Gus Hamilton @gushamilton Twitter profile

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Gus Hamilton

@gushamilton

9 months

@Jopo_dr What is crazy, is that I can not think this is at all common. I mean, how often do 7 consultants agree on *anything*, let alone something so controversial. If all consultants in dept say - 'this is really unusual, we are worried', this is already a 1 in a million event..

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Gus Hamilton

@gushamilton

2 years

Whatever you think of @VPrasadMDMPH , he certainly knows how to take apart a study. I do think community masking has a small effect on community transmission, but why CDC are promoting this is so odd. I can't imagine ECDC, UKHSA, NCID (SA) or others doing anything like this.

Vinay Prasad MD MPH

@VPrasadMDMPH

2 years

What happened to science? When the pandemic ends, and people have no faith in public health, it would be wrong to blame Joe Rogan. It's institutions like the CDC and our leaders who push bad info masquerading as science. My analysis:

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Gus Hamilton

@gushamilton

4 months

@HannahStockley8 @Jinggyyi @mb999111 @Dr_Done_ @Xeon4f145d96s1 @RCRadiologists Sorry, to be 💯 clear, the GMC won't let neurosurgical experts do neuro IR, but unregulated people can do - and this is being allowed by NHSE? Someone needs to make some decisions - these two decisions are logically incompatible.

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Gus Hamilton

@gushamilton

2 months

The PA issue is complex and multifaceted, but the idea that NHSE is saying I as a secondary care doc holding MRCP *cannot* see undifferentiated patients but those with 1-2yrs uni course can does not follow much logic.

Uwa Ima-Edomwonyi

@uwa_ie

2 months

@DrNeenaJha @parthaskar @NHSEngland @NHSE_WTE @RCPhysicians @NHSEmployers @trishgreenhalgh @mmamas1973 @doctor_oxford @JanetEastham @DrAsifQasim @DrLKVaughan @RowanHarwood @UKGastroDr @AntonEmmanuel2 @rcgp It’s all ‘slightly’ messy @DrNeenaJha There’s a new GP contract that states: “Supporting guidance will also be issued to clarify that NON-GP DOCTORS should not see undifferentiated patients, and that they continue to be required to operate within their sphere of competence”

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Gus Hamilton

@gushamilton

4 years

Proud to present our follow up data on our COVID-19 DISCOVER cohort here in @ResearchNBT @NorthBristolNHS @BristolARU . Important implications for #LongCovid , follow up, and policy makers ( @BTSrespiratory ).

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Gus Hamilton

@gushamilton

2 years

New MR paper out on the risk of sepsis associated with iron status - short answer: more iron = more sepsis. We think this probably has implications for iron supplementation programmes in healthy adults (i.e. be conscious of risks) 1/n

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Gus Hamilton

@gushamilton

2 years

1/ We have a new preprint out that provides promising evidence using genetic data that IL-6 inhibition (e.g. with drugs like tocilizumab) might work in sepsis, like it did in COVID-19. We think this deserves a randomised trial:

Therapeutic potential of IL6R blockade for the treatment of sepsis and sepsis-related death:...

Introduction Sepsis is characterised by dysregulated, life-threatening immune responses, which are thought to be driven by cytokines such as interleukin-6 (IL-6). Genetic variants in IL6R known to...

www.medrxiv.org

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Gus Hamilton

@gushamilton

8 months

PhD submitted! @nic_timpson i finally committed

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Gus Hamilton

@gushamilton

4 years

I've created another short blog on the geography of COVID-19 in the UK. It's here: , but there is a short thread attached. Short answer: It's everywhere, and has been for a while (probably) (1/n)

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Gus Hamilton

@gushamilton

3 years

@VirusesImmunity @WilenLab @chennifer_jen @StephanieEisen Interesting data. Some data that NSAIDs beneficial in mild infection (e.g pyelonephritis) but we and others shown NSAIDS associated with harm in pneumonia (wasn't what we were looking for but hey-ho) .

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Gus Hamilton

@gushamilton

2 years

1/ Based on the inspiring work from @TaurVil @LB_Barreiro on the Black Death and evolution at immune loci, we have a new short report out, looking at one of the loci they identified in more detail! It is SUPER interesting (I promise)

Variation in ERAP2 has opposing effects on severe respiratory infection and autoimmune disease

ERAP2 is an aminopeptidase involved in immunological antigen presentation. Genotype data in human samples from before and after the Black Death, an epidemic due to Yersinia pestis , have marked...

www.medrxiv.org

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Gus Hamilton

@gushamilton

2 years

Wow. I just managed to log on to editorial manager first time without resetting a password. Incredible. Probably - no - unquestionably my greatest achievement in academia.

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Gus Hamilton

@gushamilton

2 years

Regardless of your views on Djokovic, this is making terrible PR for Australia.

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Gus Hamilton

@gushamilton

7 months

New paper out that looks at the duration of symptoms for cellulitis - a suprisingly commonly asked question by patients and clinicians! We extracted data from a recent RCT that tested adjunctive clindamycin and recorded a number of measures:

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Gus Hamilton

@gushamilton

3 years

Great to see our new comment on @LancetRespirMed out. AGPs.... are not a helpful term!

Trisha Greenhalgh

@trishgreenhalgh

3 years

"The term AGP has neither face validity nor construct validity. We should focus on the risk in plain sight: caring for patients with COVID-19 who are coughing." New paper arguing to bury the term 'aerosol generating procedure'. Great work from Bristol team.

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Gus Hamilton

@gushamilton

3 years

Nice to see our paper out and getting Topol'ed! Of course, this is a small (n = 66), unblinded, cohort which has limitations, and our main finding is that symptoms and quality of life metrics are certainly not made worse by vaccination in patients with long COVID. 1/n

Eric Topol

@EricTopol

3 years

First prospective report (preprint) of vaccines helping people with #LongCovid (LC): 44 LC individuals vs 22 matched, unvaccinated controls with 8 months follow-up. A significant increase of symptom resolution (23 v 15%) in this small study. h/t @CovidTooo

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Gus Hamilton

@gushamilton

6 months

Bring your own popcorn

BIA

@biainfection

6 months

Congratulations to our Barnett Christie Lecture winner: Dr @gushamilton Join us at 1pm to hear his lecture on Inflammation in Infection #FIS2023

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Gus Hamilton

@gushamilton

2 years

On service. I am increasingly of opinion that tests with a turn around time of > 5 days have almost zero clinical utility in inpatients. Probably negative as increase length of stay waiting for them. All they do is turn up in my inbox after discharge.

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Gus Hamilton

@gushamilton

2 years

Controversial take: pharmacists are very sensible and I doubt if well regulated, there would be a notable increase in AMR with sensible guidance and clear limitations on indication. Hospital prescribing (by doctors, largely) of broad spectrum antimicrobials is bigger issue.

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Gus Hamilton

@gushamilton

9 months

We have a new short preprint up examining two commonly used non-linear Mendelian randomisation approaches using negative controls in the wake of recent concerns about their performance

Non-linear mendelian randomization: evaluation of biases using negative controls with a focus on...

Mendelian randomisation (MR) is an established technique in epidemiological investigation, using the principle of random allocation of genetic variants at conception to generate predicted causal...

www.medrxiv.org

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Gus Hamilton

@gushamilton

1 year

Clinical research careers - at my stage - are a minefield. Few jobs, very few specific funding posts (NIHR Advanced Fellow, MRC Clin Scientist), matching up CCT date with fellowship, real chance of bouncing out. Oh, and I'm still a registrar. I qualified in 2012. Years to go.

Martin Smith

@martinrsmith

1 year

Fix clinician research careers: "There is an urgent problem with the current mechanisms for clinician scientists to effectively develop and undertake their research careers. The Govt must rectify this to improve the ability of the NHS to deliver more effective health care."

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Gus Hamilton

@gushamilton

3 months

*every single* retweet of this is negative. I've actually never seen a ratio this high. Normally one positive comment. Kinda remarkable. Shows strength of feeling (of internet denizens at least) on this issue.

GMC

@gmcuk

3 months

🧵The updated #GoodMedicalPractice2024 uses the term ‘medical professionals’ as a collective term for doctors, physician associates (PAs) and anaesthesia associates (AAs), rather than listing out each individual role for every reference. We haven't removed doctors from the…

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Gus Hamilton

@gushamilton

3 years

@SmallRedOne @BallouxFrancois @skepticalzebra I think I disagree Catherine. I think people should be judged on their content, not their credentials. Whether they have a PhD / medical degree is kind of irrelevant. Look at people like @JamesWard73 and @BristOliver - fantastic content, no prof experience in ID epi (I think!)

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Gus Hamilton

@gushamilton

3 years

@ThatRyanChap I honestly have no idea what will happen in Aus. It's actually plausible they will have a worse time than W Europe. To get hit with delta with no pre-existing immunity is a pretty tough gig. I hope the vaccines come soon. Delta is a firecracker.

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Gus Hamilton

@gushamilton

3 years

Great to see NPIs being tested. Effect size is actually bigger than I expected - look forward to seriously getting into the data.

Jason Abaluck

@Jabaluck

3 years

With dozens of researchers at Yale, Stanford, Berkeley and IPA and several other organizations, we ran a cluster randomized trial involving almost 350,000 people and 600 villages in Bangladesh to assess the impact of community masking on COVID.

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Gus Hamilton

@gushamilton

4 years

Symptoms: Unlike radiology/lung function - symptoms were VERY common across all severities of COVID-19 - this is #LongCovid . 74% of patients had >=1 symptom at follow up. Breathlessness, insomnia, and excessive fatigue were very common.

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Gus Hamilton

@gushamilton

2 years

@EddCarlton so many questions...!? I would 100% be rather tried in a criminal court for any actions I had done than in some GMC Kangaroo court - they are awful.

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Gus Hamilton

@gushamilton

9 days

Our recent piece in @bmj_latest around recent fluoroquinolone restrictions from the MHRA - we need more information on why restrictions were made! We cannot stop using this class of drugs without knowing why. All we ask for is the data.

Fluoroquinolones: clearer evidence and guidance on safety are needed

Guidance on drug safety from regulatory agencies must be sensibly communicated and based on strong, clear evidence Doctors learn early in their careers about the central importance of communication...

www.bmj.com

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Gus Hamilton

@gushamilton

10 months

How on earth did this get to a tribunal Look at the dates This is *years* of someone's life

Partha S Kar 🇮🇳🇬🇧🏏🎥

@parthaskar

10 months

Another day,another case Without opening the case,guess where this doctor has qualified from. And ethnicity (H/T @nysuri for flagging) @gmcuk referrals-weaponised by #NHS to destroy lives It’s not the law, it’s application of it- with prejudice #IMG

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Gus Hamilton

@gushamilton

3 years

I should actually tweet the paper - Headlines: CPAP not an AGP, HFNO v likely not, cough bad. (caveats, as always, in the paper!) Thanks to all who volunteered for CPAP (esp @Hamilton_09 - who tolerated it well by all accounts). Thanks, Sis!

Aerosol emission from the respiratory tract: an analysis of relative risks from oxygen delivery...

Background Risk of aerosolisation of SARS-CoV-2 directly informs organisation of acute healthcare and PPE guidance. Continuous positive airways pressure (CPAP) and high-flow nasal oxygen (HFNO) are...

www.medrxiv.org

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Gus Hamilton

@gushamilton

1 year

Really tough day yesterday. After what I thought was an OK performance last year I was expecting a callback to be the nursery's father Christmas. Turns out I have been replaced by a younger model!! Had prepared costume already. Thinking of filing formal complaint.

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Gus Hamilton

@gushamilton

2 months

More broad spectrum abx use when you use a biofire rapid PCR panel in pneumonia Not a stewardship win in adults and ~£100-150 a pop... Not much hint of any other benefit I'm skeptical of any great benefit of these multiplex panels (there will be some)

Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟

@ABsteward

2 months

A step forward in the treatment of CAP! 🔥CAPNOR RCT🔥 Routine deployment of PCR testing for lower respiratory tract pathogens led to faster and more targeted microbial treatment for patients with suspected CAP #IDXposts

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Gus Hamilton

@gushamilton

9 days

This is a huge shock to me Huge Completely and utterly surprised

Nature Medicine

@NatureMedicine

10 days

Controlling for confounders calls into question the robustness of some associations of microbiota with colorectal cancer stages. @RaesLab @VIB @KULeuven #QMP #CRC #MicrobiomeCRCConfounders #QMPMicrobiomeColorectalCancer #GutColorectalcancerQMP

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Gus Hamilton

@gushamilton

6 months

Really glad HEE have sorted out the major issues in medical training such as v low levels satisfaction, greatest pressures in NHS ever, concern re academic training pathways, CESR, non medical practitioners and therefore can find the time to write this helpful guidance on dating.

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Gus Hamilton

@gushamilton

5 months

i have never seen a bigger effect in my life and I think i believe it, seeing PICU last week. This will make a dramatic difference next winter in places where it is used.

Toni Soriano

@tonisoriano66

5 months

Update RSV in Catalonia, reduction in 84% for hospitalizations and 87% in PICU admissions compared to 2022-23 👇👇👇🔝🔝🔝

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Gus Hamilton

@gushamilton

2 years

@BallouxFrancois People think immunosuppression is bad for infection, but it's not nearly as bad as other comorbidities (generally). We have a paper under review that looks at outcomes from bloodstream infection in the transplant population - very interesting, and not what you might think...

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Gus Hamilton

@gushamilton

4 years

Have you had an antibody test? Were you convinced you had COVID-19 - but it was negative? Our new study might help. In this study (again - at @NorthBristolNHS - we look at the performance of one of the commercial, PHE approved Abbott Architect tests 1/n

Kinetics and performance of the Abbott Architect SARS-CoV-2 IgG antibody assay

Objectives To assess the performance (sensitivity and specificity) of the Abbott Architect SARS-CoV-2 IgG antibody assay across three clinical settings. Methods Antibody testing was performed on...

www.medrxiv.org

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Gus Hamilton

@gushamilton

4 months

Wow. I feel very unsure about this as a hospital infection person. The studies I have seen have all been heavily biased by confounding by indication. FQs are great drugs with bad adverse event profiles. I certainly feel comfortable using them in severe infection.

Selvaseelan Selvarajah

@DrSelvarajah

4 months

From today, fluoroquinolone antibiotics must only be administered when no other antibiotics are appropriate for use - @MHRAgovuk This is going need a bit of an updating of antibiotics guidelines & disseminating to all parts of #NHS incl #TeamGP .

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Gus Hamilton

@gushamilton

2 years

Metadata is nearly always more useful than data. I will die on this hill. The fact that you did a blood test at 2am tells me more than the result. If the senior nurses is worried. Etc etc. Time and time again. There is good empirical data on this...

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Gus Hamilton

@gushamilton

3 years

@apsmunro @EpiEllie Very sad to see. It's not even a compelling argument, even if one agreed with the sentiment. "Potable water - my grandparents didn't have it - so its not important".

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Gus Hamilton

@gushamilton

3 years

Fantastic news... 70 percent reduction in malaria with vaccine. Really could be a game changer.

NEJM

@NEJM

3 years

RTS,S/AS01E vx noninferior to chemoprevention in preventing malaria; a combination of vx and chemoprevention superior to either alone.

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Gus Hamilton

@gushamilton

4 years

We have a new paper: looking at the role of aspirin in preventing cardiac events after pneumonia. A collaboration between @capcbristol , @BristolARU and @UEMSHealthStats . Firstly, it is recognised that pneumonia leads to stroke and MI

Aspirin reduces cardiovascular events in patients with pneumonia: a prior event rate ratio analysis...

Background Ischaemic stroke and myocardial infarction (MI) are common after pneumonia and are associated with long-term mortality. Aspirin may attenuate this risk and should be explored as a therap...

erj.ersjournals.com

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Gus Hamilton

@gushamilton

3 years

@CollignonPeter Peter, I'm not sure that reflects the underlying data well. @doctimcook has reviewed; rates in HCW were vastly higher than community (at least in UK) and not in the AGP delivering specialities. Other reviews too. Our local data from @infection_doc also

The safety of anaesthetists and intensivists during the first COVID-19 surge supports extension of...

A key controversy in the COVID-19 pandemic has been over staff safety in health and social care settings. Anaesthetists and intensivists were anticipated to be at the highest risk of work-related...

www.ncbi.nlm.nih.gov

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Gus Hamilton

@gushamilton

1 year

John Turnidge making it clear that @BradSpellberg has had the largest effect on current antibiotic prescribing practice by his enthusiasm and effort. Hats off Brad!! #ECCMID2023

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Gus Hamilton

@gushamilton

3 years

New (short) paper out - A Bayesian re-analysis of the convalescent plasma (CP) arm of RECOVERY with @DrToddLee @karlahemming @rjlilford and @DavidT_Arnold . Key question: Is CP futile in hospitalised patients with COVID-19? 🧵 below...

Is convalescent plasma futile in COVID-19? A Bayesian re-analysis of the RECOVERY randomised...

Introduction Randomised trials are generally performed from a frequentist perspective reporting point estimates and 95% confidence intervals. This approach can confuse “evidence of no effect” with...

www.medrxiv.org

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Gus Hamilton

@gushamilton

2 years

@VPrasadMDMPH I have actually shifted my position on N95's over the pandemic; as the evidence has shifted, i think it is pretty clear that medical staff caring for COVID-19 patients should wear them (and paramedics etc). But masking a 4 year old is not going to have anywhere near same tradeoff

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Gus Hamilton

@gushamilton

3 years

Literally don't know where to start with this.

Dr Ellie Murray, ScD

@EpiEllie

3 years

Genuine q for ppl more concerned about schools being closed than covid: are you aware mandatory schooling is barely a century old in this country? Maybe ur all grandparents had highschool, but what about ur great-grandparents? Yes, education is important. But it’s a pandemic!

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Gus Hamilton

@gushamilton

2 years

Not the photo you expect the nursery to send you of your toddler....

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Gus Hamilton

@gushamilton

2 months

We looked at fluoroquinolone prescribing in the UK over last 5 years as MHRA claim in 2023 update "no change in FQ prescribing". We find using @theosanderson and @openprescribing 's data that.. this..isn't really true. 5% drop per year in primary care..

Trends in fluoroquinolone prescribing in UK primary and secondary care between 2019 and 2023

Introduction Fluoroquinolones are important, widely used antibiotics but have associations with a significant number of adverse outcomes. A recent (January 2024) decision by the UK drug regulator,...

www.medrxiv.org

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Gus Hamilton

@gushamilton

3 years

This ventilation thing ALWAYS gets me. It's a hard problem. It's not an easy fix. The easy fixes have already been done. I think HEPA might work (not proven), but "improving ventilation" has either happened, is very difficult, or is very costly / time consuming.

The Sharing Scientist

@ScienceShared

3 years

Given they're already widely using the perceived low-cost/harm measured such as vax passports, masks, and apparently ventilation, it will be interesting to watch the policy response to any COVID surges across Europe.

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Gus Hamilton

@gushamilton

3 years

@ThatRyanChap It is so frustrating..of course they work, but the effect size people think they have is clearly inflated dramatically. Regardless of your views on them, decisions re them will not alter the pandemic in the UK in any meaningful fashion in my view.

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Gus Hamilton

@gushamilton

5 months

How can we get 14,000 randomised for another (null) Vit D study yet it's taken us years to even ask the most basic questions in infection ever? I have never drunk the Vit D Kool Aid but it appears to be popular

Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟

@ABsteward

5 months

🆕️✨️VITAL RCT✨️🆕️ @CIDJournal In older adults not selected for vitamin D deficiency,supplemental vitamin D did NOT lower upper respiratory infection risk overall. Whether effects differ in subgroups requires further study. #idxposts #MedEd

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Gus Hamilton

@gushamilton

4 years

QoL and symptom burden are massive ( #LongCovid ). We need effective strategies to manage these impacts of COVID-19 - on people - perhaps rather than performing lots of testing on patients who have had mild COVID-19.

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Gus Hamilton

@gushamilton

10 months

@drmattuk @pash22 Matt, please let me know if you want any help with coding / spatial plotting etc. Have a bit of experience in R and geographic data with mixed models etc. Thanks for collating this important data.

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Gus Hamilton

@gushamilton

5 years

@d_spiegel David, there is an excellent re-analysis of this on datamethods (not mine, although I wish it was my idea:

Bayesian Re-Analysis of Clinical Trial Data

@DanLane911 and I have been working on a broader application of the Bayesian re-analysis application that was originally built for the ANDROMEDA-SHOCK trial. I was hoping to get some feedback on...

discourse.datamethods.org

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Gus Hamilton

@gushamilton

2 years

Literally don't know where to go with how bad an idea this is on so many levels

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Gus Hamilton

@gushamilton

2 years

Nice to see our work covered in this weeks Thorax cover. And @artibiotics for the images - really helpful to explain what was a pretty complex study. @BristolARCentre @BristolARU @ResearchNBT @NIHRresearch

Ciléin Kearns

@artibiotics

2 years

The latest issue of @ThoraxBMJ features art I designed for a comic explaining the AERATOR studies (discussed inside) to make the findings more accessible. Thank you to @DavidT_Arnold et al for commissioning the comic: #graphicMedicine #scicomm

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Gus Hamilton

@gushamilton

2 years

Couldn't be more proud of my @gw4_cat @wellcometrust doctoral fellow colleague @bnar - an MBE for her amazing work on vaccines information through @muslimdoccymru . All alongside her PhD. Proud to be a colleague! @cardiffuni @JeremyFarrar @SharpDebbie

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Gus Hamilton

@gushamilton

3 years

Had a paper rejected this am after 2 fair peer reviews. Feel surprisingly positive - manuscript will be improved by comments, and it probably wasn't high enough quality for the journal I was submitting too. Feel like I should feel more grumpy... But the comments were fair!

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Gus Hamilton

@gushamilton

4 months

Well done to the research teams, but also my baby son who despite waking me up just now is in this landmark study that will change paediatrics! (He got nirsevimab!)

Saul Faust

@SaulFaust

4 months

Thank you to all the families who took part in the HARMONIE trial which showed nirsevimab could reduce hospitilisations due to RSV by 83% in a trial that was done in near real-life situations @NIHRresearch @UHSFTresearch @UoS_Medicine @southamptonCRF @NIHRCRNWessex

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Gus Hamilton

@gushamilton

3 months

One of the INCREDIBLY frustrating things about working as a clinical academic is leaving employer A (for literally 3/12), then rejoining and acting as if they've never heard of me. You literally gave me a degree. 2 days ago. You emailed it to me. I don't need to prove it to you!

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Gus Hamilton

@gushamilton

7 months

New manuscript out that identifies that small HDL is the major HDL component that predicts future risk of sepsis (and sepsis outcomes), and that this effect is (in part), driven by IL-6 signalling.

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Gus Hamilton

@gushamilton

5 months

Outside of surgical prophylaxis, advanced HIV and haem malignancy, where does prophylaxis with abx ever work? It doesn't seem to work ever! (Maybe acute variceal bleed?)

Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟

@ABsteward

5 months

🔥PRECIOUS🔥 OL multifactorial RCT in patients >=66y, prophylactic use of metoclopramide, ceftriaxone, or paracetamol in the first 4d after ischaemic stroke or ICH did not result in improvement of functional outcome or a reduction in the risk of death.

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Gus Hamilton

@gushamilton

7 months

Really neat work from @Dr_J_Underwood @harryahmed01 @DaveGuk87 looking at the reported cause of death from BSI in Wales over >10 years most deaths from cancer not sepsis. Higher CRP = more likely sepsis death. implications for how we do RCTs! @ABSteward

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Gus Hamilton

@gushamilton

2 years

only 4% of GNB will recur/relapse Average relapse > 100 days later I am not convinced we need >7 days for GNB for nearly all (perhaps less)

Clinical and Molecular Analyses of Recurrent Gram-Negative Bloodstream Infections

Recurrent gram-negative bacterial bloodstream infections with the same species occurred in 4% of patients. Relapse was more common than reinfection. Clinic

academic.oup.com

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Gus Hamilton

@gushamilton

1 year

Wow wow - practice changing This is an amazing study Kudos to authors

NEJM

@NEJM

1 year

In this multicenter trial, a single oral dose of azithromycin in women planning a vaginal delivery reduced the risk of maternal but not newborn sepsis or death. #SMFM23

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Gus Hamilton

@gushamilton

4 years

The much sexier part of our @NIHRresearch AERATOR grant profiled in the guardian. Great work from our colleagues @BristolChem - will link perfectly to our clinical aerosol studies here at @ResearchNBT @uhbwNHS @BristolARU @theotherdodd @Carrielou_white @DavidT_Arnold

Adam Finn

@adamhfinn

4 years

It’s taken 6 months to get from deciding to try and do this to actually doing it. Congratulations to the whole team for making it happen. Excited by the thought of results coming through. ⁦ @BristolUncover ⁩

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Gus Hamilton

@gushamilton

11 months

This is literally incredible EDs under such pressure Randomising to a complex pleural intervention out of hours in the circumstances is amazing. Well done to research teams involved

Kate Coates

@KCoatesBristol

11 months

Wouldn’t it be great if my inbox looked like this every day? Thanks to all the @CoMiTEDTrial weekend workers 😍

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Gus Hamilton

@gushamilton

2 years

@ShabirMadh SA will be the first country; I think; to truly come out the other end. I hope.

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Gus Hamilton

@gushamilton

2 years

A few months ago we had a patient who had (at the time) the longest recorded case of COVID. We wrote this up, and it's instructive to see how persistent infection can not always lead to such severe disease - perhaps a breeding ground for variants?

Chronic SARS-CoV-2 infection and viral evolution in a hypogammaglobulinaemic individual

There is widespread interest in the capacity for SARS-CoV-2 evolution in the face of selective pressures from host immunity, either naturally acquired post-exposure or from vaccine acquired immunity....

www.medrxiv.org

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Gus Hamilton

@gushamilton

1 year

6 years in the making - I will do a thread tomorrow...but all started when @DavidT_Arnold and me had a pint and we chatted about whether ASA might work in pneumonia, then 3 years ago , and now the RCT is open!!

Aspirin reduces cardiovascular events in patients with pneumonia: a prior event rate ratio analysis...

Aspirin use was associated with reduced cardiovascular events after a pneumonia episode in a large UK primary care cohort and is a promising avenue in managing cardiovascular risk in pneumonia...

erj.ersjournals.com

ASPECT Study

@AspectStudy

1 year

Our first site opened this afternoon 🎉 ASPECT IS OFFICIALLY OPEN! @ResearchNBT were given Greenlight at midday and have already recruited their first 2 patients. Massive congratulations to their hard work! #pneumonia #research #clinicaltrials 22,598 patients to go!

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Gus Hamilton

@gushamilton

8 months

Important paper here in Nat Med. Looks like transmission of C diff rare, but asymptomatic carriage the major risk factor. Has infection control implications for sure. @abst

Nature Portfolio

@NaturePortfolio

8 months

A low rate of Clostridioides difficile transmission within an intensive care unit supports the effectiveness of prevention practices and highlights the greater risk to carriers of toxigenic C. difficile, according to a paper in @NatureComms .

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Gus Hamilton

@gushamilton

5 months

This will absolutely transform care in S. Aureus. And more importantly, will give another opportunity for competition between 🦘 and 🇬🇧 The new ⚱️🏏? £10 that UK will beat Aus in numbers by next Christmas? @syctong @Josh_S_Davis @dr_michaelmarks @DrToddLee (🇨🇦 now play 🏏)

MRC Clinical Trials Unit at UCL

@MRCCTU

5 months

Great news that @snap_trial has launched in the UK - with 1st UK participant at @UCLH ! SNAP is the largest ever trial in Staphylococcus aureus bloodstream infection. We are pleased to be leading on trial management & statistical analysis in the UK. More👉

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Gus Hamilton

@gushamilton

2 years

@EricTopol @NEJM How can paxlovid instantly stop me dying on day 0? @DrToddLee ? I wonder if there was a bias that could account for this

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Gus Hamilton

@gushamilton

2 years

Shorter. Is. Better.

Prophylactic Antibiotic Regimens After Endoprosthetic Reconstruction for Lower Extremity Bone Tumors

This randomized clinical trial of patients with a primary bone tumor or a soft tissue sarcoma compares the effects of a 5-day vs 1-day regimen of postoperative, prophylactic, intravenous antibiotics...

jamanetwork.com

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Gus Hamilton

@gushamilton

9 months

New ESC endocarditis guidelines out. Why do they recommend with Class 1 evidence a TOE in stable patients before switch to PO therapy??? The refs are to POET trial..

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Gus Hamilton

@gushamilton

6 months

By far the coolest study I've been involved in. Will do full thread later, but this involved measuring aerosol using state of the art measuring kit in out of hospital cardiac arrest - generating policy level evidence on risk of transmission.

𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢

@Anaes_Journal

6 months

🔓Cardiopulmonary resuscitation generates 100-fold higher concentrations of respiratory aerosol than in awake or anaesthetised patients. @_andyshrimp @vickibrown999 @JerryPNolan @jas_soar @gushamilton @doctimcook @TonyPi314 @drjulesbrown 🔗

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Gus Hamilton

@gushamilton

3 years

Wow. This is stark. We must invest in primary care! Less people like me worrying about bugs in the lab. We can't improve care without focussing on where most people get their care.

Professor Azeem Majeed

@Azeem_Majeed

3 years

This is the most striking data in the Lancet Commission on the Future of the NHS, showing the changes in the number of NHS GPs and consultants per 1,000 people between 2008-18. Note the decline in GP numbers compared to the increase in consultant numbers.

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Gus Hamilton

@gushamilton

1 year

Just booked ECCMID 2023. Eventually! Excited. First big in-person conference since COVID.

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Gus Hamilton

@gushamilton

2 years

Unequivocally good news - London hospital admissions appear to have stopped rising, and possibly peaked. Raw data from Of course, caveats around holiday season reporting (yesterdays figure seems v low), but COVID bed occupancy fits the story.

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Gus Hamilton

@gushamilton

3 years

Actually, I think this is the most important paper I have read this year (yeah, I know it's Jan). Key thread explaining why sometimes simple things that seem beneficial, *might* harm patients. The whole field of "quality improvement" needs to read this paper. Twice.

F. Perry Wilson, MD MSCE

@fperrywilson

3 years

Thread to discuss our new RCT (ELAIA-1) appearing in @bmj_latest that showed some unexpected results in the world of electronic alerts for acute kidney injury.

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Gus Hamilton

@gushamilton

3 years

Our Bayesian re-analysis of the RECOVERY trial with @DrToddLee @karlahemming @rjlilford @DavidT_Arnold is out in IJID. Now we know REGN-CoV-2 works, we consider whether convalescent plasma works (it probably does), and whether the null result is fair.

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Gus Hamilton

@gushamilton

3 months

I have an incredibly supportive department at university and hospital level, have been lucky in traditional metrics (grants papers etc) and it is still *very* challenging to do this job. Needs to change.

Charlotte Summers

@charlot_summers

3 months

There is a crisis in clinical academia in the UK. We talk of the need to expand medical schools, embed research into the NHS to improve care, & the importance of a vibrant life sciences sector for the economy of the UK, & yet we seem unable to tackle the underlying issues 1/9

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Gus Hamilton

@gushamilton

1 year

Amazing. Even in complex intra abdominal infection shorter is better. Although we kind of know abx in appendicitis are arguably anyway. But keep it short. My career is in danger at current rate - 48h abx seems to work for nearly everything!

Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟

@ABsteward

1 year

🔥APPIC study🔥 2 days of IV antibiotics for pts with complex appendicitis post laparoscopic appendicectomy is non-inferior to 5 days in terms of infectious complications & mortality within 90d, based on a non-inferiority margin of 7·5% #shorterisbetter

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Gus Hamilton

@gushamilton

7 months

I appreciate trial regulations, but i am on page 6 of writing a CTIMP protocol and ...I mean...there is a BIG difference between a novel product requiring intense review and a widely used product for a subtly different indication. How much time is wasted on this stuff.

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Gus Hamilton

@gushamilton

1 year

@ABsteward @BradSpellberg @ASPphysician @DrToddLee Sorry. Are they serious. So 50% of HAP should get 2 antipseudomonals + linezolid??? Do they realise that most people with HAP have had prior IV abx.. at least in my pop? Am I misreading this???

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Gus Hamilton

@gushamilton

2 years

Sort of crazy that you can WGS a human and find a disease causing variant about 4 times quicker than we can tell you if you have bloodstream infection and whether the bug is resistant to augmentin

John Gorzynski DVM PhD

@Johngorzynski

2 years

Quickly diagnosing a critically ill patient using whole genome sequencing is challenging, but we have found a solution! Published today in @NatureBiotech , we detail the technical methods to dx genetic disease in < 8 hours using @nanopore sequencing. 1/8

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Gus Hamilton

@gushamilton

4 months

Massive effect size - using the new regulatory endpoint. I think hard to not favour (co-)amox + clari as first line for CAP now, rather than say a floroquinolone or co-amox monotherapy. Endpoint seems meaningful, and more alive and out of hosp at d90.

Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟

@ABsteward

4 months

🔥ACCESS RCT🔥 @LancetRespirMed The addition of clarithromycin to standard of care* to adults in the hospital with CAP who had systemic inflammatory response syndrome** enhances early clinical response & attenuates the inflammatory burden of CAP #idxposts

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Gus Hamilton

@gushamilton

2 years

I honestly don't know how you find out before I do It's kind of incredible @ABsteward . Paper below. Immunosuppression a complex beast in infection. Difficult to draw causation from obs data (and transplant patients v different from non, but interesting...)

Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟

@ABsteward

2 years

🆕💥💥 @gushamilton Organ transplantation is associated with a near halving of short term mortality in BSI including a cohort matched for comorbidities infective pathogen & focus Steroid usage is associated with ⬆️ mortality regardless of transplant status

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Gus Hamilton

@gushamilton

3 months

Every Sunday.

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Gus Hamilton

@gushamilton

4 months

@Dr_Done_ Are NE likely doctors? Genuine don't know but suspect wide spread of professions and most multifactorial with multi professional input? Would love to see data!

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Gus Hamilton

@gushamilton

7 months

We have a number of ACFs in Bristol including in Infectious Disease and Medical Microbiology. Really happy to chat to any potential applicants. Huge range of ID research from vaccines to pharmacokinetics to AMR to epi. Please apply!

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Gus Hamilton

@gushamilton

1 year

Ok. I'll admit it. Moana has the best soundtrack of any film ever. Great tunes to authorise urine results ever.

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Gus Hamilton

@gushamilton

1 year

Well, that's my afternoon:

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Gus Hamilton

@gushamilton

2 years

Omicron booster trial for those who live in Bristol. Both arms get vaccine!

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Gus Hamilton

@gushamilton

3 years

Was going to tweet about our article, but Bassam beat me to it. No association between time-to-positivity of BC and outcomes. V interesting, given we think that pathogen load is a key driver of outcomes in other infections (e.g. COVID-19). This is probably because..

Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟

@ABsteward

3 years

🆕💥Analysis Data from RAPIDO RCT Time to positivity is not associated with mortality, except in Candida spp (longer times associated with worse outcomes), and possibly in Streptococci (shorter times associated with worse outcomes) #IDTwitter #medtwitter

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Gus Hamilton

@gushamilton

3 years

No hospitalisations after single dose AZ. Great news. Suggests JCVI right! Well done all especially local Bristol people involved @LazarusRajeka @adamhfinn

🕷️The strife scientific🕷️

@ProfKatieEwer

3 years

Our new preprint on the efficacy of a single dose of the Oxford/AZ ChAdOx1 nCoV-19 #vaccine -76% efficacy against symptomatic infection from day 22 to day 90 post vaccination in 17,177 trial participants in UK, Brazil and S Africa:

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Gus Hamilton

@gushamilton

10 months

This really is incredible work This trial will answer fundamental questions about the management of SAB - and will be appropriately powered A true global effort UK still waiting to start !

Steven Tong

@syctong

10 months

The @snap_trial has hit 1000 randomised participants today! The DSMC meets tommorrow for the first 500 outcomes. Recruitment to end of June 2023 below. Thanks to all the participants, site investigators, and everyone else involved!! @Josh_S_Davis @DrToddLee

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Gus Hamilton

@gushamilton

3 months

I and others provide some comment about the @MHRApress decision to essentially ban fluoroquinolones. Leaves infection doctors in a pickle. Thanks @bmj_latest for the opportunity to comment. We have more on this soon.

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Gus Hamilton

@gushamilton

1 year

Credit where credit is due, have just had 2 excellent, detailed reviews on a paper submitted only twelve days ago. Not all positive comments (!) but amazing experience and feels breath of fresh air...

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