Thanks to @abimfoundation.bsky.social ation for posting the video of my recent lecture on the LA General Policy to Override Policies. For those of you who know my lectures, this one is among the most entertaining. And it's only 10 min. Check it out & implement the policy! youtu.be/RuKAKH8A604?...

Another plug for #wikiguidelines @bradspellberg.bsky.social When guidelines don’t keep up with medicine

Me reading DOTS trial #IDsky #DOOR

I love Dalba I just don’t know why we should do a PhD in statistics to understand a trial now Or maybe am just getting old and grumpy

As @bradspellberg.bsky.social would say CRP is missing a letter as a test "A" (CRAP) - www.sciencedirect.com/science/arti...

International guidelines recommend 5 to 7 days of antibiotic prophylaxis for patients with cirrhosis & upper GI bleeding. 🆕🔥Systematic Review ( 14 RCTs, N=1322) & Bayesian Meta-Analysis challenged this universally held dogma #idsky jamanetwork.com/journals/jam...

#IDsky The Infectious Disease Brad Boy himself, @bradspellberg.bsky.social , has an updated Oral vs IV table, now including the Plague (Y really) and Lyme! Link here: www.bradspellberg.com/oral-antibio...

WikiGuidelines lapel pins are available for purchase on WikiGuidelines website: www.wikiguidelines.org Support us to incorporate humility of uncertainty into guidelines!

“We’re asking the wrong question. Let’s use fundamental PK. Let’s get the drug to where the bug is, at a high enough concentration to kill the bug, and not worry about whether we label the drug static or cidal”. As said by @bradspellberg.bsky.social 🤩😇 Fabulous conversation! #IDSky #MedSky #AMSSky

Really compelling story by @corinnepurtill: "Strangers in the middle of a city: The John and Jane Does of L.A. General Medical Center". This short video tells the powerful story of the unidentified admissions to one of the busiest trauma centers in the US. www.latimes.com/00000197-c35...

Great article on dogma in ID (with parallels to critical care) We have HUGE problems re: guidelines making recommendations & *redefining* entire diseases based on minimal data. Gov't metrics exacerbate this further. @bradspellberg.bsky.social @absteward.bsky.social @drtoddlee.bsky.social #EMIMCC

Oh snap! I hope this conversation happened near a hospital that has a burn unit @bradspellberg.bsky.social

How much evidence is needed to revise established clinical practices? and, can data alone truly catalyze such shifts? Our 🆕🔥 Article at @cidjournal.bsky.social with 🌟s @bradspellberg.bsky.social Practicing With Intent: How to Teach an Old Dogma New Tricks #IDSky academic.oup.com/cid/article/...

Thank you to @jamanetworkopen.com for publishing economic analysis of our Safer@Home virtual acute care program! Modeling shows simple reimbursement would enable a win-win-win: patients get better patient-centered care, hospitals save money/free beds, and payors save! jamanetwork.com/journals/jam...

The work has been deeply collaborative. The idea to crowdsource controlled vaccine trials came from @bradspellberg.bsky.social, and we've had a phenomenal team - @abhaydhand.bsky.social, @alejodiaz81.bsky.social, Dr. Ali Meza Vazquez, Neal Fox, and help from many contributors from around the world.

#JoinTheMovement #MedicalScience #ClinicalResearch #RCTmatters #HealthcareInnovation #MedEd #WikiGuidelines

Your Role: Review existing guidelines across all specialties to evaluate whether or not recommendations are based on high-quality, adequately powered, peer-reviewed, and publicly accessible prospective studies, including at least one randomized controlled trial

📢📢📢Join our team appraising the level of evidence used to make consensus guideline recommendations across all specialties Deadline to sign up: 6/20/25 New to WikiGuidelines? Use the link below to complete WikiGuidelines New Participant application. forms.office.com/r/Tyb8R0iM8X

Amazing job, summarizing 260 RCTs of vaccines with nearly 2.5 million patients randomized! We will turn this into a peer reviewed manuscript, but the table summarizing the trials can be seen on the web: www.bradspellberg.com/vaccine-rcts

Just wrapped data extraction for our global vaccine RCT review: 260 trials (1951 to 2025) 2,468,751 trial participants Possibly the most comprehensive dataset of its kind. Huge thanks to the team that powered through to this milestone. @bradspellberg.bsky.social docs.google.com/spreadsheets/d…

LA General is seeking a Director of Inflammatory Bowel Disease and Director of GI Ambulatory Care in the Division of Gastroenterology and Hepatology. See job description attached!

Thanks to @absteward.bsky.social for finding the most recent Shorter is Better: TB Is Complex Study. Shows 8 week regimens are inferior to 24 week for cure. Sets a lower boundary for TB. Slides and website updated. www.bradspellberg.com/shorter-is-b...

Our crowd-sourced spreadsheet of controlled vaccine RCTs just hit 189 trials - spanning Adenovirus to Zika & 2.1 million participants. Every row links to the primary paper. More to come... docs.google.com/spreadsheets/d… @bradspellberg.bsky.social @apnews.com @statnews.com @nytimes.com

The results of this study call into question the accuracy of susceptibility testing for organisms containing MBLs when conducted in nutrient-rich media and reiterate the need for clinical validation of in vitro susceptibility testing results #idsky

This is a great way to characterize these tests as 'zombies' 😨 Hard to get folks to stop ordering these tests despite the lack of data , especially in immunocompromised patients! @idsensei.bsky.social @bradspellberg.bsky.social @ast-idcop.bsky.social

Grateful to @cidrap.bsky.social & @mtosterholm.bsky.social highlighting our vaccine RCT table in this viewpoint. This kind of recognition reinforces the value of collective, evidence-based efforts to bring clarity to vaccine research. @bradspellberg.bsky.social www.cidrap.umn.edu/anti-science...

This may be of interest @mtosterholm.bsky.social @cidrap.bsky.social

Fresh #s from our crowd-sourced, verifiable vaccine trial dataset: bit.ly/4mbdl6U - 123 controlled trials (polio to chikungunya) - 1.9 million participants - ~80% placebo, 15% active control (used only when placebo would be unethical) Every entry links to primary source @bradspellberg.bsky.social

Folks from around the world came together (off the clock, with no funding) not to argue, but to illuminate. Grateful to @bradspellberg.bsky.social, @abhaydhand.bsky.social, @adamlauring.bsky.social, Neal Fox, @jkeelan57.bsky.social, @alejodiaz81.bsky.social, & many other contributors bit.ly/44zoJDm

Those stand-alone measles ’65, mumps ’67, rubella ’69, and tetanus toxoid ’54 saline-placebo RCTs are priceless history that many folks have never seen. They’re all in the sheet, which is now up to 107 trials. Love seeing the continuum grow from those early studies to today’s vaccines bit.ly/3EuYzqI

What's more, we found individual placebo controlled RCTs of measles vaccine by itself, mumps vaccine by itself, and rubella vaccine by itself. And tetatnus toxoid by itself, followed by tetanus toxoid alone vs. tetanus+diphtheria, and then tetanus+diphtheria+placebo vs. tetanus+diphtheria+pertussis.

In the latest @SIDPharm column, Dr. Brent Footer, @mmaximos.bsky.social and @alyssachristensen.bsky.social offer insights on WikiGuidelines, which produces novel clinical practice guidelines developed with pragmatic, applicable methodology. #IDsky

@teddyrosenbluth.bsky.social @helenbranswell.bsky.social @enirenberg.bsky.social @adamjkucharski.bsky.social @aetiology.bsky.social @bradspellberg.bsky.social @angierasmussen.bsky.social @drandrealove.bsky.social

I’ve been getting a lot of questions about what it really means for a vaccine trial to be “placebo-controlled” - and how that differs from other control groups. It’s a great question, and clarity here really matters. Let’s break it down. @bradspellberg.bsky.social @adamlauring.bsky.social #IDsky

105 controlled vaccine trials. 110 yrs. 1.8 M participants. All in one live, crowd-sourced sheet. Built by contributors worldwide to counter the myth that vaccines weren’t tested with controls. Quiet work still breaks through the noise. www.bradspellberg.com/vaccine-rcts @bradspellberg.bsky.social

13 days ago we started a crowd-editable Google Sheet with 7 placebo/​active-controlled vaccine RCTs. It now lists 102 trials & 1.79 M participants- polio ➡️ RSV & malaria. Browse or drop a PMID 👇 bit.ly/3EuYzqI @bradspellberg.bsky.social @alejodiaz81.bsky.social Open evidence beats myths every time.

Now up to 102 trials, describing 1.78 million patients in the trials.

What is the role and the sensitivity and specificity of a urinalysis for the diagnosis of urinary tract infections? 🧪🧫🔬

Thanks to @josemolinagb.bsky.social from Seville, Spain, for finding a great Shorter Is Better study from 2021 for bronchiectasis exacerbations! Updated tables attached, with link to website with citations. Had to shrink the font to fit so many RCTs in table! www.bradspellberg.com/shorter-is-b...

Caring for patients with bronchiectasis poses a challenge for both pulmonologists and #AMSky teams. Standard 14d treatments for exacerbations lack good evidence support. This small RCT favors shorter durations such as 8d 👉🏻 publications.ersnet.org/content/erj/... #IDsky @bradspellberg.bsky.social

Placebo trials of vaccines; it's amazing what you find when you look! @jakescottmd.bsky.social @abhaydhand.bsky.social @alejodiaz81.bsky.social Thus far, 94 RCTs of vaccines identified. Among them, 69 placebo controlled, & 4 control groups received nothing. So... www.bradspellberg.com/vaccine-rcts

@lageneral.bsky.social Congratulations to LA General for 3 straight Leapfrog A grades! 1.5 years of sustained excellence and counting!

HOT off the press… 🗞️🗞️🗞️ An outstanding collaboration here at @lageneral-id.bsky.social helping to answer the question of blood culture bottle quantity and days of bacteremia to help guide pre-test probability of infective endocarditis 🧪🫀 jamanetwork.com/journals/jam... @bradspellberg.bsky.social

All species had significant negative LRs if only 1 of 4 blood culture bottles was positive on admission. This includes S aureus, challenging the current practice that every patient with S aureus community-acquired bacteremia requires a TTE for further work-up. #IDSky #EMIMCC

🆕🔥Case-control study @bradspellberg.bsky.social Just 1/4 blood cultures positive (≥2 sets drawn) or early clearance → low IE probability. Persistent bacteremia or 4/4 bottles ↑ pretest probability Simple bedside clues to sharpen your endocarditis game. #IDSky #EMIMCC jamanetwork.com/journals/jam...

Cool table from @bradspellberg.bsky.social of RCTs of vaccines, in case anyone honestly believes there have been no RCTs of today's routine childhood vaccines: www.bradspellberg.com/vaccine-rcts

Tasing, yes. And if sent by an I.D. with mention « ulcer culture, just in case »; 1y of prison

What should be the punishment for sending a swab of an ulcer for culture? Tarring and feathering? Defenestration? @bradspellberg.bsky.social any thoughts?

Updated vaccine RCT table looking amazing! Sorted for vaccine type, now more interactive in table, can click directly on the pubmed links in the table to go to the manuscripts. bradspellberg. www.bradspellberg.com/vaccine-rcts

< 72 h from launch → 48 placebo / active-controlled vaccine RCTs logged - now including all 5 COVID trials 1.43 M participants Crowd-powered, freely accessible evidence that buries the “never placebo-tested” myth. Browse or drop a PMID 👇 bit.ly/3EuYzqI cc @bradspellberg.bsky.social