Some thought about DVT prophylaxis in ICU.
Part of my presentation on the same topic.

Question 1: What is the incidence of DVT and PE in current era of widespread thrombo-prophylaxis?
#FOAMed

A week ago I voluntarily admitted myself to the hospital to get help bc I am losing weight as a result of increased food intolerances, secondary to my very severe #MECFS. A psychiatrist here decided that im mentally ill, 1/

purely on the basis that the medical workup was unable to explain my food intolerance. My psych eval only found mild anxiety and depression. 2/

They have put me on a 72hr psych hold while they work to get the county courts to commit me to a psych ward. This is a nightmare. They have taken away most of my belongings, put me in a new uniform, and are keeping me under 24/7 video surveillance. 3/

In the middle of the night last night when I sat up to use the urinal loud alarms sounded, as though I was trying to escape. I can’t even walk and hadn’t even left my bed. 4/

If they succeed in having me fully committed I will lose ability to communicate with the outside world except for an occasional phone call. I will lose all agency, and will very likely have treatments forced upon me. 5/

The #RELAx trial has been published today in @JAMA. It was coordinated by Anna Algera. This thread is to explain the rationale, what we did, the findings and the meaning.
The rationale of #RELAx is based on the following

First, there is NO adequate evidence on the level of PEEP in non-ARDS patients. Most of the studies are old, conducted in post-surgical patients (short-term ventilation), and were not powered to detect differences in patient-centered

Second, despite the absence of evidence, the levels of PEEP used in non-ARDS patients increased over years, from 5 to 7/8 cmH2O, probably as a reflection of studies and practice in ARDS

Third, one IPDM showed that higher levels of PEEP could benefit more severe ARDS patients. However, opposite trends (higher mortality and longer ventilation) were found in mild ARDS with higher PEEP (despite not powered to be statistically

Fourth, most of the weaning protocols include PEEP ≤ 5 cmH2O as a criterion for readiness to wean. Theoretically, a standardized liberal strategy of higher PEEP could delay weaning in some

"Public health" isn't just about vaccinations, clinics and urgent care: it's a holistic discipline that encompasses all the contributors to health outcomes, which include things like housing, employment, transportation, pollution and more.

1/

A new working paper from @nberpubs estimates the number of US covid deaths that could have been prevented with a coherent, effective eviction moratorium and a ban on utility cutoffs:

The paper, written by a multidisciplinary group of Duke researchers from medicine and economics, found that housing precarity (a risk of losing your home) drove risky behavior that increased the spread of the disease and the resulting deaths.

3/

For example, it forced people to double-up on lodgings, making social distancing impossible, to say nothing of self-isolating after an exposure. It also drove people to tolerate high-risk workplace conditions, including illegal conditions.

4/

The authors used regression techniques to control for confounding variables, and used like-for-like counties with different utility and eviction policies to estimate the effect that these had on infection rates.

5/

I think that, in the face of an ongoing global health emergency and a pressing need to reopen safely, some form of health pass is a reasonable option to consider. But debate is a good thing, so here are some brief thoughts on various concerns I've heard about them... [thread]

"A health pass discriminates against people who have refused the vaccine." No. A health pass should also support proof of test result for people who haven't been vaccinated, and exemptions for people who cannot be vaccinated (get vaccinated if you can though, for heaven's sake).

"A health pass is an invasion of privacy." No. A health pass should be privacy preserving, allowing you to prove your status to third parties without giving away personal data or letting them track you without your permission.

"A health pass is unfair to people without smartphones." No. A health pass should accommodate people without a smartphone, e.g. with a printable option as a fall-back (though for most of us, carrying a digital pass on our phone will be much more convenient).

"A health pass will become obsolete as the virus mutates." No. A health pass should actually give us more insight and flexibility to adjust our response as our knowledge of the virus, and the ways we test / treat / vaccinate for it, increases.