When evaluating a clinical trial, readers often jump to the P value of the primary endpoint to determine whether the results of a trial are “statistically significant” or not. Although the P value is truly a continuous variable, the scientific community has been conditioned to disregard all results with P values ≥ 0.05, but to fully endorse any trials with a “statistically significant” P value less than 0.05.
Putting the debate and controversy about P values aside for the moment, as a reader, would you be less impressed with a study that changed from being statistically significant to insignificant if one single patient changed from not having the primary endpoint to having the primary endpoint? Especially in an era with a blind reliance on P values, the knowledge of the “fragility” or “robustness” of a study’s P value is another useful data point for readers to critically understand and analyze the results of a clinical trial.
The Concept of the “Fragility Index” for Clinical Trials
Colistin (in the form of colistimethate sodium, or CMS, in the United States) is an older, last-line agent for multidrug-resistant gram-negative infections. Because of colistin’s complex pharmacokinetics and for historical reasons, there is a paucity of data regarding its dosing in patients with severe gram negative infections, particularly for those with concurrent renal dysfunction.
In one of the largest pharmacokinetic analyses of colistin to date, Garonzik et al. published a detailed analysis of CMS dosing in critically ill patients. This analysis included dosing recommendations for patients with normal renal function, acutely changing renal function, intermittent hemodialysis (IHD), and continuous renal replacement therapy (CRRT).
ClinCalc is excited to announce our new colistin dosing calculator, which is based on the Garonzik pharmacokinetic recommendations. This calculator was developed in coordination with Julie Ann Justo, PharmD, MS, BCPS, AAHIVP — an Assistant Professor at the South Carolina College of Pharmacy who specializes in infectious diseases and HIV pharmacotherapy. Continue reading
We’re releasing a major update to the calculation for our popular vancomycin calculator today. Briefly, the new update implements more advanced calculations when adjusting a vancomycin dose based on a trough level.
Drug Elimination during Vancomycin Infusion
When adjusting vancomycin based on a trough level, pharmacokinetic textbooks recommend estimating a vancomycin peak level using the following equation: Continue reading
ClinCalc.com is proud to announce that ICU Trials by ClinCalc, a mobile application that summarizes landmark critical care trials, has surpassed 100 studies in the app database!
With our most recent update on April 18th, the following recent and historic landmark trials were added:
- MIDEX (2012): Dexmedetomidine vs. midazolam for mechanical ventilation
- PAC-Man (2005): Efficacy of PA catheters in ICU patients
- FEAST (2011): Fluid boluses in African children with severe infection
- VSE (2013): Vasopressin, steroids, and epinephrine during cardiac arrest
- MOPETT (2012): Alteplase for moderate PE
- Brochard (1994): T-piece, SIMV, or PSV for ventilator weaning
At ClinCalc.com, we’re huge fans of listening and watching educational content at a faster than normal pace. Unfortunately, the video provider used for The Top 250 Drugs (online drug therapy course) does not allow for the ability to change playback speed.
Given our dedication to high-yield, rapid foundational learning, we’ve decided to build a free Google Chrome extension that activates playback controls within all of ClinCalc Academy’s videos. As shown in the screenshot below, this extension adds buttons in the top, right-hand corner for video playback at 1.25x, 1.5x, 1.75x, or even 2x normal speed:
Screenshot showing Vimeo video playback at 1.25x, 1.5x, 1.75x, or even 2x normal speed
ClinCalc.com has been a bit quiet over the past year. Our Twitter account has been mute, email updates rare, and website updates sparse.
Why the radio silence?
We’ve been diligently working on an exciting new product for the past year. Quite literally, HUNDREDS of hours have been poured into the conception, creation, and implementation of this amazing new product. Given this massive undertaking, we’ve kept website and mobile app updates to a minimum in order to expedite our production schedule. Continue reading
Advanced vancomycin pharmacokinetics equations has never been this easy.
Our original Android-based Vancomycin Calculator was released in July 2011, followed a year later by our iPhone version. In both mobile technology and the features of the ClinCalc.com website, a lot has changed in the last 2.5+ years.
Today, we’re proud to announce a full redesign of the popular Vancomycin Calculator by ClinCalc on Android and iOS devices. Continue reading
The newest ACC/AHA ASCVD Pooled Cohort Equations has been a very hot topic lately. Our free web-based ASCVD tool and mobile applications have been very well received. A number of ClinCalc readers have asked for a better understanding of the Pooled Cohort Equations — how is an ASCVD calculated? How “strong” is each risk factor?
To help clinicians understand the new Pooled Cohort Equations, we’ve released a fantastic new visualization and graphing tool. The tool is intended for the advanced clinician who wants to delve deeper into the equations and visualize the tool in a novel, interactive way.
At ClinCalc, we’re very proud to announce the availability of both a web-based 10-year ASCVD Risk Calculator (also termed the Pooled Cohort Equations Calculator). This risk assessment tool is recommended by the newly published 2013 ACC/AHA cholesterol guidelines to estimate 10-year risk of atherosclerotic cardiovascular disease (ASCVD).
We’ve been working hard behind the scenes in preparation for American Pharmacists Month. To celebrate, we’re rolling out four new clinical tools and calculators on ClinCalc.com:
- Benzodiazepine Equivalence Calculator
- Enteral and Parenteral Nutrition Summary
- Number Needed to Treat
- Odds Ratio to Risk Ratio Conversion