Discover and read the best of Twitter Threads about #TWEETORIAL

Most recents (24)

"What is the best Venous Access Device for my patient?"

An #InterventionalRadiology (#Irad) #Tweetorial to address a frequent clinical dilemmas for #Medtwitter and #NurseTwitter

#FOAMed
1a/

Type of VAD:

PIV: 3-6 cm, enter and terminate in peripheral veins.

US-PIV: US to reach deep veins when superficial veins difficult to palpate, ≥8 cm

Midline catheter: 7.5-25 cm, inserted basilic/cephalic vein), terminating short of subclavian. 🚫 vesicant infusions
1b/

CVC: duration 7-14 d, direct puncture of internal jugular, subclavian, or femoral veins.

TC : diff from CVC, seperate insertion site in upper chest and venipunture in neck
⬇️ risk of infection due to cuff
👍 location for catheter care
Read 15 tweets
As promised, here is a #tweetorial on spatially-fractionated radiotherapy aka Lattice aka GRID.

If you missed the #CTOS2019 talk by @Notorious_RBE, this one is for you!
Spatial fractionation aims to intentionally deliver heterogeneous dose: alternating “hot” and “cold” areas with a differential of 30-100% Rx.

Thats right: you want 30% cold spots in tumor. (👇 #MedPhys reaction).
It seems crazy, but it is associated with excellent response and limited toxicity. Per reports. That are retrospective.

Dramatic response in rads refractory sarcoma: link.springer.com/article/10.100…

Case series of 71 palliative patients: ncbi.nlm.nih.gov/pubmed/1052442…
Read 14 tweets
Another day on service and you are starting with answering a page from PACU. "Hi this is nephrology fellow returning your page". "Great! This is Ortho, and our patient post op has low potassium here; I believe you call it HYPOkalemia" #Loveourorthopods #Tweetorial #medthread
Join us for our electrolyte abnormality du jour and learn how to break it down! #nephtwitter #medtwitter #FOAMED See our full post @RenalFellowNtwk > renalfellow.org/2019/11/14/the…
59 yo F with a hx of HTN, and HLP admitted for a left femur fracture; she was found down by her neighbor 3 days after her fall; awake and in pain. Now, patient is post op; and on labs: (baseline cr: 0.51). UA unremarkable.
Read 19 tweets
Welcome to my first #tweetorial! Inspired by @NnekaUfereMD's talk @AASLDtweets to give back as a trainee

There are many things to discuss with #cirrhosis patients.
Ascites, HE, varices, HCC, transplant, GOC, rehab: the list goes on.

#Nutrition needs to be part of that routine!
Why is this such a big deal?

Independent of severity of liver dysfxn, poor nutrition, sarcopenia leads to:
1⃣Lowers survival (HR 2.18)
2⃣Increased risk of infxn
3⃣Increased HE, ascites ➡️ lower QOL
4⃣Lower survival in post-transplant setting
But what’s so special about nutrition in #cirrhosis?

For that we have to do a VERY BRIEF return to med school and the 1953 Nobel Prize winning work on energy extraction (citric acid cycle) 3/
Read 9 tweets
1/
ERYTHEMA MULTIFORME – a #dermatology #tweetorial/#medthread!

#MedEd #FOAMEd #dermatologia #dermtwitter #medtwitter #derm pc: @dermnetnz

Let's warm up with a question for all y'all tweeps out there!

What is the most common trigger for erythema multiforme (EM) in adults?
2/
EM is an immunologic syndrome usually triggered by infection in adults. We usually consider HSV and mycoplasma. A simple history for cold sores or genital ulcers can be telling, but mycoplasma can go undetected symptomatically.

What primary lesions do you expect in EM?
3/
EM is usually made up of papular (raised) targets. Pic1 is of EM; you can see the 3 zones in a typical target (red rim, then white, then red center). Versus SJS/TEN (pic2), where macular targetoid (2 zones of red rim, dusky center & flat).

2nd photo: my.clevelandclinic.org/health/disease…
Read 10 tweets
Herniación Cerebral en Traumatismo Craneoencefálico
#PedsICU #FOAMed #MedEd

Abro hilo, iniciamos y abiertos los comentarios👩‍⚕️👨‍⚕️
Último hilo del año sobre la serie de #TCE.
Antes de iniciar, te dejamos los 4 enlaces de la serie completa (#tweetorial):

1. Abordaje Prehospitalario e Inicial en el TCE
Todo empieza antes de llegar al Hospital, así se logra el mejor desenlace.

2. Cuidados basales en el #TCE Severo
Lo que todo paciente con Escala de Coma de Glasgow igual o menor de 8 debe recibir.

Read 31 tweets
It’s tough to be an intern!
As a resident, 1st priority is to provide quality care for our patients & 2nd our interns.
Here is a series of tweets on ways residents (and staff) can take care of our interns 💛
#medtwitter #loveourinterns
#HappyTuesday #tweetorial
1. Give credit where credit is due. When your intern does a good job it’s best to give them props in front of the team! But if you give them props just to the attending make sure you tell them that you told the attending what a great job they did and that you appreciate them👏
2. Fall on the sword. The flip side of this is if you make a mistake as a resident make sure it’s clear to the team that it was your mistake, not your interns. This keeps morale high, and it’s honest. Nobody wants to get blamed, especially for something they didn’t do. ⚔️
Read 12 tweets
1/ A continuation #tweetorial from my last one introducing human leukocyte antigen (#HLA) , the cell surface antigen...

Below, let's briefly review basics of #Luminex testing & "cross-matching."

What/who is Luminex?
2/ In this #tweetorial, we'll answer 3Qs that help us assess a #kidneytransplant recipient's immunological risk:

1. Does this recipient have #DSA* (against HLA-antigens) ?
2. Can the antibodies bind?
3. Can the antibodies activate complement?

*DSA: donor specific antibodies
3/ Q1: How do know if the recipient's serum contains DSA against HLA-antigens?

A1: #Luminex testing, a solid-phase (BEAD) based assay. To perform the test, take the recipient's serum and pipette it into multiple wells - each well has beads coated with #HLA antigens...
Read 12 tweets
This week, I taught the @UCSF IM residents about tools for cognitive assessment in hospitalized patients. For my very first #tweetorial – I’m sharing my pearls with #medtwitter! #FOAM #geriatrics #MedEd 1/
@UCSF Throughout my training, I was taught to use the MoCA (Montreal Cognitive Assessment). But after a few months seeing patients at @VABostonHC, I noticed that most of my patients were getting a score of 21-23. Everyone especially seemed to think this was a hippo. 2/
@UCSF @VABostonHC I wanted to know why! So I looked into the development and validation of the MoCA a bit. Turns out, a cognitive test developed in a mostly white, highly educated, bilingual population (aka the people of Montreal) hasn’t really panned out for use among other groups. 3/
Read 16 tweets
It’s been a long time since I did a new #cartoonepi #tweetorial, so let’s talk about how CAUSAL GRAPHS can help us think about MEDIATION!
Consider the following example:

•Drug X improves blood pressure.
•Exercise also improves blood pressure.
•People who take Drug X exercise more than those who don’t.

The causal graph (DAG) below shows these variables & their relationships.
Now suppose we want to know *how much* we can improve people’s blood pressure by having them take Drug X and how much of that improvement is not because people taking Drug X exercise more.

What can we do?
Read 24 tweets
1/ sGLT2i educational symposia #KidneyWk #Tweetorial. Trying this out for @AJKDonline rather than a blog post. This is a live tweet thread of the info from this great session.
@AJKDonline 2/ Before we start, if you haven’t already done so, check out the amazing #Tweetorial by @aishaikh on this topic:

@AJKDonline @aishaikh 3/ Initial studies of this mechanism of action was on phlorizin isolated from apple trees, further research identified SGLT carrier proteins.
Read 41 tweets
It's time for #TwitterReport! This time, we're making a #tweetorial on how to use tweetorials for case-based teaching.

Follow along to our Mid-Atlantic @SocietyGIM workshop in Ballroom B from 12:45-1:45 pm at the @PittTweet University Club on 11/15/19.

Let's get started!
@SocietyGIM @PittTweet 1/ What even is a #tweetorial?

A Tweetorial is a short thread of tweets which provides educator-driven content centered around a chosen topic.

Tweetorials leverage the multimedia capabilities of Twitter to dissect a topic using supporting articles, videos, diagrams, and polls.
Read 14 tweets
In a new study in @CMAJ_Open, we analyzed survey data from @StatCan_eng to understand if #contraception use differed among female youth aged 15-24yrs by household income. bit.ly/2NkAYeU @cartgrac @e_nethery @wvnorman @DrLSchummers @womensresearch @CanPaedSociety /1
A more general summary of the study in the @ubcnews release here: bit.ly/2WPkGxV

Now attempting my first #tweetorial – shout out to @s_l_lake @ubcspph for this idea and her brilliant example /2
Despite Canada’s universal health insurance, we do not have universal coverage of #contraception.

More effective methods like ‘the Pill’ can cost 15-40$
per month. Condoms are usually the cheapest, around $1 each, but are less effective in real-life conditions (85%). /3
Read 11 tweets
1/
Hi hi hi. We see lots of red flags on a daily basis when we review labs.

One thing we see commonly is #lymphopenia. Should we care? When can we dismiss it and when should we work it up?

Let’s find out.

#MedEd #MedTwitter #IDTwitter #Tweetorial #oncology
2/
- Lymphopenia assc w/ ⬆️risk of sepsis
- More common in elderly and w/ co-morbidities
- lymphs account for 20-40% of WBC, may go unnoticed when WBC checked w/o diff
- Primary- recurrent infxns in kids, CVID in adults
- Secondary-⬇️production; ⬆️destruction; hiding in tissue
3/
What is the most common cause of lymphopenia in hospitalized patients?
Read 14 tweets
1/ Can hemolytic anemia exist with no reticulocytosis?

Incoming #MedTwitter #Tweetorial #HemOnc #heme #hematology
2/ We've all been taught that hemolysis and hemorrhage are accompanied by a compensatory marrow response which leads to reticulocytosis and a slight increase in MCV (reticulocytes are larger than your average RBC).
But what if hemolysis co-existed with reticulocytopenia?
3/ A 46 y.o. M with no significant PMH and PSH presented after he noticed a change in his urine color (darker) for the past wk. He mentions that the last 2 times he tried to donate blood in the past year, he was told he was too anemic to donate. Prior to this, no issues donating.
Read 26 tweets
Here's my promised #tweetorial for the month of October 2019. The theme is "How to Communicate your Ideas in Groups, without being Downed". Ready? How many times have you experienced the inability to put across your point of view to another, because the person whom 1/n
you are trying to speak to, is either rude, loud, unreasonable or just unwilling to listen to your perspective? If the answer is, “many times”, take heart! You're not alone! All of us have had to deal with people –within our families, among friends, during transactions in the 2/n
mall, or at work - who seem to dominate a conversation & make it difficult to have another perspective brought into the dialogue. Surely it feels bad to deal w/ such people; & we often experience hurt feelings, frustration, anger & a desire to get even with them ‘in future’. 3/n
Read 16 tweets
Folks, this is a big study out today in @nejm by @kbilimoria et al. This is the most comprehensive assessment of mistreatment in surgical training that I have seen. Kudos to the authors for taking on this important issue. Here's my #tweetorial on it.

1/
@NEJM @kbilimoria I’m going to focus on the women but want to acknowledge there are other important data—about racial discrimination and men—in this paper.

They surveyed residents at 262 programs and got responses from >7400 residents. Of those, 40% were women.

2/
@NEJM @kbilimoria @YueyungHu @ryanellismd A few points before going into the results: 1. These data were collected after the in-training exam. I have concerns about people’s mindset after a several-hour exam and their ability to really engage with the sensitive questions asked by this group.

3/
Read 17 tweets
1/
VENOUS STASIS LEG ULCERS!!!

A #tweetorial for the #dermtwitter, #medtwitter, #medstudenttwitter, and #hospitalist crowd. 📸:@dermnetnz #medthread

Let's start with a question - What percentage of leg ulcers do you think is caused by venous stasis?
2/
Roughly half (40-50%) of all leg ulcers are the result of venous stasis! Since 1% of the population will get stasis ulcers at some point, it's quite common, both in the inpatient & outpatient settings!

While some say they aren't painful, many of my patients would disagree....
3/
Let's talk exam. These ulcers are predominantly on the lower legs, and often near the medial malleolus. They're usually chronic, so they may have a base covered by yellow fibrinous debris. They tend to be shallow, and given the pathophysiology, quite exudative.
Read 15 tweets
1/ A short #tweetorial introducing human leukocyte antigen (HLA) and typing...an important and often confusing topic in #transplantation #kidneytransplant

#FOAMed @MedTweetorials

What is an "HLA"?
2/

HLAs = cell surface proteins encoded by highly polymorphic major histocompatibility complex (MHC) genes on Ch 6 🧬

In #transplantation, HLA proteins are #polymorphic antigens ➡️ alloreactive trigger for the immune response ➡️ can ultimately lead to organ #rejection ☠️
3/ The 2 primary classes of MHC molecules are 1⃣ and 2⃣.

Class 1⃣ MHC are found on the cell surface of ALL nucleated cells + platelets. Their role is to present intracelleular peptide fragments to CD8 #Tcells
Read 8 tweets
In the run up to the switch from Daylight Saving Time to Standard Time: here’s a #Tweetorial about SRBR’s position paper written by @TillRoen & colleagues on the consequences of choosing to live on #DST or Standard Time. journals.sagepub.com/doi/full/10.11…. 1/13
SRBR advocates for an end to the annual ritual of switching the clocks by an hour. Based on the existing data, SRBR recommends to #endDST & #LockTheClock to #PermanentStandardTime. Why? Continue reading 👇 2/13
Before the modern era, humans – just like other animals – structured their lives by the sun clock that is set by the rotation of Earth. This clock was in synchrony with their body clock, which is set by our individual biological clock. 3/13
Read 13 tweets
starting #ACCPAM19 with the amazing @emilylheil presenting an update on the recently-published community-acquired pneumonia #CAP guidelines ncbi.nlm.nih.gov/pubmed/31573350
@emilylheil So what actually causes CAP? @emilylheil states "the pathogenesis and etiology of CAP has changed over time with increased rates of vaccination and better diagnostics." Jain et al 2015 unable to identify a pathogen in > 60% of patients, viruses most common
ncbi.nlm.nih.gov/pubmed/26172429
@emilylheil Since etiology a great unknown, do we need to cover atypicals? Garin et al found BL monotherapy NOT non-inferior to combo, but on flip CAP-START suggested atypical coverage perhaps unneeded...
ncbi.nlm.nih.gov/pubmed/25286173
ncbi.nlm.nih.gov/pubmed/25830421
Read 19 tweets
#Quemaduras en Pediatría (#Burn)🔥

Parte 2/2. Abordaje y Tratamiento.🏥

Abro hilo, iniciamos y abiertos los comentarios.👨‍💻

#PedsICU #tweetorial
Antes de continuar este hilo, recuerda pasar a revisar la primera parte, por lo que te dejamos el enlace⬇️

Recordemos que en todo paciente grave, tener la mayor información posible antes de que llegue a Urgencias es fundamental.
El mejor desenlace ocurre con un adecuado apoyo prehospitalario, por lo que debemos apoyar a los servicios prehospitalarios y contribuir a su capacitación.
Read 23 tweets
1/

This week’s #MedEd #Tweetorial will focus on #LearningStyles. Courtesy of my @uicdme coursework with @mededdoc

What are learning styles?
Is there evidence to support them?
Should we tailor our teaching (or learning) to them?

Let’s get started.
@uicdme @mededdoc 2/

What are learning styles?

This article by Pashler et al (doi.org/10.1111/j.1539…) defines learning styles as

“the view that different people learn information in different ways”
@uicdme @mededdoc 3/

To most of us, the concept of learning styles makes intuitive sense.

One popular model (by Dunn and Dunn) includes the concept of “modality preferences” where individuals prefer that information appeals to one of the senses: auditory, visual, tactile, or kinaesthetic.
Read 16 tweets
1/
Have I ever told y’all how much I loooove to give #feedback?

Here’s why:
1. It adds meaning to my work in #MedEd.
2. It honors the learners and the patients.
3. It informs my final evaluations.
4. It improves the learning climate.
5. It's necessary.

*Shout out to #2.
2/
I know lots of experts have written and presented great stuff on this. But if #medtwitter has taught me nothing else, it's that we can always add new ways to look at stuff.

Right?

So with that, here’s my practical approach to feedback on the wards and in clinic. Ready?
3/
Okay, so 1st, let’s quickly revisit how feedback was defined in Ende’s classic paper:

“an informed, nonevaluative, objective appraisal of performance intended to improve clinical skills”  

(Ende J. Feedback in clinical medical education. JAMA. 1983;250:777–781)

Cool? Cool.
Read 22 tweets

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