heparin and mortality in acutely unwell medical patients - http://t.co/inB34OtI
(Sun, 26 Feb 2012 19:30:20 +0000)
@jenrowRT @silv24 : Two hours until #twitjc - please say some of you are going to join in! It is a great paper up for discussion http://t.co/inB34OtI
(Sun, 26 Feb 2012 18:28:40 +0000)
@tobyhillmanRT @silv24 : “ @twitjournalclub : New post: Week 16 - Discussion Point http://t.co/21UttdfJ #TwitJC ” - discussion starts at 8pm tonight - please join in
(Sun, 26 Feb 2012 18:25:29 +0000)
@pabakz@silv24 @PaedsSHO : The paper can be found here: http://t.co/jq2uVkjg #twitjc >> only the abstract, unless I'm doing something wrong
(Sun, 26 Feb 2012 18:20:41 +0000)
@GPLEDeducationRT @Puffles2010 : Puffles says if you know any medics, please (*point*) them to @twitjournalclub & http://t.co/u8byW1qK #TwitJC
(Sun, 26 Feb 2012 18:12:57 +0000)
@DrDLittleRT @silv24 : “ @twitjournalclub : New post: Week 16 - Discussion Point http://t.co/21UttdfJ #TwitJC ” - discussion starts at 8pm tonight - please join in
(Sun, 26 Feb 2012 18:10:52 +0000)
@PaedsSHORT @twitjournalclub : New post: Week 16 - Discussion Point http://t.co/xkOse1dk #TwitJC
(Sun, 26 Feb 2012 16:37:23 +0000)
@twitjournalclubRT @silv24 : “ @twitjournalclub : New post: Week 16 - Discussion Point http://t.co/21UttdfJ #TwitJC ” - discussion starts at 8pm tonight - please join in
(Sun, 26 Feb 2012 16:36:15 +0000)
@Puffles2010Puffles says if you know any medics, please (*point*) them to @twitjournalclub & http://t.co/u8byW1qK #TwitJC
(Sun, 26 Feb 2012 16:36:14 +0000)
@silv24@twitjournalclub : New post: Week 16 - Discussion Point http://t.co/21UttdfJ #TwitJC ” - discussion starts at 8pm tonight - please join in
(Sun, 26 Feb 2012 16:34:53 +0000)
@twitjournalclubNew post: Week 16 - Discussion Point http://t.co/xkOse1dk #TwitJC
(Sun, 26 Feb 2012 16:32:54 +0000)
@living_as_ifRT @silv24 : If anyone is having trouble accessing the full paper for tonight's #twitjc a link can be found at - http://t.co/TNcmhUEr
(Sun, 26 Feb 2012 12:55:59 +0000)
@EpiSagarRT @twitjournalclub : Don't miss #twitjc tonight - low-molecular weight heparin and mortality in medical patients - discussion starts at 8pm http://t.co/aCkr4vNq
(Sun, 26 Feb 2012 12:54:57 +0000)
@Puffles2010RT @silv24 : If anyone is having trouble accessing the full paper for tonight's #twitjc a link can be found at - http://t.co/TNcmhUEr
(Sun, 26 Feb 2012 12:54:52 +0000)
@parkerflashRT @twitjournalclub : Don't miss #twitjc tonight - low-molecular weight heparin and mortality in medical patients - discussion starts at 8pm http://t.co/aCkr4vNq
(Sun, 26 Feb 2012 12:53:08 +0000)
@jonthehenRT @silv24 : If anyone is having trouble accessing the full paper for tonight's #twitjc a link can be found at - http://t.co/TNcmhUEr
(Sun, 26 Feb 2012 12:51:30 +0000)
@twitjournalclubRT @silv24 : If anyone is having trouble accessing the full paper for tonight's #twitjc a link can be found at - http://t.co/TNcmhUEr
(Sun, 26 Feb 2012 12:50:04 +0000)
@silv24If anyone is having trouble accessing the full paper for tonight's #twitjc a link can be found at - http://t.co/TNcmhUEr
(Sun, 26 Feb 2012 12:49:22 +0000)
@silv24RT @twitjournalclub : Don't miss #twitjc tonight - low-molecular weight heparin and mortality in medical patients - discussion starts at 8pm http://t.co/aCkr4vNq
(Sun, 26 Feb 2012 12:48:19 +0000)
@twitjournalclubDon't miss #twitjc tonight - low-molecular weight heparin and mortality in medical patients - discussion starts at 8pm http://t.co/aCkr4vNq
(Sun, 26 Feb 2012 12:47:38 +0000)
@wrexhamrobRT @twitjournalclub : If anyone is having trouble accessing the full paper for tomorrow's #twitjc a link can be found at - http://t.co/Cn2gQL4L
(Sun, 26 Feb 2012 12:22:06 +0000)
@pabakzhttp://t.co/PVlPOGAe Not the easiest paper to access #twitjc
(Sat, 25 Feb 2012 23:59:53 +0000)
@PaedsSHORT @twitjournalclub : If anyone is having trouble accessing the full paper for tomorrow's #twitjc a link can be found at - http://t.co/Cn2gQL4L
(Sat, 25 Feb 2012 19:01:54 +0000)
@EdanStarforthRT @twitjournalclub : If anyone is having trouble accessing the full paper for tomorrow's #twitjc a link can be found at - http://t.co/Cn2gQL4L
(Sat, 25 Feb 2012 17:56:26 +0000)
@silv24RT @twitjournalclub : If anyone is having trouble accessing the full paper for tomorrow's #twitjc a link can be found at - http://t.co/Cn2gQL4L
(Sat, 25 Feb 2012 17:52:19 +0000)
@twitjournalclubIf anyone is having trouble accessing the full paper for tomorrow's #twitjc a link can be found at - http://t.co/Cn2gQL4L
(Sat, 25 Feb 2012 17:49:22 +0000)
@silv24@k2_UK tomorrow's journal club may interest, does prophylaxis with LMWH affect mortality in medical patients? #twitjc http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 17:15:09 +0000)
@CatherinBruntonRT @silv24 : Ahead of tomorrow's #twitjc - my summary of LMWH and mortality in acutely unwell medical patients http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 15:51:11 +0000)
@amcunningham@silv24 another pay walled journal article? :( #twitjc but interesting topic ++
(Sat, 25 Feb 2012 15:04:01 +0000)
@ChiparaRT @silv24 : Ahead of tomorrow's #twitjc - my summary of LMWH and mortality in acutely unwell medical patients http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 14:53:33 +0000)
@MrEpidRT @silv24 : Tomorrow's #twitjc should be interesting - does low molecular weight heparin as thromboprophlaxis affect mortality? http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 14:48:36 +0000)
@twitjournalclubRT @silv24 : Tomorrow's #twitjc should be interesting - does low molecular weight heparin as thromboprophlaxis affect mortality? http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 14:47:21 +0000)
@silv24This is a great paper for medical student to join in & critique & an important patient safety issue - hoping for a lively discussion #twitjc
(Sat, 25 Feb 2012 14:47:12 +0000)
@Puffles2010RT @silv24 : Ahead of tomorrow's #twitjc - my summary of LMWH and mortality in acutely unwell medical patients http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 14:46:29 +0000)
@silv24Tomorrow's #twitjc should be interesting - does low molecular weight heparin as thromboprophlaxis affect mortality? http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 14:45:54 +0000)
@PaedsSHORT @silv24 : Ahead of tomorrow's #twitjc - my summary of LMWH and mortality in acutely unwell medical patients http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 14:45:03 +0000)
@twitjournalclubRT @silv24 : Ahead of tomorrow's #twitjc - my summary of LMWH and mortality in acutely unwell medical patients http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 14:44:17 +0000)
@silv24Ahead of tomorrow's #twitjc - my summary of LMWH and mortality in acutely unwell medical patients http://t.co/IFQVHWX3
(Sat, 25 Feb 2012 14:43:47 +0000)
@docshannonRT @PaedsSHO : Week 16 – Low Molecular Weight Heparin & Mortality in Acutely Ill Medical Patients http://t.co/JVBRkAjv #twitjc
(Sat, 25 Feb 2012 09:24:11 +0000)
@PaedsSHOWeek 16 – Low Molecular Weight Heparin & Mortality in Acutely Ill Medical Patients http://t.co/JVBRkAjv #twitjc
(Sat, 25 Feb 2012 00:38:09 +0000)
@taggiemonsterRT @twitjournalclub : New post: Week 16 http://t.co/9FXXjxj3 #TwitJC
(Sat, 25 Feb 2012 00:22:54 +0000)
@whole_patientsRT @silv24 : The paper for this Sunday's #twitjc - summary of the paper to be posted shortly (delayed slightly by this virus) http://t.co/pZ2wwEtR
(Fri, 24 Feb 2012 22:58:39 +0000)
@twitjournalclubNew post: Week 16 http://t.co/3pqzUzT5 #TwitJC
(Fri, 24 Feb 2012 22:10:34 +0000)
@silv24@SuzetteWoodward This Sunday's #twitjc might interest you, LMWH and mortality in medical patients http://t.co/pZ2wwEtR
(Fri, 24 Feb 2012 17:15:13 +0000)
@gasclassRT @silv24 : The paper for this Sunday's #twitjc - summary of the paper to be posted shortly (delayed slightly by this virus) http://t.co/pZ2wwEtR
(Fri, 24 Feb 2012 16:35:59 +0000)
@twitjournalclubRT @silv24 : The paper for this Sunday's #twitjc - summary of the paper to be posted shortly (delayed slightly by this virus) http://t.co/pZ2wwEtR
(Fri, 24 Feb 2012 16:06:48 +0000)
@silv24The paper for this Sunday's #twitjc - summary of the paper to be posted shortly (delayed slightly by this virus) http://t.co/pZ2wwEtR
(Fri, 24 Feb 2012 16:06:25 +0000)
@rmtyner@twitjournalclub Paper for this week& #39 ;s #twitjc will be LMWH & Mortality in Acutely Ill Medical Patients http://t.co/QT3hMegB #meded
(Fri, 24 Feb 2012 02:28:27 +0000)
@Aghoury_RT @twitjournalclub : Paper for this week& #39 ;s #twitjc will be Low-Molecular-Weight Heparin & Mortality in Acutely Ill Medical Patients http://t.co/JOdL2WyZ
(Thu, 23 Feb 2012 23:12:15 +0000)
@PaedsSHORT @twitjournalclub : Paper for this week& #39 ;s #twitjc will be Low-Molecular-Weight Heparin & Mortality in Acutely Ill Medical Patients http://t.co/JOdL2WyZ
(Wed, 22 Feb 2012 22:53:48 +0000)
@PaedsSHORT @twitjournalclub : New post: Week 16 http://t.co/7jcd9kzM #TwitJC
(Wed, 22 Feb 2012 22:53:42 +0000)
@PHTwitJCRT @twitjournalclub : Paper for this week& #39 ;s #twitjc will be Low-Molecular-Weight Heparin & Mortality in Acutely Ill Medical Patients http://t.co/JOdL2WyZ
(Wed, 22 Feb 2012 18:04:49 +0000)
@DrPlumEURT @twitjournalclub : New post: Week 16 http://t.co/7jcd9kzM #TwitJC
(Wed, 22 Feb 2012 17:55:57 +0000)
@silv24RT @twitjournalclub : New post: Week 16 http://t.co/7jcd9kzM #TwitJC
(Wed, 22 Feb 2012 17:52:05 +0000)
@silv24RT @twitjournalclub : Paper for this week& #39 ;s #twitjc will be Low-Molecular-Weight Heparin & Mortality in Acutely Ill Medical Patients http://t.co/JOdL2WyZ
(Wed, 22 Feb 2012 17:51:58 +0000)
@twitjournalclubNew post: Week 16 http://t.co/7jcd9kzM #TwitJC
(Wed, 22 Feb 2012 17:49:29 +0000)
@twitjournalclubPaper for this week& #39 ;s #twitjc will be Low-Molecular-Weight Heparin & Mortality in Acutely Ill Medical Patients http://t.co/JOdL2WyZ
(Wed, 22 Feb 2012 17:42:52 +0000)
@GasCast@silv24 @fidouglas @twitjournalclub - love the idea of #twitjc so much we've featured it on our latest podcast - http://t.co/28bQxNeR
(Wed, 22 Feb 2012 13:56:59 +0000)
@PAT_LibrariesRT @twitjournalclub : The paper for this Sunday's #twitjc will be announced tomorrow...watch this space for further details
(Tue, 21 Feb 2012 09:35:14 +0000)
@twitjournalclubThe paper for this Sunday's #twitjc will be announced tomorrow...watch this space for further details
(Mon, 20 Feb 2012 18:11:37 +0000)

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