@NIHRresearch Academic Clinical Lecturer | Paediatric Immunology and Infectious Diseases | Clinical trials | Vaccines | Antibiotics | @apsmunro.bsky.social
United Kingdom
Joined April 2013
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I’ve noticed many comments criticising RCTs of masks or filters come from engineers
These criticisms are often, understandably, caused by misunderstandings about what RCTs are for (engineers do not usually use RCTs)
Here is my attempt to explain
munro-link.alasdairmunro.wor…
Alasdair Munro retweeted
Had another discussion with an MD concerned re fosfomycin for pyelo because "it doesn't get into the kidney". The damage guidelines have done medicine is incalculable. Perpetetuators of myth & legend. Forcing patients to get IV when they don't need it. It is time for a reckoning.
Alasdair Munro retweeted
The 1st of 2 new articles in CID critical of clinical guideline process is out. See
academic.oup.com/cid/article…
It is long past time clinical guidelines incorporate the humility of uncertainty & stop creating standards of care absent of reproducible prospective studies.
@ABsteward
Alasdair Munro retweeted
Underpinning this is a concept that became very apparent during #COVID19
Is the presentation missed, delayed or or late?
blogs.bmj.com/bmj/2020/08/15…
When undertaking reviews of these cases understanding these subtle differences critical to ensure true learning for the future
Alasdair Munro retweeted
A tour-de-force in healthcare communication from @apsmunro
The contradiction of a healthcare campaign promoting illness recognition only to see it potentially make the problem worse....
alasdairmunro.substack.com/p…
Alasdair Munro retweeted
Nice explanation from @apsmunro
Sepsis is rare, but devastating. It is a needle in a haystack for emergency care. Campaigns for ‘early awareness’ makes the haystack bigger, meaning that the needles are even more difficult to find.
There is a massive amount of attention on sepsis and "increasing awareness" among the public
There seems to be little recognition that increasing the amount of early presentations will also, paradoxically, increase the number of "missed" diagnoses
munro-link.alasdairmunro.wor…
Increasing awareness of sepsis simultaneously increases the number of "missed" diagnoses, whilst also increasing the number of diagnoses made early
This confusing paradox stems from the difficulties of assessing children earlier in the disease process
munro-link.alasdairmunro.wor…
There is a massive amount of attention on sepsis and "increasing awareness" among the public
There seems to be little recognition that increasing the amount of early presentations will also, paradoxically, increase the number of "missed" diagnoses
munro-link.alasdairmunro.wor…
I recently gave a talk at a paediatric OPAT conference which I titled “The death of OPAT”
Given the superiority of oral antibiotics in almost all cases, prolonged courses of IV for children should be considered a failure unless there is an exceptional justification
Alasdair Munro retweeted
Does the shingles vaccine reduce the risk of developing dementia? The science isn't as solid as some claim, but private vaccinations are soaring. Was great to speak to @apsmunro to understand where we are at on the evidence:
thetimes.com/article/f9801b5…
Alasdair Munro retweeted
The NHS specifically advises AGAINST sponging or ANY physical cooling measures for fever
It does NOT bring core temperature down, and only serves to make the patient LESS COMFORTABLE by increasing their bodies efforts to keep their temperature elevated
nhs.uk/symptoms/fever-in-chi…
Excellent to see completely false information (from a doctor, no less) TRENDING on X
Link below with the official information from the NHS - SPECIFICALLY SAYING NOT TO COOL YOUR CHILD WITH A SPONGE
nhs.uk/symptoms/fever-in-chi…
Alasdair Munro retweeted
We need this on t-shirts all over the land.
You do absolutely none of these, because physically cooling someone with a fever will make them feel WORSE
Physiologically their hypothalamus already thinks they are cold and is warming them up
Antipyretics can switch this off, but physical cooling is WRONG
Two new trials of adjunctive steroids for Kawasaki disease are negative for the primary outcome of reducing coronary artery aneurysms
But I might use them anyway
Why? Join me to explore the conclusive but intriguing results of these new studies!
munro-link.alasdairmunro.wor…
Alasdair Munro retweeted
The sum total of evidence that IV abx must be used for IE is:
1) uncontrolled case series of oral sulfa drugs (not trim-sulfa, sulfa alone), tetracycline, or erythromycin from the 1940s-50s
2) an opinion from Max Finland in a review article in NEJM in 1954, citing those series
Piperacillin/tazobactam (Tazocin, Zosyn etc) is ultimately a drug for Pseudomonas aeruginosa
Are you worried about Pseudomonas? Pip/taz is a great choice
Not worried about Pseudomonas? You don’t need pip/taz, there is almost certainly a better option
Two new RCTs of adjunctive steroids for Kawasaki disease
Both negative for improving coronary artery aneurysms (primary outcome)
BUT both show quicker resolution of fever and inflammatory markers, and less "salvage therapy" (2nd IVIg, biologics)
Does this make steroids useful?