Understanding Stepped-Wedge Clinical Trials
Play episode · 19 min

Cluster randomized trials are performed when an intervention must be delivered to a group of patients like when testing new nursing protocols on award or different means for cleaning beds on a ward. One type of cluster trials is called a stepped-wedge where every cluster in the study ultimately undergoes the intervention. How this works it is explained by Susan Ellenberg, PhD, from the Department of Biostatistics, Epidemiology, and Informatics at the University of Pennsylvania School of Medicine.

Related Article:

The Stepped-Wedge Clinical Trial

Bedside Rounds
Bedside Rounds
Adam Rodman, MD, MPH, FACP
57 - The Second Wave
In August of 1918, a horrific second wave of the Spanish Flu crashed across the world. In this episode, the third of a four-part series exploring hydroxychloroquine and COVID-19, I’ll explore this single moment in time, through the mysterious origins of the Spanish Flu and historiographical controversies, scientific missions to mass burial sites in remote Alaskan villages, the ill-fated journey of the HMS Mantua, debates about how to count victims of a pandemic, and the mystery behind Pfeiffer’s bacillus. Plus a new #AdamAnswers about that annoying yellow on blue powerpoint template so common in the medical field! Sources: * Viboud, C. et al. Age- and Sex-Specific Mortality Associated With the 1918–1919 Influenza Pandemic in Kentucky. J Infect Dis 207, 721–729 (2013). * Oxford, J. S. & Gill, D. A possible European origin of the Spanish influenza and the first attempts to reduce mortality to combat superinfecting bacteria: an opinion from a virologist and a military historian. Hum Vacc Immunother 15, 2009–2012 (2019). * Epps, H. L. V. Influenza: exposing the true killer. J Exp Medicine 203, 803–803 (2006). * Patterson, S. W. & Williams, F. E. PFEIFFER’S BACILLUS AND INFLUENZA. Lancet 200, 806–807 (1922). * Taubenberger, J. K. & Morens, D. M. The 1918 Influenza Pandemic and Its Legacy. Csh Perspect Med a038695 (2019) doi:10.1101/cshperspect.a038695. * Trilla, A., Trilla, G. & Daer, C. The 1918 “Spanish Flu” in Spain. Clin Infect Dis 47, 668–673 (2008). * Taubenberger, J. K. The origin and virulence of the 1918 “Spanish” influenza virus. P Am Philos Soc 150, 86–112 (2006). * Heinz, E. The return of Pfeiffer’s bacillus: Rising incidence of ampicillin resistance in Haemophilus influenzae. Microb Genom 4, (2018). * Barry, J. M. The site of origin of the 1918 influenza pandemic and its public health implications. J Transl Med 2, 3 (2004). * Johnson, N. P. A. S. & Mueller, J. Updating the Accounts: Global Mortality of the 1918-1920 “Spanish” Influenza Pandemic. B Hist Med 76, 105–115 (2002). * Tomkins SM, Colonial Administration in British Africa during the Influenza Epidemic of 1918-19. Canadian Journal of African Studies / Revue Canadienne des Études Africaines. Vol. 28, No. 1 (1994), pp. 60-83 (24 pages) * Qiang Liu et al, The cytokine storm of severe influenza and development of immunomodulatory therapy. Cell Mol Immunol. 2016 Jan; 13(1): 3–10. * Spreeuwenberg et al. Reassessing the Global Mortality Burden of the 1918 Influenza Pandemic.Am J Epidemiol . 2018 Dec 1;187(12):2561-2567. doi: 10.1093/aje/kwy191. * R. F. J. Pfeiffer: Vorläufige Mittheilungen über den Erreger der Influenza. Deutsche medicinische Wochenschrift, Berlin, 1892, 18: 28. Die Aetiologie der Influenza. Zeitschrift für Hygiene und Infektionskrankheiten, 1893, 13: 357-386.
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Cardionerds: A Cardiology Podcast
Cardionerds: A Cardiology Podcast
CardioNerds
75. Case Report: Coronary Vasospasm Presenting as STEMI – UCSF
CardioNerds (Amit Goyal & Daniel Ambinder) join UCSF cardiology fellows (Emily Cedarbaum, Matt Durstenfeld, and Ben Kelemen) for some fun in San Francisco! They discuss a informative case of ST-segment elevation (STEMI) due to coronary vasospasm. Dr. Binh An Phan provides the E-CPR and program director Dr. Atif Qasim provides a message for applicants. Episode notes were developed by Johns Hopkins internal medicine resident Evelyn Song with mentorship from University of Maryland cardiology fellow Karan Desai. Jump to: Patient summary - Case media - Case teaching - References Episode graphic by Dr. Carine Hamo The CardioNerds Cardiology Case Reports series shines light on the hidden curriculum of medical storytelling. We learn together while discussing fascinating cases in this fun, engaging, and educational format. Each episode ends with an “Expert CardioNerd Perspectives & Review” (E-CPR) for a nuanced teaching from a content expert. We truly believe that hearing about a patient is the singular theme that unifies everyone at every level, from the student to the professor emeritus. We are teaming up with the ACC FIT Section to use the #CNCR episodes to showcase CV education across the country in the era of virtual recruitment. As part of the recruitment series, each episode features fellows from a given program discussing and teaching about an interesting case as well as sharing what makes their hearts flutter about their fellowship training. The case discussion is followed by both an E-CPR segment and a message from the program director. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademySubscribe to our newsletter- The HeartbeatSupport our educational mission by becoming a Patron!Cardiology Programs Twitter Group created by Dr. Nosheen Reza Patient Summary A man in his mid-50s with alcohol use disorder, cirrhosis, atrial fibrillation, and alpha thalassemia complicated by iron overload presented with hematemesis. He was tachycardic and hypotensive. Labs were notable for Hgb 8.1 (baseline of 10.2), INR 1.3, lactate 4.2, and ferritin 4660. He was started on IV PPI and octreotide. Course was complicated initially by Afib with RVR with hypotension. Subsequently, the patient developed unstable VT requiring CPR. Post-code EKG showed inferolateral ST elevations. Troponin-I rose from 19 to 225 and his pressor requirement continued to increase despite resolution of his GIB. TTE showed LVEF 42% with new inferolateral wall motion abnormalities, normal RV systolic function, severe mitral regurgitation, and small pericardial effusion. After treatment of his GIB by IR and GI, he underwent an urgent LHC which showed 30% stenosis in proximal LAD, 70% in LADD2, and 95% in distal RCA. Coronary spasm was noted in all vessels. Intracoronary nitroglycerin and nicardipine were administered with significant improvement in spasm and resolution of STE on EKG. Vasopressors were quickly weaned off after. He was eventually stabilized, extubated, and started on an oral nitrate and calcium channel blocker. Repeat TTE showed normalized systolic function without any wall motion abnormalities.   Case Media ABClick to Enlarge A. Baseline ECG - atrial fibrillationB. ECG with inferior STEMI CORS - left system CORS- RCA pre-vasodilator CORS- RCA post-vasodilator Episode Schematics & Teaching Coming soon! The CardioNerds 5! – 5 major takeaways from the #CNCR case What are the cardiac manifestations of hemochromatosis? Cardiac hemochromatosis encompasses cardiac dysfunction from either primary or secondary hemochromatosis. Initially, hemochromatosis leads to diastolic dysfunction and arrhythmias. In later stages, it can lead to dilated cardiomyopathy.  Diagnosis of iron overload is established by elevated transferrin saturation (>55%) and elevated serum ferritin (>300 ng/mL).
1 hr 11 min
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