#bluejc transcript

Healthcare Social Media Transcript

From: Wed Jul 03 0:00:00 PDT 2013
To: Wed Jul 10 6:00:00 PDT 2013

What is #bluejc? Who were the influencers during this time period? #bluejc analytics


Healthcare Conference  - Healthcare Tweet Chats  -  Healthcare Analytics

bjogtweets
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#BlueJC starting in 25mins, Paper: http://t.co/eAVPhQ3NRp Discussion points: http://t.co/6EEsH725OY
bjogtweets
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What is the best time to schedule an elective caesarean? #BlueJC in 5 mins
amc_obsgyn
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Welcome to the twitter discussion #BlueJC @elaineleung @BJOGTweets
amc_obsgyn
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First discussion point: Is the clinical question evaluated in this study important and add s to existing knowledge? #BlueJC
elaineleung
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.@AMC_ObsGyn Thanks for the reminder- sorry I am slightly late. #bluejc
elaineleung
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.@psychologyToki indeed previous cohort studies used a composite primary outcome (also has its own advantages and disadvantages) #bluejc
elaineleung
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.@psychologyToki we are also trying to stick to the discussion pts- do you think this is a clinically important question? #bluejc
bwmol
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@psychologyToki NICU admittance is dangerous outcome as it is a process measure rather than a direct measure of the child condition #bluejc
elaineleung
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.@bwmol @psychologyToki With this being an unblinded trial, it could also add to potential bias I presume. #bluejc
elaineleung
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.@bwmol @psychologyToki If you were the designer this study, which primary outcome(s) would you choose? #bluejc
bwmol
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@Profkkhan where are you #bluejc
dromichel
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"@BJOGTweets: #BlueJC starting in 25mins, Paper: http://t.co/e0izmIN31r Discussion points: http://t.co/3gMsGAZrb7"
frekewilmink
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@bwmol @psychologyToki Incidence of NICU as primary outcome ignores all minor neonatal morbidity separating mother and child#BlueJC
elaineleung
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.@AMC_ObsGyn 1st question- we seldom perform elective c/s be4 39-week unless clinically indicated. Is is the same in Netherlands? #bluejc
amc_obsgyn
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yes, applies in the Netherlands #BlueJC
bwmol
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@elaineleung @psychologyToki my problem is that NICU admit. is dependent on the availabilty of NICU. If u have a NICU you will admit #bluejc
glavindjulie
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#BlueJC The primary outcome was chosen in order to be able to assess both risks and advantages associated with timing of the CS
elaineleung
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Welcome to #bluejc- this is the opportunity to interact with the first author of this paper @GlavindJulie
glavindjulie
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All hospitals had a NICU within the facility, but no neonates were admitted without an indication #bluejc
psychologytoki
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@bwmol @elaineleung #BlueJC that is very good point. If you do not have NICU then you cannot admit or it might be delayed >48 hrs?
frekewilmink
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@elaineleung @AMC_ObsGyn in 2010 in NL we still perform about 43% of eCS before 39weeks, however from 2000-2010 this decreases #bluejc
bjogtweets
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RT @elaineleung: Welcome to #bluejc- this is the opportunity to interact with the first author of this paper @GlavindJulie
elaineleung
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.@GlavindJulie was there any problem with availability of NICU bed during the trial? In London, bed shortage in NICU is not uncommon #bluejc
psychologytoki
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@elaineleung @bwmol I was wondering whether outcomes measures for women had to be considered. #BlueJC
elaineleung
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.@FrekeWilmink @AMC_ObsGyn Around the time this was published by Tita et al I guess? http://t.co/B9Olk0hEXP #bluejc
bwmol
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@psychologyToki #bluejc maternal outcome should be secondary ; differences due to emergency versus planned Caesarean
frekewilmink
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@AMC_ObsGyn Certainly relevant, however I have doubts about the sample size based on large estimated difference in NICU admittance #blueJC
elaineleung
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.@psychologyToki @bwmol There was a brief discussion bat maternal morbidities in the introduction, not main objective of this trial. #bluejc
elaineleung
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.@FrekeWilmink @AMC_ObsGyn differences between estimated NICU admission vs observed rates in this trial- could these be predicted? #bluejc
glavindjulie
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@elaineleung I have not heard of a bed shortage problem with regard to any of the participants in the trial... #bluejc
frekewilmink
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@elaineleung @AMC_ObsGyn Probably, however around 1995-2001 there were also several publications adressing this point #blueJC
bwmol
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@FrekeWilmink @GlavindJulie my main concern indeed is the lack of power. No significant reduction, but 2% still relevant I think #blueJC
elaineleung
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There seems to be agreement that this is a relevant trial (question 1). In terms of outcomes, some have suggested composite outcomes #bluejc
elaineleung
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.@GlavindJulie did your team consider alternative primary outcomes (e.g. a composite primary)? #bluejc
glavindjulie
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The only available NICU admission estimates are from observational studies where non-elective procedures were excluded #bluejc
elaineleung
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.@GlavindJulie did the difference in admission rates come as a surprise? Or you were suspecting the difference anyways? #bluejc
elaineleung
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.@FrekeWilmink @AMC_ObsGyn So, what has led to the change in practice (later elective c/s)? #bluejc
frekewilmink
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@elaineleung @AMC_ObsGyn If I calculated it correctly, based on rates in Tita et al sample size shoud be around 4000 #blueJC
amc_obsgyn
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the question is relevant but in view the sample size its unlikely that the answer will add substantial to excisting knowledge #bluejc
glavindjulie
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@elaineleung in our opinion NICU admission would reliably reflect neonatal morbidity and could be evaluated as a composite itself #bluejc
elaineleung
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.@FrekeWilmink @AMC_ObsGyn Tell us more about yr calculation? #bluejc
amc_obsgyn
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The hazard of the results is that it will justify elective c/s before 39 wks, thus jeopardizing neonatal condition #bluejc
bwmol
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#bluejc Swiss obsetricians already changed practice towards ealry CS based on this study
glavindjulie
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@FrekeWilmink @elaineleung @AMC_ObsGyn our sample size was based on the best available estimates (2008) from Hansen et al (BMJ 2007) #bluejc
elaineleung
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.@GlavindJulie Do you think the current trial has enough power to answer this question (I noted yr discussion)? #bluejc
elaineleung
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.@GlavindJulie just to clarify my question- because of the unexpected difference of NICU admission rates compared to estimate. #bluejc
bwmol
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@GlavindJulie I would be interested in a cost calculation of both trial arms #bluejc
profkkhan
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@AMC_ObsGyn cannot really conclude that elective c/s before 39 wks will jeopardize neonatal condition from this paper or can you? #bluejc
glavindjulie
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@elaineleung Indeed, we expected the difference in admission rates to be larger! We predicted 14% at 38 weeks and 8% at 39 #bluejc
glavindjulie
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@elaineleung - but found 14% at 38 weeks and 12% at 39 weeks #bluejc
profkkhan
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@bwmol #bluejc if Swiss obsetricians already changed practice towards ealry CS this cannot be based on just one study - other prejudices?
elaineleung
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.@Profkkhan @AMC_ObsGyn My interpretation: the two groups were not different but the study at risk of being under-powered. #bluejc
glavindjulie
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@bwmol I agree - that would be interesting #bluejc
profkkhan
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@elaineleung lack of power leads to uncertainty about a negative finding, not certainty toward the possibility of harm #bluejc
bwmol
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@Profkkhan @AMC_ObsGyn #bluejc there is 2% difference in NICU admission for a 13% emergency CS rate; #bluejc
bwmol
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@Profkkhan #bluejc that is 6 times to get out of bed to prevent one child being admitted to NICU. If you dont want that, dont do ob/gyn
glavindjulie
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@Profkkhan @AMC_ObsGyn not really, but there may be a clinically relevant difference (2%) in NICU admissions and we know too little #Bluejc
glavindjulie
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@Profkkhan @AMC_ObsGyn about long-term consequences to the child #bluejc
amc_obsgyn
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are you planning long term follow up? #bluejc @glavindjulie
profkkhan
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@bwmol 6 times to get out of bed - average answers have range of uncertainty including the possibility of staying in bed more often #bluejc
profkkhan
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@elaineleung calculating sample size and power post hoc is unncessary post mortem. the information needed is captured by CIs #bluejc
amc_obsgyn
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thanks for this interesting hour, looking forward to more input coming week. Hopefully everbody can stay in bed tonight #bluejc
elaineleung
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.@Profkkhan But how could readers deal with the recurrent uncertainties about wide CI in clinical trials? #bluejc
glavindjulie
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@AMC_ObsGyn We plan to evalute health care utilization in childhood and possibly clinical outcomes in the children #bluejc
elaineleung
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I want to know too! RT @AMC_ObsGyn: are you planning long term follow up? #bluejc @glavindjulie
profkkhan
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RT @elaineleung: .@Profkkhan But how could readers deal with the recurrent uncertainties about wide CI in clinical trials? #bluejc
elaineleung
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.@Profkkhan wide CIs seems to happen rather often in #OBGYN trials. Metaanalyses help, but has their own problems… #bluejc
elaineleung
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.@Profkkhan wide CIs seems to happen rather often in #OBGYN trials. Metaanalyses help, but hv their own problems… #bluejc
elaineleung
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RT @GlavindJulie: @AMC_ObsGyn We plan to evalute health care utilization in childhood and possibly clinical outcomes in the children #bluejc
profkkhan
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@elaineleung living we uncertainty is an art humans will only learn through evolution - till then there will be anxiety disorder #bluejc
elaineleung
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It would be interesting to hear the conclusions of other #bluejc participants> has this RCT changed your practice? #bluejc
elaineleung
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Sorry to contaminate this #bluejc, but 1st author of the last paper discussed responded via email abt 3:1 randomisation. @jimgthornton 1/2
elaineleung
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Peirce: "we have justified the 3:1 ration in the paper. We increased the sample size accordingly" 2a/2 #bluejc
elaineleung
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but did not refer to this (and the original protocol) within the paper" 2b/2 #bluejc
elaineleung
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:) RT @Profkkhan: living w/ uncertainty is an art humans will only learn through evolution -till then there will be anxiety disorder #bluejc
dsiassakos
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@elaineleung Peirce re 3:1 "1:3 randomisation was used as there were only five biofeedback machines available to randomised women" #bluejc
dsiassakos
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@elaineleung #bluejc Peirce/ see end of Methods
bjogtweets
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@DSiassakos vote is a good idea. We can do a final count up at the end of the 7-day capture period #bluejc
elaineleung
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@GlavindJulie many thanks for contributing- interesting discussion and understand the trial better. #BlueJC
elaineleung
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RT @BJOGTweets: @DSiassakos vote is a good idea. We can do a final count up at the end of the 7-day capture period #bluejc
jimgthornton
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#bluejc. It wld be clearer if exp and control arms transposed in tables 2 and 3, or RR reversed. But minor point. Lovely trial.
jimgthornton
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#bluejc But hypothesis confirmed. CS <39w increases resp problems. 1ary endpoint not signif but all other resp endpoints same direction.
profkkhan
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@bwmol hope u enjoyed #bluejc - Grateful to author @GlavindJulie on behalf of BJOG
jimgthornton
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#bluejc And need 4 cont O2 >1day signif reduced after Bonferroni. No mat advantage to <39w. I will continue to schedule CS after 39w.
jimgthornton
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#bluejc. Final comment. Was study ethical? We knew there wld b fetal harms. Occ. babies still die from RDS nr term. I wld not have approved.
elaineleung
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Yep-@jimgthornton picked up to discrepancies from original protocol (not in report). RT @DSiassakos: #bluejc Peirce/ see end of Methods
elaineleung
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RT @bwmol: not from this paper,but #tita & @FrekeWilmink showed that <39 wks jeopardizes fetus for no reason but clinicians comfort #bluejc
bwmol
https://pbs.twimg.com/profile_images/459932088557268992/df7m20Af_normal.jpeg
@Profkkhan @GlavindJulie @mimosabruinooge @FJR_Hermans @elaineleung thanks for interesting #bluejc
dsiassakos
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@jimgthornton @jimgthornton indeed. was there equipoise re:harms before this RCT? is there equipoise now? #bluejc
elaineleung
https://pbs.twimg.com/profile_images/378800000817164734/16e8deb5ce64517e83a57fb64c3a58f1_normal.jpeg
.@DSiassakos @jimgthornton The discussion reminds me of a #bmj article a few years ago debating this. http://t.co/xokotq0Key #bluejc
elaineleung
https://pbs.twimg.com/profile_images/378800000817164734/16e8deb5ce64517e83a57fb64c3a58f1_normal.jpeg
.@Nuffbioethics Any thoughts? MT @jimgthornton: Was study comparing 38wk/39wk for c/s ethical? We knew assoc w/ fetal harms. #bluejc...
nlafferty
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@r_ajjawi: @nlafferty talking about twitter journal club - 1 #FOAMed article for discussion archived by journal #mededjc #asm13#bluejc

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