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Robert Goulden

@emrobg.bsky.social
36 followers 94 following 23 posts

Emergency physician | Epidemiology PhD student | Medical Flashnotes app creator

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Robert Goulden @emrobg.bsky.social · 22/05/2026
TOWAR RCT replicates SWIFT finding no benefit of whole blood vs components for trauma shock. Quick meta-analysis of 30d mortality gives RR 1.17 (0.98-1.40), close to showing *harm* by whole blood. Huge credit to those who ran these RCTs; another physiology-based hype cycle falls
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Robert Goulden @emrobg.bsky.social · 08/12/2025
We have a new study in JAMA IM asking: do all 'hypomagnesemic' patients need supplementation? Many reflexively prescribe Mg when the number is below the reference range, but is this indicated? We used a quasi-experimental design to find out. jamanetwork.com/journals/jam...
jamanetwork.com
Magnesium Supplementation and Tachyarrhythmias
This nonrandomized clinical trial evaluates whether giving magnesium supplementation to patients with hypomagnesemia reduces adverse clinical outcomes.
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Robert Goulden @emrobg.bsky.social · 13/05/2025
Epidemiologic methods are increasingly difficult for clinicians and policy makers (and epidemiologists?) to understand. Are they at least getting us closer to uncovering causal relationships? My argument in this new piece: we don't know, because we haven't checked: academic.oup.com/ije/article-...
academic.oup.com
Time for evidence-based methodology in epidemiology
A formalized counterfactual approach to causal inference has come to dominate epidemiology in recent decades. This was, in part, a response to widely recog
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Robert Goulden @emrobg.bsky.social · 13/05/2025
Less is more wins again. RCT of high MAP target in older adults with sepsis (50% w/underlying HTN), stopped early for harm, 39% mortality MAP 80-85 vs. 29% mortality MAP 65-70 link.springer.com/article/10.1.... Recall also that the 65 Trial hinted that MAP60 may be better than 65. How low can we go?
link.springer.com
Efficacy of targeting high mean arterial pressure for older patients with septic shock (OPTPRESS): a multicentre, pragmatic, open-label, randomised controlled trial - Intensive Care Medicine
Purpose We examined the effect of a high-target mean arterial pressure (MAP) on septic shock in a previously underrepresented region. Methods A multicentre, pragmatic, open-label, randomised controlle...
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Robert Goulden @emrobg.bsky.social · 20/11/2024
New WTA resus thoracotomy (RT) algorithm. 2 new/key points: -Now incorporates POCUS: if no organised cardiac rhythm and no tamponade on POCUS, no RT (regardless of time since arrest / mechanism). -RT if pulse but refractory SBP <60 plus {blunt/penetrating thoracic injury OR tamponade on POCUS}
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Robert Goulden @emrobg.bsky.social · 18/11/2024
Do diuretics ⬇️mortality in heart failure? UpToDate, quoting Cochrane, says yes OR 0.24 (0.07-0.83). Looking at the 3 small RCTs this is based on suggests an important error in the meta-analysis, and an implausible mechanism of the diuretic benefit (1/4)
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Robert Goulden @emrobg.bsky.social · 14/11/2024
Dr Adnan al-Bursh was an orthopedic surgeon who heroically served his patients in the most impossible circumstances; this new report suggests he was beaten to death by Israeli prison guards. He is 1 of around 1000 healthcare workers killed in Israel's war on Gaza www.youtube.com/shorts/iM6pa...
youtube.com
Doctor’s final moments revealed
YouTube video by Sky News
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Robert Goulden @emrobg.bsky.social · 12/11/2024
2 big new RCTs on IO vs IV access in cardiac arrest -> another chance to check on the utility of conventional observational studies. Relative risk/odds of IO vs IV for survival in the RCTs: 1.16 (0.87-1.56), 0.93 (0.72-1.21). What about the most recent observational studies? 1/
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