Discover and read the best of Twitter Threads about #Stewardship
Most recents (17)
And now @Katy_Lock introduces the TCPA's research and guidance on long-term stewardship - and new resources now available on our website... #TCPAwebinars 
Lots of guides, checklists, sample policies and text - really useful resources to help you ensure #NewCommunities get better and better as they age... #stewardship #places #parks #communities
@threadreaderapp please unroll
He starts by asking: 'What is #stewardship? It's about looking after community assets, with the aim of creating a great #place...'
It's about community development too. And it's about 'integration'. Creating a sense of community across different households and tenures.. says Pratchett
Our webinar about long-term stewardship is about to begin... we'll be tweeting the highlights here... #TCPAwebinars
Richard Ford of @Pinsent_Masons talking about the work they do to support #stewardship, particularly in new communities...
Both developers and communities want to know that places will be looked after...
ICU Infectious Disease Pearls and Pet Peeves-Part3: These are some extra points & random thoughts regarding commonly used antimicrobials & frequently encountered ID scenarios in the ICU. Comments from ID & Pharm friends are welcome as what I post comes from memory. Here it goes:
1. Especially in immunosuppressed patients with severe septic shock, don’t be in a hurry to de-escalate the antibiotics when the Microbiology lab calls you to report a positive blood culture result. In a number of patients, likely close to 5%, the bacteremias can be polymicrobial
2. The role of anaerobes in aspiration pneumonia is probably over-rated. Not much else to say here since the topic is extensively discussed recently. The message is that anaerobic coverage is frequently redundant. In addition, there is a huge debate about...
ICU Infectious Disease Pearls and Pet Peeves – Part2: These are some additional points and random thoughts regarding commonly used antimicrobial agents and frequently encountered ID clinical scenarios in the ICU. Comments from my ID and Pharm friends are welcome. Here it goes:
1. Candida pneumonia is essentially a non-existent entity (except in the presence of SEVERE immunodeficiency). Candida in the sputum is almost always a colonizer. You can use it as a marker of systemic candidiasis in order to justify antifungal coverage but the studies...
...are not supportive of significant clinical benefit
2. If u suspect Candida in a septic pt, echinocandin (not an azole) is the preferred empirical tx. Most people in US start w 100 mg of micafungin but u can easily give 150 or even 200 (if your pharmacist doesn't freak out...)
2. If u suspect Candida in a septic pt, echinocandin (not an azole) is the preferred empirical tx. Most people in US start w 100 mg of micafungin but u can easily give 150 or even 200 (if your pharmacist doesn't freak out...)
The IPCC Climate Change 2022: Impacts, Adaptation and Vulnerability was released today. I'm going to go through the executive summary and post some "highlights". #IPCC #IPCCReport
report.ipcc.ch/ar6wg2/pdf/IPC…
report.ipcc.ch/ar6wg2/pdf/IPC…
Risk can arise from the dynamic interactions among climate-related hazards,exposure & vulnerability of affected human & ecological systems. Risk that can be introduced by human responses to #climatechange is a new consideration in the risk concept. There are 127 key risks.
Observed Impacts from Climate Change:
" The rise in weather and climate extremes has led to some irreversible impacts as natural and human systems are pushed beyond their ability to adapt"
" The rise in weather and climate extremes has led to some irreversible impacts as natural and human systems are pushed beyond their ability to adapt"
@Hogshead3Au making someone unwell longterm as solution endangering them on field of play is gross negligence.
@Olympics @FIFAcom @shiftproject @NCAA @wada_ama
#Safeguarding #stewardship #powerofdesign
swimmingworldmagazine.com/news/olympic-c…
@Olympics @FIFAcom @shiftproject @NCAA @wada_ama
#Safeguarding #stewardship #powerofdesign
swimmingworldmagazine.com/news/olympic-c…
@Hogshead3Au Nancy to help you and the @NCAA. Neither of you have ever done the work. It important to ensure ‘everyone is successful’.
@Olympics @Athlete365 @FIFAcom @shiftproject @SportandRights
#Safeguarding #stewardship #powerofdesign
@Olympics @Athlete365 @FIFAcom @shiftproject @SportandRights
#Safeguarding #stewardship #powerofdesign
A helpful Oped ref for you: @Hogshead3Au @NCAA
@wada_ama
‘IMAGINE FAIR SPORT THAT DOESN”T HARM PEOPLE’
@Olympics @Athlete365 @FIFAcom @shiftproject @SportandRights
#safeguarding #stewardship #healthwellbeing #powerofdesign
sportsintegrityinitiative.com/imagining-fair…
@wada_ama
‘IMAGINE FAIR SPORT THAT DOESN”T HARM PEOPLE’
@Olympics @Athlete365 @FIFAcom @shiftproject @SportandRights
#safeguarding #stewardship #healthwellbeing #powerofdesign
sportsintegrityinitiative.com/imagining-fair…
1/ Hey #IDTwitter #LabTwitter @ASCLS @ASMicrobiology , I want to take a moment to break down our new study: Endotracheal Aspirate Culture Variability and Antibiotic Use in Mechanically Ventilated Pediatric Patients ja.ma/31f9Zv8 via @JAMANetworkOpen @JAMANetwork
2/ This work was a multidisciplinary effort, & I am REALLY proud of that! I think this is a great example of the cool work we can do when we put our clinical laboratory and infectious disease minds together to answer questions about diagnostic tests and #stewardship #IDtwitter
3/ Dr. Sarah parker (@HandshakeASP @COpedsID ), Dr. Anna Sick-Samuels (@asicksamuels ) and myself all had a similar question: Do hospitals that use more endotracheal aspirate cultures have more days of therapy in their mechanically ventilated patients?
Do we need maintenance fluids at all? What is your preferred maintenance fluid solution?
#IFAD2021 #FOAMed #FOAMcc
REPOSITORY (access 100+ lectures): whova.com/portal/webapp/…
@avkwong - @Manu_Malbrain - @azJanPalfijn - @FOAMecmo - @Wilkinsonjonny - @strachanjamie - @iceman_ex
#IFAD2021 #FOAMed #FOAMcc
REPOSITORY (access 100+ lectures): whova.com/portal/webapp/…
@avkwong - @Manu_Malbrain - @azJanPalfijn - @FOAMecmo - @Wilkinsonjonny - @strachanjamie - @iceman_ex
When do you use starch solutions?
#IFAD2021 #FOAMed #FOAMcc
REPOSITORY (access 100+ lectures): whova.com/portal/webapp/…
@avkwong - @Manu_Malbrain - @azJanPalfijn - @FOAMecmo - @Wilkinsonjonny - @strachanjamie - @iceman_ex - @icmteaching - @Gas_Craic
#IFAD2021 #FOAMed #FOAMcc
REPOSITORY (access 100+ lectures): whova.com/portal/webapp/…
@avkwong - @Manu_Malbrain - @azJanPalfijn - @FOAMecmo - @Wilkinsonjonny - @strachanjamie - @iceman_ex - @icmteaching - @Gas_Craic
When do you use (hypotonic) albumin 4% solutions?
#IFAD2021 #FOAMed #FOAMcc
REPOSITORY (access 100+ lectures): whova.com/portal/webapp/…
@avkwong - @Manu_Malbrain - @azJanPalfijn - @FOAMecmo - @Wilkinsonjonny - @strachanjamie - @iceman_ex - @icmteaching - @Gas_Craic
#IFAD2021 #FOAMed #FOAMcc
REPOSITORY (access 100+ lectures): whova.com/portal/webapp/…
@avkwong - @Manu_Malbrain - @azJanPalfijn - @FOAMecmo - @Wilkinsonjonny - @strachanjamie - @iceman_ex - @icmteaching - @Gas_Craic
1/ Proud to be a part of this hot-off-the-press #stewardship study examining time to blood culture positivity by pathogen and primary service. A joint effort by scientists at @ChildrensColo @CUMedicalSchool @CUAnschutz. Check it out #IDTwitter ! Summary 🧵
pubmed.ncbi.nlm.nih.gov/34407980/#:~:t…
pubmed.ncbi.nlm.nih.gov/34407980/#:~:t…
2/ Some background:
* Historically, infants and children are given antibiotics until blood cultures are negative at 48-72 hours.
*Empirically treating is essential for children with bacteremia, but waiting for this negative BC period may be unnecessary. pubmed.ncbi.nlm.nih.gov/25567785/
* Historically, infants and children are given antibiotics until blood cultures are negative at 48-72 hours.
*Empirically treating is essential for children with bacteremia, but waiting for this negative BC period may be unnecessary. pubmed.ncbi.nlm.nih.gov/25567785/
3/ Why we did this study:
* Understanding the time it takes for blood cultures to become positive (with respect to certain organisms and subspecialties) can help shorten overall antimicrobial duration.
*Shortening duration= fewer adverse events, less resistance, shorter stays
* Understanding the time it takes for blood cultures to become positive (with respect to certain organisms and subspecialties) can help shorten overall antimicrobial duration.
*Shortening duration= fewer adverse events, less resistance, shorter stays
Hey #MedTwitter ready for another mystery?
Patient presents with angina and is found to have 3 vessel disease for which he undergoes CABG.
Pre-op INR 1.6
Post-op INR >13.6
What did we give him to trigger this? (Hint: it’s not warfarin)
Patient presents with angina and is found to have 3 vessel disease for which he undergoes CABG.
Pre-op INR 1.6
Post-op INR >13.6
What did we give him to trigger this? (Hint: it’s not warfarin)
It was actually cefazolin!
There’s a side chain inhibits vitamin K epoxide reductase and/or gamma-gutamyl-carboxylase altering synthesis of vitamin K dependent clotting factors and thus has a warfarin like effect in some patients.
There’s a side chain inhibits vitamin K epoxide reductase and/or gamma-gutamyl-carboxylase altering synthesis of vitamin K dependent clotting factors and thus has a warfarin like effect in some patients.
Obviously this doesn’t happen every time we give cefazolin - it seems to be more likely in patients with recent surgery, renal failure, cancer, ileus, and poor nutritional status at baseline.
1/I want to take some time to share findings from our semi-recent PETACS study. This was a wonderful collaboration between @COpedsID faculty, survey designers, and #microbiologists across the US.
@JClinMicro @ASMicrobiology #ASMClinMicro
jcm.asm.org/content/59/3/e…
@JClinMicro @ASMicrobiology #ASMClinMicro
jcm.asm.org/content/59/3/e…
2/ First, I want to emphasize that this project highlights many of the reasons I chose to pursue a #PhD in clinical & translational science. As a long-time microbiologist, I can say that the clinical lab doesn't often have a seat at the clinical effectiveness / research table.
3/ This project focuses on the tracheal aspirate culture- a diagnostic process that is greatly limited by contamination with normal respiratory flora, and which lacks consensus or standardization across labs and hospitals. @ASCLS @ASMicrobiology @ASCP_Chicago
An avalanche of corporate marketing attempts to lay siege to the collective psyche. They seek to maintain the #sociallicense in order to secure/continue their plunder within a new global architecture.
Presenting the "guardians" & "stewards" as deemed by the #Pope & #Vatican.
Presenting the "guardians" & "stewards" as deemed by the #Pope & #Vatican.
Abracadabra. The devils we know, that have poisoned/ plundered/exploited the planet & all life it sustains - appointed as new "stewards" & "guardians". The magic of bullshit & storytelling.
"'The Devil We Know:' How DuPont Poisoned the World w/ Teflon"
organicconsumers.org/blog/devil-we-…
"'The Devil We Know:' How DuPont Poisoned the World w/ Teflon"
organicconsumers.org/blog/devil-we-…
This is a #rebrand of the Coalition for Inclusive #Capitalism conceptualized in [May] 2012 by Lynn Forester de #Rothschild; "Founder, Managing Partner, & member of the Management Committee of Inclusive Capital Partners, member of the Council on Foreign Relations & Chatham House.
I have a few things to say this morning. A small but mighty 🧵.
First , I can't say thank you enough to @KatherineJWu for writing this amazing piece highlighting the crucial work of clinical laboratory scientists/medical technologists. Please read it: nytimes.com/2020/12/03/hea…
First , I can't say thank you enough to @KatherineJWu for writing this amazing piece highlighting the crucial work of clinical laboratory scientists/medical technologists. Please read it: nytimes.com/2020/12/03/hea…
The article captures a piece of the talent, expertise, and dedication of these healthcare workers. This is especially true of my dear friend @darcyavelasquez, who works relentlessly day in and day out at @ChildrensColo to provide the best care possible to Colorado's children.
Sometimes it feels like the @KatherineJWu's, @kmess44's, and @jesscataldi's of the world are one-in-a-million. The failure to recognize the clinical laboratory (and people within it) for its importance in how healthcare works is not just a #COVIDー19 issue.
Thoughts on upcoming #COVID19 #serology tests:
This is actually quite a challenge! (#Diagnostics often involve a lot of complexities). There is a lot of pressure to roll these tests out, but they need to perform well, or we do more harm than good. #MicroRounds (A thread)
This is actually quite a challenge! (#Diagnostics often involve a lot of complexities). There is a lot of pressure to roll these tests out, but they need to perform well, or we do more harm than good. #MicroRounds (A thread)
WHY we need these soon:
1. Contact tracing.
2. Can be used to test if a vaccine is working during a clinical trial (70 of them ongoing right now, I believe)
3. Inform public policy makers about rate of asymptomatic cases + previous infections/exposures =informed decision making
1. Contact tracing.
2. Can be used to test if a vaccine is working during a clinical trial (70 of them ongoing right now, I believe)
3. Inform public policy makers about rate of asymptomatic cases + previous infections/exposures =informed decision making
It's all @kelvy_bird 's fault, haha ! Her book made me try to map a four-fold unified evolutionary scene: the #evolution of Life, means, ends & the #sustainability discipline/#metrics. Yes, I know it needs to be improved. #generativescribing in Plato's cave
@kelvy_bird LEFT: Let me explain what came to my mind, while trying to draw this . The left side obviously is about #Spirit, #God or the #Creator and it was @TimFreke who made me aware that we are now entering a next evolutionary stage: the development & story of #soul.
@kelvy_bird @TimFreke UPPER: For me it's a #Maturity Model of #Stewardship for our vital #capital resources. With our egoistic human nature, we depleted (as usual) our capital resources. #Sustainability marked the barrier in context & #Regeneration is all about (re)paying our debt
I was BLOWN AWAY by the caliber of #QI work presented today. Clear impact demonstrated by our resident leaders! #ICRE2017
One project by Justin Hall @UofTPGME used patient-reported outcomes to measure improved quality of ED discharge communication #ICRE2017
@UofTPGME One project by Elizabeth Martin @gloshospitals used frequent PDSA cycles to improve management of acute pain in the ED #ICRE2017
