Discover and read the best of Twitter Threads about #choosingwisely
Most recents (11)
Moving over to the ASH #ChoosingWisely campaign because this title definitely caught my attention (reducing unnecessary premeds for parenteral iron therapy)! #ASH22 @ASH_hematology props for making this a session. 1/n
@ASH_hematology Introducing Dr. Carol Mathew @CarolMathewMD from University of Florida. Some background, they have an infusion center with 47 chairs (on the onc floor - haha) with 3000+ iron infusions. #ASH22 2/n
@ASH_hematology @CarolMathewMD Why do people think we need to premedicate? mostly from high molecular weight iron which they no longer have since 2009. Fishbane reactions resolve within a few minutes after stopping -- as opposed to anaphylaxis (1 in 250,000 infusions!) #ASH22 3/n 
New @JAMAInternalMed w/ @DKorenstein: #ChoosingWisely has had huge reach in shaping conversations - and efforts to reduce - #lowvaluecare. We unpacked the types and expected impact of U.S. #ChoosingWisely recommendations, w/ some surprising finds. 🧵1/ jamanetwork.com/journals/jamai…
In 2012, @ABIMFoundation @ConsumerReports launched #ChoosingWisely - asking professional societies to list low-value services to avoid. CW intentionally let docs set their own priorities to leverage their professional values, but some worried about unintended consequences. 2/
In our qualitative analysis of all 626 U.S. physician recs, most recs identified low-value imaging and lab studies in patients w/ chronic conditions or w/ risk factors alone. Few tackled (for example) visits/hospitalizations or services at end-of-life (missed opportunities?) 3/
Attending an engaging session at #PHM21 on #ChoosingWisely in Pediatric Hospital Medicine. Dr. Vivian Lee providing the background of how this came to be. 1/thread
3/ He notes:
- Abx courses with pre-set durations aren’t based on high quality evidence
- Earlier transition to enteral abx can achieve equal outcomes
- Abx courses with pre-set durations aren’t based on high quality evidence
- Earlier transition to enteral abx can achieve equal outcomes
1/20 Tweetorial about our new JAMA paper!!
**Should you get a regular check-up?**
(“general health checks” in the paper)
From @davidtliss, @ToshiUchida, Cheryl Wilkes, @a_radakrishnan, and me.
jamanetwork.com/journals/jama/…
**Should you get a regular check-up?**
(“general health checks” in the paper)
From @davidtliss, @ToshiUchida, Cheryl Wilkes, @a_radakrishnan, and me.
jamanetwork.com/journals/jama/…
2/20 First, big debt of gratitude to @EbonyBoulware, @GailDaumit, @Neil_R_Powe, @ebcBass, @cochranecollab, @LasseKrogsboll, @PGtzsche1, @DyakovaMariana, and others…
…for doing earlier systematic reviews that got us started!
…for doing earlier systematic reviews that got us started!
3/20 Now, some, including @ZekeEmanuel, have said “skip your annual physical.”
nytimes.com/2015/01/09/opi…
nytimes.com/2015/01/09/opi…
Today’s #BSTMode inspired by @JHospMedicine #TWDFNR was 🔥!! Our first ever @EmoryDeptofMed + @MSMEDU hybrid version—woot!!
Today’s BSTs
Nour B., Emory PGY3
Krystal M., MSM PGY2
Joey S., Emory PGY2
Joi H., MSM PGY2
4 awesome talks + Q&A—all in under an hour! Let’s go! 👉🏽
Today’s BSTs
Nour B., Emory PGY3
Krystal M., MSM PGY2
Joey S., Emory PGY2
Joi H., MSM PGY2
4 awesome talks + Q&A—all in under an hour! Let’s go! 👉🏽
2/
Dr. Krystal Mills of @MSMEDU taught us about trending ammonia levels in hepatic encephalopathy—don’t do it. Shout out to her coach Dr. @TracyVettese of @EmoryDeptofMed. Read this article if you haven’t! 👉🏽
Dr. Krystal Mills of @MSMEDU taught us about trending ammonia levels in hepatic encephalopathy—don’t do it. Shout out to her coach Dr. @TracyVettese of @EmoryDeptofMed. Read this article if you haven’t! 👉🏽
3/
We learned from @dr_jsharp, Emory IM PGY2, that we need to pump the brakes on reflexive antipyretics in patients with a fever. His coach, Dr. Benjamin Renelus, @MSMEDU faculty supported in style! Want to know more? Read this paper. So good! 👉🏽
We learned from @dr_jsharp, Emory IM PGY2, that we need to pump the brakes on reflexive antipyretics in patients with a fever. His coach, Dr. Benjamin Renelus, @MSMEDU faculty supported in style! Want to know more? Read this paper. So good! 👉🏽
Merci ! C’est incroyable comme ces gens essayent de se faire passer pour des lanceurs d’alerte alors même qu’ils préconisent un traitement bidon voire toxique (l’assoc #HCQ + #AZT) et nous insultent quand on dit « Primum non nocere ». Ils sont l’exact opposé d’Irène Frachon.
L'argument le plus incroyable étant "vous voulez mettre du remdesivir à tout le monde" alors que justement on essaye de défendre une juste prescription qui par définition vise à ne prescrire que des traitements qui apportent un bénéfice...
On a réalisé et publié la Top-5 list en médecine interne avec des collègues dont @RevMedInterne #SNFMI qui vise justement à identifier 5 pratiques à éviter dans un objectif d'optimisation des soins
springermedizin.de/the-french-soc…
springermedizin.de/the-french-soc…
After a week on #COVID19 service, I have some non-clinical reflections for #hospitalists. This is NOT your regular ward time. I’ll be honest, it was a tough week. I’ll start with the tough stuff. But stick with me – ending with more positivity and some helpful hints.
The need for constant vigilance was exhausting. I felt pretty safe in patient rooms with gown, mask, gloves. But on unit, constantly reminding myself to open doors with a paper towel, wipe computer/phone with bleach before using, not touch face: v. tiring. theguardian.com/society/2020/m…
The frustration of knowing certain patients were going to deteriorate and not being able to do anything about it except watch it happen was very tough emotionally. I’ve been spoiled by modern medicine – in general, I’m not used to feeling quite so helpless.
I am extremely skeptical about tests like these. Screening for cancer (or any other disease) should have strong evidence to back it, failing which the test will only exploit innocent public. What do I mean by evidence to support it?
Thread
Thread
The only reliable evidence to support screening is from large randomized trials offering screening to one arm & routine care to the other, & conclusively demonstrate decreased mortality in the screened arm. Sorry, but no alternative expedient methods of "evidence" matter. Why?
Screening has the real potential for harm, by way of unnecessary tests, interventions that can cause harm, or even death, diverting scarce health resources to useless treatment & costs involved. Which is why, if there is no mortality reduction, the screening tool is merely a tool
@MarkGraban @evanluxzenburg So, this is where a savvy patient community can make all the difference. Problem is, not all diseases have savvy communities. My own incomplete cobbled list on my site: epatientdave.com/communities
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@MarkGraban @evanluxzenburg Remember "the lethal lag time" - chances are very good that the 3 docs have different views of "latest / best information" epatientdave.com/2019/12/18/pri…
2/n
2/n
@MarkGraban @evanluxzenburg Then there's the nasty practical reality that surgeons & their friends often recommend surgery just Because. See @ElyseInOz e-patient origin story participatorymedicine.org/epatients/2009…
3/n
3/n
I’m having some concerns about a behaviour I’ve been seeing in some receiving referral centres that is bothersome. I’m not sure it has a formal name, but I’m calling it #consultdiva . It needs to stop. What do I mean? See thread.
Def- #consultdiva : refusing consult requests by referring doctors claiming the referral is incomplete or deficient. Usually without any effort to correct those deficiencies themselves.
Let’s use some examples (I’m using a lot of Uro because hey…why not):
- GP: U/S shows renal mass
- Uro: incomplete referral, needs triphasic CT and re-refer.
-GP: please see for gross hematuria
- Uro: incomplete referral, need UA, triphasic CT, urine cytology then re-refer
- GP: U/S shows renal mass
- Uro: incomplete referral, needs triphasic CT and re-refer.
-GP: please see for gross hematuria
- Uro: incomplete referral, need UA, triphasic CT, urine cytology then re-refer
Morning report #ChoosingWisely tracker featuring @zacfeilchenfeld leading #AMreport at @Sunnybrook. Let’s see what teaching points he makes...#MedEd
Patients with atrial fibrillation do not benefit from treatment with rhythm control meds like amiodarone over rate control meds alone from stroke prevention standpoint. See AFFIRM trial nejm.org/doi/full/10.10…
Now @zacfeilchenfeld reviews toxicity of amiodarone:
GI-nausea, vomiting, liver toxicity
Neuro-peripheral neuropathy
Pulm-interstitial lung dz
Endo-hyper/hypothyroidism
Derm-skin hyperpigmentation
GI-nausea, vomiting, liver toxicity
Neuro-peripheral neuropathy
Pulm-interstitial lung dz
Endo-hyper/hypothyroidism
Derm-skin hyperpigmentation
