There are a number of reasons that an idea may be impossible to test scientifically. Perhaps the disease state that the idea applies to is extremely rare. Perhaps it is logistically impossible to test the idea, due to issues with blinding or time constraints. This post will focus on an insidious reason that ideas are thrown beyond the wall: the timeframe and study size required to test them are unachievable.
Urosepsis is one of my favorite ICU diagnoses. In almost all cases, patients will improve dramatically within 12-24 hours and leave the ICU with minimal sequelae. But that shouldn’t lull us into a false sense of security: careful antibiotic selection, aggressive resuscitation, and (in some cases) emergent drainage may be required for a good outcome.
If you haven’t started seeing these yet, you will soon. Checkpoint inhibitors are a form of immunotherapy being used for an increasingly broad range of malignancies. They cause a diverse range of adverse events, due to releasing uncontrolled autoimmune hyperactivity. Clinically this can mimic just about any rheumatologic condition. Fortunately these events are quite treatable. However, a high index of suspicion and prompt therapy is important.
This paper slipped across my twitter feed over the weekend. It was a bit disquieting to see that it was getting a lot of attention, despite being a methodological train wreck (seriously, MedTwitter, where’s the skepticism??). This post will briefly walk through some of the main flaws. There will be a bit of pharmacology, a modicum of methodology, and a lot of ranting.
Adrenal crisis is a can’t-miss diagnosis. Prompt identification and proper management will generally lead to rapid improvement. The most important aspect is maintaining a high index of suspicion. When in doubt, start empiric therapy first and ask questions later. The IBCC chapter is located here. The podcast & comments are below. Follow us on iTunes