FOAMed

Transcript

1. FOAMed North Battleford Grand Rounds Dr. Braden Bouchard - Family Medicine Resident January 17, 2014
2. Free! Open! Access! Meducation
3. Why?
5. Update Clinical Practice FOAMED
6. Shorten time from knowledge generation to dissemination to implementation! ! Iterate faster on techniques and treatments! ! Connect for peer review with motivated and interested clinicians in the public light
7. • Emergency Medicine! • Critical / Intensive Care Medicine! • Anaesthesia! ! And slowly but surely…! • General Practice / Family Medicine
9. USask FOAM Collaborative @socmobem Chris Bond, Adult EM Physician! Foothills Hospital, Calgary @brent_thoma Brent Thoma, EM Resident! Simulation/Research Fellow at Massachusetts General @ermentor Nadim Lalani, Adult and Pediatric EM Physician @olszynskip Paul Olszynski, Adult EM Physician
13. It’s a nice thought to be able to disseminate information so quickly and widely, but:! ! “It’s not peer reviewed”
14. The power that FOAMed has:! ! “24/7 near-instantaneous post- publication commentary by anyone in the world with an internet connection”! ! — Brent Thoma (@brent_thoma)
15. The post-publication peer review process in action:! ! ! PE Prognostication
17. The Myths, according to Dr. Senthi:! ! 1. That untreated PE has a high mortality! ! 2. That CTPA has an exceedingly low risk of harm! ! 3. That CTPA is accurate at diagnosing PE! ! 4. That if we diagnose PE we can significantly reduce a patient’s risk of death by treating them with anticoagulation
18. Dr. Senthi’s Proposed Algorithm:! ! 1. Using a higher test threshold for CTPA (>4.8%)! ! 2. Using the sPESI score to prognosticate in the tricky mildly-symptomatic patient category! ! 3. Anticoagulation may not really be making a big difference to outcomes in simple, haemodynamically stable, small PEs
20. Minh Le Cong @rfdsdoc @DrSenthi @broomedocs @MDaware @gruntdoc @SAEMEBM how many cases of CTPA induced contrast death have you seen ? Simple question Sep 12 Details Reply Retweet Favorite More Casey Parker @broomedocs @rfdsdoc @DrSenthi @MDaware @gruntdoc @SAEMEBM Answer: I don't know! Seen lots of renal failure. Multi factorial etiology. Some had contrast Sep 12 Details Reply Retweet Favorite More Chris Cole @DocOnSkis @rfdsdoc @DrSenthi @broomedocs @MDaware @gruntdoc @SAEMEBM None. Absence of evidence is not evidence of absence. Limited view from ED world. Sep 12 Details Reply Retweet Favorite More Anand Senthi @DrSenthi @rfdsdoc @broomedocs @MDaware @gruntdoc @SAEMEBM hmm .. changing the subject Minh? That question will be answered on Part4 pdocast-patience Sep 12 Details Reply Retweet Favorite More Minh Le Cong @rfdsdoc @DrSenthi @broomedocs @MDaware @gruntdoc @SAEMEBM no. just trying to get back to real world.doomsday comet has not hit earth yet too. Sep 12 Details Reply Retweet Favorite More
21. The post-publication peer review process in action:! ! PE Prognostication:! Weingart Weighs In
23. Dr. Weingart Weighs in:! ! “The reason we work up these patients is to make sure they don’t have the predisposition to have another clot in a few weeks.”
24. Dr. Senthi Strikes Back:! ! Articles | 17 July 2001 Excluding Pulmonary Embolism at the Bedside without Diagnostic Imaging: Management of Patients with Suspected Pulmonary Embolism Presenting to the Emergency Department by Using a Simple Clinical Model and D-dimer Philip S. Wells, MD, MSc; David R. Anderson, MD; Marc Rodger, MD, MSc; Ian Stiell, MD, MSc; Jonathan F. Dreyer, MD; David Barnes, MD; Melissa Forgie, MD; George Kovacs, MD; John Ward, MD; and Michael J. Kovacs, MD After 3 months, patients were followed up for development of thromboembolic events at a return appointment or by telephone contact.!
25. Resources Emergency / Critical Care:! • Mike Cadogan & Chris Nickson! • lifeinthefastlane.com • foamem.com • www.ultrasoundpodcast.com • emcrit.org ! General Practice / Family Medicine:! • FOAM4GP.com
26. Dr. Tim Leeuwenburg! @kangaroobeach