Discover and read the best of Twitter Threads about #equipoise
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There was an interesting paper this week on different stakeholders understanding of the concept of #equipoise. Equipoise is an essential concept in clinical trials but is often not well understood 1/8
#MethodologyMonday
#MethodologyMonday
For it to be ethical to randomise in a trial, it is important that there is uncertainty which treatment is best 2/8
Originally uncertainty (equipoise) had to be at the level of the individual clinician but was refined to uncertainty at the professional community level by Freedman in the 1980s 3/8
nejm.org/doi/full/10.10…
nejm.org/doi/full/10.10…
#equipoise is the WORD OF THE DAY! @cdcdirector explained they didn't do a randomized clinical trial for masking because there was no equipoise in the question of masking. Wait, what does equipoise mean, you ask? Well, it has multiple definitions. Dr. Walensky SHOULD'VE... 1/
...defined it, but she didn't. While it can be frustrating to define things for others who don't know, it's her duty to do so. 'Cuz what's the point of communicating without creating connections in others? SO, let me define it for you. #equipoise has multiple definitions &... 2/
...as a VERB #equipoise means to provide balance or to counter-balance. AS A NOUN, it means balanced or counter-balanced (arguments, interests, power etc.). Scientifically, there is "clinical equipoise", which I believe (too bad @CDCDirector is forcing me to assume) is what... 3/
Our viewpoint "Preserving equipoise and performing randomized trials for COVID-19 social distancing interventions" with @NaudetFlorian and John Ioannidis @METRICStanford now in press @EpiPsychSci @CambridgeCore
cambridge.org/core/journals/…
cambridge.org/core/journals/…
In this viewpoint we make two main arguments. 1. There is equipoise for non-pharmacological interventions (NPI) for #SARSCoV2 #COVID19 containment because there is uncertainty re: the magnitude of both effectiveness & harms. Uncertainty is vast for some measures.
2. An agenda of randomized controlled trials of NPIs is both possible & feasible. We delineate measures that could be the focus on RCTs, along w/ issues related to designs, comparators (not advocating doing nothing!), outcomes (type, timing), obstacles & counterarguments to RCTs.
1/ @STARRTAKI now published in @NEJM nejm.org/doi/full/10.10… – an updated thread follows below
#starrtaki #aki #FOAMcc @nephjc
@DrRonWald @CCCTG_ @anzicsctg @UKCCRGroup @ICCCTN @CIHR_IRSC @NIHRresearch @nhmrc @HRCNewZealand 🇨🇦🇦🇺🇦🇹🇧🇪🇧🇷🇨🇳🇩🇪🇫🇮🇫🇷🇮🇪🇮🇹🇳🇿🇨🇭🇺🇸🇬🇧
#starrtaki #aki #FOAMcc @nephjc
@DrRonWald @CCCTG_ @anzicsctg @UKCCRGroup @ICCCTN @CIHR_IRSC @NIHRresearch @nhmrc @HRCNewZealand 🇨🇦🇦🇺🇦🇹🇧🇪🇧🇷🇨🇳🇩🇪🇫🇮🇫🇷🇮🇪🇮🇹🇳🇿🇨🇭🇺🇸🇬🇧
2/ Current CPGs do not make strong recommendations (Not Graded) on when to start RRT in ICU patients with AKI, in the absence of urgent indications, due largely to discrepant findings from prior RCTs (bit.ly/3fKqEZy) (bit.ly/39etR0N) @goKDIGO @NICEComms
3/ The @STARRTAKI trial is the largest multinational trial (168 sites, 15 countries) to address whether an accelerated (early) strategy compared with standard (delayed) strategy impacts mortality and kidney recovery in ICU patients with AKI #generalizability
