Archive for deep vein thrombosis

on Astra and clots

Posted in Books, Kids, pictures, Statistics with tags , , , , , , , , , , , , on March 16, 2021 by xi'an

A tribune this morning in The Guardian by David Spiegelhalter on having no evidence that the Oxford/AstraZeneca vaccine causes blood clots.

“It’s a common human tendency to attribute a causal effect between different events, even when there isn’t one present: we wash the car and the next day a bird relieves itself all over the bonnet. Typical.”

David sets the 30 throboembolic events among the 5 million people vaccinated with AstraZeneca in perpective of the expected 100 deep vein thromboses a week within such a population. Which coincides with the UK’s Medicines and Healthcare Products Regulatory Agency statement that the blood clots are in par with the expected numbers in the vaccinated population. (The part of the tribune about the yellow card reports, based on 10 million vaccinated people, reiterates the remark but may prove confusing to some!) As for hoping for a rational approach to the issue,  … we would need a different type of vaccine, far from being available! As demonstrated by the decision to temporarily stop vaccinating with this vaccine, causing sure additional deaths in the coming weeks.

“Will we ever be able to resist the urge to find causal relationships between different events? One way of doing this would be promoting the scientific method and ensuring everyone understands this basic principle. Testing a hypothesis helps us see which hunches or assumptions are correct and which aren’t. In this way, randomised trials have proved the effectiveness of some Covid treatments and saved vast numbers of lives, while also showing us that some overblown claims about treatments for Covid-19, such as hydroxychloroquine and convalescent plasma, were incorrect.”

an afternoon in emergency

Posted in Travel with tags , , , on September 2, 2015 by xi'an

Last Thursday, I drove a visiting friend from Australia to the emergency department of the nearby hospital in Paris as he exhibited symptoms of deep venous thrombosis following his 27 hour trip from down-under. It fortunately proved to be a false alert (which alas was not the case for other colleagues flying long distance in the recent past). And waiting for my friend gave me the opportunity to observe the whole afternoon of an emergency entry room (since my last visit to an emergency room was not that propitious for observation…)

First, the place was surprisingly quiet, both in terms of traffic and in the interactions between people. No one burst in screaming for help or collapsed before reaching the front desk! Maybe because this was an afternoon of a weekday rather than Saturday night, maybe because emergency services like firemen had their separate entry. Since this was the walk-in entry, the dozen or so people who visited the ward that afternoon walked in, waited in line and were fairly quickly seen by a nurse or a physician to decide on a course of action. Most of them did not come back to the entry room. While I saw a few others leave by taxi or with relatives. The most dramatic entry was a man leaning heavily on his wife, who seemed to have had a fall while playing polo (!) and who recovered rather fast (but not fast enough to argue with his wife about giving up polo!). Similarly, the interactions with the administrative desk were devoid of the usual tension when dealing with French bureaucrats, who often seem eager to invent new paperwork to delay action: the staff was invariably helpful, even with patients missing documents, and the only incident was with a taxi driver refusing to take an elderly patient home because of a missing certificate no other taxi seemed to require.

Second, and again this was surprising for me, I did not see many instances of people coming to the emergency department to bypass waiting or paying for a doctor, even though some were asked why they had not seen a doctor before (not much intimacy at the entry desk…). One old man with a missing leg spent some time in the room discussing with hospital social workers about where to spend the night but, as the homeless shelters around were all full, they ended up advising him to find a protected spot for the night, while agreeing to keep his bags for a day. It was raining rather heavily and the man was just out of cardiology so I found the advice a bit harsh. However, he was apparently a regular and I saw him later sitting in his wheelchair under an awning in a nearby street, begging from passer-bys.

The most exciting event of the afternoon (apart from the good news that there was no deep venous thrombosis, of course!) was the expulsion of a young woman who had arrived on a kick-scooter one hour earlier, not gone to the registration desk, and was repeatedly drinking coffees and eating snacks from the vending machine while exiting now and then to smoke a cigarette and while bothering with the phone chargers in the room. A security guard arrived and told her to leave, which she did, somewhat grudgingly. For the whole time, I could not fathom what was the point of her actions, but being the Jon Snow of emergency wards, what do I know?!