Discover and read the best of Twitter Threads about #meded

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I’ve been working as a hired consultant with a national specialty medical organization to co-create an antiracism curriculum for their entire profession from the top leadership to the students from various disciplines. A thread 🧵 #medtwitter #psychtwitter #MedEd
1| it is important that we are aware that a commitment to progress in this work can be both felt and seen. Working on projects like this can feel invigorating, rewarding and nourishing. Working on projects like this can also feel paralyzing, disorienting and frustrating. Why?
2| I’ve noticed that it boils down to whether a true commitment exists defined as ‘the state or quality of being dedicated to a cause, activity, etc.’ For example, anticipating challenges and being motivated to overcome them is observed and felt.
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1/ The June 2021 Edition of MDA Fellows JCWatch 📰 is now available❗️ Check out all 6️⃣ #journalclub summaries below 👇🏽 that cover GU, GI, & breast medical oncology ➕ classical hematology & SCT! #meded @MDanmolsingh @HemOncFellows @HOJournalClub @Hemoncq @MDAndersonNews
2/ First up, Dr. Ferreri presented an interesting article evaluating the potential to classify tumor microenvironments into one of four subtypes to predict response to immunotherapy ⚡️ 🔗
3/ Next, Dr. @FasaAgbedia presented the results of the phase 3️⃣ ASCENT trial that demonstrated ⬆️ OS and ⬆️ PFS w/ sacituzumab govitecan vs standard single agent chemotherapy in pretreated metastatic TNBC #bcsm 🔗
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1/9 You admit a patient overnight with hyponatremia and you diagnose it as SIADH. But how are you going to manage it?

To review how to diagnose SIADH, check out the volume-based or ADH/RAAS-based approaches below.

#MedEd #FOAMed #MedTwitter #NephTwitter #Tweetorial
2/9 The cornerstone of treatment is to treat the underlying cause. Everything else is just a 🩹. It can sometimes be very hard to treat the underlying cause immediately (assuming you can identify it).
3/9 Free water restriction is going to help (to a certain degree), but make sure that it’s feasible for the patient (they often need to do this beyond hospitalization). Consider restricting 500 cc below their 24-hour urine output:
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1/💡📝🧵"Building structural competency through community engagement" | @ClinicalTeacher

I tweet often about WHY health equity curricula should center #StructuralCompetency & community voices.

Our new #MedEd paper shows HOW we've tried to make it happen.… Masthead for our manuscript in The Clinical Teacher, titled
2/ My first #MedTwitter foray was sharing this project 👇🏽 in 2019.

Our vision was simple: Moving #MedEd from ahistorical discussions of health disparities ➡️ exploring fundamental causes, centering community voices, and honing in on hyperlocal inequities.
3/ We drew from two main pedagogical frameworks: #StructuralCompetency and community-engaged pedagogy (similar to CEnR/CBPR).

Though "community-based medical education" and "service learning" are widely used, we know these approaches often aren't enough:
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1/9 Let’s say you are about to do a thyroid exam. Before the exam you do not suspect goiter (pre-test prob of 50%). How does the exam influence your probability? Let’s review some LRs from McGee!
#MedEd #FOAMed #MedTwitter #MedStudentTwitter #EndoTwitter @MedTweetorials
2/9 You may think “well that’s nice, but my thyroid exam technique is not the best.” Don’t worry, the Stanford 25 has got your back (including this clinical pearl)!…
3/9 Now that you’ve identified a goiter, you will probably end up ordering some lab and imaging studies. But don’t leave the bedside just yet! Let’s first break down the differential for an enlarged thyroid (thanks again to the Stanford 25).
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My (preaching to the choir) 🔥 take: digital educational skills -- whether teaching on #MedTwitter, podcasting, or making videos -- are essential #meded skills for the 21st century. And we can teach these to future educators.

A Tweetorial🧵:
Last year, @ShreyaTrivediMD @StaciSaundersMD and I at @iMedEducation started a curriculum to teach digital educational skills to our @BIDMC_IM residents.

We just published this article going over our curriculum and providing tips for you to do it too:
We ended up integrating our curriculum into a pre-existing one-to-two week Senior Teacher rotation, which had two great benefits:

1⃣MUCH easier to get off the ground
2⃣Stressed that traditional educational principles are transferable for teaching digitally
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Empagliflozin, an SGLT2 inhibitor, showed positive results for heart failure with preserved ejection fraction according to Boehringer's statement.♥️

Full results will be released in August.

Let's discuss SGLT2 inhibitors?…

Follow the 🧵

#MedEd #FOAMed
Sodium-glucose transport proteins (SGLT) are found both in the small intestines (SGLT1) and in the kidneys (SGLT2).

In the nephron, SGLT2 is the main responsible for the reabsorption of the filtered glucose. For this reason, its inhibition⬆️ glucosuria, decreasing hyperglycemia.
Phlorizin, a non-selective SGLT inhibitor, was isolated in the 1800s.

Why don't we use it?
- Instability;
- ⬇️ bioavailability;
- Inhibition of SGLT1, leading to ⬇️ intestinal glucose absorption and diarrhea
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What is the optimal approach to monitoring patients being treated with #isotretinoin for #acne? In this Tweetorial, let’s review the evidence for best practices! #dermtwitter #MedEd 1/13
First, why do we monitor labs?

-Prevent severe adverse effects
-Guide dosing


With respect to current practices, as of 2016, over 40% of clinicians were checking CBCs, LFTs, and lipid panels monthly! And rates of monitoring do not appear to be decreasing over time. Is this optimal? 3/13…
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#idboardreview heart-lung transplant 2yrs ago on tacrolimus, mycophenolate, TMP/SMX, lung nodules on voriconazole, +diffuse body aches, AlkP 2x ULN, Bone scan numerous scattered areas of uptake. Xray periosteal thickening, Calcified excrescences. dx? #medEd #idmedEd #idtwitter
#Voriconazole SE vision changes, rash, nausea, vomiting, abnormal liver function tests, hallucinations
#Periostitis w/ long term voriconazole diffuse body aches, ,inc AlkP patches of periosteal thickening on Xray &+bone scan. Calcified excrescences are sometimes seen.
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(1/) It can be difficult to remember all the different breathing patterns🫁 associated with brainstem 🧠 injury! Here are my rules of thumb when attempting to localize a breathing pattern. #tweetorial #neurotwitter #MedEd #Neurology #Medstudent Image
(2/) Major Caveat: like all of neurology, these rules have exceptions and nuances. Think of it more like a way to ballpark ⚾️ an injury within the brainstem. A quick google search can result in all sorts of useful pictures 📸! Image
(3/) Higher level injuries (Cortex, Thalami, or Midbrain) tend to result in patterns with faster breathing 🌬️. Compare this to injuries to the Medulla which can result in ataxic breathing or even respiratory arrest ☠️. High = Hyperventilation. Image
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THREAD: Shedding light on the risks of anticholinergic drugs

1/8 NEW information on risk of dementia and harm in the frail elderly. Free #BestEvidence webinar w/ Dr. Aaron Tejani @amtejani on July 14th


#MedEd #deprescribing #medsafety
2/8 One of every 14 of the top 200 💊 prescribed in BC has anticholinergic properties

They include: amitriptyline, cyclobenzaprine, fluoxetine, quetiapine, sertraline, trazadone, venlafaxine, zopiclone, citalopram...

👉🏽More here…

#MedEd #deprescribing
3/8 What kinds of harms can #anticholingergics cause?
👉🏽Dry mouth 😦

❓Could your patient on an anticholinergic be experiencing bad breath/gum problems/tooth decay/trouble swallowing? 🤔

More here:…

#MedEd #deprescribing
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1/7 Spacers confused me, so I wanted to sort them out. Let’s start with a question - what type of inhalers can benefit from a spacer?

#MedTwitter #FOAMed #MedEd #MedStudentTwitter #PulmTwitter
2/7 Metered dose inhaler (MDIs) are best used with a spacer! Pressurized devices were invented far earlier, but the technology was adapted to treat asthma in the form of an MDI in 1957 by Riker Labs.…
3/7 MDIs have various advantages and disadvantages, some of which can be mitigated by spacers.…
Read 7 tweets
#idboardreview A businessman develops diarrhea while traveling to Thailand.The illness progresses to passage of grossly bloody stools. Sick x3d when returns home. +bloody stools, weak, febrile, tachycardic, stool:gull wing shaped GNR. Treatment? #medEd #idmedEd #idtwitter
Single dose of azithromycin (1 gram). Acute febrile & dysenteric diarrhea in single adult traveling to a developing region is most likely caused by strains of Shigella, #Campylobacter or Salmonella. Campylobacter shown here Ref pic…
Treatment of choice must be guided by antibiograms of likely organisms in geographic region where pathogen was acquired. In South Asia ciprofloxacin-resistant Campylobacter is most likely cause of febrile dysentery. Tinidazole is useful for giardiasis not Campylobacter diarrhea
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#idboardreveiw 45 F hx IUD w/ incarcerated, inguinal hernia. During surgery: hernial sac w/ putrid, inflammatory, tumorous formation around R ovary. Histopath highly active zone of abscess formation, w/ granular conglomerates of a filamentous organism. #idmedEd #medEd #idtwitter Image
#Actinomycetes anaerobic, gram+ filamentous bacteria sulfur granules in tissue & highly sensitive to penicillin. This pt needs tx as abscess but in general #Actinomyces normal GI flora & asymptomatic female genital colonization is not uncommon, especially if an IUD is in place
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1/7 Let’s go over the evidence-based physical exam for lower extremity deep vein thrombosis (LE DVT). In the spirit of quantifying clinical concern, here is a question - besides inspection (and #POCUS), which tool will help you the most?

#MedTwitter #FOAMed #MedEd
2/7 The answer is a ruler! Let’s look at the LRs.

Quick review of LRs:
- The (+) and (-) indicate the LR if a finding is present or absent, respectively
- The more the LR deviates from 1, the more useful it is
3/7 For this particular set of exam findings, it may be more helpful to see how much the LRs change your post-test probability (assuming a pre-test probability of 50%). The presence of absence of asymmetric calf swelling seems to be the most helpful.

Graphic from McGee
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Quick #meded / #psychtwitter teaching

"We need to listen to our patients," right? But *HOW* we listen matters! Many annoyingly *parrot*, which makes the person feel UNHEARD.

This is called "reflecting" and it is ANNOYING AF.
"I feel angry."
"It sounds like you feel angry."

"My wife left me."
"So you're telling me your wife left you."

It's really really really annoying.

There are good and easy modifications that REQUIRE THOUGHT AND EFFORT but both demonstrate to the patient that you've heard them, but also advance the conversation and allow the patient to think/reframe what they are saying.

Let's look at the statement.

/3 "Will you please just leave me alone? Nobody can help m
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1/ Welcome to another edition of West’s Well-Being Wednesday! As a reminder, I’ll briefly highlight papers, topics, questions, etc. related to healthcare professional #wellbeing, with a new 🧵 each week. #wellbeingwednesday #burnout #medtwitter #meded
2/ To start Year 2, I’ll link to the threads from July 2020.
First, from July 15, a thread on #burnout history back to Freudenberger.
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Let's review the evidence-based physical exam for Cushing syndrome!

Quick review of LRs:
- The (+) and (-) indicate the LR if a finding is present or absent, respectively
- The more the LR deviates from 1, the more useful it is

#MedTwitter #MedEd #EndoTwitter #FOAMed Image
Things that stand out to me
- "Buffalo hump" doesn't have a defined LRs despite being taught as a "classic" finding (occurs in 34-75% of patients)
- The presence of moon facies has a lower LR than I expected (1.6)
- The absence (or presence) of abdominal striae is not particularly helpful
- The presence of a thin skinfold (thickness on the back of the hand <1.8 mm in women of reproductive age) can be VERY telling
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A patient presents with abdominal distension.

What do you think is going on?

Open this thread and I'll explain my thought process and reveal the final diagnosis.

#MedEd @MedTweetorials
#MedTwitter #MedStudentTwitter

@AndreMansoor @PeteSullivanPDx @grepmeded @CPSolvers
The causes of abdominal distension are often remembered as the 6Fs:

Fat (obesity)
Faeces (constipation)
Foetus (pregnancy)
Flatus (gastrointestinal)
Fluid (ascites)
Fatal tumour (intraabdominal malignancy)
In this case the rounded shape with flank fullness makes you suspicious of fluid in the peritoneal space.

Check for shifting dullness to confirm your suspicion of ascites. Alternatively you could use point-of-care ultrasound (POCUS).
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On my last day as a trainee, I’m reflecting back on the best advice I’ve received at each stage.

Hopefully this 🧵 may offer something. #MedStudentTwitter #medtwitter #internalmedicine #cardiotwitter #ACCFIT #meded #cardioed

2/ Pre-clinical med students—Immerse yourself in what you’re learning. Remember that you’re building a foundation to be a great doctor, not just preparing for exams.
3/ Clinical med students—Spend time with your patients; you have more time now than ever again. Keep an open mind about each specialty. Once you decide, pay even more attention on all the rotations you won’t pursue. They will be your colleagues one day; learn how they think.
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THREAD:5⃣things to know from 5 recent TI Therapeutics Letters👩🏽‍🔬

1/5: How to choose a good #mirtazapine dose? 🤔

Mirtazapine has a dose response 💊for harm but NOT for efficacy: harm ↗️ after 30mg/day but efficacy doesn't:

#MedEd #deprescribing #ptsafety
2/5: Want to learn about recent @GovCanHealth #medsafety or international warnings for medications?

Read our Therapeutics Letter on international drug safety advisories: ⚠️ 💊

#drugsafety #SegPac #ptsafety
3/5: Do you like receiving feedback on your #prescribing?👩🏽‍⚕️💊

Read about Personal Prescribing Portraits:

#MedEd #deprescribing
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#Nephrology #POCUS short story:
1/ Simple case, want to remind some pitfalls in routine practice.
There was a patient with orthostatic hypotension. Likely neurogenic secondary to amyloidosis.
Read the thread 🧵below:
#IMPOCUS #MedEd mini #tweetorial
2/ Physician A orders IV albumin q 6 hours and keeps continuing because:
1. 'Formal' echo from 4 days ago reported a RAP of 3 mmHg = not high
2. 'Documented' weight showed 3 kg drop since admission
Interestingly, documented cumulative fluid balance is +4 L!
3/ Physician B comes in and performs physical examination (#POCUS). Supine BP is relatively low (SBP ~103 mmHg) but nothing different compared to patient-reported figures at home. Pt feels OK, on midodrine.
Here is the IVC👇
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A patient presents with red legs.

What do you think is going on? What would you do next?

Open this thread and I'll explained my thought process and reveal the final diagnosis.

#MedEd @MedTweetorials
#MedTwitter #MedStudentTwitter

@AndreMansoor @PeteSullivanPDx @grepmeded
Cellulitis is overdiagnosed and misdiagnosed in up to 30% of cases.

So it's important to consider the common mimickers of cellulitis which include:
- Venous stasis dermatitis
- Lymphoedema
- Deep vein thrombosis
- Gout
- Contact dermatitis

Photo courtesy of @JAMA_current.
This is a case of erythema nodosum.

It's characterised by erythematous, tender nodules particularly on the shins .

Biopsy can be useful to confirm the diagnosis. It would show septal panniculitis without vasculitis.

Photo courtesy of @dermnetnz
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