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The Arguments Against

The Arguments Against. Dr. Anthony G. Crocco. Why listen to me?. Deputy Chief - McMaster Children’s Hospital ER Pediatric Consultant - BEEM Tutor - EBCP Course Member - PERC International Educator No industry sponsorship. The Argument Against. Research problems :

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The Arguments Against

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  1. The Arguments Against • Dr. Anthony G. Crocco

  2. Why listen to me? • Deputy Chief - McMaster Children’s Hospital ER • Pediatric Consultant - BEEM • Tutor - EBCP Course • Member - PERC • International Educator • No industry sponsorship

  3. The Argument Against • Research problems: • How the evidence was presented • Risk of the unknown • A researcher’s story • The true value of this paper

  4. Plint - 2009 • “Among infants with bronchiolitis treated in the emergency department, combined therapy with dexamethasone and epinephrine may significantly reduce hospital admissions.”

  5. Plint - 2009

  6. Plint - 2009 • “Among infants with bronchiolitis treated in the emergency department, combined therapy with dexamethasone and epinephrine may (NOT) significantly reduce hospital admissions.”

  7. Plint - 2009 • “our results should be considered exploratory” • “confirmation of our findings by a study powered specifically to compare combined epinephrine and dexamethasone therapy with placebo is needed”

  8. Steroids safe?

  9. Steroids safe? • False belief that systemic steroids in premature infants was safe • Developmental delay (Barrington 2001)

  10. Steroids safe? • False belief that inhaled steroids had no effect on long-term height • 1.2cm difference (Kelly 2012)

  11. Steroids safe?

  12. A Researcher’s Story... • What would you do if...?

  13. The True Value • Exciting and unexpected synergy between epinephrine and steroid use • Clinically confirms evolving understanding of cellular receptors • Future work needs to be done to find the lowest, shortest and safest dosing

  14. Conclusions • Results that may benefit, may not benefit! • No confidence lines? No confident results! • First do no harm! Beware of myopia! • The researchers are not suggesting routine use and would not use it on their own family!

  15. The Arguments Against • Dr. Anthony G. Crocco

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